Trusts' ability to tackle complex challenges by working together at scale has been one of the key policy drivers for provider collaboration. One such challenge is the demand for diagnostic tests. The success of national efforts to tackle long waiting lists and to recover elective performance depends on increasing diagnostic capacity, which has not grown in step with the increasing demand over the past decade. Diagnostics are a key part of over 85% of all clinical pathways, with the NHS spending over £6 billion annually (McCaughey and Powis 2020). 

The need to expand diagnostic capacity nationally had been identified before the Covid-19 pandemic. However, the pandemic highlighted the importance of diagnostics, as the NHS's response depended on the availability of infrastructure to support rapid testing and timely reporting. To provide inpatient capacity for patients with Covid-19, non-urgent elective care was put on hold, meaning fewer diagnostic tests were carried out, and average activity levels decreased.

As part of the 2019 NHS Long Term Plan (NHS England 2019), Sir Mike Richards was asked to undertake a review of diagnostic services in the NHS. The review was published in September 2020 (Independent review of diagnostic services for NHS England 2020) and explicitly accounted for the impact of the Covid-19 pandemic on these services. The case for change set out in the review highlights the impact of long-term underinvestment in diagnostics. It cites data from 2017, in which the UK had the lowest number of CT scanners compared to 23 OECD countries and was in the bottom quartile for the number of MRI scanners.

The review found activity had grown in all areas of diagnostic activity, and predicted this increase would continue as safe and effective models of care require increased dependence on diagnostic capability. Over two million patients are being urgently referred for cancer diagnoses each year, an increase of around 10% over five years. These patients all need one or more diagnostic test. Meanwhile at present only 55% of stroke patients receive a CT scan within an hour of arrival at hospital. The Richards review therefore called for a rethink of diagnostic services delivery, including advocating for the establishment of CDCs – which he recommended could, over time, take on almost all the diagnostic tests requested by GPs and many of the tests required from hospital outpatient services. 

To support the step change needed in the delivery of these services, diagnostics has become a key area where providers have collaborated effectively to build additional capacity.