Demand for diagnostics services is on the rise, but a lack of infrastructure combined with staffing shortages means waiting lists are growing.
The expansion of the Community Diagnostic Centre network will only tackle diagnostic waiting times if centres are adequately equipped and staffed, without the removal of capital funding or staff from hospitals.
This page provides analysis on the diagnostic pressures in the English NHS and is updated regularly with new data.
Demand for diagnostic tests continues to increase
Diagnostic waiting lists are growing
In April 2023, around 1.6 million people in England were waiting for a diagnostic test, twice as many as in January 2006 (0.8 million), when this dataset began. This waiting list has been growing steadily since 2008, well before the start of the COVID-19 pandemic.
People are also waiting longer for tests. The NHS constitution states that patients referred for diagnostic tests should receive a test within six weeks, yet this target has not been met since February 2017.
The COVID-19 pandemic exacerbated this situation. Between the start of the pandemic and April 2023, the number of people waiting over six weeks for a diagnostic test rose from around 30,000 to 431,000 – a 14-fold increase.
At the same time, performance against the six-week wait target plummeted from 97% to 42% during the first lockdown (February – May 2020). It has only recovered partially since, and stood at 72.4% in April 2023.
Demand will continue to increase as the population grows and ages
At the same time, the population in England is growing and ageing, bringing a growing burden of disease.
The ONS (Office for National Statistics) expect the population in England to grow by 6.7% by 2045 – an increase of 3.2 million. At the same time, the number of people aged 85 years or over will have nearly doubled. This means more and more people will become NHS patients, fall ill, and require a diagnosis. The strain on diagnostic services is thus set to increase further in coming years.
Demand for diagnostics is already outstripping capacity
Growing waiting lists for diagnostic tests are a function of capacity limitations and a growing burden of disease.
The UK has less diagnostic equipment than other countries
Demand for diagnostic services is outstripping capacity. In comparison to EU nations, the UK has much less diagnostic equipment in its hospitals:
- The UK has just 10 CT scanners per 1 million people, fewer than any EU nation. The average number in OECD EU nations is 19.8.
- The average number of MRI scanners per 1 million people in the EU is 12.1, while the UK has 8.6.
- The average number of mammography machines per 1 million people in the EU is 12.1, while the UK has 11.2.
There is not enough diagnostic staff in the NHS
Besides insufficient diagnostic capacity in terms of machinery, England has a clear shortage of diagnostic staff. Over recent years, expansion of key staff groups has not kept pace with the above increases in demand and activity.
According to the Royal College of Pathologists, 97% of histopathology departments in the UK do not have enough staff to meet demand, and an Independent Review of Diagnostic Services found that the imaging workforce will require 11,370 additional staff by 2025. Similarly, Royal College of Radiologists has reported a nearly 30% workforce shortfall amongst consultant and interventional radiologists.
Community diagnostic centres are no silver bullet
In February 2022, as part of the Elective Recovery Plan, the Government announced their plan to build a network of over 160 Community Diagnostic Centres by 2025 in a bid to speed up diagnostic processes in the NHS. However, the government admitted that the centres needed an extra 3,500 radiographers, as well as 2,000 radiologists and 500 advanced practitioners.
Given existing workforce shortages, it is clear that running these centres requires more diagnostic staff than is available. There is also a risk of redistributing workload across the same stretched workforce, if staff is moved from hospitals to diagnostic centres. Any workforce plans must ensure that staff are well-integrated across all sites to avoid a wholesale migration of acute hospital staff into the community.
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 BMA continues to lobby for adequate investment in diagnostic infrastructure, as well as staffing. 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.
Diagnostic services must also be underpinned by IT interoperability across the NHS – and there is an equal urgent need for investment in digital transformation. There must be easy access to test results between different hospitals themselves, and between primary and secondary care.