The vision is for CDCs to be ‘one-stop shops for checks, scans and tests’, designed to achieve early diagnoses for patients and timely treatment and intervention, and are part of the offer of more place-based, person-centred approaches to care, removing some of the known barriers to access. For example, CDCs could reduce the time and cost associated with travelling to hospitals by being set up in more convenient locations.
CDCs are seen by the government as a flagship initiative for ‘busting’ backlogs in care. To realise this ambition, 92 centres have already opened in a variety of settings from football stadiums to shopping centres – carrying out 2 million tests since being set up in October 2021.
But are CDCs living up to their promise? Maria Caulfield, former Minister of State for Health, acknowledged in parliament that 47 of the centres have been built on existing hospital sites. As the map shows, only an estimated 1 in 5 are based in the community (such as in shopping centres) rather than on a traditional health care site (such as a hospital or a primary care centre). This may undermine the promise to have the CDCs offer ‘more accessible and convenient’ access to diagnostics.
The centres are also conceptualised by the government as a key way of tackling health inequalities by moving diagnostics closer to home. It has widely been shown that people living in more deprived areas have lower life expectancy, poorer quality of life and suffer higher prevalence of long-term conditions. Inequalities can happen across the care pathway, from early identification of symptoms, through diagnosis and onto effective treatment.
Health inequalities can also stem from the fact that people from particular social groups may be less likely to engage with the health care system, instead waiting until symptoms are more severe, delaying diagnosis and treatment. For example, in a study from the Black Equity Organisation, 65 per cent of Black people reported experiencing discrimination by health care professionals. Such lived experiences can contribute to mistrust of the system and lead to worse health outcomes through delayed diagnosis.
CDCs could help address inequalities by opening up easier access to diagnostics to people who wouldn’t traditionally visit health services. They could also realise the value that genuine community-based programmes have in increasing uptake of health initiatives, as seen with the Covid vaccine rollout, and by beginning to improve trust in services by having them in familiar locations and more connected to local communities.
The CDCs programme has much to learn from the Covid-19 vaccine programme rollout on how to improve access and address health inequalities. Providing vaccines in local communities, not only in GP practices or hospitals but also in places that were convenient and familiar, was particularly important to offering equal access and involved taking the service to places that the NHS would not otherwise routinely go, such as temples and churches. The rollout capitalised on community assets and networks and used community champions to spread the word about the vaccine to these groups and provide reassurance about its safety and efficacy. However, there were still inequalities in take up between communities, despite these efforts – so while there was good progress, it was not able to completely bridge inequalities.
The CDCs are adding much needed additional diagnostic capacity, helping to tackle the backlogs in care. But there is a disconnect from what is offered – care that is both closer to home and more convenient – and what is being delivered, which is diagnostics services delivered in mainly traditional NHS settings. There is something innovative in offering services in convenient and familiar places, like with the Covid-19 vaccine being delivered in churches and temples. While it is welcome that some locations have changed when alternative places that better serve their communities have been found, going forward the government must make more of an effort to deliver on the promise of CDCs and assess how they will address health inequalities, and then tailor strategies and investment to ensure the most impact.
Where are these going to be exactly?
The model had very much been to place the diagnostic hubs in the heart of the community away from hospital sites. This would help to split off planned work from the acute work of hospital trusts and encourage those facing health inequalities to use service. The intention has also been to try and develop more pathways and 'one stop shops' for care, to simplify the patient journey.
In South West London and particularly Croydon this is how we started this journey
Many things have worked against this model. Uncertainties in the future of commercial property that offered short leases and high rates, lack of suitable properties with space and utilities were significant factors. These projects have also been driven hard to be up and running in a very short space of time with many iterations of funding models.
Outreach work in the community had shown that most people were less concerned about the site, and more that the standard of care was good with sound public transport links
For those in our team, we have tried to work flexibly around these issues. Compromise was the only clear way forwards though only in terms of site, not clinical care
I believe it is important to increase the numbers of these CDS's and make them available to more patients rather then looking to bring the centres closer to the community. Make it easier and quicker for the GP to refer their patients to a CDS, this can only be done with more capacity.
Visited one recently. Attractive building, car park and garden - nice surrounds. What matters though is the service offered. The training, expertise and oversight of staff (who are not necessarily working for the NHS). Who oversees all this, particularly when this initiative is being rolled out so fast?
I felt everything was rushed and that my questions were not answered. The mobile facilities where the test was done at the back, did not match the grandeur at the front.
I agree. The local hospital is just as likely to be well served by public transport as anywhere else, if not more so. It's only an improvement if the diagnostic centre is really near to the patient's home.
I think that a diagnosis report in the NHS should be regarded as a product rather than a service. There are good reasons for this - one is that product development processes could then come into force. This is my area of research.
" ...only an estimated 1 in 5 are based in the community (such as in shopping centres) rather than on a traditional health care site (such as a hospital or a primary care centre). This may undermine the promise to have the CDCs offer ‘more accessible and convenient’ access to diagnostics."
Really? Are hospitals and primary care centres not also in the community? Are most not already in 'accessible and convenient' locations? Developing CDCs off acute sites is sensible to protect elective pathways, but can we stop pretending hospitals and primary care centres are located in locations that are 'inconveniently located'.