National Demand Optimisation Group (NDOG): demand optimisation in laboratory medicine - phase IV report

2 Executive summary

Demand Optimisation is defined as the process by which diagnostic test use is optimised to maximise clinical utility, which in turn optimises clinical care and drives more efficient use of associated scarce NHS resources.

The Scottish Government has funded the National Demand Optimisation Group (NDOG) since its establishment in 2016, under the auspices of the Healthcare Science National Delivery Plan (NDP). The programme continues to deliver successfully against ambitious objectives in line with the ethos of Realistic Medicine. A prototype of the Atlas of Variation was developed, published and launched in Phase III and successfully demonstrated potential in identifying unwarranted variation that could facilitate interventions to drive more optimal testing across NHS Scotland and was well received in early 2020 at its launch in NHS Lothian.

As with all aspects of healthcare, the impact of the COVID-19 pandemic on the Demand Optimisation programme has been significant and work was temporarily paused in early 2020. The programme of work has been refreshed to reflect and meet the dynamic requirements of the new pandemic healthcare landscape.

This report highlights the many achievements in Phase IV of the programme, including:

• Publication of interactive recovery monitoring dashboards for Pathology and Blood Sciences. The dashboards demonstrate substantial reductions in diagnostic testing across participating NHS Boards throughout the COVID-19 pandemic and allow Boards to identify, prioritise and address gaps in healthcare provision and allow scarce resources to be more efficiently directed to where they are needed the most.
• Formation of new strong links with Scottish Government Policy Teams, Primary Care colleagues and other key stakeholders.
• Development of feedback reports for tests included in the recovery monitoring dashboards.
• Awarded Royal College of Pathologists 2020 Award for 'Innovation in Pathology Practice.'
• Finalists at Advancing Healthcare Awards 2021 in Scottish Government's category for 'Driving Improvement, Delivering Results.'

The NDOG has identified the following areas where the recovery monitoring dashboards may be utilised:

• Phlebotomy capacity: monitoring and directing resource.
• Cancer: identifying gaps in the screening, diagnosis and monitoring of specific malignancies.
• Chronic disease pathways: focusing on specific disease pathways to identify healthcare gaps.
• Targeted prioritisation: identifying healthcare gaps to be assessed and prioritised as Scotland recovers from the COVID-19 pandemic.
• Targeting and reducing unwarranted variation: ensuring appropriate laboratory test use is tracked. This is especially important during post-pandemic recovery.
• Laboratory resource allocation – varying demand and pressure on laboratory services will occur as healthcare recovery brings heavier use of lab tests. This will be mostly felt across pathology where a predictable overshoot above normal pre-pandemic workloads will require urgent additional resource.

It is vital that National Demand Optimisation work continues, for both the emerging pandemic and recovery-monitoring work and to ensure delivery against the initial aims. Appropriate laboratory testing, reduction in unwarranted variation and the associated laboratory intelligence data will continue to be pivotal in informing decisions around priorities and driving COVID-19 recovery and renewal.