In the NHS, for most trusts and certainly all networks, at the moment the key constraints are entirely financial. With increased productivity is it possible to see increased return on investment and in the past this has been enough to keep finance departments happy – by demonstrating that a new tool, system or process will allow for a unit to see more patients on a daily basis and therefore increase the revenue flow of the unit.

However, with some of the new financial restrictions being placed and the loss of other finance streams, trusts and networks are being forced to lower their return on investment expectations from products and services in order to prioritise making spending cuts all together.

This does put other NHS targets at risk, some of the NHS’ 10 year plan includes focuses on

• Workforce Expansion and Retention
• Prevention and Early Detection Schemes
• Waiting List Reductions
• Shift from Hospital to Community
• Digital Transformation and Innovation
• Climate Action – Net Zero Targets

Every one of these targets is put at risk when trusts are forced to choose between improving their financial position and simply cutting their spending levels. 

Yet, the NHS is still a business and must be able to achieve financial stability in order to continue existing well into the future. These can feel like contrasting statements – to say there is an expectation to have to achieve a more varied set of targets than ever before whilst reducing spending costs and attempting to increase return on investment all at the same time. 

Many trusts have begun walking this tightrope but it is difficult to identify exactly where cuts can be made without significantly impacting performance, patient welfare and the rest of the above goals.

Agency spending is a target for cost cutting 

One of the most available and realistic to achieve of these was set out by the government as a target last year – reduce insourcing spending. Agency staff come at a premium cost, in the past this cost has been absorbed by many trusts as a way to combat rising waiting list times but with finances being the primary focus more and more trusts are reducing or removing their agency spends altogether.

Some trusts have treated this as a way to simultaneously increase their workforce plans whereas others have chosen to cut these additional lists entirely. Yet THRIVE data still routinely reveals over 100 lists per month in just one discipline within the North West of England recorded as having an agency staff member as the list leader. 

Another option many trusts are employing is to reduce the number of low value procedures and tests being performed, though this isn’t without clinical risks. Similarly, reducing administration costs by instead using software tools or merging multiple roles into one has also been employed by many trusts and networks.

What happens to procedures from Weekend Lists?

Elsewhere other trusts have begun to explore improving performance on ‘cheap’ sessions in order to reduce the number of ‘expensive’ sessions they put on. Specifically speaking, some trusts are actively looking at improving their Monday – Friday, Morning and Afternoon performance as a way to remove the need to perform Weekend or Evening lists.

THRIVE recorded over 5,000 lists in Endoscopy in May 2025 with an average planned points of 9.93 and an average achieved points of 8.83. Of these lists; weekday performance recorded 4463 lists at 9.79 planned points and 8.70 achieved points.

On weekends THRIVE also recorded 613 lists with 10.96 planned points and 9.97 achieved points.

On the face of this data, it reveals that weekend lists actually plan and achieve more points on average, however weekend lists rarely perform inpatient procedures, emergency lists or any complex lists which can often reduce the amount achieved on a list.

Additionally weekends tend to see much more straightforward procedures as there are often less specialists in the hospital for the scenario where a procedure goes wrong and specialist attention is needed. In this timeframe weekday lists saw 36 different procedure types while weekend lists only had 16 types of procedures.

Combine this with the additional expense required for a trust to put lists on a weekend or evening and some have begun working towards reducing the number of weekend lists performed by increasing productivity on weekday lists.

If over the 4,463 weekday lists the average achieved points had increased by just 0.3 points from 8.70 to 9.00 then it would have been possible to achieve an additional 1339 points. This would be the equivalent of the total points achieved by over 20% of our weekend lists. 

Thus, by increasing the average achieved points by 0.3 over all weekday lists there is the possibility to eliminate the costs associated with 135 weekend lists and still achieve the exact same throughput of monthly procedures as are currently being performed.

Extrapolating from this, applying the same above logic but posited that the achieved points increased by an entire point to 9.70 then departments could eliminate 75% of all weekend lists without losing any overall performance.

Ways to see improvements

It’s very important to remember that there aren’t any procedures that take just 0.3 points, so it’s not as easy as simply moving an individual procedure directly from a weekend list to a weekday list. Rather the emphasis must be on overall performance in which improvements can be monitored against initial baselines.

Exactly how trusts make these improvements varies entirely on where each trust believes more performance can be found. Some are focusing on reducing time lost to late starts and subsequently filling the time they regain with additional procedures. Others are focused on increasing their session utilisation rates or reducing the amount of procedure slots lost due to cancellations.

There are a host of available options and the THRIVE ‘Best Practice Series’ launching later this year will help to spread work being done across the North West that could feasibly be implemented or reviewed at any location.

Once again there is also the need to consider our understanding of current most important priorities. While finances are at the top of everyone’s lists, some trusts and networks still stand out above others as needing essential help to reduce their 6+ week wait lists. For these locations increasing performance is still essential, so weekend and evening lists may remain a necessity for the foreseeable future.

No one department is the same, so it increases the importance of knowing what exactly is happening in a specific hospital and being able to balance best practice with the reality of the pressures and priorities. THRIVE enables a clear view of current procedure numbers and productivity and allows insights into the impacts of all changes made – allowing for trusts to make changes that make a difference.