In October 2021 the government announced plans for new community diagnostic centres (CDCs) across England. The ambition was that these centres would provide people with increased and more convenient access to diagnostics tests, and would lead to earlier diagnosis and reduce pressure on hospitals. Two years on, with 127 centres open and 1,563,400 patients waiting for a diagnostic test as of the end of August 2023, how are community diagnostic centres getting on and what challenges are they facing?
In September 2022, the government’s plan for patients promised up to 160 CDCs, which will support the NHS to carry out up to 17 million tests by March 2025. Given 127 centres are open and the government has announced it will deliver the 160 centres in 2024, this promise is on track. But in terms of the number of tests, while there has been increased diagnostic activity, with an 8.9% rise in the number of the 15 key diagnostic tests (a total of 2,218,600) performed during August 2023 compared to August 2022, there is a question about how much of this activity is carried out by CDCs. The vast majority of diagnostic tests are taking place outside of CDCs; CDCs carried out only 6.3% (139,000) of the tests done in August 2023. Since March 2023 (when data was first published), CDCs have carried out 717,270 tests, checks and scans. There is a long way to go to build CDC capacity to meet the ambition of 17 million tests. Given more than 85% of patients seeking NHS care require diagnostics, building this capacity is important to reduce how long people are waiting for treatment.
'Given more than 85% of patients seeking NHS care require diagnostics, building this capacity is important to reduce how long people are waiting for treatment'
This could be down to the workforce situation – concerns have been raised that there may not be enough staff to run both CDCs and existing diagnostic facilities. The Royal College of Radiologists found that 89% of CDCs are staffed with existing trust employees and so rotating staff between the CDC and acute sites may be diluting capacity in both settings. However, positively, CDCs may be contributing to retention of existing staff, with feedback from staff saying they provide ‘a positive environment’ with ‘better working hours’. Any increase in diagnostics facilities and equipment, including Labour’s recent promise to double the number of scanners in the NHS, needs to take account of how many staff are needed to run those services.
While these are all important operational challenges, a more existential one is whether CDCs will be able to deliver the original vision of the Sir Mike Richards’ review. The review called for CDCs to represent ‘a radical change in the provision of diagnostics’, moving them into the community with the scope to improve patient pathways and expand accessibility. However, translating this vision into reality has been warped by the environment CDCs were released into – one dominated by elective recovery and the fact that many people on the waiting list, now at 7.75 million, are waiting for a diagnostic test. This pressure has added significant pace to the programme with a desire to get as many centres open as quickly as possible, and Steve Barclay, Secretary of State for Health and Care, reportedly turning down business cases for centres that would not open this year.
The tension between the vision and the implementation can be seen in conflicting messages about flexibility to meet local needs. While the Richards review was clear that configuring CDCs was a local decision to meet local population need, the implementation of CDCs has seen each required to deliver a core minimum specification of diagnostic tests. This means CDCs have become more of a ‘one-size-fits-all’ model than originally intended as the need to increase the number of tests has taken precedence. The review also championed CDCs as an important opportunity to look again at diagnostic pathways that have remained almost unchanged for decade and are centred around hospitals. However, the pace at which the programme is moving means local areas are prioritising delivery, rather than exploring the potential avenues for innovation and change to pathways.
'The tension between the vision and the implementation can be seen in conflicting messages about flexibility to meet local needs.'
The ambition for CDCs was also to deliver diagnostics differently, to tackle health inequalities and move access to diagnostics into underserved and more-deprived communities. However, setting up CDCs outside existing NHS estate, such as acute or community hospitals, is expensive. Upfront costs are high and there are risks associated with using space let by private landlords, while there is also the cost of relocating and maintaining equipment. Given, the finite pot of funding allocated for the rollout of CDCs and with all integrated care boards reporting deficits, it is hard to see that the risk and long-term financial commitment associated with locations such as shopping centres could be justified going forward. This may result in most CDCs being located on existing NHS estate, potentially preventing them from addressing health inequalities and access issues as originally intended.
With so many people waiting for diagnostic tests it is not surprising that delivering more activity has trumped the parallel ambition to deliver activity differently. But the real value of CDCs is in realising the vision of doing diagnostics differently, and this is where the focus needs to be. Otherwise there is a risk that with staffing and financial pressures, coupled with the small volume of activity being delivered, that CDCs are side-lined or scaled back in favour of traditional diagnostic provision.