It is almost nine months since Professor Sir Mike Richards’ report, Diagnostics: Recovery and Renewal, was approved by the NHS England & NHS Improvement Board. This report paved the way to reimagine what diagnostics provision could look like in England – not only to build up much needed capacity but also to take a more innovative and patient centred approach to service design.
The subsequent strategic ambitions for NHS diagnostic services set this out clearly – to deliver services that provide the right tests, at the right time, in the right place for patients, and have sufficient capacity to meet growing demand, as well as helping to reduce health inequalities. Moving away from traditional hospital locations, the idea of new Community Diagnostics Hubs was therefore born with the aim of providing services in the heart of people’s communities – including in high street and retail locations which can provide quicker and easier access to tests and greater convenience to patients.
Looking at the data, taking a different approach to diagnostics provisions couldn’t come soon enough. Demand for almost all aspects of diagnostics has been rising year on year, and for some diagnostic modalities demand was outstripping capacity before the pandemic. Indeed, there has been a significant increase in the number of those waiting over 6 weeks for diagnostic procedures with the national target for <1% of patients waiting 6+ weeks having not been met for almost a decade. The number of patients waiting more than six weeks for a diagnostic test increased markedly between 2017 and 2019, with particular deterioration in waits for gastrointestinal endoscopy procedures and urodynamics. This is despite activity increasing markedly across almost all aspects of diagnostics over the past five years (for example Pet-CT scans have increased by over 18% from 2014/15 to 2018/19).
England also lags far behind the OECD averages for CT, MRI and PET-CT scanners per million population, ranking lowest among 23 countries for CT scanner provision. Though figures for scans per million population do indicate that our low asset base is used better than that in some other countries.
However, the growing backlog of tests and scans as a result of the pandemic and worsening patient access (in March 2021, almost one quarter of patients were waiting over 6 weeks for a test) has once again brought to fore the need for a long term plan for diagnostics provision.
The introduction of these new Community Diagnostic Hubs, which will both put the patient at its centre and respond to local population need, as well as substantially increasing capacity, should therefore be a game changer.
But with NHS systems still battling with the pandemic, dealing with covid recovery and the huge pressure on elective waiting lists, how can independent providers best support local leaders to successfully deliver these hubs and ensure they meet the needs of local communities both now and in the future?
Independent sector diagnostic providers of course are already a core part of the UK health system, bringing both capacity and capability and delivering great care to patients. Alongside widespread local partnerships, the national CT contract which was put in place during the pandemic enabled mobile capacity to be delivered across the country and to where it was needed most and led to the delivery of over 250,000 vital NHS patient scans.
And from this week, diagnostic providers, whether NHS or independent sector, can apply to be part of the new Community Diagnostic Framework which aims to be in place in early autumn. This framework is part of the support that will be available to systems both in year 1 and beyond.
As recommended in the Richards’ review, a key way of delivering Community Diagnostic Hubs can be through innovative public-private partnerships that can mobilise rapidly through pooled resources, as well as extending existing arrangements with the independent sector where this readily supports the overall aims. This is vital as many independent diagnostic providers have been running community hubs for many years now, using the latest technology and new ways of working and who are adept at finding solutions to the gnarly problems that can get in the way of doing things differently.
In short, this is an incredibly exciting time in the diagnostics world and these new hubs have the potential to really transform healthcare provision and bring a focus on prevention that the health system has needed for so long. To be successful, however, there needs to be a real commitment to long term partnership working between the NHS and independent sector, and a willingness to innovate and do things differently. But if done right will bring big rewards for patients everywhere.