Insight

Financial Improvement Plans: Schemes to Target Outcomes

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.

 

References

[1] National rollout of crucial systems will reach just 20 trusts in two years [online]. Available at: https://www.nhsprocurement.org.uk/news/national-rollout-crucial-systems-will-reach-just-20-trusts-two-years

[2] Akeso. I’m a patient get me out of here. 2022. [Online] Available at: https://akeso.co.uk/insights/im-a-patient-get-me-out-of-here/

[3] Akeso. Technology-enabled virtual wards the future of healthcare. 2022. [online] Available at: akeso.co.uk/insights/technology-enabled-virtual-wards-the-future-of-healthcare/

[4] Centre for Perioperative Care (CPOC). 2020. [Online] Available at: https://www.cpoc.org.uk/cpoc-publishes-major-evidence-review-impact-perioperative-care

[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.

[6] HSJ.  Dozens of Trusts still not sharing single Pathology Service. 2022. [online] Available at: https://www.hsj.co.uk/service-design/dozens-of-trusts-still-not-sharing-single-pathology-service/7033372.article

 

Contact our experts

Scott Healy

Scott Healy

Director
Case studies – newspapers
Case Study

Optometry / Ophthalmology Digitalisation PMO

Akeso were engaged by a London ICS to provide programme management expertise for a NHSx 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 NHSx 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.

Responsible for Programme Management, Akeso were responsible for end-to-end programme implementation accountable to the Programme Board and reporting back into NHSx.z

The Akeso project team were responsible for 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 successfully evaluated at the end of Year 1, with a board decision to continue the programme.

The Akeso team facilitated an efficient project roll-off following a short-term extension into Year 2, with the Programme Management moving into BAU activity.

Contact our experts

Olivia Jeffery

Olivia Jeffery

Manager
Case studies – newspapers
Case Study

Vision Paper Development

Working collaboratively with a global MedTech provider, we structured a vision paper to support defining themselves in an overcrowded market and calling out the national need for their technology – this resource is now key marketing material used in respected conferences such as HETT

INSIGHT

The client offers a suite of technologies, already commonly employed in acute care settings across the UK. However, the local market was changing, with a growing demand for solutions that move patients from hospital to home. The Virtual Ward solution had been developed to service this demand and was already in use across Europe and the US.

With the market quickly becoming competitive, the client needed a robust, rapid approach to establish their Virtual Ward solution as the ‘gold standard’ and to grow their market presence.

ACTION

Akeso were commissioned to support a global MedTech provider in bringing their Virtual Ward solution to the local market.

Working collaboratively with the client, we came to understand that the key issue they faced was ‘standing out from the crowd’; defining themselves in an overcrowded market.

Using a structured discovery approach, we built a detailed understanding of the clients offering, what made it different, its competitors, and the opportunity in the local market. This information was used to develop a Vision paper which, on a single page, communicated to healthcare providers how the client’s technology could support them and what made it unique.

This resource is now used as key marketing material for the solution, supporting the client at HETT, the UK’s largest digital health event, to build brand awareness and market interest.

RESULTS

  • A key piece of marketing material, promoting the solution
  • Increased brand awareness and market interest
  • Better understanding of market position and competitors
  • NHS connections from Akeso’s contact base

Contact our experts

Martin Shiderov

Martin Shiderov

Associate Director
Virtual Wards - first-of-kind case study on heart failure
Case Study

Virtual Wards: First-of-kind case study on Heart Failure

Summary

One of the first datasets of its type, pioneers within technology-enabled virtual wards West Hertfordshire Hospital in partnership with Masimo, used hospital grade digital health platform, Masimo SafetyNet to establish a robust clinical pathway to support early discharge and readmission avoidance for patients with heart failure. Key findings include, 36% reduction (3 days) in average acute LoS, 38% reduction in readmission and excellent patient satisfaction.

Background

Following the call by NHS England for ICSs to embrace innovation and establish technology-enabled Virtual Wards, a first-of-kind study has been released by early pioneers at West Hertfordshire Teaching Hospitals NHS Trust who have developed a Heart Failure Virtual Hospital using leading digital health platform, Masimo SafetyNet®.

Designed by a local Integrated Care Service consisting of representatives across the Acute Trust, Community Heart Failure Services and primary care, the West Hert’s Heart Failure Virtual Hospital was established to allow patients to safely receive care from the comfort of their home. In doing so, a study was conducted to quantify how this technology-enabled Virtual Ward could (1) safely reduce acute length of stay through early discharge and (2) deliver high patient outcomes through preventative readmission, all whilst maintaining positive patient experience.

To establish the Heart Failure Virtual Hospital, West Hert’s in partnership with technology providers, Masimo, developed a comprehensive clinical pathway and platform customised for eligible patients. At the centre a Virtual Hospital monitoring hub was formed to collate and monitor patient data, sent directly via Bluetooth from the Masimo monitoring app on the patients mobile device. Automated vital signs readings were recorded three times per day, as well as daily questionnaires and phone calls by a Virtual Ward nurse and daily Virtual Wards rounds by a heart failure consultant.

Key outcomes

The study, which is the first datasets of its type, collated data across length of stay, readmission rate and patient experience for 183 patients. Preliminary analysis collated the following key findings:

  1. Acute length of stay was significantly reduced through early discharge
    • 36% reduction (3 days) in average acute LoS – mean acute LoS was 5.8 days compared to 9.1 days for patients not onboarded into the Virtual Ward for the same period
    • 68% of patients (125) were successfully discharged after a Virtual Ward stay
  2. Preventative readmission indicated strong decline
    • 11% reduction in readmission rate into the acute following 30-day follow-up with a primary HF diagnosis – 3.2% for Virtual ward vs. 3.6% for non-Virtual Ward group
    • 38% reduction in readmission rate for all causes – 9.6% for Virtual Ward vs. 15.5% for non-Virtual Ward group
  3. Patient satisfaction was excellent
    • 83% of patients agreed that going home sooner from hospital aided their recovery
    • 85% of patients agreed that they felt safe as a patient in the Virtual Hospital
    • 88% of patients agreed that the frequency of contact and communication by the monitoring hub was about right.

Key success factors for implementation

  1. Robust technology – Hospital grade technology that is both compliant and from a recognised and trusted provider, is a key driver to overcoming the potential barrier of both Clinician and patient acceptability. Due consideration should be given to the user experience and journey so to empower the patient and Clinician.
  2. Clear methodology – As with any large clinical transformation which involves adoption of new technology, a clear plan that reflects a comprehensive understanding of the problem to be addressed is crucial. This includes identifying the appropriate use case and patient cohort.
  3. Pilot approach – Avoid a ‘big bang’ approach. We recommend phasing Virtual Wards in, targeting two or three patient cohorts of highest priority / acceptability first.

How can we help you?

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.

Key features of Masimo SafetyNet® include:

  • Continuous and spot check sensors to monitor patient vital signs remotely via Bluetooth connectivity in real-time
  • Over 150 live Customisable care programs, including training and educational material
  • Secure NHS NDG compliant network via AWS cloud, enabling 24/7 two-way audio and video communications with the capability for EMR integration
  • Dynamic dashboard and customisable alert limits to automatically notify and inform Clinicians as required

Masimo has a vision to support healthcare providers deliver effective and safe patient care from the comfort a patient’s home through hospital grade technology-enabled Virtual Wards. To support providers in rapidly implementing Virtual Wards, Masimo in partnership with Akeso have developed a suite of documents to achieve their goals, whilst ensuring quality patient care.

To access Masimo and Akeso’s free implementation guide for Virtual Wards, please click here, or get in touch with us on Martin.Shiderov@Akesoco.com

Contact our experts

Martin Shiderov

Martin Shiderov

Associate Director
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