Beyond capacity: Building a sustainable and technology-enabled future for NHS imaging

Just scanning more patients with existing resources in the hopes of driving marginal capacity gains won’t be enough to deliver better patient outcomes in the long run. That’s why Trusts must look to tech-enabled demand management. This approach involves managing the whole patient pathway from end-to-end. From treating capacity and workforce as an interconnected system, to enabling imaging information to move with the patient, tech-enabled management approaches can rewire how imaging services are delivered.

That’s why the future of imaging services requires a proactive, integrated, collaborative, and tech-forward approach. Drawing on our experience working with NHS Trusts and insights from our recent roundtable with clinical and operational imaging leaders, we set out a path towards the future of diagnostics and explore the opportunity presented by greater digital innovation and connectivity.

Managing NHS diagnostic imaging services demand

Managing demand remains one of the most persistent and complex challenges for diagnostic services. Imaging demand has exploded, driving growth in waiting times for scans and slowing down delivery of reporting outcomes. Providers have increasingly relied on outsourcing to supplement scanning and reporting capacity, with independent providers delivering 10 percent of all NHS funded elective activity in 2024, compared with only 0.02 percent 20 years ago.

Traditional processes to drive productivity, such as enhanced booking and scheduling rules, template-demand alignment, scanner utilisation incentives, radiographer-led vetting, and referral management, have had some impact, but not at the scale required.

During our recent roundtable event with imaging and diagnostic service leaders and clinical professionals, we explored demand management, the role of Community Diagnostic Centres (CDCs) and imaging networks, and why digital innovation holds the key for the future of imaging diagnostics.

During the session, a consistent theme emerged: demand management should not be viewed solely as a mechanism to improve utilisation or reduce imaging requests, but instead as part of a wider system approach encompassing the entire patient pathway.

As one participant reflected, “I haven’t known a time when demand management hasn’t been a hot topic… We’ve never managed really practically to curtail demand.”

Managing referral demand must be supported by a sustained drive to ensure patients receive the right test at the right time and in the right location. To do so:

• Vetting should be paired with advice and guidance, allowing referring clinicians to access specialist input before adding patients to a waiting list
• Imaging records must be seamlessly accessible across providers to prevent patients undergoing duplicate examinations which creates avoidable demand across already constrained services
• Workforce planning for radiologists, radiographers, sonographers, imaging assistants, and others needs to match service capacity and demand to ensure smooth clinical practice.

Effective demand management must be proactive, addressing the entire patient pathway through coordinated workforce planning and integrated image sharing. This requires systems to work together rather than in silos, with CDCs and imaging networks at the heart of enabling this shift.

Unlocking the potential of Community Diagnostic Centres

There are now approximately 170 CDCs across England, delivering millions of diagnostic tests annually. CDCs have a range of delivery models, from standard centres, larger-scale facilities, to hub-and-spoke configurations. Recent investment in CDCs has led to a significant shift in how imaging is delivered, moving towards a more localised treatment model for patients.

As one roundtable participant explained: “We’re shifting a lot of routine work into CDCs to accommodate activity on the acute site”, which is already having a positive impact on capacity. CDCs provide the place, imaging networks provide the system architecture, and interoperability provides the connectivity. But imaging leaders stress there’s a lack of joined up ways of working between these causing friction. One expert lamented: “Are we duplicating scans? Have the patients had their scans in the community and we don’t have access to those?”

So, in order to reap the benefits from CDC investment, requirements must be designed together as part of one operating model – with managed access across all systems, mature triage processes, and effective data sharing as a core requirement. A unified operating model would open the door to primary care access, maximise the use of centres with the latest scanning technology, and ensure imaging records can be accessed wherever scans are performed.

Harnessing technology to solve patient pathway challenges

Technology has become a core part of infrastructure planning, delivery, and access to imaging services. Beyond digitising existing processes, there’s a real opportunity to meaningfully re-design imaging pathways for faster access to information, more consistent prioritisation, clearer clinical decision-making, and a core focus on managing demand across the patient pathway.

Imaging is a prime opportunity to utilise operational AI solutions, from AI-enabled urgent case flagging in chest X-rays, to AI-enhanced CT head scans prioritising suspected bleeds for clinical review.

The UK Government announced £21 million for AI imaging and decision-support tools across 64 NHS Trusts in 2023 and in 2026 announced further investment to rollout AI-powered X-ray tools out to every NHS Trust in England by 2029. This could result in over 4 million patients receiving faster diagnoses for conditions such as lung cancer as a result.

The NHS must harness this investment by targeting technology at specific pathway problems. For example, where urgent patients face delays because examinations are reviewed in chronological order, AI-enabled prioritisation could bring suspected critical findings to clinical attention sooner. Imaging leaders must identify where access, decision-making, or flow is breaking down, deploy technology against that constraint, and measure whether it improves outcomes without shifting pressure elsewhere in the pathway.

Designing infrastructure that moves with the patient

Digital infrastructure that allows imaging data to move with the patient has the potential to fundamentally shift how imaging services operate. The new National Imaging Registry will provide a national service for federated discovery and retrieval of diagnostic imaging, enabling clinicians to access imaging and reports across NHS organisations in real-time. Currently in beta phases, once fully rolled it will have the power to deliver the kind of interoperability that is essential for imaging networks to function as truly interconnected systems. This must be a core focus for all imaging services, CDCs, and Imaging Networks.

But UK healthcare providers could go even further. In South Korea, there's plans to introduce QR-based CT and MRI image sharing by 2027, alongside AI-enabled checks of patients’ imaging histories.

Meanwhile, a study across 12 German sites found that AI-supported mammography increased cancer detection by 17.6 percent without increasing recall rates.

These examples demonstrate the potential for imaging technology to shift from standalone tools towards infrastructure that supports earlier detection, reduces duplication, and follows patients across care settings, rather than isolated testing.

Optimising systems and structures for better integrated pathways

Beyond the clinical elements of imaging, there’s significant opportunity to improve how services operate through smarter scheduling, digital referrals, automated vetting support, cloud-based reporting, voice recognition, and structured reporting. These technologies can reduce administrative burden, improve list utilisation, support more consistent decision-making, and free up scarce clinical time to focus on patient care. As with many areas of the NHS, the greatest value will come not from a single technology, but from how multiple systems work together to support the patient pathway.

Realising these benefits requires more than technology deployment alone. Procurement, governance, interoperability, and clinical engagement must be aligned around clear service and pathway objectives.

Imaging leaders should start with the clinical and operational challenges they are trying to solve, then ensure technology, workforce, and processes are designed together to address them. The most effective decisions are made when non-clinical enablers, such as procurement and system design, are shaped by clinical requirements and informed by the staff who use these services every day.

Technology can help imaging services manage demand and become more productive and resilient, but only when it’s implemented as part of wider service transformation rather than as a workaround for workforce, capacity, or pathway challenges.

Looking ahead to the future of diagnostics

The opportunity now is to bring technology, workforce planning, and service design together around the whole patient pathway. A more connected, proactive approach can help NHS imaging services move beyond capacity gains towards a sustainable future for diagnostics.