Read Jack Serle's latest HSJi Review, which discusses ring-fencing operating theatres and wards for elective work, and shielding them from the disruption of emergency pressures.

But delivering on this principle requires detailed coordination. Read the full article here.

Latest investigations

University Hospitals of North Midlands Trust

The University Hospitals of North Midlands Trust is currently facing significant challenges with its accident and emergency and cancer/diagnostic services, although elective care and financial performance are in a relatively better position. NHS England has been brought in to review the operation of the large A&E department in Stoke. In response, the Trust has developed an improvement plan focused on operational management, culture, and efficiency. This includes the establishment of new urgent treatment centres at both of its hospitals, the creation of a new day-case unit, and a strategy to shift most elective surgeries to County Hospital in Stafford. Additionally, the Trust is seeking to outsource orthopaedic and spinal surgeries to the private sector. A major cost improvement programme is being planned for 2025/26, featuring a range of measures to control pay spending. The Trust is also leading a system-wide procurement of a new electronic patient record (EPR) system, with the business case currently under development and a tender expected before the end of 2025. On the sustainability front, the Trust is refreshing its “green plan,” having already invested in heat pumps and solar panels, and has long-term plans to connect to the regional geothermal power network.

Bradford Teaching Hospitals Foundation Trust

Bradford Teaching Hospitals Foundation Trust is bringing a new day case centre online, while facing challenges in several areas, including staff shortages in its audiology service and mounting pressure on gynaecology and urology cancer services. The Trust has ambitions to expand its virtual wards as part of its care delivery strategy. Governance issues have come to the forefront, with the Trust currently subject to NHS England enforcement action due to related concerns. A former chair is pursuing an employment claim against the Trust, though doctors have publicly supported the current leadership amid tensions involving non-executive directors, an MP, and the former chair. Efforts to improve maternity services are ongoing through a dedicated improvement programme. Financially, the Trust is relying heavily on significant pay bill reductions to achieve its savings goals, while also aiming for substantial efficiencies through digitisation, improved medicines management, and contract reviews.

University Hospitals Sussex Foundation Trust

University Hospitals Sussex Foundation Trust is facing significant challenges, with a recent report revealing widespread cultural failings, leading to the resignation of the CEO and the appointment of an interim replacement. The Trust is once again forecasting a substantial financial deficit and plans to implement cuts to temporary and administrative staff, while increasing substantive staffing to reduce reliance on agency workers and outsourcing. Improved theatre utilisation is seen as a critical factor in boosting patient throughput, particularly as the Trust remains one of the worst performers on elective care nationally and continues to make extensive use of independent providers. A&E performance is also poor, adding further pressure. A major reconfiguration of the Royal Sussex County Hospital is underway, which includes the development of a new cancer centre and upgrades to emergency care services. In parallel, the Trust is working on establishing specialist centres of excellence at sites away from the Royal Sussex County Hospital.

Data points

The following data points were updated this week:

• Emergency care streaming indicator, Type 1 Departments - Major A&E %, 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 in July.
• Number of cases waiting over one year, Proportion of cases waiting over one year % of Acute, community, and specialist in June.
• Faster Diagnosis Standard of Acute in June.
• EIP waiting time performance (Early intervention Waits) of MH in Q1 2025-26.
• Elective admissions of Acute, Sp in Q1 2025-26.
• 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 in Q2 2025-26.
• Out Patients of PP in Q1 2025-26.
• Discharge delays due to ‘internal’ reasons, Discharge delays due to ‘external’ reasons of ICS in July.