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

The National Demand Optimisation Group (NDOG) is a Scottish Government commissioned group. Its main objective is to reduce unwarranted variation in laboratory diagnostic testing, contributing to improved patient outcomes The group has recently completed its fourth phase of work.

1 Foreword

Our health and care system is under significant pressure. We know that demand for health and care services is increasing and the COVID-19 pandemic has accelerated the need to make optimal use of the resources we have to provide better value care, for patients and our system.

There are many factors which affect the sustainability of our NHS. The NHS in the UK has experienced growth in demand for healthcare services of around 4.5% per annum and almost two thirds of it is generated by increases in the volume of activity, or innovation. Less than 10% of the growth is due to the healthcare needs of our ageing population. A significant portion of the increase in volume in clinical practice is clinician determined, and we need to support clinicians to understand and tackle the unwarranted variation within healthcare systems that leads to overuse of tests and interventions.

The Organisation for Economic Co-operation and Development (OECD) estimate that across OECD member countries between 10 – 34% of this increase in clinical activity is likely to be low value treatment and care, or waste. Low value and futile tests and treatments often lead to more patient regret. We know too, that all healthcare has potential to cause harm - exposure to radiation from imaging, risks from procedures, and side effects from medication. Over-investigation and overtreatment can lead to unwarranted variation in health, treatments and outcomes and is likely to be causing harm, while also wasting our precious healthcare resources that could be better used elsewhere.

There is also an underuse of some tests and interventions which are very high value, and that is often linked to inequality of access to services. Disinvestment in low value tests and interventions allows resources to be redeployed to meet this unmet need and improve outcomes more equally for our population.

All of this suggests we are going beyond the 'point of optimality' - the point of delivering the best balance of benefit to harm to a population. As we recover and reform services, we must build towards a more sustainable healthcare system that delivers better value care.

The Scottish National Demand Optimisation Group (NDOG) continues to produce invaluable reports and recommendations that highlight the proactive and collaborative measures to reduce unwarranted variation in the delivery of healthcare in NHS Scotland.

This report highlights the main outcomes of the Phase IV programme of work, including the publication of the interactive recovery monitoring dashboards. Phase IV has built on the existing principles of the first three phases, demonstrating the successful modification of well-established data collection and display methods to focus on more relevant testing trends occurring during the COVID-19 pandemic and into the recovery phase.

As Scotland moves into the next phase of recovery, laboratory testing will continue to play a hugely important role in healthcare delivery and improved outcomes in patient care. Existing unwarranted variation and inappropriate diagnostic test requesting was significantly impacted by the COVID-19 pandemic across all NHS Boards in Scotland and the dashboards demonstrate the value of the data in measuring the impact of the pandemic, and allows for well-informed and targeted decision-making.

We fully support the continued work of the NDOG and look forward to the anticipated outputs of Phase V over 2021-2022.

Catherine Ross
Chief Healthcare Science Officer
Scottish Government

Dr Gregor Smith
Chief Medical Officer
Scottish Government



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