New community diagnostic centres may struggle to live up to ministers’ promises to improve access to services and reduce the NHS backlog, warns a new briefing on NHS diagnostics from The King’s Fund.
There are currently more than 1.5 million people waiting for a key test or scan in England to help them get their symptoms checked and receive a potentially life-saving diagnosis. However, historical underinvestment, significant staff shortages across specialist areas such as radiology, and outdated equipment such as scanners, MRI units and x-ray machines has meant that the ‘standard’ six week wait target for a diagnostic test has not been met since February 2017.
In response to the rising demand for diagnostics and the growing backlog – which has been worsened by the pandemic – the government have proposed to deliver 160 community diagnostic centres (CDCs) across the country by 2025. Ministers have said that the aim of the CDCs is to speed up diagnosis times by offering tests ‘closer to home’ and eliminating unnecessary hospital trips.
However, the new briefing warns that although CDCs may increase the physical capacity to deliver services with more facilities, better equipment and potentially closer proximity to patients, there may not be enough skilled staff to run both new centres and pre-existing facilities. Without a diagnostic workforce strategy, staff shortages and skills gaps may undermine the additional community capacity that the centres are aiming to create.
CDCs could also help to address access issues to diagnostics by reducing the time and cost associated with travelling to hospitals. However, of the 92 Centres that have been set-up so far, half (47) of these are on existing hospital sites raising questions how much impact they will have on reaching the people they need to.
Charlotte Wickens, Policy Advisor at The King’s Fund and author of the briefing said: "Easier access to timely and effective diagnostic services is critical to providing high-quality care, reducing waiting times for treatment and improving health outcomes. However, years of underinvestment in equipment coupled with severe staffing shortages across all areas of diagnostics mean people are waiting too long for vital tests, and demand continues to balloon.
"The government has claimed that CDCs will be key to ‘busting the backlog’. However, the location of many centres around existing healthcare facilities should raise questions over whether the government really will achieve its goal of moving diagnostic tests closer to people’s homes. Looking at the current locations, it appears that only 1 in 5 sites are not on a traditional health care site such a hospital or a primary care centre. If we look back to the COVID-19 vaccine roll-out, vaccines were provided, not only in GP practices or hospitals, but in places that were convenient and familiar, and this was particularly important to offering equal access to everyone, wherever they lived.
"While the roll-out of these new diagnostic centres is very welcome, more effort must be made to deliver on the promise of CDCs being located in more convenient community locations. And ultimately without action from the government to tackle the workforce crisis their potential to increase the number of diagnostic tests the NHS delivers, and provide quicker access to all, will be limited."
The report also questions how effective CDCs will be in breaking down barriers to access and tackling health inequalities – something the government has said is a key priority for the centres. It has widely been shown that people living in more deprived areas have lower life expectancy, poorer quality of life and suffer higher prevalence of long-term conditions. CDCs have the potential to address these inequalities by offering easier access to diagnostics generally, and to people who wouldn’t traditionally visit health services. A shift to new and trusted community sites will be crucial to widening access and improving uptake, however as stated in the briefing: ‘while this is cause for optimism, there is also a need for realism.’
Overall, there is huge potential for diagnostics to play an even greater role in driving better health outcomes across England, but going forward the government must be clear on how they will address and assess health inequalities and tailor strategies and investment to ensure the most impact.
The report, Why do diagnostics matter? Maximising the potential of diagnostics services, was independently developed, researched and written by The King’s Fund. Work for this project was sponsored by Roche Diagnostics, a member of The King’s Fund’s corporate partnerships programme.
