The new Government has set a clear direction of travel on health reform, including a shift from providing care in hospital and acute settings towards making more services available in community settings.
People tell us that they want to get care in places that are convenient to them and would prefer to avoid hospitals when possible. Offering a wider range of services in the community could go a long way towards acting on people’s feedback and making quality healthcare easier to access.
However, any shifts in the care delivery model will require careful planning. The good news is that planners – whether they’re NHS or government – don’t need to start from scratch.
In recent years, the most notable attempt to shift care into the community has come with the introduction of Community Diagnostic Centres (CDCs). The rollout of CDCs holds important lessons not only for the future of diagnostic services but also for any ambitions to deliver care outside of traditional acute and hospital settings.
Learning from the CDC experience
The previous government established the first CDCs in 2021. By the end of the last Parliament, 160 live CDC sites had delivered over seven million tests outside of traditional hospital settings, including shopping centres and car parks.
In January 2024, Healthwatch England invited local Healthwatch teams to visit CDCs to speak to patients and collect insight into people’s experiences of using them. Overall, 18 Healthwatch visited 22 sites and spoke to 282 people.
Our research, A local diagnosis: Learning the lessons of Community Diagnostic Centres, published today, reveals that this service already meets the needs of patients in England and that people value the timely and convenient care it provides.
Feedback was overwhelmingly positive, with 93% of the people we spoke to having good things to say about their CDC experience. People told us about the benefits of having care closer to home, particularly those with frequent tests. They told us how the service felt more personal, how they could more easily fit appointments around other commitments, and how efficient the running of CDCs felt compared to visiting other acute testing sites like hospitals.
However, we also heard about teething issues that must be overcome to make CDCs effective for all users. Three examples are particularly important as they hold wider lessons for government and healthcare leaders planning to roll out community-centred models of care.
Access challenges
First, patients need to be able to access services. Simply moving their location doesn’t mean they will be easier to reach.
Although 70% of the people we spoke to took less than 30 minutes to get to their CDC appointment, people told us about issues finding their way to the site. At one site, for example, every person we spoke to complained about poor signage explaining how to reach the testing centre.
Added to this, once patients arrive on site, there are still access challenges. Seven sites, for instance, had limitations that could cause difficulties for people with dementia.
Five sites had no hearing loops, and five had no visual fire alarms installed. Five sites had issues that could cause problems for people with mobility issues. Two had no marked-out Blue Badge parking spaces.
The Accessible Information Standard (AIS) states that services must proactively identify communication needs. And yet, 75% of the people we spoke to said that no one had asked if they had any communication needs. More than half of the sites didn’t have information in Easy Read format, information about what to do if you need a translation service, or posters encouraging people to tell staff if they had communication needs.
Involving patients in planning and design
Second, patients need to have a role in planning and evaluating services. This will help identify and resolve issues around accessibility and ensure that new services are meeting the wider needs of the local community.
We know that these issues aren’t unique to CDCs. But new services offer the chance to get things right from the start. This means involving local communities in the design process and amplifying the voices of those with different lived experiences to make sure the service works for them.
NHS England and NHS Elect have taken positive steps towards involving service users in the evaluation and improvement of CDCs. Through the Experience-Based Design (EBD) programme, CDC sites will continually collect data about people’s experiences and implement improvements based on their feedback. These findings should be shared publicly so that any new services, including Neighbourhood Health Centres, can learn from this insight and adopt similar approaches.
Alongside the EBD programme, we’re calling on NHSE to adopt a proactive approach to capturing and amplifying feedback, especially from those most likely to experience access issues and/or health inequalities.
Give patients a choice
Most people we spoke to weren’t offered a choice of location (78%) or time (61%) around their diagnostic appointments, even though this may have helped them access more convenient care. We also learned that information for patients about the CDCs, the services they offered and the steps they’d taken to improve accessibility were difficult to find for both patients and healthcare professionals referring them for a test.
Providing up-to-date site information on the NHS’s Service Finder, the NHS App, and the NHS e-Referral Service would go some way to improving the meaningful choice that patients have over their care.
With improvements to accessibility, better and clearer information about what services are available and more public participation in the design and evaluation of CDCs, decision-makers have a useful template to build on as they try to move care closer to patients. The government would do well to learn these lessons from CDCs as it seeks to transform the NHS into a neighbourhood health service.
