NHS leaders have for several years highlighted significant variation in the provision of NHS diagnostic services. Lord Carter’s reviews into NHS pathology and acute productivity noted considerable variation in the cost and productivity of NHS pathology and diagnostic radiology services. From some perspectives this is perhaps unsurprising as both scientific disciplines have evolved dramatically over the past 20 years and technological advances have enabled new techniques and tests to be developed. However, this has meant that not only have some diagnostic tests been superseded (and are therefore superfluous) but also the most efficient way of providing those tests has changed.

Observing variation and suggesting change is one thing: without stating the ‘what’ and ‘how’ the system has relied upon exceptional leaders to identify the delta between present services and an optimal operational configuration. It is no easy task, especially while undertaking the ‘day job’, to move away from structures and practices long-established as ‘effective’. This is especially so in the context of multiple vested interests; multi-faceted discussions on value, efficiency and risk; and long-established professional, organisational and geographical boundaries.

We often meet colleagues tasked with building a business case to save money by making changes to how services are undertaken. Inevitably the cases will suggest considerable investments in technology and other inputs that are expected to lead to efficiency improvements. However, experience suggests that without careful planning and credible leadership of operational change, the expected benefits from these business cases can only be modest. We believe that there is limited chance of meaningful operational change in the absence of overarching decisions on corporate and clinical governance, organisational form, risk and benefit shares between partners, and an appropriate process for stakeholder consultation.

By seeking advice from service leaders, it is possible to first develop a shared vision of what key principles should underpin a future diagnostic service. A good starting question is: what do patients and clinicians consider future excellence looks like? It is also important to consider, for example: what future demand can be reasonably expected; where are internal examples of best practice to build upon; and, how might future technologies and techniques change current practice. Next, it is important to accurately describe the current service elements of: people, ‘kit’, space, cost, productivity and contracts. By identifying the difference between the existing and future service it becomes possible to agree the priorities and most efficient plan to achieve the desired transformation.

In this context, reference to the status quo can be useful to measure proposals for change, but it cannot be reasonable to assume that by continuing to provide a service in the same way any significant improvements will eventuate (however those are measured). Put bluntly, improvements only happen when something changes. And so leadership teams must contemplate alternatives, including operational reconfiguration and, potentially, consolidation of services to gain efficiencies of scale and scope.

Perhaps most importantly, there is no single answer to achieving optimum efficiency and effectiveness from available resources. Despite common regulatory and governance frameworks, every NHS diagnostic service has its own unique capabilities, challenges, and organisational memory: one size very definitely does not fit all!

We believe that proposals for transformation should always be framed by setting out clearly the patient and clinical benefits that will be gained from any change. In our experience, having a clear vision grounded in the improvement available for patients provides a strong framework for stakeholder discussions.

Let us know if you think your plans might benefit from an informal conversation about how to build the framework your diagnostic transformation.