Our journey into 2025/26

We are UHMBT - Purpose, Visions, Values and Strategy

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.Our four areas of focus listed as 4 parts of a cog - quality, colleagues, resources and partnerships

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

A line illustration drawing of a nurse shaking hands with a person in a wheelchairWe 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  A line illustration drawing of a person lying down about to have a health scan, with a health professional standing with them wearing a stethoscope
  • 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 

A line illustration drawing of someone sitting in a comfy chair with a drink, while a health professionals walks towards them holding a clipboardThere 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.A line illustration drawing of a pregnant person being hugged by their partner and a health professional putting their hand on the pregnant person's shoulder

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. A green square which includes of one our areas of focus for the 2025/26 financial year - Make the best use of our financial and physical resource

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 a series of engagement sessions in May/June and October 2025, and February/March 2026. Further dates will be shared soon.

Public engagement sessions presentation (plain text version)

Outline of today's session

  • Update on some areas of focus for the next three months​
  • Progress in four of our areas of transformation:​
    • Clinical service reconfiguration and pathway standardisation​
    • Estates optimisation​
    • Digital​
    • Capacity reduction and demand management​
  • Next steps​
  • Questions

Areas of Focus

  • Neighbourhood Health Implementation Programme - providing care closer to home​

  • Involvement in the National Maternity and Neonatal Investigation​

  • Care Quality Commission (CQC) inspection of our urgent and emergency care andmaternity services​

  • The money​

  • Improving how we engage with our colleagues, stakeholders and local communities​

Clinical service reconfiguration and pathway standardisation​ - Trauma and Orthopaedics​

What is being considered?

  • Any opportunity to improve services - making them safe and sustainable well into the future ​

  • How we can carry out more surgeries in our newly accredited Surgical Hub at WGH​

  • Working to make sure we consistently follow best practice, like the Getting It Right First Time (GIRFT) approach,including:​

    • Running outpatient clinics in a similar way across different specialties, so we can see more patients efficiently​

    • Organising theatre lists to focus on straightforward, high-volume procedures - helping us treat more people, cutwaiting times, and save money​

    • Reducing last-minute cancellations and shortening how long patients need to stay in hospital​

What have we done? 

  • Changed the way we deliver some operations and outpatient clinics to allow us to see more patients and reduce waiting times, including: ​

  • Carrying out four primary hip or knee operations on all day lists ​

  • Reorganising our outpatient clinics so they run more consistently and see as many patients as possible

What will we do next? 

Continue to work with doctors and other clinical staff to make improvements to the Westmorland Surgical Hub, so that more patients can have their operations there

What have we done?

Visited other NHS Trusts to see how they deliver services in their Surgical Hubs and general operating theatres to help us develop our plans

What will we do next?

Explore ways to help orthopaedic patients go home sooner - making their experience better and helping us check if we have the right number of beds for this service

Clinical service reconfiguration and pathway standardisation​ - Gynaecology​

What is being considered?​

  • Every opportunity to improve services - making them safe and sustainable now and well into the future ​

  • How we can carry out more surgeries in our newly accredited Surgical Hub at WGH​

  • Working to follow best practice consistently, including the Getting It Right First Time (GIRFT) approach. This means:​

    • Doing more procedures as day cases, so patients can go home the same day​

    • Carrying out suitable treatments in outpatient clinics instead of admitting patients to hospital​

    • Increasing the number of operations we do using keyhole (laparoscopic) surgery, which helps patients recoverfaster​

What have we done?

Secured national funding to buy new equipment so we can carry out hysteroscopic tissue removal using local anaesthetic in our outpatient clinics. This means around 150 patients a year - who would normally need a general anaesthetic - can now have a quicker, less invasive procedure

What will we do next?

Work with our teams to agree how the service will run in the future, aiming to carry out all suitable procedures in our Surgical Hub. This will help us treat more patients and cut waiting times

What have we done?

Started working with our clinical teams to explore new ways of delivering care. The goal is to carry out more planned operations in our Surgical Hub where operations are less likely to be affected by unexpected events like emergencies

What will we do next?

Look at different ways to organise our teams and explore options to invest in roles like nurses and allied health professionals, so the service can continue running well in the future

Estates optimisation​

What is being considered?​

  • We’re reviewing how we use our buildings and spaces - both in hospital and in the community - to:​

    • Spot areas that aren’t being used well and look at options to combine or repurpose them​

    • Make sure we’re getting good value from partners who use our space, either by increasing income or cutting costs​

    • Improve how patients and supplies are moved around, making transport safer, quicker, and more efficient​

What have we done?

Reduced taxi use by introducing a new approval and booking system, and making sure everyone across the Trust knows how it works

What will we do next?

Monitor all taxi use to ensure it is appropriate and publish a timetable of contracted courier services to move equipment /drugs/consumables across sites on the intranet transport page

What have we done?

Stopped using private ambulances at WGH, FGH and RLI. Internal RLI patient transport is now managed in house and we’re making sure patients know early on what to expect for their discharge and travel arrangements

What will we do next?

Keep an eye on the changes to ambulance provision to make sure they become part of our regular way of doing things. Continue educating and supporting staff in eligibility criteria and alternative options for patients

What have we done?

Moved out of Moor Lane Mills in Lancaster and making progress in identifying new space for those affected

What will we do next?

Continue to progress estates works to facilitate moves together with options for further leases for teams

What have we done?

Started reviewing how our sites are being used, and the assessment is now well underway

What will we do next?

Continue to review how we use our buildings and spaces, to make sure they’re being used in the best way

What have we done?

Launched a new Commercial Strategy, which means we can now look at ways to bring more money into the Trust and strengthen our finances

What will we do next?

Update our Private Patient policy to make the process clearer and better managed, so we can safely increase private patient activity in selected specialties and procedures without impacting on NHS activity

Digital

What is being considered?​

  • We’ve chosen three key digital tools to help us work more efficiently and save money:​

    • Ambient Voice Technology (AVT) - lets clinical colleagues record notes and information hands-free​

    • Patient Engagement Portal (PEP+) - helps patients manage appointments and access information online​

    • Non-clinical Digital Assistant - supports admin tasks so colleagues can focus on tasks only humans can do​

What have we done?

Ambient voice technology (AVT)​

  • Successfully tested AVT in four specialities, with positive feedback from clinicians​

  • Started the process of buying the software​

  • Reviewed how AVT will affect the types of admin roles we’ll need in the future to support clinical teams

What will we do next?

AVT​

  • Finalise the purchase of our AVT system​

  • Make sure AVT links smoothly with our electronic patient records to keep processes efficient​

  • Roll out AVT across outpatient, inpatient, and community services​

  • Create a workforce plan for clinical admin and helping colleagues build new skills as their roles change

What have we done?

Patient Engagement Portal (PEP+)​

  • Updated our PEP+ system so we can send letters to patients electronically, helping us save money on postage​

  • Patient Inclusion Passports are now available across our Trust systems and shared with partner organisations, so everyone involved in care can access them

What will we do next?

PEP+​

  • Roll out electronic letters to all specialties​

  • Extend self booking options for patients, so they can pick appointments that fit

What have we done?

Non-clinical digital assistant​

  • Designed a digital assistant for People Services that will let colleagues access information they need, day or night

What will we do next?

Non-clinical digital assistant​

  • Finish testing on our People Services digital assistant ​

  • Look at ways digital assistants could help across the organisation

Productivity and efficiency​ - Outpatients

What is being considered?​

  • Launching a new digital booking system that lets patients arrange appointments at a time that suits them​

  • Expanding Patient Initiated Follow Up (PIFU) in the right specialties so patients control when they need a follow-upappointment​

  • Using Advice and Guidance to help patients get the right care without always needing to come into hospital​

What have we done?

Advice and Guidance​

  • Increased the number of referrals we can safely redirect from 45% to 48%. This means fewer patients need a first outpatient appointment and can get treatment sooner in other appropriate settings

What will we do next? 

Patient-Initiated Booking for Outpatient appointments​

  • Launch a new digital booking system - based on the NHS App - so patients can book their own appointments when it suits them

What have we done?

PIFU​

  • 18 specialties are now using Patient Initiated Follow Up (PIFU) in at least 5% of cases - up from 15 specialties in April 2025. This means more patients are in control of when they receive the care they need

What will we do next?

PIFU​

  • Aim to have 27 specialties using PIFU by the end of March 2026

What have we done?

Missed Appointments​

  • Started using AI to spot patients who might miss their appointments, so we can contact them early and help avoid delays

Capacity reduction and demand management​ - Not Meeting Criteria to Reside

What is being considered?​

  • Ways we can reduce the number of patients who no longer need to stay in hospital, so we can improve their experienceand help others get care quicker. This includes reviewing how we manage discharges inside the hospital and workingwith other organisations to tackle delays outside the hospital, like arranging care or transport​

What have we done?

Internal delays​

  • Redesigned our discharge process so that Local Authority teams are involved earlier when patients have more complex needs​

  • Boosted our community therapy teams so they can support more people at home​

  • Introduced a new Wellness model of care, which is already showing strong results - Emergency Department visits are down by 31%, and hospital bed use has dropped by 75% in patients who have used the service

What will we do next?

  • Make ward and board rounds more effective, learning from what works well elsewhere, and removing obstacles so patients can be discharged quickly and safely to the right place​

  • Help patients who stay longer avoid losing strength and mobility (known as de-conditioning)​

  • Aim to discharge patients every day of the week​

  • Support doctors and nurses to use clear criteria to decide when patients are ready to go home​

  • Expand our virtual ward so more patients can be safely monitored or recover at home - freeing up beds for others

What have we done?

Delays due to onward capacity​

  • Moved the Hospital Homecare team to Westmorland and Furness Council to improve how we discharge patients ​

  • Continuing to use beds at Park View Gardens for patients who don’t need acute hospital care​

  • Review criteria for Maudes Meadow residential care home in Kendal (non-therapy)​

  • Launched weekly reviews of the ten most complex discharge cases to help reduce delays

Next steps

  • Work closely with key people - including patients, commissioners (the ICB), local oversight committees, colleagues, partners and our communities - to make sure their views help shape what we do​

  • Commitment to listening, involving the right people, and consulting properly if required​

  • Keep everyone informed by sharing regular updates through social media, our website, and other communication channels​

  • Next ‘Our Story’ sessions planned for February / March 2026​

Digital and AI

I’m sceptical that the IT advances will make that much of a difference.

The advances that Chat GPT is making has been amazing in helping people with everyday life. If we can harness some of that to ensure that some of those routine tasks are automated – so that our colleagues do the things that only humans can, it will definitely help in delivering healthcare.

Previous IT projects have been multi-million pound systems, this is something else – using AI to do tasks, with checks and balances built in to ensure everything is safe.

Will ambient AI be used just for consultants or will others, such as physios, be able to make use of it?

While the initial trials are with medical workforce, we do not see this being limited to them, and so it will be able to used by all groups of people for tasks where it can help, allowing colleagues to focus on just the things that only humans can do.

Transport and Discharge issues

How does this line up with the 10-year NHS plan? How do we ensure it’s carried through?

We expect our plans to line up with those in the 10 year plan, however we will need to wait for publication. The plan is expected to be balanced and therefore not be affected by any changes in government down the line, however we can only work with the information we have.

Within community therapy we have put a lot of time into making a very efficient patient transport resource, and we’re worried this will be lost?

Our current provider for that service has lost other contracts so cannot provide the service any more in the way that we want it, so we are discussing with them what the alternatives are.

Service provision

How can we help with prevention?

We cannot do huge public information campaigns, but we can and should do more. If we can help to stop people getting ill in the Morecambe Bay area and keep people well longer then that is something we should do with our partners.

How will we involve patients and persuade patients they may have to wait a bit longer?

We have a full programme of activities to involve the public with our public membership and through our governors to ensure that they have the opportunity to contribute.

We’re part of frailty but this is the first we have heard of it

The main focus of the frailty work is at the RLI – that is where we can see the biggest opportunity. These programmes are not about spending money (so if you have a business plan with a cost attached – we haven’t the funds for it) but at the RLI we can use our resources differently to get a better outcome for our patients.

Will you be closing services?

This is not about closing services – that would require public engagement and consultation from the ICB and different commissioning intentions.

This work is about things within our control. It may mean doing things differently, and asking patients to travel further – but in return they would get seen sooner or see better clinical outcomes

Can you share with staff which services and specialities generate the most money, as a service manager I don’t know how others are performing, and it would be helpful to see the bigger picture?

This is a really good point, and we can make this information available in future finance briefings and in Divisional communications.

Who will make the decisions on which services will change, clinicians or management?

It isn’t about removing resources overnight we will work together and with the data and GIRFT to support the decision making. We must balance the risk associated with the patients care.

Estate/New Hospital programme issues

We have tried to make MU2 at the RLI a focus for therapy before but it hasn’t worked – why will it this time?

This time we are not doing it in isolation but in conjunction with other workstreams and they will need it to work, so there will be much more focus and resource behind it

If you want people to be seen closer to people’s homes, the community estate isn’t as up to standard as some of the hospital estate – what can be done about this?

We will have to look at the capital programme to address some of these issues