This report will investigate the unintended consequences of the rapid increase in diagnostic testing. It will examine the effect of the growth on processes and flows within the NHS, and the potential impact of continued growth.
It will review a range of diagnostic disciplines, including imaging, endoscopy, physiological measurements, and pathology.
What do we know?
The number of diagnostic tests carried out in primary and secondary care has grown in the last two decades. This trend is likely to continue given the key role that testing will play in achieving NHS commitments around cancer and heart disease.
There has been limited consideration of the indirect effects of this growth. A rare study into the growth of diagnostics in primary care suggested that “increased diagnostics earlier in pathways can burden patients and stretch general practice workloads, inducing downstream service utilisation and unintended ‘market failure’ effects.”
Meanwhile, in secondary care, growth in diagnostic testing has likely increased referral to treatment (RTT) times, A&E waits and inpatient length of stay.
What questions might this project address?
We will set out the current situation, examining trends in diagnostic testing and identifying the types of activity that are driving growth at this time. We will illustrate (where available) how costs and positivity rates have changed in recent years.
- Unintended consequences
We will describe the impact that the growth in diagnostic testing has had on patients, processes, and flows. We will pay particular attention to the effects in secondary care. An increase in testing has likely affected referral to treatment (RTT) times, A&E waits, and inpatient length of stay.
Test rates are expected to continue to rise, due to increases in hospital attendances, more urgent referrals, and broader applications for existing technologies.
This section will examine the current projections, and ask questions such as: How many tests might we expect by 2025, and 2030? What would it look like if the UK had the same test rates as Germany or the US? And, given the findings in Part II, what might be the impact of such increases?
Finally, we will explore ways to mitigate the difficulties that may arise due to the continuing growth of diagnostic services.
How might this analysis be used to improve health outcomes or service delivery?
This project will give insight into the potential impact of growth in testing on service delivery and population outcomes. The findings could inform pathway redesign or initiatives to mitigate these effects.
We will produce a detailed written report setting out the objectives, methods, data sources, results and conclusions.
All code (R and T-SQL) will be published on GitHub and accessible to DSU Network members
We are planning to publication in a peer-reviewed or trade journal.