NHSE Midlands Elective recovery

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The challenge

An NHS England and Improvement (NHSE/I) review in July 2021, highlighted that if no intervention or action was taken by March 2022, 51,568 patients within the Midlands would be waiting over 104 weeks (104+) for their elective surgery. Pressure on the service was significant and help was required to reduce this number as much as possible.  

NECS was asked to step in and support the Midlands Elective Recovery Programme. 

The main aims were: 

  • Improve patient experience by ensuring patients were seen as quickly as possible
  • Improve patient outcomes by validation and correct P coding
  • Share best practice across 11 ICS
  • Pan-regional approach to delivery – not 11 ICS’s working in silos.

Our response

Facilitation and Engagement: NECS worked collaboratively with all stakeholders across the health and social care system, including NHSE/I Regional teams, ICS and national teams to build strong and trusting relationships in a short period of time. This enabled the region to maintain a system-wide approach. Having the same mission as staff on the ground resulted in the Midlands Systems asking for help when needing to unblock issues, facing challenges or needing advice or guidance. 

Analytics and Oversight: Our Analytical team rapidly improved the data quality and flow to Systems, Regional and National colleagues. This enabled a single version of the truth, regular and accurate updates and evidence-based improvement, allowing data flow enabled providers to identify challenges earlier and request support such as Mutual Aid from other providers and the independent sector. 

System Wide Governance: Central to the approach, our team facilitated the flow of information between National/ Regional, the PMO team and Systems. The team monitored progress on reducing long waits with a target of zero 104+ patients by 30 June 2022, through regular monitoring of regional delivery against 104+ plans. We established clear and consistent governance arrangements across the region around performance and improvement, including standardised action plans and risk logs. 



Since July 2023, NECS has helped the Midlands team and ICS leaders to treat 23,661 patients who would have waited over 104 weeks by June 2022 and may not have been treated in a timely fashion. 

We established an evidence-based approach and a supportive environment to discuss with the 11 ICS customers across the Midlands region. Our team understood the challenges they were facing to clear the elective backlogs, helped to identify priority areas and solutions and facilitated cross boundaries conversations including sharing of best practice. 

Expanding the team has resulted in a knock-on effect, ensuring the delivery of the regional outpatient programme, tracking of TIF funding and a renewed focus on cancer performance and 78 week waiters. 

“We needed to work with a partner who really understood the elective recovery national and system challenge. NECS gave us an agile, competent team which hit the ground running, transitioning quickly into the team and focused solely on working with system leaders to treat as many patients as possible. 

Adam Andrews

Head of Access, NHS England Midlands