Case Study

ICS Collaborative Operating Model and Commercial Efficiency

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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Chris Robson

Chris Robson

Managing Partner
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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Andrew Paterson

Managing Partner
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.

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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