Diagnostic tests or procedures are a critical part of the care of many patients. Shorter waiting times are beneficial as they help people get quicker access to the treatments they need.
The six-week diagnostic wait was initially introduced as a ‘milestone’ in March 2008 to support the achievement of the 18-week referral to treatment (RTT) target, but diagnostic waiting times are now part of the NHS Constitution. This gives patients the legal right to have a diagnostic test within six weeks of the request being sent.
NHS England published new guidance in May 2021 for the prioritisation of waiting lists for diagnostic procedures. It states that waiting lists should be reviewed and prioritised according to clinical need rather than waiting time in areas where more than half of patients have been waiting for more than six weeks.
A review of NHS access standards is currently being undertaken, but the publication of recommendations has been delayed in light of the coronavirus (Covid-19) pandemic. The Interim Report proposed that the maximum six-week wait for diagnostic tests, with the threshold set at 99%, would remain unchanged.
The latest data presented here are for March 2021, and reflect changes in diagnostic activity as a result of the Covid-19 pandemic. These indicators measure the waiting times of patients still waiting for any of 15 key diagnostic tests or procedures at the end of the month.
This data does not include testing for Covid-19. See ‘About this data’ for the full list of tests included.
The proportion of patients waiting six weeks or more for a diagnostic test fell until March 2008, when the diagnostic wait ‘milestone’ was introduced. In June 2010, central performance management of targets was relaxed, and this corresponded to an increase in waits of six weeks or more in the summer of 2011. The NHS Operating Framework 2012/13 introduced a further expectation that less than 1% of patients should wait six weeks or longer for a diagnostic test. The impact of this can be seen clearly, as from February 2012 to November 2013 the proportion stayed at around 1%. However, since then the 1% target has not been met.
In March 2020, the percentage of patients who had been waiting six weeks or more for a diagnostic test began to increase dramatically, reaching 58% in May 2020 – the highest level since records began. This corresponds to a sharp fall in the number of diagnostic tests performed, from 1.9 million in February 2020 to a low of 612,232 in April 2020, as non-urgent elective care was put on hold to free up capacity for the response to the Covid-19 pandemic. Performance has since improved, but remains considerably worse than before the pandemic. As of March 2021, 24% of patients had been waiting six weeks or more for a diagnostic test, equating to 305,061 people.
The introduction of the six-week target also had an impact on the total number of patients on the waiting list for a diagnostic test or procedure. In December 2008, the waiting list fell to a low of just over 400,000 patients. Since then the list has been steadily increasing, reaching a high of over one million people waiting for a diagnostic test in February 2020. This should be seen in the context of an increase in the number of diagnostic tests being undertaken each month: in July 2007, 995,098 diagnostic tests were carried out, and this almost doubled to reach 1.9 million in February 2020.
However, in March 2020 both the waiting list and number of diagnostic tests carried out began to fall considerably as a result of the Covid-19 pandemic. The waiting list fell to a low of 838,569 in March 2020 and the number of tests carried out fell to 612,232 in April 2020. Since then, the waiting list has increased to over 1.2 million in March 2021, 50% higher in March 2020 and 17% higher than in March 2019. The number of tests carried out has increased to over 1.9 million, 27% higher than in March 2020 but 2.7% lower than in March 2019.
In March 2021, the number of diagnostic tests carried out was higher than in March 2020 for almost all of the 15 key tests or procedures included in this indicator, with the exception of flexi sigmoidoscopy (1% lower) and urodynamics – pressures and flows (2% lower). The largest increase was for cystoscopy (43% higher).
NHS England’s guidance published in May 2021 states that waiting lists should be reviewed and prioritised based on clinical need in areas where more than half of patients have been waiting for more than six weeks.
In addition to looking at the proportion of people waiting six weeks or more for a diagnostic test, we can also examine changes in the median waiting time. In February 2008, the median waiting time fell to 1.9 weeks in anticipation of the introduction of the national target. The lowest median wait of 1.5 weeks occurred in January 2009.
Since then, the overall median wait has been slowly increasing over time. This is demonstrated by the rise in the 12-month rolling average, from 1.7 weeks in 2009 to 2.1 weeks in 2019. In general, the median wait peaks in December every year – this is likely due to people not being able to schedule or attend appointments over the Christmas holidays.
In May 2020, the median wait increased dramatically to 8.6 weeks, following the reduction in the number of diagnostic tests being carried out due to the Covid-19 pandemic. Since then, the median wait has decreased but remains higher than before the pandemic. In March 2021, the median wait was 2.8 weeks.
About this data
These indicators measure the waiting times of patients still waiting for any of 15 key diagnostic tests or procedures at the month end. The waiting times are for patients who have been referred for a test, but whose test had not taken place by the end of the reporting period.
Once a decision has been made that a patient needs a diagnostic test or procedure and the request has been sent, they are on the waiting list and the clock starts for their diagnostic test waiting time. The clock stops once they have had their diagnostic test or procedure.
The 15 key diagnostic tests that are included are:
- Magnetic resonance imaging (MRI)
- Computerised tomography (CT)
- Non-obstetric ultrasound
- Barium enema
- Dual-energy x-ray absorptiometry (DEXA) scan
- Audiology assessments
- Neurophysiology – peripheral neurophysiology
- Respiratory physiology – sleep studies
- Urodynamics – pressures and flows
- Flexible sigmoidoscopy
For further guidance on these data, please see the NHS England website.