From Lord Carter’s 2015 report through to Scan4Safety in 2017 mandating GS1 and PEPPOL compliance, the call for improved patient safety through better inventory management prior to and following the COVID-19 pandemic has long been stated. Yet despite these initiatives, many Trusts are still grappling with a lack of the right systems and processes to enable achievement of these aims.
In June 2023 the government published a mandate to address the most urgent needs for the NHS. Amongst the three key priorities outlined, a target was set for all Trusts to adopt barcode scanning of high-risk medical devices and submit data to the national, mandatory Medical Device Outcome Registry, by March 2024.
Nine months later and we’ve seen several programmes and initiatives kick start with the aim of supporting the advancement of patient safety through barcode scanning, including the NHS Supply Chain inventory management programme, which Akeso supported to mobilise, as well as more recently the reinvigoration of the Scan4Safety programme.
Whilst there has been notable investment, a significant number of Trusts do not have the right inventory management systems and processes in place to enable Scan4Safety effectively. Based on our analysis, we understand that almost half of acute Trusts in England do not currently have sufficient capability to meet the mandate requirements set out through barcode scanning capabilities. Furthermore, we estimate that only 30% of acute Trusts have the capability to manage inventory at the point of care and therefore meet Scan4Safety requirements.
Untapped Benefits within Inventory Management
Given the significant gap between Trusts with and without barcode scanning capability, there is an opportunity to tap into the wide-reaching benefits that optimised inventory management can achieve – from improvement to patient safety, greater traceability and operational productivity, to cash-releasing supply chain efficiencies. The below outlines some of the expected benefits Scan4Safety through inventory management optimisation can bring.
Based on our analysis we estimate that the average Trust could achieve the following key benefits:
Equivalent of 5 clinical WTE released back to critical patient facing activities
One-time cash releasing benefit of c. £1 million and recurring financial benefit of £50,000-£100,000
Wider supply chain and logistics efficiencies through greater visibility and control of ordering as well as improved supplier relationship management
However, despite this, the reality can be quite different for many Trusts. With common barriers, including siloed working across functions and Trust data maturity, understanding the landscape and due consideration to the change required is critical to the success of achieving positive and sustainable change.
Key Success Criteria
Based on our experience we have summarised the key success criteria that are required to effectively optimise inventory management through barcode scanning. Together these key success criteria make up the core fundamentals which enable inventory management optimisation best practice.
How We Can Support You
Akeso have worked hand-in-hand with a number of Trusts from business case development and benefits modelling through to implementation and benefits realisation, including most recently the establishment of the NHS Supply Chain inventory management programme. As such we are well positioned to support Trusts and ICBs navigate the current landscape and support accelerate your Scan4Safety proposition.
Sign up to access our free ‘how to’ guide for further information on how healthcare organisations can accelerate Scan4Safety through inventory management optimisation:
Olivia is an experienced consultant in the private and public healthcare sector specialised in delivering tangible benefits to supply chain operations and strategic sourcing. Prior to joining Akeso, Olivia worked in the FMCG sector developing innovative products for global and market-leading healthcare brands.
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
Chris has spent almost 25 years working in the commercial and operations space, in both private and public sector across the automotive, financial services, telecoms, energy and healthcare sectors.
As a Managing Partner and co-founder of Akeso, Chris is passionate about the value that can be realised when an organisation takes a fresh look at how it can enhance the quality and cost efficiency of the services and products it delivers by leveraging third-party led innovation, technology and solutions and has worked collaboratively with many providers and suppliers to the Health & Care sectors in the UK and internationally to realise this objective.
Outside of work Chris enjoys spending time with family, watching Arsenal, running and doing DIY projects.
Experts, politicians, third-sector organisations, and industry players all met to discuss the key challenges within the UK’s health and social care sector, and how these can be overcome going forwards. Headline speakers from the political sphere included Karin Smyth MP, Shadow Health Minister, Steve Brine MP, Chair of the Health and Social Care Select Committee, and Daisy Cooper MP, Deputy Leader of the Liberal Democrats.
With a General Election on the horizon, there was discussion on the perceived failures of the current and previous governments amid the NHS and health and social care sector facing the most challenging time in history. Equally, there was political positioning of potential changes that could be in store depending on the colour of the winning party. Interestingly, challenges identified were broadly recognised across party lines and fell into the core themes identified below. What was lacking, however, was a true sense on how a future state that addresses the underlying challenges is truly patient-centric and dignifies workers can truly be realised and, ultimately, funded. In summary, there seems to be a reasonable consensus on the direction of travel for a robust health system to evolve, and the core themes below outline that, but further thinking needs to occur on how, exactly, we get there.
The core themes identified were:
Preventative health and moving activity upstream
A cross-departmental, public health approach
Social care workforce and a National Care Service
Need for continuity in policy design, systems, and interventions
Digital / data and its potential
Life science research and development in the UK
In this article, we will focus on perhaps the three most pertinent of these – preventative health, public health, and the tragedy of adult social care and its future.
1. Preventative health and moving activity upstream
If there were one major thread running through the panels, it was around the need to focus on prevention, moving healthcare from reactive to proactive. Be it through more and earlier screening and diagnosis, better personalised data, new drugs, and, for the techno-optimists, new technology to support people before it becomes too late and they are showing up at the hospital front door (to put it bluntly).
The evidence base for a preventative approach to healthcare is well documented, yet it is often ‘unseen’ to both service users and the wider public. This then, is the crux: prevention is hard to measure, relies on a wide, holistic approach to health (e.g., inequalities, education, housing as discussed in the next section), and can take years to ingrain and realise. We can all agree that it is a sensible and necessary approach, but it will take a brave government to empower prevention as a central tenet of its healthcare policy. Especially as it will likely require the movement of funding from the overstretched acute sector who are unlikely to see the benefit in the short term.
2. A cross-departmental, holistic approach to public health
From the speakers in the room, it appears all three major parties are in agreement that there is a need for a public health approach to healthcare, with health permeating throughout government policy. Both Labour and the Liberal Democrats believe in the creation of a cross-government board to enable health policy considerations across all areas (e.g., environment, housing, poverty). For the Liberal Democrats, this would be the ‘Health Creation Unit’ in Number 10, alongside a ‘Neighbourhood Health Service’ to empower people to receive care closer to home.
The rationale for a public health approach differs between political persuasion. The Liberals are more interested in the ‘health and wealth’ idea with, supposedly, close to two million of the 8 million on NHS waiting list being too ill to work. Labour’s reasoning is from the viewpoint of equity, looking at inequalities across education, income, and race and how these have such a big impact on future health outcomes.
How public health can best be impacted, and at what level of government delivery of public health initiatives should be realised was generally agreed to be at the local level. Whilst this may feel like just another attempt of central government pushing more work to over-stretched and under-resourced local authorities, a representative from the West Midlands Combined Authority detailed specific policy interventions they had made that were applicable to the geography and demography of the West Midlands. The local theatre where interactions take place also tied into the idea of proportionate universalism, with the Covid-19 vaccine roll-out shown as an example where increased intensity and prioritisation of low-vaccine neighbourhoods was almost carried out on a street-by-street basis.
3. Social care workforce and a National Care Service
Throughout the day, workforce was constantly mentioned but nearly always in the context of adult social care provision. The secondary and primary care workforce was mentioned in passing as a challenge but never analysed or dissected.
Instead, a lot of time was spent on the wicked problem of adult social care. The statistics outlined were incredibly stark:
Social care provision takes up to 70% of some Local Authority budgets.
20% of the population will be living with a major acuity or illness by 2040
152,000 vacancies in social care (1 in 10 of the workforce)
392,000 have left or moved roles in the last year (1 in 4)
45% of home support workers are on zero hours contracts
The Care economy underpins the real economy and accounts for more GDP than tourism and other sectors
And yet, despite these shocking numbers and the severity of the challenge, very little has been done with social care not included in the workforce long-term plan. Why it hasn’t been tackled appears to be that:
an aging population (and care workforce for that matter) has been put in the ‘too difficult to deal with box’ by successive governments
adult social care has a level of invisibility to it when compared to other domains of healthcare
The invisibility stems from large demographic changes but no changes in the assumptions that underpin those groups. Health policy currently appears to not always consider the social care dimension at all, which is as much about the social as it is the medical. Care workers are incredibly undervalued and maligned, leaving a sector in crisis. It doesn’t deliver for patients or staff or, due to existing commissioning arrangements, the taxpayer.
The panels essentially argued that to tackle adult social care, we require a ‘reset’ to develop the visibility of social care and to bring the public ‘on a journey’. The Fabian Society’s vision of a National Care Service (NCS) has been partially coopted by Labour and it is considered that it will create a social care system with a higher status. Higher pay will inevitably be part of this, with collective bargaining and a set of minimum standards for care across the country regardless of provider. Whilst delivery and models of care will be local, a NCS would be able to scale up good practice and examples of innovation.
To sum up, the New Statesman Future of Healthcare Conference shed light on the critical challenges facing the UK’s health and social care sector.
The discussions highlighted the urgent need to shift towards a patient-centric, preventative healthcare approach, promote a cross-departmental, holistic public health strategy, and address the pressing issues within the adult social care workforce. It is evident that the future of healthcare in the UK hinges on innovative solutions and a collective commitment from all stakeholders involved.
At Akeso, we understand the importance of reliable and trustworthy healthcare services, which is why we take pride in being a dependable partner and trusted advisor to healthcare organisations, particularly in the NHS and Health and Social care sectors. Our team of experts possess extensive knowledge in both the public and private sectors, and we work closely with leading providers to deliver exceptional services that benefit all stakeholders involved.
Whether you’re looking to improve your organisation’s overall efficiency or enhance the quality of care provided to patients, we can help. So, if you’re interested in learning how Akeso can assist your organisation, speak to our experts today and take the first step towards a brighter future for your healthcare practice.
Scott has dedicated his career to performance improvement in healthcare and life sciences working both within a multinational consulting firm, and for the last decade as a co-founder of Akeso.
As a Managing Partner of the company, he has led the development of Akeso as an established boutique consultancy committed to improvement in UK health. His project specialisms and areas of interest are systemwide performance improvement, the national and international healthcare supply chain and the use of data to drive tangible and actionable improvement insights.
His approach is flexible, warm and fact-based and he is proud to have delivered numerous collaborative/ICS projects being able to engage positively across multiple stakeholders, specialisms and styles to achieve outcomes around aligned goals.
Outside of work his passions are almost all sports (mainly watching nowadays although can be found trying to find his wayward golf balls in the woods / long grass / water) and spending time with family, including Rump the cocker spaniel who is also the honorary office dog.
Akeso were engaged to work closely with the Clinical and Operational teams from the 9 hospitals who deliver Endoscopy Services in the ICB to model a shared waiting list for Endoscopy and identify opportunities to pool resources across neighbouring hospitals across the region to treat patients more quickly and reduce the waiting list.
INSIGHT
The demand for Endoscopy Diagnostics is increasing year-on-year driven by increases in Gastroenterology and Colorectal Surgery. As of April-24, the NHS waiting list for Gastroenterology-related Diagnostics stood at almost 170k nationally.
From an ICB perspective, pooling of resources across a regional Health system can be a key means to addressing the growing waiting list for a given clinical service, particularly for day case / walk in activity such as Endoscopy. It also maximises utilisation of existing resources. Our work with Health providers across the NHS suggests that capacity increases of over 20% can be achieved through pooling of waiting lists and associated resources.
To be successful however, there are a number steps that must be taken beyond the simple aggregation of the waiting list across a group of providers including: (1) building a detailed understanding the cohort of patients awaiting diagnostics / treatment, (2) understanding potential challenges and barriers to patients accessing and receiving care at an alternative provider and (3) developing strategies and plans for how these can be overcome.
ACTION
Akeso conducted a full service ‘as-is’ review, presented through data collation, validation and analysis, which provided a network wide view of current service, including waiting lists, capacity, activity, and workforce;
Scenario modelling was then performed utilising the current network status and changeable inputs and outputs allowing for simulation testing to understand the potentials of service optimisation, in terms of absolute waiting list reduction, additional income and costs;
A series of business cases were then developed exploring specific options available to individual Trusts as well as the network as a whole. This incorporates options to clear the current backlogs / waiting lists, as well as how to future proof the service in accordance with demand predictions;
A final interactive dashboard tool was developed to be used for short-medium term service planning, providing real-time service and workforce optimisation based on Trust needs.
RESULTS
We found that the ICB in question could realise a capacity increase of 20% through the pooling of waiting lists and resources. We also proposed and developed a series of recommendations, on supply and demand side, to help them address potential barriers to patients accessing available with alternative providers in the region.
Adam has 18 years’ experience as a healthcare consultant, delivering change and transformation in the UK and overseas, with a focus on delivering improved productivity and efficiency. He has previously led healthcare consultancy teams at NECS CSU and Deloitte.
He has held a number of senior NHS positions with large London providers and with Monitor/NHS Improvement, and has served as a Non-Executive Director and as Chair with a number of local health and social care-focused charities.
Adam is a Chartered Management Accountant and a Prince2, MSP and Green Book Practitioner.
We supported the design, development, and implementation of a collaborative procurement function across North East London, including the delivery of over £1m in savings on non-pay spend, service specific ICS category strategies, and standardised processes
INSIGHT
North East London (NEL) are one of the largest integrated care systems across England, formed of five Trusts, with a total third-party, non-pay spend over £1.2bn.
Akeso were engaged to analyse this spend and deliver £1m in cost savings efficiencies through the collaborative model, in addition to designing a new operating model for procurement services, develop collaborative category strategies, and transform singular service provisions into integrated delivery models.
ACTION
Akeso developed an initial opportunity assessment analysing the ICS’s total £1.2bn non-pay spend (60% non-clinical products and services; 19% clinical products and services; and 21% on drugs)
From this, Akeso delivered a series of collaborative opportunity recommendations, which ranged from 3rd-party spend cost reduction initiatives to yield ‘hard’ benefits, to ‘softer’ service enhancement and capability development initiatives
We developed an overarching governance and reporting structure to track opportunities and value delivery and designed a detailed workstream and category management structure and supported value-delivery projects including; CIPs, procurement exercises, strategy design, and business case development across clinical products and services, estates and facilities, corporate services, and IT, data, and systems
RESULTS
Across the programme we developed and implementation a new collaborative operating model, including an overarching collaborative governance structure, delivered over £1m in collaborative annual savings, developed approved service specific business cases, consistent ways of working, processes, standardised templates, and the upskilling of NEL team members
Chris has spent almost 25 years working in the commercial and operations space, in both private and public sector across the automotive, financial services, telecoms, energy and healthcare sectors.
As a Managing Partner and co-founder of Akeso, Chris is passionate about the value that can be realised when an organisation takes a fresh look at how it can enhance the quality and cost efficiency of the services and products it delivers by leveraging third-party led innovation, technology and solutions and has worked collaboratively with many providers and suppliers to the Health & Care sectors in the UK and internationally to realise this objective.
Outside of work Chris enjoys spending time with family, watching Arsenal, running and doing DIY projects.
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:
Understand specific challenges of the local demography and economy e.g., employment, skill gaps, and diversity of businesses.
Identify relevant initiatives to the project being delivered / service procured e.g., consideration for service accessibility, with considerations for those with protected characteristics.
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.
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.
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.
Chris has spent almost 25 years working in the commercial and operations space, in both private and public sector across the automotive, financial services, telecoms, energy and healthcare sectors.
As a Managing Partner and co-founder of Akeso, Chris is passionate about the value that can be realised when an organisation takes a fresh look at how it can enhance the quality and cost efficiency of the services and products it delivers by leveraging third-party led innovation, technology and solutions and has worked collaboratively with many providers and suppliers to the Health & Care sectors in the UK and internationally to realise this objective.
Outside of work Chris enjoys spending time with family, watching Arsenal, running and doing DIY projects.
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.
Chris has spent almost 25 years working in the commercial and operations space, in both private and public sector across the automotive, financial services, telecoms, energy and healthcare sectors.
As a Managing Partner and co-founder of Akeso, Chris is passionate about the value that can be realised when an organisation takes a fresh look at how it can enhance the quality and cost efficiency of the services and products it delivers by leveraging third-party led innovation, technology and solutions and has worked collaboratively with many providers and suppliers to the Health & Care sectors in the UK and internationally to realise this objective.
Outside of work Chris enjoys spending time with family, watching Arsenal, running and doing DIY projects.
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.
Chris has spent almost 25 years working in the commercial and operations space, in both private and public sector across the automotive, financial services, telecoms, energy and healthcare sectors.
As a Managing Partner and co-founder of Akeso, Chris is passionate about the value that can be realised when an organisation takes a fresh look at how it can enhance the quality and cost efficiency of the services and products it delivers by leveraging third-party led innovation, technology and solutions and has worked collaboratively with many providers and suppliers to the Health & Care sectors in the UK and internationally to realise this objective.
Outside of work Chris enjoys spending time with family, watching Arsenal, running and doing DIY projects.
So far, Akeso’s Financial Improvement series has outlined the opportunities for realising tangible efficiencies and savings over short, medium, and long-term timeframes, with examples of our proven experience working with NHS organisations, collaboratives and systems.
In this article, we will take a closer look at the opportunities for Integrated Care Boards to leverage Population Health Management to support long term improvements in health outcomes and associated efficiencies.
Context
The prevalence of chronic health conditions in the UK continues to rise, and with this so does the burden on healthcare services. For example, more than 4.9 million people live with diabetes, with 13.6 million at risk of developing type 2 diabetes[1]. Obesity is another significant public health challenge. It is estimated 36% of adults within the UK will be obese by 2040[2], a key risk factor for type 2 diabetes, as well as cardiovascular disease, cancer, and musculoskeletal disorders, amongst others.
These chronic conditions not only impact quality of life at population level but also come with significant financial and economic implications – last year, NHS spend on diabetic care accounted for circa 10% of the total budget[3], with the annual cost of obesity to the UK economy estimated at £58 billion. Quality of Life Years (QALYs) measures the loss of productivity and quality of life costs for individuals at £39.8 billion, and costs for society as a whole at £7.5 billion, demonstrating that addressing health risks can add far more benefits than just cost reductions to the NHS[4].
Integrate Care Boards and Population Health Management
Population Health Management (PHM) is a methodology that uses data-driven planning and delivery of proactive care via risk stratification and population segmentation to improve physical and mental health, promote wellbeing and reduce health inequalities across a population, with a specific focus on the wider determinants of health (e.g., housing, employment, education). In turn, this improves health outcomes, specifically for people for long-term conditions, and releases long-term financial and economic efficiencies.
ICBs and partnerships are best placed to lead on PHM by designing tailored interventions for their local populations. It is vital that a broader view of ‘value’ is taken (and over a longer timeframe than a single year) as this will inform decisions on investment into interventions to improve the health of communities, release longer term efficiencies for the NHS and deliver wider societal benefits. Examples of proven interventions include investment in the self-management of chronic conditions such as asthma, COPD, and diabetes.
The range and potential for PHM interventions will be determined by the ambition of local healthcare leaders and decisions makers. The key challenge will be to balance the immediate and acute pressures facing the NHS with a forward-looking approach to the local population’s care needs and associated financial burden.
Akeso and Population Health Management
Akeso has developed various solutions to support ICBs and Partnerships, to address the PHM and longer-term efficiency challenge.
A Bespoke PHM Modelling Approach
We have developed a bespoke PHM modelling approach that benchmarks the cost of health and care provision for ICBs and Places with similar demographics. This was initially developed with NHSE’s Finance Department to identify performance and cost improvement opportunities across all CCGs, using national health, health access, socio-economic, and demographic data. We have further developed the model and combined 46 variables including, cost and access to primary and secondary care, age, ethnicity, rurality, deprivation, diabetes prevalence, and cancer prevalence.
Enhancing Business Cases and Cost-Effectiveness in Health and Care Interventions
We have developed an approach to developing business cases, benefits, and the cost-effectiveness of health and care interventions, that goes beyond the requirements of the 5 Case Model for HM Treasury Green Book Business Cases. For example, we calculate Quality of Life Years (QALYs) and capture economic and societal benefits from the impact of population health management interventions.
Data-driven Study for Improved Healthcare Outcomes Akeso is currently studying healthcare data to identify potential underdiagnosis rates among adolescent ADHD patients. To achieve this, we are analysing data from the Millennium cohort study and national prescribing rates. The findings of this review will be used to support education initiatives, improve healthcare outcomes and understand the potential for longer-term efficiencies, as well as societal and economic benefits.
Our Population Health Management solutions are designed to deliver tangible outcomes, offering a data-driven approach that empowers our clients to make informed decisions. Through our benchmarking, enhanced business cases, and targeted studies, we provide the tools needed to optimise resource allocation and prioritise interventions. Our goal is to transform healthcare systems, resulting in better health outcomes, reduced costs, and improved well-being for communities.
If you would like to find out more information on how Akeso can support you in delivering financial improvement schemes, please get in touch with Scott Healy, who leads our Financial Improvement offering.
Andrew is a results-driven transformation leader with experience spanning strategic planning, operational efficiency, and transformative change management for leading healthcare organisations in both the private and public sector.
After leaving the NHS, he spent 15 years with EY’s Consulting practice, overseeing large and strategically significant client projects across the health sector at front-line, regional and national level.
The highly anticipated NHS Workforce Plan was released last week, with many weighing in to give their assessment. The main themes of ‘train’, ‘retain’, and ‘reform’ have generally been well received but as with all grand plans, what matters now is execution.
Akeso highlights three key areas that will be instrumental in the successful execution of the ambitious plan.
The commitment to support recruitment across a wide range of healthcare roles is commendable – with a target of an additional 300,000 clinicians by 2036/2037, including 170,000 nurses and 60,000 doctors[1]. This is based on top-down national-level modelling to steer the strategy in the right direction.
To translate these targets, it is essential that ICBs and their regional partners develop their own local service plans. These plans must be founded on locally validated capacity and demand, informed by assumptions linked to innovative, technology-enabled workforce models.
This is a long-term plan to expand workforce and will require a productivity increase of up to 2% to fund new initiatives. [2]This investment will be needed if we are to realise the ambition of “delivering care closer to home while avoiding costly admissions, achieving operational excellence, and reducing administrative burden through better technology and infrastructure.’’ [3]Therefore, it is imperative ICBs and NHS organisations can deliver achievable Financial Improvement Plans, which depend on two main factors:
a sustainable investment in NHS estate and equipment
use of technology and digital innovation (with consideration for funding availability)
Perhaps the most challenging initiative is to retain staff, starting by making the NHS an attractive place to work. In 2022, the reported level of absence due to sickness was 5.6% (well above the public sector average), which equates to 27 million days across 2022 and 74,500 full-time equivalent staff.
Unsurprisingly, morale is also declining, with nearly a third of NHS staff thinking about leaving their organisation[4]. Further research on why this is the case is urgently needed but, in the meantime, immediate solutions to retain staff must be implemented.
However, the plan does little to address the elephant(s) in the room: pay,compensation and termsandconditions. The recent strikes by doctors and nurses highlight that significant progress is needed in these areas.
Equally important is attracting and retaining non-clinical roles, particularly in medical technology, to support use of artificial intelligence, robotics and automation diagnostic solutions and treatments to deliver improved, efficient and patient-focused care.
Chris has spent almost 25 years working in the commercial and operations space, in both private and public sector across the automotive, financial services, telecoms, energy and healthcare sectors.
As a Managing Partner and co-founder of Akeso, Chris is passionate about the value that can be realised when an organisation takes a fresh look at how it can enhance the quality and cost efficiency of the services and products it delivers by leveraging third-party led innovation, technology and solutions and has worked collaboratively with many providers and suppliers to the Health & Care sectors in the UK and internationally to realise this objective.
Outside of work Chris enjoys spending time with family, watching Arsenal, running and doing DIY projects.
In the first article of Akeso’s financial improvement series, we set the scene on the financial challenge faced by NHS organisations and Integrated Care Boards (ICBs) and outlined the opportunities to leverage tangible savings within differing time horizons.
In this article, we share examples of the proven efficiency and savings schemes that Akeso have supported our clients to implement, which also address clinical, operational, and patient challenges.
Short-term
Quick-win initiatives with in-year benefits realisation, and tactical savings in as little as 3 to 6 months:
Controlling costs by reducing the use of inappropriate products and services, whilst finding feasible ways to change spend patterns throughout the organisation is key to managing demand. Additionally, implementation of robust stock management principles reduces excess stock and releases clinical time to care, whilst ensuring staff have the correct type and number of items at the correct time for safe and effective care delivery.
Conducting detailed reviews with budget holder input to identify all types of discretionary spend. Outputs from reviews support data-informed decisions to implement the necessary controls, governance, and tracking across organisations. For example, highlighting inflated contract spend for renegotiation, and non-essential ad-hoc spend.
Clinicians should also be engaged to develop an exclusion list to protect budgets, where necessary
At a provider level, implementing process improvement to focus on reducing agency spend. At a system level, partners working collaboratively to operate joint banks, aligning agency rates across the system, and sharing specialised clinical resource, rather than competing to recruit from the same pool.
Reducing expenditure on non-clinical staffing should be a priority.
Medium-term
Schemes delivering within one to two years:
Use of data, technology, and digitalisation to automate processes, reduce administrative burden, and provide care closer to home, whilst releasing staff time and resources through:
Robotic Process Automation (RPA) for both front office activities, for example patient administration, and corporate services, for example Finance and HR systems.
Inventory Management and Point of Care solutions. A recent NHS Supply Chain (NHSSC)review found ‘improved inventory management represents the most significant cash-releasing saving and operational efficiency available in supply chain management within the NHS’[1].
Implementing best practice initiatives, such as improved discharge planning, to reduce length of stay, release of escalation beds, and increase income through delivery of more elective operations.
Akeso have a Discharge to Assess (D2A) and community support maturity matrix that helps acute Trusts, local authorities and ICBs to understand the fundamental requirements for D2A to be a success[2].
Out-of-hospital programmes, including virtual wards and remote monitoring, enable release of bed days and improve patient outcomes through admission avoidance and delayed discharges, supported by a well-defined benefits framework[3].
Virtual ward schemes are essential if we are to meet the national target of 50 Virtual Wards per 100,000 population.
At a provider level, informed by Getting it Right First Time (GIRFT) benchmarking, the focus is on improving productivity through booking procedures, scheduling, and improving staff skill mix.
At a system level, supporting providers in moving procedures to the most appropriate setting, e.g., from traditional theatres to community and outpatient settings, as well maximising the use of digital tools for virtual care, where appropriate.
Long-term
Opportunities to realise savings after two years, with strategic programmes delivering five years and beyond.
Population Health Management analytics and benchmarking support optimisation of resources and best-practice clinically led care across pathways. Examples include:
Innovative cross-pathway workforce models such as use of advanced practitioners and nursing staff in the community and acute settings, recognising current recruitment constraints.
Improving workforce productivity and elective recovery by using analytical tools to understand, predict and plan for system-wide capacity and demand.
Self-management of chronic conditions such as asthma, COPD, and diabetes. Recent evidence also suggests prehabilitation is cost effective in reducing the need for surgery, reducing complications by 50% and improving recovery[4].
Establishing Shared Support and Collaborative Functions in clinical support services for systems such as:
Regional pathology networks to deliver the recommendations of the Carter report[5] – recognising the capital funding challenge. One in three pathology networks are still running at Trust-level, despite the roadmap to service consolidation published over five years ago[6].
Developing innovative pharmacy supply chain functions at an organisation and provider collaborative level, delivering benefits of inventory reduction, net operating cost savings and release of clinical time to care.
Implementing collaborative procurement functions to leverage the of economies of scale and switching to evidence based lower priced products.
Centralising sterile service functions across providers to promote standardisation and reduce operating costs.
Detailed, system-wide estate planning allows organisations to work together to use their combined estate to share workloads, improve efficiencies, and reduce costs.
Examples of using a shared estate are Integrated Care Centres, to allow co-location of GP surgeries alongside other primary care facilities such as pharmacy and dental services.
Savings can also come from a system approach to the disposal of surplus properties, running costs, and backlog maintenance.
If you would like to find out more information on how Akeso can support you in delivering financial improvement schemes, please get in touch with Scott Healy, who leads our Financial Improvement offering.
The next article in our financial improvement series will focus on one of the longer-term opportunities, which is also a hot topic in public health: the role of ICBs in Population Health Management.
[5] Carter, P.R. Operational productivity and performance in English NHS acute hospitals: Unwarranted variations. An independent report for the Department of Health by Lord Carter of Coles. 2016. Department of Health.
Andrew is a results-driven transformation leader with experience spanning strategic planning, operational efficiency, and transformative change management for leading healthcare organisations in both the private and public sector.
After leaving the NHS, he spent 15 years with EY’s Consulting practice, overseeing large and strategically significant client projects across the health sector at front-line, regional and national level.
As we progress towards medium-term pandemic recovery, there is a renewed focus from central government and NHSE on delivering greater efficiencies, whilst continuing to improve quality of care and patient outcomes.
Unsurprisingly, Financial Improvement Plans remain a standing priority for NHS organisations, particularly in light of the recent NHSE announcement of up to 6% savings targets in FY23/24[1]. There is also additional pressure on ICBs to achieve financial balance, including those still carrying huge pre-pandemic deficits.
In light of this, the challenge is to address, achieve, and exceed previous performance, whilst sustainably offsetting inflation in the context of ever-increasing service demands, an over-burdened workforce, and ageing infrastructure.
Opportunities for Financial Improvement: ICBs and Collaboration
NHS leaders acknowledge that no single organisation can tackle the systemic and efficiency challenges facing the health and care sector alone[2]. Trusts and their system partners have been developing collaborative ways of working for several years as national policy has shifted away from competition to collaboration. However, workforce, funding, and investment barriers have been challenging to overcome. With the formalisation of ICBs, there is now a real opportunity to tackle the financial challenges with a collective effort, whilst acknowledging collaborative programmes can take longer to deliver to benefits and savings. Areas of focus for ICBs should include:
Akeso’s Approach:
Our series on financial improvement plans for the NHS will look at pragmatic and tangible opportunities over differing time horizons and objectives, whilst also achieving clinical, operational, and patient benefits.
Quick-win, short-term initiatives can realise benefits within a year, and tactical savings within as little as 3 to 6 months. Medium-term schemes are designed to deliver between one to two years, and longer-term opportunities look two years and beyond, with some strategic programmes (e.g., system-wide estates planning) spanning over five years.
While cost reduction has become byword for relentless programmes of marginal gains, in the current environment organisations should a) take a holistic approach – managing cost pressures (including inflation) is arguably as important as identifying savings; and b) recognise that delivering better outcomes with the same resource has significant value.
The next article in our Financial Improvement series will provide further detail on the proven methodologies to deliver savings in the short- and medium-term. We will then set out how Population Health Management can support ICBs in the long-term. For more details, please get in touch with Scott Healy, who leads our Financial Improvement offering.
Andrew is a results-driven transformation leader with experience spanning strategic planning, operational efficiency, and transformative change management for leading healthcare organisations in both the private and public sector.
After leaving the NHS, he spent 15 years with EY’s Consulting practice, overseeing large and strategically significant client projects across the health sector at front-line, regional and national level.
“Virtual wards” are a key initiative across health and social care to help keep people at home, or to get them back to their usual place of residence after a hospital spell. The issues of bed occupancy in acute trusts are well-known (see the figure below), as is the imperative to look after people well to prevent deterioration wherever possible and avoid a trip to hospital.The use of the name “ward”, therefore, is slightly misleading as it suggests hospital-type care whereas the gains are at least as great in admission avoidance and the maintenance of health. The word “virtual” also has negative connotations (suggesting that care is less immediate or personal) but, for the purposes of this paper, we’ll use the current expression whilst appreciating its potential breadth of meaning.
The idea is not new (it was first developed about 20 years ago) but the current interest from digital and technology providers, together with significant amounts of funding (£450m over the last 2 years), has led to their adoption accelerating over the last 2 years. In principle, it has multiple benefits over the long term:
It generates better outcomes for patients (being at home keeps people healthy and aids recovery, relative to being in an acute setting);
It is a much better experience for patients, carers and clinicians (in general, people would prefer to be at home surrounded by family and familiar surroundings, knowing that you can access support as and when you need it)
It makes better use of clinical resource (more attention in hospitals can be spent on those who need it), and is more financially efficient (the cost of running a virtual ward is much cheaper than that of a physical hospital ward).
Through the Spring of 2023, Akeso conducted research across all trusts within England in order to understand how widespread the adoption of virtual wards has been and whether they are having the predicted impact. In this first article, we present the current state of coverage across the country.
Through the Spring of 2023, Akeso conducted research across all trusts within England in order to understand how widespread the adoption of virtual wards has been and whether they are having the predicted impact across all domains. In this first article, we present the current state of coverage across the country.
The rule of two-thirds
For completeness, all 240 trusts in England were invited to contribute to a survey which aimed to capture a snapshot of the state of the virtual ward programme across England. These included large acute trusts (for which the relative share of potential virtual ward beds was large, given their catchment and coverage), specialist trusts, and community trusts. The trusts were separated into 4 categories: category 1 trusts were the largest trusts in the country who, between them, would cover about 50% of all potential virtual ward beds1; categories 2-4 trusts had smaller proportions (approximately 30%, 15% and 5% respectively).
Over 2 months, responses were received from over 160 – about 2/3rds of all trusts within England – which is sufficient to make projections about the overall state across the nation.
Adoption: Encouragingly, every one of the category one trusts who responded said they had virtual ward pathways in place. Perhaps more surprisingly, even 90% of the category 2-4 trusts who responded also indicated that they also have pathways in place. There was no correlation between adoption and CQC rating – the adoption of virtual wards was similar across all four ratings categories.
Coverage: Coverage: So, if almost everyone has some form of virtual ward offering, how significant is their capacity? Our respondents between them have about 6,500 virtual ward beds open at the moment; and the average number of virtual ward beds available is 50-60 (the equivalent of a couple of physical wards). This number is likely to almost double by the end of 2023/24 (likely before Winter pressures hit) to a figure ofnearly 11,000, as plans for the rest of the year are delivered. If this figure were replicated across all trusts across the country, the number of virtual ward beds which will be open by the end of the year will hit nearly 15,000. Progress is good and will continue to be positive, therefore, but it’smost likely that the total number of virtual ward beds open by the end of this year will fall significantly below NHS England target of 24,000 (which corresponds to about 40 beds per 100k head of population in England). Again, the proportion is about 2/3rds.
Specialty representation:Building on the capacity analysis, what are the beds being used for. Much of the existing literature on good virtual ward case studies points to a predominance of respiratory and cardio-vascular pathways. The responses confirm this: of the 300+ pathways that were identified as being available across trusts which responded, the top three were indeed respiratory, general frailty, and cardiology. Again, these made up about 2/3rds of all available pathways. However, there were a total of 33 different pathways listed, including diagnostic and maternity pathways, which indicates the growing spread of virtual wards to very many clinical areas. It is worth noting that, whilstsurgery, cancer, paediatrics and women’s health were all represented, the majority of the pathways were related to medical specialties.
Technology: given the increased comfort with remote and digital technology platforms in facilitating clinical services, it was no surprise to find that there was a plethora of private technology companies who are assisting trusts of all sizes with the adoption of virtual wards. 13 different companies were named specifically, and often trusts were engaging multiple technology providers who delivered different pathways, depending on their clinical efficacy. We think this is an under-representation of the range of technology providers who are involved – many smaller trusts listed large acute trusts as their partner and, thus, may not have been aware of the supporting technology provider.
Summary
Progress in the roll-out of virtual wards has been positive, with 15,000 such beds likely to be open by the end of the year. The funding which has been made available has undoubtedly helped and it is very encouraging to see the range of different pathways which are represented. As is the way with innovation and adoption, using local workforce to figure out what works locally leads to solutions which are likely to succeed – this is not a simple exercise in “plug-and-play” the latest digital between the EPR and iPhones. Time, space and resources will continue to be needed so that learning is made and adoption sustained.
In the long term, virtual wards have to show benefits for patients and carers (in terms of experience and health outcomes), staff (in terms of working conditions and job satisfaction) and efficiency in terms of use of capacity (both physical space and the valuable workforce). At the moment, whilst beds are open, their occupancy is actually relatively low, and there is very little evidence that sustainable impact is being made – over time, it should be easy to see that admissions are falling, acute-based length of stay in decreasing, and that staff are being better used (and happier in their jobs). For this to happen, there are a number of factors across six operating model domains which need to be in place. Our next article in this series will dig deeper into a number of these to unearth further promising progress.
We continue to work with NHS and partners alike to learn and spread best practice in virtual wards to improve services for patients, carers and staff alike.
Chris has spent almost 25 years working in the commercial and operations space, in both private and public sector across the automotive, financial services, telecoms, energy and healthcare sectors.
As a Managing Partner and co-founder of Akeso, Chris is passionate about the value that can be realised when an organisation takes a fresh look at how it can enhance the quality and cost efficiency of the services and products it delivers by leveraging third-party led innovation, technology and solutions and has worked collaboratively with many providers and suppliers to the Health & Care sectors in the UK and internationally to realise this objective.
Outside of work Chris enjoys spending time with family, watching Arsenal, running and doing DIY projects.
Akeso supported Moorfields Eye Hospital in the rapid deployment of a stand-alone ophthalmology remote diagnostic hub to increase capacity for diagnostic clinics for Glaucoma and Medical Retina Services
INSIGHT
Shortly following the onset of COVID-19 Moorfields Eye Hospital (MEH) looked to establish a first-of-kind ophthalmology remote diagnostic hub to support both short-term backlog clearance due to COVID-19 as well as a broader strategic objective to meet the medium to long term service delivery within MEH’s clinical model.
In implementing this site, MEH wanted to showcase an innovative model which could become a key exemplar for large scale ophthalmology services and further benefit planning for Oriel.
ACTION
We supported MEH with the rapid 3-month deployment of the remote diagnostic hub in Hoxton, North Central London through the following activities:
Defined strategic vision to inform the scope and operating model
Assessed patient need and identified the hub’s target patients to ensure that every aspect of the service model and patient pathway are built around this
Modelled patient activity and capacity across the whole patient pathway. Capacity within the CDH must align with the Trust’s internal capacity
Delivered robust planning from the outset, with involvement from multiple stakeholders, to capture dependencies at each stage and ensure delivery to budget
Reviewed service resilience to ensure the safety of patients and wider service resilience through reviewing patient flow and infection control
RESULTS
MEH successfully opening a six-lane remote diagnostic hub facility, providing Glaucoma and Medica Retina diagnostic services within a 3-month timeframe. The Hoxton remote diagnostic hub was able to increase capacity by up to 2,700 patients per month, addressing the immediate backlog as well as provide a COVID secure pathway.
Olivia is an experienced consultant in the private and public healthcare sector specialised in delivering tangible benefits to supply chain operations and strategic sourcing. Prior to joining Akeso, Olivia worked in the FMCG sector developing innovative products for global and market-leading healthcare brands.
Akeso engaged with ABUHB in a two-phase non-patient transport and logistics service review & optimisation to conduct a current state assessment of existing service operations, identify a series of evidence-based improvements for review, document a new and improved SLA and remodel existing service
INSIGHT
Aneurin Bevan University Healthboard (ABUBH) utilise Health Courier Services (HCS) – the logistics arm of NHS Wales SBS, as well as third-party providers for the provision of non-patient transport including specimens, pharmaceuticals, sterile equipment and mail.
The service level agreement with HCS, hadn’t been reviewed fully since 2009, despite multiple changes to ABUHB service delivery, most notably, the opening of a new acute Hospital. ABUHB were seeking a full-service review, ahead of contract extension
ACTION
Phase One: Conducted a detailed current state assessment across the full scope of 24/7 transport operations, through a robust data gathering and analysis exercise on volumes, frequency and costs of current service. Following this, Akeso conducted a substantiated and validated opportunity assessment, addressing a number of the key inefficiencies identified which would help to deliver benefits over the immediate / near term, medium and longer term
Phase Two: Through successful delivery of Phase One, Akeso were engaged to deliver the optimal improvement opportunity; re-modelling the route network operations. This phase required further extensive stakeholder engagement across key service users to ensure critical requirements were accurately captured and fed into the design of a streamlined service model, which also considered location, items and regulatory restrictions. The model was developed iteratively based on the defined department workflows (particularly Pathology, Pharmacy and Sterile services), user requirement parameters and HCS implementation feasibility.
RESULTS
Over course of the two phases, Akeso delivered:
A series of evidence-based service improvements to secure a greater value-for-money contract
Defined a Transport Maturity Model to document an improved and renewed SLA
Re-modelled the existing service routes to design a streamlined service which achieved a potential 10.4% annual saving on the original service costing
Scott has dedicated his career to performance improvement in healthcare and life sciences working both within a multinational consulting firm, and for the last decade as a co-founder of Akeso.
As a Managing Partner of the company, he has led the development of Akeso as an established boutique consultancy committed to improvement in UK health. His project specialisms and areas of interest are systemwide performance improvement, the national and international healthcare supply chain and the use of data to drive tangible and actionable improvement insights.
His approach is flexible, warm and fact-based and he is proud to have delivered numerous collaborative/ICS projects being able to engage positively across multiple stakeholders, specialisms and styles to achieve outcomes around aligned goals.
Outside of work his passions are almost all sports (mainly watching nowadays although can be found trying to find his wayward golf balls in the woods / long grass / water) and spending time with family, including Rump the cocker spaniel who is also the honorary office dog.
Akeso completed an Outline Business Case on behalf of the West Yorkshire Association of Acute Trust (WYAAT) following an options appraisal relating to their Aseptic Pharmacy Services.
INSIGHT
The West Yorkshire Association of Acute Trusts represents collaboration across six hospital trusts with the aim of delivering the highest standards of patient care. This extends to pharmacy care via ready-to-administer (RtA) intravenous medication. There is currently limited production capacity with expected demand growth in the future of this service area. Akeso were contracted to undertake an options appraisal to complete the subsequent business case for this service area.
ACTION
Our consultants undertook a series of interviews, workshops and site visits with clinical leads and service area experts to understand current operations, potential demand growth and factors currently limiting volumetric output, as well as other challenges facing the WYAAT aseptic services.
We analysed qualitative and quantitative data to understand the ‘as-is’ operations, individual and group aims for the future of pharmacy aseptic services. This was subsequently built into a model that flowed into the DHSC’s comprehensive investment appraisal (CIA) model, which considered initial and lifecycle capital costs and revenue costs (primarily via staffing and 3rd party purchase costs) against expected benefits realisation. Benefits focused on the avoided 3rd party medication purchase costs and the potential nursing time to care released.
The results of the preferred option were written up in the form of an OBC for approval by NHSE on behalf of the WYAAT Pharmacy Network.
RESULTS
We completed an outline business case on behalf of the WYAAT Pharmacy Network. If approved by NHSE, it will result in an initial capital investment of approximately £28.4m to release nursing time equivalent to the value of £118m and cost avoidance valued at approximately £22m over the course of the modelled 25-year project lifecycle.
Scott has dedicated his career to performance improvement in healthcare and life sciences working both within a multinational consulting firm, and for the last decade as a co-founder of Akeso.
As a Managing Partner of the company, he has led the development of Akeso as an established boutique consultancy committed to improvement in UK health. His project specialisms and areas of interest are systemwide performance improvement, the national and international healthcare supply chain and the use of data to drive tangible and actionable improvement insights.
His approach is flexible, warm and fact-based and he is proud to have delivered numerous collaborative/ICS projects being able to engage positively across multiple stakeholders, specialisms and styles to achieve outcomes around aligned goals.
Outside of work his passions are almost all sports (mainly watching nowadays although can be found trying to find his wayward golf balls in the woods / long grass / water) and spending time with family, including Rump the cocker spaniel who is also the honorary office dog.
Following on from similar work completed with the West Yorkshire Association of Acute Trusts (WYAAT), Akeso were invited to complete and options appraisal and business justification case regarding the future of two Bristol based NHS Trusts and their combined Pharmacy and Technical Services.
INSIGHT
Following Lord Carter of Coles’ 2020 Transforming Aseptic Care in England report, several trusts have been conducting options appraisals with the aim of investing to modernise facilities, cope with expected demand growth and reduce reliance on non-NHS medication suppliers.
Following work completed with WYAAT, Akeso were tasked with conducting an options appraisal to review the future of a combined pharmacy technical services for University Hospital Bristol and Weston and the North Bristol Trust.
ACTION
We completed an options appraisal starting with site visits, interviews with clinical leads and data gathering sessions to understand the current operational activity. Following workshop sessions, we defined project specific critical success factors and explored what the options for appraisal could look like.
Through extrapolation of baseline data, we were able to build modelled scenarios for each option over a 25-year period starting with the do nothing and do minimum options which reflected shut down of operations and continuation of as-is operations, respectively.
Modelled scenarios reviewed potential refurbishment of a new on-site facility on the UHBW Trust site and leasing of a new facility off site. Cost elements were considered from the baseline data and assumptions made following discussions with clinical lead, estate and facilities colleagues, financial colleagues and wider NHS experts. The preferred option was selected based on CSF and VfM scoring.
RESULTS
Akeso successfully demonstrated that the preferred option will be for a new off site hub facility.
Akeso completed a short form business case in full in line with HMT Five Case Methodology for the preferred option which require initial capital investment of c. £24.5m but result in lifecycle savings of approximately £200m (relative to the do minimum).
Scott has dedicated his career to performance improvement in healthcare and life sciences working both within a multinational consulting firm, and for the last decade as a co-founder of Akeso.
As a Managing Partner of the company, he has led the development of Akeso as an established boutique consultancy committed to improvement in UK health. His project specialisms and areas of interest are systemwide performance improvement, the national and international healthcare supply chain and the use of data to drive tangible and actionable improvement insights.
His approach is flexible, warm and fact-based and he is proud to have delivered numerous collaborative/ICS projects being able to engage positively across multiple stakeholders, specialisms and styles to achieve outcomes around aligned goals.
Outside of work his passions are almost all sports (mainly watching nowadays although can be found trying to find his wayward golf balls in the woods / long grass / water) and spending time with family, including Rump the cocker spaniel who is also the honorary office dog.
“On 28th April 2023 Akeso will be bidding a very fond farewell to our Category Tower 8 team as the service that Akeso has successfully delivered for almost 5 years transfers to NHS Supply Chain on 1st May. Akeso secured the contract for Category Tower 8 in 2018 to deliver the category management, procurement and sourcing service to NHS Supply Chain for Diagnostic, Pathology & Therapy Technologies and Services.
The decision by NHSE and NHS Supply Chain to bring the category management and procurement of all clinical products and service back in-house was made in 2022 in recognition of the increasingly challenging economic environment within which the service needs to operate.
Whilst we are sad to see service leave us, we have been reflecting on the journey we have been on and feel hugely proud and honoured to have had the opportunity to develop and lead the CT8 Team who have delivered so much. We have delivered over £100m in savings to the NHS, as well as exceeding all other metrics and targets. We have led the way in the development of category and sourcing strategies for some of the more complex areas of sourcing in the NHS, whilst managing the COVID-19 response for our categories including the initial sourcing of swabs for COVID-19 testing and developing the national supply resilience strategy for continuous renal replacement therapy (CRRT).
As we look forward, we are confident we will be able to use the unique and valuable experience, knowledge and skills we have gained in delivering the service to NHS Supply Chain to support our other clients; our category and sourcing approach has become more refined and flexible to complex sourcing projects, our analytics capability and toolkits have developed increasingly sophisticated approaches to support demand forecasting and spend analysis and our wide networks within the NHS and the markets that serve the NHS have become broader and deeper.
We wish our staff all the very best in their new organisation, NHS Supply Chain are lucky to have you, and we are confident that the talent, experience and knowledge that NHS Supply Chain gains from all of the Category Towers that are transitioning will ensure it’s future success in delivering value for the NHS.”
Chris has spent almost 25 years working in the commercial and operations space, in both private and public sector across the automotive, financial services, telecoms, energy and healthcare sectors.
As a Managing Partner and co-founder of Akeso, Chris is passionate about the value that can be realised when an organisation takes a fresh look at how it can enhance the quality and cost efficiency of the services and products it delivers by leveraging third-party led innovation, technology and solutions and has worked collaboratively with many providers and suppliers to the Health & Care sectors in the UK and internationally to realise this objective.
Outside of work Chris enjoys spending time with family, watching Arsenal, running and doing DIY projects.
Thirty-six draft Integrated Care System (ICS) strategies have now been released with the final 5-year forward plans due to be completed by the early summer.
So, what can we learn from the strategies?
As to be expected, they reflect different levels of maturity and development of systems, which are impacted by current operational pressures.
Common themes across all the strategies are the focus on improving population health using collective resources, reducing health inequalities, as well as the emphasis on longer-term prevention, integration, and personalised care. The biggest gap in describing key priorities is around how the NHS can support wider social and economic development, perhaps because of the limited definition of what this entails.
Whilst there are nuances in how ICSs define Population Health Management (PHM) it is refreshing to see commonality in how the term is referenced. In general, it is described as using data to allocate resources optimally to population cohorts with the greatest need, and to interventions that add most value. There is also the emphasis on predicting the health and care needs of local people in the future.
Although the strategies tick the box of ‘what’ should be included in an integrated strategy the ‘how’ of implementation has still not been defined.
Akeso have outlined four key challenges that need to be overcome to turn rhetoric to reality.
ICSs capacity to progress longer term objectives such as preventing ill health is at risk from shorter term pressures: There is a risk that ICSs will struggle to make progress on local or longer-term priorities such as increasing healthy life expectancy and reducing avoidable ill-health given the national focus on shorter-term challenges such as the elective care backlogs and A&E waiting times. The recent National Audit Office (NAO) report outlines while 77% of senior ICS staff consider their ICSs intend to invest in preventative measures, only 31% feel they currently have the capacity to.
ICSs need to have the capacity and headspace to focus on prevention, and a framework to develop well defined business cases or evaluations, which set out the timeframe to achieve benefits and the required investment. The DHSC also need publish to its response to its consultation; Advancing our health: prevention in the 2020s.
The NHS and social care continue to maintain separate budgets despite the ambition of integrating services through these new reforms. Therefore, a key priority is to remove system, organisation and workforce barriers so the NHS can work more closely with local government and other partnersto tackle the wider social determinants of health, and the broader issue of health inequalities. It also needs to be clear which improvements ICSs will be specifically accountable for, which are the responsibility of NHS England, and which are wider government responsibilities. This should be helped by the DHSC’s guidance on the scope of pooled and aligned budgets, which is due be released imminently.
Significant workforce challenges across health and care: It is well documented there are critical shortages across the NHS and social care workforce, for example the number of people working in social care fell in 2021/22 for the first time in the least 10 years. The NHS Long Term Plan committed to producing a Workforce Implementation plan by September 2020, this now needs be an urgent priority to set the blueprint for workforce planning at a local level. This should include integrating workforce across health and adult social care, developing new cross-system ways of working, as well as exploring opportunities for system-wide recruitment and deployment, informed by joined-up workforce planning and skills development.
What will be measured is likely to drive ICS direction and focus: Key system metrics and KPIs have yet to be set for most Integrated Care Systems. A system wide balanced scorecard will need to be agreed by system partners, which is inclusive of domains such as health inequalities, quality, workforce, and finance. The balanced scorecard will need reflect the short, medium, and longer strategy of the ICS, and include carefully selected metrics so reporting is not too onerous. Success measures outlined in the strategies will also need to be turned into ‘SMART’ goals so integrated care partnerships can track and report progress to local people.
Chris has spent almost 25 years working in the commercial and operations space, in both private and public sector across the automotive, financial services, telecoms, energy and healthcare sectors.
As a Managing Partner and co-founder of Akeso, Chris is passionate about the value that can be realised when an organisation takes a fresh look at how it can enhance the quality and cost efficiency of the services and products it delivers by leveraging third-party led innovation, technology and solutions and has worked collaboratively with many providers and suppliers to the Health & Care sectors in the UK and internationally to realise this objective.
Outside of work Chris enjoys spending time with family, watching Arsenal, running and doing DIY projects.
Akeso supported NHSE SW to design and procure a regional CDC service for the South West, built in partnership with the independent sector. Key aspects of our support spanned Commercial Model & Business Case development as well as the full end-to-end procurement delivery to secure the provider partner.
INSIGHT
Driven by the recommendations of Professor Sir Mike Richards’ report, Diagnostics: Recovery and Renewal, NHS England South-West (NHSE SW) engaged Akeso as an operational delivery partner to support in the regional roll-out of Community Diagnostic Centres, in partnership with the Independent Sector. The programme aimed to rapidly expand capacity and transform diagnostic provision for the local populations across the seven ICS systems, whilst maintaining ownership of the service.
ACTION
Through our deep understanding of the community diagnostic landscape and procurement expertise, our delivery team supported NHSE SW in the following:
Commercial Model: Akeso developed critical CDC-related business, organisational and operational requirement solutions from the perspective of an “intelligent customer” in order to secure best value-for-money. These included development of optimal clinical service model, integrated workforce strategy, approach to integration of diagnostic technology and digital connectivity with local healthcare providers and an appropriate financial model.
Procurement Preparations & Delivery: Akeso managed the end-to-end procurement strategy including facilitation of supply market engagement, development of service specification defining key requirements and mapping CDC processes based on programme vision and objectives, ICS demographic and patient needs and delivered a full and compliant procurement tender and contract award process.
RESULTS
Akeso successfully developed the Commercial Model and procured the Independent Sector provider to form the foundations for joint service delivery with NHS across a ten-year fixed CDC site contract and three-year mobile CDC site contract, with a total worth of £250 million.
Jake is an experienced manager who has worked with Akeso for over 5 years. In that time, he has accrued significant experience in the healthcare supply chain and operations space working with numerous clients across multiple disciplines of projects.
Jake has comfortably led long-term engagements with senior project teams within both the public and private sector, working closely to ensure successful project deliveries with multiple workstreams delivering significant value for his clients.
Prior to joining Akeso, Jake worked for a prestigious Investment Banking firm where he developed strong project operations and risk management skills.
Akeso provided procurement and contracting services to support the delivery of core services for this newly established Scientific Research Charity.
INSIGHT
Our Future Health, a charity establishing the UK’s largest ever health research programme, designed to enable the discovery of more effective approaches to prevention, detection and treatment of diseases.
The aim of the programme is to recruit 5 million adult volunteers that will provide information about their health, lifestyles and a sample of blood for genotyping and analysis.
Our Future Health required the procurement of services for blood sample processing, Genotype assay design, manufacture, genotyping services and sample storage.
ACTION
Our Future Health were required to operate under PCR15 to procure and contract and without any in-house procurement expertise, the organisation needed to navigate all elements of this complex procurement including development of specifications and evaluation criteria and managing the tender process through to contract.
In addition, the volumes and timescales were still being developed and a solution was needed that could flexibly ramp up to meet the evolving needs of the programme but also needed to start within 8 months.
It was also recognised that some elements of the requirement were very specialist with limited providers. The client needed a solution that would provide the full service but allow for effective competition for all elements.
Akeso supported Our Future Health by coordinating its significant scientific expertise with a PCR2015 compliant foundation in order to deliver this large and complex procurement.
RESULTS
Our Future Health now has the infrastructure in place to be able to process and genotype 5 million samples from the UK population to deliver the largest research programme of its kind. A key objective was to avoid any legal challenge to the process, meet the ambitious timescale whilst ensuring SME participation.
Chris has spent almost 25 years working in the commercial and operations space, in both private and public sector across the automotive, financial services, telecoms, energy and healthcare sectors.
As a Managing Partner and co-founder of Akeso, Chris is passionate about the value that can be realised when an organisation takes a fresh look at how it can enhance the quality and cost efficiency of the services and products it delivers by leveraging third-party led innovation, technology and solutions and has worked collaboratively with many providers and suppliers to the Health & Care sectors in the UK and internationally to realise this objective.
Outside of work Chris enjoys spending time with family, watching Arsenal, running and doing DIY projects.
Akeso supported Moorfields Eye Hospital in the implementation of a first of kind Research Diagnostic Hub to explore new ways of providing excellent patient care in the community
INSIGHT
Moorfields Biomedical Research Centre (MBRC), in partnership with UCL Institute of Ophthalmology, looked to establish a first-of-kind ophthalmology research diagnostic hub which would test methods to reduce patient visiting time and improve patient experience.
Funded through NIHR, the initiative aimed to set out the key principles for delivery of care in the community which would be applicable for any high-volume NHS outpatient setting, such as orthopaedics and cardiology.
ACTION
We supported MBRC to design, plan and build a research diagnostic hub at Brent Cross shopping centre in North London through the following activities:
Defined strategic vision to inform the scope and operating model
Delivered robust planning from the outset, with involvement from multiple stakeholders, to capture dependencies at each stage and ensure delivery to budget
Modelled demand and capacity through patient activity and workforce modelling across the whole patient pathway to plan and forecast patient flow
Designed, planned and implemented four phased operating models to test patient flow and enhance efficiencies in a controlled live environment
Explored various build environments and real-time tracking to assessment movement of staff and patient within the clinic.
RESULTS
Through the ‘one stop shop’, established in a major London shopping mall, MBRC were able to:
Reduce patient visiting time from nearly 2 hours to 45 minutes.
Reduce average ‘Did not attends’ to below 10% from historic levels of 15% – 20%.
Olivia is an experienced consultant in the private and public healthcare sector specialised in delivering tangible benefits to supply chain operations and strategic sourcing. Prior to joining Akeso, Olivia worked in the FMCG sector developing innovative products for global and market-leading healthcare brands.
We supported Homerton Healthcare Hospital Foundation Trust pro-bono to secure over £950k funding across three Trust charities in the North East London ICS, working in community partnerships to bring measurable health outcomes to communities negatively impacted by COVID-19.
The Challenge:
In 2020 when the coronavirus pandemic hit, Captain Tom Moore and many others raised £150m for NHS Charities Together (NHSCT) in response to their COVID-19 Urgent Appeal. This funding was split into various programmes, namely the Stage 2 Community Partnership Grant, where the funds are distributed to Integrated Care Systems (ICS) across the country.
We were engaged by Homerton Healthcare Hospital Foundation Trust (HUHFT) as a lead charity to support the North-East London (NEL) ICS, providing a governance and project management structure throughout the application process.
Some of the key challenges identified included:
Ensuring equal management of the funds across the 3 Trust charities applying under NEL ICS
Managing different processes across the ICS
Responding to changing requirements for proposals and applications due to the novel nature of this Grant
Demonstrating each charity’s programmes met the community partnership guidelines
Solution:
In response to the challenges identified at the beginning of the project, our first step was to set up weekly governance calls with representatives from all Trust charities within the NEL ICS. We used these meetings to agree and document terms of references for the group, how the money would be managed, and track each organisation’s progress.
Following this, we segmented both the proposal and application template from NHSCT into a clear and concise structure which could be used across the organisations applying within NEL.
We ensured each charity’s application clearly demonstrated the following:
Resulted in a measurable improvement in health outcomes for communities adversely affected by COVID-19
Involved a partnership with community organisations
Lead to a direct, positive impact on the NHS whilst responding to the COVID-19 pandemic
Results:
The full amount of over £950k (inclusive of an operational grant) was successfully awarded and shared equally across all 3 Trust charities.
Our governance meetings were particularly useful to bring all organisations together and share knowledge from their own applications, capturing lessons learnt for future Grants. They provided a platform for colleagues who carried out similar work to come together when they otherwise do not have many opportunities to.
Next Steps:
As the programmes go live, we will continue to provide governance and structure across the ICS, ensuring all organisations track the progress of their programmes in a standardised format. Interim reports are required to demonstrate the appropriate use of the funds in order to unlock future allocations of the Grant funds. As we did for the application process, we will provide a structure to the reports and build processes to easily demonstrate the organisation’s goals have been met to date.
Scott has dedicated his career to performance improvement in healthcare and life sciences working both within a multinational consulting firm, and for the last decade as a co-founder of Akeso.
As a Managing Partner of the company, he has led the development of Akeso as an established boutique consultancy committed to improvement in UK health. His project specialisms and areas of interest are systemwide performance improvement, the national and international healthcare supply chain and the use of data to drive tangible and actionable improvement insights.
His approach is flexible, warm and fact-based and he is proud to have delivered numerous collaborative/ICS projects being able to engage positively across multiple stakeholders, specialisms and styles to achieve outcomes around aligned goals.
Outside of work his passions are almost all sports (mainly watching nowadays although can be found trying to find his wayward golf balls in the woods / long grass / water) and spending time with family, including Rump the cocker spaniel who is also the honorary office dog.
At Akeso, we are extremely saddened by the current healthcare crisis caused by the unprecedented NHS capacity constraints which is threatening the lives of so many of us this winter.
According to the latest discussions at No10, the Government’s response to this challenge is an improved discharge to medically fit patients that is enabled by solutions such as virtual wards.
Although programmes such as discharge to assess (D2A) and virtual wards are not new, we welcome the recognition that doing the same but (slightly) better is not going to solve the problem this winter, or in fact any winter going forward.
According to the NHS, there are 12,809 patients fit for discharge who are occupying beds which could be available to save lives. In an analysis by HSJ, 7,000 virtual ward beds exist, but only half of them are occupied.
So, what is causing this disconnect and why aren’t virtual wards that are in place delivering results?
We believe that the system is struggling with uptake due to the lack of mechanisms that offer a partnership platform between healthcare professionals, who must continue to care for patients uninterruptedly, and specialist partners that can facilitate discharge programmes and implement functional virtual wards.
Akeso can offer such a mechanism and work with Trusts to deliver improvements to discharge practices and implement technology enable virtual wards. We can enable this by offering:
Demand and capacity analysis to enable care pathway remodelling.
Workforce optimisation and empowerment to support discharge and remote care.
Project management to ensure programmes and solutions offer evidenced results.
Comprehensive guide and methodology which takes a Trust ‘step-by-step’ through business case, implementation, effective management and scaling of virtual wards.
A medically graded virtual ward technology which offers proven discharge results by reducing length of stay of medically fit patients.
We are here to talk and help Trusts and ICSs with a free assessment and actionable plan that can offer results right now!
Together with HSJ and Masimo we’ll be hosting a roundtable which will focus on Virtual Wards and Discharge in March. Watch this space for updates!
With an elective care backlog in excess of 7 million [1], record high workforce shortages [2] and decaying estates, our healthcare system is close to breaking point. Numerous tools have been deployed to try and combat these problems, but they continue to fall short of the mark. Not all hope is lost though. Driven by the global Covid-19 pandemic, we have seen a flurry of new techniques and solutions enter the market, promising to solve our problems and redefine healthcare nationally. One of these tools, Virtual Wards, has established such a strong base of supporting evidence that they can no longer be ignored. But are they the answer to our prayers? When deployed in a technology-enabled manner, following a structured implementation plan, they just might be.
In response to rising demand and in preparation for winter, NHS England (NHSE), Health Education England (HEE) and NHS Digital (NHSD) are collaborating to support ICSs in adopting Virtual Wards. Outlined in a two-year funded transformation program, the ambition is to have 40-50 Virtual Ward beds available in each Trust across the UK (24,000 beds in total). This is to be delivered in a tight time frame, with all Trusts required to meet the capacity target by December 2023.
With NHSE putting their faith in Virtual Wards, so too should we. But what is a Virtual Ward? What kind of benefits can they deliver and how can we ensure that our Virtual Ward is actually successful?
About Virtual Wards
Virtual Wards aren’t new, with the first examples deployed over 15 years ago [3]. At their core, they aim to move patients out of hospitals and into homes, whilst still delivering an acute level of care. Despite being used across the UK (and globally), their model of care remains largely unchanged, with little innovation or improvement seen in the space. That is, until now.
Many Virtual Wards currently in use are ‘traditional’ in their approach, with the care delivery model underpinned by telehealth services and routine home visits. This approach requires significant clinical time investment, proliferating systemic workforce problems and, in some cases, functioning to hinder the service rather than help it.
There is, however, a ‘non-traditional’ Virtual Ward model, one that uses state of the art remote monitoring technology to deliver acute level care to patients [cite]. These models are defined as ‘Technology-enabled Virtual Wards’, delivering quality care without the same workforce demand as traditional models.
Technology-enabled Virtual Wards
The NHS defines a technology-enabled Virtual Ward (TEVW) as ‘the management of patients via a digital platform’. A broad definition which could be used to describe any number of solutions currently on the market. It is also, a misleading one, as beyond the shared use of technology, there is very few similarities between the different solutions. App only, monitoring + app and telehealth platforms can all be considered as technology enabled Virtual Wards, but each has a unique set of benefits and delivers care in a novel way.
Although telehealth and app only solutions have their place, providers should be focused on deploying Virtual Wards that utilise hospital grade remote monitoring technology. These Virtual Wards are the new frontier of digital health, delivering a broader suite of benefits, to a greater patient cohort, than any other solution [4].
For the remainder of the article, when we refer to a TEVW, we refer specifically to one that is using hospital grade, remote monitoring technology.
Benefits of Technology-Enabled Virtual Wards
Not all TEVWs are built the same, with maximum (in terms of both breadth and depth) benefits only observed in those that integrate remote monitoring in patient care pathways. But what are these benefits? Where, how and by who will they be felt? To understand the potential impact of TEVW, we have conducted benefits modelling using leading technology within the Virtual ward space, Masimo SafetyNet as an example, to explore the following areas:
Average Length of Stay
Workforce efficiency
Readmission rate & admission avoidance
Backlog reduction
Release of acute bed capacity
Our analysis models the potential positive impacts that an average sized Trust (778 beds) could achieve by adopting a TEVW. This is not the only potential application though. With appropriate tailoring, TEVWs can be applied to any use case, with the technology being used globally to support the care of patients suffering from any number of conditions from cancer to heart failure.
In the context of the acute emergency and orthopaedics cases, we understand there to be two main applications for a TEVW respectively: avoiding admission and expediting discharge. The benefits of TEVWs will be discussed in the context of these primary applications.
1) Avoiding admission
TEVWs offer providers a way to avoid unnecessary admissions and re-admissions to the acute setting, instead delivering care to patients in the home environment. Acute patients, such as emergency department attendees, can be admitted to the Virtual Ward, rather than the physical ward, preventing the occupation of an acute bed.
Our benefits modelling indicates that for an average sized Trust of c.760 beds, up to 7,000 bed days could be released through readmission avoidance of acute emergency patients [5,6,7,8]. This would save an estimated £3 million in avoidable readmission costs [7,9] and release 63 hours of clinical resource back to patient facing activities [10]. In addition to financial and capacity benefits, research has shown that patients have a greater perceived quality of care and sense of empowerment when treated through a TEVW model [11].
In the context of acute emergency cases:
2) Early discharge
TEVWs enable postprocedural remote monitoring and encourage early discharge, releasing both clinical and bed capacity [12,13].
Wearable sensors alert clinicians to changes in a patient’s condition, in real-time, helping the remote management team to intervene sooner and ensuring patients receive the same quality of care within the Virtual Ward [12,13]. This functionality brings the home environment in line with the acute environment and provides clinicians with the confidence they need in order to discharge more acutely unwell individuals, earlier. 1/3 patients stay in hospital beyond the necessary point of care, the ability of TEVWs to reduce length of stay will be critical in reducing this number and expediting discharge. You can read more about this in our D2A technology article here.
Reducing length of stay will release clinical and bed capacity, allowing critically ill patients to be treated with fewer delays and removing a key bottleneck in care delivery. In the case of primary hip and knee procedures, the ambition is that technology enabled Virtual Wards will reduce length of stay by up to 3 days. This could release an estimated 900 bed days which could be utilised to addressing the current backlog for orthopaedic procedures.
In the context of orthopaedics patients:
Implementing technology-enabled Virtual Wards
The potential benefit of technology enabled Virtual Wards is clear and as a result NHSE calling for their rapid adoption [14,15]. However, without firm guidance on how to implement these solutions effectively, they may fail to deliver expected benefits and jeopardise patient care [16].
Learnings from previous Virtual Ward implementations have been distilled into a set of critical success factors which must be considered if the TEVW is to be delivered effectively. Sourcing the right solution, defining a clear objective, mapping the commercials and understanding the use case are all pivotal in achieving success. Steps to address these factors are outlined as part of our comprehensive Virtual Ward implementation guide.
Akeso’s methodology is based on Masimo SafetyNet which you can find here.
Sourcing the right solution, and partnering with the right provider, are essential in ensuring the Virtual ward is both clinically compliant and highly effective. Several providers claim to meet these criteria, but with only a few functioning examples of TEVWs locally, it is difficult to assess the validity of these statements. route of sourcing an effective, complaint TEVW is utilise the Sparks Dynamic Purchasing System (DPS) framework. Spark DPS categorises leading technology providers across a variety of sectors based on their capabilities and offerings. We have summarised these providers, and what they offer (based on the DPS framework), below.
Figure 1 – Summary of key technology-enabled Virtual Ward providers on the Spark DPS framework.
When considering which TEVW supplier to use, it is important to consider future TEVW applications, beyond the current target. Many providers have Virtual Wards up and running, supplied by different organisations. This can lead to problems with integration, consistency and quality for both patients and clinicians. The aim should be to procure a single solution that is scalable and adaptable to all areas of your service. Masimo SafetyNet is a robust example of a TEVW solution that holds this capability.
The Future
We currently have a discharge problem in the NHS, with patients waiting up to 9 months to be sent home [cite]. Virtual Wards will support expedited discharge, reducing Length of Stay back toward national targets. Read more about it in our Discharge to Assess (D2A) technology enablement article ‘Turning homes into hospitals’.
Although current benefits are obvious, we should begin to think about what role TEVWs might play in the future of healthcare. Using the clinical information TEVWs provide, we could look to begin moving the discharge threshold, allowing higher acuity patients to be treated in an at home environment. Doing so would extend the benefits of Virtual Wards, beyond what current models (including our own) predict.
Figure 2 – The vision for technology enabled Virtual Wards
But the future of Virtual Wards doesn’t just lie in moving the discharge threshold. Traditionally, Virtual Wards were deployed to prevent patient admission- the opposite end of the care pathway to the current discharge focus. We believe technology-enabled Virtual Wards could eventually be deployed across every stage of the patient care journey, not just the bookends, supporting a movement toward personalised medicine and redefining care pathways completely. There is evidence of this globally already, with Virtual Wards across Australasia supporting entire cancer care pathways [17].
Figure 3 – Potential future applications of technology-enabled Virtual Wards, across the entire patient care pathway.
It is important to keep these opportunities top of mind as we deal with our current issues, continuing to innovate and adapt during a time of immense pressure. Doing so will ensure that solutions implemented can flex and change as our needs do, remaining relevant long into the future.
References
The British Medical Association. NHS backlog data analysis. 2022. [online] Available here.
House of Commons Committee. Workforce: recruitment, training and retention in health and social care. 2022. [online] Available here.
KingsFund, 2006. Case study: Virtual wards at Croydon Primary Care Trust. [ebook] Available here.
NHSX. A guide to setting up technology-enabled virtual wards. 2022. [online] Available here.
1.6 WTE/bed based on avg staff required to service a 40-bedded ward in hospital published on the VW Bed Benefit Tool from NHSEI available at https://www.future.nhs.uk
Nunan, J., Clarke, D., Malakouti, A., Tannetta, D., Calthrop, A., Hanson Xu, X., Berin Chan, N., Khalil, R., Li, W. and Walden, A., 2020. Triage Into the Community for COVID-19 (TICC-19) Patients Pathway – Service evaluation of the virtual monitoring of patients with COVID pneumonia. Acute Medicine Journal, 19(4), pp.183-191.
There are seven key steps to generating traction and improving the discharge-to-assess pathways. These are a mix of technical development in respect of discharge-to-assess (such as the establishment of agreed patient strata) and the generic challenges of change management (such as engagement, communication, and skills building). The first 3 phases (which are the planning phases) will be broadly sequential but the delivery phases can be run in parallel, as the figure below indicates:
Establish a core guiding coalition: build a small group with representation from the acute, community, and social care teams who will act as the core accountable team. This team will guide the program to ensure time and resources are well spent.
Understand where you are and why, in order to build the local case for change, including:
Maturity model completion: complete the self-assessment complete the self-assessment of the Akeso discharge-to-assess maturity model to show where the current system is already fit-for-purpose and where changes need to be made
Internal analysis on “no right to reside” and other key metrics (such as risk adjected length of stay, and elective and cancer waitlist variation) to give additional local relevance
Define the overall model of discharge-to-assess which best suits your location, given the NHS England guidance, known exemplar case studies, and the results from the maturity assessment, including:
Patient stratification: be clear on which patients fall under the category of relevant for discharge-to-assess and how/when they are highlighted
Workforce models: with community and social care partners, develop a sustainable workforce model which meets local population health needs and is achievable with local resources
High-level process: agree what the high-level discharge-to-assess process is which balances discharge efficacy with clinical risk
Technology aspirations: be clear on where technology will help (with both current and potential future systems)
Launch the program of change: take the time to engage with a broad range of stakeholders to lay out the overall aims of the discharge-to-assess program and how it contributes to the aims of the organisation, including:
Vision expected outcomes, and expected timelines: establish what success looks like from an outcome perspective (for example, number of patients remaining in the acute setting with no right to reside; 7-day re-admission rate
Leadership team & resource: ensure that there is sufficient resource ring-fenced to deliver and manage the work, and that senior leaders are actively supportive
Govern and track effectively: embed discharge-to-assess governance within the existing board and directorate mechanisms to ensure its visibility
Communicate plans and progress
Establish portfolio of work: the maturity matrix and case study examples will suggest a wide range of work to be done. It’s important that any portfolio and phasing is chosen which reflects the need and resources available, including:
Pilot and refine: choose 1-2 specific patient groups or services on which to pilot the design where there is both a clear need and support for discharge-to-assess; learn from these pilots and moderate the initial designs as necessary and remember that “getting it right first time” doesn’t apply in this situation! Learning and adapting is part of the process. To aid this, you may want to instigate regular learning cycles (such as Plan-Do-Study-Act) and daily management meetings
Embed and roll-out: broaden the scope of patients and services for whom discharge-to-assess is available, building on the learnings from the pilots (in 1 or 2 further phases)
Business case development: when investment is necessary, put together a robust business case (using recognised approaches such as the HM Treasury 5-case model)N.B. when engaging in technology-driven change, it is very important to ensure that practices are “digital-ready” before they become digitised so take the time to improve ways of working before the technology is available. It is value destroying to embed poor current practice within a new system. Many organisations, therefore, go through two phases of transformation: pre-tech and post-tech availability
Train, support and reward those involved in delivering this new way of working. The pilots will establish local standard methods and learnings. These should be documented and shared with groups involved in subsequent phases of roll-out. The pioneers who drive the change should be given the reward and profile that it deserves.
Communication progress, learnings, and successes, including regular broad updates and particular highlights. Appreciation of the efforts of everyone involved could be included within monthly and annual recognition systems.
Keeping people healthy and returning them to their usual home after a hospital spell is a key ambition for all those involved in health and social care. There is an even greater imperative to do so given the pressures on the system now (be they workforce, elective backlog or capacity constraints). Discharge-to-assess, enabled by technology is one of the ways in which we can work together to ease this problem. Many organisations are already making this work. We hope that these four articles can encourage more progress for the benefit of citizens and health and social care workers alike.
For a free Discharge-to-assess consultation, please contact us for an initial conversation with our consultants.
D2A pathways and associated practices are key tools in expediting patient discharge, relieving pressure on the acute environment and improving patient flow [1,2]. Although effective on their own, by applying technology in new and innovative ways, these pathways can be further enhanced to generate further benefits.
Supporting technology is best viewed as ‘catalysts’ for D2A pathways. When implemented effectively, they can amplify the benefits of discharge to assess such as: improved patient experience, faster discharge, and the release of capacity for other clinical need.
The role of technology enablement in D2A
The number of D2A enabling technologies is increasing continually, catalysed by the global Covid-19 pandemic. Solutions such as “Virtual Wards” and various health apps provide cost-effective ways of delivering care to more patients in a resource efficient manner [3,4]. With so many technologies, solutions, and providers now on the market, the space has become confusing. An understanding of what the technologies do, what benefits they may generate, and how they support more efficient discharge is not easily come by.
In order to help, we have clustered the current propositions into three main types: ‘alternative models of care’, ‘care management tools’ and ‘service augmenters’ which are explained below. Each of these enhances one or more of the D2A pathways as defined in our previous articles.
Extended models of care to include a patients’ home
Technology solutions labelled as ‘alternative models of care’ seek to fundamentally redefine the patient care pathway. Key solutions in this space include Virtual Wards and Telehealth Services, effectively turning our homes into hospitals.
Technology-enabled Virtual Wards are pioneering, demonstrating the ability to move patients out of the acute environment whilst maintaining the same quality of care [5]. In Masimo’s SafetyNet solution, for example, this is enabled by remote monitoring, allowing real-time assessment of patient “vital signs” and automated alerts when patients conditions begin to deteriorate [6]. When implemented effectively, these solutions can reduce length of stay and release clinical capacity.
Care management and enhanced communication between professionals
The second suite of D2A enabling technologies aim to consolidate the care management process, presenting a complete view of the end-to-end process. Patient discharge is managed by multidisciplinary teams, each uniquely involved in the movement of the patient out of the acute environment and their continued care in the community. Historically, communication between these groups has been limited, delaying discharge, and causing continuity issues in care delivery.
Innovative technology platforms such as ‘Hospital to Home’ [7] provide consolidated views of both the discharge process and the overall patient care pathway, in a way that fosters collaboration between clinical stakeholders. In the context of D2A, these platforms can enable faster, more consistent discharge practices, supporting clinicians to understand discharge stages, who needs to be involved and what needs to happen when.
Accessing national capacity as and when it is needed
Driven by the growing workforce shortage across the NHSE, several 3rd party clinical service providers have been established over the past few years. These providers offer access to clinicians, via telehealth platforms, to support with rate-limiting tasks such as triage. diagnostic and outpatient assessments. In doing so they expand a provider’s workforce, reducing bottlenecks and delays.
These services can diffuse pressure, such as during Winter, to mitigate against seasonal variation for the period when it’s needed. Virtual Lucy [8] and Medefer [9] are industry leading providers of these services, not only demonstrating the ability to reduce discharge delays but also preventing patients from unnecessary admission to acute services in the first place.
Ensuring the solution is successful
The implementation and management of digital transformations is rarely done well, but there are steps that can be taken to improve the chance of success. Each technology implementation is different, with unique challenges and success metrics. There are, however, key success factors, common to all implementations regardless of technology type or use. The programme objective, intended use case and commercial viability are all essential to consider if the technology implementation is to achieve success.
Programme objective
A single objective should be defined to drive progress and foster alignment across the delivery team.
Often, we see large programmes of work undertaken as a knee jerk reaction to changing pressures across our health landscape, resulting in ‘solutions’ that are naïve of the problem they attempt to solve [10].
Providers must be proactive in defining their programme objective, setting a clear goal before work commences. It should be easily understood and clearly linked to actions that support its realisation. Having a single, clearly defined objective (for example, enhanced patient experience) will align stakeholders, keep the project on course and ensure positive outcomes are achieved.
The clarity of this objective will then lead to Key Performance Indicators (KPIs – such as a relevant PROM, percentage of patients in an acute site beyond their point of need, and patients supported at home) which can be used to assess the success of the solution.
Intended use case
Technology should be aligned to where it is needed most.
Discharge processes differ significantly, not just between providers but between clinical pathways. It is unlikely, therefore, that there will be a ‘one size fits all’ technology solution across providers; adaptation is always required to tailor the needs of each unique situation. Many providers fail to consider this, deploying generalised rather than tailored solutions. Providers should focus on strategic deployment models, delivering technology solutions to highest need or highest-pressure pathways first, and then expanding these solutions across lower priority / lower risk pathways over time.
In defining the use case for the D2A enabling technology, an understanding of the underlying population should be developed. Demographic factors such as ethnicity, gender and comorbidity are known to influence the efficacy of healthcare interventions. Understanding these factors will support delivery of tailored, technology-enabled, discharge solutions.
Commercial viability
The commercial viability of the technology should be defined early in the project lifecycle.
The balance between costs and benefits (as captured in KPIs) underpins the commercial viability of a technology solution. Through defining a clear objective and understanding the intended use case, the benefits of a technology solution can be easily understood. The financial implications (both ongoing and upfront) of the technology should be modelled to support an equal understanding of associated costs.
Aside from Virtual Wards, which have £450 million in backing, there is no ring-fenced funding available for D2A enabling technologies. A formal business case will be required to secure funding for initial set up and continued use of these technologies. To complete the NHSE business case in full, clear definition of costs, benefits, and ROI time horizons will be required. Importantly, financial benefits must be shown to outweigh costs, with a robust evidence base established to support this conclusion.
What’s next
Having understood the D2A enabling technology landscape, and how to ensure these tools work to support you, the task of delivery comes next. This is where all the value is generated. The final article in our series will focus on setting up delivery programmes to succeed, demystifying the process by establishing the key elements for success.
References
[1] Rojas-García, A., Turner, S., Pizzo, E., Hudson, E., Thomas, J., & Raine, R. (2018). Impact and experiences of delayed discharge: A mixed-studies systematic review. Health expectations: an international journal of public participation in health care and health policy, 21(1), 41–56. https://doi.org/10.1111/hex.12619
[4] Shah, S.S., Safa, A., Johal, K. et al. A prospective observational real world feasibility study assessing the role of app-based remote patient monitoring in reducing primary care clinician workload during the COVID pandemic. BMC Fam Pract22, 248 (2021). https://doi.org/10.1186/s12875-021-01594-7
How hospital grade remote monitoring technology can enable the delivery of high-impact patient outcomes.
Technology-enabled Virtual Wards have arrived, are you ready?
The NHS must establish 24,000 Virtual Ward beds by December 2023 to support a targeted increase of 30% in elective care procedures by 2025. The delivery of effective ‘in-hospital’ patient care depends on reliable communication, monitoring, and alerts. Maintaining this level of care efficiently and effectively in a Virtual Ward, outside of the hospital, requires reliable, trusted, proven and privacy-compliant solutions for timely detection, prevention, and treatment. Masimo SafetyNet® is a Digital Health platform from Masimo, whose innovative monitoring products have been in use across the NHS for over 15 years, with a proven track record of success.
Masimo SafetyNet is an example of Virtual Ward enabling technology
For Patients: Technology-enabled Virtual Wards help assure higher-acuity patients that they remain under the watchful eye of clinicians even following discharge to their own home.
For Acute Care Providers: Masimo SafetyNet offers advanced automation features so institutions can more easily deploy home monitoring, track patient compliance, identify when intervention may be required, and prioritise patient needs whilst maintaining the ability to scale up to meet patient demand.
For NHS Leaders: Masimo SafetyNet is an effective, easily deployed turnkey solution designed to address the challenge of rapidly establishing and operating Virtual Wards whilst optimising use of clinical resources.
For an average sized2 NHS Trust, a robust technology-enabled Virtual Ward could…
The above figures are estimates, for further detail on inputs for the analysis, please see the references below 3, 4.
Masimo offers an end-to-end approach to help NHS providers implement Virtual Wards with the Masimo SafetyNet app currently available at no charge for NHS Trusts.
Deployment launched across the NHS; contact Masimo to activate your site!
Akeso & Co have supported Tanner Pharma Group UK’s (TPGUK) successful delivery of over 300m units of lateral flow devices (LFDs) to the U.K. Health Security Agency (UKHSA) since October 2021.
Insight
The Coronavirus (COVID-19) Pandemic was an unprecedented global crisis that challenged the limits of Healthcare systems around the world. A nation’s testing ability represented the most effective way to monitor and limit the spread of COVID-19 whilst also navigating the imminent threat of a nationwide lockdown. Throughout the pandemic, TPGUK have been a key supplier of self-test LFDs to the U.K. Government via the UKHSA.
TPGUK were contracted by the UKHSA in October 2021 to supply LFDs through an intricate and complex global supply chain. Combined with the emergence of the Omicron variant and in the lead up to winter 2021, the project rapidly escalated in scale and scope. We, as supply chain and procurement experts, were contracted to support and oversee all elements of the logistics and delivery process.
Some of the key challenges identified included:
Planning the delivery schedule based on manufacturing capacity in China;
Identifying and managing the flight booking process;
Responding to the rapid escalation of demand for LFDs because of the Omicron variant and winter pressures; and
Monitoring the overall logistics schedule.
Action
Our first priority was to understand manufacturing capacity which would ultimately dictate the delivery schedule. We had numerous meetings with manufacturing partners in China to review their production capacity and plan the downstream deliveries accordingly. Additionally, we developed a flight tracker to balance flights booked against production capacity. In this way, we ensured cost effective utilisation of flights, while also maximising the capacity to inbound LFDs into the U.K. at a time of increased demand.
Initial support regarding logistics tracking and planning progressed to overall management and integration with flight planning elements. We led stakeholder engagement and management through the daily operations review calls schedule with Kuehne and Nagel (TPGUK’s logistics sub-contractor) and twice weekly contract progress report updates to UKHSA.
Results
We were able to support the process and delivery of over 300m LFDs to the UKHSA when there was greatest need for them. This involved the operation of over 150 flights via 27 different routes involving 13 Chinese and 10 U.K airports over four months.
We ensured that the pace of project delivery matched that of the project escalation, while reacting to numerous challenges that threatened to delay or derail the rate of delivery. The efficiency improvements from the development flight tracker meant that we were able to leverage our expertise more effectively. This helped to mitigate risk, minimise financial waste and ensure delivery KPIs were met.
In February 2022, UKHSA announced that TPGUK would continue to supply LFDs as the COVID-19 Pandemic progresses toward endemic status. Having recognised and implemented several improved ways of working, we have been able to further support TPGUK in their most recent purchase order delivery while achieving some key savings. With logistic operations simplification and improved planning, we delivered a relative reduction of 28% in flight costs, a 33% damage rate reduction and a 40% relative reduction in storage charges.
Scott has dedicated his career to performance improvement in healthcare and life sciences working both within a multinational consulting firm, and for the last decade as a co-founder of Akeso.
As a Managing Partner of the company, he has led the development of Akeso as an established boutique consultancy committed to improvement in UK health. His project specialisms and areas of interest are systemwide performance improvement, the national and international healthcare supply chain and the use of data to drive tangible and actionable improvement insights.
His approach is flexible, warm and fact-based and he is proud to have delivered numerous collaborative/ICS projects being able to engage positively across multiple stakeholders, specialisms and styles to achieve outcomes around aligned goals.
Outside of work his passions are almost all sports (mainly watching nowadays although can be found trying to find his wayward golf balls in the woods / long grass / water) and spending time with family, including Rump the cocker spaniel who is also the honorary office dog.
In 2014, the Department of Health (DH) commenced an ambitious program, Scan4Safety, to transform the way that the NHS manages the numerous interventions that take place in NHS Providers at all points of care delivery everyday, both internally and externally with suppliers. The DH invited outline business case applications from NHS Provider Trusts interested in being one of six NHS demonstrator sites, who would be awarded investment of up to £2m to act as early adopters and communicate the benefits of Scan4Safety.
Working with a large top-tier Consultancy, we were engaged as a subject matter expert to deliver four of the final 12 Outline Business Cases, leveraging our direct experience of delivering transformational projects in the NHS involving technologies and solutions covered by Scan4Safety. We worked with a number of leading academic NHS Trusts around their process maturity and eProcurement capabilities. Our directors have presented on the topic at a number of events in the UK and the US, on behalf of GS1 and other organisations.
INSIGHT
The benefits of Scan4Safety adoption are significant: improved transactional efficiency, improved traceability and risk reduction, inventory and wastage reduction, released clinical time to patient care – all of which lead to improved patient outcomes and safety.
We have extensive experience of Scan4Safety relevant technologies including a number of Use and Enabler cases. We brought a number of methodologies and tools, including Hospital Supply Chain Maturity Framework and Diagnostics Tools, Financial Modelling and Market Studies of Healthcare Inventory Management and Procure-to-Pay systems.
ACTION
We analysed submissions from applicant NHS Providers. We engaged key stakeholders in organisations at all levels up to an including Executive, to validate the ambition levels within each of the four Trusts.
We developed a comprehensive business case framework for the final applications, based on the HM Treasury Blue Book methodology. We worked closely with applicant Trusts to complete the comprehensive business cases This included engagement with external suppliers, modelling of solution options as well as development and costing of implementation plans to take forward if successful.
We then developed four final recommendations and business case applications for DH Board approval.
RESULTS
Three of the four applications validated by us were successful in securing investment of up to £2m, as part of the six NHS providers selected as Scan4Safety demonstrator sites.
Scott has dedicated his career to performance improvement in healthcare and life sciences working both within a multinational consulting firm, and for the last decade as a co-founder of Akeso.
As a Managing Partner of the company, he has led the development of Akeso as an established boutique consultancy committed to improvement in UK health. His project specialisms and areas of interest are systemwide performance improvement, the national and international healthcare supply chain and the use of data to drive tangible and actionable improvement insights.
His approach is flexible, warm and fact-based and he is proud to have delivered numerous collaborative/ICS projects being able to engage positively across multiple stakeholders, specialisms and styles to achieve outcomes around aligned goals.
Outside of work his passions are almost all sports (mainly watching nowadays although can be found trying to find his wayward golf balls in the woods / long grass / water) and spending time with family, including Rump the cocker spaniel who is also the honorary office dog.
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.
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.
Risk management processes play a key role in building the resilience a business needs to operate smoothly during disruption. This is particularly the case in pharmaceutical and MedTech businesses, in which supply chains are often complex and services are multi-layered.
Disruption can come in many forms, including challenges caused by the rapid growth to regulatory changes and rare but destabilising events such as the Covid-19 pandemic. A vigorous business continuity plan (BCP) enables businesses to weather these storms. They have also become a requirement in many commercial tendering processes, which puts companies that do not have one at a competitive disadvantage.
Here we explore how to successfully identify risks and prepare to mitigate them with a robust BCP.
Developing a business continuity plan
Although different parts of an organisation may understand the risks specific to their function, a holistic view of risk across a business is often lacking. Robust organisation-level BCPs will ensure there are structures in place to keep core services running in times of uncertainty and constraint.
The pharmaceutical sector is diverse and each BCP needs to be tailored to each organisation’s specific situation, but there are three overarching steps we would recommend you take when devising one:
Carry out an enterprise-wide risk assessment process to identify, assess and prioritise key risks – to make the most of this exercise, you will want to engage with a broad group of stakeholders, from board level to teams on the ground, ensuring you cover a range of perspectives. This will involve interviews and workshops designed to identify and prioritise risks, pinpoint what risk management initiatives are already in place and establish who, if anyone, is responsible for managing each scenario. This process is likely to reveal risks that may not have been considered previously, which makes this part of the process so crucial.
Examine if and how the risks that have been identified could impact the business and which functions need to be incorporated into business continuity planning – to understand the key priorities, we use our risk assessment matrix, which you can see below. This matrix helps create a risk register by plotting the likelihood of an event occurring against the extent of its impact on revenue and reputation.
Develop a contingency plan that responds to the information that has been gathered – it will set out the BCP structure and the core roles and responsibilities within it. This plan will also establish recovery strategies that will minimise the impact of any disruption and detail how they should be implemented.
This thorough three-step process will lead to a comprehensive plan that strengthens a business’s ability to respond effectively to change and disruption, as well as embrace the opportunities that often come with it.
A living document
When the facts change, plans need to change with them. The development of a BCP described above is not a one-off event, it is the start of an ongoing process.
From the beginning it should be established that roles and responsibilities outlined are continuous, and the risks posed to the organisation will be kept under regular review. In this way the BCP document can be amended and refined to reflect evolving circumstances.
Those responsible for certain risks can then playback renewed strategies with the business continuity management team, to meticulously test their logic and probable effectiveness.
Our planning in action
Akeso & Co put these principles into play when we developed a business continuity plan for a leading mid-sized pharma company with a range of licensed therapeutics.
As a growing business with a complex supply chain, the disruptions of the Covid-19 pandemic highlighted the need to review and update its continuity plans, including assessing the vital third parties it works with.
A new plan then had to be developed that ensures the organisation and its network of manufacturing and distribution partners is able to respond quickly to disruption in the future. Together with the Chief Operating Officer and a senior team, we followed our three-step approach to do this.
Alongside common risks such as IT failure and disaster, we identified specific issues unique to their business model. For example, certain raw materials where supply could become constrained, and weaknesses in distribution channels such as the Suez Canal. We also located potential single points of failure, where one employee had sole responsibility for a business-critical relationship.
The BCP we developed has provided the business with a flexible framework that will enable the senior leadership team to overcome disruptions to critical business functions. They also now have visibility of the key risks facing the business, supported by effective controls and a process to monitor and manage changes to their risk profile.
Building this kind of agility into a pharma or MedTech organisation enables it to adapt to change and provide a continuous service to its clients. To discuss how Akeso & Co can strengthen your business’s ability to thrive during uncertainty, get in touch.
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.
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.
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.
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.
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.
Akeso & Co supported Homerton University Hospital Foundation Trust (HUHFT) in the design and implementation of a Scan4Safety Programme and Inventory Management System (IMS). Captured in a detailed business case, the initiative is set to drive significant operational efficiencies and improvements to patient safety and care.
Challenge
Homerton University Hospital Foundation Trust (HUHFT) is a major NHS provider of acute care in the London Borough of Hackney. With services spanning 75 locations across East London, including approximately 450 beds, 11 wards, three day-surgery theatres and six main operating theatres, HUHFT has a complex set of services and supporting supply chain.
Following a thorough opportunity assessment, a number of challenges were identified with regards to the current operations, accumulating in clinical time wasted, health and safety risks, as well as opportunities for cost improvements.
Some of the key challenges identified include:
Inefficient and inconsistent supply chain processes across wards and departments
Lack of visibility and control of inventory levels due to limited reporting capabilities
Segmented spending on products and consumables across wards and departments
Limited traceability of theatre implants through the supply chain to procedure due to manual processes
Strained working relationships between clinical and material management staff
Solution
To address the challenges identified, the project recommended HUHFT would benefit significantly from a Trust-wide IMS to improve inventory management and achieve patient-level costing. We supported HUHFT through a three-phased approach from business case development through to successful implementation.
Phase 1) Secure investment through a robust business case
With the support of key HUHFT clinical and operational stakeholders, we developed a compelling business case and secured the required backing to proceed to procurement. Through a detailed appraisal of the potential qualitative and quantitative benefits and risks, it was identified that implementation of a trust-wide IMS could deliver £1.4m in benefits over the next five years, from an initial £469k one-time investment.
Phase 2) Source and partner with the optimal provider
Following a route to market assessment, we facilitated a phased procurement process through a formalised ‘mini-competition’ to assist the Trust in their rigorous selection of a suitable IMS provider. Through taking this approach, we were able to secure an optimal solution balancing system capability and total five-year cost.
Phase 3) Implementation through rigorous PMO and change management
We project managed the implementation of the new IMS and change management of associated processes encompassed within the Scan4Safety programme, reporting to the patient safety board. From the outset, programme governance was implemented to ensure the new system and its related benefits were achievable and sustainable. This involved the recruitment and setup of a programme board of Trust directors, and the chairing of regular meetings and presenting programme updates at Trust-wide Scan4Safety engagement sessions.
Results
The full benefits of the IMS solution will be seen during the next five years but it is already delivering significant savings and process improvements.
The one-time investments equating to £469,000 and subsequent improved processes is expected to generate £1.4m in cost savings, including:
In addition to the projected quantitative benefits, implementation of a Trust-wide IMS is also expected to deliver number of qualitative benefits, including:
A reduction in the likelihood of ‘never events’ thanks to the patient level costing functionality which improves the traceability of implants, surgical instruments and medical equipment.
The release of up to six clinical WTEs, allowing them to re-focus on patient facing activities.
Automated processes, such as Barcode-driven ordering, that drive efficiencies in areas including procurement and recall.
Additional management information insights that enabled further efficiencies.
Increased clinical confidence in supply chain processes.
Compliance with GS1 and Scan4Safety.
What is next for HUHFT?
Following the success of the IMS and Scan4Safety pilot programme, HUHFT will continue to drive adoption of Scan4Safety to extended use cases, including potentially Blood Transfusion Scanning, Pathology samples, eMedicine, and many more.
Scott has dedicated his career to performance improvement in healthcare and life sciences working both within a multinational consulting firm, and for the last decade as a co-founder of Akeso.
As a Managing Partner of the company, he has led the development of Akeso as an established boutique consultancy committed to improvement in UK health. His project specialisms and areas of interest are systemwide performance improvement, the national and international healthcare supply chain and the use of data to drive tangible and actionable improvement insights.
His approach is flexible, warm and fact-based and he is proud to have delivered numerous collaborative/ICS projects being able to engage positively across multiple stakeholders, specialisms and styles to achieve outcomes around aligned goals.
Outside of work his passions are almost all sports (mainly watching nowadays although can be found trying to find his wayward golf balls in the woods / long grass / water) and spending time with family, including Rump the cocker spaniel who is also the honorary office dog.
We’ve helped shape the NHS Wales Shared Services Partnership (NWSSP)’s long-term use and vision of a one-of-a-kind NHS physical shared service facility.
Challenge
In 2018, Welsh Government acquired a 275,000 sq.ft. warehouse in Newport to store core medical supplies as part of the EU Exit preparations. Longer term, the Welsh Government intended that the warehouse would be a strategic investment for Wales. NWSSP were responsible for defining the future shared service opportunity and asked us to develop a strategic outline case, demonstrating that the facility could generate broad benefit to Wales and be financially sustainable in the future.
Solution
We understood the importance of maximising the warehouse’s potential to contribute towards NHS Wales and broader government strategic priorities. We broke the project into four phases to determine how best to respond to the opportunity.
The first was to engage with key stakeholders to identify how everyone might benefit from the warehouse. The second was to evaluate service options that could deliver clinical, social, operational, and financial benefits for the Welsh Healthcare system. The third was to outline how the warehouse space could be best configured to support different functions and balance a range of benefit opportunities. And the final phase was to draft the strategic outline case and recommend the preferred future option for the Welsh government’s approval.
Results
The NWSSP Executive approved the preferred option and ring-fenced ongoing funding, with the adopted approach estimated to generate over £8m in benefits over the next 10 years. The recommended configuration will serve as a cornerstone for key Welsh strategies including the Wellbeing of Future Generations Act, Taking Wales Forwards and A Healthier Wales. It also provides an opportunity to fast track and accommodate initiatives already underway, including the Transforming Access to Medicines Programme.
Peter has over 14 years’ experience of private and public sector healthcare.
He worked for 11 years at EY’s health and social care consulting practice and is now Associate Director at Akeso, leading on the Discharge to Assess and Population Health offerings.
Peter has experience and expertise in operations improvement, whole system redesign, cost improvement, performance improvement and programme delivery.
Peter is currently supporting a large Welsh Health Board on virtual ward implementation. He has led system health infrastructure projects for East Kent, North-West London and Cornwall, and has supported NHSE/I on the evaluation of supported self-management and behavioural interventions.
The Greater Manchester Health and Social Care Partnership, is the largest of the 44 Sustainability and Transformation Partnerships (STPs) defined by NHS England, covering a group of 12 NHS providers (acute, mental health and community), with a non-pay spend of over £2bn per annum, covering a population of 3m and 480 primary care practices. As part of the Greater Manchester devolution agenda, we were engaged to identify and validate in detail the incremental benefits that could result from formalisation of the existing collaborative model and from leveraging the transformational changes from the implementation of the Greater Manchester STP. The project scope included Sourcing and Procurement and Supply Chain of Goods and Services and Pharmacy.
Insight
Whilst the core aim of “ensuring the availability of Goods and Services required to deliver effective and efficient Patient Care to the regions population” will be common to all Healthcare providers in a region, the distribution of this activity and the way in which it is delivered can be very different for each provider. Whilst the benefits of regional working are compelling (greater scale, more cost efficient delivery, sharing of best practice and standardisation, pool investment in technology), understanding each provider’s strategy, their relative areas of focus, priorities, strengths and Procurement capabilities is a crucial first step in the collaborative journey. Our consultants brought a number of methodologies, tools and experiences that have been developed and refined in a Healthcare context, including Capability Assessment and Organisational Diagnostics Tools, a proven Procurement Transformation approach that addresses all areas of capability (People & Organisation, Process and Systems) and Category Intelligence (Client experience, Market Studies etc.).
Action
Our consultants conducted a detailed analysis of resources and costs, capabilities, governance, process maturity and technology to develop a detailed as-is view of the current Procurement Operating Model across providers in the region, identifying areas of commonality and difference. We conducted a total 3rd-party spend analysis with opportunity assessment, analysing four key areas in depth, that would most benefit from a regional approach across Clinical and Non-clinical spend on Goods and Services and Pharmacy. We evaluated a range of options to maximise the return on the collaboration and developed and socialised a Board-level paper which set out the options we had evaluated with a recommendation, underpinned by a HM Treasury 5-case business model.
Results
We developed a fully costed recommendation that reflected the optimal balance between commercial ambition and cost, operational capability and efficiency, and overarching provider strategies. A number of key initiatives from overarching strategy have been taken forward on an advanced basis. We continue to play a role in the delivery of these projects.
Chris has spent almost 25 years working in the commercial and operations space, in both private and public sector across the automotive, financial services, telecoms, energy and healthcare sectors.
As a Managing Partner and co-founder of Akeso, Chris is passionate about the value that can be realised when an organisation takes a fresh look at how it can enhance the quality and cost efficiency of the services and products it delivers by leveraging third-party led innovation, technology and solutions and has worked collaboratively with many providers and suppliers to the Health & Care sectors in the UK and internationally to realise this objective.
Outside of work Chris enjoys spending time with family, watching Arsenal, running and doing DIY projects.
We have been engaged separately by two leading Private Hospital Groups who were keen to explore the potential value of taking a more integrated approach to the supply chains serving their networks of Healthcare facilities. The two projects were delivered independently and confidentially.
Insight
Like public sector Hospitals, private operators have to deal with the receipt, handling and onward distribution of a diverse range of product supplies and equipment. Unlike their public sector counterparts (who until very recently were focussed on Hospital operations within a city or a very concentrated area), private sector Hospital providers have been grappling with the challenge of how to secure supply chain network efficiencies over a wide geographic area for some time. This is compounded by the faster pace of change to their businesses and the need to turn a profit.
Our consultants brought extensive Healthcare and cross-sector experience to these projects including insights on leading supply chain and inventory management practices and established methodologies including a Hospital Supply Chain Maturity Framework, Cost-to-Serve models and Market Intelligence on leading sector Logistics and Solution providers.
Action
We confirmed the scope of supply chain relevant activities, gathered and analysed spend, contract and activity data from across the organisation to built a detailed ‘cost-to-serve’ model for the entire Hospital provider network. We benchmarked the activity and practices to public sector and cross industry (Fast-moving consumer goods, Retail and Automotive) comparators. We engaged with clinical and operational stakeholders to understand the current situation, key challenges and requirements.
We modelled a range of value enhancing supply chain options (using segmented flow models) and jointly, alongside key stakeholders, developed a recommended supply model which reduced costs and improved service levels.
We then developed a final recommendation that achieved the best balance of client and stakeholder requirements, including a full detail business and investment case to take forward on subsequent phases.
We developed an implementation roadmap with interdependencies and priorities clearly specified and mapped. This included a central control capability established to enable benefits to be sustained and tracked over the longer term.
Results
We identified, quantified and developed a series of initiatives that would yield c. 30% to 40% in one-time inventory benefits and 25-35% savings in recurrent supply chain costs, thus reducing average cost-to-serve.
Scott has dedicated his career to performance improvement in healthcare and life sciences working both within a multinational consulting firm, and for the last decade as a co-founder of Akeso.
As a Managing Partner of the company, he has led the development of Akeso as an established boutique consultancy committed to improvement in UK health. His project specialisms and areas of interest are systemwide performance improvement, the national and international healthcare supply chain and the use of data to drive tangible and actionable improvement insights.
His approach is flexible, warm and fact-based and he is proud to have delivered numerous collaborative/ICS projects being able to engage positively across multiple stakeholders, specialisms and styles to achieve outcomes around aligned goals.
Outside of work his passions are almost all sports (mainly watching nowadays although can be found trying to find his wayward golf balls in the woods / long grass / water) and spending time with family, including Rump the cocker spaniel who is also the honorary office dog.
Guy’s & St Thomas NHS Foundation Trust (GSTT) comprises two of London’s best known teaching hospitals, St Thomas’ Hospital and Guy’s Hospital, providing a full range of hospital services to the local community and specialist services nationally. GSTT is one of the largest Trusts in the UK with a turnover of almost £1.5bn and 15k staff, treating over 2.4m patients per year, including 88k inpatients, 103k day cases, 1.2m outpatients and 800k patients in community services.
GSTT operates a wholly owned subsidiary, Essentia, which provides Facilities Management (FM) for GSTT. Essentia was challenged to deliver cost savings, improve service quality and manage an aging asset base to maintain uptime through a blend of in-house and externally contracted services. Akeso were engaged by Essentia to complete a total cost review of the Hard Facilities Management service (Engineering and Building Maintenance) to identify near term and long-term cost reduction and operational efficiency opportunities in 3rd party spend and the internal service.
Insight
Essentia was challenged to deliver cost savings in addition to assuring service quality and maintaining an aging and diverse asset base, with very limited funds for investment. We brought a number of methodologies, tools and experiences to support the client through each stage of the project including a proven Opportunity Assessment approach, Capability Development (People & Organisation, Process and Systems) and Hard Facilities Management-relevant Category and Market Intelligence.
Action
In Phase 1, our consultants led the process to identify the value through benchmarking GSTT to peer Trusts in terms of scale/ size and location using latest Estates Return data from NHS Digital. We completed in depth reviews and analysis for a number of key product and service contracts with the client and incumbent providers to evaluate fulfilment of requirements and to develop strategies to improve performance and leverage benefits where suppliers were failing to meet performance standards. We then prepared a Board level recommendation for a Programme Delivery setting out a range of tactical and strategic options.
In Phase 2, we designed and led a joint Consultant:Client delivery program to implement the recommendations. We developed and ran multiple Tenders, which included soft supplier market engagement, the development of output based specifications and the design of contract models that would permit the involvement of local SME providers. We finally designed and costed a detailed process improvement plan to transform the end-to-end Hard FM Callout process handling 50k callouts per year.
Results
We established and mobilised a structured Trust-wide improvement programme which delivered savings and improvements across all areas of Engineering and Building Maintenance to improve customer service and regulatory compliance and reduce cost to serve.
Scott has dedicated his career to performance improvement in healthcare and life sciences working both within a multinational consulting firm, and for the last decade as a co-founder of Akeso.
As a Managing Partner of the company, he has led the development of Akeso as an established boutique consultancy committed to improvement in UK health. His project specialisms and areas of interest are systemwide performance improvement, the national and international healthcare supply chain and the use of data to drive tangible and actionable improvement insights.
His approach is flexible, warm and fact-based and he is proud to have delivered numerous collaborative/ICS projects being able to engage positively across multiple stakeholders, specialisms and styles to achieve outcomes around aligned goals.
Outside of work his passions are almost all sports (mainly watching nowadays although can be found trying to find his wayward golf balls in the woods / long grass / water) and spending time with family, including Rump the cocker spaniel who is also the honorary office dog.
NHS Pathology Laboratories in England process nearly 800m blood specimens per year. Of these, c. 50m tests (6%) originate from the 7,800 GP practices (av. 6,440 tests per GP practice) the others originate from Hospital Provider network and other sources.
We were engaged by a number of Pathology Service Providers, individual providers and regional collaborations, (the largest handling up to 1.75m samples from almost 400 GP practices and community locations operating Phlebotomy services) to assess, design and implement efficiency improvements to the Community Specimen Collection Network.
Insight
Like any network, the Specimen Collection Network is dynamic and evolves over time. It quickly begins to change as individual GP practices and community care providers makes changes to their practice locations, opening hours and service locations and new providers enter the market providing Phlebotomy services.
We used a number of Network Modelling methodologies and tools, combined with our sector experience, to understand the current network and design a solution which best met the customer and Laboratory requirements (better service, reduced collection cost per reported test result, etc.).
Action
Our consultants analysed the volumetric, activity and financial data from across the network to baseline costs. We engaged key stakeholders in the Pathology Laboratory and sample of key GP and community customers to understand the current situation, key challenges and customer requirements.
We led the engagement with local and national Transport and Technology providers to identify relevant solution options. We modelled a range of solution options and developed a recommendation which best met the customer requirements. We led the implementation of our recommendations which included the development of specifications, competitive tenders and the implementation of change management providing the client with a toolset to track benefits and monitor volumetric going forward.
Results
We delivered savings ranging from 9% to 17.5% (reduced collection cost per reported test result, reduced carbon footprint) through the consolidation and redesign of collection routes and times whilst keeping within the critical four hour collection-to-test window. We improved the customer service and provided enhanced sample traceability (sample collection to test) and further ensured that the efficiencies are sustainable and would enable the Pathology provider to keep apace with future developments of the network.
Scott has dedicated his career to performance improvement in healthcare and life sciences working both within a multinational consulting firm, and for the last decade as a co-founder of Akeso.
As a Managing Partner of the company, he has led the development of Akeso as an established boutique consultancy committed to improvement in UK health. His project specialisms and areas of interest are systemwide performance improvement, the national and international healthcare supply chain and the use of data to drive tangible and actionable improvement insights.
His approach is flexible, warm and fact-based and he is proud to have delivered numerous collaborative/ICS projects being able to engage positively across multiple stakeholders, specialisms and styles to achieve outcomes around aligned goals.
Outside of work his passions are almost all sports (mainly watching nowadays although can be found trying to find his wayward golf balls in the woods / long grass / water) and spending time with family, including Rump the cocker spaniel who is also the honorary office dog.
NHS Pathology Laboratories in England process nearly 800m blood specimens per year. Working on behalf of a vanguard Pathology Services Collaboration (following the Lord Carter report) involving 8 Hospital providers, over 400 community sites and over 28m reported tests, we were engaged to evaluate current testing costs, baseline non-pay, diversity and opportunities to consolidate Diagnostic and Laboratory Equipment portfolio, Consumables and Services with the aim of delivering efficiencies and cost reductions across the newly formed Pathology operation.
Insight
As in any post-merger cost reduction situation, the key to success is to rapidly bring together data and information from a number of disparate sources and organisations and develop a working view of the merged reality that allows the client to understand which areas of spend are addressable, which are committed and for how long, the opportunities to drive value and what needs to happen to enable and maximise these opportunities.
We used a number of methodologies and tools, including Opportunity Assessment, Financial Modelling, Category Workbooks for Pathology Equipment, Consumables and Services and Programme Planning to understand the current situation, identify cost reduction opportunities and recommend a cost reduction programme.
Action
Our consultants gathered and analysed spend, contract and activity data from across the newly merged organisations to baseline costs. We engaged key stakeholders in the Pathology Laboratories and Hospital Customers to understand the current situation, key challenges and customer requirements.
We led the engagement with leading providers, incumbent and competitor, to understand leading technologies/ solutions and identify relevant value opportunities. We modelled a range of programme delivery options and developed a recommendation which best met the client requirements.
We led the implementation of our recommendations which included development of specifications, sourcing and implementation of Managed Pathology Services for Biochemistry platforms and consolidation and sourcing of Research Consumables. We also provided the client with a toolset to track benefits.
Results
We delivered a savings programme that yields annualised savings averaging 8% on a total non-pay spend of £22m. Sub-category initiatives delivered savings ranging from low single digit to high double digits.
We supported the implementation of Hub and Spoke strategy delivering a Diagnostics Platform strategy that consolidates and standardises test platforms over three years.
Chris has spent almost 25 years working in the commercial and operations space, in both private and public sector across the automotive, financial services, telecoms, energy and healthcare sectors.
As a Managing Partner and co-founder of Akeso, Chris is passionate about the value that can be realised when an organisation takes a fresh look at how it can enhance the quality and cost efficiency of the services and products it delivers by leveraging third-party led innovation, technology and solutions and has worked collaboratively with many providers and suppliers to the Health & Care sectors in the UK and internationally to realise this objective.
Outside of work Chris enjoys spending time with family, watching Arsenal, running and doing DIY projects.
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