This year (2025/26) is the next year in our planned recovery and transformation journey.
We want to clearly set out what the next 12 months will look and feel like for our services so that our colleagues and communities can be aware of what changes are being considered and how they might affect the way we work.
It’s clear that the NHS, and our Trust, can’t continue to operate how it does now. We need to transform the way we work and deliver our services locally so that we can support the government’s vision for the NHS.
There is going to be less investment into acute hospital services to prioritise funding for community, primary care and population health improvements so we need to change.
This is very different to how we have approached previous years - we’ve made changes but nothing at the scale we will see over the next 12-18 months. Our hospitals and community services will look and feel different; and whilst that doesn’t mean that we will reduce the number of hospitals we run or the essential services we offer, it will mean changes to the way we deliver services.
Transforming our Trust
We have split the work we need to do in 2025/26 into five areas (detailed in the tables below).
These areas have been chosen as the big opportunities for this year because:
- There is a national focus on moves to community, digital and prevention rather than traditional models
- There are real opportunities to improve services - reduce length of stay and re-admission rates, ensure patients receive the care and rehabilitation they need in the best place and lessen admin burden on clinicians
- Data and evidence tells us that some of our services could be delivered more efficiently
- We know there are unnecessary variations in some of our services and we don’t always benchmark well against peers for how we provide certain services
- We know we don’t use our capacity effectively - including regular empty theatre and clinic slots which could be used to see more patients and calling patients back for follow-ups when the evidence tells us it isn’t necessary
- We want to empower patients to take control of when and how they access their healthcare
- Our hospital and community premises and estate could be used better
- The needs of our populations, the clinical evidence, and local health priorities are changing
- Patients face long waits for care and overcrowding in our Emergency Departments and Urgent Treatment Centres
- There are a high number of patients with us who no longer require hospital care but can’t access the rehabilitation they need
Our transformation programmes
This project focuses on reorganising identified clinical services to align with best practice models and clinical guidelines to improve patient flow, reduce length of stay and make them sustainable and value for money.
Looking at:
- Trauma and Orthopaedics
- Gynaecology
- Outpatients
- Frailty
- Children’s and Young People services
It might mean:
- Services looking different - including delivery on less sites
- Asking patients to travel further so we can concentrate our specialist resources
- Patients being cared for by different appropriate members of the clinical team - not just doctors
- Care being delivered outside of a traditional environment, such as theatres or even hospitals
- Development of the use of nurse associates to support our nursing workforce
- Change to the inpatient model of care in Medical Unit 2 at the RLI to provide rehabilitation and reconditioning - based on step-down model of care
- Launch of a digital patient-initiated booking system - giving patients control of their healthcare
- Continued roll out and promotion of Patient Initiated Follow Up (PIFU) across appropriate specialties
- Increased use of Advice and Guidance
This project aims to ensure we use our hospital and community buildings, assets and land to the best of our ability - ensuring we use them flexibly, reduce costs and comply with relevant laws and regulations. We’ll also look at opportunities to work with partners on suitable estate outside of our usual footprint.
Looking at:
- Hospital estate (patient facing)
- Community estate (patient facing)
- Partner and commercial estate opportunities
- Patient and non-patient transport
It might mean:
- Reduction in non-clinical use of clinical areas
- Reconfiguration or redesign of spaces to better meet current and future needs
- Creation of adaptable spaces that can be reconfigured for different purposes by different teams
- Renting out available spaces on our estate to other sectors
- Changes to where teams / services are located to ensure we don’t waste valuable space
- Moving relevant and appropriate services out of hospital premises into the community
- Changes to the way we use transport for patients and goods
- Encouraging patients to use their own transport wherever possible
This project will make sure we are getting the most out of digital technology - focusing on automating manual tasks, AI transcription, and promoting self service for patients and colleagues.
Looking at:
- Clinical AI
- Non-clinical AI
- Patient Engagement Portal
- Robotic Process Automation
- Digital assistant
It might mean:
- Using AI in clinics to capture information to inform clinic notes and letters
- Changes to the way colleagues work
- Re-design of processes
- Access to digital assistants 24/7
Freeing up time to do activities that only humans can do
This project focuses on increasing the number of patients we see in ‘core’ capacity - i.e. the resources (colleagues, space, equipment, etc) we have available - and ensuring we use our capacity properly and reduce the need for unnecessary and expensive additional activity.
Looking at:
- Resource-based planning
- Delivering national standards
- Optimising core utilisation
- Get It Right First Time (GIRFT)
It might mean:
- There will be times when people may have to wait longer for care
- Asking patients to travel further so we can concentrate our specialist resources
- Not always being able to meet expectations where they go beyond national standards
- Service Managers and clinical colleagues will need to work differently - planning activity weeks in advance
- Reducing what we spend on certain services and projects
- Some appropriate procedures may take place outside of a traditional theatre environment
- Colleagues having to work differently
- Offering patients only the interventions that evidence tells us will benefit them and giving them control of access to care
This project focuses on reorganising identified clinical services to align with best practice models and clinical guidelines to improve patient flow, reduce length of stay and make them sustainable and value for money.
Looking at:
- Services to grow and services to stop
- Demand management (partners / Whole System Flow)
- Not Meeting Criteria to Reside (NMC2R)
- Discharge planning
It might mean:
- Services looking different - including delivery of more services in the community closer to home
- Changes to some services - growing, consolidating or stopping
- Reduction in the threshold for ‘Not Therapy Fit’ (NTF)
- Integration of our Discharge to Assess, Supported Discharge and Community Therapy Services - with extended service hours and urgent same day response
- Additional therapy support in our Emergency Departments and for daily reviews of NMC2R / NTF
- Development of single assessment process to support Physiotherapists and Occupational Therapists
- Colleagues working differently and more closely with other teams and professions
- Working differently with our partners (primary care, social care, etc) to ensure our patients get access to the care they need in a timely manner
- Patients receiving rehabilitation care in the community rather than in hospital
- Changes to discharge process – making decisions earlier
- Streamlining of how patients are admitted into intermediate care to continue their recovery
We are still very much at the scoping stage for each area and no decisions have been made. Over the next few weeks and months, we will start to talk to the teams involved about the challenges we face and work with them to develop the right solutions.
Keeping our services safe for patients
There will be times where we may need to compromise where we haven’t previously but to be very clear, this does not include accepting delivery of unsafe services or care, avoidable harm or unwarranted variation in clinical and care pathways. However, there are things we may have to accept including familiar services needing to look different, the fact that there will be times when patients may have to wait longer or travel further and not always being able to meet expectations that go beyond national standards.
To help ensure that the patient is at the centre of any plans, each area has an Executive lead and will include clinical leadership throughout. Any proposed changes will require detailed Quality and Equality Impact Assessments approved to ensure they do not negatively impact on patients or colleagues. We will also ensure we satisfy any colleague, stakeholder and public engagement and consultation requirements.
Turning our financial challenge into opportunity
Finance has dominated lots of conversations and decisions over recent months, and we understand that may give the impression that we are putting money above all else. To be really clear, that is fundamentally not true and will never be true. The quality and safety of our services will always be the most important thing, and we will not compromise on that.
That said, we cannot and will not ignore the money. To be a truly safe, sustainable and thriving organisation, we need to have all the four critical areas (quality and safety, performance, finance and colleague wellbeing) working effectively. One cannot work without the other.
This last year has been difficult in terms of finance. Our final outturn position for 2024/25 was as forecasted at £19m (after some support funding), and we also achieved a Cost Improvement Plan of £20m. This means that in just four years, alongside all of the improvements to our services, we have halved our overall deficit from £80m to £38m. This is a huge achievement.
We’ve also been successful in our application for Local Price Modification (LPM) which means we will receive more funding (to a total of around £22m a year from this year) to support us in delivering services in the way we have to due to the vast geography we serve. This follows years of operating services where the income we receive did not match the cost of delivering them. The only reason we have been successful at achieving this is because we delivered what we said we would in 2024/25 in relation to the money and that has given the national team confidence in our abilities to deliver.
We have committed to ending the 2025/26 financial year with a breakeven position which means we need to live within our budgets, whilst making savings of £32.5m (£17.6m of which has been identified to date).
Getting to a breakeven position means we will have more control over how we spend our money, the ability to invest in our services like never before, more capital money and realistic savings targets for teams.
If we get this right, this time in 18 months or so, we could start to have conversations about where we spend our money - which services to invest in, which extra equipment to buy, which digital infrastructure to look at, which research or innovation we want to support, etc. It has been a long time since every business case hasn’t been required to save money so this is a real opportunity for us to start to have very different conversations. 
To do this, we must live within our means - i.e. deliver services within the funding available and not spend more than we have. It sounds easy, but it is something that we haven’t got right yet amongst many of our services and departments, and we need to.
The freedom to control how we invest is at our fingertips.
How will we ensure we engage with and involve colleagues and communities in change?
We know that this level of change can be challenging, and we need to take colleagues and our communities on this journey with us - so meaningful engagement and involvement is key.
Our Executive and Divisional Directors will be holding regular engagement sessions to talk about what the next year or so looks like. This will be done in a variety of ways so there will be lots of opportunities to talk to us.
Engagement sessions
We held the first series of engagement sessions in June 2025, and more sessions will be held in October 2025. We will share more information and dates of the upcoming sessions as soon as possible.
Our story 2025-26 - public engagement sessions presentation (May-June 2025)
Public engagement session recording
Public engagement sessions presentation (plain text version)
A recap on our progress so far
Despite the challenges we have faced, our teams have managed to achieve some remarkable things, including:
Consistently being one of the top performing Trusts in the country for:
- Urgent and emergency care access
- Cancer
- Diagnostics
- Elective recovery / referral to treatment times
- Two-hour urgent community response
- Stroke care
Delivering a total of £47m in savings in the last two years.
Transitioning from NHS Oversight Framework (NOF) 4 to NOF 3 and exiting the Recovery Support Programme.
Delivering a positive experience in maternity, inpatients, cancer and Emergency Departments - according to national patient surveys.
Being one of the top performing Trusts in the country for Patient Initiated Follow Up (PIFU) services.
Making significant improvements in our maternity and stroke services - leading to all Care Quality Commission (CQC) regulatory action being lifted.
Launching our People Strategy and People deal - setting out expectations for all colleagues to ensure we bring our values into our actions, attitudes and behaviours.
Improving our services and halving our overall deficit from £80m to £38m in just four years!
Context
National context
- 10-year plan for the NHS due to be published soon - clear direction and agreement that the NHS needs to change by:
- Moving care from hospitals to communities
- Making better use of technology
- Focusing on preventing sickness, not just treating it
- National Planning Guidance for 2025/26 clearly sets out that we must:
- Live within our budget, reduce waste and improve productivity
- Maintain a focus on the overall quality and safety of services
Local context
- 2025/26 is the next step in our planned recovery - focusing on improvement to evidence we can achieve a CQC rating of ‘Good’, financial sustainability and NHS Oversight Framework Segment 2 (NOF 2)
- Our strategic priorities remain the same:
- Patient first - providing compassionate care, involving patients and listening to their experiences
- Quality and safety driven - continuously improving and delivering services that are evidence-based and best practice
- Clinically led - focusing on patients’ needs, prioritising clinical expertise and involving clinical colleagues from all professions in decision making
Financial position
We will never put money before quality and safety.
To be truly safe and sustainable, we need to have all four areas of our dashboard working effectively. One cannot work without the other: Quality and Safety, Performance, Finance, Colleague Wellbeing.
We hit our 2024/25 financial plan - £19million deficit after support funding and £20million savings.
Because we hit our plan, we have secured £22million additional funding to support us to deliver services in the vast geography we serve.
We have committed to ending 2025/26 with a breakeven position – we need to live within our budgets whilst making savings of £32.5million.
Hitting breakeven is a game changer – we’ll have more control on how we spend our money to improve services for patients and the working lives of our teams.
Our approach to 2025/26
- 2025/26 will bring challenges we’ve not faced before - we can’t continue to operate as we are now
- A very different approach - we’ve made changes but nothing like we will see over the next 12-18 months
- Our hospitals will look and feel different - not a reduction in the hospitals we run or the essential services we offer but there will be change for colleagues and patients
- There are some things in our plans that may require us to compromise - patient safety is not one of them
- Our Areas of Focus will guide us in all we do - quality and safety, colleague wellbeing, using our resources well and working in partnership
- Five areas of transformation agreed for 2025/26:
- Clinical service reconfiguration and pathway standardisation
- Estates rationalisation
- Digital
- Productivity and efficiency
- Capacity reduction and demand management
Talking openly with colleagues, stakeholders and our communities is key.
In making change, we will not accept:
- Delivery of unsafe services or care
- Avoidable harm
- Delays in treatment for cancer / high priority patients
- Unwarranted variation in clinical and care pathways
- Not doing what the evidence shows is the right thing to do
- Not providing statutory services
- Failure to meet engagement and statutory consultation duties
- Deviating from national practice and standards
- Reduction in the prioritisation of colleague well-being or support offer
- Behaviours that are not aligned to our values
- Failing to meet our public sector equality duties
- Not involving colleagues and communities in any changes
- Quality and care being used as a necessity for spending more money
In making change, we may have to accept:
- Familiar services needing to look different
- There will be times when people may have to wait longer
- Asking patients to travel further so we can concentrate our specialist resources
- Not always being able to meet expectations that go beyond national standards
- Offering patients only the interventions and pathways that benefit them most
- Some patients may feel their expectations have not been fully met
- Reductions in overperformance
- Changes may not be accepted or easy
- Some colleagues choosing to seek other opportunities
- A temporary reduction in colleague satisfaction
- Things taking a bit longer and potentially some double running whilst we implement new technologies
- Not meeting the Green agenda
Clinical service reconfiguration and pathway standardisation
Aims of project: Align services with best practice models and clinical guidelines and make them sustainable and value for money. Reorganise identified clinical services to improve patient flow and reduce length of stay for patients
Executive lead: Dr Caroline Brock, Interim Chief Medical Officer
What is being looked at?
Gynaecology/Trauma and Orthopaedics/Ophthalmology
Why are we looking at this?
- Data and evidence tells us that the services could be delivered more efficiently
- Activity and occupancy is low
- The service is operated differently across the Trust
What might this mean?
- Services looking different - including delivery on less sites
- Asking patients to travel further
- Patients being cared for by different clinical colleagues
- Care being delivered outside of a usual hospital environment
What is being looked at?
RLI Medical Unit 2 (Wards 22 and 23)
Why are we looking at this?
- Patient flow at the RLI is often challenging and there are high numbers of patients NMC2R who require rehabilitation in the community
- Lack of intermediate care facilities locally
What might this mean?
- Change to the inpatient model of care to provide rehabilitation and reconditioning - based on step-down model of care
- Change to staffing model - more Clinical Support Workers and therapy colleagues and less registered nurses
What is being looked at?
Children and young people (CYP)
Why are we looking at this?
- Royal College reviews says we should deliver our services differently
- Our CYP wards are only near full occupancy for eight weeks of the year but only 40% occupied outside of that
What might this mean?
- Services looking different - including delivery on less sites, outpatients operating differently and asking patients to travel
- Using Advanced Paediatric Nurse Practitioners and nurse associates to support nursing and medical colleagues
- Development of Paediatric Same Day Emergency Care
What is being looked at?
Outpatient transformation
Why are we looking at this?
- A need to focus on a small number of key pieces of work and do them well
- Drive to hand more control to patients about when and how they access their healthcare
- Ensuring equitable access to services
What might this mean?
- Launch of a digital patient-initiated booking system - giving patients control of their healthcare
- Continued roll out and promotion of Patient Initiated Follow Up (PIFU) across appropriate specialties
- Increased use of Advice and Guidance
Estates rationalisation
Aims of project: Ensure we use our hospital and community buildings, assets and land to the best of our ability - ensuring we use them flexibly, reduce costs and comply with relevant laws and regulations. Look at opportunities to work with partners on suitable estate outside of our usual footprint
Executive lead: Helen Cobb, Interim Chief Financial Officer
What is being looked at?
Hospital and community estate (patient facing)
Why are we looking at this?
- We don’t use our hospital or community estate efficiently - there are areas that may be underused, overused or not allocated properly
- We want to ensure our sites are safe and accessible
What might this mean?
- Prioritisation of estate for patient facing services
- Reconfiguration or redesign of spaces and creation of adaptable spaces that can used by different teams
- Changes to make sure that all colleagues, including those with disabilities, can access and navigate the premises
What is being looked at?
Partner / commercial estate opportunities
Why are we looking at this?
- There may be opportunities for us to receive income by allowing partners / commercial services to use our estate
- We currently spend a lot of money to occupy other organisation’s estate and this could be reduced
- It supports left shift to health services being in the community as much as possible
What might this mean?
- Renting out available spaces on our estate
- Changes to where teams / services are located to ensure we don’t waste valuable space
- Moving relevant and appropriate services out of hospital premises into the community
What is being looked at?
Patient and non-patient transport
Why are we looking at this?
- We think we can improve the way we transport patients or goods within our estate our between locations
- There are times where we use transport inappropriately or inefficiently
What might this mean?
- Changes to the way we use transport for patients and goods
- Encouraging patients to use their own transport wherever possible
Digital
Aim of project: Maximising digital technology to focus on automating manual tasks, AI transcription, and promoting self service for patients and colleagues.
Executive lead: Ali Balson, Chief People Officer
What is being looked at?
Ambient Artificial Intelligence – clinical
Why are we looking at this?
- Reduced time spent on clinical admin, enabling clinicians to focus on clinical activity
- Improved note quality and real time information
- Improves efficiency
What might this mean?
- Using AI in clinics and ward rounds to capture information to inform clinic notes and letters
- Proof of concept starting May 2025
- Changes to the way colleagues work
What is being looked at?
Patient Engagement portal (PEP)+
Why are we looking at this?
- Empower patients to take control of their own health – allowing them to self-book some appointments, access their letters and choose communications preferences
- Lower costs due to reduce letter printing and postage
What might this mean?
- Changes to the way colleagues work
- Focus on digital inclusion and literacy for our patients
What is being looked at?
Robotic Process Automation (RPA)
Why are we looking at this?
- Longstanding technology in other sectors
- Replaces transactional manual activities with automation
What might this mean?
- Process redesign
- Changes to the way colleagues work
- Freeing up time to do activities that only humans can do
What is being looked at?
Digital Assistant and non-clinical AI
Why are we looking at this?
- Self-service for a range of queries
- 24/7 access to digital assistants
- Reducing administrative activities
What might this mean?
- Pilot in people services
- Access to digital assistants 24/7
- Changes to the way colleagues work
- Freeing up time to do activities that only humans can do
Productivity and efficiency
Aims of project: Increase the number of patients seen in ‘core’ capacity - the resources (colleagues, space, equipment, etc) available. Ensure we use our capacity properly and reduce the need for unnecessary and expensive additional activity
Executive lead: Scott McLean, Chief Operating Officer and Deputy Chief Executive
What is being looked at?
Elective control room
Why are we looking at this?
- Need to use our available capacity effectively and reduce reliance on high-cost additional activity
- Provides co-ordination of vital resources: booking, outpatient clinics, theatre lists, additional activity, etc
What might this mean?
- There will be times when people may have to wait longer for care
- Asking patients to travel further
- Not always being able to meet expectations where they go beyond national standards
What is being looked at?
Specialty resource-based planning
Why are we looking at this?
- Move to making early decisions about activity which is planned, communicated and risk assessed
- Requirement to only spend what is in the budget
What might this mean?
- Reducing what we spend on certain services and projects
- Service Managers and clinical colleagues will need to work differently - planning activity weeks in advance
What is being looked at?
Get it right first time (GiRFT)
Why are we looking at this?
- We know there are unnecessary variations in some of our services and we don’t always benchmark well against peers for how we provide certain services
What might this mean?
- Some procedures may take place outside of a theatre
- Offering patients only the interventions that evidence tells us will benefit them and giving them control of access to care
What is being looked at?
Levelling to national mean performance
Why are we looking at this?
- Some specialities perform better than the national target of 71% for Referral to Treatment within 18 weeks
- Under-performing specialities could get up to the national target by using resources from those over-performing
What might this mean?
- There will be times when people may have to wait longer for care
- Not always being able to meet expectations where they go beyond national standards
- Colleagues having to work differently
What is being looked at?
Core utilisation optimisation
Why are we looking at this?
- We don’t use our capacity effectively - empty theatre and clinic slots, calling patients back for follow-ups unnecessarily, and avoidable theatre cancellations
What might this mean?
- There will be times when people may have to wait longer
- Offering patients only the interventions and pathways that evidence tells us will benefit them most
Capacity reduction and demand management
Aims of project: Review services to ensure resources are used effectively to meet the changing needs of the population and deliver the best possible care. Work with partners to ensure that when patients no longer need hospital care, they can access the appropriate service for their ongoing rehabilitation quickly
Executive lead: Tabetha Darmon, Chief Nursing Officer
What is being looked at?
Services to stop and services to grow
Why are we looking at this?
- National focus on moves to community, digital and prevention rather than traditional models
- Evolving clinical evidence, and local health priorities
- We have some high-cost services with comparatively low activity and fragile staffing
What might this mean?
- Services looking different - including delivery of more services in the community closer to the patient’s home
- Changes to some services - growing, consolidating or stopping
What is being looked at?
Not Meeting Criteria To Reside (NMC2R)
Why are we looking at this?
- NMC2R and some ‘Not Therapy Fit’ (NTF) patients should receive their ongoing care in the community
- Opportunities to increase patients’ mobility to prevent deconditioning and reduce length of stay
- Reduction in NMC2R enables the configuration of our hospitals to be reviewed and improved
What might this mean?
- Reduction in the threshold for ‘Not Therapy Fit’ (NTF)
- Integration of our Discharge and Community Therapy teams - with extended hours and urgent same day response
- Additional therapy support in our Emergency Departments (EDs) and for daily reviews of NMC2R / NTF
- Development of single assessment process
- Patients receiving rehabilitation care in the community
What is being looked at?
Demand management (partners / Whole System Flow)
Why are we looking at this?
- Increased pressure on our urgent and emergency care services with no additional resources
- Long waits for care and overcrowding in our EDs and Urgent Treatment Centres
- Long waits for mental health / social care assessments
What might this mean?
- Working differently with our partners (primary care, social care, etc) to ensure our patients get access to the care they need in a timely manner
What does this mean in 2025/26
- Changes to some of the services we offer - including Gynaecology, Trauma and Orthopaedics, Children and Young People, Ophthalmology, Outpatients, and RLI Medical Unit 2
- Changes in how some patients receive their care - including potentially having to wait longer, travel further, or being seen in a different setting or by a different health professional
- Colleagues may have to work differently - including potentially working in different areas / locations or with different teams
- We need to live within our budgets whilst also saving £32.5m
- We’ll reduce the amount we spend on staffing - including a reduction in high-cost temporary staffing and the number of colleagues we employ
- Changes to how we use our hospital and community estate
- We’ll start to use digital innovations to support our clinical and non-clinical services
If we get this right
- Support the direction for the NHS - providing care that is closer to home, more personalised and preventative
- The evidence tells us that:
- Patient care and outcomes will be improved
- Patients will receive the care they need quicker and easier
- We’ll live within our resources
- We’ll be more resilient and able to respond flexibly to fluctuations in demand
- Our services will be safe and sustainable for many years to come
- Financially, we are now very close to a breakeven position - meaning we can take control of our future with:
- More control over how we spend our money
- The ability to invest in our services like never before
- More capital money to spend on improving our sites
- More realistic and easier to achieve savings targets for teams
- Essentially - getting this right would mean improved services for patients, access to care closer to home, and autonomy and investment for our Trust
- Important we work together, be open to change, and support each other as we take these next steps
TBC