Overview
In 2024, a large NHS teaching hospital engaged MBI Health to carry out a series of independent diagnostic reviews, covering Referral To Treatment (RTT) performance, Cancer tracking, and Diagnostic (DM01) data quality. The initial remit was to assess and advise on data integrity and patient pathway management, following significant concerns raised by both internal and external stakeholders.
What began as a review programme evolved into a full-scale operational transformation. After MBI’s initial findings, the Trust invited the team to step into key leadership roles to implement recovery and redesign the Trust’s elective care and data governance infrastructure.
This case study summarises both the diagnostic phase and the delivery impact of MBI’s engagement.
Phase 1: Diagnostic Review
1 – RTT Data Quality Review
MBI’s review uncovered systemic failures in RTT tracking. Instead of a single PTL, the Trust operated three separate milestone lists — first outpatient, continuing, and admitted — managed via SQL extracts, spreadsheets, and workarounds outside the main PAS. Key issues included:
- Inappropriate exclusions: Thousands of patients were removed from RTT PTLs using local rules that breached national guidance. In one month alone, over 3,500 red-rated exclusions were applied.
- Missing clock starts: Over 20% of pathways lacked an identifiable RTT start date, hindering chronological booking and risking unmanaged delays.
- Broken validation and governance: RTT statuses weren’t recorded in PAS. Instead, validation took place offline via spreadsheets, with admin teams interpreting clinical letters—making PAS unreliable.
- Site-level inconsistencies: One site had no live PTLs and provided poor-quality data. Clocks were routinely reset at referral, artificially shortening reported waits.
Conclusion: The Trust’s RTT infrastructure was unfit for purpose. MBI recommended treating recovery as a PAS re-implementation—starting with data cleansing and rebuilding validation processes from the ground up.
2 – Cancer PTL Review
Cancer pathway tracking was also fragmented. Only the 62-day PTL was live — and even that was incomplete.
- No live 2WW or 31-day PTLs: Performance was monitored retrospectively, with minimal real-time oversight.
- Data silos across sites: Some tumour sites weren’t using Infoflex; others relied on manual entry, leaving teams blind to large parts of the cancer waiting list.
- Missing DTT and TCI dates: Most patients on the 62-day PTL lacked decision-to-treat or treatment dates, weakening assurance.
- No central 31-day tracking: Despite strong reported performance, there was no live system to flag delays or outliers.
Conclusion: Despite strong treatment performance, the Trust lacked visibility. Tracking was incomplete, reactive, and left patients at risk of being missed.
3 – Diagnostic Data Quality Review
MBI assessed the completeness and accuracy of data underpinning the DM01 national return.
- Imaging data was reliable, supported by a Radiology Information System.
- Non-imaging diagnostics were under-reported due to reliance on free-text fields for procedure intent, with detection dependent on keyword searches rather than coded entries.
- Planned diagnostics showed significant gaps: thousands of patients lacked due dates, and many had TCIs in the past, indicating they were likely overdue and unmanaged
Conclusion: Non-imaging diagnostics were under-reported and poorly managed. Surveillance patients were missing from core PTLs, creating clinical and reputational risk.
Phase 2: Leadership and Delivery
Following the diagnostic phase, MBI was asked to take up key operational & leadership roles across both sites to lead the recovery programme.
Programme Structure and Governance
MBI deployed a multi-disciplinary team into the Trust, filling key interim posts including:
- Elective Recovery Programme Director
- Elective Recovery Specialists
- Operational Leads at both hospital sites
- Programme Management Office (PMO) Leadership
- ECRP (Elective Care Recovery Programme) Co-ordination
The remit covered both technical and operational transformation, with MBI leading the design and execution of recovery plans working directly to the Trust Executive Team and providing regular updates to NHSE.
Outcomes
Following MBI’s diagnostic review and leadership of the elective recovery programme, the Trust achieved a full operational and cultural transformation.
- Within 12 months, all major data quality and patient tracking issues across RTT, cancer, and diagnostics were resolved.
- The Trust resumed national RTT reporting with high data confidence and reduced its long-waiter backlog to among the lowest in England. New, accurate PTLs were created for all pathways, supported by real-time PAS data, with teams operating under a clear performance rhythm and accountability.
- Cancer services were overhauled with full pathway tracking (2WW and 31-day PTLs) and consistent Infoflex use across tumour sites. Diagnostic accuracy improved through coded procedure tracking and guaranteed admission dates. Surveillance patients are now actively managed and prioritised.
- Now one of England’s top-performing elective care providers, the Trust continues to benefit from the governance framework established by MBI—anchored in strong leadership, reliable data, and a high-performing culture.
MBI’s work delivered not only operational fixes but a sustainable recovery model—proving that expert external leadership, paired with internal commitment, can drive sector-leading NHS transformation.
