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DIAGNOSTICS


Community diagnostic hubs to help solve crisis


Lindsay Dransfield discusses how transformative Community Diagnostic Hubs (CHDs) have the ability revolutionise diagnostic services in the UK while protecting against COVID-19.


It is no secret that we face an elective care crisis in the UK. Not only do we have an ever-growing number of patients being added to the waiting list to receive elective care, but we also have those already on the list experiencing severe delays to their planned care. Of course, COVID-19 has exacerbated the situation – hospital closures over the last year paired with a lack of resources has made a challenging situation even more volatile, and it is becoming increasingly difficult to understand how the healthcare sector will balance the elective care crisis with the ongoing pandemic response. One thing that has been highlighted during the pandemic is that there is an urgent need to radically reform the way the healthcare sector operates if we are to appropriately tackle the elective crisis in the short-term, and bolster our NHS in the long-term. As of 15 April 2021, NHS England show that waiting lists have hit a 14-year record high of 4.7 million people.1


Of those


4.7 million people, 387,885 patients have waited longer than 52 weeks for routine operations and procedures – an increase from 224,205 in December 2020 – and


the highest number since December 2007. The demand for elective care has been steadily growing for a number of years, with the referral-to-treatment (RTT) waiting list growing by more than 7% year on year.2


As


a result of this increase in patients, paired with cuts to public spending in 2010 and staff shortages across England, waiting times have been increasing for a number of years even before the pandemic. It has now been more than four years since the NHS Constitution 18-week RTT3


standard for


planned care was last met, and more than six years since the 62-day cancer treatment standard was met.4


During COVID-19, hospital closures resulted in less patients being added to the waiting list compared with prior years, meaning there is a very strong chance that the current figures are missing patients.6 As we start to slowly re-open acute settings to diagnostic and elective appointments, we are expecting a sharp increase in the number of people added to the waiting list. The REAL Centre predicts that if there are six million ‘missing patients’, and if 75% of these patients are referred


for treatment in 2021, the current waiting list could grow to 9.7 million patients by 2023/24.7


Clearly, this is not sustainable,


and the NHS will be overwhelmed if we maintain our current approach and allow the elective care backlog to increase by this amount.


Another crack in the healthcare system that was exposed by the pandemic is that health inequality is also playing a role in the elective care crisis: perhaps a much more significant role than we initially expected. In 2020, statistics showed that deprived areas of England experienced the most disruption to elective care, with the number of most deprived areas successfully completing elective treatments falling by 31%, compared with 26% in the least deprived areas.8 The factors leading to health inequality are complex, but health inequalities are not inevitable.9


In order to tackle health


inequality, we must develop a holistic approach that takes concerted and systemic action to addressing the myriad of causes of inequality. The extent to which health inequalities and unbalanced access to healthcare in England is contributing even further to the elective care crisis has been showcased through the pandemic and must be tackled if we are to promote the NHS values10


of compassion, commitment


to quality of care, respect and dignity, and critically, the ideal that ‘everyone counts.’ Fortunately, the NHS and indeed central Government is acutely aware of the need to address this situation with urgent action. The release of the Richards’ Report11 in 2020 outlined the pressing need to introduce a new diagnostics model, where more facilities are created in free standing locations away from main hospital facilities. In this NHS commissioned independent report into diagnostic services, Sir Mike Richards argues that we should utilise high street, retail and other similar local sites to deliver mobile healthcare that will provide quicker and easier access to diagnostic


AUGUST 2021 WWW.CLINICALSERVICESJOURNAL.COM l 83





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