Community Diagnostic Hubs - a patient centred pathway through the diagnostic journey

Community Diagnostic Hubs are intended to improve diagnostics across England. This study on what patients want from a local Community Diagnostic Hub (CDH) was carried out by Healthwatch Brighton and Hove from start to finish in just two weeks (1st -14th April 2021) in order to meet NHS England and NHS Improvement (NHSEI) deadlines. NHSEI are currently developing a model of how CDH’s should operate at a national level. They spoke to 21 people from communities whose voices are often less heard: people with Black, Asian and minority ethnic backgrounds, people from the gay, lesbian, bisexual and trans community, younger people (under 25), and those with complex clinical conditions.

Top of the list is good communications. This includes good interpersonal skills, clear information as regards the process and about their condition. Good communication needs to be an ongoing proactive process that keeps patients fully informed about what is happening to them, with whom, where, and in what timescale – and that meets their language preferences and needs.

People’s recent experience of diagnosis reveals less than satisfactory experiences, with people’s lives being on hold and “in limbo”. Whilst people did have some specifics related to their communities, their needs mostly related to been listened to, treated with dignity and their whole person being addressed. However, some people with language and cultural needs will need some additional sensitivities when arranging services, such as translators and awareness of religious needs, awareness of gender issues and the availability of sign language services.

The concept of a CDH was welcomed by people who took part in the research as a place where all tests could be carried out concurrently, but questions remain about where they would be, what services they would contain, and whether and how specialist advice could be on hand - and how they fitted in with ‘other’ services. People also mentioned wanting the option to go elsewhere if a CDH was, for instance, not an easy journey. Good public communications which define CDHs will be needed as they cannot be seen as the panacea for all diagnostics.

A number of people spoke about the role of the GP both at the beginning of the diagnostic process and afterwards - to support and explain the implications of a diagnosis and this crucial relationship must be addressed in any CDH model.

Lastly, people had some very good practical ideas as to how diagnostics could be improved from IT solutions to incorporating preventive services into CDH’s. Co-designing with users from their experiences will provide a better inclusive model for everyone.