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:
Olivia is an experienced consultant in the private and public healthcare sector specialised in delivering tangible benefits to supply chain operations and strategic sourcing. Prior to joining Akeso, Olivia worked in the FMCG sector developing innovative products for global and market-leading healthcare brands.
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
Chris has spent almost 25 years working in the commercial and operations space, in both private and public sector across the automotive, financial services, telecoms, energy and healthcare sectors.
As a Managing Partner and co-founder of Akeso, Chris is passionate about the value that can be realised when an organisation takes a fresh look at how it can enhance the quality and cost efficiency of the services and products it delivers by leveraging third-party led innovation, technology and solutions and has worked collaboratively with many providers and suppliers to the Health & Care sectors in the UK and internationally to realise this objective.
Outside of work Chris enjoys spending time with family, watching Arsenal, running and doing DIY projects.
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.
[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.
Andrew is a results-driven transformation leader with experience spanning strategic planning, operational efficiency, and transformative change management for leading healthcare organisations in both the private and public sector.
After leaving the NHS, he spent 15 years with EY’s Consulting practice, overseeing large and strategically significant client projects across the health sector at front-line, regional and national level.
Akeso were engaged by a London ICS to provide programme management expertise for an NHS national pilot programme supporting the delivery of an Electronic Eyecare Referral System between community optometry and secondary care ophthalmology.
INSIGHT
The Electronic Eyecare Referral System (EeRS) pilot, jointly commissioned by NHS England and NHS Improvement and NHS in November 2020 was a pilot programme that sought to achieve:
Electronic referral management between primary and secondary care
The ability to share complex diagnostic images (e.g., Optical Coherence Tomography Scan (OCT scan)
ACTIONS
With eERS being procured and managed on a regional basis, Akeso were engaged by a London ICS to support the roll-out of eERS within the region. The Akeso project team were responsible for standing up the programme management, maintaining oversight of the budget, supplier and contract compliance, and working with a diverse stakeholder group from independent, private and NHS sectors.
With 6 workstreams including Information Governance, Communications, Clinical Safety, Digital Integration, Commissioning and Evaluation, Akeso ensured the project progressed to timeline, with the London region being a national exemplar, with the highest level of optometry engagement as well as being first-movers in implementing a technical integration into secondary care and resolving IG issues.
RESULTS
Owing to Akeso’s programme management support, the proof-of-concept eERS programme in London was evaluated at the end of Year 1, with a board approval to continue due to its success. Following a period of transfer, Akeso then upskilled the existing internal team to deliver the programme.
Olivia is an experienced consultant in the private and public healthcare sector specialised in delivering tangible benefits to supply chain operations and strategic sourcing. Prior to joining Akeso, Olivia worked in the FMCG sector developing innovative products for global and market-leading healthcare brands.
Akeso supported NHSE SW to design and procure a regional CDC service for the South West, built in partnership with the independent sector. Key aspects of our support spanned Commercial Model & Business Case development as well as the full end-to-end procurement delivery to secure the provider partner.
INSIGHT
Driven by the recommendations of Professor Sir Mike Richards’ report, Diagnostics: Recovery and Renewal, NHS England South-West (NHSE SW) engaged Akeso as an operational delivery partner to support in the regional roll-out of Community Diagnostic Centres, in partnership with the Independent Sector. The programme aimed to rapidly expand capacity and transform diagnostic provision for the local populations across the seven ICS systems, whilst maintaining ownership of the service.
ACTION
Through our deep understanding of the community diagnostic landscape and procurement expertise, our delivery team supported NHSE SW in the following:
Commercial Model: Akeso developed critical CDC-related business, organisational and operational requirement solutions from the perspective of an “intelligent customer” in order to secure best value-for-money. These included development of optimal clinical service model, integrated workforce strategy, approach to integration of diagnostic technology and digital connectivity with local healthcare providers and an appropriate financial model.
Procurement Preparations & Delivery: Akeso managed the end-to-end procurement strategy including facilitation of supply market engagement, development of service specification defining key requirements and mapping CDC processes based on programme vision and objectives, ICS demographic and patient needs and delivered a full and compliant procurement tender and contract award process.
RESULTS
Akeso successfully developed the Commercial Model and procured the Independent Sector provider to form the foundations for joint service delivery with NHS across a ten-year fixed CDC site contract and three-year mobile CDC site contract, with a total worth of £250 million.
Jake is an experienced manager who has worked with Akeso for over 5 years. In that time, he has accrued significant experience in the healthcare supply chain and operations space working with numerous clients across multiple disciplines of projects.
Jake has comfortably led long-term engagements with senior project teams within both the public and private sector, working closely to ensure successful project deliveries with multiple workstreams delivering significant value for his clients.
Prior to joining Akeso, Jake worked for a prestigious Investment Banking firm where he developed strong project operations and risk management skills.
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:
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
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
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
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.
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.
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.
Adam has 18 years’ experience as a healthcare consultant, delivering change and transformation in the UK and overseas, with a focus on delivering improved productivity and efficiency. He has previously led healthcare consultancy teams at NECS CSU and Deloitte.
He has held a number of senior NHS positions with large London providers and with Monitor/NHS Improvement, and has served as a Non-Executive Director and as Chair with a number of local health and social care-focused charities.
Adam is a Chartered Management Accountant and a Prince2, MSP and Green Book Practitioner.
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:
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.
Understand where you are and why, in order to build the local case for change, including:
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
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
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:
Patient stratification: be clear on which patients fall under the category of relevant for discharge-to-assess and how/when they are highlighted
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
High-level process: agree what the high-level discharge-to-assess process is which balances discharge efficacy with clinical risk
Technology aspirations: be clear on where technology will help (with both current and potential future systems)
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:
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
Leadership team & resource: ensure that there is sufficient resource ring-fenced to deliver and manage the work, and that senior leaders are actively supportive
Govern and track effectively: embed discharge-to-assess governance within the existing board and directorate mechanisms to ensure its visibility
Communicate plans and progress
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:
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
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)
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
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.
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.
How hospital grade remote monitoring technology can enable the delivery of high-impact patient outcomes.
Technology-enabled Virtual Wards have arrived, are you ready?
The NHS must establish 24,000 Virtual Ward beds by December 2023 to support a targeted increase of 30% in elective care procedures by 2025. The delivery of effective ‘in-hospital’ patient care depends on reliable communication, monitoring, and alerts. Maintaining this level of care efficiently and effectively in a Virtual Ward, outside of the hospital, requires reliable, trusted, proven and privacy-compliant solutions for timely detection, prevention, and treatment. Masimo SafetyNet® is a Digital Health platform from Masimo, whose innovative monitoring products have been in use across the NHS for over 15 years, with a proven track record of success.
Masimo SafetyNet is an example of Virtual Ward enabling technology
For Patients: Technology-enabled Virtual Wards help assure higher-acuity patients that they remain under the watchful eye of clinicians even following discharge to their own home.
For Acute Care Providers: Masimo SafetyNet offers advanced automation features so institutions can more easily deploy home monitoring, track patient compliance, identify when intervention may be required, and prioritise patient needs whilst maintaining the ability to scale up to meet patient demand.
For NHS Leaders: Masimo SafetyNet is an effective, easily deployed turnkey solution designed to address the challenge of rapidly establishing and operating Virtual Wards whilst optimising use of clinical resources.
For an average sized2 NHS Trust, a robust technology-enabled Virtual Ward could…
The above figures are estimates, for further detail on inputs for the analysis, please see the references below 3, 4.
Masimo offers an end-to-end approach to help NHS providers implement Virtual Wards with the Masimo SafetyNet app currently available at no charge for NHS Trusts.
Deployment launched across the NHS; contact Masimo to activate your site!
Akeso & Co have supported Tanner Pharma Group UK’s (TPGUK) successful delivery of over 300m units of lateral flow devices (LFDs) to the U.K. Health Security Agency (UKHSA) since October 2021.
Insight
The Coronavirus (COVID-19) Pandemic was an unprecedented global crisis that challenged the limits of Healthcare systems around the world. A nation’s testing ability represented the most effective way to monitor and limit the spread of COVID-19 whilst also navigating the imminent threat of a nationwide lockdown. Throughout the pandemic, TPGUK have been a key supplier of self-test LFDs to the U.K. Government via the UKHSA.
TPGUK were contracted by the UKHSA in October 2021 to supply LFDs through an intricate and complex global supply chain. Combined with the emergence of the Omicron variant and in the lead up to winter 2021, the project rapidly escalated in scale and scope. We, as supply chain and procurement experts, were contracted to support and oversee all elements of the logistics and delivery process.
Some of the key challenges identified included:
Planning the delivery schedule based on manufacturing capacity in China;
Identifying and managing the flight booking process;
Responding to the rapid escalation of demand for LFDs because of the Omicron variant and winter pressures; and
Monitoring the overall logistics schedule.
Action
Our first priority was to understand manufacturing capacity which would ultimately dictate the delivery schedule. We had numerous meetings with manufacturing partners in China to review their production capacity and plan the downstream deliveries accordingly. Additionally, we developed a flight tracker to balance flights booked against production capacity. In this way, we ensured cost effective utilisation of flights, while also maximising the capacity to inbound LFDs into the U.K. at a time of increased demand.
Initial support regarding logistics tracking and planning progressed to overall management and integration with flight planning elements. We led stakeholder engagement and management through the daily operations review calls schedule with Kuehne and Nagel (TPGUK’s logistics sub-contractor) and twice weekly contract progress report updates to UKHSA.
Results
We were able to support the process and delivery of over 300m LFDs to the UKHSA when there was greatest need for them. This involved the operation of over 150 flights via 27 different routes involving 13 Chinese and 10 U.K airports over four months.
We ensured that the pace of project delivery matched that of the project escalation, while reacting to numerous challenges that threatened to delay or derail the rate of delivery. The efficiency improvements from the development flight tracker meant that we were able to leverage our expertise more effectively. This helped to mitigate risk, minimise financial waste and ensure delivery KPIs were met.
In February 2022, UKHSA announced that TPGUK would continue to supply LFDs as the COVID-19 Pandemic progresses toward endemic status. Having recognised and implemented several improved ways of working, we have been able to further support TPGUK in their most recent purchase order delivery while achieving some key savings. With logistic operations simplification and improved planning, we delivered a relative reduction of 28% in flight costs, a 33% damage rate reduction and a 40% relative reduction in storage charges.
Scott has dedicated his career to performance improvement in healthcare and life sciences working both within a multinational consulting firm, and for the last decade as a co-founder of Akeso.
As a Managing Partner of the company, he has led the development of Akeso as an established boutique consultancy committed to improvement in UK health. His project specialisms and areas of interest are systemwide performance improvement, the national and international healthcare supply chain and the use of data to drive tangible and actionable improvement insights.
His approach is flexible, warm and fact-based and he is proud to have delivered numerous collaborative/ICS projects being able to engage positively across multiple stakeholders, specialisms and styles to achieve outcomes around aligned goals.
Outside of work his passions are almost all sports (mainly watching nowadays although can be found trying to find his wayward golf balls in the woods / long grass / water) and spending time with family, including Rump the cocker spaniel who is also the honorary office dog.
As recent headlines have highlighted, the NHS backlog in routine operations and procedures has reached worrying heights during the pandemic. Data from NHS England shows that currently more than 5 million people in England are waiting for hospital treatment, with 3.63 million fewer elective surgeries carried out between April 2020 and May 2021. Meeting this backlog of care is going to be one of the key challenges for Trusts across the country over the coming months.
To achieve this, every element of a Trust’s service needs to be operating as effectively and efficiently as possible. One critical area that is often overlooked is decontamination and sterilisation services. Without effective surgical instrument sterilisation, even basic procedures cannot be carried out.
This insights article looks at some of the problems Trusts face when it comes to providing sterile services and how they can be addressed within integrated care systems (ICS) in a post-COVID world.
The current SSD landscape
There are more than 3,000 NHS hospital theatres across England, carrying out 10 million theatre operations each year, all of which are supported by sterile service departments at an estimated annual running cost of more than £200m.
Typically, sterile services are provided on-site on a Trust-by-Trust basis and are co-located adjacent to Theatres. The size and scope of this service provision is contingent upon both volume and type of a Trust’s elective caseload. The graphic below shows how this £200m spend breaks down by region and ICS, with percentages representing the proportion spent by each ICS within a region.
Figure 1 – ICS annual spend on sterile services across England by region
Disparities across NHS Trusts’ Sterile Services
Given the scale of these services, some variation in service performance and delivery is expected. However, digging deeper into NHS Digital data, Akeso & Co found significant disparities across Trusts that need to be addressed.
In fact, the total annual spend on sterile services per ICS, varies extensively in relation to the number of theatres in a Trust and the floorspace their sterile service department takes up. These variations are outlined in the graphic below which plots ICS spending driven by surgical activity and case type, against number of theatres and SSD floorspace.
Figure 2 – Unwarranted variation in sterile services performance in England, shown by the total annual spend of STPs/ICSs compared to the number of theatres and SSD floorspace (sqm)
There is significant variation in spend on sterile services by ICS and Trusts when accounting for a hospital’s number of theatres, volume and scope of surgical activity, and unit size. One major cause of this unwarranted variation, highlighted above, is the varying age and condition of sterilisation equipment and assets.
Because the service is capital intensive, with high-value complex assets and costly support facilities, this commonly results in the assets operating beyond their lifespan. Inevitably, this leads to high levels of breakdown, maintenance costs and downtime which impacts a theatre’s ability to operate. In a capital-limited environment, most Trusts do not have the funds to upgrade their sterilisation assets to a standard which would be optimal and compliant.
However, where there is variation in service performance and efficiency, and an increasing backlog of demand, there are clear opportunities for Trusts to improve how they run these services. Trusts should welcome the challenge of further ICS integration as a means of combatting these issues. This will also enable them to redefine operational processes within the entire peri-operative value chain, embrace novel technologies and explore a variety of commercial models.
Addressing the challenges
How Trusts transform sterilisation services to reduce inefficiencies and unwarranted variation will depend on a number of determining factors specific to each Trust. Addressing each one will enable Trusts to create efficient sterile services that allow theatres to function as effectively as possible, as they tackle the backlog of cases caused by Covid-19. Moreover, in reshaping the provision of sterile services, Trusts also have the opportunity to better manage their equipment and explore how they can optimise their floorspace, not least in the context of required theatre expansion programmes, where floorspace is at a premium.
We have identified several factors that will influence a Trust’s decisions, including:
Hospital site type, number of sites and location
Level of collaboration within an ICS / STP
Theatre case volume and type
State of assets and equipment
Financial position and capital availability
These all need to be taken into account when considering how to best prepare a Trust for the demands of a post-pandemic world.
To achieve this there are three steps we would recommend taking:
1.Understand the Trust’s requirements and activity
Theatre case volume, case type and surgical preference all impact decontamination activity. For example, orthopaedic surgeries require the greatest volume of associated surgical equipment and, in turn, sterilisation. Moreover, in larger Trusts, having a detailed understanding of the relationship between multi-site and multi-organisation environments is crucial. Only once the demand on sterile services has been accurately understood, can Trusts begin planning their bespoke sterilisation improvement strategies.
2. Tackle mismatches between theatre activity and decontamination volume
Through improved operational planning, Trusts will be able to manage surgical instrumentation to better meet peak demand and rapid turnarounds when necessary. Currently, the level of sterilisation activity does not always align with the volume of theatre cases, as illustrated in Figure 3 below.
Typically, cases and elective surgeries run throughout the working day, with sterile services running alongside them, often at max capacity. Trusts should look to adopt, where possible, a hybrid working model, whereby sterile service activity is better managed to align with demand and activity. This hybrid model would see the core volume of activity processed outside of the traditional elective window (also shown in Figure 3). This will improve their ability to respond to ad-hoc surgical demand and reduce pressure on already burdened capital assets, enabling crucial machine downtime.
Figure 3 – Misalignment in theatre cases and sterilisation activity
3. Adopt technological capabilities to maximise current operations
Alongside better planning, advances in technology can help ensure the instrument peri-operative value chain is as efficient and effective as possible. Track and trace technologies, such as Radio Frequency Identification (RFID), offer full visibility over surgical instrumentation from surgical use to decontamination and other movements. This enables workflow optimisation and full utilisation of the existing asset base. Work conducted by Akeso & Co discovered that a third of one leading Trust’s surgical instrumentation had not been used for three years, with instrument dormancy going as far back as 2004.
In situations like this, RFID can pinpoint where medical instruments are dormant. Although there are valid clinical reasons for not using certain instruments, a clearer oversight of assets gives Trusts the option to generate value by disposing of unnecessary equipment and freeing up hospital floorspace.
4. Explore a variety of commercial models
There are a number of different commercial models which Trusts should consider, such as joint ventures and managed services that can reduce the significant capital investments required. The graph below shows the range of commercial models currently available, and the different value propositions they offer depending on a Trust’s objectives.
Figure 4 – The range of commercial models available, including the level of service each offers and the advantages of a managed equipment service (MES)
Each commercial model comes with various advantages and opportunities. Depending on the selected model, Trusts have the possibility of further integration within the ICS to share capital and the option of taking sterilisation services off site if appropriate. Further to this, there is the opportunity to create revenue by acting as a lead partner in a commercial SSD network and offering services to the private sector.
Choosing the right model
There are benefits and risks to every solution and weighing up a Trust’s specific needs is an important part of the process when deciding which is the right route to take. We have worked with several Trusts over the years to identify the best direction for their SSD and build a business case to support this.
In transforming sterile services departments, Trusts will put themselves in a stronger position to deal with the fallout from the pandemic. Additionally, this will also increase theatre efficiency, improve infection control measures, generate space savings that enable theatre expansion programmes and potentially create much-needed income.
To discuss how Akeso & Co can help sterile service departments perform their critical role more effectively, get in touch.
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.
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:
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.
Scott has dedicated his career to performance improvement in healthcare and life sciences working both within a multinational consulting firm, and for the last decade as a co-founder of Akeso.
As a Managing Partner of the company, he has led the development of Akeso as an established boutique consultancy committed to improvement in UK health. His project specialisms and areas of interest are systemwide performance improvement, the national and international healthcare supply chain and the use of data to drive tangible and actionable improvement insights.
His approach is flexible, warm and fact-based and he is proud to have delivered numerous collaborative/ICS projects being able to engage positively across multiple stakeholders, specialisms and styles to achieve outcomes around aligned goals.
Outside of work his passions are almost all sports (mainly watching nowadays although can be found trying to find his wayward golf balls in the woods / long grass / water) and spending time with family, including Rump the cocker spaniel who is also the honorary office dog.
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.
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.
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.
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.
Peter has over 14 years’ experience of private and public sector healthcare.
He worked for 11 years at EY’s health and social care consulting practice and is now Associate Director at Akeso, leading on the Discharge to Assess and Population Health offerings.
Peter has experience and expertise in operations improvement, whole system redesign, cost improvement, performance improvement and programme delivery.
Peter is currently supporting a large Welsh Health Board on virtual ward implementation. He has led system health infrastructure projects for East Kent, North-West London and Cornwall, and has supported NHSE/I on the evaluation of supported self-management and behavioural interventions.
