NHS Intelligence Briefing PUBLIC VERSION
1. Cross-Trust Insights
The peninsula is in a state of severe, systemic financial distress characterized by massive underlying deficits, reliance on non-recurrent bailouts, and extreme efficiency targets. Devon system carries an underlying deficit approaching £286.4m, requiring a combined £281m system CIP in 2026/27. Acute trusts are resorting to non-recurrent property sale-and-leaseback deals, emergency PDC drawdowns, and terminating long-standing social care contracts to survive, while ICBs cut administrative headcount by up to 50% under national running cost caps.
Most financially pressured: University Hospitals Plymouth (UHP) and Torbay & South Devon FT. UHP was 1 of 16 national outliers submitting a non-compliant plan requiring an £91.6m CIP (~8% of turnover) and PwC intervention. Torbay carries a £99.5m underlying deficit and was forced to terminate its 20-year Section 75 Adult Social Care agreement over an unfunded £35m gap.
Most stable: SWAST. The ambulance trust successfully delivered a £29.9m CIP in 2025/26, completely eliminated agency spend, achieved breakeven outturns, and generated recurring software license savings despite macro fuel cost spikes.
Convergence on Epic EPR Platform vs Post-Go-Live Data Validation Crises
The peninsula has seen major Epic EPR go-lives across Torbay (April 2026) and University Hospitals Plymouth (July 2026), alongside Royal Devon. However, post-implementation stabilization has created acute data quality, clock-counting, and statutory reporting bottlenecks, with Torbay formally escalating Corporate Risk 570 and UHP noting severe clinical coding inaccuracies.
Significance: While single-platform rollout improves regional clinical visibility, post-go-live data corruption threatens income reconciliation, RTT compliance tracking, and board-level operational governance across the system.
Unprecedented System Efficiency Targets and Workforce Downsizing
Every Trust in the region is operating under extreme financial distress, requiring an aggregate system CIP in Devon exceeding £281m. This is forcing aggressive ICB running cost reductions (28-50%), voluntary redundancy schemes across acute and mental health providers, and formal trade union disputes over clinical safety.
Significance: Reliance on non-recurrent financial patches and administrative headcount reductions jeopardizes business-as-usual reporting, data quality management, and statutory safeguarding capacity.
Strategic Rejection or Delay of National FDP in Favour of Local/Epic Architecture
Trusts across the footprint are showing skepticism toward national software schemes: Royal Devon explicitly terminated its Palantir FDP incubator project to build natively in Epic, Torbay formally confirmed non-adoption of the FDP, and SWAST successfully migrated analytics from Tableau to Power BI.
Significance: Demonstrates a clear shift toward optimizing existing core platforms and local BI architecture over buying or adopting external national software layers.
Emergence of Generative AI and Ambient Voice Tech alongside AI Risk Governance
Rapid adoption of Ambient Voice Technology (AVT) and Copilot across acute, mental health, and ambulance settings (Royal Devon, DPT, SWAST) has triggered the formal addition of AI Governance to corporate risk registers to manage clinical safety, hallucination, and privacy risks.
Significance: As clinical documentation AI scales to save administrative hours, trusts require formal data governance and validation models to prevent unverified data from corrupting patient records.
Shared risks across Trusts:
- System Financial Sustainability & CIP Delivery Non-Compliance
- Urgent & Emergency Care Flow / NCTR Exit Blockades
- ICB Restructuring & Mandatory Running Cost Reductions
- Digital Capacity & Cyber Security Vulnerabilities
Rare/distinctive risks:
- Artificial Intelligence Hallucination & Governance Risk (SWAST)
- Tower Block Fire Safety / Higher Risk Building Status (Torbay)
- Section 75 Social Care Disaggregation & Uncoupling (Torbay)
- Inconsistent System Role Alignment across CAD, GRS, and ESR (SWAST)
- CQC / HSE Warning Notices in Secure Mental Health Services (DPT)
2. Trust Dossiers
DPT
Devon Partnership NHS Trust (DPT) is operating under intense structural financial pressure and heightened regulatory scrutiny, highlighted by an underlying deficit of £11.6m–£12.5m, a record 2026/27 Cost Improvement Plan (CIP) target of £26.5m, and CQC Section 29A and HSE notices in Secure Services. Following its November 2023 migration from CareNotes to SystmOne, the Trust has pursued an aggressive digital agenda—including a Core Care Record, EPMA rollout, Microsoft Copilot expansion, and AI-assisted clinical documentation—while acknowledging that digital ambitions have outstripped delivery capacity (BAF SR4). Major workforce restructuring through voluntary and compulsory redundancies in 2026, alongside acute bed occupancy consistently exceeding 100%, makes data governance, demand analytics, and administrative efficiency critical priorities for senior leadership.
Financial
DPT's financial trajectory shifted from managed in-year performance to severe structural pressure over the period. In 2023/24, the Trust delivered its planned £3.3m control total surplus through heavy reliance on non-recurrent savings against an £18.4m CIP target. In 2024/25, DPT again reported an on-plan £3.6m surplus, but revealed an underlying structural deficit of £11.1m. By 2025/26, despite delivering £21.5m in savings (45% non-recurrent) to hit breakeven, the underlying deficit grew to £12.58m. Enter 2026/27, the Trust faced an unprecedented £26.5m CIP target (~7% of provider budget), forcing a multi-phase Voluntary Redundancy programme and non-clinical workforce reductions, while persistent out-of-area spot-bed expenditure (£8m–£13m annually) and bank staffing overspends continued to undermine baseline stability.
Digital
The Trust's digital roadmap evolved from post-go-live stabilization of SystmOne (which replaced CareNotes in late 2023) into an ambitious digital transformation programme. Across 2024 and 2025, DPT deployed the Brigid mobile app, MaST caseload tools, e-Rostering/SafeCare, and a new Wavenet telephony platform for the First Response Service (FRS) to address call abandonment. By late 2025 and 2026, digital ambitions expanded to include the Core Care Record (CCR), community EPMA, Microsoft Copilot (expanding to 500 licences), Ambient Voice Technology trials, and preparation for the One Devon Finance and Procurement Hub. However, this momentum caused strategic risk BAF SR4 (Digital Transformation) to escalate to 15, as executive leadership recognised that prioritised digital ambitions outstripped available human and financial resource capacity.
Risk
DPT's risk profile escalated steadily, transitioning from operational workforce gaps to severe regulatory and strategic sustainability threats. Top corporate risks remained locked at the maximum score of 20 throughout the period, including Underlying Long Term Financial Sustainability (CAF033), Acute Bed Availability (CAF054), Complex Placement Discharge Barriers (CAF091), and Consultant Psychiatrist Vacancies (CAF041). Operational safety risks peaked in mid-2025 with the issuance of a CQC Section 29A Warning Notice and an HSE Notice of Contravention in Secure Services, alongside EPMA outage safety risks (POT043) and GP collective action impacts (POT042). Strategic risk BAF SR1 (Culture / Resistance to Change) escalated to 12 in 2026 as workforce anxiety rose surrounding voluntary redundancies and declining NHS Staff Survey scores.
Operational
Operational pressures were dominated by severe acute inpatient bed occupancy (>100% to 107%) and extended average lengths of stay (>65 days against a 53-day target), which sustained high reliance on costly out-of-area private bed placements. Crisis response improved significantly after 2024: First Response Service call abandonment rates (>60s) dropped from >20% in early 2024 to ~7%–9% in 2026 following the Wavenet telephony rollout and the launch of the Clinical Assessment Service 'Hear and Treat' model. Substantive staff vacancy rates improved from ~9% to ~3% overall in 2025 before inpatient nurse vacancies spiked back to 19%–21% in 2026 due to establishment re-basing, while high sickness absence (~5.3%–7.1%, predominantly mental health) drove persistent temporary staffing reliance above the 30% NHSE cap.
Data & digital timeline:
- 1 November 2023 — SystmOne EPR successfully goes live across DPT, replacing the legacy CareNotes system.
- 22 January 2024 — Soft launch of NHS 111 mental health crisis routing via First Response Service.
- March 2024 — SystmOne Optimisation Programme formally commences alongside PowerBI reporting transition.
- April 2024 — Brigid mobile app pilot begins on Beech Ward for physical health checks; 24/7 NHS 111 MH option fully launches.
- November 2024 — SystmOne 1-year anniversary celebrated; Data Quality Maturity Index (DQMI) reaches 95.4%, exceeding national target.
- May 2025 — 2025/26 Digital Improvement Plan approved, including Core Care Record build, EPMA community rollout, and CareLoop digital pilot.
- September 2025 — New Wavenet telephony platform goes live for First Response Service to improve call handling.
- December 2025 — First Response Service Clinical Assessment Service (CAS) goes live; Core Care Record build phase enters testing.
- April 2026 — Phase 1 release of the clinician-facing Core Care Record (CCR) goes live in SystmOne.
- July 2026 — Electronic Prescribing Service (EPS) community rollout begins; MS Copilot expanded to 500 licences; EOI submitted for Ambient Voice AI technology.
Key risk trends:
- Underlying Long Term Financial Sustainability (CAF033 / BAF SR3) (stable at maximum) — Underlying structural deficit grew from £11.1m to £12.58m; persistent reliance on non-recurrent CIPs.
- Acute Bed Availability & Flow (CAF054) (stable at maximum) — Bed occupancy consistently exceeded 100%; driven by social care discharge barriers (CAF091) and out-of-area placement spend.
- Digital Transformation & Maturity (BAF SR4) (↑ escalated) — Risk score increased to 15 as digital ambitions (AI, CCR, EPMA) outstripped financial and workforce capacity.
- Cultural Resistance to Change (BAF SR1) (↑ escalated) — Escalated outside risk tolerance due to staff anxiety over voluntary redundancy schemes and transformation pace.
- Medicines Safety During EPMA Outages (POT043) (stable at maximum) — High clinical safety risk caused by network outages and temporary/agency staff access issues.
Key people:
- Rafael (Raf) Sorribas (Chief Information Officer)
- Phill Mantay (Chief Executive Officer)
- Aideen Tucker (Chief Finance Officer)
- Hazel Powell (Chief Nursing Officer and Allied Professions Lead)
- Simon Hamilton (Non-Executive Director & Chair of Finance and Investment Committee)
- Paul Fox (Non-Executive Director & Chair of Audit Committee)
NHS Devon ICB
NHS Devon ICB remains trapped in Segment 4 (NOF4) of the NHS Oversight Framework under national Recovery Support Programme intervention, attempting to manage severe underlying deficits alongside continuous reorganisation. Although an £80m non-recurrent NHSE bailout artificially delivered a breakeven outturn in 2024/25, escalating financial pressures—including annual Cost Improvement Programme (CIP) targets exceeding £250m and running cost reduction requirements expanding from 30% to 50%—have forced a formal clustering with NHS Cornwall & Isles of Scilly ICB ahead of a planned 2027 merger. Operationally, severe acute pressures and systemic failings in children's neurodevelopmental and SEND services (triggering Ofsted/CQC 'Inadequate' ratings) present persistent clinical and regulatory risks. Consequently, the ICB has explicitly halted new digital technology spending to focus on optimizing existing architecture and improving real-time BI and data governance.
Financial
The financial narrative spans a transition from heavy operating losses to engineered balance and back to acute cash constraints. In early 2024, the system reported a 2023/24 deficit of £46.9m against an original breakeven plan, driven by £25m+ in prescribing overspends and £53m in agency costs. For 2024/25, the ICB resubmitted an £80m deficit plan with a £213.3m system CIP target; at Month 6, NHSE injected £80m in non-recurrent deficit support funding to pull the system forecast back to breakeven (£0), though this funding remains repayable. By mid-2025, cash crises escalated as NHSE withheld £8.97m in deficit support due to off-plan performance, while the 2025/26 CIP target was raised to £256.7m (7.8% of allocation). Facing a 50% mandated reduction in ICB running costs (£12.4m further savings needed in Devon), the board formed a joint cluster with NHS Cornwall ICB in 2026 to pare down executive and corporate management overheads.
Digital
Digital strategy evolved from active procurement of fragmented local projects to an explicit, finance-driven freeze on new systems in favor of extraction and optimization. Throughout 2024, the ICB pursued multiple point solutions, including primary care cloud telephony, NetCall waitlist validation, Peninsula LIMS/PACS procurement, and Epic EPR sign-off for UHP and Torbay. However, internal audit repeatedly flagged a lack of strategic alignment between digital plans and NOF4 recovery. By May 2025, board leadership formally agreed to scale back digital investment and focus solely on maximizing existing tools (such as the Devon & Cornwall Care Record, Joy App, and Brave AI). By May 2026, focus shifted toward governance, cyber security in Standing Financial Instructions, and internal audit calls for real-time live data dashboards to support cluster-wide board oversight.
Risk
The risk profile migrated from operational waiting times toward organizational survival and statutory compliance. Board Assurance Framework (BAF) scores for Finance (Risk 3) and Population Health (Risk 2) escalated from 12 to 16 in mid-2024 following a £3.7m clawback of health inequality funding and growing CIP delivery risks. In 2025, two major strategic risks scored at 20 (high) were added to the BAF specifically addressing the threat of the 50% running cost reduction and the risk of failing to maintain 'business as usual' during ICB reorganisation and clustering. Concurrently, regulatory risk peaked in children's services, following Ofsted 'Inadequate' ratings for Devon County Council Children's Services and Torbay SEND, where over 7,800 children faced neurodevelopmental waitlists with maximum waits reaching 202 weeks.
Operational
Urgent and Emergency Care (UEC) and children's pathways suffered continuous strain, while elective recovery achieved isolated progress on long waits. Throughout 2024 and 2025, Category 2 ambulance response times consistently missed the 30-minute target (ranging from 39 to 61 minutes), and acute trusts faced severe handover delays, leading to CQC Section 29A and Section 31 warning notices at UHP and Devon Partnership Trust. Conversely, elective recovery successfully eliminated 104-week waitlists and reduced 65-week waitlists from 3,985 in late 2023 to 434 by early 2025. However, community waiting lists, S117 mental health registers, and children's autism/ADHD assessments degraded markedly, forming a primary focus for regulatory enforcement.
Data & digital timeline:
- February 2024 — Deployment of SHREWD (Single Health Resilience Early Warning Dashboard) and XCAD in emergency departments to capture live UEC data and track ambulance handovers.
- March 2024 — 100% rollout of cloud-based telephony across Devon GP practices completed; Internal Audit flags lack of strategic clarity in Digital Strategy under NOF4 constraints.
- May 2024 — Procurement initiated for Peninsula LIMS and PACS solutions across the peninsula clinical network.
- July 2024 — Electronic Treatment Escalation Plan (e-TEP) goes live on the Devon and Cornwall Care Record (DCCR) across Plymouth and West Devon.
- November 2024 — DCCR connection targets for Torbay and RDUH delayed to December 2024 due to project management capacity constraints.
- December 2024 — Centralized '4Risk' corporate risk management system rolled out across the ICB.
- January 2025 — Implementation of Brave AI in primary care to identify high-risk patients; Epic EPR contract signed for UHP.
- May 2025 — Board formally resolves to scale back new digital investment and prioritize extraction of value from existing assets; Digital Partnership formed with NHS Shared Business Services (SBS) for finance and procurement.
- August 2025 — Digitising Social Care programme reaches 92% adoption across care providers; Full Business Case approved for joint UHP/TSDFT EPR.
- May 2026 — Internal audit recommends adoption of live/real-time data dashboards for cluster board reporting; Standing Financial Instructions updated to incorporate Digital and Cyber Security governance.
Key risk trends:
- Preventing Ill-health and Reducing Health Inequalities (BAF Risk 2) (escalated and persistently high) — Escalated from 12 to 16 in July 2024 when £3.7m was reallocated from the health inequalities budget into bottom-line financial recovery.
- Finance and Use of Resources (BAF Risk 3) (↑ escalated) — Maintained artificially at 12 during 2024/25 due to £80m NHSE deficit support, but escalated to 16 in mid-2025 as underlying deficit and cash shortages returned.
- Reducing ICB Running Costs & Transition (New BAF Risk) (new high risk) — Introduced in May 2025 following national mandate to reduce ICB running costs by 50% and cluster functions with NHS Cornwall ICB.
- Leadership and Capability (BAF Risk 5) (variable) — De-escalated in late 2024 following permanent CEO appointment, but escalated back to 16 in July 2025 amid ICB clustering and executive restructuring.
Key people:
- Mark Hackett (Interim Chief Executive, NHS Cornwall and Isles of Scilly & NHS Devon Cluster)
- Steve Moore (Chief Executive Officer, NHS Devon ICB (former))
- Simon Gittoes-Davies (Chief Finance Officer, NHS Cornwall and Isles of Scilly & NHS Devon Cluster)
- Libby Ryan-Davies (Chief Strategic Planning and Commissioning Officer, Cluster)
- Dr Peter Collins (Chief Population Health Officer, Cluster (former CMO))
- Graham Clarke (Independent Non-Executive Member (Audit and Risk Chair))
Royal Devon
Royal Devon is navigating severe financial and operational distress, moving from an initial 2025/26 breakeven plan to a £44m actual deficit, which triggered NHS England regional intervention and a Red Board Capability rating. For 2026/27, the Trust has reset to a breakeven plan requiring an extraordinary £80.7m (6% of operating costs) savings target alongside voluntary redundancy schemes. Operationally, persistent high No Criteria to Reside (NCTR) rates (15-20%) and severe consultant vacancies in Northern services have forced the temporary suspension of births at North Devon District Hospital. On digital, the Trust successfully supported regional Epic EPR go-lives and wide ambient voice AI rollout, notably choosing to terminate a Palantir/FDP incubator scheme to focus on native Epic development.
Financial
The Trust's financial position degraded rapidly in early 2026, transitioning from a planned breakeven to a formal £44m deficit outturn for 2025/26, backed by £38.7m in revenue cash support and regional NHSE intervention. Only 26% of delivered savings were recurrent, creating a structural deficit entering 2026/27. The 2026/27 plan was reset to breakeven but hinges on delivering an unprecedented £80.7m Delivering Best Value (DBV) CIP, mitigated by a Voluntary Redundancy scheme cutting ~82 WTE (£4m recurrent savings). At Q1 2026/27, Month 3 deficit stood at £9.6m on trajectory, but net unmitigated financial risk remains high at £13.7m.
Digital
Digital strategy is centered around maximizing the One Devon Epic EPR platform (supporting Torbay's April 2026 and Plymouth's July 2026 go-lives) and rapid adoption of Ambient Voice Technology (AVT) across outpatients, which reduced consultation documentation time by 30%. Crucially, the Trust terminated a Palantir/FDP theatre scheduling project to build functionality natively within Epic. Despite restoring £1.4m to recruit 36 WTE digital roles, digital capacity governance remains a high risk (BAF Risk 11), and severe SAR backlogs led to an expected 'Standards Not Met' DSPT submission.
Risk
The financial revenue risk (BAF Risk 4) score was de-escalated from 25 to 20 once the £44m deficit baseline was formally accepted by NHSE, though the Trust's Board Capability was downgraded to Red. Digital capacity governance (BAF Risk 11) and capital/estates fragility (BAF Risk 9) remain persistent high-level risks, exacerbated by the national deferral of the main NDDH hospital rebuild to 2035–2038. Extreme consultant staffing deficits in Northern services escalated clinical risk, forcing the suspension of acute maternity services at NDDH in August 2026.
Operational
Urgent and emergency care pressures remained acute throughout the period, with ED 4-hour performance hovering between 50-57% for Type 1. Operational flow was severely compromised by high No Criteria to Reside (NCTR) bed occupancy (15–20% vs 8% target), costing £1.4m per month. Elective backlogs showed modest RTT improvements, but 52-week waiters remained above 1,300. Structural workforce shortages in North Devon culminated in operational fragility across maternity, pharmacy, and emergency care.
Data & digital timeline:
- 9 January 2026 — Executive controls enacted non-clinical overtime sign-off requirements for digital and estates out-of-hours activity.
- 28 January 2026 — Business case initiated for an additional cyber security specialist following work to reduce the original £6m digital capital request.
- 25 March 2026 — Board confirmed termination of Palantir FDP theatre scheduling project to develop natively within Epic; £1.4m restored to recruit 36 WTE digital staff.
- 27 May 2026 — Epic EPR go-live completed at Torbay & South Devon over Easter; SAR backlog identified as a primary blocker to DSPT compliance.
- 29 July 2026 — Epic EPR successfully launched at Plymouth (23 July); Patient Privacy Monitoring System went live; AVT expanded Trust-wide across outpatient clinics.
Key risk trends:
- BAF Risk 4: Finance Revenue / Non-Delivery of Financial Plan (↓ de-escalated) — Reduced from 25 to 20 after formal NHSE approval of the £44m deficit forecast outturn and provision of cash support.
- BAF Risk 11: Digital Capacity Governance (→ stable) — Target risk score increased from 6 to 9 due to system-level demand and capacity governance imbalances across Devon ICS.
- BAF Risk 9: Our Future Hospital / Northern Estates Infrastructure (→ stable) — Sustained high risk driven by national rebuild deferral to 2035–2038 and failing NDDH theatre/chiller infrastructure.
Key people:
- Professor Adrian Harris (Chief Medical Officer for Research and Digital)
- Richard Potter (Non-Executive Director and Chair of Digital & Transformation Committee)
- Sam Higginson (Chief Executive Officer)
- Angela Hibbard (Chief Finance Officer)
- Melanie Holley (Director of Governance)
SWAST
South Western Ambulance Service NHS Foundation Trust (SWAST) has undergone a major operational and digital turnaround between 2024 and 2026. Recovering from a severe 12-hour CAD outage in August 2024 and crippling hospital handover delays exceeding 70 minutes per patient, the Trust delivered a £29.9m CIP in 2025/26 and achieved record non-conveyance (59%) and Hear & Treat (22.7%) rates while eliminating agency staffing spend. SWAST has modernised its digital core by migrating reporting from Tableau to live Power BI, moving GRS to the Cloud, replacing its Control Room Solution, and progressing major re-procurements for CAD (go-live October 2026) and EPR. Following the retirement of long-serving CDIO Tim Bishop in March 2026, Acting CDIO Janet Bayet is overseeing digital delivery amid newly emerging corporate risks around AI governance, system identity/role alignment, and fuel cost inflation. The Trust represents a high-value advisory prospect for data architecture, AI governance, and master data alignment.
Financial
SWAST's financial position moved from severe in-year deficit pressure in mid-2024 (£3.87m deficit at Month 5) to stable breakeven outturns through rigorous cost improvement. After delivering a £16m CIP in 2024/25 with the help of £5m non-recurrent operational funding, the Trust successfully absorbed a massive £29.9m CIP target in 2025/26. This was achieved through corporate role reductions (£5m savings), eliminating agency spend, shared procurement, and IT license/tool optimisations (£140k/yr from migrating Tableau to Power BI and £150k/yr from M365 F3 licensing). Entering 2026/27, the Trust faces a £20.2m CIP requirement alongside a £2.5m cost pressure from fuel inflation (£1.87/L vs £1.37 baseline), relying on a Mitigation Escalation Action Plan (MEAP) to maintain its forecast breakeven outturn while maintaining zero agency spend.
Digital
The Trust's digital landscape has evolved from stabilizing legacy infrastructure following a catastrophic 12-hour CAD outage in August 2024 to delivering an integrated, cloud-first architecture. SWAST successfully replaced its legacy ICCS with LifeX CRS in September 2024, migrated GRS to Totalmobile Cloud, completed MDVS deployment across 647 vehicles, and decommissioned Tableau in favour of live Power BI performance dashboards embedding Making Data Count (MDC) SPC standards. Major transformational procurements advanced significantly, with the new CAD system scheduled for October 2026 go-live and EPR contract awarded alongside 500 new tablet deployments. Following CDIO Tim Bishop's retirement in March 2026, Acting CDIO Janet Bayet has assumed digital leadership, establishing formal AI Governance on the Corporate Risk Register (score 15) to manage hallucination and data privacy risks following ambient voice technology trials.
Risk
The Trust's risk profile reflects a shift from extreme operational crisis to strategic digital and system complexity. System Activity and Flow (CRR 02/0224) dropped from its maximum score of 25 (Consequence 5 x Likelihood 5) throughout 2024 down to 16 in early 2026 following the implementation of the 45-minute Timely Handover Process standard operating procedure, though it briefly re-escalated to 25 during unprecedented summer 2026 heatwaves (>4,200 calls/day). BAF 4 (Data, Digital & Financial Sustainability) de-escalated from 25 to 20 as financial recovery plans delivered. Key new technical and corporate risks escalated onto the register include Inconsistent Role Alignment across CAD, GRS, and ESR (CRR 24/0925, score 16), AI Governance (score 15 in 2026), Fleet Mechanical Reliability (CRR score 16), and Fuel Price Volatility (CRR 27/0326, score 20).
Operational
Operational delivery saw dramatic structural recovery between 2024 and 2026. In late 2024, acute hospital handover delays averaged over 70 minutes per patient, absorbing over 1,100 ambulance hours per day and pushing Category 2 response times above 57 minutes. Collaborative implementation of the 'Timely Handover Process' across South West acute trusts in late 2025 reduced average handovers to 24–30 minutes, driving Category 2 response times down to 30–31 minutes (the best in 3 years). Operational efficiency was further reinforced by expanding clinical triage, driving Hear & Treat rates from 13.7% to 22.7% and ED non-conveyance to 59.4%. However, frontline stability remains challenged by persistent Emergency Operations Centre (EOC) dispatcher turnover (25–32%) and extreme climate-driven demand surges.
Data & digital timeline:
- 2024-06-30 — Achieved full compliance with NHS England Multi-Factor Authentication (MFA) Policy across 92 web-accessed applications.
- 2024-08-26 — Experienced a 12-hour Computer Aided Dispatch (CAD) system outage over bank holiday weekend, forcing paper business continuity plans and accelerating re-procurement.
- 2024-09-25 — Successfully went live with hosted LifeX Control Room Solution (CRS) across Exeter and Bristol EOCs, replacing legacy Capita DS2000 ICCS.
- 2024-11-28 — Approved 2-year extension for InPhase risk and incident management software and launched UK-first Virtual Reality Command Training Programme.
- 2025-01-30 — Completed server virtualization refresh with Dell Technologies, successfully migrating 272 locally hosted servers to a modern platform.
- 2025-03-31 — Migrated Global Rostering System (GRS) to Totalmobile Cloud platform and completed migration of top 45 gold-standard reports from Tableau to Power BI (£140k/yr savings).
- 2025-05-01 — Completed testing of Robotic Process Automation (RPA) for driver licence verification and awarded contract for new digital Inventory Management System (IMS).
- 2025-06-30 — Completed deployment of Mobile Data and Vehicle Solution (MDVS) across 647 Rapid Response Vehicles and Double Crewed Ambulances.
- 2025-09-11 — Escalated Corporate Risk 24/0925 (score 16) regarding inconsistent staff role and access alignment across CAD, GRS, ESR, and physical security systems.
- 2025-11-06 — Rolled out Windows 11 to 95%+ laptops, adopted M365 F3 licensing (£150k/yr savings), and established test environment for new CAD system.
- 2026-03-31 — Chief Digital Information Officer Tim Bishop retired; Janet Bayet appointed Acting CDIO / Digital Lead.
- 2026-05-07 — Implemented WorkInConfidence two-way anonymous Freedom to Speak Up platform and progressed EPR Outline Business Case.
- 2026-07-02 — Awarded HSCN contract, deployed GoodSAM Video across EOCs, and published refreshed Trust-wide Data Quality Framework.
- 2026-09-10 — Approved Electronic Patient Record (EPR) contract award with 500 iPad deployments and added AI Governance as a Corporate Risk (score 15) following Ambient Voice Technology trials.
Key risk trends:
- System Activity and Flow / Hospital Handover Delays (CRR 02/0224) (improving overall with seasonal spikes) — De-escalated from 25 to 16 following implementation of the 45-minute Timely Handover Process backstop across acute hospitals; temporarily spiked back to 25 during extreme July 2026 heatwaves.
- BAF 4: Failure to create a sustainable organisation that is data & digitally driven / Financial Sustainability (stable at elevated level) — Escalated to 25 in late 2024 due to revenue deficits and CAD outages. Reduced to 20 following successful delivery of £16m CIP in 24/25 and £29.9m CIP in 25/26, remaining at 20 due to multi-year CIP requirements, estate backlog (£15.7m), and CDIO transition.
- Inconsistent Access / Role Alignment across CAD, GRS, ESR & Security (CRR 24/0925) (new risk / stable) — Escalated in late 2025 to capture system-wide data inconsistencies in Joiners, Movers, Leavers (JML) processes impacting user access control across core systems.
- Artificial Intelligence Governance & Operational Risk (new risk) — Added to the Corporate Risk Register in mid-2026 following trials of Ambient Voice Technology (AVT) and Copilot to manage data privacy, clinical safety, AI hallucinations, and lack of human oversight.
Key people:
- Janet Bayet (Acting Chief Digital Information Officer)
- Andrew Rosser (Executive Director of Finance and Infrastructure)
- Amy Beet (Executive Director of People and Deputy Chief Executive)
- Raz Akbar (Non-Executive Director / Chair of Audit and Risk Committee)
- Tina Cantelo (Executive Director of Strategy, Transformation and Communications)
SWP Board
The South West Peninsula (SWP) Board, uniting NHS Devon and NHS Cornwall & Isles of Scilly ICBs into a single cluster ahead of a planned April 2027 merger, is operating under extreme structural financial pressure, rapid executive restructuring, and dual major EPR rollouts. While Cornwall achieved a balanced 2025/26 outturn (supported by a £150m NHSE historic debt write-off), Devon ended 2025/26 with a £64.3m deficit and a £286.4m underlying gap, necessitating an unprecedented £281m system efficiency target for 2026/27. Simultaneously, the cluster is executing an aggressive 28% staffing cut to hit the national £19/head running cost ceiling, triggering formal trade union disputes over clinical safety and statutory capacity. Operationally, acute sites remain severely constrained by Emergency Department corridor care and high No Criteria to Reside (NCTR) rates, while digital strategy centers on Epic EPR deployments at Torbay and Plymouth alongside the re-procurement of the Devon & Cornwall Care Record (DCCR).
Financial
In late 2025, the peninsula faced a Devon deficit challenge of £229m and an underlying system gap of over £200m. By January 2026, Devon's full-year deficit forecast expanded to £64.4m as Royal Devon Healthcare reported a £44m variance, triggering the loss of £26.9m in Deficit Support Funding across Torbay and Plymouth. The 2025/26 financial year closed with Cornwall achieving breakeven (helped by a £150m debt write-off) and Devon delivering a £64.3m deficit with an underlying deficit of £286.4m. Entering 2026/27, the cluster submitted a balanced plan backed by £38m in NHSE financial support for Devon, but this relies on a record £281m system CIP target in Devon (including £91.6m at Plymouth and £80m at Royal Devon) and a £131.7m combined ICB efficiency requirement, while delays in ICB restructuring add £1m per month in unbudgeted running cost pressures.
Digital
Digital investment throughout late 2025 concentrated on shared infrastructure—expanding the Devon and Cornwall Care Record (DCCR) to 93% GP coverage, pushing One Devon Dataset coverage to 75%, and preparing for DCCR re-procurement. The year 2026 marked a major dual EPR transition across the peninsula: Torbay successfully went live with Epic over Easter 2026 (replacing 100+ legacy systems), and University Hospitals Plymouth followed on 23 July 2026. Conversely, Royal Cornwall Hospitals (RCHT) paused its eCare EPR go-live in May 2026 following a 60-day gateway readiness review, formally resetting its deployment target to April 2027. Meanwhile, escalating GP collective action in mid-2026 threatened data-sharing agreements and OptimiseRx technology, prompting the establishment of a joint Primary Care and Digital Task Group.
Risk
The risk profile shifted dramatically from operational delivery concerns toward corporate merger stability and statutory governance. Cyber security and digital infrastructure remained persistently elevated at Red (16-20) on BAF registers across both ICBs. By early 2026, ICB running cost reduction and cluster capacity risks escalated to maximum levels (20) as mandated cuts to £19 per head forced voluntary redundancy schemes. By mid-2026, recognized trade unions formally warned the Board of statutory safety breaches and equal pay liabilities stemming from a 28% workforce reduction. Consequently, while some quality and financial risks were de-escalated on paper through shared governance oversight, reconfiguration and service change risks remained at maximum (20) due to political and local authority pushback in Cornwall regarding the dilution of local accountability in a single peninsula ICB.
Operational
Operational pressures across the period were dominated by severe exit block, Emergency Department overcrowding, and widespread corridor care across all four acute trusts (RCHT, UHP, TSD, RDUH). No Criteria to Reside (NCTR) rates hovered between 12% and 14% (against targets of 5-7%), heavily suppressing Type 1 A&E performance (RCHT dropping to 51.1% and Plymouth to 37.4%). Elective RTT 18-week compliance suffered productivity dips during EPR deployments (falling to 57-63% in Devon trusts), while mental health out-of-area placements (OOAPs) remained a persistent quality and financial drain, driving a £3.6m OOAP budget delegation to Cornwall Partnership FT for community pathway redesign. Secondary pressures included extreme neurodivergence diagnostic wait times (up to 11 years for adult autism) and CQC regulatory intervention (Section 29A Notice at CPFT).
Data & digital timeline:
- 16 October 2025 — Preparation initiated for the business case and re-procurement of the Devon and Cornwall Care Record (DCCR); £300k awarded from Respiratory Pathway Transformation Fund.
- 27 November 2025 — One Devon Dataset coverage reaches 75% toward an 80% target; Joy App social prescribing adoption reaches 71% of PCNs.
- 29 January 2026 — Torbay & South Devon EPR (Epic) go-live confirmed for Easter 2026; RCHT eCare (Oracle) initiates integration testing and trial data migration.
- 26 March 2026 — Brave AI risk stratification operationalized across PCNs and Integrated Neighbourhood Teams; DCCR re-procurement business case endorsed.
- 28 May 2026 — Torbay successfully goes live with Epic EPR over Easter 2026; RCHT pauses eCare go-live following a 60-day gateway review; 12 Cornwall GP practices notify withdrawal from data-sharing agreements under collective action.
- 30 July 2026 — University Hospitals Plymouth goes live with Epic EPR on 23 July 2026; RCHT Board approves revised eCare go-live date of 4 April 2027; options appraisal underway for shared/single cluster IM&T corporate infrastructure.
Key risk trends:
- Digital, Data and Analytics Capability (Incl. Cyber Security) (→ stable) — High inherent cyber threat across trusts; infrastructure vulnerability noted during dual Epic/eCare EPR rollouts and ICB merger planning.
- System Financial Sustainability (→ stable) — Driven by an underlying Devon deficit of £286.4m, requiring an unprecedented £281m system CIP in 2026/27 and £131.7m combined ICB savings.
- ICB Running Cost & Cluster Restructuring (↓ de-escalated) — Mandated cuts to £19/head running cost target forced voluntary redundancies and a 28% staffing reduction, triggering formal Trade Union dispute over statutory safety.
- Reconfiguration and Service Change / ICB Merger (→ stable) — Persistent extreme risk regarding stakeholder engagement and political pushback from Cornwall Council over loss of local accountability in a single peninsula ICB.
Key people:
- Mark Hackett (Interim Chief Executive Officer, SWP Cluster)
- Simon Gittoes-Davies (Chief Finance Officer, SWP Cluster)
- Andrew Abbott (Director of Digital Development)
- Kelvyn Hipperson (Chief Information Officer and System Digital Lead (CIOS))
- Susan Bracefield (Chief Clinical Officer / Chief Nursing Officer)
Torbay and South Devon NHS Foundation Trust
Torbay and South Devon NHS Foundation Trust is navigating a high-stakes operational and structural turnaround characterized by NOF Level 4 oversight, a £99.5m underlying financial deficit, and critical estate vulnerabilities including a £120m+ backlog and severe fire safety risks in its Tower Block. In April 2026, the Trust achieved a major strategic milestone by successfully going live with the 'One Devon' Epic Electronic Patient Record (EPR), replacing over 100 legacy systems and the country's oldest PAS. However, the post-go-live phase has introduced significant data quality and validation challenges that are directly impacting RTT clock counting, waiting list reporting, and income reconciliation. To protect core NHS delivery, the Trust took the radical step in March 2026 of terminating its 20-year integrated Section 75 Adult Social Care contract with Torbay Council due to an unfunded £35m annual shortfall, creating a complex 12-month data and operational disaggregation landscape.
Financial
The Trust's financial position deteriorated significantly over the 12-month period, shifting from a 2024/25 outturn deficit of £33.5m (against a £13.6m plan) to an underlying recurrent deficit of £99.5m entering 2026/27. While the Trust achieved its 2025/26 in-year CIP target of £41.5m, over half was non-recurrent, forcing the 2026/27 savings requirement up to £54.4m to hit a planned breakeven position contingent on receiving £57.8m in Deficit Support Funding (DSF). Cash flow remained acutely fragile due to in-year DSF withholding by the ICB, requiring emergency Public Dividend Capital (PDC) drawdowns. To halt structural losses, the Board served 12-month formal notice in March 2026 to end the Adult Social Care Section 75 agreement with Torbay Council—which generated a £35m annual funding gap—and launched an NHSE-approved Voluntary Redundancy scheme targeting 90–150 WTE corporate and administrative posts.
Digital
The digital agenda was dominated by the rollout of the joint 'One Devon' Epic EPR system, which successfully went live across acute and community services on 3 April 2026 (followed by University Hospitals Plymouth in July 2026). The transition retired over 100 legacy clinical systems, introduced the MY CARE patient portal (surpassing 24,000 sign-ups and integrating with the NHS App), and deployed an automated inpatient pharmacy robot ('Spencer'). Parallel digital developments included migrating incident management to Datix DCIQ with Yellowfin reporting, procuring mobile X-ray integration, and rolling out 1,000 Microsoft Copilot licences. However, post-EPR stabilization triggered acute reporting challenges, with data migration and clock-start counting issues corrupting RTT and elective waiting list reporting by late 2026. Crucially, the Trust formally confirmed in August 2026 that it has not yet adopted the NHS Federated Data Platform (FDP).
Risk
The Trust's risk profile evolved from pre-implementation digital deployment risks to severe post-go-live data governance, structural transition, and estate hazards. Corporate risk registers remain dominated by maximum-score (25) threats: Financial Sustainability (£99.5m underlying deficit), Estate Backlog Maintenance (>£120m), and Tower Block Fire Safety (classified as a Higher Risk Building requiring a £126m long-term replacement strategy). Following the April 2026 Epic go-live, a major new risk (CRR 570, scored at 20) was escalated regarding performance data quality and statutory waiting list reporting accuracy. Additionally, organizational disaggregation risks (BAF-OT, scored at 20) rose sharply following the decision to terminate the Section 75 Adult Social Care agreement.
Operational
Operational delivery was severely disrupted by winter pressures, critical incidents, and post-EPR stabilization. Throughout late 2025 and early 2026, the Trust experienced extended periods in OPEL 4 and critical incident status, with Type 1 A&E 4-hour performance hovering between 50% and 67% and average ambulance handovers exceeding 45 minutes alongside persistent corridor care. RTT 52-week wait counts fluctuated and then spiked post-Epic go-live (reaching 1,319 in July 2026), though this was heavily confounded by reporting and data validation lags. Operationally, the Trust began disaggregating its integrated health and social care model, transferring Children and Family Health Devon (294 WTE) to Devon Partnership Trust in April 2026 and re-allocating physical infrastructure, such as securing £4.6m capital to relocate life-expired Cellular Pathology services to Gadeon House in Exeter.
Data & digital timeline:
- 25 September 2025 — Extra £19.5m capital funding secured for One Devon EPR rollout and infrastructure upgrades; MY CARE patient portal preparation announced.
- December 2025 — Automated inpatient pharmacy dispensing robot ('Spencer') installed to integrate with Epic EPR.
- 13 January 2026 — Successful 90-day Epic Go-Live Readiness Assessment (GLRA) completed.
- 03 April 2026 — Epic EPR successfully goes live at 02:00 across acute and community services, replacing 100+ legacy systems and England's oldest PAS.
- 30 April 2026 — Trust migrates from Datix Web to Datix DCIQ, with Yellowfin dashboard reporting scheduled for July 2026.
- 23 July 2026 — University Hospitals Plymouth goes live on Epic, bringing all three Devon acute trusts onto a unified shared platform.
- 12 August 2026 — Trust confirms via Governor Log that it has not yet adopted the NHS Federated Data Platform (FDP) / Palantir system; MY CARE portal directly linked to NHS App.
- 03 September 2026 — Post-Epic data quality issues officially escalated as Corporate Risk CRR 570 (score 20) due to impact on RTT clock start validation, activity reporting, and contract income.
Key risk trends:
- Financial Sustainability (Risk 2996 / BAF-FN) (→ stable) — Underlying deficit escalated from £81.8m to £99.5m due to recurrent CIP slippage; heavily reliant on £57.8m Deficit Support Funding and Section 75 exit.
- Estates Backlog & Tower Block Fire Safety (Risk 1083 / 2801 / BAF-ST) (↑ escalated) — Critical backlog maintenance exceeds £120m; Tower block classified as Higher Risk Building with fire safety exceeding Board risk appetite.
- Post-EPR Performance Data & Waiting List Reporting (CRR 570) (↑ escalated) — New corporate risk raised post-Epic go-live due to data quality issues, RTT clock start counting discrepancies, and unvalidated waiting lists.
- Adult Social Care Transition & Section 75 Disaggregation (BAF-OT) (↑ escalated) — Formal 12-month notice served on Torbay Council in March 2026 due to £35m annual shortfall; complex workforce and service transition risks.
Key people:
- Dr Martin Beaman (Chair of the Board)
- Joe Teape (Chief Executive Officer)
- James Corrigan (Chief Finance Officer)
- Sam Wadham-Sharpe (Chief Operating Officer)
- Simon Tapley (Chief Strategy and Planning Officer)
- Kevin Pirie (EPR Operational Director)
UHP
University Hospitals Plymouth NHS Trust (UHP) enters mid-2026 in National Oversight Framework (NOF) Segment 4, carrying an underlying deficit of £110m and an unprecedented £91.6m cost improvement target. Operationally, the Trust remains severely bottlenecked by an ageing estate operating at 'half the size required', driving widespread corridor care and CQC regulatory scrutiny while construction proceeds on its £247m Emergency Care Building. Digitally, UHP achieved a major milestone on 23 July 2026 by going live with Epic as part of the shared One Devon EPR platform alongside Torbay and Royal Devon. However, CEO Neil Macdonald has explicitly highlighted low baseline data literacy and widespread clinical coding inaccuracies across the Trust, creating a critical need for post-EPR data governance, analytical validation, and operational data transformation.
Financial
UHP's financial position deteriorated significantly from late 2024 through mid-2026. In 2024/25, a planned £54.6m deficit was offset by £38.9m in non-recurrent national support to outturn between £8.6m and £21.1m adverse. For 2025/26, the Trust targeted breakeven via a £68.3m Financial Improvement Plan (FIP); while delivering £69.4m gross savings, over-reliance on non-recurrent mitigations carried a £30.2m recurrent deficit shortfall into 2026/27. By early 2026, UHP was flagged as 1 of only 16 NHS trusts nationally submitting a non-compliant financial plan, triggering NHSE and PwC intervention across Devon ICS. To agree a restated 2026/27 breakeven plan, UHP raised its CIP target to £91.6m (~8% of turnover), relying on £35m in non-recurrent system funding, a £25m property sale-and-leaseback transaction, and drastic temporary staffing cuts.
Digital
The digital story is anchored by the multi-year mobilisation and deployment of the Epic Electronic Patient Record (EPR) under the One Devon programme. Moving from FBC gateway review approvals in late 2024 and contract execution in January 2025, UHP completed joint orientation, 90-day, and 60-day readiness milestones to successfully achieve Go-Live on 23 July 2026. Concurrently, UHP delivered core infrastructure refreshes (datacentre renewals, cloud ePMA transition, DSPT CAF v7 compliance), pathology automation (£5.5m Peninsula cellular pathology investment), and digital inclusion tools like the Hospital Passport App. As Epic went live, digital focus rapidly pivoted toward AI adoption (M365 Copilot, AI Stroke prediction, AI Innovation Lab) alongside an urgent executive focus on remediating pervasive data entry and coding errors.
Risk
UHP's Board Assurance Framework (BAF) reflects persistent operational, cultural, and financial distress. Urgent & Emergency Care safety risks remained capped at the maximum score of 20 throughout, driven by acute flow blockages and corridor care averaging 17–20 patients daily. Financial sustainability risks (S1/S3) fluctuated between 16 and 20 as non-recurrent patches were applied to underlying structural deficits. Culture and Wellbeing (W2) escalated from 16 to 20 following severe Freedom to Speak Up (FTSU) reports, CQC ED breaches, and high recorded sexual misconduct (5.5%). Conversely, Digital/EPR Risk (S2d) steadily de-escalated from 20 down to 16 as national business case approvals and go-live criteria were met ahead of the July 2026 launch.
Operational
Operational delivery exhibited a stark divide between emergency crowding and elective wait-list recovery. UEC faced extreme pressure with CQC Section 29a notices and ED overcrowding, although mean ambulance handover delays improved markedly from over 6,000 hours lost down to ~2,000 hours. Elective recovery successfully eliminated 104-week and 78-week waits while drastically curtailing 65-week breaches, but cancer 62-day pathways struggled under a 55% surge in prostate referrals and Plym theatre demolition, placing UHP in Tier 1 national cancer oversight. Operational transformation remains heavily dependent on capital schemes including the £247m Emergency Care Building, the £22m Colin Campbell Court CDC, and the Plymouth Oncology Centre extension.
Data & digital timeline:
- 25 September 2024 — Kath Potts appointed Chief Digital Officer to lead joint EPR business case finalisation across UHP, RDUH, and Torbay.
- 30 October 2024 — EPR Full Business Case submitted for regional NHS England gateway review; CAFM system procurement initiated.
- 27 November 2024 — EPR Full Business Case clears regional review, heading to National Review Board; cloud migration initiated for core clinical applications.
- 29 January 2025 — EPR contract signed with Epic following national FBC approval; Beacon Oncology Module added to scope.
- 26 March 2025 — Over 600 staff participate in One Devon Epic Orientation Day; shared regional SharePoint launched.
- 27 May 2026 — Formal 60-day Go Live Readiness Assessment confirmed for Epic; Generative AI roadmap outlined for non-clinical administration.
- 23 July 2026 — Epic EPR officially goes live across UHP, creating a unified digital patient record across Devon.
- 29 July 2026 — Post-EPR enablers launched including M365 Copilot licenses, AI Innovation Lab establishment, and Brave AI risk stratification.
Key risk trends:
- Safety - Urgent & Emergency Care / Flow (Q1 / Q1a) (→ stable) — Maintained at maximum score throughout due to chronic overcrowding, 12-hour ED breaches, and corridor care averaging 17-20 patients daily (~89 unestablished bed spaces).
- EPR Implementation & Digital Maturity (S2d / SR5) (↓ de-escalated) — Reduced from 20 to 16 following national FBC approval, secured PDC capital, datacentre refresh, and successful July 2026 Epic cutover.
- Organisational Culture & Staff Wellbeing (W2 / SR3) (↑ escalated) — Escalated from 16 to 20 following severe FTSU report volumes (highest in England), CQC ED findings, and high recorded sexual misconduct in theatres (5.5%).
- Financial Plan Delivery & Medium-Term Sustainability (S1 / S3) (↔ fluctuating) — Reflects non-compliant 2026/27 plan submission (1 of 16 national outliers), PwC intervention, and subsequent re-baselining to a £91.6m CIP requirement.
Key people:
- Neil Macdonald (Chief Executive Officer)
- Sarah Brampton (Deputy Chief Executive & Chief Finance Officer)
- Kath Potts (Chief Digital Officer)
- Adel Jones (Chief Operating Officer)
- Herjinder Cleaver (Chief People Officer)
- Professor Arunangsu Chatterjee (Non-Executive Director)
3. Themes Worth Watching
- The Post-EPR Data Hangover: Why going live with Epic is only 50% of the journey and how acute trusts can prevent statutory reporting collapse.
- Why NHS Trusts are rejecting national FDP incubators in favor of native Epic and Power BI architecture.
- AI Governance in Clinical Practice: Why ambulance and acute trusts are formally placing AI hallucination on corporate risk registers.
- Unpicking 20-year integrated care contracts: The hidden data architecture and IG challenges of ending Section 75 social care partnerships.
- Moving from 500-page PDF board packs to live Power BI: How NHS trusts can implement Making Data Count SPC standards safely during headcount cuts.