Demand optimisation in diagnostics: standardising diagnostic testing in NHS Boards

Section 6: Conclusions

The NDOG through its meetings and work streams have been able to gather much information regarding Demand Optimisation activity, produced several pieces of guidance for consideration and implementation across all NHS Boards and developed proof of concept/pilot information for several key associated strategies. The following conclusions can be made:

a) Demand Optimisation activity already has a high profile within many NHS Boards driven by the current financial climate. This would benefit from a wider whole systems review, sharing of practice and central oversight.

b) Collection of data that captures diagnostic test requesting activity is vital and underpins any Demand Optimisation Programme.

c) Data can be obtained manually relatively easily from individual NHS Boards. The incorporation of such data into a comprehensive, accessible system across NHS Scotland would however need expertise and resource allocation.

d) General Demand Optimisation Guidance produced by the NDOG, if implemented across all NHS Boards, would allow a coordinated, consistent approach to Demand Optimisation.

e) Educational Feedback Programmes similar to the one being piloted across NHS Grampian Primary Care could be replicated across other NHS Boards. This consistent approach could lead to more rational use of laboratory and other diagnostic tests and reduce variation in practice.

f) Information technology is fundamentally important to the delivery of many Demand Optimisation strategies. It is vital that systems supporting such activities are fit for purpose and that there is a degree of consistency across all NHS Boards.

g) A programme of Effective Diagnostic Pathways, linked in with emerging work on Effective Care Pathways, could help promote rational, consistent pathways of care and unblock bottlenecks that limit the introduction of new tests and technologies as a result of silo budget inflexibility.

h) Governance - in order to support and facilitate the roll out of a consistent, "Once for Scotland" approach to Demand Optimisation, it is vital that the appropriate governance and support structures are in place both centrally and locally within each Health Board so as to enable definition of strategy, dissemination and implementation. Initial provider based strategy should make way for the longer term aims of developing a "whole systems approach".