Exclusive: Plans for 150 new diagnostic hubs to cut rising waits

The document pointed out the hubs “were highlighted in the phase 3 letter [from Sir Simon Stevens] and will be recommended as part of new service models for diagnostics in the forthcoming [Sir Mike] Richards’ Review of Diagnostics Capacity”.

It said “at least 150 CDHs should be established in the first instance (broadly equivalent to the number of acute hospitals)” although it appears many of these may be temporary facilities.

The document continued: “[until] March 2021 [health and care] systems should maximise use of existing NHS estate, including diagnostic facilities on ‘cold’ NHS sites and the independent sector” to get these up and running during winter. It added the “speed of mobilisation should be a key factor in site identification” and in the “immediate term CDHs will be hosted by acute providers”.

The phase 3 letter said systems should mange the “immediate growth in people requiring cancer diagnosis and/or treatment returning to the service by… the development of community diagnostic hubs” among other measures.

The Richards review was commissioned by NHS England in 2019 as it had long been recognised that England has one of the lowest levels in Europe of diagnostic equipment as well as a shortage in facilities and staff. Last month think-tanks warned of significant worsening of cancer outcomes because of the backlog in diagnosis and treatment created by a fall in referrals during the pandemic, with one calling for a government commitment to match OECD levels of CT and MRI machines.

The NHSE blueprint gives a highly prescriptive list of “estate and equipment requirements” for the hubs, including how many rooms and pieces of equipment are necessary for the “minimum” procedures NHS England would like them to provide.

These diagnostic services include: CT, MRI, ultrasound, plain X-ray, echocardiography, ECG and rhythm monitoring, spirometry and some lung function tests, phlebotomy and, in some CDHs, endoscopy facilities. It added the latter could be better provided in standalone facilities and that these could also become endoscopy training academies.

It said the centres should run for 12 to 14 hours a day seven days a week although acknowledges “workforce constraints may make this unachievable in the short-term”.

The NHSE blueprint said even greater capacity than that asked for by Sir Mike was now needed as diagnostic efficiency had declined further due to covid-19 as acute hospitals introduced more stringent infection control processes.  

It said the CDHs should follow new covid rules allowing them to work at 90 per cent capacity to allow for infection control processes. This is compared to acute facilities which the document said are working at just 70 per cent capacity due to the need to deep clean equipment.

To do this it said CDHs “will rely upon rapid testing being available at each site” with patients asked to remain in their cars or in a “holding area” on arrival, instead of waiting rooms.

It also said systems should separate out elective (from GPs and community providers) and acute referrals to “streamline” diagnostics to “help to address the current backlog and aid the longer-term recovery of services”. 

In the medium to longer term, the blueprint said the new sites should not “usually” be located on acute hospital sites and recommended community hospitals, retail parks or high street shopping centres as “suitable locations”.

NHS England said from September 2020 “regions working with integrated care systems/sustainability and transformation partnerships, cancer alliances and existing local diagnostic services should develop long-term plans for the sustainable development of CDHs…[which should include] a phased roll out to achieve three CDHs per 1 million population by 2023-24”. The hubs should also align with new cancer rapid diagnostic centres as well as other existing diagnostic networks.

The blue print said commissioners should “pay for diagnostic testing within existing commissioning arrangements with providers,” but the document does not indicate whether additional capital or revenue funding will be made available to systems to set up these new clinics. HSJ understands that funding will likely be tied to the upcoming spending review, with the NHS to present the report from Sir Mike Richards.

NHS England was approached for comment.