Many regional procurement strategies in the UK are still treating radiology and pathology as separate entities when it comes to the imaging platforms that underpin workflows. But with ever-increasing pressures on diagnostic services, is it time to change that mindset?
When pathology services started to consider the genuine opportunities of digitization, the conversation quickly shifted from comparing microscopes and digital images to something more meaningful.
Innovative service leaders were interested in making the most of their workforce and the precious time of pathologists. They recognized opportunities for clinical collaboration, more equitable access to expertise, and new possibilities for working across boundaries.
Early advocates at the coalface were eager to embrace more flexible working patterns, the benefits of modern tools, and the time efficiencies in digital working.
Fast-forward to 2026, and digital pathology has gone from pockets of early adoption to being a widespread and key digital milestone for laboratories and healthcare providers.
Digital progress has been good. But has an opportunity been missed?
Meanwhile, pathologists in the UK are faced with greater pressures than ever. Take your pick of policy documents – from the National Health Service (NHS) 10-Year Plan to the Medium Term Planning Framework, or specific drives around productivity targets, elective recovery, community shift, or greater routine screening, to name just a few. Almost everything requires growth in diagnostic activity – whilst human resources stay the same, or even diminish.
Counterparts in radiology are facing similar pervasive pressures. Imaging volumes across NHS networks are growing annually, against a substantial workforce shortage. Demand is being driven by an aging population, efforts to improve access, and an intent to detect more cancers sooner. And it is accelerating faster than any efficiency program can offset. So, what can be done?
One response is already happening with positive effect. Integrated diagnostics – the bringing together of radiology, pathology, and indeed other ‘ologies’, under a single enterprise imaging platform – can support efficiency, patient outcomes, and reduced cost.
But integration is only occurring in pockets. The majority of regions are still approaching procurement as if pathology and radiology are unrelated, despite a common reliance on high quality digital images to deliver clinical value.
A silo problem that is not inevitable
Funding models for NHS diagnostic services have fuelled a tendency toward isolation. Pathology networks and imaging networks typically receive separate pots of funding, and are often both procured and managed separately.
As digital pathology has positively advanced, the result is that two enterprise imaging solutions can end up serving the same hospitals, the same patients, and even the same oncology pathways – at significantly greater cost and with avoidable friction.
These are not small investments – they are major clinical systems that, when scaled across multiple healthcare providers in a region, are budgeted for in the tens of millions of pounds, or potentially even more.
Picture the scenario: an enterprise imaging solution has been procured by an imaging network spanning multiple trusts and millions of patients, replacing siloed hospital imaging platforms with a single instance that unleashes collaboration across radiology departments.
A pathology network or cancer alliance in the same region later starts a separate procurement for a digital pathology system, most likely very similar to that used by radiology, but in this case to allow pathologists to examine and draw conclusions on pathology images.
This intensive process carries duplicate cost not only in technology, but also in isolated business change, pathway design, procurement process, and much more.
Unless suppliers and healthcare leaders make the case for convergence, those two systems will deploy in glorious isolation – duplicating infrastructure, detaching data, and serving (or frustrating) clinicians through two separate platforms, in clinical professions that are intertwined in serving patients.
This illustration isn't an isolated example. It is often the default scenario.
What integration actually delivers
There is a strong case for integrated diagnostics. In oncology, the speed and quality of diagnosis is time-critical for patient outcomes, potentially a matter of life and death. But consider the process: a radiologist identifies something significant on an x-ray or CT scan; a tissue sample is taken; a pathologist reports; a high-cost multidisciplinary team (MDT) of time-poor clinicians assembles.
When radiology and pathology share a single enterprise platform, that pathway has the potential to accelerate with reduced friction. Images and reports from both disciplines can be accessed in the same environment at the click of a button. Diagnosticians have the opportunity to enrich their own reports based on a more complete picture. And MDT meetings, rather than being hindered by projectors, piles of slides, or even the manual searching of digital records and imaging, can operate through a fluent, integrated workflow.
AI – increasingly central to NHS diagnostics strategy – may conceivably function better in a future integrated environment. A great many tools exist for pathology and radiology use cases that can prioritize urgent cancer cases for earlier reporting. In supporting and augmenting clinical decisions, they can improve quality of diagnosis.
Most are currently highly specific in nature – supporting defined tasks for individual disciplines. But future-proofing the technology environment for future AI that might support more complex tasks and potentially cross-disciplinary activity, requires an integrated foundation to be put into practice.
That same integrated picture builds the foundation that is being called for in national strategy: genomics, personalized medicine, and a shift to prevention.
Productivity and efficiency gains can also be achieved through shared infrastructure, databases, business-as-usual contingencies, consolidated system administration, and potentially program teams capable of sharing expertise and vision across both disciplines.
A pathology platform procured independently could easily cost 40 to 50 percent more to run than the same capability delivered as part of an integrated solution. That is before accounting for the value of a richer, unified dataset that can surface business intelligence across the full diagnostic pathway.
Proven success in some regions
Integrated diagnostics is having an impact in different parts of the world. In the UK in particular, several regions have demonstrated what becomes possible when integrated diagnostics is treated as a strategic priority.
Northern Ireland has had a unified vision for enterprise diagnostic imaging for close to two decades – one it has delivered. It stands today as arguably one of the most advanced examples of integrated diagnostics anywhere in the world. Digital pathology has been fully embedded across the region. Pathologists no longer work from microscopes. Collaboration between disciplines is possible at scale. And disciplines integrated into its enterprise imaging solution span far beyond pathology and radiology.
Greater Manchester took a different route to a similar destination. Following significant governance reform and the arrival of a highly effective central leadership, the region began a sustained program of integration. The result is a combined diagnostic network – no longer separate entities, but a single strategic body with shared leadership and accountability, and a platform built around patient needs across a population of millions.
Other regions are also starting on this journey, and some are further along than many appreciate. This isn’t just about a shared technology platform. It is about strong, central, cross-disciplinary leadership that is not tied to radiology or pathology in isolation, but accountable for the whole diagnostic piece.
The procurement challenge
Barriers are real. Procurement complexity can cause challenges to adopting a fully integrated solution from a single provider – even when the ambition is to deliver substantially better financial and clinical value than two separate procurements.
But to move away from a more fragmented and expensive outcome for patients, clinicians, and the NHS budget, commissioning bodies and procurement teams must embrace greater strategic intent in decisions. The question isn’t what does radiology or pathology need, but what does a network of diagnostic services need to serve patients?
The future
The NHS 10-Year Plan directs the health service to embrace genomics, personalized medicine, and a shift to prevention. An integrated diagnostic platform does more than fit in with that ambition. It is a fundamental requirement. The workflows and relationships between radiology, pathology, genomics, and other diagnostic services that are needed to enable personalized care, don’t work in disparate IT systems. They require a common data environment that supports diagnosticians, clinicians at the point of care, the people designing and deploying services, and patients.
Regions that have deployed that environment are already demonstrating the gains. Conversely, pursuance of siloed procurement risks a need to rebuild again in the future, at substantial cost, disruption, and disenfranchised workforce that doesn’t want to start over with yet another major digital transformation further down the line.
This is one of the most demanding periods faced by staff in the history of the NHS. Integrated diagnostics is not going to fix everything – but in a complex policy landscape that must succeed, it definitely makes sense.
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