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Diagnostic Industry Advisory Group (DIAG) – NHS England Diagnostics Strategy

By January 31, 2024No Comments

BIVDA is a member of the secretariat for the DIAG. This group was set up as a forum to engage with industry to support NHS England’s Diagnostic Transformation Programme.

The Health Technology Partnership, OLS, Industry including BIVDA and NHS England recently reviewed how to maximise the impact of the group.

This review resulted in a joint secretariat, revised terms of reference and a new structure. This will be a core membership and the creation of sub-groups to deliver actions and objectives.

The first meeting of the new format was held on Monday 29 January.

The first section of the agenda covered review and reflections on the previous break out sessions held in 2023. These sessions focused on Imaging, Diagnostic digital capability, Point of Care, Pathology and Physiological Science.

BIVDA and member companies participated in Point of Care & Pathology breakout sessions.

Point of Care

Aim – To explore how NHS England can work with Industry to build the evidence base needed to promote the wider use of PoCT.

Actions – To work with industry to identify the evidence that is needed to address POCT in community settings: This would involve identifying and agreeing on key areas of development and planning next steps.

Update:

The Diagnostics policy team is currently working on evaluating the use of PoCT in ARI Hubs with support from BIVDA, ABHI and the RCGP Research and Surveillance Unit.

The aim of the evaluation is to understand the role that POCT (multiplex LFD +/- CRP +/- RSV) can play in improving the clinical management of patients with acute respiratory infections, so they can distinguish which patients need treatment or care, even if appearing well and those that can avoid antibiotics and a potential attendance at A&E, despite appearing unwell.

It will also help create an evidence base on the use of these PoCT in community settings.

Pathology

Aim – To explore how industry can support performance improvement in histopathology.

Actions

  • Pathology Transformation to encourage systems/Pathology Networks to engage suppliers in shaping an optimised histopathology laboratory workflow as part of the Histopathology Transformation and Recovery Programme (HT&R).
  • Pathology Transformation and industry colleagues recognise the need for laboratory and local expert resource to facilitate a prompt implementation of innovation in laboratories. Pathology Transformation to reflect the impact of current demand pressures on pathology workforce as a barrier to rapid adoption of innovation in delivery timelines.
  • Pathology Transformation to recognise an optimal workflow supported by the introduction of automation is likely to be a combination of multiple equipment solutions, from different providers.

Update –

NHS England wrote to ICBs in April on prioritising new diagnostic capacity for cancer services and asked all trusts to work towards meeting the histopathology turnaround time target by March 2024, with an immediate improvement target to 70% within 10-days. A national Six-Point Histopathology Improvement Plan has been developed which was launched at a national event on 14th November – Paul Fisher attended this for BIVDA. In bringing together national NHS policy leaders, Pathology Network change makers, Cancer Alliances and Professional Bodies, and industry partners this forum provided an opportunity to exchange expertise, experiences, and actionable information through discussion.

Following discussions with DIAG and industry partners in other forums an optimised automation workflow. NHS England continue to work closely with BIVDA and ABHI to progress the agenda on improving histopathology turnaround times.

After the reflections on current workstreams, Professor Sir Mike Richards presented the new NHS England Diagnostics Strategy “The diagnostics vision.”

The vision was expressed as:

“Maximise and expand diagnostic infrastructure and employ new service models, so that growing diagnostic demand is met through the smarter use of capacity that makes diagnostics an engine of NHS productivity.”

  1. Expand the separation of acute and elective diagnostics.
  2. Enhance diagnostic services’ productivity and performance.
  3. Accelerate the digitisation of diagnostics through the expansion of diagnostic networks to create efficiencies and enhance workforce productivity.
  4. Grow, reform and retain the diagnostics workforce to meet diagnostic demand.

The impacts expected are to:

  • Achieve and sustain 95% 6WW target, reduce the diagnostic waiting list back to pre-2020 levels and achieve the 99% constitutional standard for long waiters.
  • Drive productivity gains in other NHS services to enhance patient experience and outcomes.
  • Tackle pervasive diagnostic challenges (e.g. CYP, the FDS in Cancer) and improve outcomes.
  • Enable NHS-wide innovation (e.g. companion diagnostics, AI and enhanced phlebotomy).

The new strategy looks at how improved diagnostics can improve the productivity of NHS. The view is that if in patient diagnostics are better, they can shorten the length of stay, which is a key message that BIVDA and members have been giving for a long time. They also hope to quicken digitalisation, networks and hospitals.

The strategy is heavily focused on the need for the workforce to grow and reform and importantly retain staff at all levels.

They need to deliver the impact of improved wait times. Cancer programme. Give the foundation for innovation. AI – safety and effectively.

Capacity can be increase smartly, through the continued separation of acute and elective diagnostics. This aims to optimise pathways through CDCs but acknowledge this takes a long time and should be simplified.

Upgrade to CDCs and new ones are planned. These will include clinical rooms and procedure rooms, giving flexibility.

There is need automated requesting and reporting.

Automation of Histopathology is required for productivity gains.

There are high levels of diagnostic activity increasing month on month, and this strategy is key to reducing admin burden on staff. Making sure the NHS achieves optimal times and throughput.

There will be more endoscopy. Demand is increasing and so is activity, but it is still not keeping pace with level of demand seeing increases year on year.

There are new and emerging demand drivers, such as ageing population, changes to screening (Bowels, Breast and Lung), precision medicines – image-based and bio markers and a recognition of the pipeline of innovation.

There are opportunities for AI, Histopathology, POC – ARI/ ambulances and intelligent scheduling and reducing missed appointments, as well as virtual imaging and ophthalmology and dermatology at CDC and macular degeneration at home.

Digitisation was a theme throughout, with better automated testing and results.

Enhancement of management systems and allowing information to be shared through the system are also called out.

The strategy seeks to facilitate home reporting, by supporting and enabling the workforce to be more efficient.

They need better infrastructure in place, which will enable new models of care and opportunities to digitise services. There will be protected facilities for access and equitable access.

A key part of the strategy is to replace out-of-date equipment, and as they begin to move this through – they hope that networks benefit economies of cascade and opportunities to integrate the workforce, to get high quality patient outcomes.

Workforce is critical. They are not just thinking about training but also enhancing roles. They want to enable staff to move through and therefore retain staff, allowing professionals to operate at top of licence which is more rewarding, by removing the admin burden.

Increasingly important are companion diagnostics for precision medicines. (Genomics) biomarker and protein testing. BIVDA has Genomics high on our priority list for 2024 onwards and will be focusing on this with our member companies and advocacy. They see blood based cancer screening as a huge opportunity.

Through the strategy, similar to BIVDA’s, they aim to address health inequalities through better patient access and care. Including paediatric diagnostics. Waiting lists are going up higher than for adult services. They need to examine how to transform diagnostic services and CDCs so they address health inequalities, and to demonstrate how all activity can deliver wider benefits across the NHS allows scores to increase capacity for acute diagnostics.

Optimise pathways through CDC for faster throughput and faster diagnosis standard and 62 days wait.

They recognise pathway review, and moving tests in pathway get answers quicker and how this can also impact the number of patients who attend outpatient appointments. The system is seeing the outcomes related to better access to diagnostics. They have taken the input from POC teams of how important diagnosis is through Near Patient Testing. Near Patient Testing is BIVDA’s third priority area, following AMR (and infectious disease), Genomics (and companion diagnostics).

Comments from DIAG attendees on the strategy include;

Genomics and where they are aligned with the GLHs, as there are challenges between Labs and GLH.

Industry to drive behaviour. Key aim to be located in areas of deprivation to make travel easier for people. One of the questions is to get distribution of services. Preliminary findings is patient experience is good, and looking at increasing what can be done at home.

Productivity – supportive of the overall approach holistic – screening and specialised commissioning tests instead of perpetuating silos at centre. Learn from independent sector. Keen to integrate.

Where does the accountability sit, it is with the Diagnostics Transformation team?

How does it flow into NHS and laboratories and how will they work in community? Concerns in funding in community diagnostics and funding for rapid IVD and demand signalling to industry.

Need to make sure it’s not just the national team. Important for regions and ICBs to be on board.

How will strategy affect implantation of infection diagnosis?

Health inequalities.

What is the funding? Need to make the case strong as possible. Necessary investment but effective investment. Industry is needed to help make the case.

Is this strategy subject to central funding? Is there more capacity?

There is a concern that other NHS England and wide system programmes are missing from the deliverables and collaboration.

Ben Kemp