Read Jack Serle's latest HSJi Review, which says how successive governments and cadres of policymakers in the NHS have tried to deliver the three shifts, but have mostly failed.

Locally, however, some progress has been made over the years. Recent investigations by HSJ Intelligence have demonstrated, for example, how some elements of care are slowly shifting away from large acute hospitals. Read the full article here.

Latest investigations

University Hospital of Derby and Burton Foundation Trust

The trust is currently reliant on mutual aid and private providers to keep up with elective work, while ageing radiotherapy machines are contributing to delays in cancer treatment. An ongoing maternity improvement programme is underway, and the trust has set a 5 per cent savings target for 2025-26 as part of its broader efficiency plans. A new electronic patient record system is being rolled out, which was jointly procured with Chesterfield Royal Foundation Trust to support closer collaboration and joint working. The trust also has a well-established track record of shifting services into the community and currently operates three community diagnostic centres.

Walsall Healthcare Trust

Walsall Healthcare Trust is part of a group arrangement with the Royal Wolverhampton Trust, and both are working within a provider collaborative that is in the process of merging corporate functions. As part of wider efforts to improve efficiency, the trust is focused on boosting the productivity of elective services, cutting headcount, and closing wards where appropriate. Alongside these measures, a dedicated programme is underway to expand community services, with frailty identified as the top priority. The trust is also showing increasing ambition for the development of place-based services, aiming to deliver more care closer to home and better tailored to local needs.

Norfolk & Norwich University Hospital Foundation Trust

The trust must save £47m in 2025-26, with half of the savings coming from cutting more than 400 posts and reducing bank staff. Its productivity drive targets theatre efficiency, diagnostics, and length of stay. Despite this, the trust struggles to meet elective care targets, and cost-saving pressures threaten its reliance on outsourcing and insourcing. It plans to develop an “Institute of Robotic Surgery” and expand patient-initiated follow-up pathways. To improve cancer care, the trust aims to increase digital pathways. Shared leadership with two other trusts will oversee the reconfiguration of maternity, stroke, and other services, with a shared EPR to be rolled out across all three trusts in 2026.

Data

• Emergency care streaming indicator, Type 1 Departments - Major A&E %, Emergency care streaming indicator, Type 3 Departments - Other A&E/Minor Injury Unit, Four hours A&E performance (all patients), 12 hour A&E waits, 12 hour A&E waits (% of total attendances), A&E attendances, % beds occupied by delayed discharges, Discharge delays due to “internal” reasons, Discharge delays due to “external” reasons, Super stranded patients of Acute for April
• Number of cases waiting over one year, Proportion of cases waiting over one year % of Acute, community, and specialist for March
• Faster Diagnosis Standard of Acute for March
• Elective admissions of Acute for Q4 2024-25
• Incidents Per Quarter, Percentage of patients taken to A&E, THE 18-MINUTE TARGET(MINS.SECS), THE APPROPRIATE CONVEYANCE TARGET(MINS.SECS), THE SEVEN MINUTE TARGET(MINS.SECS) of Amb for Q1 2025-26
• Discharge delays due to “internal” reasons, Discharge delays due to “external” reasons of ICS for April
• Elective activity Recovery of ICS for Q4 2024-25
• System oversight framework rating of ICS for Q1 2025-26
• Out Patients of PP for Q4 2024-25
• Total population served, Percentage 75 and over of Scotland for 2025-2026