Background
The Northern Health and Social Care Trust (NHSCT), one of five Trusts in Northern Ireland, provides integrated health and social care services to a population of 470,000. Endoscopy services at NHSCT are delivered across four hospital sites—Antrim Area, Causeway, Mid Ulster, and Whiteabbey—handling approximately 12,000 diagnostic and therapeutic procedures each year.
Despite the vital role Endoscopy plays in early diagnosis and treatment, operational inefficiencies had led to underutilised capacity, delays in scheduling, and an over-reliance on waiting list initiatives. In 2020, as the service sought to rebuild elective capacity following the onset of COVID-19, Meridian Productivity was commissioned to deliver a structured improvement programme focused on endoscopy service optimisation.
Analysis
Meridian carried out a three-week operational review across all Endoscopy sites. The study revealed systemic inefficiencies including:
Poor list utilisation and scheduling delays
Lack of transparency in performance reporting
Limited planning tools for session management
Inconsistent downtime across procedure rooms due to ventilation constraints
Gaps in capacity forecasting and demand alignment
The findings pointed to significant untapped potential to increase throughput, reduce lost time, and improve service performance.
Implementation
Working closely with clinical leads, service managers, and the assistant director of surgical specialties, Meridian delivered an 18-week improvement programme. Key components included:
Introduction of a 6-4-2 session planning process to improve future list scheduling
Installation of weekly operational performance dashboards and review meetings
Creation of a Demand and Capacity Model to support commissioning and planning
Development of tailored procedure room norms accounting for cleaning, ventilation, and set-up times
Implementation of a new booking process designed to optimise session utilisation
Staff participated in CPD-accredited training, fostering a proactive culture and strengthening operational ownership. Importantly, all changes were delivered amid ongoing COVID-19 pressures, ensuring compliance with infection control measures while driving capacity recovery.
Results
The programme delivered measurable and lasting results:
12% increase in the average number of patients seen per list, with no increase in staffing
£90,169 in weekly savings from improved utilisation
30% reduction in late starts across all sites
Improved activity delivery, with commissioned activity rising from 35% to 53%
Sustainable behavioural change and better forecasting tools for long-term planning
The return on investment was clear. NHSCT gained improved visibility, tighter control over list efficiency, and the ability to align capacity with demand—critical in a post-pandemic environment where diagnostic backlogs remain a national concern.
