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Mixed Methods Evaluation of the high-volume low-complexity surgical hUb pRogrammE (MEASURE)

What is a high-volume low-complexity surgical hub?

The UK government is investing approximately £1.5 billion in High-volume, low-complexity (HVLC) surgical hubs. These ‘hubs’ are being developed to reduce the backlog of patients waiting for elective (non-emergency) operations post-COVID-19 pandemic. 
Surgical hubs will bring together the skills and expertise of staff ‘under one roof’ and will provide dedicated surgical beds for patients waiting for planned operations. These beds are separate from emergency services. 
The HVLC programme is initially aiming to focus on six high-volume but low-complexity surgical specialities: ophthalmology, general surgery, trauma and orthopaedics, gynaecology, ENT and urology. 
When this research was funded there are more than 90 elective surgical hubs across the NHS in England. It is expected that more than 50 new hubs will be implemented over the next three years. 
You can read more about the HVLC surgical hubs on the ‘Getting it right first-time’ website 

Why is our research needed? 

NHS hospitals have taken different approaches to setting up these hubs, and the physical layout, staffing mix and remit (e.g. orthopaedics or multi-speciality) of hubs differ across England. Additionally, surgical hubs are at different stages of implementation. 
The Getting it Right First Time programme has identified the following as expected benefits of the HVLC surgical hubs: 

  • Provide more efficient use of theatre capacity through increased throughput
  • Increase resilience against winter pressures
  • Streamlined pathways and shorter lengths of stay
  • Application of innovative, more sustainable workforce
  • Reduced pressure on staff and improving morale, recruitment and retention. 

Independent evaluation is needed to find out if the HVLC surgical hubs can achieve their aims and offer value for money. 

What do we want to find out? 

What is the impact of the HVLC surgical hubs on productivity, patient care and NHS staff? 
More specifically we want to explore: 

  • What HVLC hubs already exist or are currently being set up in England.
  • How (quickly) the hubs are set up, what they do, how they work, and lessons that can be learned.
  • What the hubs mean for patients and carers.
  • What the hubs mean for its staff.
  • Whether the hubs have any unintended negative effects on the local NHS Trust and their workforce as a whole.

How will we do this? 

  • We will review documents from NHS hospitals and services and interview key policy and decision-makers for the hubs initiative.
  • Statistical analysis will compare NHS data on what happens in areas with and areas without hubs. We will do this every year during the project to look at levels of service, number of patients treated, waiting times and whether all patients benefit equally from hubs.
  • Researchers will visit up to nine hubs to watch and speak to patients and staff who work at the hub. This will help us find what works well, what needs improving, and how improvements can be made.
  • Health economics will help us find out which hubs are most and least productive. We will look at factors such as people’s medical conditions, survival rates and waiting times in relation to resources such as equipment, facilities and number of staff.
  • We will look at the way hubs are staffed and how that affects their wider NHS Trust.

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Funders(s) National Institute for Health Research, Health Services and Delivery Research Programme (HS&DR) NIHR153387
Start Date May 2023
End Date April 2027


University of York Team members

External project members

  • Professor Andrew Street, London School of Economics and Political Science
  • Professor Caroline Moore, University College London 
  • Mr Ahmed Saad, South Tees Hospitals NHS Foundation Trust