Community Diagnostic Centres: A critical response to regional inequalities

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CDC regional equality

The latest report from Vanguard, Assessing the current state of play of CDC delivery across England, 2021, provides much needed clarity on the current status of CDC rollout and identifies where more support is required to achieve regional equality in healthcare provision.


The backlog in patient care is affecting every region across England, with waiting lists at an all-time high and services struggling to keep up with demand. Community diagnostic centres (CDCs) were earmarked by Sir Mike Richards as a necessity across communities to support quicker and safer access to both elective and diagnostic procedures in 2019.

A few years and a global pandemic later and the need for streamlined diagnostic service provision is now greater than ever.

An additional layer to the elective care crisis is the disproportionate impacts being felt across England; while no region of the country has been left untouched by the crisis, some are clearly being affected more severely than others. The approach to delivering CDCs is also disjointed across regions and their respective integrated care systems (ICS).

To deliver high-quality diagnostic care in the face of the backlog, a joint up and co-ordinated approach is vital. The latest report from VanguardAssessing the current state of play of CDC delivery across England2021, outlines the findings of a Freedom of Information (FOI) research project, undertaken in 2021. The findings of the report not only provide a bigger picture on the current status of CDC rollout but also identifies where more support is needed in order to achieve regional equality in healthcare provision.

Compounding inequalities

Health inequalities have been widening across England in recent years and these societal fault lines were underscored by the impact of Covid-19. There is currently a gap of almost 19 years in healthy life expectancy between the most and least deprived areas of the country. Further still, during the pandemic average life expectancy fell for the first time since 2000.

Higher rates of Covid-19 were concentrated in the most deprived areas of England, intensifying pressure on the hospitals and care services within these regions. This has caused patients living in these areas to suffer the greatest disruptions to elective care services.

According to evidence submitted by the Health Foundation to the House of Commons Health and Social Care Committee, patient treatment completion in the most deprived areas of England has fallen by 31 per cent, while completion fell to 26 per cent in the least deprived areas. Regional inequalities are only set to widen as the effects of the pandemic continue to impact patient waiting times.

 “A joint up and co-ordinated approach across England is vital to minimise the disruption to services and reduce the patient care backlog.”

Targeting inequalities with CDCs

The Vanguard report, Assessing the current state of play of CDC delivery across England, 2021, provides an overview of current CDC delivery across England. The region with ICS, STP and Clinical Commissioning Groups (CCGs) that are farthest along in their delivery strategy is the Southeast. A high proportion of respondents reported to have a strategy in place and expect their CDC to be fully operational in the next three years. The Southeast also had the highest proportion of respondents that identified CDCs as a high spend priority.

Contrastingly, just one-third of respondents in the West Midlands identified CDCs as a high spend priority. Furthermore, the West Midlands region has the highest waiting lists for all procedures in England, accounting for 20.5 per cent of all national waiting lists as of July 2021. It is evident from the current picture of CDC roll out that more regionally tailored support is needed to level out delivery across the country, ensuring that the impact of CDCs is maximised.

Central to the CDC ‘mission’ is to minimise regional inequalities by supporting the delivery of integrated care, helping to join up disconnected patient pathways and bring services closer to the communities that use them. It is hoped this will expand capacity and improve access to care. By increasing the capacity to tackle waiting lists, the successful implementation of CDCs could help to reduce healthcare inequalities and disparities in patient outcomes.

Lindsay Dransfield, Chief Commercial Officer at flexible Healthcare Spaces provider, Vanguard said: “CDCs are an essential component to reducing patient care backlogs, creating more accessible healthcare for individuals in more deprived areas.

“Following the recent government announcement that £2.3 billion is to be spent on increasing diagnostic activity across the UK, it is now more important than ever to reduce regional health inequalities through the introduction of more CDCs.”

Fair access to funding

While the Health and Care Levy, introduced in September 2021, provides significant funding for tackling waiting lists and elective care backlogs, there remains significant challenges in ensuring equitable distribution of funding. For CDCs to be rolled out with more consistency across England, the government must ensure that regions are able to fairly access funding and support. There is currently a lack of clarity across ICS/STP/CCGs around how decisions are made to allocate funding, this lack of guidance is detrimental to regions already being impacted by higher waiting lists and capacity issues.

The Vanguard report recommends that the government and NHS “remove bureaucracy in the national procurement process to ensure CDC delivery is accessible for all bodies involved with the ICS”. Unnecessary bureaucracy in the procurement process has cost and time implications for healthcare providers, in some cases making it impossible for them to undertake the application process.

On top of reducing bureaucracy around funding, the report recommends putting in place regionally ringfenced budgets for CDCs that are calculated based on a number of indicators, such as waiting lists, current budgets, staffing requirements and available land. This will ultimately help to provide a more consistent approach in the roll out of CDCs and subsequently generate fairer patient outcomes.

A co-ordinated approach

Central to the NHS Long Term Plan is the goal of delivering fully integrated community-based healthcare. To achieve this, the Vanguard report demonstrates the need for a clear framework for CDC delivery to provide clarity across ICSs. A joint up and co-ordinated approach across England is vital to minimise the disruption to services and reduce the patient care backlog, but the benefits must be felt equally. With the most deprived areas of England facing some of the harshest consequences of the pandemic, the roll out of CDCs is an important step in ensuring accessible and equal healthcare.

The Vanguard report recommendations include:

  1. Put in place clear, accessible national funding streams in order to secure confidence in CDC delivery and enable the development of long-term, futureproofed plans.
  2. Ringfence central Government funding for CDC delivery per region, assessed on a range of factors (such as number of patients, average time for delivery of care, number of ICSs in region) to ensure the roll out of CDCs is fair and serves to actively reduce regional inequalities.
  3. Develop localised awareness and education programmes for ICSs to ensure all bodies involved with CDC delivery are aware of the opportunities available to them in terms of funding, partnership opportunities and have access to necessary additional support to ensure the success of CDC delivery.
  4. Broaden the national awareness of regional health inequalities and provide additional support and resources, beyond funding alone, to regions suffering from covid-related backlogs to better prepare them for future incidences of heightened pressure and to prioritise patient outcomes.
  5. Remove bureaucracy in the national procurement process to ensure CDC roll out is accessible for all bodies involved in the ICS.
  6. The Government and NHS should actively identify appropriate infrastructure partners who can rapidly design, build and commission appropriate high quality, safe clinical infrastructure and develop a register of verified infrastructure delivery partners to ensure CDC delivery is consistent on a national scale.
  7. Develop a sustainability guide for CDC delivery to help the NHS reach its goal of Net Zero carbon by 2045.
  8. Promote Modern Methods of Construction (MMC) for CDC delivery to transform existing facilities and create purpose-built new estates that have the flexibility to be re-purposed and expanded upon, enabling a rapid response to changing demands and enabling ICSs to build out there CDC in a modular fashion to tackle patient waiting lists.

Clarifying the metrics: A true picture of system wide activity

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metrics

Maria Kane, Chief Executive of North Bristol NHS Trust, addresses the need for defined and aligned metrics to provide one overall picture of system wide activity and reveal where improvements can be made.


Every acute trust is facing three challenges: the elective care debt, urgent care recovery and an exhausted and depleted workforce. With Integrated Care Systems (ICSs) on the horizon, we have an opportunity to step back and look at the bigger picture to see where we can make system improvements to meet these challenges and add value to the patient, public and taxpayer.

However, it is difficult to understand what is going on in any given health and care system. This is because the finance framework and metrics currently available are not defined or aligned enough to help determine the exact value (cost and outcome) of activity the funding is producing.


A clear picture of each health system

Each ICS will be responsible for allocation of funding at system level. The aim is to distribute resources according to population need and to help reduce health inequalities. However, all payment systems are complex and to ensure the right calculations for payment of care and enable health systems to provide the right care in the right places, it is vital to have access to the right sources of data. Where patient-level data is limited, this can impact on how system budgets are allocated.

Currently, trusts are operating with a mixed economy of block and activity contracts. Most of these are now block contracts since Covid-19 began, but there are also have large numbers of individual providers on specialist and general contracts, which makes it difficult to see the big picture. Specialist contracts, for example, can cover wide areas which makes it harder to pin down what is happening in each ICS. Operating with a variety of contracts like this can create significant challenges when trying to set out a whole system budget.


A greater understanding of each system

ICSs provide the health system with an opportunity to clarify and get on top of the metrics and to have a single interpretation within each system. This will allow the scope to broaden and incorporate areas such as mental health.

Giving full responsibility of finances to ICSs and enabling them to operate the whole budget will bring many benefits and allow good population health management. However, there needs to be a shared understanding of how local services are run to ensure all areas of the system are given adequate funding. All members of the ICS need to understand how each part of the system works and it is crucial that financial decisions are based on a sound knowledge of the challenges across the whole system.

Bringing together sources of data from across community, primary and acute care can help to provide one overall picture of how the system is performing. Data can highlight where funding needs to be focused to help create change, improvement and the best patient care, as well as being able to highlight areas where proactive care can start to make a difference, but  the finance framework and metrics need to be tackled first.


Capita Healthcare Decisions have been at the forefront of tackling the challenges within healthcare systems for over 27 years. To find out more visit: https://capitahealthcaredecisions.com/