Tests to diagnose an illness help patients receive an accurate diagnosis and the correct treatment.
Tests to diagnose an illness help patients receive an accurate diagnosis and the correct treatment. The consequences of delays in obtaining a test or reporting the results are patients suffering symptoms and being anxious for longer periods. A course of treatment can be less effective and take a more prolonged period to work. Also, in the case of hospital-acquired infections (HAIs), the time taken to complete a diagnostic test can be the difference between controlling an infection and allowing it to spread to other patients.
It is little wonder, then, that Audit Scotland describes diagnostic services as an essential part of the healthcare system in a report published today. A pointer to their vital role can be detected from the annual expenditure on radiology, endoscopy and laboratory services: more than £280m on more than 87 million procedures. The report from the public spending watchdog assesses whether these services provide the best possible value for money. In many ways, the results are positive. NHS boards have improved services and allocated millions of pounds of extra state funding virtually to eradicate the number of patients waiting more than nine weeks for key tests, from more than 10,000 in July 2006 to two in the same month this year.
However, the report finds significant variations in the efficiency of diagnostic services, not just across boards but within them. Managing resources remains an issue in the NHS. According to the report, some 10% of endoscopy sessions to view internal organs were not taken up, mainly because staff were off sick or on leave. Perhaps the biggest cause for concern arising from the report, however, relates to discrepancies in the time taken to secure results for the MRSA superbug. The mid-point for an inpatient test for this HAI, processed between Friday and Monday, can vary from about 18 hours to two and a half days.
Hospitals in north Glasgow use a test that takes up to 24 hours for a negative MRSA result and at least another 24 for a positive one. But in south Glasgow the process can take twice as long for a negative result and an extra 24 hours for a positive one. If there is a postcode lottery at work, it is one that is very difficult to fathom, given that hospitals on both sides of the river are managed by the same NHS Greater Glasgow and Clyde Health Board.
Different approaches to testing explain some of the variation in turnaround times, but they do not justify such outcomes. It is not only separate boards that need to talk to each other to identify and disseminate best practice. It is perplexing, to say the least, that delivering consistency to the highest possible standard doesn't appear to be practised within Scotland's biggest health board. The Golden Jubilee Hospital in Clydebank has no MRSA because patients are accommodated in single rooms and, crucially in this context, each is screened for the superbug as part of pre-admission procedures.
The Scottish Government is investing time and cash in initiatives to improve hospital hygiene and cleanliness to tackle HAIs. One project involves a one-year test scheme for routine MRSA testing of patients on admission to several hospitals. It is a worthwhile project, but can we be confident about the results and how they might affect future approaches to tackling HAIs, given the wide variation in timescales for producing MRSA test results? This is an area where a uniform approach is surely essential, deploying the most effective and efficient test regimes across the board.
