Case Study

Diagnostic Transformation Team Options Appraisal

Akeso were commissioned by an Acute Provider Collaborative to deliver and options appraisal and business case for the reconfiguration, funding and hosting of their Diagnostic Transformation Function.

Insight

As the local ICB continued to streamline its functions in line with the mandated Running Cost Allowance reductions, the Acute Provider Collaborative sought to review the funding and hosting of its crucial Diagnostic Transformation Team, which had successfully led on driving excellence across the system, and in accessing large-scale capital funding for system-level diagnostic investment.

Action

Options Appraisal

Akeso supported the Collaborative by working with a large cohort of local stakeholders from across multiple clinical disciplines, partner and client organisations to deliver an options appraisal to select the most appropriate, effective and sustainable host organisation and funding stream for the Diagnostic Transformation Function.

Operating Model

This exercise also included a review of the Team’s size and configuration in order to ensure optimal effectiveness and value for money for the final model.

Full Business Case

Having scoped, developed and agreed preferred options, Akseo developed a Final Business Case for the selected service and funding model, supporting the Client in navigating this though the complex local provider landscape.

Results

The options appraisal identified an optimal funding and hosting model, along with an enhanced operating model for the Transformation Function.

We developed a Full Business Case for the preferred model which obtained approval, releasing £1.5m annual funding and identifying a sustainable funding stream for the Function.

Consequently, this work has protected the system’s ability to continue to successfully attract tens of millions of pounds of additional capital investment into local diagnostic capacity.

Case Study

UK Point-of-Care Market Entry Strategy

Akeso supported a non-UK based POC manufacturer to develop a market entry strategy to support bringing a number of their POC products across a wide-spanning disease portfolio into the UK, through a detailed opportunity assessment, commercial strategies and overall entry recommendation.

INSIGHT

Anbio (Xiamen) Biotechnology are a non-UK based manufacturer of laboratory diagnostics and point-of-care (POC) products, who experienced particular success with their COVID-19 LFD portfolio.

Anbio had identified a possible commercial opportunity to expand into the UK market with their wider POC portfolio and engaged with Akeso to seek support in conducting a market opportunity assessment and developing a strategy recommendation to implement this market entrance.

ACTION

Akeso developed the recommendation report via a two-phase approach:

  • Opportunity Assessment: Via utilisation of a top-down strategy, Akeso conducted a full UK POC market assessment reviewing overall performance/growth, industry trends and barriers, supplier landscape and disease segment analysis, to identify evidence-based disease-level opportunities. From this, Akeso short-listed further product prioritisation opportunities across each of the identified disease areas, reviewing both of Anbio’s Antigen Rapid Test and Chemiluminescence Instrumentation product portfolio (as requested)
  • Strategy Recommendation: Akeso documented a supporting disease- and product-specific commercial strategies across public and private healthcare and wider public sectors. These were supported by a market entry strategy, operating model and roadmap to establish a business within UK market.

RESULTS

Due to our in-depth understanding of UK healthcare, POC testing specifications, procurement and distribution, and market access, Akeso successfully:

  • Identified disease & product-level opportunities and potential revenue benefits, in addition to market and product developments recommendations
  • Documented commercial strategy roadmap supported by a number of key enablers to provide “quick win” activities to support successful entry

Contact our experts

Scott Healy

Managing Partner
Case Study

Digitalisation of ICB Ophthalmology

Akeso were engaged by a London ICS to provide programme management expertise for an NHS national pilot programme supporting the delivery of an Electronic Eyecare Referral System between community optometry and secondary care ophthalmology.

INSIGHT

The Electronic Eyecare Referral System (EeRS) pilot, jointly commissioned by NHS England and NHS Improvement and NHS in November 2020 was a pilot programme that sought to achieve:

  • Electronic referral management between primary and secondary care
  • The ability to share complex diagnostic images (e.g., Optical Coherence Tomography Scan (OCT scan)

ACTIONS

With eERS being procured and managed on a regional basis, Akeso were engaged by a London ICS to support the roll-out of eERS within the region. The Akeso project team were responsible for standing up the programme management, maintaining oversight of the budget, supplier and contract compliance, and working with a diverse stakeholder group from independent, private and NHS sectors.

With 6 workstreams including Information Governance, Communications, Clinical Safety, Digital Integration, Commissioning and Evaluation, Akeso ensured the project progressed to timeline, with the London region being a national exemplar, with the highest level of optometry engagement as well as being first-movers in implementing a technical integration into secondary care and resolving IG issues.

RESULTS

Owing to Akeso’s programme management support, the proof-of-concept eERS programme in London was evaluated at the end of Year 1, with a board approval to continue due to its success. Following a period of transfer, Akeso then upskilled the existing internal team to deliver the programme.

Contact our experts

Olivia Jeffery

Olivia Jeffery

Manager
Case Study

Virtual Ward Implementation Programme Methodology

Working collaboratively with a global MedTech provider, we structured an implementation guide to support overcoming key barriers to implementation which were potentially limiting sales opportunities – this resource is now key material used in respected conferences such as HETT.

INSIGHT

Virtual Ward implementation were (and continue to be) viewed as complicated and involved, with a lack of clear guidance on how to implement them effectively.

The client suspected this was leading to lost opportunity / sales and required a required a solution that provided current and future clients with the support & piece of mind they sought. The solution needed to make it clear what needed to be done and when whilst, most importantly, showing how easy Virtual Wards are to implement- demystifying the process.

ACTION

Akeso was engaged to support in the development of this solution; a comprehensive Virtual Ward implementation guide.

We conducted a comprehensive discovery exercise to understand the Virtual Ward implementation environment, what was done well, what was done badly and what regulatory / funding processes providers had to complete.

Using an agile approach, we began to develop an implementation guide from the gathered information, breaking the process down into easily digestible chunks. The iterative style of our delivery allowed the method to be tested with clinicians and client stakeholders, adapting the material in real time.

We delivered a concise, clear and visually engaging Virtual Ward implementation guide which has now been distributed to over 10,000 industry stakeholders across the UK.

RESULTS

  • A comprehensive Virtual Ward implementation guide
  • Increased brand awareness and market interest
  • Improved internal implementation practices
  • Industry leading material and a competitive advantage

Contact our experts

Adam Thwaites

Director
Case studies – newspapers
Case Study

Commercial Case for NHSE South-West Community Diagnostic Hubs

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.

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Man smiling

Jacob Cross

Manager
Case Study

Programme Management of a New Outpatient Facility

Akeso supported Moorfields Private Eye Hospital in the establishing of a brand-new state of the art private outpatient eye centre providing refractive laser and operating theatre suite.

INSIGHT

Moorfields Private (MP) acquired the lease of a five-storey site situated in the heart of London’s medical district on New Cavendish Street with the intention to extend and build a brand-new state of the art eye centre.

The construction required complex restructuring and adjoining of two large Central London townhouse building, fitting of a refractive laser and operating theatre suite and full refurbishment.

ACTION

We supported MP with the planning, building and mobilisation of Moorfields private outpatient centre on New Cavendish Street over three build phases, through the following activities:

  • Delivered robust planning from the outset, with involvement from multiple stakeholders, across estates, operations, IT and workforce to capture dependencies at each stage and ensure delivery to budget and time
  • Supported in the planning and design of an efficient operating model and patient pathway
  • Provided procurement support in scoping and sourcing medical equipment
  • Managed third party providers, including interior designer and equipment suppliers
  • Monitored outpatient, theatre and laser activity to ensure accurate revenue planning and forecasting

INSIGHT

MP successfully opened their brand-new private outpatient centre in Spring 2022 which boasts the latest laser and theatre technology, including a state-of-the-art Surgicube, and are on track to deliver revenue targets.

Contact our experts

Olivia Jeffery

Olivia Jeffery

Manager
Insight

Technology-enabled virtual wards the future of healthcare

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:

Patients per year graph

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:

Reduce length of stay

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
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.

The vision for technology
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].

Future applications of technology-enabled Virtual Wards
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

  1. The British Medical Association. NHS backlog data analysis. 2022. [online] Available here.
  2. House of Commons Committee. Workforce: recruitment, training and retention in health and social care. 2022. [online] Available here.
  3. KingsFund, 2006. Case study: Virtual wards at Croydon Primary Care Trust. [ebook] Available here.
  4. NHSX. A guide to setting up technology-enabled virtual wards. 2022. [online] Available here.
  5. 15.5% avg national re-admission rate, as reported by Nuffield Trust in https://www.nuffieldtrust.org.uk/resource/emergency-readmissions
  6. 20% patient eligibility for MSN-enabled virtual ward, as an Akeso&Co assumption
  7. 6.6 days of avg length of stay for re-admission acute patients, as reported by the Internal and Emergency Medicine inhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8354916/
  8. 90% avg bed occupancy for General and Acute beds, as reported by NHSE onhttps://www.england.nhs.uk/statistics/statistical-work-areas/bed-availability-and-occupancy/bed-data-overnight/
  9. £400 per bed per day, 2022-23 national tariff payment system, as reported by NHSE on <https://www.england.nhs.uk/wp-content/uploads/2020/11/22-23-National-tariff-payment-system.pdf
  10. 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
  11. 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.
  12. Masimo. Masimo SafetyNet Telesurveillance Solution. Presentation; 2020.
  13. Masimo.co.uk. Masimo – About. [online] Available at: https://www.masimo.co.uk/company/masimo/about
  14. England.nhs.uk, 2022. Delivery Plan for Tackling the backlog of elective care. [ebook] NHS. Available at: https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2022/02/C1466-delivery-plan-for-tackling-the-covid-19-backlog-of-elective-care.pdf
  15. NHS England, 2022. 2022/23 priorities and operational planning guidance. [ebook] Available at: https://www.england.nhs.uk/wp-content/uploads/2022/02/20211223-B1160-2022-23-priorities-and-operational-planning-guidance-v3.2.pdf
  16. James Illman (2022). ‘Patients at risk’ from ‘hastily rolled out virtual wards’. Health Service Journalhttps://www.hsj.co.uk/quality-and-performance/patients-at-risk-from-hastily-rolled-out-virtual-wards/7031648.article
  17. https://theclinician.com/
Insight

Transforming homes into hospitals

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.

Homes into hospitals

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 

[2] NHS Confederation (2021). Discharge to assess: the case for permanent funding. NHS Confederation. https://www.nhsconfed.org/system/files/2021-07/Discharge-to-assess-funding-briefing-for-HMT.pdf  

[3] Independent Healthcare Providers Network (2020). Our Virtual Ward improves patient flow at Kettering General Hospital NHS Foundation Trust. Independent Healthcare Providers Network. https://www.ihpn.org.uk/wp-content/uploads/2021/05/HAH-discharge-case-study.pdf  

[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  

[5] Health Innovation Network South London (2021). Rapid evaluation of Croydon Virtual Ward. Health Innovation Network South London. https://healthinnovationnetwork.com/wp-content/uploads/2022/01/Croydon-VW-Evaluation-Report-to-NHSX-v10.pdf  

[6] Masimo SafetyNet.  https://www.masimo.co.uk/products/hospital-automation/masimo-safetynet/  

[7] Hospital-to-home. https://hospital-to-home.uk/  

[8] Virtual Lucy. https://www.virtuallucy.co.uk/  

[9] Medefer. https://medefer.com/  

[10] James Illman (2022). ‘Patients at risk’ from ‘hastily rolled out virtual wards’. Health Service Journal. https://www.hsj.co.uk/quality-and-performance/patients-at-risk-from-hastily-rolled-out-virtual-wards/7031648.article

Insight

Technology-enabled Virtual Wards

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

Virtual ward chart

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…

Tech enabled ward example
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!

uksales@masimo.com | + 44 (0)1256 479988

Covid-19 tests – logistics management for a global pharmaceutical company
Case Study

Logistics Management for a Global Pharmaceutical Company

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.

Akeso – Tanner Pharma – Case Study Results

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.

Akeso – Tanner Pharma – Case Study Quote

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Scott Healy

Managing Partner
Insight

Preparing for the challenges of tomorrow with robust continuity planning

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:

  1. 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.
  2. 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.Akeso risk matrixAkeso risk matrix description
  3. 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.