Big teaching trusts put under extra NHSE ‘oversight’

The quarter three tiering update, seen by HSJ, shows:

• Leeds Teaching Hospitals Trust  has been moved into Tier 1 – the highest level of oversight – for both elective and cancer performance. Previously it was in Tier 2 (of 3) for cancer; and was not being monitored for electives;
• The Royal Free London, another large provider, in north London, has been moved to Tier 1 for cancer performance. Previously it was in Tier 2; and
• Oxford University Hospital Foundation Trust has been moved into Tier 1 for elective performance (previously in Tier 2).

Leeds, the Royal Free and Oxford are among some of the biggest trusts, with a combined annual turnover of more than £5bn, and serving a population of about 13 million across the South, South East and Yorkshire.

Meanwhile, James Paget University Hospitals Foundation Trust, a small district general hospital in the Norfolk and Waveney Integrated Care System, was also moved into Tier 1 for both cancer and elective performance. It was previously in Tier 2 for both.

Leeds and Oxford hospitals were among the trusts which did not meet the target of virtually eliminating 65-week elective waits by September, and have been given an extension of three months.

In July 2022, trusts with the biggest 62-day backlogs were grouped into tiers 1 and 2. This means there are more “regular conversations” between their leaders and NHSE officials, and more support – sometimes including additional funding – from NHSE regional performance teams and cancer alliances. Other trusts are in Tier 3, with no extra oversight.

The tiering system has since developed to also include the 28-day faster diagnosis and 62-day referral to treatment cancer standards.

In September, the latest available data, Leeds’s performance on the 62-day target was 63 per cent, putting it 103 out of 139 trusts which reported. Its performance on the 28-day standard, meanwhile, was 74.1 per cent, putting it 88 out of 133. Many of the providers above Leeds treat fewer patients.

In terms of electives, Leeds’s position on 65+ weeks waits in September was 16 out of 155 trusts. It had 392 (0.4 per cent of total list size) people waiting this long for treatment, down from 1,083 in September last year.

The Royal Free’s performance on the 62-day target was 52 per cent, putting it 126 out of 239. On the 28-day target, meanwhile, its performance was 113 out of 133.

Oxford had 677 people waiting 65+ weeks for treating, putting it 5 out of 155 trusts. 

James Paget’s performance on the 62-day cancer target was 72 per cent, putting it 65 out of 139 trusts. On the 28-day target its performance was 74 per cent, putting it 93 out of 133.

Leeds Hospitals said it still had long waits in ENT, paediatrics, and surgery, but pointed out the overall number was “falling”. 

A Royal Free spokesperson said it had so far received 2,000 more elective referrals this year, compared to the previous 12 months. The trust added that it was running weekend clinics and operating lists to try to cut waiting lists.

Oxford Hospitals declined to comment.

James Paget said it hoped that the opening of its new orthopaedic elective hub in two months would increase capacity and reduce lists.