Everybody wins if we make prevention and early diagnosis a priority

Anyone reading this will understand that the significant challenges facing the NHS are currently being compounded by one of the most demanding winter periods we have ever seen.¹

A broad range of short-term coping strategies are already in play to help ease pressure on hospitals, and Integrated Care systems across the country are now setting out their long-term plans to improve prevention and provide more targeted and timely treatment and care in community settings.²

The value of mobilising diagnostics out of hospital was never more evident than during the covid-19 pandemic, when industry worked in partnership with the NHS and government to make the latest testing technology available and easily accessible to everyone. The development of the first PCR test for covid, which was approved for use in March 2020,³ and rolled out across the country in a matter of weeks, enabled health and care systems to diagnose people with the virus quickly to minimise further spread and reduce the huge pressure which was already mounting on hospitals. However, there is no doubt that this would have been much easier if the UK had historically invested in its diagnostic infrastructure in the same way as other European countries, such as Germany; proving what many of us already knew, that sustained investment in diagnostics is a much more efficient way of running these services and enabling rapid escalation in response to future healthcare emergencies.⁴

As well as the health benefits of prevention and early diagnosis, there is a compelling economic case for better infrastructure for community-based testing too. Take, for instance, detection of heart failure. Currently, the majority of patients are diagnosed with heart failure following an acute admission to the hospital even though 40 per cent have previously presented to their GP with symptoms in the past five years.⁵ A simple blood test, NT-proBNP, can be performed in community settings to help rule out heart failure or to ensure triage for further specialist assessment and echocardiography. Importantly, if heart failure is ruled out, there is no need for an expensive echocardiogram. However, the current use of this test and adherence to the national guidelines for heart failure diagnosis is low and, as a result, heart failure is often diagnosed late and outcomes are poor.⁶

Professor Sir Mike Richards conducted an independent review of diagnostic services for NHS England and his report, published in November 2020, called for a more joined up approach to diagnostic services and improved provision in the community, through community diagnostic services, primary care and care homes.

Building on this work, The King’s Fund took up the mantle of reviewing the current state of play for diagnostics, publishing its briefing Why do diagnostics matter? this autumn. The report finds that each year, the NHS undertakes more than 1 billion diagnostic tests, which accounts for approximately 6 per cent of the NHS budget. Unfortunately, the diagnostic workforce has not kept pace with the significant year-on-year increases in demand and activity, and there are now substantial staff shortages across all specialties. This situation understandably threatens the ability of the NHS to deliver across a whole raft of services and specialties. However, The King’s Fund briefing also highlights significant opportunities to expand the accessibility and delivery of diagnostics. Realising this much-needed increase in NHS diagnostic capacity will require a concerted policy focus, a meaningful expansion in the workforce and considerable capital investment.⁷

We all have a part to play to take forward these recommendations, and ICSs are uniquely placed to take a holistic view of health and care across their region. Diagnostics should form a key part of their strategies, including improved infrastructure to facilitate the tests which are already undertaken every year and also, crucially, establishing environments where new and existing technologies can be quickly and safely adopted in the future.

Innovation in diagnostics is continuous, with new developments and extended use cases for existing tests evolving all the time. For example, it won’t be long before Alzheimer’s disease is detectable through a simple blood-based biomarker test, hopefully allowing confident, appropriate and timely management of patients with dementia far earlier than previously possible. This devastating disease is projected to place an increasing burden on patients, families and health and social care systems,⁸ which needs to be answered with the forging of new and more efficient diagnostic pathways to alleviate both human suffering and soaring costs.

The way in which the NHS, industry and academia worked together to stand up testing when the pandemic broke should be a lasting legacy that informs our preparedness for future pressures. Organisational barriers, unhelpful and obstructive processes and egos were put to one side to deliver what was needed, to the people who needed it, and quickly. We have both an opportunity and a responsibility to apply similar flexibility, agility and ingenuity to the more immediate challenges the NHS is facing, and the longer term strategy for managing the ever-growing demand for healthcare.

References:

¹The Guardian, NHS England to set up ‘war rooms’ for ‘tough winter ahead’, https://www.theguardian.com/society/2022/oct/19/nhs-england-war-rooms-tough-winter-ahead-covid-flu

²NHS England, NHS achieves key Long Term Plan commitment to roll out integrated care systems across England, https://www.england.nhs.uk/2021/03/nhs-achieves-key-long-term-plan-commitment-to-roll-out-integrated-care-systems-across-england/

³The Telegraph, ‘Test, test, test’– a crucial but confounding element of the pandemic response https://www.telegraph.co.uk/global-health/science-and-disease/test-test-test-crucial-confounding-element-pandemic-response/

⁴Exemplars, Emerging Covid-19 Success Story: The Challenge of Maintaining Progress, https://www.exemplars.health/emerging-topics/epidemic-preparedness-and-response/covid-19/germany 

⁵Heart. Routes to diagnosis of heart failure: observational study using linked data in England. Bottle A, Kim D, Aylin P. https://pubmed.ncbi.nlm.nih.gov/28982720/

⁶Eur Heart J. Long term trends in natriuretic peptide testing for heart failure in UK primary care: a cohort study. Roalfe AK, Lay-Flurrie SL, Ordóñez-Mena JM. https://pubmed.ncbi.nlm.nih.gov/34849715/

⁷The King’s Fund, Why do diagnostics matter? Maximising the potential of diagnostics services, https://www.kingsfund.org.uk/publications/why-do-diagnostics-matter

⁸Alzheimer’s Society, Facts for the media about dementia, https://www.alzheimers.org.uk/about-us/news-and-media/facts-media