Doris-Ann Williams MBE, CEO, BIVDA, calls for increased community testing as a way to clear the NHS backlog and deal with the increasing number of people who are living with undiagnosed diseases in the UK
Catching diseases early is essential for identifying key health issues, increasing the odds of successful treatment and reducing strain on the NHS. That is why BIVDA is calling for an increase in community testing – to beat the backlog, improve the nation’s health and get people back into healthcare settings.
The pandemic has dominated the healthcare agenda over the past 18 months and, concerningly during this time, diagnostic testing saw a downward trend across the board. Significant decreases have been seen in clinical areas such as anaemia (down 29%), HbA1c tests for people with diabetes (down 14%), and PSA prostate cancer (down 17%), among many others. This is a clear concern and, if left unfixed, there could be a new health emergency on the horizon.
Before Covid, the NHS was already facing a growing waiting list, which is now expected to grow to 14 million by Autumn 2022. Obviously, the priority focus has been on reducing the strain faced by the NHS to ensure no patient misses essential treatment, but a casualty of this has been routine diagnostic testing. As a result, there could be thousands of people currently living with undiagnosed, life-threatening diseases.
From the corridors of power in Westminster to local GPs surgeries and charities, there is a lot of talk about this challenge. However, what is the solution? One key tactic that could make a tangible difference is to increase community testing. The rollout of community testing during the COVID-19 pandemic ensured successful scaling of testing for the virus. This meant both symptomatic and asymptomatic members of the public could be tested without having to attend traditional healthcare settings.
As well as flagging who was carrying the virus and triggering contact tracing, this also meant new variants and outbreak areas could be identified, with additional NHS resources being allocated accordingly. That same approach could be applied when testing for serious illnesses such as diabetes and cancers.
What’s in it for the NHS?
Putting testing at the heart of the community benefits both patients and the health service. For the NHS it reduces the strain on hospitals and GPs, allowing them to focus on the ever-increasing backlog of surgeries and delayed procedures – as well as emergency medical care. Even as hospitals and doctors’ offices ease their Covid restrictions, there will still be a desire to keep out unscheduled and non-emergency visits. Putting routine testing within the community reduces these visits to hospitals.
Community testing also reduces ‘future strain’ on the NHS. Catching illnesses early means they’re more treatable, require fewer resources and have higher success rates. Identifying and beginning treatment on diseases in their early stages means the NHS isn’t over-encumbered with patients suffering from late-stage illnesses who require more attention and resources, in turn increasing the strain on the system and ultimately meaning a lower success rate with treatment.
This community focused approach can also help to identify health trends earlier. We’ve all read reports on the towns with the lowest life expectancy, poorest dental hygiene etc. With community testing, local health services can monitor health concerns more easily, responding appropriately with additional resources and ensuring the problem of the postcode lottery for healthcare doesn’t worsen.
Patient care is obviously the main priority. But, when used appropriately, information from diagnostics tests also improves the quality of healthcare delivery whilst at the same time improving efficiency within the NHS. An increase in community-based testing increases the number of diagnostics tests being carried out thanks to increased access. This testing data can help reduce hospital stays, avoid unnecessary or incorrect treatment and improved management of patient health. All of this ultimately leads to reduced costs, so an increase in testing can actually reduce the burden on the NHS in many cases.
What about Joe Bloggs?
For the everyday patient, community testing obviously has the benefit of providing easier access to healthcare. However, cutting down time spent on public transport isn’t the primary goal here, it’s about encouraging the public to go into healthcare settings regularly. Focusing routine appointments in the community builds up a confidence in healthcare and empowers patients to take an interest in their own health.
For most patients, diagnostic tests are there to confirm there is nothing to worry about. For those who have life changing or long-term conditions, they are a vital tool in managing their medical needs. For instance, people with diabetes routinely monitor the level of sugar in their blood to help them balance what they’re eating and whether or not they’ll need to apply medication like insulin. But every six months they should also have a glycated haemoglobin or HbA1c test. This gives their diabetes specialist a longer term picture about how well their blood sugar levels have been maintained since their last test and can be used to help make changes to daily management and prevent the long term consequences of unmanaged diabetes.
For those with long term conditions like diabetes, this access to testing makes those 6-monthly check-ups even more accessible. Moreover, they can also be coupled with standard diabetes screenings for those who show symptoms or are part of at-risk groups, helping to monitor local populations and catch the disease early.
Near patient testing is not something that can be rolled out overnight. As Covid demonstrated, these initiatives require a coordinated and nation-wide effort to be made effective. This kind of rollout needs careful: planning, training, management of reagents, quality control, transmission of results, and most importantly a strong partnership with the corresponding local NHS lab to provide support as required. So don’t expect a mobile diagnostics unit on every high street by next week.
However, Covid did demonstrate that these systems can work and be rolled out. Even a small scheme focusing on one clinical area would help to reduce NHS pressure and build patient confidence, while laying the groundwork for future initiatives.