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Elective care

What are our overall aims by 2028?

Out patient services are transformed with patients having the choice of personalised, digital and face to face appointments as close to home as possible from a range of NHS and Independent Sector (IS) providers who offer equitable waits to be seen and Patient Initiated Follow Up (PIFU) appointments.

Planned elective waiting lists are reduced and stabilised to pre-Covid levels such that patients wait no more than 18 weeks from referral to treatment.

Patients with cancer receive earlier diagnosis through a range of transformed screening programmes and enhanced community based diagnostic capacity which ensure increased uptake, provide straight to test pathways and reduce inequalities of access across the population.

Patient pathways, including those that provide tertiary and specialised services, have been reviewed and transformed and deliver improved outcomes and patient experience, reduced inequalities and enhanced productivity and value for money.


What’s our starting point?

As a system we have made good progress in restoring elective and diagnostic services and offering equitable, faster and more convenient access to our whole population:
- Building on the Accelerator Programme, the system utilises a single System Patient Tracking List to support equitable waiting times through mutual aid across local NHS Acute Trusts.
- All 3 Acute Trusts now utilise Index of Multiple Deprivation data as well as clinical information to prioritise how patients on waiting lists are treated and ensure equity of access and personalised care.
- Community Diagnostic Hubs are now operational within all 4 Places and provide the foundation for further expansion of accessible diagnostic and screening capacity.
- The Targeted Lung Health Check Pilot offers a strong foundation for the roll-out of the whole programme across our footprint and provides learning to support transformation of other early diagnosis cancer screening programmes.
- An ICB led review of ophthalmology pathways across the system provides the blueprint for a series of ongoing pathway reviews.

What are some of the key links to other parts of the plan?

Health Inequalities– triangulating waiting list detail with Index of Multiple Deprivation data so that we are intelligently managing our waiting lists is critical in addressing health inequalities, enhancing our PHM Programme and delivering personalised care initiatives.  We will also align pathway developments to the inequalities agenda through effective HEAT tool analysis.

Digital, Data and Technology– use of data and digital technology is critical in transforming how we intelligently plan, improve and deliver future efficient elective and diagnostic services based on the analysis of our patient and population needs and expectations. Patient portals, use of digital technologies within our outpatient services and system wide validation technology are key elective delivery digital enablers.

Estates and Addressing Climate Change – providing more accessible elective services closer to home requires more community based delivery underpinned by a more flexible estate, and contributing to our ambitions in relation to sustainability.


What will we be focusing on in the next 2 years?

Reducing waiting lists in line with national trajectories – 65 weeks by quarter 4 2023/24 and 52 weeks by quarter 4 2024/25.

Delivering the system Outpatient Transformation Programme with all  Patient Initiated Follow-ups, Did Not Attend, virtual appointment and New to Follow Up metrics met by quarter 4 2023/24. 

Delivering Getting It Right First Time (GIRFT) recommendations for elective care to improve performance, productivity and quality of provision for patients consistently to ensure equity of access and outcomes utilising capacity effectively in both acute and community settings.

Reviewing and transforming ophthalmology and dermatology pathways and implementing new service models by quarter 4 2023/24 delivering cost savings of circa £650k collectively.

Reviewing and transforming agreed pathways in conjunction with the Acute Provider Collaborative likely to include Ear, Nose and Throat, Cardiology and Urology reviews by quarter 4 2023/24.

Transforming and embedding best practice cancer pathways across tumour sites, with a focus on national priority areas in order to improve patient waits, reduce the system wide backlog position and support the achievement of the faster diagnosis targets.

Delivering diagnostic tests within 6 weeks by quarter 4 2023/24 and ensuring that plans are in place to identify steps needed to maximise diagnostic utilisation, efficiency and productivity, including the use of new technologies.

Supporting the development of Community Diagnostic Centres over the next two years to ensure system-wide consistency of cancer pathways, delivering the faster diagnosis pathway and ensuring no delays.

Working across elective, cancer and diagnostic pathways in conjunction with workforce planning to reduce any capacity workforce risks.

Improving performance within cancer pathways so that the number of patients on a cancer pathway waiting over 62 days to commence treatment continues to reduce.


Key Challenges

Workforce constraints within all professions.

Capacity available within secondary care to deliver the national expectations of waiting list recovery.

Estate infrastructure timescales that support elective recovery.

Increased UEC demand and potential impact on elective care provision

Pay rates and associated strikes/actions that impact elective care

Balancing variation of elective access and capacity available to effectively address inequalities which are more varied within our ICS due to geographical position and varied population profiles within each Place.


Key Metrics and Deliverables


Continue to reduce the numbers of patients waiting over 62 days with week on week improvements.

Meet the faster diagnosis standard by March 2024 so that 75% of patients who have been urgently referred by their GP for suspected cancer are diagnosed or ruled out within 28 days.

Increase the percentage of cancers diagnosed at stages 1 and 2 in line with the 75% early diagnosis ambition by 2028, with agreed annual milestones to achieve this target.

Implement and maintain the priority pathway changes for lower gastrointestinal, dermatology and prostate.

Expand Targeted Lung Health Checks with the associated diagnostic capacity for demand.



Increase the percentage of patients that that receive a diagnostic test within six weeks  in line with the March 2025 ambition of 95%.

Deliver diagnostic activity levels that support plans to address elective and cancer backlogs and the diagnostic waiting time ambition.

Maximise the role out of additional diagnostic capacity (supporting cancer pathways) and ensure Community Diagnostic Centres are established on time.

Deliver a 10% improvement in pathology and imaging networks productivity by 2024/25 through digital diagnostic investments and meeting optional rates for test throughput.


Planned Care

Eliminate waits of over 65 weeks for elective care by March 2024 (except where patients choose to wait longer or in specific specialties).

Deliver system specific activity targets to include a reduction of DNAs to below 5%, a 25% reduction in follow up appointments, increased use of advice and guidance (aim is 20%), maintained use of PIFU at 5% and maintaining virtual activity at 20%.

Increase productivity and meet 85% day case and 85% theatre utilisation expectation targets as set our by GIRFT.

Deliver around 30% more elective activity than before the pandemic, after accounting for the impact of improved care through system transformation.