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How can pharma respond to shortfalls in diagnostic capacity?

As well as jeopardising patients’ health, the ebb and flow of diagnostic capacity within the NHS can have a big impact on industry’s bottom line. Oli Hudson, Content Director at Wilmington Healthcare, looks at the challenges facing the health system today, and what industry can do to protect itself from its worst effects.


The pharmaceutical industry has been buffeted by many ill-winds over the last few years, but one that blows particularly harshly at the moment is the shortfall in patient access to NHS diagnostic tests – without which, of course, it is impossible to get someone onto the pathway and started on an appropriate course of treatment.

The COVID legacy

Before the pandemic, the early diagnosis of major illness was a central aim of the NHS Long Term Plan. This included a flagship ambition to increase the proportion of cancers caught at stage 1 or 2 to 75%, as well as commitments to identify and treat cardiovascular and respiratory diseases sooner.

However, as we highlighted in our recent State of the Nation review, COVID-19 hit reverse on these ambitions in a big way. In all, there were 18 million fewer outpatient appointments during 2020-21, reflecting a 36.5% drop in outpatient costs and a 33.8% fall in diagnostic testing and rehabilitation spend, as large swathes of the health system were forced to shut down.

The human impact is only slowly revealing itself. Last year, Macmillan research suggests there were up to 50,000 “missed” cancer diagnoses during 2020-21, while tens of thousands more people have experienced delays in diagnosis of heart failure, diabetes, and many other chronic conditions. The most likely legacy is an epidemic of patients presenting with late-stage disease across many different clinical pathways in the years ahead: indeed, analysis of ONS data suggests that this may already be causing excess deaths.

A stuttering response

Much has been made of the Government’s response, which includes the NHS backlog plan published in February, the one million additional checks carried out by new Community Diagnostic Centres (CDCs) around the country, and Sajid Javid’s much-vaunted “war on cancer” speech, which reasserted the Long Term Plan’s commitments to early diagnosis.

Despite this, the underlying figures are proving stubbornly hard to shift. Latest data shows that nearly 425,000 patients in England are currently waiting six weeks or more from referral for one of 15 key diagnostic tests. Overall, over 1.5 million people were awaiting a diagnostic test – an increase of nearly 140,000 compared to the previous year.

There are a few crumbs of comfort scattered among the statistics. The trajectory in terms of diagnostic capacity is positive, with close to 100,000 diagnostic tests now being performed every working day, and the Government has pledged that 9 million additional tests and checks will be carried out by the 160 new CDCs by 2025, which would be a game-changer.

However, serious doubts remain about whether there are enough skilled professionals to run these new centres at peak capacity. It has been calculated that 6,000 radiologists, radiographers and other staff would be needed to deliver this expansion – and the Society of Radiographers has said workforce shortages would mean this additional resource would involve “robbing Peter to pay Paul” as posts would need to be filled by staff leaving jobs elsewhere in the NHS.

The implied danger in all of this is a so-called ‘bottle-neck’ effect, whereby if patients were to come forward in greater numbers there simply would not be the staff available to test them and process their results. As with many other aspects of NHS recovery, therefore, the view seems to be that unless the government discovers a “magic clinical workforce tree”, we are likely to find these significant shortfalls in diagnostic capacity lasting far beyond 2025.

Responding to the challenge

So what can industry do in these circumstances to shield itself from the worst effects?

First, it needs to recognise that the backlog is reshaping the way diagnostic services are being delivered, and this will have implications for its stakeholder mapping, particularly in respect of the increasingly important role being played by primary and community health professionals in reaching out and signposting people to rapid diagnostic centres. Future proofing the way it manages its relationship with the NHS now will pay dividends in future.

Second, it should keep a handle on the regional and local variations in diagnostic activity within a given pathway. Priorities will vary across different parts of the country, and this will be reflected in the relative investment made into diagnostic capacity. Engagement and field force activity will therefore need to be targeted accordingly, based on activity data.

And third, it should be alive to opportunities to forge strategic partnerships with systems and places that have a specific diagnostic focus. ICSs will be looking for support in terms of understanding where their cohorts of undiagnosed patients may be, and industry has the insights, knowledge and expertise to help them uncover them.

Conclusion

The other big question is ‘what next’. It is clear that the new Prime Minister and her Cabinet have a considerable to-do list ahead of them. However, it remains to be seen how prominently the issue of diagnostic access will feature in their wider management of the NHS, or indeed how much further they can realistically “shift the dial” on diagnostic testing with the available workforce.

In the meantime, pharma will need to think creatively and work collaboratively with NHS customers to find new ways of identifying and connecting stranded patients with the diagnostic services that are available to them.

Wilmington Healthcare provides market leading data, insight and intelligence across the healthcare community. To find out more about how we can support your NHS partnerships, visit wilmingtonhealthcare.com.

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Oli Hudson
Oli Hudson
Oli Hudson is Content Director at Wilmington Healthcare.

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