The future of diagnostics

Enough has been said about how the diagnostics community has been central to the response to the pandemic, but it does not do justice to the facts behind diagnostics and why we must not let this moment slip through our fingers, says Citadel Health advisory board member David Wells in a piece published in Pathology In Practice.

IBMS Chief Executive and Citadel Health UK advisory board member David Wells.

Pre-pandemic, our diagnostic services were second-to-none. We led the world in the march of quality improvement, innovation and diagnostic services – some of which we still lead in. However, we remain in the camp of providing services and solutions to a healthcare world that we are responsive to, not one that leads the patient pathway.

We had excess capacity to ensure we could safely deliver services that primary, secondary and tertiary care asked of us. This was often delivered on the same site, with the same equipment and workforce. It added burden and complexity to the challenge of responding to every ask, great and small. We showed quietly without fuss or complaint that we could do that. But that hid the truth of what lengths we went to, delivering services of exceptional breadth. Although we nominally had excess equipment capacity, we had no excess in the workforce, or the bandwidth to add new services when needed.

The pandemic revealed many things – one was that our laboratory teams when called upon could work miracles. Their expertise meant that we did not need to wait for commercially available kits to create a UK-wide testing capability that would go on to be the envy of the world. Our broadly trained biomedical scientists rose to the challenge and provided a pandemic response alongside routine healthcare provision. However, our quiet success pre-pandemic meant that our voice was not heard. Others sought to drive ill-fitting solutions into the system – not just in healthcare delivery but also from the diagnostic industry.

Rising to the challenge

Professionalism in the face of this challenge saw many scientists and clinicians provide support in areas they had not ventured before. Not just in healthcare but in the mass testing programmes, in government policy and strategy, and in day-to-day decisions of how the country should respond to every twist and turn of the pandemic. Innovation, research and adoption occurred at phenomenal speed thanks to teams of scientists working towards a common goal.

The pandemic also showed that we did not have a fit-for-purpose diagnostic service. It didn’t have the natural resilience, in supply chain or workforce. It didn’t have the right equipment in the right places, or the data links to connect everything. As the pandemic moves into an endemic phase, many of these issues have been tackled for SARS-CoV-2 but little else. There are now new challenges, of having even more capacity available to healthcare. To give an idea of the scale, in 2019, England performed 300,000 molecular microbiology tests in total. At the end of the pandemic, we had that capability to undertake that number of tests per day for COVID-19.

Emerging from the shadows

We now have a once in a generation opportunity to bring diagnostics out of the shadows and begin a new conversation with our patients and users. The willingness of our patients to self-test, monitor and engage with healthcare using diagnostics is the key. The adoption of new equipment and technology outside of our laboratories brings greater awareness. Who could have predicted that the public would be having debates around the sensitivity and specificity of testing approaches, or that they would be keen to access the right test to confirm a diagnosis?

Who would have considered that we would be discussing at the highest political levels the advantages of one technological approach over another to deliver a flattening of the pandemic curve? Recognising the need to ensure that quality and efficacy were central to getting our testing right, albeit by not using the embedded approach, we saw examples where provision fell far short. However, that has also been recognised and work to address this goes on.

I often speak of the importance of earlier diagnostics, better handling of data and a strong connection across healthcare provision. This will bring about an unrivalled improvement in how we use and access healthcare. It will, I am convinced, lead to better outcomes for patients. We sit at a moment where we can drive this change.

Busting the backlog

The country is facing one of the largest backlogs of planned and unplanned healthcare ever. Continuing ‘as is’ will serve no one well and will be one of the greatest travesties. We have shown that the diagnostics community has the capability and wherewithal; we now need to speak up and offer new and innovative solutions to our clinicians and patients. We must not wait to be asked.

Whether this is testing at the point of need, in homes, clinics, diagnostic centres or in hospitals, making sure we see those who need care when they need it. Whether this is advanced clinical practice for our scientists, working alongside our medical consultant colleagues delivering reporting and direct clinical care in safe and effective ways, slicing through the backlog of diagnostic cases. Or if this is working with industry to roll out and adopt the latest tests and make them universally available across the country as soon as their efficacy is demonstrated. Or, connecting all the data to give researchers and clinical teams insight into disease at a level of which we have as yet only dreamed.

This will keep the UK at the forefront of diagnostics, as it is currently with genomics – leading at the cutting edge and attracting and developing world-leading scientists and clinicians. What is needed in return is support, resources, new funding and national leadership to provide the time, space and capacity to make this fundamental change. This support needs to come from government, incentivising industry and healthcare leaders to prioritise, enabling diagnostic experts to deliver on realistic and achievable ambitions.

This is all possible, today, and it is not our responsibility but our obligation to make it a reality.

About David Wells

In June 2021 David Wells was appointed IBMS Chief Executive. Previously he led the NHS England and NHS Improvement Pathology consolidation programme, tasked with delivering efficient, high-quality pathology services across England. As Head of Pathology at NHS England, David was responsible for leading the laboratory response to COVID-19. David has been recognised as one of the most powerful advocates for pathology in the global community by The Pathologist magazine, featuring in their Power List Top 100 every year since 2018. He sits on the Citadel Health UK advisory board.