Demand for diagnostics services is on the rise, but a lack of infrastructure combined with staffing shortages means waiting lists are growing.
This page provides analysis on the diagnostic pressures in the English NHS and is updated monthly with new data.
Demand for diagnostics is outstripping capacity
The UK has less diagnostic capacity than other countries
In comparison to other nations, the UK has a much lower diagnostic capacity in its hospitals than other countries.
- The average number of CT scanners per 1 million people in OECD EU nations is 19, while the UK has just 9.
- The average number of MRI scanners per 1 million people is 11.5 while the UK has 7.7.
- The average number of mammography machines per 1 million people is 11.6, while the UK has 7.8.
Waiting lists are growing as more people need tests
The ONS (Office for National Statistics) expect the population in England to grow by around 9% over the next 25 years.
At the same time, improvements to life expectancy mean that more people are reaching much older ages. By 2043, at least one in four adults will be aged 65 or over, and the number of people aged 85 years or over will have nearly doubled.
The growing and ageing population brings with it a growing burden of disease. It means that between January 2010 and January 2020, the number of diagnostic tests carried out across the NHS in England increased by 75% - from 1.14 million to 2.07 million.
Without expansion in diagnostics capacity, this has led to a growing number of people having to wait longer for their diagnostic test or procedure, as well as growing waiting lists. In January 2020 over one million people were on waiting lists for diagnostic tests – more than double the amount ten years prior.
The NHS constitution states that patients referred for diagnostic tests should receive a test within six weeks. Yet, the number of patients waiting over six weeks had been steadily rising even prior to the pandemic.
In January 2020, seven times as many people were waiting over six weeks than in January 2010.
COVID-19 has impacted diagnostic capacity
The need to postpone non-urgent elective activity in March 2020, combined with the country entering lockdown, initially caused a decline to the waiting list and the number of tests done.
The waiting list reduced between February 2020 and March 2020, while the number of tests carried out fell by 71%.
There has since been a rise in the number of tests done, although levels are not quite back to pre-pandemic numbers.
Meanwhile, the waiting list for diagnostic tests has continued to grow as a result of capacity limitations and the backlog. As of December 2021, there are 1.45 million patients waiting for a diagnostic test – a record high since the collection began in 2006.
The pandemic has seen the number of people waiting over six and 13 weeks rise to levels not seen since before NHS England first introduced the six-week wait target in March 2008.
Staff working in diagnostic services
There is a clear and pressing need to urgently expand the diagnostics workforce.
High quality, efficient diagnostic services require a wide range of health professionals. However, over recent years, expansion of key staff groups has not kept pace with the above increases in demand and activity.
A census carried out by the Royal College of Radiologists in 2020 indicated that there are 1,675 full-time consultant clinical radiologist posts unfilled in England.
Likewise, a survey by the Royal College of Pathologists in 2018 indicated that 45% of histopathology laboratories were having to outsource work and 50% of departments had to use locums, with workforce being the major constraint.
What the BMA is calling for
The BMA has long called for improvements to the way diagnostic services are delivered. We support the recommendations set out in the October 2020 Independent Review of Diagnostic Services for NHS England.
The review calls for major expansion and radical reform of diagnostic services over the next five years to aid recovery and meet rising demand. In line with the recommendations, the 2021 autumn budget announced:
- £2.3 billion for diagnostic services and equipment including CTs, MRIs and ultrasounds
- the introduction of 100 community diagnostic centres across England.
The expansion of diagnostic infrastructure and community centres must also be met with a sufficient and sustainable staffing model, with staff well-integrated across all sites to avoid a migration of acute staff into the community and acute sites.
We are also calling for a clear workforce strategy for training, recruitment and development backed by sufficient and sustainable investment to grow the whole medical workforce. See our NHS workforce data analysis for more details.