An elective care hub is due to open in Spring 2025 at St Albans City Hospital. The hub is being developed in partnership between Hertfordshire and West Essex (HWE) Integrated Care Board and the three acute trusts within the system (made up of East and North Hertfordshire NHS Trust, The Princess Alexandra Hospital NHS Trust, and West Hertfordshire Teaching Hospitals NHS Trust). The development of the hub aims to address the challenge of recovering elective activity by increasing capacity for ring-fenced elective work within the HWE Integrated Care System (ICS), by providing two new operating theatres. This additional capacity will provide patients with surgery faster, reduce waiting times and improving clinical outcomes and experience for patients across the system.
The collaborative work takes place through a joint programme, with all organisations represented and supported by a joint project team. An executive level Programme Board is chaired by Michael Meredith, director of strategy and estates at The Princess Alexandra Hospital NHS Trust, the ICS's senior responsible owner for the elective care hub. The board oversees seven workstreams which have been established to deliver key areas of the programme. The workstreams each have leads and membership from all three trusts and the ICB. In addition, there is an elective care hub clinical advisory group and further clinical engagement taking place via the ICS clinical networks.
The case for the hub was made following analysis by the HWE system, which found that there was inequitable and insufficient access to elective care, with patients waiting a long time for treatment, and evidence that patients waiting for lower complexity surgeries were being delayed due to urgent trauma and emergency care.
While the hub will focus on HVLC elective activity – particularly hip and knee surgery, spinal injections and ear, nose, and throat (ENT) procedures, it is expected to deliver wider system benefits through cutting waiting times more broadly. Most notably, creating significant additional capacity will free up theatre capacity within the three trusts to support cancer, paediatric and complex surgery. The system currently has pressure points within all these surgical pathways and the opportunity to clear the routine elective backlog will help the system achieve better waiting times and outcomes in these areas.
In total, the capital requirements to design and build the new hub are approximately £25m, £22m of which was approved by NHS England from TIF funding. The system agreed to provide capital funding to support this case and therefore each partner acute trust and the ICB have agreed to fund the remaining £3m through system capital funding.
Although it will be built on the West Hertfordshire Teaching Hospitals NHS Trust site, the three acute trusts have developed and agreed a joint working agreement which sets out how the hub will act as a system asset for all partner organisations.
Under the agreement, the three organisations have agreed to a risk and profit share arrangement. This means that each organisation is allocated capacity within the hub and is responsible for the required revenue costs for their theatre lists. Each organisation is therefore responsible for running their own lists as efficiently as possible, and receiving their individual financial return based on how productive and efficient that trust has been within the hub. This is overseen by a business unit which will manage the overall operational and financial running of the hub.
The three trusts have optimised the opportunity by developing a clinical model to standardise care for patients and streamline clinical pathways. Through consultation and continued co-creation with clinicians and patients, the three trusts will adopt a best practice model recommended by GIRFT (GIRFT, 2023) to support 40% of patients attending the hub for hip and knee operations to go home the same day. The model requires intensive therapy provision, and a standardised approach across all staff. The intention is that as this model is rolled out at the hub it will also be integrated across all three organisations to improve outcomes and patient experience.
Having their operation at the hub will be offered as a choice for patients. When a patient does choose the hub, they will receive their pre-operative and post-operative outpatient care within their "home" trust, supporting care closer to home and avoiding unnecessary travel. This will be supported by collaborative workforce planning to manage and carry out the procedures. Consultant surgeons and anaesthetists from all three trusts will work together within the facility, supported by a dedicated theatre, ward and therapy team. In addition, the three organisations are implementing a competency framework for theatre staff at the hub and across the trusts. The framework will standardise capabilities of theatre staff, offer fast track opportunities for orthopaedic scrub nurses and introduce new band 4 roles, all with the aim of supporting highly productive theatres and offering opportunities to staff to upskill and progress.
The hub will open in Spring 2025. The projected benefits include:
- Two additional theatres, delivering recurrent activity of 4,388 elective cases by the time the hub is fully operational in 2026/27.
- A reduction in the cost of outsourcing elective work to independent sector providers. The partners aim to eliminate outsourcing of procedures that will be carried out at the hub by 2026/27.
- Capacity freed up at the acute sites for complex, cancer and trauma/emergency work as a result of the additional capacity provided by the hub.
- As the facility will be dedicated to HVLC procedures, it is anticipated that levels of productivity will be higher. This will be facilitated through specific productivity targets, which include 6-day operating, 2.5 session days, and 85% theatre utilisation (in line with GIRFT recommendations).
- Improved service resilience through providing ringfenced capacity on a planned care site and freeing up theatre capacity for complex electives at existing acute sites.
- Increase in training, retention and development opportunities resulting in reduced vacancy and turnover rate.
- Improvement in waiting times and patient outcomes and experience.
The success of the collaborative approach to date has been due to a common commitment to tackle system challenges, identify opportunities to standardise care and innovate, and maximise the investment to the benefit of patients across the system.