The NAO report found that while CDCs are operational and have provided an increasing proportion of diagnostic activity, NHSE analysis in June 2024 showed that it would not meet waiting list targets due to a shortfall of around 3.6 million tests.34 We questioned the Department whether for CDCs there had been a failure to track whether spending had been properly linked to outcomes at the local level. The Department told us that it did not think there had been a failure to track this and it was trying to strike a balance between targeted investment and local flexibility, but acknowledged that the C&AG’s report had found a failure to track the impact of programmes.35 Similarly, the NAO report found that additional activity in surgical hubs was below planned levels by an average of 48% between April 2023 and September 2024.36