‘Radical’ expansion of diagnostic capacity urgently needed, claims NHSE report

A doubling of CT scanning capacity, a significant increase in staffing, new diagnostic networks and faster access to scans are among 24 recommendations set out in a report by Professor Sir Mike Richards, chair of the independent audit of diagnostic services for NHS England.

The report, published on Thursday, states that diagnostic activity is increasing at a rate faster than hospital activity. Growth in recent years has been more than 15 per cent higher in some cases than activity growth in emergency departments, emergency admissions and outpatient referrals.

Professor Richards described services as “approaching a tipping point” even before the covid-19 pandemic. He said separating acute and elective diagnostic services was a “key recommendation”, with HSJ last month revealing the report’s vision of 150 community diagnostic hubs.

While the NHS long-term plan highlighted a need to reform diagnostic capacity, Professor Richards said covid-19 “has further amplified the need for radical change in the provision of diagnostic services, but has also provided an opportunity for change.”

The report says a huge backlog of 580,000 patients waiting more than six weeks for a test had built up by early June 2020, compared with around 30,000 in February.

While Professor Richards envisages future savings from reduced outsourcing to private providers, it adds: “In the immediate term, independent sector facilities should be used to reduce backlogs wherever possible.”

The most significant recommendations include:

• A major expansion to the workforce, including 2,000 additional radiologists and 4,000 radiographers. Data from the respective royal colleges suggests the radiology workforce was around 4,800 in 2019, and the radiotherapy/radiographic workforce around 3,500.
• Diagnostics for elective care should be split from acute sites, in new community diagnostic hubs.
• Delay-free imaging in emergency departments with inpatients to be imaged or undergo endoscopy on the same day of request.
• Doubling CT scanning capacity and ensuring any acute site with an ED has access to a minimum of two scanners.
• MRI, PET-CTG and plain X-ray equipment should be expanded and all imaging equipment should be replaced if older than 10 years;
• Continued establishment of imaging and pathology networks, and the development of new endoscopy and cardiorespiratory networks; and
• New training academies for endoscopy staff.

The report states services will require major investment in new facilities to replace “obsolete” equipment. It argues that training of new staff should start “as soon as possible”.

According to Professor Richards, separating acute and elective diagnostics would relieve pressure on acute sites and “markedly reduce outpatient referrals and attendances”.

This would enable emergency and inpatients to be tested on the same day as the request being made, which would reduce length of stay.

The report said there was “broad clinical support” for the expansion of CT capacity being given the “top priority” within imaging. Professor Richards estimated demand for CT is likely to increase by at least 100 per cent in the next five years.

He suggested smaller, single-site hospitals with only one CT scanner should be prioritised for getting a second scanner.

England currently lies at the bottom of a table of 23 OECD countries for CT scanning capacity per million population.

On endoscopy services, which have been hit particularly hard by covid-19, Professor Richards estimated that around 20 trusts would require a “complete rebuild of their facilities”.

He proposed the formation of endoscopy networks – similar to the imaging and pathology networks established in the last three years – which could operate at “ICS level”.

Professor Richards, presenting his report to a meeting of NHS England’s board, said workforce was the greatest long-term challenge to the sector.

His report called for a greater focus on skill-mix, more training and staff, and investment in AI and supporting technologies to maximise efficiency.

Dr Jeanette Dickson, president of the Royal College of Radiologists, said the recommendations shared a number of similarities with her college’s recent submission to the comprehensive spending review, which called for “hundreds of millions of pounds” to transform the sector.

She said: “If we don’t invest in this, we will see a significant worsening of trends that have always been there. Poor cancer outcomes, poor outcomes for heart disease and respiratory disease, lengthier stays in emergency departments, and lengthier stays in hospital - all of which represent money poorly spent for the health service.”

Addressing NHSE/I’s board, Professor Richards said the NHS was already starting to implement his recommendations, but warned “we can only go so far” without capital.

His report comes one week after it emerged that a multi-year spending review has been delayed due to the pandemic.

NHSE has already set up a diagnostic board, chaired by medical director Stephen Powis and improvement director Hugh McCaughey, to oversee the report’s implementation.