Starting in August 2025, over 15 weeks, Eleventh Hour Insourcing (EHI), in collaboration with a Midlands NHS Trust, delivered a highly impactful, and reflective Insourcing project. One that stands as a clear example of what happens when an Insourcing model is embedded ensuring operational discipline, clinical excellence and partnership.
This project was a live illustration of a high-pressure environment tackling real backlog challenges in ophthalmology follow-up care, and the results speak for themselves.
A Rapid Start, Built for Impact
Speed matters in the NHS context, where delays translate directly into patient risk and operational strain. From the initial implementation meeting to service delivery in just 20 working days, the project moved at a rapid pace without compromising quality.
Over just 15 active weeks, the service delivered excellent results as identified below.
This is what effective Insourcing should look like. A structured clinical pathway that moves patients forward safely and efficiently.
Quality That Holds Under Pressure
Our patients recognised and were grateful for the high-quality and precise service EHI were able to seamlessly integrate into an already existing and committed department.
Even more telling is what happened beneath those numbers. Patient feedback was always acted on. Where one average score appeared, an action plan followed immediately to ensure a functioning feedback loop.
Operational Control Driving Outcomes
One of the clearest indicators of operational maturity was the shift in DNA (Did Not Attend) rates.
As the Trust transitioned to a new ERP system, combined with internal sickness, gaps in booking efficiency became visible through the under booked clinics and rising DNA rates. Rather than working around this, EHI intervened directly by embedding a dedicated booking coordinator to take control of scheduling and optimise clinic capacity.
Alongside this, a controlled 5% overbooking approach was introduced to mitigate expected DNAs. The impact was immediate and measurable. DNA rates reduced to 7% by the end of the contract. Thus demonstrating a direct improvement in patient access and resource utilisation, with utilisation reaching over 90%
This is where many services fall short. Our EHI Ophthalmology team strengthened the system around them, and the results really show this.
Clinical Governance That Endures
Governance is often overused as a term and underdelivered in practice. Here, it was visible and effective:
- Strong integration between clinical and management teams
- A total of 22 Consultants across 4 sub-specialties
- 131 clinic lists
- Continuity of staffing, reducing variability in care
- All KPIs met
- 33% patient satisfaction survey uptake driven by our strong service lead
- 0.06% Incident rate
- Issues resolved quickly through collaborative working
Patient Satisfaction Statistics 4
There’s a difference between operating alongside a Trust and operating with it. This project demonstrated the latter.
Financial Clarity and Value
Alongside clinical and operational performance, the service delivered clear, transparent cost efficiency under the follow up tariff.
For services under constant financial pressure, delivering high-quality care at this level of cost efficiency is imperative. It strengthens the case for Insourcing done properly as a both a strategic and operational solution that can be embedded long term
Restoring Utilisation and Driving Financial Value
Midway through the contract, the service transitioned onto a new Electronic Patient Record (EPR) system. As expected, this created short-term operational pressure, particularly around booking accuracy and clinic utilisation. Clinics were not being filled to optimal levels, which had a direct impact on both efficiency and patient flow.
EHI responded quickly by introducing an additional dedicated booking coordinator. This was a targeted operational intervention, focused on stabilising scheduling, improving patient communication, and ensuring clinic capacity was fully utilised.
The impact was clear and measurable.
By week 15:
- Attendance reached 93%
- DNA rates reduced to 7%
- Overall utilisation reached 76%
At this stage, EHI demonstrated operational performance and financial performance alignment. Within the NHS’s Payment by Results (PbR) framework, income is directly linked to patient activity. Put simply, when patients attend, Trusts are reimbursed. By improving attendance and utilisation, the service became more efficient and financially effective for this Trust.
In practical terms, this meant:
- More patients seen within existing clinic capacity
- Increased income recovery from commissioners
- Reduced wasted clinical time
This wasn’t about adding more clinics. It was about making every clinic count.
Client Feedback
The client consistently reinforced the strength of delivery across both clinical and operational performance. Senior stakeholders highlighted the clarity and consistency of communication, the structure and discipline of reporting, and the confidence created through a well-governed clinical model. Just as importantly, feedback reflected the day-to-day experience on the ground, from organised team huddles to responsive issue resolution and a proactive approach to continuous improvement. The following testimonial captures that experience directly:
“We have been thoroughly impressed by the outstanding communication and regular reporting provided throughout the partnership with Langley Clark. Updates were always timely and transparent, ensuring we remained fully informed at every stage.
“The clinical teams consistently demonstrated the highest standards of professionalism and expertise, underpinned by a robust governance process that gave us complete confidence in their approach. Our staff were extremely impressed with the organisational approach of the work, from the team huddle first thing to all updates and feedback.
“Against our set targets and KPIs, performance was excellent, with all objectives met or exceeded. Furthermore, the team consistently delivered added value and support beyond contractual expectations by proactively identifying opportunities for improvement and sharing best practice insights, which has had a lasting positive impact on our department. We look forward to continuing this highly successful collaboration.” General Manager, Midlands NHS Trust
What This Project Demonstrates
This project shows that when Insourcing is executed with the right structure, the right people, and the right level of accountability, it can:
- Reduce backlog without compromising care
- Improve patient experience at scale
- Integrate seamlessly with Trust operations
- Deliver measurable financial value
- Strengthen long-term clinical pathways
Too frequently, Insourcing is misunderstood as merely temporary capacity. This project positions it correctly, as a high-performance extension of NHS delivery.
Moving Forward with Confidence
The demand on NHS services isn’t reducing. Backlogs, workforce pressures, and rising patient expectations are here to stay. What EHI demonstrates is that there is a way to respond that is controlled, measurable, and effective.
Eleventh Hour Insourcing builds systems that hold. If this is the benchmark, the next step is clear. Scale it, refine it, and repeat it where it’s needed most.
