Diagnostics
The location of CDCs CDCs aim to enhance diagnostic capacity in underserved communities, with NHSE prioritising their placement in areas identified through health deprivation maps to target and address disparities in life expectancy. Bids undergo a thorough approval assessing local diagnostic capacity, health inequalities, transport links, and cost-effectiveness. Many initial CDCs were set up on acute hospital sites, but recent data shows a shift, with 5.2% of approved sites on acute hospital estates and 41% on community hospital estates. Evidence suggests that embedding CDCs in the heart of communities, after overcoming public scepticism using NHSE communication toolkits, significantly improves access to and uptake of diagnostic services, especially for those less likely to seek healthcare. However, challenges remain as only about half
of CDCs are situated in the heart of communities due to Trust budget deficits, high upfront costs, and risks associated with private renting hindering ICSs from making the “brave” choice. NHSE stated that, where possible, they have pursued partnerships with private landlords and commercial property developers to secure long-term affordable and sustainable lease agreements for CDCs within shopping centres or other community hubs, such as Barnsley Glassworks and the Metrocentre. Negotiating long-term leases with reasonable rent increases can alleviate cost concerns, making it easier for CDCs to be embedded in the heart of communities. Recommendations included:
l The government should allocate further funding to establish CDCs in the remaining areas with high levels of deprivation, health inequalities, and limited healthcare resources.
Bexhill Community Diagnostic Centre
In November 2022, East Sussex Healthcare NHS Trust transformed a deserted car show room into the Bexhill Community Diagnostic Centre. To raise the profile of the CDC, Trust employees presented to local bus drivers. Seeing the value in the innovation, this group went on to successfully campaign to change buses routes
l NHSE should regularly review changing demographics and healthcare needs to ensure CDCs continue to be established in areas of greatest need.
l NHSE should: l Provide financial incentives to ICSs willing to set up CDCs in community-based locations, so long as these locations meet the deprivation criteria. These incentives can help offset the high initial setup costs and mitigate concerns around risks associated with renting from private landlords for instance.
l Expand support for ICSs pursuing partnerships with private landlords or commercial property developers to secure sustainable lease agreements for CDCs which are embedded in the heart of communities.
The right tests, checks and scans CDCs offer a range of diagnostic services, with minimum provision covering imaging, physiological measurement, and pathology due to their critical role in healthcare and high demand. Additional services, tailored to meet local needs, have and should continue to be integrated to confirm CDCs as true “one-stop- shops” for patients. Unfortunately, a lack of data and research limits the assessment of the programme’s effectiveness in achieving this goal. The report recommended:
l NHSE should include phlebotomy data in the CDC NHSE Monthly Diagnostics Data datasets to allow scrutiny of the delivery of community phlebotomy services.
l NHSE should commission research into the benefits and risks associated with integrating screening services and pre-assessment services for elective care into CDCs.
Physical and digital infrastructure Ensuring CDCs are equipped with up-to-date machines is crucial for accurate and efficient diagnostic procedures. NHSE are committed to providing new equipment for CDCs and are actively monitoring the condition of machines to
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to ensure the CDC was more accessible to patients. The evidence suggests that patient utilisation and equitable access to CDCs hinge on their accessibility, and that CDCs embedded in the well-connected economic heart of communities offer promising opportunities for achieving this.
maintain a high standard of care. Digital tools, such as the iRefer tool and
NHS App, are vital to streamlining diagnostics, improving efficiency and patient engagement. Unfortunately, despite pilot programmes
like Feedback Medical’s digital infrastructure solutions at Queen Victoria Hospital showing significant gains, challenges with basic infrastructure and data sharing (plus inconsistent digital advancements) persist, underscoring the need for additional funding for robust digital infrastructure. The report states that NHSE should
provide more centralised digital leadership by developing a national strategy for the integration of patient data and digital tools within CDCs. This strategy should outline a roadmap for the adoption of digital solutions, including clinical decision support systems, to streamline the diagnostic process. In addition, NHSE should develop and enforce
interoperability standards for digital tools used within CDCs to ensure seamless data exchange and collaboration between primary and secondary care settings. This standardisation will enable clinicians to access patient information across different points of care, improving coordination and decision-making.
Workforce The Richards’ Review advocated for a substantial increase in the diagnostic workforce. However, the inquiry points out that persistent staff shortages, compounded by inadequate workforce planning and funding, continue to impede the effectiveness of CDCs. The report points out that there is “an urgent
need to expand the diagnostic workforce in line with growing patient demand”. Among the recommendations included:
l NHSE should regularly assess the workforce needs for the CDC programme. These assessments should feed into the NHS Long Term Workforce Plan, the modelling for subsequent workforce projections, and any workforce expansion plans.
l There is a need to encourage local recruitment and training. NHSE should
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