The Department has made no specific assessment of the effectiveness of the national health service in diagnosing tuberculosis. The Care Quality Commission, as part of its Annual Health Check of NHS organisations, monitors the implementation of National Institute for Health and Clinical Excellence (NICE) guidelines and assesses how the NHS implements delivery of services, including TB services. The organisation and running of local services are matters for local NHS management. Primary care trusts are responsible for procuring TB services to fit their local demography and incidence of TB in their area, and ensuring that those standards are monitored, met and reviewed as part of the commissioning process.
The Department published a toolkit in June 2007 for the NHS recommending that the NICE clinical guidelines (published 2006) on the diagnosis and management of tuberculosis should be followed by all NHS service providers.
The diagnosis of TB is made from a combination of context, symptoms, clinical signs and investigation. NICE recommends that clinical investigation for pulmonary TB (the only infectious form) comprise a chest X-ray, followed by multiple sputum samples for TB microscopy and culture. These represent the current ‘gold standard' diagnostic tools, and NICE advises that if the clinical signs and symptoms are consistent with pulmonary TB then treatment should be started without waiting for further tests.
NICE identified areas for future research, one of which concerned Interferon Gamma Release Assay (IGRA) tests, to assess whether interferon-gamma tests are acceptable to patients and more effective than tuberculin skin tests for predicting subsequent development of active TB, or diagnosing or ruling out current active TB. Research proposals have been set in motion for these, but results of these studies are likely to be some years away.