Shirley Mincher’s breast tumor, discovered in 2016 after a routine mammogram, was small, the size of a pea.
“My surgeon told me to set the example for breast screening because I would never have found it that early myself,” she says.
The lump was removed and Shirley received radiotherapy, after which she took the drug letrozole for the next five years to keep it at bay. In 2021, she stopped because she was in remission, but was advised to have a mammogram every three years.
‘Of course I would never miss a screening appointment, but I always dreaded going to the hospital for one because you had to queue for 45 minutes for the car park, appointments were an hour late and the busy environment made me uncomfortable.’
But last week, on her 75th birthday, Shirley’s screening took place at a new, local ‘hub’ – one of more than 174 such centers set up across England for testing and checks.
Shirley Mincher had her mammogram at one of England’s new community diagnostic centers (CDCs). There are 174 centers across England (File Image)
She was seen at Glass Works shopping center in Barnsley, where she lives with her husband, Stephen, 76, a retired firefighter.
The experience could not have been more different from previous appointments. “I was immediately struck by how bright and clean it was, all open, very different to when you go into an NHS hospital,” says Shirley. ‘The chairs in the waiting areas are different colors and the purple chairs for breast scans were easy to find.
‘It was relaxing, there was no emergency care. I was seen on time and was back outside within 15 minutes. Stephen had parked in a multi-storey car park, so different from the ‘one in, one out’ system in the hospital car park.
‘Afterwards we did some shopping and had coffee; it was so much fun,” said Shirley, a retired administrative assistant.
She had her mammogram done at one of the new community diagnostic centers (CDCs) in England. Most of these are in buildings converted for this purpose (including one in a former car showroom), and are designed to be patient-friendly and accessible, placed at the heart of the community, for example in shopping centers or universities, and staffed by NHS, sent from local hospitals.
The CDC programme, launched two and a half years ago at a cost of £2.3 billion, was designed to revolutionize the way the health service carries out tests and scans; removing most non-urgent tests from acute hospitals to reduce waiting lists and provide rapid access to tests.
According to The King’s Fund, 85 percent of waiting patients require diagnostic tests, from MRI and PET scans to biopsies, ultrasounds and blood tests – and demand is increasing by 10 percent every year.
The NHS diagnostic service is creaking, with almost 1.6 million people on waiting lists for MRI or CT scans in England alone.
The NHS diagnostic service is creaking, with almost 1.6 million people on waiting lists for MRI or CT scans in England alone. Stock Image: Doctor and patient making a mammography (File Image)
The CDC plan is the brainchild of Professor Sir Michael Richards, a leading cancer expert in Britain and a former chief inspector of hospitals.
In 2020, he was asked by the then head of NHS England, Lord Simon Stevens, to help reform it. “He recognized that a new approach to diagnostics was needed to deliver on his promises to the NHS,” says Sir Michael.
His review, published three years ago, laid out the vision for CDCs.
The goal was not only to speed diagnosis, but also to attract people who weren’t interested in hospitals or who didn’t make their health a priority – making CDCs easy to reach, attractive, and trusted so people would be more likely to use them to make.
It sounds promising, but as Good Health can exclusively reveal, a parliamentary report on CDCs published tomorrow makes for discouraging reading.
The APPG (All-Party Parliamentary Group) for Diagnostics research found that in September 2023, only 6.5 per cent of all NHS England tests were carried out in CDCs. The goal was for the CDCs to have conducted 17 million tests by March 2025. yet only six million have been done in the last two and a half years.
“That target date is only 14 months away,” says Maggie Throup, the Tory MP for Erewash, Derbyshire, and a former vaccines minister who is now chair of the APPG for Diagnostics.
“There hasn’t been enough singing and dancing about the importance of these new centres,” she argues. ‘Some GPs do not refer patients because they know nothing about it.’
There are other important problems. Although there are now 138 CDCs open and a further 36 will be operational by March next year, only about half are in easily accessible places such as shopping centres, the APPG report shows – with 5.2 per cent in hospital locations (in unlike Sir Michael’s plan) and 41 percent linked to community hospitals.
“The easy option was taken to simply place CDCs on existing sites,” says Maggie Throup.
‘If it is linked to an existing hospital, in addition to what is already there, it is only a way to get more money for new scanners and is not the solution.
‘As minister of vaccines, it really struck us that many people are afraid of hospitals, but go to a shopping center for a medical procedure.
‘If people are referred for a scan, they don’t have to go to a hospital two bus rides away, or somewhere where they can’t park, and risk losing pay if they take half a day off work.
‘We need to make this easier so that we can detect diseases early, so that waiting lists are shorter and people’s outcomes are better.’
The APPG report also points to a shortage of staff to carry out the testing and analysis, which ‘continues to hinder the effectiveness of the centres’.
But it also highlights good news, including smart approaches to promoting CDC services.
For example, Wood Green CDC in north London, which opened in a shopping center in August 2022, placed advertisements on the sides of buses and staff went to GP surgeries to increase referrals.
65,000 tests have already been carried out, including MRI and CT scans.
Meanwhile, an empty car showroom in Bexhill was converted into a CDC by East Sussex Healthcare NHS Trust. It then gave a presentation about it to bus drivers, who convinced the bus company to change its routes so that services stopped outside the centre.
The CDC at The Glass Works in Barnsley, where Shirley was seen, was originally “going to be added to an existing building, such as a GP practice,” says Bob Kirton, director of the CDC.
‘Barnsley Council offered us a discount on the rent to live in the shopping centre. Our shiny new CDC opened last March: we have a beautiful location and everything works on time – very un-NHS – as it’s easy to park or get the bus.
“Almost all patients have told us they show up on time or early for their appointments, and say the longer hours and working weekends are helpful. They say they really love us.”
But beyond the success stories, there are also challenges for CDCs, the report concludes.
A ‘key limiting factor’ is that there are not enough qualified staff, leading to ‘unmanageable workload’. These staff shortages include radiographers, who perform the scans; radiologists, who interpret images; sonographers, who perform ultrasounds; and pathologists, who examine tissue and fluid samples.
The workforce shortage has been exacerbated, the report adds, by “inadequate workforce planning and funding.” It found that trusts rotated staff between the acute site and the CDC, with no additional staff in 88 percent of CDCs; 41 percent of radiology clinical directors who worked with CDCs said the workload was unmanageable.
One told Good Health: ‘We have to report (i.e. interpret) images from a CDC as well as our existing hospitals, but I didn’t get any new staff – meanwhile the medical director is asking me why I have thousands of scans waiting to report. ‘
Maggie Throup says: ‘It’s easy for politicians to say we need more doctors and nurses, but people don’t understand how many staff we need for diagnostics.
‘Furthermore, the NHS Long Term Workforce Plan does not mention a workforce plan for CDCs at all.’
Dr. Katharine Halliday, president of the Royal College of Radiologists, added: ‘Increasing the number of CDCs without a proportionate increase in staff is akin to robbing Peter to pay Paul.’
Yet Sir Michael believes the CDCs will conduct at least 16 million tests next year.
“The waiting list is too long and that is a cause for concern,” he says. ‘But there are often six months between declaring a CDC open and reaching the desired capacity.’
Sir Michael, now chairman of the UK National Screening Committee, is not concerned that so many CDCs are in community hospitals.
He says: ‘Look at Clacton in Essex, a deprived population with little access to cars. Previously, patients had to travel to Colchester, a few hours away by public transport.
“Yes, the CDC is in a community hospital, but it is five minutes from the center of town, open seven days a week and has scanners and other facilities.”
He adds that attracting more patients for testing will lead to health problems being detected earlier. “We can put all the tests we need at a CDC in one bundle and get patients on the right path to a healthier lifestyle and the best treatment.”
He says the labor shortage is being addressed in part through international recruitment and by connecting CDCs with training centers. Technology, like advances in making MRI screening shorter, will also help, he says, but admits that “we’re going to need more money.”
Maggie Throup says it’s important to see how the CDCs are doing because “there’s still time to shape them” and “so we know how taxpayers’ money is being spent.”
To read the APPG report on CDCs, visit rcr.ac.uk