Past projects informing the future of CDCs

Community Diagnostic Centres (CDCs) were rolled out as an urgent response to a completely unforeseen challenge. In the wake of the pandemic, diagnostic backlogs were growing, hospital estates were under pressure, and the NHS required rapid, decentralised capacity to restore services and improve early detection rates.

Several years on now, and with 14.7 million diagnostic tests delivered nationally through CDCs, the conversation is still evolving. The priority question is no longer how quickly diagnostic infrastructure can be delivered, but how intelligently can it be done and what wider benefits can this work provide.

At Morgan Sindall Construction, we have delivered seven CDCs in the past two years, working alongside trusts including Norfolk and Norwich University Hospitals NHS Foundation Trust, West Suffolk NHS Foundation Trust, University Hospitals Sussex NHS Foundation Trust, Northern Lincolnshire and Goole NHS Foundation Trust, Mid and South Essex Hospitals NHS Trust, and Princess Alexandra Hospital NHS Trust.

During this time, we have seen the full spectrum across the business, from hybrid-constructed new builds at Newmarket Community Hospital, to complex refurbishments within live hospital environments such as Thurrock CDC, and town-centre retail conversions at the heart of Grimsby’s shopping centre, each has shaped how we now approach risk, the planned order and timings of construction, and stakeholder engagement.

While every single scheme has been different, clear patterns have emerged. Those lessons, whether technical, operational, or strategic, are shaping how we approach the next generation of CDCs.

From speed to strategy

The first wave of CDC delivery was undertaken at pace, which is no surprise given that funding deadlines were tight and, in the post-pandemic fallout, Trusts were under the weight of operational pressure. The importance of increasing the nation’s diagnostic capacity is underlined by the fact that over 85 per cent of NHS patients require some form of diagnostic test as part of their care pathway, and without timely imaging and testing, planned treatment and procedures get stalled, cancer targets slip, and clinical risk escalates.

The rapid delivery of healthcare environments shines a spotlight on the need for all the teams involved in the project to take extra care that any potential friction in the process has been identified and straightened out. This means putting each stage of the project under the microscope, such as ensuring that design interfaces are clear, stakeholder engagement is robustly planned, and that assumptions about existing property are accurate.

At Northgate CDC, for example, early assumptions around the existing structure would have led to significant rework later in the programme. By interrogating the building early, we identified the need for a new slab and resin floor to meet CT scanner tolerances, avoiding disruption during installation. This kind of early examination of CDC projects has proven essential.

Now that we have real-world operational data, estates teams and delivery partners have the opportunity to refine the model. This will empower future CDCs to deliver multiple benefits to the Trust, clinicians, patients, and wider communities by going beyond meeting a high standard for healthcare provision, to actively optimising patient flow, enhancing resilience, supporting digital integration, and meaningfully contributing to Net Zero ambitions.

Complexity over uniformity

One of the most important lessons to be learned is that there is no standard CDC template.

Across our projects, we have delivered:

• Linked extensions to existing community hospitals in Essex.
• A 40,000 sq. ft greenfield diagnostic facility opposite an acute hospital site in Norwich.
• A hybrid-constructed CDC at Newmarket Community Hospital.
• A town-centre retail conversion in Grimsby.
• Refurbishments beneath live operating theatres in Sussex.

And each context required an entirely different estate strategy.

The least problematic context on paper are greenfield builds, which offer a level of design control that refurbishment schemes simply cannot. Structural grids can be optimised, mechanical and electrical distribution can be rationalised, and future expansion can be designed in.

But with great control brings great responsibility. Ground conditions, utility capacity, and transport access must be cross-examined during early stages. At Norwich’s CDC, co-working with the Trust team on site proved invaluable in accelerating decisions and managing funding milestones.

And at Newmarket CDC, a hybrid construction approach with 71 per cent pre-manufactured value in addition to the use of a Structural Framing System (SFS) provided a rapid envelope solution that took the traditional brickwork off the critical path, enabling the programme to respond to tight funding deadlines while maintaining quality.

Greenfield does not mean ‘simple’ — it means the complexity is often faced during early stages. However, unlike greenfield sites, working within operational hospitals like Southlands Hospital for University Hospitals Sussex NHS Foundation Trust requires a fundamentally different mindset.

At Shoreham CDC in Southlands Hospital, works were phased beneath live operating theatres, requiring continuous coordination with clinical teams to manage shutdown protocols and avoid disruption. The programme of works was dictated as much by clinical risk as by construction logic as in a live environment, the construction programme must align with clinical risk, and any service alterations must avoid theatre downtime. Plus, infection control and acoustic separation become programme-critical components of delivery, not afterthoughts.

And it is in these sites that knowledge of the estate held by long-serving Trust engineers is often as valuable as any survey report. This emphasises the fact that early collaboration is not optional, but rather, it is risk mitigation.

Perhaps the most visible shift in healthcare estate strategy has been the move into retail environments. In Grimsby, converting five former retail units within a shopping centre into a CDC for Northern Lincolnshire and Goole NHS Foundation Trust required structural reinforcement, service trenching, and craning specialist equipment through the roof. Floors had to be built up to provide trenching for the services for the scanning equipment, while gantry systems were introduced to support imaging equipment, demonstrating just how far retail shells must be adapted to meet clinical requirements.

From an estate perspective, schemes like this demonstrate the viability of repurposing town-centre assets. They also highlight the importance of detailed early investigation. Retail shells are not designed for MRI scanners or lead-lined partitions, so features like structural load paths, vibration measures, and service capacities cannot rely on guesswork or typical expectations — every element must be verified with evidence before proceeding.

On projects like Thurrock CDC and Southlands CDC, extensive early surveys of structure and existing services were critical, not only to confirm capacity for new equipment but to ensure ongoing hospital operations were not disrupted during delivery.

And yet, the benefits are enormous. Accessibility is markedly improved for people in the local area, health inequalities are addressed, and footfall returns to town centres. Overall, the estate becomes a highly visible and active part of the community.

Early engagement is a cost strategy, not a courtesy

If there is one consistent theme across every CDC project, it is this: early stakeholder engagement reduces risk more effectively than any contingency allowance.

In our experience, clinical service managers, radiation protection advisers, imaging suppliers, estates engineers, infection control teams, and many more must be involved at the concept stage, not after planning submission.

Why? Because diagnostic spaces are unforgiving.

A CT scanner requiring a 0.5 mm floor tolerance does not allow for late design changes, much like how lead shielding calculations cannot be adjusted casually once walls are constructed.

At Newmarket CDC, clinical service managers were engaged from concept stage and remained involved throughout, allowing us to refine room layouts and patient flow as a team before construction began rather than correcting errors later.

And at Northgate CDC, for James Paget University Hospitals NHS Foundation Trust, our early examination of the existing structure prevented expensive rework later in the programme. A new slab and resin floor was installed in the CT room to ensure it met the 0.5 mm tolerance of the scanner, something we determined was necessary during early engagement sessions. Where full compliance with current standards proved impractical, we secured formal derogations early on to ensure transparency and avoid disputes.

Early contractor involvement should be viewed through the same lens. When contractors are appointed at concept stage, buildability informs the project’s design rather than reacts to it. Specialist supply chains can be engaged sooner and roles between our contracting team and turnkey imaging suppliers can be clearly defined before the procurement scope is finalised.

In practice, the importance of aligning contractors early on is underlined by the complexity presented by systems like medical gas provision, electrical resilience, and ventilation performance. All of these are sophisticated and intricate in their own right and require specialist subcontractors, but their interdependencies mean they must be approached as a single integrated system, a system that needs to be understood, mapped, and coordinated from the outset.

In CDC delivery, clarity equals programme certainty.

The imaging interface and managing risk

Across every scheme, the interface between the Morgan Sindall team as main contractor and imaging equipment supplier has been a critical risk point.

MRI, CT, and X-ray suites are not just rooms with machines placed inside them. They are highly engineered environments with precise tolerances, shielding requirements, and needs. Misalignment in this area can result in confusion around who is delivering what, unassigned responsibilities, or worse, key elements falling between contractual gaps.

The solution is procedural control:

• Early and regular coordination workshops with turnkey suppliers.
• Detailed route-tracking surveys for equipment delivery.
• Early agreement on responsibility for specialist elements.
• Alignment around fixed scanner installation slots.

At Southlands and Grimsby, detailed route-tracking surveys were undertaken early to ensure that large imaging equipment could be delivered through limited existing structures, avoiding costly late-stage redesign or programme delays.

Lead times for major imaging equipment are significant and installation windows are rarely flexible. Missing them can have cascading financial consequences, particularly where temporary scanners are hired. So for estates leaders, the message is clear: invest time early in defining interfaces — it pays dividends later.

HTM fluency and regulatory confidence

Compliance with Health Technical Memoranda (HTMs) and Health Building Notes (HBNs) underpins safe healthcare delivery. Projects could suffer when design teams lack healthcare experience, leading to delays and costly changes, so getting a team onboard who are HTM-fluent reduces learning curves hugely.

Across our projects, early engagement of healthcare-experienced designers and Radiation Protection Advisers has reduced redesign and avoided modifications to shielding at a late-stage.

At Thurrock CDC, close collaboration with Radiation Protection Advisers and NHS stakeholders ensured that room designs aligned with both HTM and HBN requirements from the outset, avoiding costly later modifications and delays.

HTM fluency is not just about avoiding non-compliance, it is about understanding intent. For example, ventilation strategies should support infection prevention and patient throughput, not simply meet numeric targets.

As CDCs become more common, building a supply chain with embedded, highly practiced healthcare knowledge will be essential to maintain quality and consistency.

Designing for operational efficiency for Trusts and the NHS

For Trust boards, CDCs are both clinical and financial assets. Patient throughput drives revenue, efficient layouts reduce waiting times, and small spatial decisions can compound over thousands of appointments. All aspects that are key to think about early when designing a CDC.

At Thurrock, early surveys on the existing buildings helped develop the design, with the main extension housing the specialist MRI, CT, X-Ray, and Ultrasound rooms, whilst the existing buildings were used for consulting rooms. This reduced the risk and ensured the equipment had the space that matched HTM standards while maximising patient throughput in lower-spec areas.

When asset allocations are time-bound and temporary equipment hire erodes budgets, delivery teams must understand these pressures and adapt accordingly. Accelerating a programme to secure funding within a financial year can determine whether a project proceeds or not, so optimising layout to increase throughput has a measurable financial impact.

Across multiple projects, we have seen how careful placement of gowning areas, scan rooms, and consulting spaces can maximise performance. Saving even one minute per patient can translate into more patients being seen and increased revenue. And understanding that dynamic changes the conversation, reinforcing how hospital estate decisions become operational strategy.

This also reinforces the importance of post-occupancy evaluation. Without capturing real performance data like patient satisfaction, staff feedback, energy consumption, maintenance, and patterns, we risk repeating avoidable mistakes.

In response, we are now undertaking structured Post Occupancy Evaluations (POEs) on completed CDCs to inform future schemes. Insights from completed schemes such as Northgate CDC and Newmarket CDC are now feeding into structured post-occupancy evaluations, allowing us to compare predicted and actual performance. The aim is to move from anecdotal learning to evidence-based refinement.

Flexibility over fashion

Healthcare infrastructure must outlast political cycles and funding waves. After all, diagnostic technology will evolve and service models will change. Designing CDCs with accessible service zones, adaptable trunking systems, and removable partitions may not always win architectural awards, but it will support long-term resilience.

At St Margaret’s CDC, this has translated into highly accessible service zones, including over 260 access hatches to ensure futureproofing for maintenance requirements going forward, prioritising practicality over architectural simplicity.

Our experience suggests that hybrid and traditionally constructed solutions often provide greater flexibility for complex clinical environments than highly standardised modular approaches. While offsite manufacturing can improve quality and safety, over-rigid systems risk introducing compliance challenges or future constraints. In short, the objective should not be speed alone, it should be adaptability.

Sustainability beyond carbon accounting

The NHS Net Zero agenda is shaping estate decisions across the country, and CDCs are no exception. CDCs not only reduce patient travel by decentralising diagnostics but provide opportunities to repurpose existing buildings where feasible and integrate low-carbon technologies such as air source heat pumps — all aspects that contribute to reducing carbon output throughout construction.

However, sustainability must extend beyond embodied and operational carbon metrics. A CDC that functions efficiently, minimises maintenance intervention, and supports long-term service flexibility is inherently more sustainable than one that requires frequent retrofitting. Carbon reporting is important, but we find that durability and adaptability are equally so.

On schemes such as Newmarket CDC, offsite manufacturing of large ventilation and air source heat pumps reduced waste and improved programme efficiency, while at Northgate CDC, a careful programme of works contributed to measurable carbon savings of
122 tonnes CO2 equivalent during construction.

Where next?

The next phase of CDC delivery should be characterised by maturity rather than urgency.

We must:

• Embed early contractor and specialist involvement as standard practice.
• Share post-occupancy data transparently across the sector.
• Strengthen healthcare-specific capability within design and construction teams.
• Continue exploring estate repurposing opportunities in community settings.
• Balance rapid delivery with long-term flexibility.

Above all, it is essential to maintain focus on the purpose of these facilities. Every CDC represents thousands of patients seeking clarity and reassurance, so faster diagnosis improves outcomes. While earlier intervention reduces long-term cost, accessible facilities narrow health inequality gaps. The estates community has a central role to play in achieving these outcomes.

Having delivered seven CDCs across a wide range of environments, we definitely cannot claim to have perfected the model. But we have gained practical insight into how these facilities perform, and where friction arises.

If the first chapter of CDC development was about swiftly increasing diagnostic capacity, the next must be about doubling down on performance and ensuring long-term resilience. By applying collective learning, engaging earlier, and designing more intelligently, we can ensure that future CDCs grow in scale and in quality, where taking the time to weigh the right options maximises impact and, ultimately, defines their long-term success.