Insight

Overcoming the barriers to developing future-ready community diagnostic services

Even before the pandemic began, demand for diagnostic services of all types were rising and, in some cases, outstripping capacity. Covid-19 has exacerbated this problem, deepening the diagnostic backlog with knock-on effects for cancer and elective care.

However, it has also demonstrated what is possible. Seemingly complex changes were implemented at a pace not seen before, transforming services within a matter of weeks to ensure they continued during lockdowns, whilst incorporating Covid-minimisation measures.

Although the challenge of catching up with the diagnostic backlog is a steep one, it presents similar opportunities to deliver much-needed long-term change in diagnostic services.

Reshaping diagnostics for the new normal

The challenges created by Covid-19 are ongoing and require new and sustainable solutions. Standard diagnostic pathways have remained the same for many years, despite the fact they are often inefficient both for the NHS and its patients.

But the drive to develop a system that harnesses new ways of working and new technology has already begun. This includes more than 40 new community diagnostic centres that are currently being rolled out by NHS England and set to provide around 2.8m scans in their first full year of operation. Situated in a range of settings from local shopping centres to football stadiums, they are designed to give patients more direct access to the full range of diagnostic tests closer to home.

Crucial to the success of many of these initiatives, will be the relationship between the community and acute services. The transition to integrated care systems (ICS) will help to create this, but a truly interconnected system will still require wider change.

An independent review of diagnostics services for NHS England recently outlined the key components of a new service delivery model. This article explores some of its recommendations and the barriers Trusts need to overcome to achieve them.

What could the future of community diagnostic services look like?

There are three key models to transforming community diagnostic services.

Optimal care pathways

Building on established pathways through existing community support, such as pharmacists, opticians, and phlebotomy services, is one model of delivery that realises the benefits of a greater separation of acute and elective diagnostics.

This provides patients with quicker and more convenient access to care closer to home or work, whilst relieving pressure on acute sites. Telephone and virtual consultations are also expected to play a much larger role in diagnostic services in the near future.

Optimising these established pathways brings a range of challenges which Trusts need to consider, including:

  • Financial arrangements – Ensuring the commercial arrangements are cost-effective and attractive for the commissioner and the service provider, is important in order for services to run smoothly. A comprehensive activity forecast and tested commercial model is critical.
  • Care boundaries – Optimising care pathways should involve eliminating the boundaries that still exist in the care system. The transition to an ICS model will play a key role here. As will an effective commercial arrangement that gives the patient true flexibility and choice on where they receive their care in the community.
  • Collaborative working – Integrated care requires collaboration on all fronts. Often parity of esteem or an assumption of vested interest builds barriers between professionals. Ensuring clinical professionals are engaged and introduced at an early stage will help alleviate this.
  • Public perception – With the introduction of any new service model, comes the requirement for change management. Fear of a patient backlash often deters Trusts from doing this, but regular patient engagement and feedback is vital.
  • Social value – An area of increasing priority, the service provider should demonstrate how they will aid recovery of the local community and economy through employment and training, as well as community support.

Community diagnostic hubs

There is an opportunity to develop new diagnostic service models outside the existing Healthcare landscape that are more responsive and innovative, such as community (or remote) diagnostic hubs (CDHs).

They provide a one-stop shop for patients requiring potentially life-saving diagnostic tests closer to home. As noted earlier, centres that deliver this kind of service are already being rolled out and have begun combatting the impacts of Covid-19.

Their numbers and the services they offer are set to grow over the next five years in a bid to reduce the pressure on acute care. In the near term, non-invasive diagnostics are the most viable, but with developments in technology and practice, there will be an increase in more time-consuming, invasive diagnostics in the community.

As part of this initiative, Akeso supported leading specialist Trusts to implement CDHs. There are several key challenges to consider during this process to ensure a successful implementation:

  • Strategic vision and scope – Fully define the strategic objectives for the hub before implementation. This will inform the scope and operating model as well as support timely decision making and evaluation.
  • Patient need – Identify who the hub’s patients will be and what their needs are. Every aspect of the service model and patient pathway must be built around this.
  • Project management office (PMO) – Robust planning from the outset is critical to the success of the project implementation. With involvement from multiple stakeholders, capturing dependencies at each stage will not only ensure the Project is delivered on budget, but also prevent surprises further down the line.
  • Resourcing – Identify and engage with the right people early on. Collaborating with clinical and operational people across the organisation, who have the right expertise and experience to implement a new service model will avoid potential setbacks.
  • Capacity modelling – Model patient activity across the whole patient pathway. Capacity within the CDH must align with the Trust’s internal capacity. This may be dependent on the capacity to book patients’ assessments and follow-up consultations.
  • Service resilience – In light of Covid-19 ensure the safety of patients and service resilience by reviewing patient flow and infection control.

New diagnostic technologies

Innovation is advancing rapidly in areas such as genomic testing, point-of-care testing and the use of artificial intelligence for imaging, endoscopy, and wearable devices. These have the potential to transform the service diagnostic hubs can offer.

Historically Healthcare providers have been slow to adopt new technological innovations. That is why it is important to explore the most effective way to introduce them. Here are some considerations to bear in mind:

  • Clinician uptake – Clinicians need to be encouraged to trust the integrity of new technology and move away from established processes.
  • Patient awareness – Patients must be supported to understand and adopt new technology. Striking the right balance between a face-to-face and digital service is vital.
  • System interoperability – New systems and equipment will need to exchange information seamlessly. Clinical data comes in a variety of formats and terminology, which means standardised catalogues will need to be developed for complete interoperability.
  • Safety – Safeguards must be put in place to ensure data compliance, and Healthcare workers are given the time and knowledge to implement them.

Combining these elements will create community diagnostics services that can rise to the challenges created by the pandemic, while also improving patient care.

By considering the key factors mentioned here at the outset, Trusts will be able to successfully implement and operate each element successfully.

As experts in delivering high quality solutions to the Healthcare sector, Akeso has a track record of supporting Trusts to do this in a way that develops the effective diagnostic services of tomorrow. To find out what we offer, get in touch at enquiries@akeso.co.uk

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Chris Robson

Chris Robson

Managing Director
Insight

Supporting Sustainability and Social Value in Estates and Facilities

Introduction

It is no secret that Estates and Facilities departments across the NHS are strained. The continuous battle to relieve backlogged maintenance, coupled with recent concerns over reinforced autoclaved aerated concrete (RAAC) in hospital facilities has added yet further pressure to upholding safe facilities for patients and staff.

There is some financial respite to the RAAC in the form of a £700m fund to manage buildings and commitments to eradicate RAAC by 2035. However, with an emphasis on maintaining facility safety and service delivery, it is perhaps no surprise that social value and sustainability may not be at the top of organisations’ agendas. That said, with the growing imperative to rebuild or refurbish buildings with RAAC present, alongside wider estate redevelopments and builds, it would undoubtedly be a lost opportunity to not consider social value and sustainability as a central tenet.

As a trusted delivery partner to the NHS and public sector, Akeso have supported a variety of Estates and Facilities programmes from conception to implementation, considering social value and sustainability best practices at all stages. Our holistic approach is patient and staff-centric and set in the context of the broader health and social care landscape, beyond just an awareness of the NHS net zero and green building commitments.

To embed social value and sustainability within Estates and Facilities programmes, Akeso support organisations in identifying, appraising, and measuring the key question of “will the project deliver tangible benefit to patients and the community it serves to enable them to live healthier, happier lives?”.

Akeso’s methodology

To answer this question, we use a 5-step methodology to work with clients to deliver true value:

  1. Understand specific challenges of the local demography and economy e.g., employment, skill gaps, and diversity of businesses.
  2. Identify relevant initiatives to the project being delivered / service procured e.g., consideration for service accessibility, with considerations for those with protected characteristics.
  3. Engage with the supply market through widespread advertisement of contract opportunities to validate that the identified initiatives are feasible to be delivered by all suppliers, including SMEs.
  4. Define a roadmap for delivery with an implementation timeline with key milestones, RACI matrix, reporting structure, and outputs to ensure a clear plan to deliver objectives.
  5. Quantify the benefit of initiatives with defined metrics in the form of KPIs that hold those delivering accountable.

This methodology considers redevelopments in their entirety, leveraging opportunities to deliver sustainability and social value both in the design and intended use of the estate, but also in the way that the estate is procured, built, and managed.

If you want to understand more about developing successful business cases or how to shape an infrastructure and estate strategy, please get in contact with Peter Marshall.

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Peter Marshall

Peter Marshall

Associate Director
Insight

How can systems integrate their estates and facilities services?

In our first infrastructure article, we assessed the current state of hospital infrastructure across the NHS and looked at the challenges and progress of the New Hospitals Programme (NHP), as a means of improving the current situation. In addition to this, we set out a series of key factors for successfully delivering these type of projects, based on our experience of supporting Treasury-approved infrastructure schemes and capital business cases aligned to the HM-Treasury Green Book model.

In this article, we will further examine the theme of NHS infrastructure and put forward a set of recommendations for how ICSs can integrate their estates and facilities services, focusing on: (1) a clinically led system-wide estates strategy and (2) an ICS operating model for estates and facilities services.

(1) Clinically Led System-Wide Estates Strategy

Legislation now enables ICSs to control and own their estate as a singular entity. This presents systems with the opportunity to manage an increased portfolio of sites and start planning truly transformative estates planning with the aims of delivering integrated care across communities with a singular capital budget. Accordingly, since the formation of ICSs, it is a requirement to develop and publish such strategies.

These strategies should assess the current property portfolio in detail, including its condition, utilisation, and suitability for its current purpose, and outline a forward-thinking strategy for how the estate is best developed and managed to suit the needs of the patients, staff, and organisations it serves.

With the combination of acute, primary care, mental health, and local government sites, ICSs should re-examine their current estates portfolio and began planning how their sites can be developed, restructure, and repurposed in accordance with clinical need. During COVID, systems moved quickly to deliver vaccine centres and PPE hubs from pre-existing locations, demonstrating the ability to transform and maximise the value of space for the purposes of patient care.

This exercise should be completed in alignment with population health management planning. From our experience, systems can deliver significant value through delivering shared services in shared space, and divesting the location of specific services from one location, and implementing them in another, commonly community based, such as community dental practices, physiotherapists, occupational therapy, and maternity outreach, to name but a few.

Based on our experience of supporting ICS estate strategies, we have defined the following four factors as being key for a successful clinically led system-wide estates strategy:

(2) An ICS Operating Model for Estates & Facilities Services

In addition to developing these strategies, the formation of ICSs also allows systems to transform their operating models for the provision of estates and facilities services, including the delivery of new governance and management structures, service delivery models, and the provision of enabling services, such as E&F teams, systems and data management, and third-party providers.

Akeso recently supported one the largest ICS in the country to develop a system-wide estates and facilities category strategy based on the options set out in ICS operating model below.

This strategy defined a new operating model for the system and set out a transformational programme of project delivery to leverage geographical synergies, exploit combined scale to increase service investment, develop a coordinated approach to service provision and management, as well as implementing collaborative procurement functions and processes and SRM scorecards. Specific projects included the development of E&F workforce training and retention strategies to work cross site, combined utilities purchasing arrangements, and cross-system and joint supplier and contract management arrangements.

In our final article of the series, we will discuss how NHS providers and ICSs can utilise their estate to deliver upon their social value aims.

If you want to understand more about developing successful business cases or how to shape an infrastructure and estates strategy, please get in contact with Peter Marshall.

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Peter Marshall

Peter Marshall

Associate Director
Insight

What now for NHS infrastructure

Hospital capital investment in the NHS is more important now than ever. Rundown buildings and the spiralling maintenance backlog, which is currently over £10bn, are putting patients at risk and stymying elective care recovery.

It has been well documented by a range of sources, including recent analysis by the HSJ, Financial Times, and Health Foundation, that the one of the core underlying problems facing the NHS is historic underinvestment in capital. This is evidenced by the current capital stock per worker being half that of most comparable health systems.

In the past weeks, much has been said about this ongoing infrastructure crisis. One element in particular which has demanded much media attention is the government’s New Hospitals Programme (NHP). This programme was responsible for delivering 40 new hospitals and rebuilds by 2030, described by the government ‘as the biggest hospital building programme in a generation’.

When the programme was launched in 2020, it was largely welcomed, notwithstanding the controversy around the definition and use of the word “new”. It seemed that after many years the need for a long-term capital investment strategy within the health service was being taken seriously. However, since then, progress with the programme has been slow.

Last week, the National Audit Office published a report analysing the problems faced by the NHP, principally whether the schemes could be delivered to time and to budget.

Whilst £20bn for the NHP had been committed, this is around £10bn less than what estimates require, many schemes due for completion by 2030 have been pushed back, and recently more than 120 bids from other providers for future schemes were rejected. The NAO report concluded that by the definition the government used in 2020, it will not now deliver 40 new hospitals by 2030.

The focus in this debate should not be on whether manifesto commitments have been delivered in the guise in which they were promised, but rather is there a serious, credible, and achievable plan for delivering new hospital infrastructure, which is fit for purpose, future-proofed, and clinically driven?

The answer to that question is currently unclear. From our engagement with hospital providers across the country, one of the underlying issues remains the same – accessing capital remains difficult and the business case sign-off process for capital investment is opaque, elongated, and inconsistent.

However, there is good news. Across a range of schemes, we have had recent success with NHS providers in delivering major capital projects, whether it be under the umbrella of the New Hospitals Programme or in the context of Elective Care Recovery.

For example, Akeso supported a major Trust in the North West successfully deliver an NHP-associated scheme through the Outline Business Case and Full Business Case process and in doing so managed to secure an additional £11m in funding on the original capital allowance. Building works are currently underway and the scheme is set to completed at the end of 2024.

Reflecting on the success of this project, Akeso have defined the following factors as being key for successful infrastructure projects and capital business cases:

  • Engage with regulators from day one and don’t stop – continual engagement with the relevant regulator is essential for the delivery of successful capital investment and infrastructure projects. The requirements of a HM-treasury compliant business case for a capital scheme can appear vast and complicated, however engagement with the regulator will clarify critical areas of focus for the project.
  • Balance the local with the national – it was announced that the NHP had been paused to explore means of standardisation from the centre, including the potential mandated use of standard layouts and repeatable rooms. Whilst efficiencies within the hospital building programme should be welcomed and encouraged, this should not negate the imperative for locally shaped hospital solutions. All hospital planning should be based on locally designed clinical models and services, in line with ICS planning and population health management.
  • Clinical model first, infrastructure design second – the first key milestone for the project should be the development of the right clinical model. Following agreement of this, a range of capital options should be scoped to deliver this model.
  • Don’t let the perfect be the enemy of the good – simply, the current biggest blocker to the NHP and wider infrastructure transformation is affordability. In the business case process, an options appraisal should evaluate all options available, particularly those which deliver the greatest degree of benefit. However, in the case of some schemes, a capital envelop has been committed. Where this is the case, the project should continue to explore all options available, but always ensure an option for the allocated value has been developed and not over stretched.

If you want to understand more about developing successful business cases or how to shape an infrastructure and estates strategy, please get in contact with Peter Marshall.

References

  1. https://www.hsj.co.uk/daily-insight/dont-blame-the-treasury-the-nhss-capital-spending-system-is-a-mess/7034974.article
  2. https://www.nao.org.uk/reports/progress-with-the-new-hospital-programme/

Contact our experts

Peter Marshall

Peter Marshall

Associate Director
Insight

Creating more effective Estates and Facilities strategies through the Integrated Care Systems model

Estates and facilities (E&F) management plays a critical role in the delivery of all healthcare services. Every department or location depends on E&F services, with each facing unique challenges. These challenges have been significantly exacerbated by recent events such as the COVID-19 pandemic and Brexit, which have placed even greater pressures on supply chains and staff.

That is why overcoming these challenges and developing robust facilities management (FM) strategies, which ensure spaces are clinically safe, fit for purpose and able to flexibly meet patient demand, is increasingly becoming a key priority for Trusts.

In this article, we will look at the opportunities the shift to an integrated care system (ICS), presents and how your Trust can leverage them.

The key Estates and Facilities challenges Trusts are facing

Before examining the potential of an ICS to transform E&F provision, it is worth taking a closer look at some of the common pressures and challenges that are impacting Trusts across the NHS.

Perhaps most stark, is the current level of backlog maintenance. At the end of the last financial year the total cost to eradicate backlog maintenance stood at more than £9bn. This is around 20% more than the NHS’s entire capital budget of £7bn, with acute settings requiring 85% greater expenditure per square metre than community settings.

Creating more effective estates graph

Impacting a Trust’s ability to address this issue is a lack of capital and labour. There has been no long-term capital commitment from the government for E&F and there was no reference to the NHS estate in the November spending review, other than what had previously been outlined in the Long-Term Plan (LTP) and Health Infrastructure Plan (HIP). The emphasis remains on ambitious building projects rather than how to meet the maintenance needs.

On the labour side, the sector is struggling with the same supply issues as many others in the wake of COVID-19 and Brexit, making it harder to complete necessary tasks. But failing to maintain E&F correctly, will present risks to patient safety. Indeed, analysis by The King’s Fund suggests more than 5,000 clinical service incidents are caused by E&F failures each year.

Looking ahead, the function and form of E&F is changing. For the past 20 to 30 years estates have been constructed for a particular purpose, but it has become clear flexibility needs to be embedded in the design to allow Healthcare settings to adapt to shifting patient demand. Alongside this, net zero is now a core principle.

Developing an ICS model to address these challenges

Into this mix of challenges, the ICS model brings complexity. Formations of ICS’s as legal entities will become a statutory requirement from the 1st of July 2022 and understanding the different service provisions and settings that come under the umbrella of an ICS, will be critical to successfully adapting to this new landscape.

But with this complexity comes a number of advantages associated with having control over an entire ICS estate, and being able to make decisions that benefit the whole ICS.

Historically speaking, Trusts have arranged the delivery of their E&F services in one of four models, which must be understood in the context of an ICS:

  • Bundled services – Several single services contracted directly with the same supplier. One of the benefits here is improving negotiating power and potentially reducing the number of suppliers needed.
  • Fully integrated services – A service provider self-delivers all services, with some limited subcontracting. The key benefit is economies of scale and the ability to provide consistent service specifications and performance standards across an entire ICS.
  • Agent model – Management functions are carried out by an agent allowing them to focus on cost reduction and management excellence.
  • Total property outsourcing – A complete outsourcing of an ICS’s property needs to be done in a consortium of, for example, private sector finance groups.

The first two models are the most common, but the circumstances of individual ICSs will determine which is the most appropriate path to follow. In each case, a joined-up ICS-wide approach will enable Trust’s to seize opportunities that are emerging across hard FM, soft FM and utilities.

For example, the recent increases in virtual care and working will enable an ICS to re-examine their entire portfolio of sites and optimise for the requirements of the future.

There will also be numerous opportunities to create synergies and efficiencies, including:

  • Re-distributing service lines according to new organisational, geographic and category types.
  • Unifying maintenance contracts across sites.
  • Strategic sourcing and economies of scale throughout the supply chain.
  • Performance tracking and relationship management.
  • Greater career opportunities for the workforce.

Similarly, utilities consumption will be able to be monitored across different settings and supply consolidated where it makes sense to do so. Moreover, the ICS model will also enable larger group purchasing, which will strengthen the ability to weather the significant sector and price instability currently being experienced.

Understanding the opportunities of an ICS

To take the E&F opportunities available to them, Trusts must first be able to identify how effective their current E&F provision is within the context of their ICS.

Akeso & Co’s E&F dashboard has been developed to provide this capability. Its data-driven insights will support Trusts to devise an E&F strategy in several ways, including:

  • The ability to focus on key areas of E&F management to provide a clearer view of how each compares to NHS E&F management across England.
  • The ability to target analysis of a specific Trust or group level to identify organisations that can provide transformational advice.
  • The ability to benchmark within an ICS or on a national level to understand where best performance is and to develop new strategies.
  • The ability to filter information and drill down into it to understand a range of cost profiles at different organisational levels and identify opportunities for improvement.
  • The capacity to evaluate key metrics to understand potential future regional or organisational challenges.

As the ICS model becomes fully embedded in the NHS, Trusts must actively engage with the potential benefits on offer to realise them.

Tools such as Akeso & Co’s dashboard bring visibility and understanding to the complexities involved, enabling them to identify opportunities and take them.

If you would like a demonstration, please do get in touch with Debora Salvado at debora.salvado@akeso.co.ukdebora.salvado@akeso.co.uk.

Insight

Reshaping long neglected sterilisation services to meet the increased demands of a post-Covid world

As recent headlines have highlighted, the NHS backlog in routine operations and procedures has reached worrying heights during the pandemic. Data from NHS England shows that currently more than 5 million people in England are waiting for hospital treatment, with 3.63 million fewer elective surgeries carried out between April 2020 and May 2021. Meeting this backlog of care is going to be one of the key challenges for Trusts across the country over the coming months.

To achieve this, every element of a Trust’s service needs to be operating as effectively and efficiently as possible. One critical area that is often overlooked is decontamination and sterilisation services. Without effective surgical instrument sterilisation, even basic procedures cannot be carried out.

This insights article looks at some of the problems Trusts face when it comes to providing sterile services and how they can be addressed within integrated care systems (ICS) in a post-COVID world.

The current SSD landscape

There are more than 3,000 NHS hospital theatres across England, carrying out 10 million theatre operations each year, all of which are supported by sterile service departments at an estimated annual running cost of more than £200m.

Typically, sterile services are provided on-site on a Trust-by-Trust basis and are co-located adjacent to Theatres. The size and scope of this service provision is contingent upon both volume and type of a Trust’s elective caseload. The graphic below shows how this £200m spend breaks down by region and ICS, with percentages representing the proportion spent by each ICS within a region.

CE Akeso sterilisation graphs ics annual spend on sterile services across england by region
Figure 1 – ICS annual spend on sterile services across England by region

Disparities across NHS Trusts’ Sterile Services

Given the scale of these services, some variation in service performance and delivery is expected. However, digging deeper into NHS Digital data, Akeso & Co found significant disparities across Trusts that need to be addressed.

In fact, the total annual spend on sterile services per ICS, varies extensively in relation to the number of theatres in a Trust and the floorspace their sterile service department takes up. These variations are outlined in the graphic below which plots ICS spending driven by surgical activity and case type, against number of theatres and SSD floorspace.

CE Akeso sterilisation graphs unwarranted variation in sterile services performance in england
Figure 2 – Unwarranted variation in sterile services performance in England, shown by the total annual spend of STPs/ICSs compared to the number of theatres and SSD floorspace (sqm)

There is significant variation in spend on sterile services by ICS and Trusts when accounting for a hospital’s number of theatres, volume and scope of surgical activity, and unit size. One major cause of this unwarranted variation, highlighted above, is the varying age and condition of sterilisation equipment and assets.

Because the service is capital intensive, with high-value complex assets and costly support facilities, this commonly results in the assets operating beyond their lifespan. Inevitably, this leads to high levels of breakdown, maintenance costs and downtime which impacts a theatre’s ability to operate. In a capital-limited environment, most Trusts do not have the funds to upgrade their sterilisation assets to a standard which would be optimal and compliant.

However, where there is variation in service performance and efficiency, and an increasing backlog of demand, there are clear opportunities for Trusts to improve how they run these services. Trusts should welcome the challenge of further ICS integration as a means of combatting these issues. This will also enable them to redefine operational processes within the entire peri-operative value chain, embrace novel technologies and explore a variety of commercial models.

Addressing the challenges

How Trusts transform sterilisation services to reduce inefficiencies and unwarranted variation will depend on a number of determining factors specific to each Trust.  Addressing each one will enable Trusts to create efficient sterile services that allow theatres to function as effectively as possible, as they tackle the backlog of cases caused by Covid-19. Moreover, in reshaping the provision of sterile services, Trusts also have the opportunity to better manage their equipment and explore how they can optimise their floorspace, not least in the context of required theatre expansion programmes, where floorspace is at a premium.

We have identified several factors that will influence a Trust’s decisions, including:

  • Hospital site type, number of sites and location
  • Level of collaboration within an ICS / STP
  • Theatre case volume and type
  • State of assets and equipment
  • Financial position and capital availability

These all need to be taken into account when considering how to best prepare a Trust for the demands of a post-pandemic world.

To achieve this there are three steps we would recommend taking:

1.Understand the Trust’s requirements and activity

Theatre case volume, case type and surgical preference all impact decontamination activity. For example, orthopaedic surgeries require the greatest volume of associated surgical equipment and, in turn, sterilisation. Moreover, in larger Trusts, having a detailed understanding of the relationship between multi-site and multi-organisation environments is crucial. Only once the demand on sterile services has been accurately understood, can Trusts begin planning their bespoke sterilisation improvement strategies.

2. Tackle mismatches between theatre activity and decontamination volume

Through improved operational planning, Trusts will be able to manage surgical instrumentation to better meet peak demand and rapid turnarounds when necessary. Currently, the level of sterilisation activity does not always align with the volume of theatre cases, as illustrated in Figure 3 below.

Typically, cases and elective surgeries run throughout the working day, with sterile services running alongside them, often at max capacity. Trusts should look to adopt, where possible, a hybrid working model, whereby sterile service activity is better managed to align with demand and activity. This hybrid model would see the core volume of activity processed outside of the traditional elective window (also shown in Figure 3). This will improve their ability to respond to ad-hoc surgical demand and reduce pressure on already burdened capital assets, enabling crucial machine downtime.

CE Akeso sterilisation graphs misalignment in theatre cases and sterilisation activity
Figure 3 – Misalignment in theatre cases and sterilisation activity

3. Adopt technological capabilities to maximise current operations

Alongside better planning, advances in technology can help ensure the instrument peri-operative value chain is as efficient and effective as possible. Track and trace technologies, such as Radio Frequency Identification (RFID), offer full visibility over surgical instrumentation from surgical use to decontamination and other movements. This enables workflow optimisation and full utilisation of the existing asset base. Work conducted by Akeso & Co discovered that a third of one leading Trust’s surgical instrumentation had not been used for three years, with instrument dormancy going as far back as 2004.

In situations like this, RFID can pinpoint where medical instruments are dormant. Although there are valid clinical reasons for not using certain instruments, a clearer oversight of assets gives Trusts the option to generate value by disposing of unnecessary equipment and freeing up hospital floorspace.

4. Explore a variety of commercial models

There are a number of different commercial models which Trusts should consider, such as joint ventures and managed services that can reduce the significant capital investments required. The graph below shows the range of commercial models currently available, and the different value propositions they offer depending on a Trust’s objectives.

CE Akeso sterilisation graphs the range of commercial models available
Figure 4 – The range of commercial models available, including the level of service each offers and the advantages of a managed equipment service (MES)

Each commercial model comes with various advantages and opportunities. Depending on the selected model, Trusts have the possibility of further integration within the ICS to share capital and the option of taking sterilisation services off site if appropriate. Further to this, there is the opportunity to create revenue by acting as a lead partner in a commercial SSD network and offering services to the private sector.

Choosing the right model

There are benefits and risks to every solution and weighing up a Trust’s specific needs is an important part of the process when deciding which is the right route to take. We have worked with several Trusts over the years to identify the best direction for their SSD and build a business case to support this.

In transforming sterile services departments, Trusts will put themselves in a stronger position to deal with the fallout from the pandemic. Additionally, this will also increase theatre efficiency, improve infection control measures, generate space savings that enable theatre expansion programmes and potentially create much-needed income.

To discuss how Akeso & Co can help sterile service departments perform their critical role more effectively, get in touch.