Striving for same-day diagnosis – community diagnostic centres
Optimism is growing about the potential of new diagnostic approaches, as David Duffy found when speaking to delegates and presenters at the Public Policy Projects healthcare and life sciences conference.
Two years have passed since Professor Sir Mike Richards published his review of England’s diagnostic services. In the face of unprecedented NHS diagnostic demand and ever-limiting capacity, the message from Professor Richards’ report was clear – the NHS needs more, and it needs different.
As Professor Richards wrote in Hospital Times back in April: “CDHs [community diagnostic hubs] will be expected to offer a range of diagnostic tests and to provide one-stop services where this is feasible. Integration of CDHs into seamless pathways of care will be vital. Some CDHs may be provided directly by the NHS, others in partnership with independent sector providers. Whatever the delivery mechanism, joint workforce planning and ongoing training will be essential. Overall, CDHs need to play their part in improving health outcomes, delivering more diagnostic capacity, improving efficiency, reducing health inequalities and improving patient experience.”
While the terminology may have changed, (hubs have now become ‘centres’) the case for moving diagnostic capacity away from the acute sector has never been stronger. Across A&E departments, one in 10 patients now need CT scans and only half of NHS stroke patients are being scanned within an hour. The NHS Long Term Plan target of diagnosing 75 per cent of early-stage cancers by 2028 looks an increasingly ambitious ask.
“If done correctly, CDCs will inevitably lead to less cost, a better patient experience and wholeheartedly better patient outcomes” Matt Gibson, Head of Diagnostic Imaging, Siemens Healthineers
A system “ripe for transformation”
The development of community diagnostic centres (CDCs) has taken on profound importance in the face of daunting service demand. The government does appear to be heeding these calls to transform diagnostic service provision. Of the £5.9 billion funding boost it recently announced to address the NHS backlog, £2.3 billion of this has been marked for CDC development.
This cash injection has been followed up by a £10 billion procurement framework to manage providers for services for around 150 new centres, designed to provide imaging, cardiorespiratory, pathology and endoscopy services and a host of others.
These developments were described as “game-changing” by Peter Harrison, Managing Director of Siemens Healthineers GB & Ireland. Peter was speaking at the Annual Conference for Healthcare and Life Sciences, hosted by Public Policy Projects in November. In Peter’s mind, the funding boost may be just what is needed to overcome obstacles presented by dated NHS capital estates and shared workforce shortages and could in fact finally facilitate a move from traditional to transformational diagnostics.
There is no guarantee, however, that CDCs will have this effect. Experts agree that if money is simply pumped into the same old system, then the underlying issues facing UK diagnostics are unlikely to change, a point stressed by Matt Gibson, Siemens Healthineers’ Head of Diagnostic Imaging. He said: “What cannot happen is for money to be spent on capacity without a view as to how that capacity is going to enable better outcomes, and have we thought about the pathway in totality?” The ability to “zoom out” and take in the entire patent pathway is central to CDC development.
Peter’s optimism in CDC development is partly rooted in the feeling that UK diagnostic inefficiency “can’t get any worse”. He told Hospital Times at the conference: “It would be generous to describe the existing diagnostic pathways as sub optimal. There are simply so many inefficiencies and scope for errors in the current system, as patients often have to engage multiple appointments with multiple clinicians usually with multiple delays to get to a point of diagnosis. This is both inefficient from a direct cost perspective but can also allow progressive disease to develop impacting the ultimate treatment success and outcome for the patient. Furthermore, the impact of patient stress and anxiety as they navigate the current pathways should not be underestimated.” A system that Peter insisted is “ripe for transformation”.
“Sometimes you must challenge the status quo to reform, and we have got to encourage this disruption to maintain momentum for CDC development” Peter Harrison, Managing Director, Siemens Healthineers GB & Ireland
Part of the ‘holy grail’ vision for CDC development lies in the possibility of same-day diagnosis, a principle perhaps unthinkable based on traditional diagnostic infrastructure but one that could become a reality through the modern and flexible infrastructure offered by CDCs.
“It’s about enabling faster, streamlined diagnostic decision making. Once the patient is off the scanner, what do we do next? And what works best for the patient?” said Matt, emphasising the profound impact that real-time diagnostic capacity could have on health service provision. “If done correctly, CDCs will inevitably lead to less cost, better patient experience and wholeheartedly better patient outcomes,” he explained.
Peter made the same point. “Why should we not strive for same-day diagnosis? Why should it ever be considered unattainable?” He sees almost as much benefit for staff being able to participate in an end-to-end delivery service as for the patients who will receive same-day diagnosis.
Momentum building for CDCs
Cautious optimism was the recurring theme among specialists at the PPP annual conference. CDCs are in the early stages of development and careful consideration will need to be given to the technology that can thread the process together, the staffing of these facilities and, of course, the built environment of the centres themselves.
However, it is fair to say that the pandemic has underscored the need for flexible diagnostic delivery in the UK. As Nancy West, Head of Enterprise Services and Solutions for Siemens Healthineers put it: “Covid-19 has acted as a huge catalyst for change and widespread adoption of tech-led collaboration tools.
“By accelerating adoption of medical technologies and CDCs, not only will the NHS create financial efficiencies but will also dramatically optimise the speed, quality and provision of care, through more informed decision-making, and to make sure that patient outcomes are actually improved.”
However, as Peter outlined at the conference, key to facilitating this transformation is a disruptive mentality in healthcare delivery, and this should be fed by NHS leadership. “Sometimes you must challenge the status quo to reform, and we have got to encourage this disruption to maintain momentum for CDC development.”