Recommendation 5

HM Government Acknowledged

The Department and the NHS have published the Delivery Plan for Tackling the COVID-19 Backlog of Elective Care. This plan sets out a clear vision for how the NHS will recover and expand elective services over the next three years. At the 2021 spending review, we announced £2.3 billion investment to increase the volume of diagnostic activity and to roll out up to 160 community diagnostic centres (CDCs) by March 2025 to help clear the backlog of people waiting for clinical tests, such as MRI, ultrasound and CT scans. CDCs increase diagnostic capacity, supporting faster, earlier diagnosis and reduced waiting times for better patient outcomes. CDCs collectively delivered over 880,000 diagnostic tests in 2021/22, which represents a full year effect of 1.7 million. The funding for diagnostics transformation is projected to deliver 17 million more diagnostic tests over the next three years and will increase our annual capacity by 9 million tests by March 2025 - a 38% increase in the number of scans the NHS can deliver every year. The expansion of CDCs will mean that the NHS is projected to have 37.9% more MRI capacity, 44.7% more CT capacity, 26.8% ultrasound, 23.1% echocardiography and 18.7% endoscopy capacity by March 2025 compared to pre-pandemic levels. This funding is modelled to provide an additional 200 MRIs, just under 300 CTs and around 160 endoscopy rooms which will be added through the CDC programme. Alongside increased endoscopy capacity through CDCs, NHSEI intends to level up endoscopy provision across England through £312m of investment (part of the £2.3bn awarded at the SR). This will ensure each system has 3.5 rooms per 100k population over 50 years of age so that gastro-intestinal symptoms can be investigated within two weeks. Cancer Alliances are a key part of the design and approval of new CDCs, with a letter of support from the local Cancer Alliance required in order to approve a CDC business case. As part of this process, Cancer Alliances are working with teams developing CDCs to identify how cancer pathways can most effectively make use of the capacity provided by CDCs. CDCs offer an opportunity, for example, to ensure that patients who require multiple diagnostics can receive them on the same day. As well as delivering improved performance and speed of diagnosis for the roughly half of people diagnosed with cancer who are initially placed on an urgent cancer pathway, additional capacity can also widen access to diagnostic tests for those who aren’t initially suspected of having cancer, increasing the chance that cancers without ‘red flag’ symptoms are picked up early. For example, CDCs are expected to provide greater direct access to testing for GPs, which will improve their ability to understand and manage risk and clinical urgency for their patients. The NHS and Health Education England are working together on a plan to ensure sufficient workforce capacity for CDCs and expand the workforce within the right roles, in the right locations and at the right time. NHSEI and HEE are seeking to scale up existing cross- professional workforce good practices to free up capacity. This will be achieved through optimisation, skill-mix, retention and wellbeing. There will be a particular focus on roles that are important for cancer diagnoses, such as endoscopists and radiographers. NHS EI are also looking to increase capacity by improving workforce productivity through digital diagnostic investment. This is projected to deliver around a 10% uplift in workforce productivity as well as speeding up testing and sharing results across the NHS via digital patient health records. These reduce duplication to speed up clinical care. Government funding for digital investments will enable, for example, all reporting clinicians in pathology and imaging services to have access to the latest technology for primary diagnosis. This will reduce turnaround times in diagnostic pathways due to instantaneous electronic transmission of images via nationwide networks, enabling rapid access to specialist opinion.