Exploring whether NHS England’s investment in 160 community diagnostic centres is delivering on its aims

In 2021 the Government announced a £350m investment in 40 new community diagnostic centres (CDCs) across England, part of a drive to reduce waiting times, cut down on the number of patients having to visit hospital sites in the aftermath of the COVID-19 pandemic, and achieve earlier diagnoses for major health conditions.

Initially proposed in Professor Sir Mike Richards’ report, Diagnostics: Recovery and Renewal, the one-stop shops for checks, scans, and tests aimed to deliver 2.8 million additional appointments in the first year of operation.

The following year the Government announced plans for an expanded network of 160 centres, supported by the largest central cash investment in MRI and CT scanning capacity in the history of the NHS.

And, in October 2023, the Department of Health and Social Care revealed it was on track to deliver the facilities a year ahead of the 2025 deadline.

But, has the programme achieved what it set out to do?

Shortfalls

In January of this year, the All-Party Parliamentary Group (APPG) for Diagnostics published the findings of an inquiry into CDCs, and it raises key questions about their efficacy, particularly around location, staffing, and shortfalls in technology adoption and data sharing.

The report reveals that NHS England and the Government have made strides in delivering the programme, so far approving 174 CDC sites and opening one in each Integrated Care System (ICS).

However, it reveals concerns over ‘unequal’ geographic distribution and funding constraints for future expansion.

“Analysis of CDC activity reveals a slow pace, with only around five million tests conducted since July 2021 against a target of 17 million by 2025,” it states.

“Collaboration with the private sector has expanded services, but persistent high demand and limited capacity pose ongoing challenges, emphasising the need for continuous scrutiny and transparency from NHS England to assess the impact on patient outcomes.”

A major stumbling block has been the location of the centres.

Initially, the aim of the programme was to enhance diagnostic capacity in underserved communities and enable access to services outside of acute hospital sites.

Closer to home

It was intended that the clinics would be sited in a range of easily-accessible community-based settings such as local shopping centres and football stadiums.

But, in reality, a large number have been co-located on existing hospital sites.

The APPG report states: “Questions remain over how many CDCs are truly community based, with 5.2% and 41% of approved CDC sites located on acute hospital and community hospital estates respectively.

“NHS budget deficits, high upfront costs, and risks with privately renting retail spaces limit CDC placement in community hubs and overcoming these obstacles is crucial for ICSs to make the brave choice of placing CDCs where they can significantly impact community healthcare.”

One of the driving forces behind the decision on location appears to be workforce planning.

The report reveals: “Ongoing staff shortages, demonstrated by shortfall figures and reports of unmanageable workloads, compounded by insufficient workforce planning and funding, limit CDC effectiveness.

Recruitment

“Proposed workforce solutions include acute/CDC rotation models, international recruitment, ‘grow your own’ initiatives, and private sector collaboration, each with its own advantages and drawbacks.

“Ultimately, there is an urgent need to expand the diagnostic workforce in line with growing patient demand.”

The Royal College of Radiologists found that 89% of CDCs are staffed by existing trust employees and warned that rotating staff between the CDC and acute hospital sites may be diluting capacity in both settings.

However, the study also found that, positively, CDCs may also be contributing to the retention of existing staff, with feedback revealing CDCs provide ‘a positive environment’ with ‘better working hours’.

Responding to APPG report’s findings, Charlotte Wickens, policy adviser at health think tank, The King’s Fund, said: “The programme  has a wider ambition to deliver diagnostics differently, in a way that tackles health inequalities and moves access to diagnostics into underserved and deprived communities.

“This means the location of the CDCs is also crucial.

“While it might make sense to co-locate CDCs with existing NHS facilities, there are also benefits to having these centres embedded in the community.

“The Government’s announcement that it will speed up opening 160 CDCs by March 2024 is a good thing for capacity in the NHS, but it is important that this increased pace does not eclipse the ambition for the new centres to improve access for underserved communities.”

High cost

She added that setting up CDCs outside of the NHS estate 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,” she told Healthcare Property.

“And, 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.”

Under scrutiny

The type of services being delivered within the hubs is also coming under scrutiny.

“CDCs provide essential diagnostic services, encompassing imaging, physiological measurement, and pathology to meet high healthcare demand,” says the APPG report.

“Additional services, tailored to meet local needs, have, and should, be integrated to establish 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.”

Although the CDCs are equipped with up-to-date diagnostic equipment, the report calls for increased adoption of technology to fully realise the ambitions of the programme.

“Digital tools, such as the iRefer tool and NHS App, are vital to streamlining diagnostics, improving efficiency and patient engagement,” it adds.

Private providers

“Unfortunately, despite pilot projects showing significant benefits, challenges in basic infrastructure, data sharing, and inconsistent digital advancements persist, underscoring the need for additional funding for robust digital infrastructure.”

In response to the criticisms, the Government and NHS England has set out an ambition to increase use of independent-sector capacity.

At least eight of the final wave of CDCs, announced last August, will be independently run, functioning like NHS-operated facilities, but staffed by independent-sector employees, with the private provider also owning the building.

Companies signed up to deliver services include InHealth, which is delivering CDCs in a number of locations, including Greater Manchester, Bristol, Ealing, Bicester, Liverpool, Ipswich, and Milton Keynes; and Alliance Medical, which created the country’s first CDC and now operates a network across the country.