Elective Recovery for Manchester University NHS Foundation Trust

CF worked in partnership with the COO Directorate Team at MFT to develop and mobilise plans for elective recovery on an accelerated three month timeline. This included maximising the use of the Trafford Elective Hub, realising the benefits of a newly implemented EPR, and achieving theatre productivity trajectories to increase elective activity. The results mean that significantly more people are treated by the Trust within the same cost base, and at the Trafford Elective Hub, there has been an 50% increase in throughput.

What did we do?

Manchester University NHS Foundation Trust (MFT) is one of the largest NHS providers in the UK, providing services for over 750,000 people, employing over 28,000 staff and with an annual turnover of £2.5bn. The Covid-19 pandemic had a significant impact on MFT. Like other providers all around the country, the response to managing this national emergency included repeated pausing the delivery of planned care. The consequence for MFT was by January 2023, it had the largest patient waiting list and the longest waits for elective care of any provider in the country.

What did we do?

  • Mobilised delivery of an elective recovery plan including supporting theatre productivity trajectories and a tactical site optimisation plan to ensure underutilised capacity was filled as fast as possible
  • Rapidly set up a Delivery Unit to oversee the delivery of and achieve productivity trajectories for the number of operations per four-hour list, efficiency of how each four-hour list was used (theatre utilisation) and ongoing management of the number of people waiting

How did we do it?

  • Working in partnership with the COO Directorate Team, established a weekly rhythm with a strong focus on where analytical insights and practical improvements could be made
  • Rapidly analysed over 100 data points to establish a transparent site and speciality based baseline view of activity, physical and workforce capacity
  • Co-developed elective recovery and tactical site optimisation plan with senior clinical leads with agreed productivity trajectories by site and speciality to ensure underutilised capacity on a site was used and throughput through existing capacity was increased

What was the impact?

  • Despite significant disruption due to industrial action across a number of NHS staff groups, MFT has made significant progress to reducing the backlog with the total number of people waiting has reduced by 27,000 people with people now waiting on average a month less than they did before
  • Every month that means around 3,450 more people are being treated by the Trust in the same cost base than before the work
  • At the Trafford Elective Hub, specifically, an additional 75 people a week are treated, which represents a 50% increase, in throughput
  • This was achieved through:
    • a 20% increase in the number of operating procedures per four-hour theatre list,
    • a 53% increase in the number of four-hour theatre lists used, as a result of improved booking and scheduling and reduced cancellations on the day,
    • a 23% increase in the number of sessions with 96 sessions running per week,
    • with sustained performance in patient experience metrics.


“CF engaged with myself, my fellow Executives, and our clinical and operational teams over three months: their ability to work collaboratively with and manage a wide range of stakeholders was impressive. Our Trust has the most people waiting of any Trust in the country and CF’s insight and expertise into the clinical and operational requirements allowed us to implement pragmatic solutions at pace, treat more patients faster and ensure that changes were sustained. The team rapidly analysed data and information, shared it transparently and added insight and expertise, providing constructive challenge to support us in making informed choices about how to provide the better planned treatment for our patients. I would highly recommend CF as trusted partners for the NHS and would not hesitate to work with them again.”

Julia Bridgewater, MBE, Group Deputy Chief Executive

Manchester University NHS Foundation Trust

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