Diagnostics

Alison Moore

Diagnostics is one of the great success stories of the 18 weeks programme: the numbers waiting more than six weeks for a test have reduced from nearly 600,000 to less than 15,000 in two years.

As well as helping the NHS achieve the 18 week target, this is better for patients, ensuring they get diagnosed and get appropriate treatment faster.

Collecting and publishing data on diagnostic waits was the necessary first step: before then, no one knew how many people were waiting for how long.

To get rid of the long waits, the NHS has invested significantly in additional diagnostic capacity. But it has also required change to the way that tests are provided – where they are provided in the care pathways and who provides them. The diagnostic investigations are now properly integrated into pathways, it is understood by managers and IT projects to support diagnostics services is now being put in place.

Buy-in and leadership by frontline staff has been crucial to this - this is not about imposing something from the centre. Prompt access is part of a high quality service. This is what matters to patients, and is an incredible success for the NHS.

The number of people waiting for an endoscopy has fallen from an estimated 250,000 three or four years ago – including waits of a year or more – to just a couple of thousand waiting more than six weeks.

“This is a tremendous achievement for what had traditionally been a Cinderella service,” says Dr Roland Valori, national clinical lead for endoscopy. And this improvement has also been accompanied by improved quality, better training for endoscopists and considerable extra demands on the service as bowel cancer screening has been introduced.

The transformation has not only helped the NHS move towards the 18 week target, it has provided swift reassurance and diagnosis for patients with gastrointestinal symptoms.

Leadership has been key to this, says Dr Valori who has worked with a team of clinical leads in the regions to drive forward changes. Initiatives have included training more nurse endoscopists and an accreditation scheme linked to participation in the bowel cancer screening programme.

A payment system, which means there is an obvious income stream from carrying out the work, has also helped. As 15 to 20 per cent of endoscopy patients are in hospital, a quicker service can also ensure patients don’t occupy beds unnecessarily while they wait for tests.

In diagnostic imaging, providing appointments from seven in the morning through to 10 at night – and at weekends – is just one way parts of the NHS have responded to long waits.

Four years ago, waits of a year for a routine MRI scan were not unusual – but now waits across the whole of diagnostic imaging are down to an average of two weeks, says Dr Erika Denton, national clinical lead for imaging. "It has been a massive transformation in the ways that departments function."

There has been an expansion in imaging equipment to meet increased demand and speed. "It is partly using equipment to best effect, it is partly new equipment and it is partly using other service providers," she explains.

Greater use of technology has meant reporting times for results have also fallen – helping to shave more time off the patient pathway.

But none of this would have been possible without sign-up from those at local level. "The workforce, by and large, has embraced this. We ran a huge engagement programme working through all the professional bodies and imaging departments," she says.

The 18 week target has helped to bring physiological measurement services to the fore in many trusts as their importance in end to end patient pathways became clear. Historically some of these services – especially audiology - have had very long waits. In October 2006, more than 130,000 patients were waiting more than six weeks for audiological assessments; now only a few thousand are waiting – a tremendous achievement for the NHS and for the national team working with the service.

Professor Sue Hill, Department of Health chief scientific officer and national clinical lead for physiological measurement, says the first step was to collect data on waits, which aided understanding of who was waiting and for what investigation. How diagnostic tests and investigations were delivered then had to be transformed. Some could be provided much earlier in the patient pathway through direct access provision for primary care to help in referral decision making, or through a bundle of diagnostics as part of “one stop” outpatient clinics making use where possible of new technology such as hand-held devices.

In audiology, where assessment is closely linked for example to the fitting of a digital hearing aid, new models of care were introduced to promote an assess-and-fit type of referral using the benefits of open ear technology. Earlier this year to capture the waits for the treatment part of the patient pathway, a direct access to the audiology department referral to treatment measurement was introduced.

Finally, the right workforce had to be in place to deliver the new models of care and streamlined patient pathways which have seen the development of new roles locally, particularly at assistant and advanced practitioner level.

Trusts have been supported from the centre through clinical champions across the eight physiological measurement, the production of guidance material and spreading best practice, the development of quality enhancement tools and, where necessary, directly supported by service improvement and innovation teams.

"Our approach has been around collecting the data, enabling the NHS and raising awareness among stakeholders," says Professor Hill. "But it has been the dedication of the clinical teams that has achieved this."


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