The Joint Health Overview and Scrutiny Committee for Northern Care Alliance met on Thursday 24 September 2026 to discuss a range of operational and strategic matters concerning the Northern Care Alliance NHS Foundation Trust. Key topics included an update on the Northern Care Alliance's Channel 4 programme, feedback from a well-led inspection, and the impact of industrial action, alongside a review of the Clinical Leadership Model and cost improvement plans.

Northern Care Alliance Programme and Inspections

The committee was scheduled to receive a briefing on the Northern Care Alliance (NCA) and was to be updated on any early outcomes or feedback from a well-led inspection. Additionally, an update on the impact of industrial action on the NCA's services was planned. The NCA has been transparent about its challenges and is implementing an integrated improvement plan to address issues identified by regulatory bodies. This plan is built around the principles of listening, learning, and partnerships, and spans six strategic themes and 17 programmes of work. The NCA received a Section 29A warning notice following a CQC well-led assessment in July, covering areas such as learning from incidents and complaints, staff speaking up, patient safety, staff wellbeing, and equality, diversity, and inclusion.

Clinical Leadership Model Update

A significant item on the agenda was an update on the implementation of the Clinical Leadership Model (CLM), which went live on 1 April 2026. The CLM was introduced to strengthen clinical leadership, improve accountability, reduce unwarranted variation in care, and create a more consistent approach to service delivery across the NCA. This involved replacing the previous Care Organisation structure with six Clinical Groups and 34 Clinical Service Units (CSUs). The report indicated that the transition was completed without significant disruption to patient services, and early positive impacts included clearer routes into service leadership for external partners and stronger Clinical Group oversight of complaints. However, it was noted that the site management model requires further development, and new leaders have reported spending excessive time in meetings due to legacy governance arrangements. The anticipated benefits of a fully embedded CLM model include reducing unwarranted variation in care, improving patient experience, strengthening clinical leadership, and supporting more effective use of workforce and organisational resources. The committee was asked to receive this update, note the progress made, and acknowledge the ongoing work to embed the model.

Cost Improvement Plans and Patient Impact

The committee was scheduled to receive an update on the NCA's Cost Improvement Plan (CIP). The NCA has developed a robust infrastructure to support the identification, development, and delivery of cost improvement targets, aiming to support the delivery of the NCA's Financial Sustainability Plan. The report highlighted that the total savings identified for FY26/27 were £80.6 million, with a gap to the target of £23.5 million. Key programmes contributing to these improvements include Medical Workforce, Nursing & AHP, Medicines Management, Digital, Estates & Facilities, Procurement, Outpatients, Length of Stay, and Theatres. The report indicated that all saving schemes are quality assessed, including their impact on patients.

Integrated Performance Report

An Integrated Performance Report was scheduled for review, which would provide an overview of the NCA's performance across various metrics. This report utilises Statistical Process Control (SPC) charts to highlight variation in data over time, distinguishing between common cause variation and special cause variation that may require further action. The report detailed Drive and Watch metrics across several key areas, including People & Learning, Elective Care & Productivity, Urgent & Emergency Care & Cancer, Finance, Quality, Safety, and Adult Social Care (Salford Only) & Community.

Within the People & Learning section, highlights included the completion of workforce planning for 2026/27 and mandatory training compliance at 93.50%. Areas of concern included sickness absence remaining above target and Welcome Back discussions being below target.

For Elective Care & Productivity, highlights noted improvements in RTT 18 weeks performance and outpatient productivity. However, industrial action was identified as a concern, reducing theatre capacity.

In Urgent & Emergency Care & Cancer, highlights indicated that 4-hour performance was consistently better than the previous year, and cancer access targets were met. Areas of concern included higher A&E attendances than the previous year.

The Finance section reported a year-to-date deficit of £18.3 million, in line with the plan, but noted that the level of CIP delivery remained the largest risk to the financial plan.

The Quality section highlighted a continued decline in stillbirth rates and reduced overdue risks. Areas of concern included new thresholds for CDI and E. coli infections and delays in complaint case management.

Safety metrics included the commencement of a Duty of Candour implementation refresh. Areas of concern noted a risk that a full improvement collaborative approach to Safer Sooner might be paused due to industrial action and medical engagement challenges.

The Adult Social Care (Salford Only) & Community section reported significant positive progress in reducing RTT community waiting times. Areas of concern included capacity constraints in some locality services and digital systems.

Work Programme

The committee was also set to consider and note the Joint Health Overview and Scrutiny Committee for Northern Care Alliance's Work Programme for 2026/27. Items requested for inclusion during the meeting included urgent care across hospitals, saving scheme plans and their effects on patients, patient experience (including complaints), clinical leadership updates, and a breakdown of Key Performance Indicators by the four areas (Oldham, Rochdale, Bury, and Salford) along with the context of each hospital's offer. An additional item suggested was a deep dive into community services.