Read Jack Serle's latest HSJi Review, which discusses, as summer turns to autumn, our attention turns to the annual data release on the state of the NHS’s estates.  Read the full article here.

Latest Investigations

North East London ICS

The ICB is undergoing a significant restructure but will not merge, instead forming “neighbourhood health services” across its seven “places”. Its priorities include improving services for complex adults and children, while contract incentives are being redrawn. Four provider collaborative are shaping system-wide configurations, though a major electronic patient record rollout has been delayed. A new system-wide patient engagement platform is set to launch additional features, and artificial intelligent technology is being deployed to address waiting lists. The breakeven plan relies heavily on cost savings, with a focus on standardising procurement and targeting high-cost care. Providers are cutting back on temporary on temporary and corporate staff amid ongoing cash pressures. Operational delivery networks are working to standardise specialised care, clinical networks are driving service redesign, and trusts are developing alternatives to accident and emergency and tackling diagnostic delays.

Cheshire and Merseyside ICS

The ICB has seen major leadership changes, with both the chair and CEO retiring within months of each other. It has appointed a first-time NHS CEO, formerly the chair of another system, and is also recruiting a permanent finance director. Leaders are working to define how place-based leadership will operate to drive local service transformation. The system faces one of the largest deficits in the country and is targeting significant workforce reductions while focusing on more efficient drug management and cutting the costs of complex healthcare packages. However, savings plans by providers risk destabilising the ICB’s financial recovery. The system is also grappling with a controversial maternity services reconfiguration in Liverpool and a long-awaited urgent and emergency care overhaul in Southport. Persistent year-long waits continue to pose challenges, with poorer-performing trusts required to submit 90-day improvement plans and receive mutual aid to recover elective performance. Sitting in the bottom third nationally for accident and emergency performance, the ICB’s leaders hope that improved front-door streaming will help ease ongoing capacity pressures.

The NHS market for management consultancy and legal services

The NHS’s reliance on professional services firms continues to rise, despite the government’s stated aim to reduce such spending. Much of this demand stems from the government’s own major restructure of the NHS, which has created a need for expert advice on managing the resulting changes. Trusts’ ongoing pressure to deliver unprecedented savings has further fuelled demand for consultancy support, with central spending still heavily driven by the New Hospital Programme. Expenditure on defending clinical negligence claims is also increasing, while IT consultancy spending remains focused on the rollout of electronic patient records. Meanwhile, new restrictions on wholly owned subsidiaries are disrupting many trusts’ efficiency plans, prompting the search for alternative approaches. Professional services firms are also being used to provide commercial and procurement support, assurance and oversight of workforce changes linked to service transformation or mergers, and assistance with employment tribunals, inquests, and other healthcare law matters such as deprivation of liberty orders.

Data points

The following data points were updated this week:

• Number Details and Telephone Number for Acute,Sp,Com,MH,Amb in Q2 2025-26
• Telephone numbers for PP, Wales, Scotland in Q2 2025-26
• C-diff rate and MRSA rate for Scotland in Q1 2025-26
• E-COLI HOSPITAL-ONSET CASES (12-MONTH ENGLAND AVERAGE), E-COLI HOSPITAL-ONSET CASES (12-MONTH REGIONAL AVERAGE), E-COLI HOSPITAL-ONSET CASES (12-MONTH REGIONAL AVERAGE), MRSA hospital-onset cases (12-month rolling count), C-Diff hospital-onset cases (12-month rolling count) and C-Diff hospital-onset cases (12-month rolling count) for Acute in July
• Emergency care streaming indicator, Type 1 Departments - Major A&E %, Four hours A&E performance (all patients), 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 and Super stranded patients for Acute in Sept
• Number of cases waiting over one year and Proportion of cases waiting over one year % for Acute, community, and specialist in August
• Faster Diagnosis Standard for Acute in August
• A&E waiting target and Emergency admissions for Acute in Q2 2025-26
• Discharge delays due to ‘internal’ reasons and Discharge delays due to ‘external’ reasons for ICS in Sept
• A&E Performance and Emergency admission per 1000 population for ICS in for ICS in Q2 2025-26
• Expenditure on Primary Healthcare Services, Expenditure on healthcare from other providers, Expenditure on Hospital and Community Health Services, Net operating costs for the financial year, Gross capital expenditure, Tax payers equity for Wales in 2024-25
• A&E waiting target, Beds occupied by delayed discharges and Length of delayed discharges in Scotland for August