Client: An East Staffordshire Acute Hospital NHS Trust working with a local Integrated Care Board (ICB)
Focus: Improving cancer Referral-to-Treatment (RTT) performance and pathway delivery
Overview:
An Acute NHS Trust had consistently failed to meet the national cancer Referral-to-Treatment (RTT) constitutional standard over a number of years. The issue posed significant risks to patient outcomes and system assurance, requiring both immediate performance improvement and longer-term pathway transformation. The Integrated Care Board (ICB) sought targeted support to address entrenched delays while maintaining a constructive relationship with the Trust.

Our Approach:
Working alongside the ICB’s Contract Manager, the owner of PALAR supported the formal use of contractual levers to drive improvement, while simultaneously enabling collaborative clinical and operational redesign. A Remedial Action Plan (RAP) was formally raised at the Trust’s contract meeting to establish clear expectations, governance, and accountability for delivery.

Recognising that contractual action alone would not deliver sustainable change, PALAR engaged directly with the Trust’s Chief Operating Officer to co-design revised cancer pathways aligned to updated NICE guidance. Detailed pathway reviews identified specific tumour sites where outdated processes were contributing to delays and breaches of the RTT standard.

Our support included:
• Raising and managing a formal Remedial Action Plan through the ICB contract framework
• Facilitating executive-level engagement between the ICB and Trust leadership
• Supporting the redesign of key cancer pathways in line with current NICE guidance
• Identifying workforce and financial constraints impacting delivery
• Broker­ing agreement to co-develop a Commissioning for Quality and Innovation (CQUIN) scheme
• Linking financial incentives to clear milestones to support sustainable transformation

Outcome:
The combined approach of contractual enforcement and collaborative partnership enabled the Trust to implement pathway changes that had previously been unachievable due to resource constraints. Performance against the cancer RTT constitutional standard improved, resulting in the standard being met after several years of underperformance.

Impact:
By aligning system assurance with clinical collaboration, the ICB and the Trust moved from adversarial contract management to shared ownership of improvement. The success of the approach was formally recognised in correspondence from the Secretary of State for Health to the ICB Chief Executive, reinforcing the value of balanced, system-wide leadership in delivering improved cancer outcomes for patients.