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Community Diagnostic Centre Rollout
Overcoming the challenges of Community Diagnostic Centre rollout – critical views from the NHS and Independent Healthcare sector
We recently hosted a virtual roundtable to discuss potential solutions to the current challenges facing Community Diagnostic Centre rollout (CDC rollout) – primarily how can they be effectively staffed to meet the demand being pushed their way.
Aspects of this of course included public and private collaboration, access, patient flow and training, amongst other things.
The purpose of this was to provide a platform to bring great minds together to discuss a key challenge facing the operational delivery of core healthcare services.
We were lucky enough to welcome people from a range of NHS Trusts and independent healthcare backgrounds to share their experiences of what’s working, what’s not working, and how we might be able to better collaborate to help achieve shared goals.
Thanks to all who came and contributed to what was a fascinating and valuable discussion.
Community diagnostic centre rollout roundtable summary
There are around 120 community diagnostic centres in operation, rolling out or at build stage, against an original target of 160. The national programme has set requirements to qualify for funding, which all community diagnostic centre leads are trying to achieve in order to get their programmes up and running.
One of the key factors that drove the creation of this working group was the realisation that the UK is unable to effectively staff these diagnostic centres to cope with the numbers they are targeted on delivering. In addition to this, the group outlined some key elements they have come up against that are hindering the forward momentum of the community diagnostic centre rollout programme across the country.
Whilst this was not a session set out just to highlight issues, it was important to get a sense of what everyone was dealing with, so that solutions could be tabled that affect the whole system, rather than dealing with things in isolation.
Core to all the solutions and ideas tabled, were the themes of collaboration, honesty and transparency at all levels. The attendees all agreed that they found it valuable to understand what other providers and teams are going through, and more communication of challenges and shared hindsight would benefit them in finding solutions.
We have split the conversation into its main themes and highlighted the key areas of discussion below.
CDC: Public-Private collaboration and competition
Highlighted throughout the discussion, it was clear that there is both a real element of competition between the NHS and independent sector, but also a perception of competition, fuelled by mistrust, that must be overcome.
The independent sector is finding it just as chaotic as the NHS and the will is very much there from the independent health providers to work with NHS. Current tender and bid processes are making this harder than it needs to be, and an increased open dialogue around workforce collaboration and realities will help mitigate some of the issues we are currently seeing.
The independent sector focuses on commercially viable, sustainable models. If Trusts can find ways to work with the private sector on these goals, then partnerships can flourish.
There was one community diagnostic centre discussed that’s being NHS-run with very limited independent sector inclusion (small amount for CT & MRI). So far this has worked for them. This won’t work everywhere, but for those finding it hard to collaborate, it serves as an example of a different approach that may benefit some areas.
Community diagnostic centre rollout: messaging, policy and funding
Multiple people shared the view that there are changes coming from the national programme on a weekly basis and this inconsistency makes clear direction impossible. Additionally, the sense that policy implementation, without true understanding of impact or deliverability, has driven some of this. There is also inconsistency between regional and national teams, which makes decision making and planning incredibly difficult at times.
It was felt by some of the NHS participants that the community diagnostic centre rollout programme seemed very political. They referenced the multiple cases where the Secretary of State had become directly involved. In their view, this has inhibited the ability to provide relevant plans to certain areas of specific need.
Funding messages were also described as inconsistent by some of those present. They described trusts and private providers putting things in place for which the promise of funding is later pulled. This makes ongoing credibility with CFOs and CEOs incredibly hard.
Community diagnostic centre communication and collaboration
Collaboration and transparency are a must. Sharing goals, visions and challenges regularly and honestly with partners to find ongoing solutions is essential. The more walls built between and within providers, the harder it’s going to be to provide a collective and adaptable response to the demand challenges.
There was consensus that providing feedback to government, and the opposition parties, could be constructive. Ensuring both sides know the reality, challenges and learns is important for any future changes in leadership, funding, or political battles, to make sure the same mistakes are not repeated, and solutions can be found early.
Some found they had got traction by bypassing the regional teams and being persistent about building relationships directly with the national team. This could be valuable for others.
Community diagnostic centre models and standardisation
‘Hub & Spoke’ models can be really effective to increase standardisation, flexibility and collaboration across a region. Standardising processes, equipment and governance across all sites within a hub & spoke set up will aid compatibility and staff rotation, sharing of equipment and procurement complexity.
However, they are really hard to build effectively if the hub and spoke are commissioned separately, with different suppliers/ leadership. Commissioning hubs and spokes together will help collaboration.
Governance is something that’s taking a hit across the country. Often it’s far from where it should be, and regularly having to be put it in place retrospectively against competing factors.
Planning ahead for maintenance or replacement of ageing equipment, not when it’s on its last legs, is a really important element of ensuring diagnostic centres can run consistently.
Combining with other Trusts to help with demand and sharing during maintenance is vital.
An interesting point was raised around doing more work to engage with partners and equipment providers to ensure they offer solutions that work with multiple Trusts. Often we find that there are different versions of the same machine, from different suppliers at sites where sharing is common. By standardising the equipment used within high sharing dependent networks, or where staff regularly switch between sites, can massively help with stock availability, training and familiarity, which will help speed up the delivery of services.
Community diagnostic centre workforce strategy
Made clear by a few members of the group was that it’s important to remember that all of the below is about having a workforce plan for diagnostics as a whole, not necessarily just about community diagnostic centre rollout in particular. It was easy to forget that whilst CDCs have taken a lot of the attention here, there is a wider diagnostics view that should be carefully considered.
Recruitment
There were a number of issues raised and potential solutions tabled around this topic. A lot focused on the skills shortage around diagnostics and how we fill that.
The predominant solution coming from government and the national team is that international recruitment is the answer. But not only is this often not flexible or rotatable resource (due to issues with visas, economic situations of individuals and mobility, amongst other things), the sheer numbers required and quoted do not stack up to fill the gaps.
When it comes to recruitment, guaranteeing posts after the end of funding streams is particularly difficult, which makes recruitment even harder.
Some providers are looking to develop university collaborations to encourage people to intern or start careers in Radiology or other required areas.
Agreement generally was that there is an opportunity to use the community diagnostic centres as really attractive places to work and make them long term hubs for attracting staff.
Flexibility
The ability to create a more flexible workforce and collaborative approach amongst and between Trusts and regions, including the benefits gained by rotating staff between sites, was raised as a key issue. NHS contracts currently restrict people to one base; they don’t allow or reward the flexibility we need to create a flexible, rotatable workforce.
It was also raised that it’s important to consider transport capability and accommodation cost
/ availability for staff if we want them to be mobile and rotate between sites. For example, living in London offers great transport networks, but is very expensive, whereas living in Norfolk might be a lot cheaper, but transport links are far scarcer in comparison.
lncentivising staff to rotate by offering opportunity for them to experience other areas and expand their abilities is an important consideration. Furthermore, extending this to include rotation between NHS and private sector, and vice versa, would achieve a number of things such as; help to demystify the preconceptions people have about both sides, increase knowledge transfer to benefit both, give staff the opportunity to experience the differences and communicate back what works/ what doesn’t to their teams, and increase the ability for improved collaboration in all areas.
Training
There is a need for training around capacity & demand modelling. This is a skill in higher and higher demand and is vital for the community diagnostic centre rollouts to be successful and operating effectively.
Mentioned a few times was that the NHSE tool is not very helpful, and in fad one Trust (Leicester) had developed its own which others are beginning to look at using now.
Community diagnostic tender and bid processes
Both NHS and independent representatives agreed that tenders are very high-level and often non-specific, with unrealistic response timeframes. Linked to this is the fad that there’s a
‘one-size-fits-all’ view from government and in reality, not all areas, commissions or tenders need, or should, be asking for this.
It was suggested that there needs to be a process pre-tender with both sides, to go through what a good model should look like before tenders are released. This will make the public and private collaboration easier at bid stage and will also mean better strategy can be put in place for each area.
The current trade-off between strategic planning and directive for action is harmful. Weighing up forgoing capital in order to develop a more robust strategy, against bidding for capital and potentially having to re-adjust a rushed strategy is not a healthy position.
Data
Multiple times, the need for better and more comprehensive work on understanding the facts around regional nuances, workforce strategy, capacity and demand, modelling and effective operations came up.
The feeling is that there is either a lack of willingness, desire or ability to truly understand the data on where the need really is. Trusts need to work together to understand needs at regional level and provide relevant services to communities. Rotation of staff between Trusts and independent providers can better happen then too.
Community Diagnostic Centre Rollout Take-aways and Actions
Each attendee shared key messages that stuck with them from the session that they will take away and action. These are collated below by way of conclusion.
People
- Create a workforce strategy that allows rotation and flexibility
- Spend time thinking about the logistics and human factors regarding how we attract people to more rural areas
- This must all be considered as a workforce strategy for diagnostics, not just community diagnostic centres
- International recruitment is a sticking plaster and not enough of one anyway. Training for the future is vital
- Keep checking and reminding what the needs of staff are
Approach
- Each area is unique. There is no “one-size fits all” approach to community diagnostic centre rollout
- Use data to really understand where the needs are
- Don’t be afraid to push back and explain what’s relevant to your patch
- Meet cultural resistance head-on
- Get agreement at CEO-level so there’s less backing down later on and greater buy-in throughout the process
- Better management of expectations and the need for improved governance at the outset
- Invest in staff opportunities to upskill around capacity and demand modelling
- Collaborate on everything
- Run it as a business
Mindset
- Individual pressures and stresses are immense. Collaboration will help as there is strength in numbers
- This is a shared experience. The stresses we’re all under are not something that has to be suffered alone
- Remember that amongst all the challenges, this is a once in a lifetime investment for diagnostics and will make a big difference
Final thoughts
Thanks again to all who contributed to this discussion. We are aiming to host a follow-up session later in 2023 to see what progress is being made and to give the group, and any others wishing to join, the chance to reconvene and continue sharing lessons, wins and ideas.
If you would like to take part, contact us on the form below and mention the roundtable by name:
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