Read Jack Serle's latest HSJi Review, which discusses how the NHS is trying to find the people, the money, and the time to tackle its waiting list. Read the full article here.

Latest Investigations

Bolton is forecasting a £21.6m deficit, among the worst in Greater Manchester, as it struggles to meet an ambitious savings plan due to historic under-delivery, reliance on one-off measures, and unplanned workforce growth. In response, leaders are freezing discretionary spending and tightening executive oversight to rein in the shortfall. The trust is also introducing a new triage model to curb spiralling costs of autism and ADHD assessments, and overhauling its digital infrastructure by extending the Sunrise electronic patient record to community and outpatient services, with a maternity EPR planned for spring 2026. Bolton sits in the mid-tier but remains under close watch from NHS England. Leaders have rolled out new clinical models, such as initial assessment and triage and more proactive discharges, to improve performance against urgent care standards, and have re-launched the “Call Before Convey” model to ease pressure on A&E. While BFT has halved year-long waits, it is still below average and continues to face diagnostic challenges. The trust relies on insourcing in several specialties, including orthopaedics, and is also trialling AI in skin cancer pathways to help reduce demand.

The organisation is a recently merged provider of acute and community services that delivers strong operational performance but faces serious financial problems. The scale of the financial challenge has limited its ability to pursue wider service reconfiguration, as leadership attention is focused on stabilising the books. Despite this, there is a clear commitment to investing in technology, including the procurement of a new EPR. Ongoing cash flow pressures, however, risk affecting the timely payment of suppliers.

The Integrated Care Board’s existing CEO and chair have remained in post despite recent leadership churn, providing some continuity as the system takes on North East Hampshire under ICB reorganisation. This expansion offers a route to more coherent commissioning, though the transition requires significant work. Financially, there is a strong focus on reducing medicines spend through tackling inappropriate prescribing and on finding savings via more rigorous continuing healthcare assessments. Demographically, the area has a large and growing population aged over 65 with long-term conditions, creating pressures that will be unsustainable without reducing admissions and addressing delayed discharges. To support more strategic decision-making, the ICB has developed an outcomes framework and is mapping health needs among deprived child populations. Portsmouth is part of the national neighbourhood pilot programme, focusing on scaling up preventive services for local residents, while Southampton is expanding integrated neighbourhood hubs. Across the system, there is also a push to expand the shared care record to enable better multidisciplinary working.

The ICB is retaining its chief nurse, medical officer and finance officer, maintaining some senior continuity, although forthcoming changes to local government structures are expected to affect joint working arrangements. The system is using AI to make continuing healthcare (CHC) processes more efficient and is extending the lead provider model pioneered in Coventry and Warwickshire across the wider patch. There is also a drive to standardise provider leadership at the “place” level to reduce variation. Looking ahead, the cluster plans to develop a framework in 2026 to oversee providers as they take on a greater role in shaping local neighbourhood health services.

Data Points

The following data points were updated this week:

• Quarterly staff absence rates and Total Workforce for Acute,Sp,Com,MH,Amb in Q2 2025-26.
• Workforce- Medical staff for Acute,Sp,MH, Comm in Q3 2025-26.
• Workforce- Nursing Staff and Workforce- Other Staff  for Acute,Sp,Com,MH in Q3 2025-26.
• Workforce- Amb Staff for Amb in Q3 2025-26.
• Nursing workforce for ICS in Q3 2025-26.