Paediatric accelerator

Case study summary

Outcomes of national funding made available to tackle CYP waiting lists.

This case study is part of a suite of examples designed to support the contents of the children and young people’s elective recovery toolkit.


In May 2021, £160 million was made available to tackle waiting lists, trial new ways of working and develop a blueprint for elective recovery across services to go further and faster, in response to the impact of COVID.


£20 million was dedicated as part of the Children’s Hospital Alliance (CHA) and funding broken down into:

  • £1 million for a joint innovation project
  • £2.7 million each for transformation in core trusts Alder Hey, Birmingham, GOSH, Manchester, Sheffield (£13.5 million total)
  • £1 million each for transformation in additional trusts Bristol, Evelina, Leeds, Oxford, Southampton (£5 million total)
  • £500,000 for a joint PMO.

Impact and benefits

Strong governance with 10 chief operating officers, directors of finance and programme leads, who oversaw workstreams including:

1. Delivery of elective activity

  • 6% activity achieved in May-Nov 2021, compared to 2019/20, against a target of >100% – through >2,000 additional appointments via 2x Super Saturdays.

2.  Innovation

  • Missed appointments cost the 10 trusts £13.4 million per year – the rollout of an artificial intelligence tool to all 10 Trusts, developed originally at Alder Hey, by March 2022, allowing trusts to identify in advance which children are most at risk of not attending appointments, so that they can support the child and their family.
  • Seven of the 10 trusts have shared data and the tool is working to 80% accuracy.

3. Inequalities

  • Building on the AI tool, across the 10 trusts, pilot programmes including free transport, appointments in schools, access for patients with ADHD, clinician led calls and access to patient portals have been used to understand and reduce health inequalities, in addition to data collections and working across trust boundaries.

4. Data and benchmarking

  • Monthly monitoring of activity and finance
  • Benchmarking on access based on deprivation, ethnicity, learning disability status
  • Use of outpatient follow-up appointments by speciality
  • Demand modelling for waitlist growth, financial gaps, activity requirements.

Trust outcomes

Alder Hey:

  • New ENT consultant treated 670 additional outpatients and 100 inpatients
  • Super Saturdays = 1,170 additional outpatient consultations and 24 theatre lists
  • Ortho and spinal = jointly ran an additional 50 weekend theatre lists.


  • Piloted a high impact intensity theatre (HIIT) list
  • Established standby patient and patient call-out processes
  • Shared learning from Sheffield and GOSH and supported a pilot for reducing general anaesthetic (GA) use in MRI
    • 200 additional operations and almost 2,000 outpatient consultations.


  • Increased activity by 10% in 2021/22
  • Changes to flow in the emergency department
  • New mental health roles
  • New outpatient neuro-rehab service and improved allergy service
    • New bed capacity in medical ward and new outpatient capacity.


  • New pre-op assessment software
  • 108 slots for neurosciences; reduced follow-up backlog by 24%
  • Urology fellow – 20 more clinics and extra capacity
  • New endocrine consultant saw 570 patients.


  • 13% increase in elective inpatient stay/day case from 2019/20, 9% increase in outpatient
  • New theatre cleaning project increased flow
  • Integrated rostering and EPR
  • Capital investment in equipment increased capacity
  • Extra capacity = able to provide mutual aid to Royal Free.


  • New outreach team for deteriorating children
  • New ‘accelerator’ matron; new complex needs team
  • Additional long-term ventilation capacity
  • Digital outpatient department room booking system
  • 710 more surgeries, 1,628 more outpatients compared with 2019/20.


  • New dental and day case theatre hubs on two sites
  • Expansion of theatre walk-in, walk-out pathway
  • Additional posts across multiple specialties
  • 7,278 additional outpatient appointments and 1,466 elective procedures.


  • 20 highly specialist spinal surgeries with very long waits completed with the independent sector
  • 7% increase in outpatient activity
  • Supported the children’s hospital to deliver 106% of 2019/20 outpatient activity overall.


  • Over 210 projects approved
  • 130 new colleagues in various roles to support extra capacity
  • Five new permanent outpatient rooms
  • Improvements to theatre suite; inequalities interventions eg health bus to reach deprived communities
  • New joint models for clinics.


  • Expansion of home sleep study service
  • Trialled ‘intelligent triage’ model for dermatology
  • New non-medical roles, eg pharmacy-led clinics
  • Saturday lists providing, eg 188 additional elective orthopaedic procedures.


Alexandra Norrish: