Service-line management

What is service-line management?

Service-line management (SLM) identifies specialist clinical areas and manages them as distinct operational units. It enables NHS foundation trusts to understand their performance and organise their services in a way that benefits patients and delivers efficiencies for the trust.

SLM also provides a structure within which clinicians can take the lead on service development, resulting in better patient care.

SLM was developed by Monitor for NHS foundation trusts, although its principles apply equally to other NHS settings. It draws on evidence and best practice from UK pilot sites and the experience of healthcare providers worldwide who use similar principles and approaches within their healthcare systems.

The following webpages should be of help in implementing SLM.

This information is guidance only and we acknowledge implementation methods will vary at a local level e.g. classification of costs. The benefits, however, should be the same.

How does it work?

Service line management uses the data from service line reporting, to develop an organisation structure and management framework within which clinicians and managers can plan service activities, set objectives and targets, monitor their service’s financial and operational activity, and manage performance.

Service line management (SLM) starts with service line reporting (SLR). Service lines are the units from which the trust’s services are delivered, each with their own focus on particular medical conditions or procedures and their own specialist clinicians. Each unit also has clearly identified resources, including support services, staffing and finances. SLR gives a clear picture of how each service is working, at both an operational and financial level.

The benefits of SLM

Implementation of SLM can deliver a range of benefits to trusts, clinicians, staff and patients and for service users.

  • Better patient care

    By bringing clinicians to the forefront of service development and promoting a culture of continuous improvement, SLM can improve services and result in a better experience for patients. Trusts using SLM report benefits including reduced waiting times, shorter hospital stays and reduced incidences of hospital-acquired infections.


  • Empowering clinicians to take the lead

    SLM puts clinicians at the heart of service-line operations. They can take greater charge of the development, performance and quality of their services. They can reshape service delivery to meet direct patient needs.


  • Greater efficiency and productivity

    SLM gives a detailed understanding of resources and costs and helps to identify areas where savings can be made; for example by maximising the use of theatres. If profits are made within a particular service line unit, a significant percentage of that can remain within the unit and be re-invested in that service. This means that service line unit leaders have a real say in investment decisions, improving the care and services they can offer.


  • Seeing the big picture

    By reporting and monitoring cost and profitability as a portfolio of service lines rather than at an aggregated level for the whole trust, a trust’s board, managers and clinicians can make informed decisions about how to manage existing services, prioritise new developments or plan investments. SLM helps to free trust boards from operational matters, allowing them to focus on strategy.


  • A robust planning process

    The approach to planning required for SLM means those who are best placed to identify a service’s opportunities and threats are able to input into its objectives, which are aligned with the trust’s overarching aims and reflected in team and individual performance goals.


  • A stronger negotiating position

    SLM data gives the true cost of treatment at a patient level, putting trusts in a stronger position when negotiating with commissioners. This brings direct benefits not only for trusts but also the whole health economy. This is of particular importance for mental health trusts where SLR has helped build proxy tariffs which are now being used in negotiations with commissioners.


  • Manageable structures

    Organising a trust into service lines enables effective delegation to a unit of a size and scale that is manageable for developing strategy and driving improved performance.


  • Decision making at the right level

    By devolving authority to service-line managers and clinicians, SLM allows decisions to be made by those with experience and knowledge of the service.


  • Engaging front line staff

    Service line management gives staff greater ownership of their service, in how it operates and develops. Trusts which have introduced SLM have reported evidence of improved morale and motivation, and focus and commitment within staff groups at all levels.


SLM framework and self assessment tool

The framework contains an initial set of overview questions for organisations to consider, followed by four more detailed areas on:

  1. organisation structure;
  2. strategy;
  3. performance management; and
  4. information management.

To complete the framework and toolkit click here.