Insight

Overcoming the barriers to developing future-ready community diagnostic services

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

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

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

Reshaping diagnostics for the new normal

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

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

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

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

What could the future of community diagnostic services look like?

There are three key models to transforming community diagnostic services.

Optimal care pathways

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

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

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

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

Community diagnostic hubs

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

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

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

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

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

New diagnostic technologies

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

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

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

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

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

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

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Chris Robson

Chris Robson

Managing Director
Case studies – newspapers
Case Study

Non-Patient Transport Service Review & Optimisation

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

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Scott Healy

Scott Healy

Director
Insight

Saying Goodbye to Category Tower 8: A Fond Farewell to Akeso’s Successful Service Delivery

“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.”

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Chris Robson

Chris Robson

Managing Director
Case studies – newspapers
Case Study

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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Chris Robson

Chris Robson

Managing Director
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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Martin Shiderov

Martin Shiderov

Associate Director
A door to redesigning a one of a kind NHS shared service facility
Case Study

Redesigning a one-of-a-kind NHS shared service facility

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.

NHS Wales Shared Services Partnership – Potential

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.

NHS Wales Shared Services Partnership – Opportunities

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.

NHS Wales Shared Services Partnership – ROI

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.

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Peter Marshall

Peter Marshall

Associate Director
Guys and St Thomas Hospital
Case Study

Facilities Management Cost Reduction

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&Co 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.

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Scott Healy

Scott Healy

Director
Optimisation of diagnostic specimen collection network
Case Study

Optimisation of Diagnostic Specimen Collection Network

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.

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Martin Shiderov

Martin Shiderov

Associate Director
Laboratory Diagnostics
Case Study

Laboratory Diagnostics Non-pay Cost Reduction Programme

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.

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Peter Marshall

Peter Marshall

Associate Director