Oldham CDC: making the Community Diagnostic Centres vision a reality
Rebecca Brandwood, Principal Consultant, Health & Education Practice, Odgers Interim and Hannah Wade, Associate Partner in the Healthcare Practice of Odgers Berndtson, were delighted to co-host an event on Community Diagnostic Centres with the esteemed Professor Sir Mike Richards.
Professor Sir Mike Richards, a hospital physician for more than 20 years, led a review of NHS diagnostic services, published in October 2020, recommending a major expansion of diagnostic capacity and a new model of service delivery. He is currently working with NHS England to help implement his report.
Sir Mike began our event by clarifying that diagnostics covers imaging, pathology, endoscopy, physiological sciences, echocardiography, ECG, spirometry and so on. It is an area in which he has a longstanding interest as a clinician and subsequently as the first National Cancer Director at the Department of Health.
Early in 2019, the then Chief Executive of NHS England, Simon Stevens, asked Sir Mike to undertake an independent review of a diagnostic services “because he recognised that the NHS long term plan had a whole lot of commitments that were not going to be delivered unless we had better diagnostic services.” While conducting the review it soon became apparent that demand was increasing rapidly for almost every single diagnostic service. Yet there had not been a matching increase in capacity, in terms of equipment, workforce and the facilities themselves.
The NHS was reaching a tipping point and one of the big recommendations in Sir Mike’s report was the separation of what he calls “acute diagnostics” – those needed for A&E or for inpatients – from “elective diagnostics”, which might be requested by a GP or very often from outpatients clinics. This is where the concept of Community Diagnostic Centres (CDCs) comes in.
A fine example of turning this vision into reality is Oldham CDC, one of the largest out-of-hospital CDCs in the country, which opened to the public in December 2022. Mike introduced panel members Barney Schofield and Beverley Wallace who shared a fascinating case study on this new community-based diagnostic facility. Barney is Director of Planning and Delivery at Northern Care Alliance (NCA) NHS Group, a large Foundation Trust with a £1.6bn operating budget. NCA spans about a third of Greater Manchester, covering the geographies of Salford, Bury, Rochdale and Oldham. Beverley is Director of CDCs at Alliance Medical, which has been involved with CDCs internationally for around 15 years and has 35 facilities in Italy. In the past six months Alliance has opened three CDCs in the UK, including Oldham. All told, Alliance is trusted partner of 100 NHS Trusts and has 1,200 staff serving 800,000 patients across 50 NHS sites and 40 mobile units.
Barney explained that NCA wanted to be in the vanguard of the CDC programme because “we were very clear that we had an out-of-date model of care with far too many patients waiting too long to access diagnostics.” NCA was in the lowest quartile in the country in terms of cancer waiting times and in addition to capacity issues there was also a site congestion problem – parking could be a challenge.
Clearly, the need for change was urgent. Indeed, NCA was already developing its own model for a community based rapid diagnostic centre ahead of Sir Mike’s report and was keen to move swiftly. In less than 12 months, the £10m project went from brownfield site to completion, with Prime Minister Rishi Sunak visiting the CDC in February 2023 and talking to patients in the waiting room. “I think a big a big message in this case study is that rapid mobilisation of CDCs is possible,” said Barney.
To make this happen, NCA knew it needed partners able to provide land, financial and political capital, diagnostic assets such as people and equipment, and innovation and development expertise. Alliance was an obvious choice as it had the capabilities and moreover already held the contract for PET scanning in Greater Manchester – and Oldham CDC had a requirement for a PET scanner. It took a little longer than expected (around nine months) to agree the contract between NCA and Alliance but negotiations went “amicably”.
Some of the diagnostic modalities at the CDC are operated by Alliance (PET-CT, CT, MRI) while NCA staff run others (naso-endoscopy, heart and lung tests, x-ray, echo, bloods). Other facilities include five consulting rooms, patient waiting/sub-waiting rooms, staff kitchen, rest room, changing areas and showers. All are joint NCA/Alliance areas.
“From a patient's perspective, they've got no idea whether it's Alliance Medical or the NHS: they are NHS patients who are there to have an NHS service,” said Beverley. “And that's actually what's happening in terms of branding, in terms of staff integration and for patient flow. It works really well and, from a partnership perspective, lends itself to a positive experience for both staff and patients.”
The CDC is open 12 hours a day, seven days a week for 363 days of the year. It has created 50 new jobs, provides diagnostic services to over 300,000 patients per year and has 60 new free car parking spaces and a cycle store. The next phase, which has a £15m budget, will create a further 50 jobs.
One big advantage of the CDC model, said Barney is the opportunity to “break down the traditional NHS construct of pathways, which is patients get referred and then wait a long time to be diagnosed, often having had to see a consultant who is gatekeeper to those diagnostics. The idea is to really turn that on its head to bring the diagnostics much earlier in the care pathway.”
Barney and Beverley were happy to share 10 lessons from their experience:
- Pace of mobilisation cannot be achieved by NHS working in isolation
- Commercial partnerships are relational and co-dependent
- Critical importance of stakeholder management
- Consulting rooms are essential for one-stop pathways
- Engage your clinicians and find your anchor tenants
- Understand and manage your interfaces (CQC expectations)
- Programme management role is critical
- Keep NHS England informed and assured
- Beware myths/unfounded fears
- Enjoy the ride!