On its launch in summer 2021 the UK’s £2.3bn community diagnostic centre (CDC) scheme offered a practical, patient-friendly way of expanding the nation’s diagnostic capacity. It was hoped that this would play a key role in reducing waiting lists for key non-emergency treatments. This was underlined by the setting of a target to conduct 17 million diagnostic tests by 2025.
Last week a report by MPs and peers into the progress and effectiveness of the CDC programme found that only 6.5 per cent of the total diagnostic activity recorded by NHS England in September 2023 was carried out in CDCs. As of the same date, only 5 million tests have been conducted against the 2025 target.
Despite anticipation that CDCs would significantly improve early patient access and streamline diagnostic testing in one-stop community hubs, two and a half years into the programme the pace of activity is too slow and the potential impact on patient wait times has not yet been realised.
Why has progress been so slow?
The research, conducted by the All-Party Parliamentary Group (APPG) for Diagnostics, found that while some progress had been made in the creation of extra capacity, progress has been hampered by a series of long-running problems. These include persistent staff shortages, inadequate workforce planning and challenges with basic infrastructure and data sharing. Many GPs are unable to refer patients into the CDCs easily leading to an immediate reduction in anticipated uptake.
I was privileged to contribute to the APPG’s research by speaking in summer 2023 about Feedback Medical’s experience in providing the digital infrastructure to power diagnostic capabilities at the Queen Victoria Hospital as part of the Sussex Integrated Care System’s CDC programme.
While the inquiry recognised the ‘impressive’ 69 per cent reduction in patient waiting times for the breathlessness pathway made possible thanks to Bleepa and CareLocker, we identified a series of barriers to scaling up the pilot’s work. These were a failure to prioritise digital infrastructure alongside building and staffing within the health service, and a lack of sufficient funding for much needed expansions in digital infrastructure to support the broader CDC programme’s success.
As I outlined to the APPG, digital is the third pillar of the CDC build, alongside bricks and mortar and staffing: without it CDCs operate in a silo that limits their ability to impact waitlists. Results alone do not move care forwards.
Results need to be presented to clinicians and rapidly turned into care decisions and this requires a digital connection that does not exist today outside of the Queen Victoria Hospital pilot. We now need to see investment in digital infrastructure to supercharge the CDC programme and maximise its impact on reducing patient waitlists.
The imperative to act now
It is understandably easy for system leaders to get disheartened by the difficulties facing the health service at a national level. But there is cause for optimism, solutions are available that work, are quick to install and easy to operate. There are compelling reasons for care systems to act now to improve diagnostic capacity and data sharing between sites and, in doing so, create faster and more efficient care pathways. When faced with staffing and funding shortfalls the only way to reliably increase capacity is through the adoption of digital solutions. This must now become the immediate priority area for investment.
The King’s Fund has found that sharing data (including diagnostic images and pathology records) between sites is difficult. This often leads to diagnostic tests being repeated when a patient moves between a CDC and an acute hospital, or simply as a workaround to a lack of effective data sharing. Further, CDC services are likely impeded by the difficulty that GPs face in referring into the service.
The APPG inquiry found that not only did our pilot with the Queen Victoria in Sussex provide a digital front door for referrals and improve data sharing, it reduced waiting times by delivering end-to-end symptom-based pathways, achieving remarkable efficiency gains. The initiative released £1.7 million for every 10,000 patients without the need for extra staff or expanding the existing CDCs on the ground.
Staff shortages mean that appropriate, secure digital tools are now essential to meet the short-term surges in diagnostic demand. When new staff cannot be found or trained in time then the staff that are available today need to be empowered to work more efficiently, something most easily achieved by facilitating digital access to data and colleagues from any location, introducing a new era of flexibility. Bleepa offers a practical solution to connecting multidisciplinary teams across a pathway.
It empowers teams of clinicians to:
- Collaborate on cases flexibly around other clinical commitments
- Review clinical results in a timely manner, on account of being prompted to review results when they become available
- Annotate comments directly onto results, such as radiology images, to speed up communication
- Track actions through a secure audit log
Prioritising digital infrastructure
As the APPG report makes clear, while the CDC programme nationally has shown signs of progress across a small number of its stated aims, it still has a long way to go to show the required level of impact on patient outcomes.
The report offers a number of recommendations designed to improve the CDC programme’s effectiveness and delivery speed. These include a call for NHS England to develop a national strategy for the integration of patient data and digital tools within CDCs. The Group also calls on the national body to prioritise patient data sharing in CDCs and develop interoperability standards for the digital tools used within CDCs.
As we move into general election territory, it is vital that key policy decisions around investment in technology and digital infrastructure are not put off or delayed, pending any possible shift in priorities by the next government. These solutions are needed now by both patients and clinicians.
While any changes required at a national level will take time, within geographic footprints we are providing the interoperability, data sharing capabilities and secure communication needed to maximise the additional diagnostic capacity that CDCs represent.
As we edge towards the end of the 2023/24 financial year, working with us offers a practical and timely way to make use of remaining in-year budgets to improve coordinated care, speed up multi-disciplinary team working and, as the APPG report has identified, reduce waiting times.
We are proud to be able to demonstrate the tangible impact that our digital infrastructure solutions provide to a CDC system, enabling them to more easily reduce waiting lists and improve diagnostic pathways.
As we embark upon two further CDC pilots designed to bolster workforce capacity, now is that time to learn about the benefits of the pathway approach to CDCs using Bleepa.
If you would like to learn more about the impact on waiting lists the Bleepa and CareLocker digital infrastructure is able to demonstrate for your organisation, please get in touch.