Diagnostics is the backbone of healthcare, often determining the success of treatment and how quickly patients move through treatment pathways. When diagnostics performance slows, all parts of the pathway slow.
Diagnostics therefore dictates whether the NHS and Government will meet targets for earlier diagnosis, prevention and elective recovery.
The system is under significant pressure. New analysis shows that 1.92m people are waiting for a diagnostic test, with more than one in five now waiting over six weeks.
Despite record activity, with over 2.6m tests delivered in a single month, demand continues to outpace capacity, and it would take a further productivity increase of 0.7% just to stop the gap between demand and delivery from widening further.
Delays are being felt most acutely by patients. Research from charity National Voices has put a spotlight on the long and drawn-out process people face when navigating diagnostic pathways. When these pathways work well, they provide reassurance, clarity and rapid access to treatment. But when pathways become fragmented, the impact on patients is significant.
Alongside colleagues from across the NHS and the diagnostics ecosystem, I have been working on a new report, commissioned by Magentus, that puts forward suggestions for system improvement. Our aim was to look at how we could do things differently, rather than simply trying to do more. If diagnostic services are to recover, I believe the following changes are essential.
- Move diagnostics earlier in the pathway
Too many pathways still require patients to attend a specialist appointment before basic diagnostic tests are carried out. This creates unnecessary delays and inefficiencies.
We must move diagnostics to the start of the pathway and enable appropriate direct referral from primary care. Embedding diagnostics earlier would allow clinicians to make informed decisions sooner, reduce repeat appointments and improve overall pathway flow.
- Give patients more information
Diagnostics is not just a clinical process; it is a patient interaction. Evidence shows there are significant gaps in communication, with many patients receiving little or no information about their diagnosis, or information that is difficult to understand.
Clear, accessible and actionable information about what a test means must be shared alongside the results themselves as standard. This includes plain-language explanations of results, clearer next steps and better use of digital tools such as the NHS App.
Getting this right will reduce anxiety, build trust and help patients engage more effectively with their care.
- Connect diagnostic pathways
Diagnostics often operates as a collection of separate services rather than a single, co-ordinated pathway. Radiology, pathology and community diagnostics are frequently disconnected, leaving patients to navigate a system that does not function as one.
Connected data is also essential if the NHS is to realise the full benefits of artificial intelligence. AI tools may help prioritise urgent cases, identify patterns across large volumes of diagnostic information and support clinical decision-making, but they will only deliver safely and effectively where the underlying data, interoperability, governance and workflow foundations are in place. Fragmented systems limit the ability of AI to support clinicians and improve pathway performance at scale.
Just as importantly, the data generated across diagnostic services often remains trapped in separate systems. Clinicians may have only a partial view of a patient's diagnostic journey, while patients are asked to repeat information, undergo duplicate tests or wait for results to move between organisations.
Without end-to-end visibility, from referral through to diagnosis, results, reporting and next steps, we lose opportunities to improve flow, reduce duplication and make better use of our workforce. Connecting diagnostic data across organisations would allow clinicians to make better-informed decisions, identify bottlenecks earlier and create a more seamless experience for patients.
Where this has been implemented, such as in integrated service models like the Cheshire and Merseyside Pathology Network, we see the benefits: reduced duplication, improved turnaround times and a more consistent patient experience.
- Use existing capacity far more effectively
While expanding capacity is important, we also need to make better use of the capacity we have.
Take community diagnostic centres, for example. They are a key part of NHS policy, but their capacity is not yet consistently aligned with demand or fully embedded in referral pathways. Data shows that regions with the longest waits often have the lowest CDC capacity, while regions with the shortest waits have the most.
More broadly, capacity across the system is frequently underused. Equipment sits idle outside core hours, referral patterns do not reflect available services and pathways have not evolved alongside new infrastructure. The result is a system where additional capacity exists, but patients are not consistently directed towards it.
Capacity must be aligned to population need, referral pathways must be redesigned, and visibility of available slots must improve across organisations.
- Focus recruitment where it is most needed
Since January 2020, diagnostic demand has grown by 83%, yet the reporting workforce has increased by only 33% in radiology and 24% in histopathology. Demand has therefore outpaced capacity by more than two to one.
For pathology especially, this is critical, as tests alone do not diagnose patients: people do. Without sufficient reporting capacity, delays are inevitable, with the most serious consequences felt in time-critical pathways such as cancer.
We must invest in the crucial roles across diagnostics, including radiographers, histopathologists, biomedical scientists, clinical scientists, advanced practitioners and support staff, ensuring services have the full skill mix needed to turn tests into timely, actionable results.
Diagnostics is central to the sustainability of the NHS. It is the gateway to care, the pacesetter for pathways and a multiplier of clinical effectiveness.
The challenge we face is significant, but the opportunity is greater still. Advances in genomics, AI, data and community-based models all offer the potential to create a diagnostic system that is more connected, more responsive and more patient-centred than ever before.
Delivering this will require collaboration between the NHS, professional bodies and industry, supported by clear standards, procurement levers, implementation support and guidance on safe, effective practice.
The question is no longer whether diagnostics must change. It is whether we are prepared to make the changes required. Get this right and we will see shorter waits, faster diagnoses, better outcomes and a system that works better for the patients it serves.
