In line with Sir Mike Richards' review, CDCs deliver diagnostic activity, away from acute facilities where possible to reduce pressure on hospitals, and provide quicker access to tests and greater convenience to patients (Independent review of diagnostic services for NHS England 2020). Where feasible they are intended to provide all necessary diagnostic tests under one roof in a single patient visit. The review did not stipulate the exact configuration of services within a centre, but it did recommend that they offer as broad a range of services as possible.
In response to Sir Mike Richards' recommendation, the government announced £2.3 billion over three years to transform diagnostic services and develop over 100 CDCs. This commitment was reaffirmed in the government’s plan for patients in 2022 (Department of Health and Social Care 2022), which committed to delivering 'up to 160 CDCs, supporting the NHS to carry out up to 17 million tests by March 2025'. The government's modelling suggested that the funding would provide an additional 200 MRI scanners, close to 300 CT scanners and around 160 endoscopy rooms through the CDC programme (Health and Social Care Committee 2022).
The national CDC programme has reached its third year with 141 CDCs now active across the country. By the end of November 2023 over six million tests had been delivered by these centres since the first centre launched in July 2021 (Department of Health and Social Care 2024). NHSE data from December 2023 showed there were on average 19 CDCs per region (ranging from 10 in London to 27 in the South East region) (NHS England 2023).
More recently, NHSE's CDC programme has identified three models (NHS England 2023a):
- The standard model delivers the minimum diagnostic tests, in a permanent manner – on the same site, it may also provider other tests that are a priority locally.
- The large model offers the standard model with additional endoscopy and other services and tests. These larger centres have multiple scanners to improve efficiency.
- The hub and spoke model consists of a central hub (which is a standard or large CDC), which is facilitated by ‘spokes’ in community health care settings, commercial settings or other non-acute health care provider settings. While hub sites must deliver nationally set minimum diagnostic tests, spoke sites are meet specific service needs by reaching certain populations or increasing local capacity for specific tests.
In its 2021 Spending Review the government committed £2.3 billion of capital funding over three years (HM Treasury 2021). This central funding pot was available to bids from providers, groups of providers or systems. Although a substantial sum in total, the funding provided is still modest in the context of the ambitions of the Richards review, to provide the new CDCs and extra equipment. Plans needed to demonstrate how they meet the CDC design criteria, including staffing plans, and how capacity generated through the CDC contributes to system level efficiencies. Some revenue funding was also made available to systems to align with successful capital business cases. Large new build projects were unlikely to be considered, unless they could demonstrate that it was the only viable approach to increasing diagnostic capacity and addressing health inequalities.
Due to this, the limited funding and the tight timeframes associated with the programme, most active CDCs have been established in pre-existing buildings, or as additions to existing structures. As a result, the preference for repurposing existing facilities could potentially make it more difficult to provide CDCs in the areas of greatest need. The national funding pot has therefore largely been spent on assets such as scanners and converting existing facilities into suitable diagnostic centres.