A growing demand with fewer resources: A conundrum for UK diagnostics provision

The Covid pandemic may have receded for many but, for those working in healthcare, ongoing significant and growing demand for diagnostic services suggests we are now in a ‘new normal’. We question here whether the workload predictions in the years prior to 2020 continue to hold and, if so, from when might we reasonably check our activity against those original plans?

Professor Sir Mike Richards, in his report published towards the end of 2020, noted the initial impact of the pandemic was to place “substantial pressure” on pathology networks in particular, and diagnostics in general. As the peaks of the pandemic have receded, NHS testing for Covid-19 has reduced significantly. However, reducing pandemic activity seems to be getting simultaneously replaced with new workstreams.

Just last week the government announced that 50 new surgical hubs are set to open across England by 2024/25, to add to the 91 hubs already running. The government is anticipating almost 2 million additional procedures over the next 3 years, the equivalent of 12% of all elective activity in 2019/20. Overall, and alongside other productivity improvements, the government is aiming to treat around 30% more elective care patients by 2023/24. To support this step-change in elective activity and cancer programmes the NHS was planning in 2021 for diagnostic activity to increase to 120% of pre-pandemic levels by 2022/23 (i.e. now!). Real-life evidence of the change in demand is already reported by the Black Country Pathology Service. It has stated that their current workload had increased by a fifth over pre-pandemic levels, considerably higher than its 2018 projections.

In this context, and even if future demand was to moderate to more traditional levels, it seems reasonable to assume that by 2030/31 demand for diagnostic services could be at more than 1.5 times the level of 2019/20 (a relevant pre-Covid-19 baseline).

Most readers of this blog are likely to have suggested a slim (or no!) chance of workload returning to what we remember as pre-pandemic ‘normal’, although they may disagree with the scale of the growth in demand we are predicting. Either way, thought should be given about how to cope. Even if there were greater funding available to employ larger teams (there isn’t), we are unaware of great numbers of unemployed pathologists and radiologists that might fill open positions. Technology may go some way to achieving productivity gains (for example, digital initiatives, AI and clinical support systems) but it is also likely to introduce new areas of responsibility for already stretched teams.

The private sector has seen an opportunity within various diagnostic specialities to provide greater short-term support, but seems highly unlikely (other than in a couple of honourable exceptions) to be a resource that can be relied on to develop and maintain a ‘full’ repertoire similar to that provided by the typical NHS diagnostic service.

We expect continuing pressure from the centre for teams to form networks, share work and consolidate demand where it makes clinical sense and creates an opportunity to do more with less.

We can help with planning and the implementation of change, if required. Please do get in touch for an initial discussion.