Service: Financial Improvement

Insight

Accelerating Scan4Safety Agenda through Inventory Management Optimisation

Home Performance Improvement Financial Improvement
Published Read Time 3 minutes

From Lord Carter’s 2015 report through to Scan4Safety in 2017 mandating GS1 and PEPPOL compliance, the call for improved patient safety through better inventory management prior to and following the COVID-19 pandemic has long been stated. Yet despite these initiatives, many Trusts are still grappling with a lack of the right systems and processes to enable achievement of these aims.

In June 2023 the government published a mandate to address the most urgent needs for the NHS. Amongst the three key priorities outlined, a target was set for all Trusts to adopt barcode scanning of high-risk medical devices and submit data to the national, mandatory Medical Device Outcome Registry, by March 2024.

Nine months later and we’ve seen several programmes and initiatives kick start with the aim of supporting the advancement of patient safety through barcode scanning, including the NHS Supply Chain inventory management programme, which Akeso supported to mobilise, as well as more recently the reinvigoration of the Scan4Safety programme.

Whilst there has been notable investment, a significant number of Trusts do not have the right inventory management systems and processes in place to enable Scan4Safety effectively. Based on our analysis, we understand that almost half of acute Trusts in England do not currently have sufficient capability to meet the mandate requirements set out through barcode scanning capabilities. Furthermore, we estimate that only 30% of acute Trusts have the capability to manage inventory at the point of care and therefore meet Scan4Safety requirements.

Untapped Benefits within Inventory Management

Given the significant gap between Trusts with and without barcode scanning capability, there is an opportunity to tap into the wide-reaching benefits that optimised inventory management can achieve – from improvement to patient safety, greater traceability and operational productivity, to cash-releasing supply chain efficiencies. The below outlines some of the expected benefits Scan4Safety through inventory management optimisation can bring.

Based on our analysis we estimate that the average Trust could achieve the following key benefits:

  • Equivalent of 5 clinical WTE released back to critical patient facing activities
  • One-time cash releasing benefit of c. £1 million and recurring financial benefit of £50,000-£100,000
  • Wider supply chain and logistics efficiencies through greater visibility and control of ordering as well as improved supplier relationship management

However, despite this, the reality can be quite different for many Trusts. With common barriers, including siloed working across functions and Trust data maturity, understanding the landscape and due consideration to the change required is critical to the success of achieving positive and sustainable change.

Key Success Criteria

Based on our experience we have summarised the key success criteria that are required to effectively optimise inventory management through barcode scanning. Together these key success criteria make up the core fundamentals which enable inventory management optimisation best practice.

How We Can Support You

Akeso have worked hand-in-hand with a number of Trusts from business case development and benefits modelling through to implementation and benefits realisation, including most recently the establishment of the NHS Supply Chain inventory management programme. As such we are well positioned to support Trusts and ICBs navigate the current landscape and support accelerate your Scan4Safety proposition.

Sign up to access our free ‘how to’ guide for further information on how healthcare organisations can accelerate Scan4Safety through inventory management optimisation:

Scan4Safety Acceleration Guide

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Olivia Jeffery

Olivia Jeffery

Manager
Case Study

Reduction of ICB Waiting List through Pooling of Resources

Home Performance Improvement Financial Improvement
Published Read Time 2 minutes

Akeso were engaged to work closely with the Clinical and Operational teams from the 9 hospitals who deliver Endoscopy Services in the ICB to model a shared waiting list for Endoscopy and identify opportunities to pool resources across neighbouring hospitals across the region to treat patients more quickly and reduce the waiting list.

INSIGHT

The demand for Endoscopy Diagnostics is increasing year-on-year driven by increases in Gastroenterology and Colorectal Surgery. As of April-24, the NHS waiting list for Gastroenterology-related Diagnostics stood at almost 170k nationally.

From an ICB perspective, pooling of resources across a regional Health system can be a key means to addressing the growing waiting list for a given clinical service, particularly for day case / walk in activity such as Endoscopy. It also maximises utilisation of existing resources. Our work with Health providers across the NHS suggests that capacity increases of over 20% can be achieved through pooling of waiting lists and associated resources.

To be successful however, there are a number steps that must be taken beyond the simple aggregation of the waiting list across a group of providers including: (1) building a detailed understanding the cohort of patients awaiting diagnostics / treatment, (2) understanding potential challenges and barriers to patients accessing and receiving care at an alternative provider and (3) developing strategies and plans for how these can be overcome.

ACTION

  • Akeso conducted a full service ‘as-is’ review, presented through data collation, validation and analysis, which provided a network wide view of current service, including waiting lists, capacity, activity, and workforce;
  • Scenario modelling was then performed utilising the current network status and changeable inputs and outputs allowing for simulation testing to understand the potentials of service optimisation, in terms of absolute waiting list reduction, additional income and costs;
  • A series of business cases were then developed exploring specific options available to individual Trusts as well as the network as a whole. This incorporates options to clear the current backlogs / waiting lists, as well as how to future proof the service in accordance with demand predictions;
  • A final interactive dashboard tool was developed to be used for short-medium term service planning, providing real-time service and workforce optimisation based on Trust needs.

RESULTS

We found that the ICB in question could realise a capacity increase of 20% through the pooling of waiting lists and resources. We also proposed and developed a series of recommendations, on supply and demand side, to help them address potential barriers to patients accessing available with alternative providers in the region.

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Adam Thwaites

Director
Insight

Supporting Sustainability and Social Value in Estates and Facilities

Home Performance Improvement Financial Improvement
Published Read Time 2 minutes

Introduction

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

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

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

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

Akeso’s methodology

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

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

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

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

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Chris Robson

Chris Robson

Managing Partner
Insight

How can systems integrate their estates and facilities services?

Home Performance Improvement Financial Improvement
Published Read Time 3 minutes

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

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

(1) Clinically Led System-Wide Estates Strategy

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

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

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

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

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

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

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

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

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

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

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

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Chris Robson

Chris Robson

Managing Partner
Insight

Financial Improvement: Targeting at ICB level through Population Health Management

Home Performance Improvement Financial Improvement
Published Read Time 4 minutes

Introduction

So far, Akeso’s Financial Improvement series has outlined the opportunities for realising tangible efficiencies and savings over short, medium, and long-term timeframes, with examples of our proven experience working with NHS organisations, collaboratives and systems.

In this article, we will take a closer look at the opportunities for Integrated Care Boards to leverage Population Health Management to support long term improvements in health outcomes and associated efficiencies.

Context

The prevalence of chronic health conditions in the UK continues to rise, and with this so does the burden on healthcare services. For example, more than 4.9 million people live with diabetes, with 13.6 million at risk of developing type 2 diabetes[1]. Obesity is another significant public health challenge. It is estimated 36% of adults within the UK will be obese by 2040[2], a key risk factor for type 2 diabetes, as well as cardiovascular disease, cancer, and musculoskeletal disorders, amongst others.

These chronic conditions not only impact quality of life at population level but also come with significant financial and economic implications – last year, NHS spend on diabetic care accounted for circa 10% of the total budget[3], with the annual cost of obesity to the UK economy estimated at £58 billion. Quality of Life Years (QALYs) measures the loss of productivity and quality of life costs for individuals at £39.8 billion, and costs for society as a whole at £7.5 billion, demonstrating that addressing health risks can add far more benefits than just cost reductions to the NHS[4].

Integrate Care Boards and Population Health Management

Population Health Management (PHM) is a methodology that uses data-driven planning and delivery of proactive care via risk stratification and population segmentation to improve physical and mental health, promote wellbeing and reduce health inequalities across a population, with a specific focus on the wider determinants of health (e.g., housing, employment, education). In turn, this improves health outcomes, specifically for people for long-term conditions, and releases long-term financial and economic efficiencies.

ICBs and partnerships are best placed to lead on PHM by designing tailored interventions for their local populations. It is vital that a broader view of ‘value’ is taken (and over a longer timeframe than a single year) as this will inform decisions on investment into interventions to improve the health of communities, release longer term efficiencies for the NHS and deliver wider societal benefits. Examples of proven interventions include investment in the self-management of chronic conditions such as asthma, COPD, and diabetes.

The range and potential for PHM interventions will be determined by the ambition of local healthcare leaders and decisions makers. The key challenge will be to balance the immediate and acute pressures facing the NHS with a forward-looking approach to the local population’s care needs and associated financial burden.

Akeso and Population Health Management

Akeso has developed various solutions to support ICBs and Partnerships, to address the PHM and longer-term efficiency challenge.

  1. A Bespoke PHM Modelling Approach
    We have developed a bespoke PHM modelling approach that benchmarks the cost of health and care provision for ICBs and Places with similar demographics. This was initially developed with NHSE’s Finance Department to identify performance and cost improvement opportunities across all CCGs, using national health, health access, socio-economic, and demographic data. We have further developed the model and combined 46 variables including, cost and access to primary and secondary care, age, ethnicity, rurality, deprivation, diabetes prevalence, and cancer prevalence.
  2. Enhancing Business Cases and Cost-Effectiveness in Health and Care Interventions
    We have developed an approach to developing business cases, benefits, and the cost-effectiveness of health and care interventions, that goes beyond the requirements of the 5 Case Model for HM Treasury Green Book Business Cases. For example, we calculate Quality of Life Years (QALYs) and capture economic and societal benefits from the impact of population health management interventions.
  3. Data-driven Study for Improved Healthcare Outcomes
    Akeso is currently studying healthcare data to identify potential underdiagnosis rates among adolescent ADHD patients. To achieve this, we are analysing data from the Millennium cohort study and national prescribing rates. The findings of this review will be used to support education initiatives, improve healthcare outcomes and understand the potential for longer-term efficiencies, as well as societal and economic benefits.

Our Population Health Management solutions are designed to deliver tangible outcomes, offering a data-driven approach that empowers our clients to make informed decisions. Through our benchmarking, enhanced business cases, and targeted studies, we provide the tools needed to optimise resource allocation and prioritise interventions. Our goal is to transform healthcare systems, resulting in better health outcomes, reduced costs, and improved well-being for communities.

If you would like to find out more information on how Akeso can support you in delivering financial improvement schemes, please get in touch with Scott Healy, who leads our Financial Improvement offering.

 

References

[1] https://www.diabetes.org.uk/professionals/position-statements-reports/statistics

[2] https://www.theguardian.com/society/2022/may/19/more-than-42m-uk-adults-will-be-overweight-by-2040

[3] https://www.england.nhs.uk/2022/03/nhs-prevention-programme-cuts-chances-of-type-2-diabetes-for-thousands/#:~:text=Evidence%20has%20shown%20that%20the,effective%20in%20the%20long%2Dterm.

[4] https://www.frontier-economics.com/uk/en/news-and-articles/articles/article-i9130-the-annual-social-cost-of-obesity-in-the-uk/

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Andrew Paterson

Managing Partner
Insight

Financial Improvement Plans: Schemes to Target Outcomes

Home Performance Improvement Financial Improvement
Published Read Time 4 minutes

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

 

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Andrew Paterson

Managing Partner
Insight

Financial Improvement Plans: From Quick Wins to Strategic Programmes

Home Performance Improvement Financial Improvement
Published Read Time 2 minutes

As we progress towards medium-term pandemic recovery, there is a renewed focus from central government and NHSE on delivering greater efficiencies, whilst continuing to improve quality of care and patient outcomes. 

Unsurprisingly, Financial Improvement Plans remain a standing priority for NHS organisations, particularly in light of the recent NHSE announcement of up to 6% savings targets in FY23/24[1]. There is also additional pressure on ICBs to achieve financial balance, including those still carrying huge pre-pandemic deficits. 

In light of this, the challenge is to address, achieve, and exceed previous performance, whilst sustainably offsetting inflation in the context of ever-increasing service demands, an over-burdened workforce, and ageing infrastructure. 

Opportunities for Financial Improvement: ICBs and Collaboration

NHS leaders acknowledge that no single organisation can tackle the systemic and efficiency challenges facing the health and care sector alone[2]. Trusts and their system partners have been developing collaborative ways of working for several years as national policy has shifted away from competition to collaboration. However, workforce, funding, and investment barriers have been challenging to overcome.  With the formalisation of ICBs, there is now a real opportunity to tackle the financial challenges with a collective effort, whilst acknowledging collaborative programmes can take longer to deliver to benefits and savings. Areas of focus for ICBs should include:

Akeso’s Approach:

Our series on financial improvement plans for the NHS will look at pragmatic and tangible opportunities over differing time horizons and objectives, whilst also achieving clinical, operational, and patient benefits.

Quick-win, short-term initiatives can realise benefits within a year, and tactical savings within as little as 3 to 6 months. Medium-term schemes are designed to deliver between one to two years, and longer-term opportunities look two years and beyond, with some strategic programmes (e.g., system-wide estates planning) spanning over five years.

While cost reduction has become byword for relentless programmes of marginal gains, in the current environment organisations should a) take a holistic approach – managing cost pressures (including inflation) is arguably as important as identifying savings; and b) recognise that delivering better outcomes with the same resource has significant value.

The next article in our Financial Improvement series will provide further detail on the proven methodologies to deliver savings in the short- and medium-term. We will then set out how Population Health Management can support ICBs in the long-term.
For more details, please get in touch with Scott Healy, who leads our Financial Improvement offering.

References

[1] HSJ. ICSs get significantly harder savings target of 6pc. 2023. [online] Available at: https://www.hsj.co.uk/finance-and-efficiency/icss-get-significantly-harder-savings-target-of-6pc/7034819.article

[2] NHS Providers. 2022. [online] Available at: Making the most of the money: Efficiency and the long-term plan (nhsproviders.org)

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Andrew Paterson

Managing Partner
Insight

The status of virtual wards across England

Home Performance Improvement Financial Improvement
Published Read Time 5 minutes
Content

“Virtual wards” are a key initiative across health and social care to help keep people at home, or to get them back to their usual place of residence after a hospital spell. The issues of bed occupancy in acute trusts are well-known (see the figure below), as is the imperative to look after people well to prevent deterioration wherever possible and avoid a trip to hospital. The use of the name “ward”, therefore, is slightly misleading as it suggests hospital-type care whereas the gains are at least as great in admission avoidance and the maintenance of health.  The word “virtual” also has negative connotations (suggesting that care is less immediate or personal) but, for the purposes of this paper, we’ll use the current expression whilst appreciating its potential breadth of meaning.

 The idea is not new (it was first developed about 20 years ago) but the current interest from digital and technology providers, together with significant amounts of funding (£450m over the last 2 years), has led to their adoption accelerating over the last 2 years.  In principle, it has multiple benefits over the long term: 

  • It generates better outcomes for patients (being at home keeps people healthy and aids recovery, relative to being in an acute setting);  
  • It is a much better experience for patients, carers and clinicians (in general, people would prefer to be at home surrounded by family and familiar surroundings, knowing that you can access support as and when you need it) 
  • It makes better use of clinical resource (more attention in hospitals can be spent on those who need it), and is more financially efficient (the cost of running a virtual ward is much cheaper than that of a physical hospital ward). 

Through the Spring of 2023, Akeso conducted research across all trusts within England in order to understand how widespread the adoption of virtual wards has been and whether they are having the predicted impact.  In this first article, we present the current state of coverage across the country. 

Through the Spring of 2023, Akeso conducted research across all trusts within England in order to understand how widespread the adoption of virtual wards has been and whether they are having the predicted impact across all domains.  In this first article, we present the current state of coverage across the country. 

The rule of two-thirds

For completeness, all 240 trusts in England were invited to contribute to a survey which aimed to capture a snapshot of the state of the virtual ward programme across England.  These included large acute trusts (for which the relative share of potential virtual ward beds was large, given their catchment and coverage), specialist trusts, and community trusts.  The trusts were separated into 4 categories: category 1 trusts were the largest trusts in the country who, between them, would cover about 50% of all potential virtual ward beds1; categories 2-4 trusts had smaller proportions (approximately 30%, 15% and 5% respectively).   

Over 2 months, responses were received from over 160 – about 2/3rds of all trusts within England – which is sufficient to make projections about the overall state across the nation. 

Adoption: Encouragingly, every one of the category one trusts who responded said they had virtual ward pathways in place.  Perhaps more surprisingly, even 90% of the category 2-4 trusts who responded also indicated that they also have pathways in place.  There was no correlation between adoption and CQC rating – the adoption of virtual wards was similar across all four ratings categories. 

Coverage: Coverage: So, if almost everyone has some form of virtual ward offering, how significant is their capacity?  Our respondents between them have about 6,500 virtual ward beds open at the moment; and the average number of virtual ward beds available is 50-60 (the equivalent of a couple of physical wards). This number is likely to almost double by the end of 2023/24 (likely before Winter pressures hit) to a figure of nearly 11,000, as plans for the rest of the year are delivered.  If this figure were replicated across all trusts across the country, the number of virtual ward beds which will be open by the end of the year will hit nearly 15,000.  Progress is good and will continue to be positive, therefore, but it’s most likely that the total number of virtual ward beds open by the end of this year will fall significantly below NHS England target of 24,000 (which corresponds to about 40 beds per 100k head of population in England).  Again, the proportion is about 2/3rds.

Specialty representation: Building on the capacity analysis, what are the beds being used for.  Much of the existing literature on good virtual ward case studies points to a predominance of respiratory and cardio-vascular pathways.  The responses confirm this: of the 300+ pathways that were identified as being available across trusts which responded, the top three were indeed respiratory, general frailty, and cardiology.  Again, these made up about 2/3rds of all available pathways.  However, there were a total of 33 different pathways listed, including diagnostic and maternity pathways, which indicates the growing spread of virtual wards to very many clinical areas.  It is worth noting that, whilst surgery, cancer, paediatrics and women’s health were all represented, the majority of the pathways were related to medical specialties.

Technology: given the increased comfort with remote and digital technology platforms in facilitating clinical services, it was no surprise to find that there was a plethora of private technology companies who are assisting trusts of all sizes with the adoption of virtual wards. 13 different companies were named specifically, and often trusts were engaging multiple technology providers who delivered different pathways, depending on their clinical efficacy.   We think this is an under-representation of the range of technology providers who are involved – many smaller trusts listed large acute trusts as their partner and, thus, may not have been aware of the supporting technology provider.

Summary

Progress in the roll-out of virtual wards has been positive, with 15,000 such beds likely to be open by the end of the year.  The funding which has been made available has undoubtedly helped and it is very encouraging to see the range of different pathways which are represented.  As is the way with innovation and adoption, using local workforce to figure out what works locally leads to solutions which are likely to succeed – this is not a simple exercise in “plug-and-play” the latest digital between the EPR and iPhones.  Time, space and resources will continue to be needed so that learning is made and adoption sustained.   

In the long term, virtual wards have to show benefits for patients and carers (in terms of experience and health outcomes), staff (in terms of working conditions and job satisfaction) and efficiency in terms of use of capacity (both physical space and the valuable workforce).  At the moment, whilst beds are open, their occupancy is actually relatively low, and there is very little evidence that sustainable impact is being made – over time, it should be easy to see that admissions are falling, acute-based length of stay in decreasing, and that staff are being better used (and happier in their jobs).  For this to happen, there are a number of factors across six operating model domains which need to be in place.  Our next article in this series will dig deeper into a number of these to unearth further promising progress. 

We continue to work with NHS and partners alike to learn and spread best practice in virtual wards to improve services for patients, carers and staff alike. 

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Chris Robson

Chris Robson

Managing Partner
Insight

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

Home Performance Improvement Financial Improvement
Published Read Time 5 minutes

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

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

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

The key Estates and Facilities challenges Trusts are facing

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

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

Creating more effective estates graph

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

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

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

Developing an ICS model to address these challenges

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

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

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

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

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

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

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

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

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

Understanding the opportunities of an ICS

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

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

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

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

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

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

Guys and St Thomas Hospital
Case Study

Facilities Management Cost Reduction

Home Performance Improvement Financial Improvement
Published Read Time 2 minutes

Guy’s & St Thomas NHS Foundation Trust (GSTT) comprises two of London’s best known teaching hospitals, St Thomas’ Hospital and Guy’s Hospital, providing a full range of hospital services to the local community and specialist services nationally. GSTT is one of the largest Trusts in the UK with a turnover of almost £1.5bn and 15k staff, treating over 2.4m patients per year, including 88k inpatients, 103k day cases, 1.2m outpatients and 800k patients in community services.

GSTT operates a wholly owned subsidiary, Essentia, which provides Facilities Management (FM) for GSTT. Essentia was challenged to deliver cost savings, improve service quality and manage an aging asset base to maintain uptime through a blend of in-house and externally contracted services. Akeso were engaged by Essentia to complete a total cost review of the Hard Facilities Management service (Engineering and Building Maintenance) to identify near term and long-term cost reduction and operational efficiency opportunities in 3rd party spend and the internal service.

Insight

Essentia was challenged to deliver cost savings in addition to assuring service quality and maintaining an aging and diverse asset base, with very limited funds for investment. We brought a number of methodologies, tools and experiences to support the client through each stage of the project including a proven Opportunity Assessment approach, Capability Development (People & Organisation, Process and Systems) and Hard Facilities Management-relevant Category and Market Intelligence.

Action

In Phase 1, our consultants led the process to identify the value through benchmarking GSTT to peer Trusts in terms of scale/ size and location using latest Estates Return data from NHS Digital. We completed in depth reviews and analysis for a number of key product and service contracts with the client and incumbent providers to evaluate fulfilment of requirements and to develop strategies to improve performance and leverage benefits where suppliers were failing to meet performance standards. We then prepared a Board level recommendation for a Programme Delivery setting out a range of tactical and strategic options.

In Phase 2, we designed and led a joint Consultant:Client delivery program to implement the recommendations. We developed and ran multiple Tenders, which included soft supplier market engagement, the development of output based specifications and the design of contract models that would permit the involvement of local SME providers. We finally designed and costed a detailed process improvement plan to transform the end-to-end Hard FM Callout process handling 50k callouts per year.

Results

We established and mobilised a structured Trust-wide improvement programme which delivered savings and improvements across all areas of Engineering and Building Maintenance to improve customer service and regulatory compliance and reduce cost to serve.

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Scott Healy

Managing Partner