Organisational features associated with high performance of high-volume low-complexity surgical hubs in the UK

Why it matters

After the COVID-19 pandemic, the number of people waiting for planned surgical treatment in the NHS, and the average waiting time for that treatment, increased sharply. By August 2025, 7.41 million patients in England were on the waiting list. Reducing long waiting lists for planned surgery is a key priority for NHS England.

Many patients on the waiting list need procedures that are fairly simple, aren’t urgent, can be planned in advance, and do not require an overnight hospital stay. Because of this, these procedures are considered ‘low complexity’ compared to other operations.

High-volume, low-complexity (HVLC) surgical hubs focus on carrying out these procedures in large numbers. They cover various clinical areas, from ear, nose and throat surgery to orthopaedics. They have been a central part of NHS England’s goal to reduce waiting times for planned surgery. There are now more than 100 of these hubs across England, and more are being created.

This study looked at five hubs that appear to be doing well, to try to understand what made a difference to their performance.

What we found

High-performing surgical hubs follow the guidelines set out by bodies that offer accreditation such as Getting It Right First Time (GIRFT), a national NHS England programme designed to improve the treatment and care of patients through in-depth review of services, benchmarking, and presenting a data-driven evidence base to support change.

A large part of the work done by the surgical hubs in our study focused on putting good practice from national guidance into action, drawing on evidence about how to improve productivity in areas such as operations management and organisational development. But participants in the study also described additional activities that they saw as really important.

The surgical hubs in our sample collected and reviewed data about their performance and enhanced it by gathering insights from staff on how they could improve the functioning of their day-to-day operations. For example, in one hub, a group including surgeons, theatre managers and matrons met weekly to go through cancellation data from the past week. “We create action plans from the data and make sure that the information gets circulated. We don’t allow fallow sessions, no session gets wasted, it gets allocated on time.”

High-performing hubs seemed to do well because they treated high performance as something to keep working on, rather than a state to arrive at, and they adapted and responded as situations changed. We found that staff used a mix of approaches to get more work done and to work more efficiently. Alongside following national standards and guidance, our analysis shows that it was important to stay flexible, respond quickly to changing needs, and adapt services to suit local staff and patient groups.