Case Study - University Hospitals of Leicester NHS Trust
Background
Each year the Trust typically performs over 54,000 operations across all surgical specialties, with a total of 48 operating theatres across their three main hospital sites. The Trust is also a ‘super specialised’ centre with many patients travelling from around the country to undergo specialist procedures. UHL also has a leading robotic surgery programme used for specialised Urology and Gynaecology procedures.
At the end of 2021, UHL was one of five Trusts in the UK with the highest elective care backlogs. Their waiting list included over 110,000 patients, almost 2,000 of whom had been waiting more than two years to start treatment. To meet NHS Elective Recovery Plan targets, UHL urgently needed support to resource a significant increase in surgical activity.
Key Features
4200+ long-waiting patients cleared across five specialties
80-strong dedicated insourcing workforce built
One in six surgical procedures classed as complex (ASA3+)
Approx 10% more productive compared to prior insourcing session outputs
Trust successfully transitioned out of NHSE Tier 1 list in October 2023
The solution
Using the pioneering new ‘allied’ staffing model, Medacs mobilised a new insourcing service for the Trust in just 3 weeks.
A dedicated workforce of over 80 was quickly built, with key members of UHL’s consultant clinical team supported by a fully externally supplied team of Nurses, ODPs and Anaesthetists.
A hands-on approach
Senior Medacs staff are present every weekend, here is an example of how this adds value:
“One weekend a patient with a pacemaker turned up for their scheduled operation and there were understandable safety concerns as this was not flagged in their pre-op assessment. Ordinarily this would have resulted in an immediate cancellation, but after I consulted with the surgeon, anaesthetist, recovery and ward nurse staff, and secured an overnight bed, everyone agreed that it was safe for the surgery to go ahead. Having waited two years for their operation, the patient was extremely grateful for my input.”
Integrated support
The contract scope was expanded to include Gynaecology, and the management of a full-time pre-operative assessment service, which supports both weekend insourcing sessions and UHL’s own in-week surgical activity.
Medacs also provided a team of skilled cardiac ICU nurses for UHL's Glenfield Hospital site, to support the Trust to restore their activity on complex cardiac surgery to baseline levels.
Tackling Complexity
Over time, the complexity of the weekly case mixes increased, with UHL trusting Medacs insourcing teams to manage specialist colorectal procedures, more complex gynaecology procedures (e.g. Total Abdominal Hysterectomy) and even major cancer cases.
On average, one in every six procedures undertaken is classed as complex. Each case mix is carefully assessed beforehand, and all surgical sessions reviewed and audited afterwards, with expert clinical coding to accurately classify procedures.
