Radiology’s role in strengthening NHS diagnostics

At UKIO this year, conversations with radiology and wider healthcare colleagues reflected a shared understanding of the pressures facing diagnostic services. Workforce constraints, rising demand and system fragmentation all remain defining challenges.

Alongside the event, Magentus launched its new report, Strengthening the Backbone: Reimagining NHS Diagnostics in England. Developed with an expert steering panel, the paper examines the pressures on NHS diagnostics and how services need to evolve to meet current and future demand.

The findings confirm what many in radiology already experience day to day. There are now 1.92 million people waiting for a diagnostic test in England, an increase of 83 per cent compared to pre-pandemic levels. More than one in five patients are waiting longer than six weeks, significantly above the NHS operational standard. These stark figures are not due to a lack of effort, as activity levels are at record highs, with over 2.6 million diagnostic tests delivered in a single month by hardworking NHS teams. Demand is simply growing faster than the system’s ability to respond, and that gap is widening. 

For radiology, this pressure is particularly visible. Imaging sits at the centre of a wide range of clinical pathways, from cancer and cardiovascular disease to emergency care and elective services. As a result, delays in imaging do not remain isolated. They have a direct impact on treatment decisions, pathway progression and patient outcomes.

A key theme emerging from our analysis is that the challenge is no longer simply about increasing capacity. The NHS has expanded activity, introduced community diagnostic centres and made progress in several areas. But despite this, waiting lists continue to grow. This suggests that how services are organised and coordinated are as important as how much activity is delivered.

Variation across regions underlines this point. In some areas, around 13 per cent of patients wait longer than six weeks for diagnostics, while in other areas, the figure approaches 30 per cent. This reflects inconsistencies in service design, workforce deployment, pathway management and data connectivity.

For radiology leaders, this raises an important question about how imaging services are structured within the wider system. Traditional models, where departments operate largely within organisational boundaries, are increasingly difficult to sustain under current levels of demand. Imaging capacity may exist within a system, but if it is not visible or accessible across organisations, it cannot be used effectively.

The report points to the need for a more connected model of diagnostics. This means designing services around patient pathways rather than departmental or organisational boundaries. It also requires a clearer view of capacity across networks, enabling activity to be directed where it can have the greatest impact.

Imaging networks provide one example of how this approach is already developing. By sharing reporting capacity, standardising workflows and improving access to expertise, networks can help reduce variation and make better use of existing resources. Where these models are working well, they demonstrate that coordination at scale can improve both efficiency and equity of access.

The report also calls out a need for more funding and investment in the diagnostic workforce.

Since 2020, diagnostic demand has grown more than twice as fast as the reporting workforce. Radiology teams are already delivering record levels of activity, yet workforce shortages remain significant, limiting how far existing capacity can be stretched. Investment needs to support workforce growth and system coordination, so that capacity is not only expanded, but made usable within connected diagnostic services.

As Professor Erika Denton, Professor of Radiology at Norfolk and Norwich University Hospital and a member of the report’s expert steering group, notes: “The biggest issue is workforce. It is largely a case of simply not having enough people to report the work, and that has a direct impact on patients, especially those waiting for cancer diagnoses. Alongside that, we have very variable adoption of technology and networking, which means we are not making the most of the tools that could help us address those pressures.”

This is where digital infrastructure becomes particularly relevant. Radiology has a long history of adopting technology, from PACS to RIS and more recently AI-supported tools. The next stage is about ensuring that these systems support connected workflows across organisations, rather than optimising individual departments in isolation.

The report highlights the importance of interoperability and data sharing as a foundation for this. Diagnostic data often remains siloed, requiring manual effort or local knowledge to access it. For imaging, this can lead to duplicate tests, delays in reporting and incomplete clinical information at the point of decision-making.

Connecting imaging data across systems allows clinicians to see the full diagnostic picture, regardless of where tests were carried out. This supports faster, more informed decisions and reduces unnecessary repetition. It also creates the conditions required for more advanced use of data, including analytics and AI, which can support radiologists in managing increasing workloads and complexity of need.

There are already examples of this approach in practice. The report highlights the use of AI within imaging networks to support earlier detection of lung cancer, integrated directly into established reporting workflows. The impact comes not from the technology alone, but from how it is embedded within a connected system that supports clinical decision-making.

Another area of opportunity lies in how diagnostics are positioned within care pathways. Many patients still follow a sequence of referral, outpatient appointment and then diagnostic testing. This can introduce delays that are not clinically necessary.

Moving diagnostics earlier in the pathway allows clinicians to make decisions at the first specialist appointment, rather than requesting tests and waiting for results. For radiology, this has implications for referral protocols, capacity planning and coordination with primary and community care.

This also reinforces the need for clearer, more consistent referral processes. The report identifies variation in referral quality as a driver of inefficiency, with incomplete or misaligned requests adding pressure to the system. Improving this aspect of the pathway can help ensure that imaging capacity is used effectively and that patients receive the right tests at the right time.

The future of radiology within the NHS is closely linked to how well it connects with the wider diagnostic system, including how services are organised, how data flows, and how capacity is managed across networks. The more fundamental shift is towards a coordinated diagnostic model with radiology at its core.

Radiology has always played a central role in patient care. As demand continues to grow, its influence on system performance will become even more pronounced. Ensuring that imaging services are supported by the right workforce, connected infrastructure and coordinated pathways will be critical to meeting the needs of patients in the years ahead.

We hope this report contributes to that ongoing conversation and supports the continued evolution of radiology within a more connected, and resilient NHS diagnostic system.

Download the full report here.

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