Elective Recovery & Transformation Programme – Cheshire & Merseyside ICS


Design and management of the elective recovery and transformation programme for the Cheshire & Merseyside Acute and Specialist Trusts Provider Collaborative


  • Design and build an elective recovery programme for 13 trusts across a complex ICS within the North West of England.
  • Oversight of the Targeted Investment Fund allocation and approvals process for capital funding to support elective recovery and transformation.
  • Manage programme management team across multiple project areas to achieve waiting time, activity, and efficiency targets as set by the NHSEI team.
  • Support delivery of the system-wide reduction of waiting lists in line with national waiting time targets, improving theatre utilisation, and increasing activity levels to secure Elective Recovery Funding.


What we did

  • Designed programme structure and governance to establish a range of programme areas including:
    • Trust level recovery plans: waiting list management, outpatient improvement programmes, separation of elective and emergency care pathways
    • Risk stratification and cohorting: supporting prioritisation and reducing clinical risk of waiting, health inequalities focus
    • Waiting well and prehabilitation: reducing the risk of decompensation whilst waiting, reducing cancellations, waiting well initiatives
    • Increased capacity: elective surgical hubs, shared waiting lists, mutual aid systems and process, increased independent sector support
    • Digital innovation and system working: digital advice and guidance systems, expansion of virtual wards and remote monitoring, and non-face to face appointments
    • Workforce innovation: shared and ringfenced staffing models, “theatre right” efficient theatre staffing, role redesign.
  • Established central programme functions, including capital funding processes, mutual aid hub, weekly PTL monitoring, theatre efficiency programme, and IS review.
  • Attain provided embedded programme director and programme manager roles to work in partnership with the system.


Our impact

  • Attain supported the system to reduce the number of patients waiting over 104 weeks by over 1,200 patients in a 6 month period.  This meant the North West was one of only 2 regions that achieved the target of eliminating 104 week breaches by July 2022, except for a small number of legitimate exemptions around patient choice.
  • In the last 13 weeks (to December 2022) the system has reduced the numbers of patients waiting over 78 weeks by over 20,000, and is on track to eliminate waits of over 78 weeks by March 2023.
  • Since the launch of the theatre utilisation programme, the C&M system has moved to the upper quartile nationally and is currently achieving 83% utilisation against a baseline of 73%, with 3 hospitals now in the top 10 in the country.  Hospitals in Cheshire & Merseyside have been treating an additional 7% more patients in theatres since March 2022, and have treated more than 19,000 patients compared to the previous 12 months.
  • Attain, C2Ai and our NHS partners received a “highly commended” HSJ award for our work on risk stratification of waiting lists using AI.

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