Policy is ambition. Business cases turn it into bricks and mortar

In the NHS like any health system, policy is ambition, but business cases are what turn ambition into bricks and mortar.

When NHS England set out its vision for Community Diagnostic Centres (CDCs) in 2021, the goal was clear: expand access to diagnostics, reduce hospital pressure, reduce waiting times, and speed up early diagnosis. I led the development of a £10m business case for a CDC in the BOB ICB, and that process revealed what it really takes to translate system-level goals into investable projects.

Community diagnostics as an important pillar in the system

Diagnostic demand in England is high and rising. As of May 2025, around 1.7 million patients were waiting for key diagnostic tests, such as MRI, CT scans, and endoscopies (NHSE Diagnostic Waiting Times and Activity Data).

There are now 135 sites operational in permanent CDC buildings and delivered over 9m tests, checks, and scans to date. These early outcomes are encouraging: a recent update shows 44,000 fewer people waited over six weeks for diagnostic tests compared to the previous year (GOV.UK). In addition, 100 CDCs in England are now running 12 hours a day, 7 days a week.

How I turned ambition into a successful business case

Our ICB had the opportunity to bid for national funding to develop a local CDC to optimise the use of existing health infrastructure in the region and to invest in local care. Leading the business case development did not 'only' require complex stakeholder management between 3 hospitals, private sector, patient groups, and NHS England. It also meant aligning strategic insight with delivery clarity:

1. Define the problem precisely. It isn't enough to say "we need more diagnostics." We quantified backlog pressures for various diagnostics, travel times for patients in the catchment areas, and local inequalities.

2. Compare delivery models. We assessed expanding hospitals versus stand-alone facilities. CDCs in community venues offered faster sessions and convenience.

3. Build a financial model rooted in system benefit. Our model included capital expenditures, staffing, and projected patient volume. More importantly, we showed how earlier diagnosis and reduced hospital burden translated into system savings over time.

4. Capture risks transparently. Offering CDC services isn't just about infrastructure, the bricks and mortar. It involves workforce planning, IT integration, and referral pathways. We built risk buffers and mitigation plans into the case.

Amongst the first 40 CDCs, the Oxford CDC was opened and since providing improved access and reduced waiting times for diagnostic tests out of hospital for patients and reduced pressure on hospitals, while continuing to add services.

What I learned

1. Policy creates markets, but only when you show system alignment. CDCs didn’t succeed because they fit strategy. They succeeded because they addressed specific problems with clear delivery models.

2. Scale means local detail. National ambitions require local costings, pathways, and evidence—consistency in vision balanced with clarity in execution.

3. Diagnostics capacity is central to system reform. Innovators developing tools for speed, imaging, or triage can tie their models directly to CDC funding and quality measures.

The takeaway

My experience building this business case reaffirmed that every strategic goal needs an operational anchor. CDCs are more than policy, they are a real, funded system change.

For innovators: align your solution to system pain points, differentiate your site of impact, and empower decision-makers with clear numbers and delivery clarity.

If you'd like to explore how to align your solution with NHS priorities or build a strategy grounded in both ambition and reality, I’d be happy to work through that with you.