NHS Diagnostic services - Podcast transcript
What’s this report about?
This report looks at three of the main types of diagnostic services provided by the NHS. So that’s radiology services, which are things like scans, endoscopy services, which are things like looking inside the bowel using a camera, and laboratory services, which are things like blood tests. These services are obviously very important to patients as they help them to get the right diagnosis and to get them started on the right treatment. So this report assesses the efficiency of these services and it also looks at the measures that NHS boards have been taking to improve services for patients. Finally, it also looks at performance against the national waiting times targets that there are for diagnostic tests.

What have you found?

We found that NHS boards have significantly reduced waiting times for eight key radiology and endoscopy tests. They’ve done this by using additional funding provided by the government and also by changing how they manage and deliver services. However, they could still do more to improve diagnostic services for patients, for example, by offering patients a choice of appointment date or time and also reporting test results quicker. We also found variation in the efficiency of diagnostic services so there is scope for boards to use resources better.

What is the impact and importance of all this for the public?

Diagnostic services are important for patients as they help them get an accurate diagnosis and the right treatment. Delays in getting tests or reporting the results can be worrying for patients and it can also mean the treatments might be less effective. 

The services we looked at provide millions of tests and procedures each year for patients at a cost of more than £280 million of public money. Boards have cut waiting times for diagnostic tests and are getting better at meeting patient needs but there is more they can do to improve services for patients and to make them more efficient.

Many patients feel they wait a long time to have a diagnostic test done. Why does it take so long?

NHS boards have actually made significant progress in reducing the time patients have to wait for eight key radiology and endoscopy tests. At the end of June 2008, only two patients had been waiting longer than the nine week waiting time target, compared with over 10,000 at the end of July 2006. Boards have done this by making changes to how they manage and deliver services and also by using diagnostic waiting times money.
The new target that will come into effect at the end of 2011 means that waiting times should be shorter; the time between any referral and a patient starting treatment should be no more than 18 weeks. This target covers all stages of a patient’s care including diagnostic tests.

You made a point earlier about variation in the performance of different boards, and in the report you make quite a point about variation and inconsistencies. Can you just explain a little bit about what you mean by that and what the impact of that is?

The report identifies that the efficiency in diagnostic services varies across NHS boards, and there is scope for more efficient use of resources. For example, around one in ten scheduled endoscopy sessions weren’t actually used across the sample of boards we looked at.

There are inconsistencies in the way NHS boards count activity and calculate costs, making it difficult to compare performance. We have made a recommendation for the government and NHS boards to improve these data so they can better compare efficiency. 

What would you like to see happen now?

In the report we’ve made a number of recommendations for both the Scottish Government and NHS boards and we believe these recommendations will help them improve diagnostic services for patients and also make services more efficient.

Some of the recommendations we’ve made around improving the efficiency of services are for boards to have better information and to use that information to actually look at how they provided services. So, how they use their equipment, how they use their staff, how they use their facilities, things like that, to actually make sure they’re using them in the best way possible and to see if they can improve the efficiency in how they use these services. 

We’ve also made a number of recommendations about improving the patient’s experience of diagnostic services. So that’s things like hospitals offering patients more choice of the date and time for their diagnostic test, and also things like offering more direct referral where GPs can refer patients directly to diagnostic tests without the patients having to wait to go to an outpatient clinic first of all.

We also made recommendations around how the health service is planning for the new 18-week referral to treatment target. There it’s about making sure that diagnostic services are included as a key part of the planning process to achieve that new target.