Insight

Accelerating Scan4Safety Agenda through Inventory Management Optimisation

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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If you would be interested to discuss how we can help you in this space, please get in touch with Olivia for an initial conversation (olivia.jeffery@akeso.co.uk).

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Olivia Jeffery

Olivia Jeffery

Manager
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 Study

Endoscopy Network Workforce Modelling

Working closely with Cheshire & Merseyside Endoscopy Network, Akeso have recently worked closely with the team to identify key opportunities to reduce increasing backlogs as part of the post Covid-19 planning, presenting a variety of scenarios to highlight the impact these options have on the end results

INSIGHT

As endoscopy services undergo recovery following redeployment of staff to respond to COVID-19, workforce requirements must be developed to provide a sustainable model and solution going forward, especially in order to tackle the elective care backlog. Opportunities of up to 20% capacity expansion through productivity measures were identified through effective utilisation of the ICS model, this further support a future-proofed endoscopy service through elective care recovery.

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
  • 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

The result of the developed network review, business cases, and dashboard defined ways of managing the backlog in endoscopy services, with a forecast reduction of 20% with the required investments and associated workforce forecasting requirements over the 5-years

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Peter Marshall

Peter Marshall

Associate Director
Case Study

ICS Procurement Collaborative

We supported the design, development, and implementation of a collaborative procurement function across North East London, including the delivery of over £1m in savings on non-pay spend, service specific ICS category strategies, and standardised processes

INSIGHT

North East London (NEL) are one of the largest integrated care systems across England, formed of five Trusts, with a total third-party, non-pay spend over £1.2bn.

Akeso were engaged to analyse this spend and deliver £1m in cost savings efficiencies through the collaborative model, in addition to designing a new operating model for procurement services, develop collaborative category strategies, and transform singular service provisions into integrated delivery models.

ACTION

  • Akeso developed an initial opportunity assessment analysing the ICS’s total £1.2bn non-pay spend (60% non-clinical products and services; 19% clinical products and services; and 21% on drugs)
  • From this, Akeso delivered a series of collaborative opportunity recommendations, which ranged from 3rd-party spend cost reduction initiatives to yield ‘hard’ benefits, to ‘softer’ service enhancement and capability development initiatives
  • We developed an overarching governance and reporting structure to track opportunities and value delivery and designed a detailed workstream and category management structure and supported value-delivery projects including; CIPs, procurement exercises, strategy design, and business case development across clinical products and services, estates and facilities, corporate services, and IT, data, and systems

RESULTS

Across the programme we developed and implementation a new collaborative operating model, including an overarching collaborative governance structure, delivered over £1m in collaborative annual savings, developed approved service specific business cases, consistent ways of working, processes, standardised templates, and the upskilling of NEL team members

NEL team

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Peter Marshall

Peter Marshall

Associate Director
Insight

Supporting Sustainability and Social Value in Estates and Facilities

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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Peter Marshall

Peter Marshall

Associate Director
Insight

How can systems integrate their estates and facilities services?

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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Peter Marshall

Peter Marshall

Associate Director
Insight

What now for NHS infrastructure

Hospital capital investment in the NHS is more important now than ever. Rundown buildings and the spiralling maintenance backlog, which is currently over £10bn, are putting patients at risk and stymying elective care recovery.

It has been well documented by a range of sources, including recent analysis by the HSJ, Financial Times, and Health Foundation, that the one of the core underlying problems facing the NHS is historic underinvestment in capital. This is evidenced by the current capital stock per worker being half that of most comparable health systems.

In the past weeks, much has been said about this ongoing infrastructure crisis. One element in particular which has demanded much media attention is the government’s New Hospitals Programme (NHP). This programme was responsible for delivering 40 new hospitals and rebuilds by 2030, described by the government ‘as the biggest hospital building programme in a generation’.

When the programme was launched in 2020, it was largely welcomed, notwithstanding the controversy around the definition and use of the word “new”. It seemed that after many years the need for a long-term capital investment strategy within the health service was being taken seriously. However, since then, progress with the programme has been slow.

Last week, the National Audit Office published a report analysing the problems faced by the NHP, principally whether the schemes could be delivered to time and to budget.

Whilst £20bn for the NHP had been committed, this is around £10bn less than what estimates require, many schemes due for completion by 2030 have been pushed back, and recently more than 120 bids from other providers for future schemes were rejected. The NAO report concluded that by the definition the government used in 2020, it will not now deliver 40 new hospitals by 2030.

The focus in this debate should not be on whether manifesto commitments have been delivered in the guise in which they were promised, but rather is there a serious, credible, and achievable plan for delivering new hospital infrastructure, which is fit for purpose, future-proofed, and clinically driven?

The answer to that question is currently unclear. From our engagement with hospital providers across the country, one of the underlying issues remains the same – accessing capital remains difficult and the business case sign-off process for capital investment is opaque, elongated, and inconsistent.

However, there is good news. Across a range of schemes, we have had recent success with NHS providers in delivering major capital projects, whether it be under the umbrella of the New Hospitals Programme or in the context of Elective Care Recovery.

For example, Akeso supported a major Trust in the North West successfully deliver an NHP-associated scheme through the Outline Business Case and Full Business Case process and in doing so managed to secure an additional £11m in funding on the original capital allowance. Building works are currently underway and the scheme is set to completed at the end of 2024.

Reflecting on the success of this project, Akeso have defined the following factors as being key for successful infrastructure projects and capital business cases:

  • Engage with regulators from day one and don’t stop – continual engagement with the relevant regulator is essential for the delivery of successful capital investment and infrastructure projects. The requirements of a HM-treasury compliant business case for a capital scheme can appear vast and complicated, however engagement with the regulator will clarify critical areas of focus for the project.
  • Balance the local with the national – it was announced that the NHP had been paused to explore means of standardisation from the centre, including the potential mandated use of standard layouts and repeatable rooms. Whilst efficiencies within the hospital building programme should be welcomed and encouraged, this should not negate the imperative for locally shaped hospital solutions. All hospital planning should be based on locally designed clinical models and services, in line with ICS planning and population health management.
  • Clinical model first, infrastructure design second – the first key milestone for the project should be the development of the right clinical model. Following agreement of this, a range of capital options should be scoped to deliver this model.
  • Don’t let the perfect be the enemy of the good – simply, the current biggest blocker to the NHP and wider infrastructure transformation is affordability. In the business case process, an options appraisal should evaluate all options available, particularly those which deliver the greatest degree of benefit. However, in the case of some schemes, a capital envelop has been committed. Where this is the case, the project should continue to explore all options available, but always ensure an option for the allocated value has been developed and not over stretched.

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.

References

  1. https://www.hsj.co.uk/daily-insight/dont-blame-the-treasury-the-nhss-capital-spending-system-is-a-mess/7034974.article
  2. https://www.nao.org.uk/reports/progress-with-the-new-hospital-programme/

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Peter Marshall

Peter Marshall

Associate Director
Insight

Financial Improvement: Targeting at ICB level through Population Health Management

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/

Contact our experts

Scott Healy

Scott Healy

Director
Insight

Akeso’s response to the NHS Workforce Plan: Translating national targets at a local level through productivity and retention

The highly anticipated NHS Workforce Plan was released last week, with many weighing in to give their assessment. The main themes of ‘train’, ‘retain’, and ‘reform’ have generally been well received but as with all grand plans, what matters now is execution.

Akeso highlights three key areas that will be instrumental in the successful execution of the ambitious plan.

The commitment to support recruitment across a wide range of healthcare roles is commendable – with a target of an additional 300,000 clinicians by 2036/2037, including 170,000 nurses and 60,000 doctors[1]. This is based on top-down national-level modelling to steer the strategy in the right direction.

To translate these targets, it is essential that ICBs and their regional partners develop their own local service plans. These plans must be founded on locally validated capacity and demand, informed by assumptions linked to innovative, technology-enabled workforce models.

This is a long-term plan to expand workforce and will require a productivity increase of up to 2% to fund new initiatives. [2]This investment will be needed if we are to realise the ambition of “delivering care closer to home while avoiding costly admissions, achieving operational excellence, and reducing administrative burden through better technology and infrastructure.’’ [3]Therefore, it is imperative ICBs and NHS organisations can deliver achievable Financial Improvement Plans, which depend on two main factors:

  • a sustainable investment in NHS estate and equipment
  • use of technology and digital innovation (with consideration for funding availability)

Perhaps the most challenging initiative is to retain staff, starting by making the NHS an attractive place to work. In 2022, the reported level of absence due to sickness was 5.6% (well above the public sector average), which equates to 27 million days across 2022 and 74,500 full-time equivalent staff.

Unsurprisingly, morale is also declining, with nearly a third of NHS staff thinking about leaving their organisation[4]. Further research on why this is the case is urgently needed but, in the meantime, immediate solutions to retain staff must be implemented.

However, the plan does little to address the elephant(s) in the room: pay, compensation and terms and conditions. The recent strikes by doctors and nurses highlight that significant progress is needed in these areas.

Equally important is attracting and retaining non-clinical roles, particularly in medical technology, to support use of artificial intelligence, robotics and automation diagnostic solutions and treatments to deliver improved, efficient and patient-focused care.

Read the full NHS Long Term Workforce Plan 2023 on NHS England’s website.

References

[1] NHS Long Term Workforce Plan (england.nhs.uk) – page 21

[2] NHS England » Record recruitment and reform to boost patient care under first NHS Long Term Workforce Plan

[3] https://htn.co.uk/2023/06/30/train-retain-reform-nhs-englands-workforce-plan-published/

[4] https://www.nhsemployers.org/articles/nhs-staff-survey-2022-analysis-results

 

Contact our experts

Peter Marshall

Peter Marshall

Associate Director
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

 

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Scott Healy

Scott Healy

Director
Insight

Financial Improvement Plans: From Quick Wins to Strategic Programmes

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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Scott Healy

Scott Healy

Director
Insight

The status of virtual wards across England

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 healthThe 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 domainsIn 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 deliveredIf 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 15,000Progress 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 forMuch of the existing literature on good virtual ward case studies points to a predominance of respiratory and cardio-vascular pathwaysThe 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 cardiologyAgain, these made up about 2/3rds of all available pathwaysHowever, 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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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
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

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Martin Shiderov

Martin Shiderov

Associate Director
Insight

Delivering improvements to discharge practices

At Akeso, we are extremely saddened by the current healthcare crisis caused by the unprecedented NHS capacity constraints which is threatening the lives of so many of us this winter.

According to the latest discussions at No10, the Government’s response to this challenge is an improved discharge to medically fit patients that is enabled by solutions such as virtual wards.

Although programmes such as discharge to assess (D2A) and virtual wards are not new, we welcome the recognition that doing the same but (slightly) better is not going to solve the problem this winter, or in fact any winter going forward.

According to the NHS, there are 12,809 patients fit for discharge who are occupying beds which could be available to save lives. In an analysis by HSJ, 7,000 virtual ward beds exist, but only half of them are occupied.

So, what is causing this disconnect and why aren’t virtual wards that are in place delivering results?

We believe that the system is struggling with uptake due to the lack of mechanisms that offer a partnership platform between healthcare professionals, who must continue to care for patients uninterruptedly, and specialist partners that can facilitate discharge programmes and implement functional virtual wards.

Akeso can offer such a mechanism and work with Trusts to deliver improvements to discharge practices and implement technology enable virtual wards. We can enable this by offering:

  • Demand and capacity analysis to enable care pathway remodelling.
  • Workforce optimisation and empowerment to support discharge and remote care.
  • Project management to ensure programmes and solutions offer evidenced results.
  • Comprehensive guide and methodology which takes a Trust ‘step-by-step’ through business case, implementation, effective management and scaling of virtual wards.

A medically graded virtual ward technology which offers proven discharge results by reducing length of stay of medically fit patients.

We are here to talk and help Trusts and ICSs with a free assessment and actionable plan that can offer results right now!

Together with HSJ and Masimo we’ll be hosting a roundtable which will focus on Virtual Wards and Discharge in March. Watch this space for updates!

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

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Martin Shiderov

Martin Shiderov

Associate Director
Insight

Discharge to Assess: Where the rubber hits the road

There are seven key steps to generating traction and improving the discharge-to-assess pathways. These are a mix of technical development in respect of discharge-to-assess (such as the establishment of agreed patient strata) and the generic challenges of change management (such as engagement, communication, and skills building). The first 3 phases (which are the planning phases) will be broadly sequential but the delivery phases can be run in parallel, as the figure below indicates:

  1. Establish a core guiding coalition: build a small group with representation from the acute, community, and social care teams who will act as the core accountable team.  This team will guide the program to ensure time and resources are well spent.
  2. Understand where you are and why, in order to build the local case for change, including:
    1. Maturity model completion:  complete the self-assessment complete the self-assessment of the Akeso discharge-to-assess maturity model to show where the current system is already fit-for-purpose and where changes need to be made
    2. Internal analysis on “no right to reside” and other key metrics (such as risk adjected length of stay, and elective and cancer waitlist variation) to give additional local relevance
  3. Define the overall model of discharge-to-assess which best suits your location, given the NHS England guidance, known exemplar case studies, and the results from the maturity assessment, including:
    1. Patient stratification: be clear on which patients fall under the category of relevant for discharge-to-assess and how/when they are highlighted
    2. Workforce models: with community and social care partners, develop a sustainable workforce model which meets local population health needs and is achievable with local resources
    3. High-level process: agree what the high-level discharge-to-assess process is which balances discharge efficacy with clinical risk
    4. Technology aspirations: be clear on where technology will help (with both current and potential future systems)
  4. Launch the program of change: take the time to engage with a broad range of stakeholders to lay out the overall aims of the discharge-to-assess program and how it contributes to the aims of the organisation, including:
    1. Vision expected outcomes, and expected timelines: establish what success looks like from an outcome perspective (for example, number of patients remaining in the acute setting with no right to reside; 7-day re-admission rate
    2. Leadership team & resource: ensure that there is sufficient resource ring-fenced to deliver and manage the work, and that senior leaders are actively supportive
    3. Govern and track effectively: embed discharge-to-assess governance within the existing board and directorate mechanisms to ensure its visibility
    4. Communicate plans and progress
      Healthcare team working
    5. Establish portfolio of work: the maturity matrix and case study examples will suggest a wide range of work to be done. It’s important that any portfolio and phasing is chosen which reflects the need and resources available, including:
      1. Pilot and refine: choose 1-2 specific patient groups or services on which to pilot the design where there is both a clear need and support for discharge-to-assess; learn from these pilots and moderate the initial designs as necessary and remember that “getting it right first time” doesn’t apply in this situation! Learning and adapting is part of the process. To aid this, you may want to instigate regular learning cycles (such as Plan-Do-Study-Act) and daily management meetings
      2. Embed and roll-out: broaden the scope of patients and services for whom discharge-to-assess is available, building on the learnings from the pilots (in 1 or 2 further phases)
      3. Business case development: when investment is necessary, put together a robust business case (using recognised approaches such as the HM Treasury 5-case model)N.B. when engaging in technology-driven change, it is very important to ensure that practices are “digital-ready” before they become digitised so take the time to improve ways of working before the technology is available. It is value destroying to embed poor current practice within a new system. Many organisations, therefore, go through two phases of transformation: pre-tech and post-tech availability
    6. Train, support and reward those involved in delivering this new way of working. The pilots will establish local standard methods and learnings. These should be documented and shared with groups involved in subsequent phases of roll-out. The pioneers who drive the change should be given the reward and profile that it deserves.
    7. Communication progress, learnings, and successes, including regular broad updates and particular highlights. Appreciation of the efforts of everyone involved could be included within monthly and annual recognition systems. 

Keeping people healthy and returning them to their usual home after a hospital spell is a key ambition for all those involved in health and social care. There is an even greater imperative to do so given the pressures on the system now (be they workforce, elective backlog or capacity constraints). Discharge-to-assess, enabled by technology is one of the ways in which we can work together to ease this problem. Many organisations are already making this work. We hope that these four articles can encourage more progress for the benefit of citizens and health and social care workers alike.

For a free Discharge-to-assess consultation, please contact us for an initial conversation with our consultants.

Insight

I’m a patient get me out of here

As the first article in this series highlighted, too many people are spending too long in an acute setting, well beyond the point of clinical need.  One in six beds in these hospitals are occupied by patients who would be much better served in their usual place of residence. 

Furthermore, with an elective backlog of almost seven million, one in eight people across England are currently waiting for operations and other types of care, and ambulance response times are at an all-time worse. Unprecedented operational challenges are anticipated for the winter period.

Therefore, it is imperative that post-discharge short-term health and care services increase in capacity, improve in quality and effectiveness, and can support system flow for both urgent and emergency care and elective recovery. Indeed, the new Prime Minister Rishi Sunak has made tackling delayed discharges a key priority and ensuring there is an available workforce in the community to deliver timely care.

To support the safe and timely discharge of patients from hospital and to ensure that people continue to receive the care and support they need after they leave, a wide range of supportive material has been produced grounded in research and practical learnings of existing Discharge to Assess (D2A) models.  The Department of Health and Social Care (DHSC), Local Government Association and the Association of Directors of Adult Social Services (ADASS) have all released guidance for organisations and local systems on implementing best practice Discharge to Assess and community support. These include:

  • Managing transfers of care – A High Impact Change model: Local Government Association (2020)
  • Hospital discharge and community support guidance: Department of Health and Social Care (2022)
  • Quick Guide: Discharge to Assess:  ADASS (2021)

The most recent guidance was outlined in July 2022 by The National Health and Social Care Discharge Taskforce. Based on their learnings from NHS and Social Care pilots, 10 best practice initiatives have been identified. 100-day discharge challenge – Improvement – NHS Transformation Directorate (england.nhs.uk).

Maturity Matrix

From the various national guidelines, alongside discussions working with a number of organisations and systems around D2A, Akeso has developed a D2A and community support maturity matrix. This helps organisations (for example, acute trusts, local authorities and ICSs) to understand what needs to be in place for D2A to work well.  There are 36 factors across 7 different domains which all need to be in place,

The 7 domains, as part of a high-level D2A operating system are set out below:

Figure 1 – D2A operating system
Figure 1 D2A operating system

Key ‘essential’ D2A priorities we recommend organisations focus on, which can be delivered in a phased approach to implementation include:

  • Short term (0-2 months) Discharge Planning: Setting up consistent processes, ensuring early multi-disciplinary engagement and planning for discharge on admission.  This is something that organisations could be progression before winter.
  • Medium/longer term (2-6+) Integrated Team Working: Potentially has the biggest impact for patients and covers 25% of D2A best practice initiatives.  Includes systems optimising workforce capacity acute, community and social care settings, for example from joint team working and a pooled workforce
  • Medium/Longer term (2-6months+): Virtual Wards:  Implementation of a tech enabled virtual ward, would require the appropriate infrastructure, funding and resources to be in place, which has shown to improve patient experience and nursing and clinical workforce productivity

As set out in the D2A operating model, D2A priorities would need to be underpinned by robust leadership and governance, and vitally, the appropriate D2A system-wide culture.

Using this framework, we have also developed a more detailed assessment matrix which allows any organisation to assess their current level of maturity against these factors. Details of what “best practice” looks like across these different factors are shown below.

D2A and Community Support leading practice

Table 1: D2A and Community Support leading practice
Table 1: D2A and Community Support leading practice (text in blue represents the 10 best-practice D2A initiatives identified by the Health and Social Care Taskforce).

We recommend that, as an organisation continues to develop its D2A capability, it uses this D2A maturity matrix to inform the programme of work that is required.  To request Akeso’s D2A maturity matrix, and if your organisation requires any support in implementing D2A best practice initiatives, please contact Mike Meredith.

In addition, based on the D2A maturity matrix, Akeso have put together a short D2A survey for D2A leaders, Organisations and system leaders.  Organisations and systems completing the survey will receive a tailored benchmarking report against their peers.

The next article in this series will focus on how technical innovations, for example tech enabled virtual wards, can improve patient experience and discharge effectiveness, followed by a D2A implementation guide.

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Martin Shiderov

Martin Shiderov

Associate Director
Insight

Discharge to Assess: What You Need to Know

When the new Health Secretary, Therese Coffey, was appointed she detailed her priorities for the NHS. These were A, B, C, D, or in other words, ambulances, backlogs, care, and doctors and dentists.

Critical to the current challenges facing the health system is the ability to create and ensure bed capacity. Currently, one out of every six beds are taken up by a patient who no longer requires it. Furthermore, without this bed capacity, it will be impossible to deliver the ambitions of NHS England’s CEO Amanda Pritchard’s around recovery, reform, resilience, and respect (her “4 Rs”).

With an elective backlog of almost seven million, one in eight people across England are currently waiting for operations and other types of care, and ambulance response times at an all-time worse. Unprecedented operational challenges are anticipated for the winter period.

One of the Government’s responses to this problem is the new Discharge to Assess (D2A) programme. This aims to discharge a greater proportion of patients when they no longer require the direct support of an acute bed. They may require further care but can have their longer-term care and support needs undertaken in a more appropriate setting. Four pathways have been established within this D2A programme. They are summarised below.

Overview Discharge to access model
Figure 1 – Overview Discharge to access model

As in any production flow environment, effective and efficient flow of D2A requires a balance of push and pull on the Hospital and Local Care Organisations respectively.

Discharge Performance

Reasons Behind Delayed Transfers of Care

Before looking to implement solutions to enable the D2A programme, it is imperative to understand the current and historic blockers to discharge. Analysis of delayed transfers of care data highlights these blockers as well as historic performance. Since 2010, there has been a 75% increase discharge delays measured by the increase in volume of additional hospital days resulting from delayed transfers of care.

Figure 2: Delayed transfers of care in hospital days by cause since 2010/11
Figure 2: Delayed transfers of care in hospital days by cause since 2010/11

Due to COVID, and the subsequent operational pressures, DTOC data is no longer published by NHS Digital. In 2019/20, there were 1,600,000 additional hospital days generated by delayed transfers of care.

The most common reason for these delays was the lack of capacity within the residential or nursing care home setting (ARNHP) accounting for a quarter of all delays. The two next greatest discharge blockers were the need to wait for a care package (ACP, 21%) and the need to wait for further non-acute care (AFNAC, 18%). Both of these blockers can be theoretically readily addressed by the discharge to assess programme. However, the ability for systems to combat the greatest blocker, a lack of capacity within the residential or nursing care home setting, in regard to D2A programmes should be carefully considered.

Current Discharge Performance

National data shows that current discharge performance across England varies widely and is significantly below NHSE’s target of discharging half of those with no right to reside, with an average discharge performance rate of 43%.[2] This equates to almost 3,000,000 instances over nine months where a patient was eligible for a discharge but remained in hospital. Or, in other words, 12,000 patients everyday remain in hospital when they should be discharged.

Figure 3: Regional discharge performance overview, from Nov-21 to Jul-22
Figure 3: Regional discharge performance overview, from Nov-21 to Jul-22

Furthermore, London is the only region achieving a discharge rate of half of patients who are eligible at 53%. All other regions are below this threshold. The South West and North West regions have both been operating at an average discharge rate of 34%. In fact, London is the only region performing stronger now than in winter 2021.

Analysis at an ICB-level portrays a similar message; performance is widely variable. On one hand, the highest performing ICS, Northumberland, Tyne, and Wear achieved an average discharge of 73%, whereas the lowest performing ICS, Birmingham and Solihull, achieved 17%.

Only 14 of the 44 ICS’s achieved an average performance rate of above 50% (full details of discharge performance by ICS can be seen within the appendix). Moreover, the South West region were the only region not to have an ICS currently meeting this target.

Figure 4: Average discharge performance by ICS and region based on percentage discharged of eligible patients, from Nov-21 to Jul-22
Figure 4: Average discharge performance by ICS and region based on percentage discharged of eligible patients, from Nov-21 to Jul-22

We further analysed discharge performance in terms of acute trust type which identified no significant trend. With exception for multi specialist trusts, performance follows the same profile. Regarding the scale or of Trust, suggesting that the economies of scale for large acute trusts, or the localised focus of smaller trusts, are not factors in discharge performance.

Figure 5 - Discharge perf
Figure 5: Discharge performance by acute trust type based on percentage discharged of eligible patients, from Nov-21 to Jul-22 (week 54 corresponds to 26/12/21 to 01/01/22

When looked at Trust level, there is again wide performance variation. The top-5 performing Trusts average ~78% discharge performance, whereas the bottom-5 Trusts average ~16%.

Figure 6: Discharge performance of the top and bottom-5 trusts, from Nov-21 to Jul-22
Figure 6: Discharge performance of the top and bottom-5 trusts, from Nov-21 to Jul-22

Responding to the discharge problem

Analysing the top and bottom-5 trusts in greater detail, it is apparent that Trust from all regions and types feature at both ends of the spectrum. The question, therefore, is what does this tell us about how providers can better respond to their discharge problems?

In answering this question, it is important to acknowledge that the analysis clearly points to this issue being universal. That is to say that discharge performance is not seemingly affected by geography, locality, Trust type or provision, or indeed by system, evidenced by wide ranging variation with ICS’s. The responses to the problem can therefore not be generic in line with the above factors. They must be organisational specific, in line with providers individual caseloads, models of care, and local leadership.

Appendix: D2A Performance by ICB
Appendix: D2A Performance by ICB

Various supportive materials, based on research and practical learnings from existing discharge-to-assess models, have been produced to encourage the adoption of discharge-to-assess principles in health and social care settings, in an effort to reduce the number of patients in acute settings with no right to stay.

All of this material has been summarized by Akeso into one useful framework. The next article in this series will focus on this framework designed to help ICSs and other organizations better understand what D2A requires in order to be successful.

References

[1] Akeso analysis of NHSE reported Delayed Transfers of Care, 2010-11 to 2019-20 – Number of Delayed Days during the reporting period, Acute and Non-Acute, for NHS Organisations in England by the type of care that the patient was receiving. https://www.england.nhs.uk/statistics/statistical-work-areas/delayed-transfers-of-care/delayed-transfers-of-care-data-2019-20/

[2] Akeso analysis of NHSE reported Covid-19 Daily Discharge Situation Report – All patients for 29 November 2021 – 30 July 2022. This data contains all inpatients 18 and over, including critical care and COVID-19 positive patients, but excluding paediatrics, maternity, and deceased patients. This includes data for acute trusts with a type 1 A&E department. Mental Health Trusts, specialised Trusts (including Children’s and Women’s Trusts) are not in scope of this collection.

Insight

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

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.

Scan4Saftey Programme
Case Study

Implementation of a Trust-wide Inventory Management System and Scan4Saftey programme

Akeso & Co supported Homerton University Hospital Foundation Trust (HUHFT) in the design and implementation of a Scan4Safety Programme and Inventory Management System (IMS). Captured in a detailed business case, the initiative is set to drive significant operational efficiencies and improvements to patient safety and care.

Akeso - Homerton Case Study - Healthcare Consultancy

Challenge

Homerton University Hospital Foundation Trust (HUHFT) is a major NHS provider of acute care in the London Borough of Hackney. With services spanning 75 locations across East London, including approximately 450 beds, 11 wards, three day-surgery theatres and six main operating theatres, HUHFT has a complex set of services and supporting supply chain.

Following a thorough opportunity assessment, a number of challenges were identified with regards to the current operations, accumulating in clinical time wasted, health and safety risks, as well as opportunities for cost improvements.

Some of the key challenges identified include:

  • Inefficient and inconsistent supply chain processes across wards and departments
  • Lack of visibility and control of inventory levels due to limited reporting capabilities
  • Segmented spending on products and consumables across wards and departments
  • Limited traceability of theatre implants through the supply chain to procedure due to manual processes
  • Strained working relationships between clinical and material management staff

Solution

To address the challenges identified, the project recommended HUHFT would benefit significantly from a Trust-wide IMS to improve inventory management and achieve patient-level costing. We supported HUHFT through a three-phased approach from business case development through to successful implementation.

Phase 1) Secure investment through a robust business case

With the support of key HUHFT clinical and operational stakeholders, we developed a compelling business case and secured the required backing to proceed to procurement. Through a detailed appraisal of the potential qualitative and quantitative benefits and risks, it was identified that implementation of a trust-wide IMS could deliver £1.4m in benefits over the next five years, from an initial £469k one-time investment.

Phase 2) Source and partner with the optimal provider

Following a route to market assessment, we facilitated a phased procurement process through a formalised ‘mini-competition’ to assist the Trust in their rigorous selection of a suitable IMS provider. Through taking this approach, we were able to secure an optimal solution balancing system capability and total five-year cost.

Phase 3) Implementation through rigorous PMO and change management

We project managed the implementation of the new IMS and change management of associated processes encompassed within the Scan4Safety programme, reporting to the patient safety board. From the outset, programme governance was implemented to ensure the new system and its related benefits were achievable and sustainable.  This involved the recruitment and setup of a programme board of Trust directors, and the chairing of regular meetings and presenting programme updates at Trust-wide Scan4Safety engagement sessions.

Results

The full benefits of the IMS solution will be seen during the next five years but it is already delivering significant savings and process improvements.

The one-time investments equating to £469,000 and subsequent improved processes is expected to generate £1.4m in cost savings, including:

Akeso - Homerton Case Study - Results

In addition to the projected quantitative benefits, implementation of a Trust-wide IMS is also expected to deliver number of qualitative benefits, including:

  • A reduction in the likelihood of ‘never events’ thanks to the patient level costing functionality which improves the traceability of implants, surgical instruments and medical equipment.
  • The release of up to six clinical WTEs, allowing them to re-focus on patient facing activities.
  • Automated processes, such as Barcode-driven ordering, that drive efficiencies in areas including procurement and recall.
  • Additional management information insights that enabled further efficiencies.
  • Increased clinical confidence in supply chain processes.
  • Compliance with GS1 and Scan4Safety.

What is next for HUHFT?

Following the success of the IMS and Scan4Safety pilot programme, HUHFT will continue to drive adoption of Scan4Safety to extended use cases, including potentially Blood Transfusion Scanning, Pathology samples, eMedicine, and many more.

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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