Efficiently procuring goods and services for large hospital Trusts is vital for an underfunded health system. The pandemic was a frenetic period for hospital Trusts, as in very short time periods, they sought to procure equipment and contracts to manage COVID patients. There is an ongoing need to ensure procurement is performed in the most effective way possible to maximise cost savings for hospitals.
There are significant roadblocks to efficiently running a procurement team. Many purchasing departments use legacy software, are not provided sufficient support to review and improve their processes, and work overtime to meet the needs of Trusts around the country. Fortunately, there is a wealth of information at the disposal of procurement teams, highlighting an enormous opportunity to harness this data, and identify cost-saving measures.
Edge Health was commissioned to find opportunities for consolidation and cost reduction through a variety of methods. Enormous product order datasets spanning five years for a very large hospital Trust in London were analysed. Edge Health identified costly contracts to renegotiate, preferred suppliers for the same items, optimal ordering and delivery routes, high-spend cost centres to focus on, and high-volume low-cost items to be targeted. The combination of these approaches would result in a significant cost-saving for the Trust.
Our analysis, supported extensively by real-world data, identified procurement cost-saving opportunities that would enable the client to save approximately £2.5m per year. These funds can be reallocated to improve healthcare outcomes.
Recently Edge health was retained by a large NHS programme in the UK to support the development of an approach to risk adjusting surgical outcome data. The client in question currently reports surgical outcome data back to practicing surgeons (confidentially) to aid them with their revalidation as well as quality improvement.
Why was risk adjustment of surgical outcome data important for our client?
Consider the following scenario, comparing two consultants. Consultant A has a very low mortality rate (0.2% of patients on which this consultant operated on sadly died), while Consultant B has a higher mortality rate (3.2% of patients undergoing the same procedure with this consultant sadly died). These “raw” rates do not consider the patient characteristics, or underlying comorbidities (case-mix) of the patients treated by each consultant.
For example, Consultant A may have seen very young, healthy patients, while Consultant B has seen older patients with more comorbidities such as heart conditions or diabetes. Despite undertaking the same surgical procedure in theory it would be unfair to say Consultant B actually performed worse.
A proper risk adjustment approach therefore has to take into account the underlying patient characteristics to adjust important outcome measures. Here, in our example, given the underlying patient characteristics, Consultant B actually performed better than Consultant A (after risk adjustment).
The resulting model
We then developed and validated a risk adjustment model that used regression based methods to predict expected outcomes based on the observed data and used this to adjust the outcomes at surgeon level. We also implemented machine learning methods to determine the performance of our model. This was especially important in this instance, as the smaller consultant level samples make it harder to evaluate performance. A key risk for us was that at individual surgeon level, risk adjustments can quickly become unstable or unreliable due to the low number of observations. It was important to present only statistically stable, reliable, risk-adjusted rates. We thus had to determine a dynamic lower bound on the number of observations required per consultant for risk adjustment, balancing consultant coverage and statistical validity.
For this project, we presented the risk adjusted rates in funnel plots with control limits (labelled alert and alarm for research purposes only) (Figure 2 below). The data is now used with selected clinicians on a confidential and voluntary basis with the goal to undertake detailed evaluation and testing and with clinician support ultimately make it available to all consultants in the country.
We are working on making the code publicly available if our client is supportive as soon as the pilot phase concludes. If you are interested in more details please do not hesitate to contact us at [email protected]
Outpatient video consultations report – press release
REPORT INTO 3 MILLION VIDEO CONSULTATIONS DURING 12 MONTHS OF THE COVID-19 PANDEMIC HIGHLIGHTS BENEFITS TO PATIENTS AND NHS
Outpatient video consultations can deliver a range of benefits to patients and the NHS, according to a research report by Edge Health published today 14 September 2021.
The report reviews 3 million video consultations over a year in one of the fastest roll-outs of a single technology in the NHS’s history. This took place in a matter of weeks across 171 NHS hospital trusts in England, involving more than 69,000 consultants and clinicians using a single NHS supported video platform.
Video consultations with patients increased from around 5,000 a month in March 2020 to 340,000 a month a year later in a wide range of areas, including mental health, orthopaedics, paediatrics, physiotherapy, neurology, maternity and reproductive medicine, respiratory, diabetes, ophthalmology and oncology.
“Not only did clinicians and hospital services adopt the technology at an impressive pace, but our research also found them using it in innovative ways, including in areas such as physiotherapy and emergency eye care”, stated Director at Edge Health George Bachelor, who led the research.
The report highlights the benefits of video consultations to patients – saving over the year a total of 4.64 million hours (530 years) inpatient travel and in-hospital waiting times and £40m in travel costs and parking charges. As a result, 3 million lost work hours were avoided saving the overall economy £108m in lost productivity. The report estimates fewer journeys to the hospital resulted in 14,200 tonnes of avoided greenhouse gas emissions, and 11 million fewer “single-use” PPE items, such as face masks, were consumed, saving the NHS over £1.1 million. The analysis also found that 1,730 hospital-acquired infections were avoided (not including COVID-19 infections) due to fewer visits to hospital sites.
Over 76% of clinicians were “positive” or “very positive” about video consultations with patients, 77% finding the national video platform “easy to use”. Research conducted earlier this year by Oxford University for NHS Scotland has also shown very high patient satisfaction rates with NHS video consultations .
Edge Health’s research also found in its regional analysis high levels of usage across a range of geographies suggesting broad patient appeal in both rural and urban areas.
“The pace and scale of video consultation adoption across NHS secondary care, as articulated in this report, is one example of this impactful transformation that began in March 2020 and continues today”, states David Probert, CEO at University College London, in a foreword to the research report.
“I have been amazed by the hard work and commitment of NHS staff across the country who have found new and innovative ways to quietly deliver and improve patient care in the most extraordinary circumstances.
“The challenge for NHS England and NHS Improvement is now to help trusts and systems raise patient awareness of video consultations as an option to them when they access the NHS.
“Only by showing patients the benefits of video consultations and backing this up with the necessary support to access care in this way will we be able to safeguard the progress made and realise further opportunities in how video technology can improve patient care”, added David Probert.
Dr Faisil Sethi, Executive Medical Director, Dorset HealthCare University NHS Foundation Trust, said, “We led the way in adopting this technology, and we will continue to lead promoting its use to deliver great NHS care for our patients. In our varied geography, our service users, patients and clinicians appreciate the benefits, flexibility and convenience of video consultations.
“Whilst video consultations don’t replace face-to-face care where this is needed, they are enabling care that is more tailored to the needs of the people we care for in Dorset”, added Dr Sethi.
 Wherton and Greenhalgh (2021) Evaluation of the Near Me video consulting service in Scotland during COVID-19 2020, University of Oxford Department of Primary Care Health Sciences, p28-30.
Notes to editors
· Edge Health is a specialist firm that uses data and analytics to help the health and care sector to deliver better outcomes more efficiently. Read more about Edge Health here and our achievements here.
· The report is an independent evaluation of the outpatient video consultation pilot and rapid roll out of video consultations in NHS secondary care led by NHS England and NHS Improvement in response to COVID-19.
· Figures are based on activity on the Attend Anywhere video platform from 1 April 2020 – 31 March 2021. Attend Anywhere is the video consultation platform that was procured and funded by NHS England and NHS Improvement as part of the COVID-19 response.
Specialist cancer nurses play a vital role in supporting people with cancer, but their numbers have not kept pace with growing demands. As cancer incidence increases across the UK, there is an urgent/ongoing need to expand the number of specialist cancer nurses working in the NHS.
Macmillan Cancer Support has been supporting nurses to become specialist cancer nurses for many years, but the NHS will need considerable additional investment from UK governments to expand the workforce to the extent needed. To help understand the scale of the need, Macmillan Cancer Support commissioned Edge Health to undertake modelling on the number of additional specialist cancer nurses required by 2030 and the funding needed for training.
Our modelling shows that an additional 3,371 specialist cancer nurses are needed in England by 2030, the training for which would cost £124 million. You can find more details of the work on Macmillan Cancer Support’s website here.
Covid-19 cases are falling for the first time since the pandemic’s start without there being a national lockdown. Unless there is a secret modelling team in PHE, it is fair to say most people are moderately surprised by the continued drop in reported case numbers.
The exam question is why? This drop is significant for policy decisions needed over the next few months rather than kicked into the autumn.
As with many things, there are probably several factors.
Vaccinations and natural immunity played a considerable role, but these have been gradually delivered (linearly) and, if anything, has slowed down in the last few weeks. This steady increase contrasts with doubling cases every few weeks (exponential) that we saw in mid-July. More importantly,* despite some differences in vaccination rates, case rates in England dropped simultaneously across all regions around 19th July – see chart below.
This simultaneous drop in case numbers contrasts to Scotland, where cases started dropping a few weeks earlier than in England. There are some broad alignment between these downturns, specifically (i) the country’s last game in the Euros and (ii) school term dates – see chart below.
In truth, there are likely two big dynamics playing out. (We need more data to be conclusive)
The first is the slow and steady increase in cases, probably driven by school mixing of a largely unvaccinated population. The second is the accelerated mixing caused by the Euros – if you look closely at the chart above, you can see a kink around mid-June (especially for Scotland). These factors driving up case numbers have now fallen away, leaving some natural immunity and reducing the overall R0.
It is slightly different for hospitalisations, which are still increasing in England. There has always been a lag in admissions from infections, so we should start to see admissions numbers drop in the next week or two as we have done in Scotland.
The critical policy question now is how to prepare for the autumn. There will be some more immunity from continued vaccinations and infections, but schools and businesses returning will likely lead to an increase in cases. While this will come as a nasty shock, it is likely to be the start of a seasonal pattern that COVID will start to take centered around seasonality.
Perhaps the most exciting aspect of this analysis is that it suggests that both Wales and Northern Ireland supported England (or possibly just football) – see chart below!
Developing Metrics to Support the Growth of the Occupational Health Market
Workplace ill-health has a significant impact on both employees and businesses, with more than 130 million days lost to sickness absence every year in Great Britain, at a potential cost to the economy of £100 billion per year. Despite this, only 45% of the workforce, and 18% of small employers, have access to Occupational Health (OH) services, which have been shown to reduce sickness absence and support employee return to work.
A key barrier to increasing uptake of OH is that employers, and in particular smaller employers, often have limited understanding of its benefits. As such, there is great potential for the use of outcome data in the OH market, to demonstrate the impact and value of an OH service and give employers access to better information to support and encourage OH purchasing.
Realising the importance of being data led, Edge Health were asked by the Getting It Right First Time Projects Directorate @RNOH to provide expert support for their work with the DHSC. Between December 2020 and March 2021, we led a feasibility study to explore the opportunity for using outcome metrics in the OH market. During this time, we conducted more than 30 interviews with OH providers, employers, business groups, industry leaders and NHS OH.
Several key conclusions arose from this work. Importantly, it demonstrated a need and appetite to support improved outcome metric collection, and highlighted important challenges in this direction of travel. Following on from this work, we were commissioned to run a pilot data collection study, aiming to define a best-practice methodology for the collection of a small number of outcome metrics. This will provide a basis for wider roll-out of this approach, which could ultimately transform the OH market.
All of our analysis on the impact of Covid-19 on the NHS is shared here – this includes our regional tracker. For further information please contact George on 07980804956 or [email protected]
Published 7 April 2020
This weekend Watford General Hospital declared an emergency and told people to stay away due to a problem with its oxygen supply.
Pre-Covid-19 the supply of oxygen through “magic wall outlets” was not too much a concern for most hospitals as capacity significantly exceeded demand – even during peak use periods. Covid-19 hugely increases demand on oxygen.
For example, a 600-bed hospital with 100 using 5 litres of oxygen per minute (e.g. for respiratory illness) and 10 critical care beds using 15 litres of oxygen per minute would have a peak flow around 650 litres of oxygen per minute. Well within the limit of most systems, which are often between 1,500 and 3,000 litres per minute depending on their age.
Under Covid-19 demand projections from NHSIE, hospitals of this size have been told to expect demand that vastly exceed normal parameters – 200 beds with oxygen, up to 100 for critical care, and around 40 beds with high flow oxygen. This category, which sits between normal beds and critical care uses devices that are non-invasive and often much less efficient in their use of oxygen – sometimes consuming up to 60 litres per minute or more.
Under this type of scenario, the peak demand for oxygen would increase from 650 litres per minute to 4,900 litres per minute. This could exceed the limits some systems were designed to meet (many have not had their limits tested in practice). When this happens, the pressure flattens and the alarms on the oxygen supplying machines across a hospital go off*.
* I understand that this happens due to the cooling effect of liquid oxygen being evaporated. When too much is evaporated at once, the temperature drops significantly (like when you spray an aerosol can too much in one go). When it goes beyond a certain point it causes the pressure in the supply system to drop quite suddenly.
All of our analysis on the impact of Covid-19 on the NHS is shared here – this includes our regional tracker. For further information please contact George on 07980804956 or [email protected]
Published 25 March 2020
The HSJ has published sobering data on deaths. Somewhat clearly, it shows that deaths are higher per critical care bed (pre-Covid count) the further you are from central London – the more giant red bubbles in the chart below.
The larger red bubbles tend to sit on the outside of the youthful green fields of London. These organisations have been vulnerable due to their relative closeness to the spike of Covid-19 infections in London, their age demographic and their not having as many critical care beds per head of population as some of the central London hospitals.
What is happening around London should be a warning signal to other hospitals and health systems to get ready now.
While many of these are still at an early stage with a handful of confirmed patients – they are at the trough of a massive and steep wave. This wave is rapidly approaching and with older populations. The chart below is on the same colour scale as the one above – notice the lack of green.
Over 2 million people are living with sight loss in the UK, 34,000 of these are living in North Central London. Over the next 16 years, this is set to increase by 50% due to an ageing and growing population. In North Central London, this growth is equivalent to serving the current demand in Birmingham.
To meet this challenge, there is a proposal to move Moorfield’s City Road services to a new facility at King’s Cross. To support the decision making around this and future eye services more broadly, Edge was asked to provide an understanding of future activity growth and how this would change with new pathways and treatments.
Edge worked extensively with system leaders and experts, conducting over 40 expert interviews and holding workshops with over 90 attendees, to build a thorough understanding of expected changes to pathways. This complemented work that was done locally that had started to develop, approve and test new pathways, such as the use of a digital platform to improve referrals by allowing information exchange between optometrists and hospital ophthalmologists.
Harnessing the collected insight with patient-level data, Edge modelled future activity. This included using simulation and sensitivity modelling to provide a robust understanding of expected epidemiological and condition-specific pathway changes by CCG, which will feed into compliant business cases. The strength of evidence also helped support alignment and joint working between Moorfields, CCGs, Specialised Commissioning and the optometry community that continues to develop.
Finally, to ensure the longevity of the work and development of local plans, Edge developed the “Ophthalmology Activity App”. This allows system leaders to craft and explore new scenarios and their impact on ophthalmology activity across key conditions.
Contact us to learn more about our clinical and demand modelling work: