National policy has not stipulated the involvement of provider collaboratives in the development of CDCs. Yet, within the context of providers considering demand and capacity and overall performance at system-level (NHS England 2021), many providers have found it helpful to build capacity collaboratively, at scale. 


In many systems, the collaborative approach to expanding diagnostic capacity has been a natural next step on from the mutual aid arrangements strengthened during the pandemic. Providers have also been able to draw on the experience and success of existing cross-organisation imaging and pathology networks. Many provider collaboratives have therefore established diagnostic programmes spanning the organisations included in the partnership. This is the case in Cheshire and Merseyside, where the Cheshire and Merseyside Acute and Specialist Trusts Provider Collaborative (CMAST) hosts the system’s CDC programme as part of a coordinated diagnostics programme spanning 13 providers. This approach reflects the collaboratives view of diagnostics as a key enabler for most clinical pathways, and a commitment to improve diagnostic service quality, reduce variation for patients and to improve sustainability in the long term.

In other cases, the provider collaborative may be approaching CDC development alongside other major system-wide capital projects. This is the case for the Norfolk and Waveney Acute Hospital Collaborative (N&W AHC), which has established a major capital projects programme which is coordinating the creation of three new diagnostic centres, one for each hospital site.

Both collaboratives have expressed strong agreement that delivering their CDC programmes jointly, rather than through individual trusts, has meant they have viewed the additional capacity as 'system capacity' from the outset. This has supported them to consider what is best for patients across their system and beyond and has resulted in people being able to access testing wherever they live, without unwarranted variation in access, outcome, or experience. 


A permissive statutory framework has supported providers in collaboratives to establish the form that best meets the function and local need. A provider collaborative leading on major capital projects, for example, will require different programme support, decision-making authority and leadership compared to one that focused primarily on day-to-day operational pressures such as reducing waiting lists. As national policymakers look to increase the benefits realised through provider collaboration, it is important to consider how different priorities will require different governance arrangements. 

The CMAST diagnostics programme, led by the chief executive of the Clatterbridge Cancer Centre NHS FT, is responsible for the development of the system’s CDCs. The collaborative’s established governance arrangements support building consensus and making decisions on behalf of the system. This robust governance and system leadership underpinned a successful bid for £52m to establish 10 CDCs across the system.

As provider collaboratives continue to refine their own governance arrangements to support the programmes they are delivering, it may become possible for collaboratives to take on a greater role in the execution of functions such as those provided through CDCs. Trusts may increasingly explore arrangements for provider collaboratives to hold and/or pool budgets, supporting programmes, such as those operationalising CDCs, be delivered entirely through the collaborative. 


Given the finite funding made available through the £2.3bn government pot for diagnostics, many providers submitted bids collaboratively, strengthening the case for investment by demonstrating the impact increased activity would have on system-wide performance. In many instances providers have collaborated to develop robust business cases based on system-level demand and capacity modelling, and taking into consideration local inequalities around access, experience, and outcomes. Working together, trusts have been able to identify suitable sites and locations for CDCs across their collective estate – this has been particularly important given the limited funding to create new sites for CDCs. Collaborating to deliver system-wide capacity has also allowed provider collaboratives to benefit from system capital and revenue funding, in addition to funding allocated from the national pot. 

The nationally available funding has not been enough to meet the full scale of ambition to expand diagnostic capacity. As a result, many providers looked to their systems' funding and to their own budgets to deliver the CDCs. This has led providers to consider the efficiencies and economies of working at scale, for example procuring equipment for the CDC through the provider collaborative. The N&W AHC has agreed a single procurement model to leverage the trusts' combined purchasing power to deliver savings that would not be possible if they were purchasing alone.

Despite significant funding having been made available for expanding diagnostics, there is ultimately not enough to fully realise Sir Mike Richards' vision: for example, CDCs being established on non-hospital sites closer to people’s homes (Independent review of diagnostic services for NHS England 2020).  Revenue funding, and additional capital funding to invest in imaging equipment and to support greater digital interoperability is likewise still limited. Building the capacity required to meet the growth in demand requires lasting and transformational change alongside sustained investment. 


The establishment of CDCs has already led to real success in increasing activity. However, alongside funding constraints, workforce shortages are also a key limiting factor that will continue to make it difficult to expand capacity. Sir Mike Richards' review (Independent review of diagnostic services for NHS England 2020) estimated the need for an additional 3,500 radiographers, 2,000 radiologists and 500 advanced practitioners nationally. These shortages are therefore limiting the progress that can be made through the centres and require innovative and collaborative approaches. Trusts working together have been able to consider shared rotas between providers, supporting trainees from neighbouring trusts to undertake placements at the CDCs, as well as making best use of the expertise of senior clinicians to review scans and provide second opinions across trust boundaries.

Despite the CDC providing system-wide capacity, each one is necessarily hosted by an individual trust, which takes responsibility for the staffing arrangements and recruitment processes. In CMAST, while The Clatterbridge Cancer Centre hosts Liverpool's Paddington CDC, the trust has worked closely with partners across CMAST on international recruitment. This has included working with local universities to consider the future pipeline of diagnosticians and support staff on to support effective future workforce modelling for the system. This has similarly been the case for N&W AHC, in which the collaborative has agreed one workforce model for its three diagnostic centres, including a common approach to training and development of existing staff and identifying new roles.