Matthew Inada-Kim, Hampshire Hospitals Foundation Trust
Marisa Logan-Ward, Stockport NHS Foundation Trust
Hari Jayaram, Moorfields Eye Hospital
Elaine Cloutman-Green, Great Ormond Street Hospital
Marisa Logan-Ward welcomed Government investment in diagnostics, particularly as laboratory information systems have traditionally lacked investment in the North-West. The investment has been particularly effective in digital histopathology. She did caution though that there needs to be a greater focus on workflows and service delivery, alongside investment in hardware and technology, to maximise impact. Remote consultations and point of care testing needs to be better integrated into central systems and questioned whether, if this is not solved, whether the backlog can be tackled meaningfully.
Elaine Cloutman-Green began by acknowledging that anything that highlights diagnostics is an excellent step forward, particularly as much of the laboratory work is unseen and perhaps therefore underappreciated. She is concerned that often the diagnostics workforce have zero input in spending decisions, leading to a tendency to invest in dazzling new technology rather than simple changes which can improve and speed-up diagnostic pathways. She also stated that moving laboratories away from hospitals into hubs makes it difficult for the diagnostic process to support the individual patient need that each hospital has due to centralisation. The patient must always be put first if patient waiting times and quality of care is to be improved.
Matthew Inada-Kim said, rather directly, that patients do not mind about any form of silo care; they simply want to be able to access to tests. The pandemic has accelerated patients’ desire for tests to certify their health and a clinician’s reassurance alone is insufficient. Patients’ also want them soon and through an acceptable reporting mechanism, and if this desire is not met then patients will simply go to hospitals – exacerbating existing problems. Regarding AI, utilising high volume, low risk diagnostic data could be a useful way to test the efficiency and capability of AI on a grand scale. Perhaps most important of all could be AI analysis which focuses on patient demographics to determine what society needs from diagnostics – namely who is most likely to need it, at what age they will likely require it, and where they might live. Lastly, Matthew stressed the importance of assessment in diagnostics, and warned against offering mass, multitudinous testing without clinical input, as this could lead to huge inefficiencies.
Elaine Cloutman=Green followed on from Matthew’s previous point by highlighting the harmful problem of over-testing. This could lead to over management and added unnecessary stresses to the patient, particularly the young, old and vulnerable. Testing should not be done for the sake of it – it must be targeted, well-thought out and part of a pathway with a clear action to be taken at its conclusion.
Marisa Logan-Ward praised the work of NHS staff in reducing the backlog, there is still work to be done. A priority needs to be a focus on what can be done to prevent harm to patients while they are on waiting lists. Liaising with GPs at a planning level is crucial in aiding this initiative and, in her experience, has increased hugely in the last year.
Hari Jayaram agreed with an audience question that much more needs to be done to boost NHS IT and the IT support workforce to ensure diagnostics data transfer is efficient and unhindered by technical difficulties. Evidently, this is a greater challenge for those hospitals which are more data-driven. He highlighted the hot summer of 2022 which caused a server problem at Guy’s and St Thomas’s and left the hospital without access to patient records for almost a week. He stated that clinicians require greater faith in where vital patient data is stored and saved, as if IT issues arise, their work is rendered redundant. Hari welcomed the move to cloud-based data solutions, particularly as a means of mitigating server issues. The only challenge with this is the safety and security of patient data, which must be managed. He stated that electronic medical records (EMRs) are intrinsic to managing patients’ diagnostics and again reinforced the message that diagnostic information must be coupled with clinician expertise if benefits are to be maximised.
Elaine Cloutman-Greene shared Hari Jayaram’s IT frustrations and emphasized the need for resilience in this area. She also highlighted that medical data requires long-term storage, often decades, and therefore systems must be expanded in order to cope with such enormous demand. On a separate note, Elaine was optimistic about the Government’s approach to technology within diagnostics, with clearer routes to adoption than before, and anticipates positive outcomes over the next few years.
Matthew Inada-Kim asserted his keenness to understand the overall demand for tests to perhaps make community diagnostic centres (CDCs) into a more fluid space to better bridge the chronic and preventative care gap. He also suggested that CDCs could adapt based upon seasons – when people are more likely to become ill or not – and could develop a strategy to perform more acute, more chronic and more sub-acute care based on this principle. Moreover, over time, clinical rooms could be added to CDCs to allow for interpretation of diagnostic results onsite, as point of care testing is much needed. Ultimately, the more places patients are asked to visit to receive care, the more likely the model is to be a failure, therefore one-stop shops are vital in tackling this issue. CDCs are still at an embryonic stage in his view, but this provides an opportunity to develop the model into a more successful form in future. ICBs and local organisations now have the chance to be braver in their decision-making and truly innovate in this area. National leaders are seeking exemplars locally to use as models on a national scale, and he implored those organisations to do what is best for their populations locally and report their findings so that healthcare across the country can be improved over time.