About this project
The work for this project was sponsored by Roche Diagnostics, a member of The King’s Fund’s corporate partnerships programme. This output was independently developed, researched and written by The King’s Fund. The sponsor has not been involved in its development, research or creation and all views are the author’s own.
Are community diagnostic centres really moving care closer to home?
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. But are they delivering on this vision by removing barriers to access and moving care closer to home? Charlotte Wickens, Danielle Jefferies and Sneha Sircar examine the evidence over on our blog.
Most diagnostic tests are blood tests and testing of the samples, once taking, is likely to benefit from increasing centralisation rather than dissemination into commuting sites, largely driven by testing machine technology relying on high throughput. You are confusing testing, which in my opinion is faster now than at any time in my career, with obtaining a blood test request form which requires increasing waits to see a medical practitioner and the subsequent wait to organise phlebotomy which remains as difficult now as it has always been. A similar situation is likely in imaging with high cost and maintenance machinery probably best left centrally, i.e. within the local hospital. I can see secondary healthcare requires freeing up of expensive space in acute hospital sites but would suggest moving much or all of outpatients and physical therapy departments out of the acute site, as occurs on the continent and North America, freeing up space to house the new imaging machines you mention.
We have a partial solution to the delays and backlogs, as myself and my colleagues have trained an algorithm to report chest films and head CTs within seconds. It has taken many years and eventually an NHS Trust has signed up with us to speed up diagnosis. It's a bit like swimming up a waterfall!!
There are some great examples in there of the value of diagnostics, but I have great concern that the 4-7% increase in diagnostic requests is unquestioned. Certainly, in my field of MSK medicine, diagnostic use is often inappropriate, contrary to NICE guidance and often used in light of poor clinical skills. The workload for the NHS both from performing inappropriate diagnostics and the subsequent workload created is a significant waste. Also, public expectation is being fuelled and the " I need a scan" demands are rising exponentially and the results often fuelling anxiety and unrealistic demands. You can guarantee more diagnostics = more work for the NHS
This document is therefore not balanced, and I have significant concerns as a reaction to waiting lists pre and post Covid is simply going to make things worse. "Unlimited diagnostics for all " seems the philosophy and smacks of a political marketing tool rather than rational health policy and expenditure. Why are we making these mistakes and killing the NHS?