James McLean MBE, Regional Chief Nurse for the North West region, and Claire Morris, Senior Workforce Improvement Lead, share their insights from the first six months of the Enhanced Therapeutic Observations and Care (ETOC) programme.

Launched by the Nursing Directorate in September 2024, the Enhanced Therapeutic Observations and Care (ETOC) programme is supporting improvements in enhanced care provision and experience, reduce length of stay in hospital and improve workforce productivity and reduced reliance on agency.

ETOC focuses on delivering true therapeutic interventions that are individualised to meet patients’ specific needs, resulting in a more personalised experience and supporting a timely discharge.

The programme has now reached its six-month milestone and is already transforming how we provide enhanced care to vulnerable patients.

Collaborative success and early impact

The programme worked closely with clinical and ETOC leaders to create a strategy that improves services and reduces differences between providers. A group of 14 trusts joined the first phase, each developing local improvement plans using quality improvement methods. Interest in the programme was strong, with over a third of all trusts wanting to take part.

Six months in, the programme’s initial results are encouraging. Collaborative members report delivering approximately 400 hours of ETOC care monthly and have seen promising improvements in workforce deployment with more care being provided by substantive staff. Members report a 24% reduction in use of temporary staff and a 50% reduction in incidents of unstaffed ETOC requirements.

These early wins demonstrate how targeted support, and collaborative working can drive meaningful changes and positively impact patient care and staff experiences.

Building a community of practice

The ETOC programme has established a thriving professional community dedicated to improving care.

• 806 colleagues have participated in our webinar series covering governance, therapeutic intervention, education and training.
• 231 members have joined the ETOC community hub on FutureNHS (the platform requires a log in), creating a vibrant space for sharing ideas, networking and accessing resources.
• An Advisory Group of 110 nursing leaders has been formed.
• The first chapter of our improvement guide focusing on data and insight has been published, providing principles and examples for effective ETOC delivery

Learning from excellence

Our community hub on Future NHS hosts valuable case studies showcasing innovative approaches:

• East and North Hertfordshire NHS Trust has developed a specialist, substantive in-house team focused on patient care, creating consistency and expertise in ETOC delivery.
• Great Western Hospitals NHS Foundation Trust implemented a quality improvement approach including root cause analysis and developed a robust training package establishing clear standards for trust accountability.
• Medway NHS Foundation Trust launched a Therapeutic Practitioner pilot aimed at reducing enhanced care needs through proactive, tailored interventions—shifting from reactive observation to preventative care.

These examples illustrate how trusts can develop local solutions while maintaining core principles of quality care.

Looking ahead: new opportunities

Building on Cohort 1’s success and recognising the increasing demand for ETOC provision, we recently invited expressions of interest for Cohort 2 of our 90-day collaborative, launching in May 2025.

This will support 21 organisations to share, develop and test clinically-led approaches while drawing on the growing library of case studies, tools and learnings. Participating trusts will conduct diagnostic assessments to identify key challenges and develop local ETOC quality improvement plans aimed at enhancing patient outcomes and experiences.

Join our growing network

• Join our FutureNHS community hub to access our insightful case studies, catch up on our informative webinar series, and engage in thoughtful conversations on our forum.
• Stay connected by joining our distribution list to keep updated on upcoming events and news related to the ETOC programme.
• If you have a case study from your trust that you’d like to share, we invite you to contact our team at england.nursingworkforce@nhs.net we would love to highlight your important work.
• Join the conversation on X @team_CNO or by using the programme hashtag #ETOCP.