Life changed dramatically in early 2020 as billions were confined to their homes, with the general population regularly using rapid diagnostics for the first time as the sensation of a swab entering our noses became a regular habit. Life has not been the same since.
In this article, we examine McKinsey’s report, ‘Rethinking the in vitro diagnostic testing model in Europe’, and how it applies to the current state of diagnostic testing in the UK. Principally, what can we learn from the pandemic and how can we utilise our experience to embed the full potential of IVDs into our healthcare landscape?
Firstly, it relies on obvious sources: investment, mobilisation and planning. When called upon, innovators sprung to action, prompted by necessity and political will. Suddenly, processes were streamlined to facilitate quick development – innovations which took years to create and introduce now took just months. Moreover, fostering behavioral change, such as the adoption of home testing, enabled these to flourish.
The UK spent historic amounts on IVD testing during the pandemic, reaching £10.4 billion in 2020 and 2021. This represents more than a tenfold increase compared to 2017. One must appreciate that these figures reflect a time of significant crisis, however, the drop-off in post-pandemic funding is disappointing. MedTech Europe IVD market report from 2022 showed the UK languishing in 23rd place in IVD spending per capita compared to other developed countries – one-third of Germany’s figure and two thirds of that of France.
Despite ‘prevention’ being the buzzword in British health policy, its potential has clearly still not been fully harnessed. Home testing during the pandemic proved the population was both willing and able to take control of their health, particularly when easily accessible. Yet despite the welcome roll-out community diagnostic centres (CDCs), they remain primarily focused on imaging to the detriment of in vitro diagnostic testing.
Contrast this to the ambitious Our Future Health programme, the UK’s largest ever health research programme, which intends to analyse millions of Britons’ DNA to learn more about disease and provide earlier diagnoses in future. Also, sites are placed in convenient locations across the country and its popularity demonstrates the population’s eagerness to learn more about their health. Whereas the majority of CDCs are located within or beside hospitals.
Policy is moving towards ensuring only those who need to visit hospital should go – both for patient convenience and reducing pressure – hence the expansion of virtual wards. Their locations therefore make very little sense. Particularly when the high street is undergoing a transformation of its own and would be far more sensible and accessible destination for most patients, particularly the most vulnerable.
The well-worn phrase ‘prevention being better than the cure’ could hardly be more apt, given our ageing population poses a myriad of problems for the NHS. One in four children born today will live to their hundredth birthday. As a society we must do our utmost to provide citizens with good health during their lifetime. Therefore, it is paramount to have coherent plans in place.
For example, the NHS spends around 5% of their budget on preventative activity and 10% of their budget on diabetes. These are evidently inextricably linked. If more resources were poured into preventing the three million people living in the UK with diabetes from developing the condition, funds could be saved and less lives affected by ill health.
Problems persist in areas such as workforce too, where a chronic shortage of clinical and anatomical pathologists exists and training fails to match population growth. The Government’s long-awaited NHS Workforce Plan seems to address this, and was welcomed by the Royal College of Pathologists, however, given its long timeframe, we must wait to see if the commitments materialise as stated.
There are significant opportunities in the existing system. The rollout of ICBs and ICSs last year, with their focus on a decentralised, local approach to health services could be of great value. By assessing a local population’s health requirements, diagnostic screening can be tailored to each area’s needs. As the report notes, primary care leaders could offer screening programmes in places which have large South Asian, Black African or Caribbean populations, to target diseases which disproportionately affect those communities. This would help to improve longstanding health inequalities in the UK.
Better use of data-sharing will improve efficiency and faster diagnosis of disease and identification of risk. This is another area that the NHS aims to develop following the 2021 Wade-Gery Review and the integration of NHS Digital into NHS England this year. Progress in this area will reduce duplication and enable a closer link between the collection and analysis of data. It is essential that data obtained by IVDs is maximised by clinicians to prevent disease and set patients on the correct pathway – whether gathered at-home, clinics or elsewhere. The NHS Test and Trace app during the pandemic demonstrated the ability of digital technology, when combined with diagnostic data, to empower and protect patients.
As the UK’s in vitro diagnostics association, we see the multitude of incredible innovations which our member companies offer, which could, if rolled out widely, have a tremendous impact on the prevention and rapid identification of disease. Some already have been, to our delight, such as Genedrive’s innovative genetic test that can help prevent newborn babies from going deaf if treated with a common antibiotic. While others, like UpFront Diagnostics’ LVOne test which rapidly identifies strokes, are being trialled and are ripe for rollout. However, we must be braver and summon the spirit of the pandemic to ensure that the genie is not put back in the bottle if we are to unleash the true potential of IVD testing in the UK.
You can also read BIVDA’s two recently published white papers for further insight. ‘In Vitro Diagnostic Test Procurement during the COVID-19 Pandemic‘ and ‘Leveraging partnerships to realise the UK’s potential in genomics‘ add to and complement many of the issues raised in this article and we highly recommend that you read them.