Last week, we were treated to the unwelcome news that patient waiting times in Scotland have hit a record high. Whilst there is no magic solution to easing the pressure on the NHS, colleagues south of the border have embarked on a new model of care – at significant scale – which could point to an eventual route out of the current stresses and strains faced by our healthcare system.
The introduction of Community Diagnostic Centres (CDCs) in England three years ago was part of a broad strategy to modernise and improve diagnostic capabilities, reduce waiting times and ultimately improve population health outcomes by diagnosing health conditions earlier, faster and more accurately. Establishing these new centres in community locations during a pandemic was designed to make diagnostic services more accessible and alleviate pressures at acute hospital sites.
If Scotland is to adopt this model it will be important to learn the lessons from the early challenges faced in England as outlined by the All-Party Parliamentary Group (APPG) for Diagnostics in a report published in January. MPs questioned the location of some centres and highlighted the lack of digital tools to help streamline pathways, improve efficiency and address data interoperability and care coordination challenges between primary and secondary care. However, they were also clear that the CDCs, allied with new technology, will play an increasing role in adding diagnostic capacity to a stretched healthcare system – with 127 centres now up-and-running.
Timely and effective diagnostic services are essential for high-quality care and reducing waiting times for treatment and future hospitalisations. Currently, diagnosing chronic conditions like heart failure, chronic obstructive pulmonary disorder (COPD), and severe asthma can be fragmented across care settings and between medical specialties. This can lead to inefficiencies such as repeat tests and data sharing issues. Inappropriate referrals, staff shortages – particularly for specialist nurses and trained diagnostic staff – and high “did not attend” rates exacerbate the problem.
The latest Public Health Scotland report for the quarter to March 2024 makes for grim reading. The figures show that more than 500,000 patients are waiting for a new outpatient appointment and a further 63,900 awaiting treatment as an inpatient or day case. The total waiting list size for new outpatient appointments is 10 per cent higher than March 2023 and more than double the waiting list total at the end of March 2020.
There are also pain points in respect of individual conditions. A freedom of information request from the British Heart Foundation in February 2024 found that waiting times for echocardiogram scans across Scotland, a key diagnostic test for detecting heart disease, had increased from 11,745 to 19,054 patients between June 2020 and June 2023. An Asthma and Lung UK report on respiratory diagnostics released in May 2024 further highlighted that delays in diagnosis for respiratory conditions is “pervasive” across the UK and claims one in four people with COPD waits more than five years for a diagnosis.
Increasing testing capacity alone won’t solve these problems. We need to consider how new digital tools can support the redesign of diagnostic pathways that automate clinical workflow steps and better support the needs of health care practitioners as well as patients.
A digitally-enabled set of care pathways will help streamline testing in community settings, incorporate patient-generated health data in advance of appointments, and improve care coordination across medical specialties and between primary and secondary care.
Automation of clinical workflow steps will also reduce the clinical and administrative burden, for example automatically generating and sending patient treatment plans and communicating with GPs. It could also, in time, support a shift towards home-based diagnostic testing for suitable conditions.
Lenus Health’s Digital Diagnostics solution exemplifies this concept. As a plug-in clinical workflow automation system, it improves diagnostic pathways for various cardio-respiratory chronic conditions. By streamlining processes, diagnostic services can enhance efficiency and coordination at every stage, from clinical workflows to resource targeting, co-located diagnostic testing, quicker diagnosis through virtual reviews rather than repeated outpatient appointments and improved patient experience.
The solution was applied to heart failure diagnostics in NHS Greater Glasgow & Clyde and was shown to reduce waiting times by 78 percent and time to treatment by 72 percent – delivering a two-and-a-half times improvement in efficiency versus the previous clinic model. An independent health economics study by the University of Glasgow has further supported the adoption of digital technology within heart failure diagnostics. The ‘Opera’ research, overseen by the Digital Health Validation Lab (DHVL) at the university, reported a 20 percent cost saving compared to standard care as a result of fewer healthcare contacts and emergency admissions due to earlier treatment of patients. The full study is awaiting publication in notable scientific journals, with a summary available on the West of Scotland Innovation Hub website.
These are undoubtedly important research findings and pave the way for the solution to be adopted at scale in Scotland – through NHS Scotland’s Accelerated National Innovation Adoption (ANIA) pathway. We see that as the logical next step alongside establishing diagnostic centres in community settings. A number of CDCs in England are already using Lenus Health’s Digital Diagnostics solution to underpin diagnostic pathways, collecting rich structured data through referral, triage, testing, diagnosis, and treatment planning.
This rich dataset, encompassing test results, observable traits, symptoms, and patient-reported outcomes, offers a more detailed characterisation of patients. This level of patient understanding can facilitate the delivery of more targeted and effective treatments advancing the goals of precision medicine and provides the fuel, in the form of structured data, to develop AI risk prediction models.
Digitising diagnostic pathways also pave the way for more widespread adoption of AI-enabled diagnostic devices that can accelerate clinical decision-making and enable more detailed reporting of pathway performance against agreed metrics.
With waiting times at an all-time high and demand set to increase, new models of care are urgently required that are underpinned by investment in trained staff and new digital tools to streamline pathways and attack the patient backlog. Whilst there remain improvements to be made to the CDCs, the MPs were unequivocal in their report when they wrote that ‘innovating patient pathways and digitising services has streamlined operations and enhanced patient experiences’.
Combining advancements in digital technology with testing services located closer to the point of need is clearly a sensible model for future healthcare delivery. With a more rural population in Scotland, we would do well to take the lessons of the CDCs in England – and apply them here.