Avail, part of Tribal with the Department of Health
The Government's historic focus on improving patient care, from reducing waiting times to ensuring fair and equitable access to services, has meant that primary care trusts (PCTs) have been able to invest in new services without having to fret too much about cost-effectiveness. But, thanks to the recession, big reductions in public sector spending are now on the way, and value for money is set to become as important a measure of performance as waiting times, patient care and fair access to services.
The NHS Purchasing and Supply Agency (PASA) is now ahead of the pack in achieving this, having established that efficiency gains of between ú449m and ú545m were achievable for its 2007 budget year.
The Department of Health (DH) wanted external support to validate these savings and to train staff to improve 'care pathways' - the different stages of treatment and care that patients with a particular condition receive, and finding ways to create shorter, better pathways that bring patients out of hospital quicker, or prevent admission in the first place.
Avail, part of Tribal, was commissioned by DH to work with four PCTs to see how best it could reduce costs while improving quality of care and patient satisfaction. The consulting firm's team, numbering between five and 12 over the course of the programme, began by carrying out domestic and international research into best practice.
The stakeholders that Avail consulted covered all commercial levels within the PCTs, from chief executive, commissioning director and finance director through to clinicians, commissioners and procurement staff. And each stage of the programme was tested against a number of core policy strands, including, 'Is this improving patient care?' and 'Is the care being delivered in the most cost-effective way?'
Avail's solution centred on developing a repeatable methodology for optimising care pathways. Optimising a pathway might, for example, involve eliminating activities that don't contribute to patient outcomes or quality of care, but which may incur cost; or replacing some activities with new ones that are more effective or efficient; or streamlining processes to remove delays.
Other options might include re-tendering some activities to increase competition and reduce the price paid for those activities; or introducing completely new services that, while incurring incremental cost in their own right, may cut overall costs by reducing demand for other services through preventative measures.
Second, Avail piloted a procurement capability diagnostic (PCD) toolkit that provides an independent evaluation of procurement capability, measured against 10 key statements of procurement maturity.
Third, it developed a good-practice framework (GPF) for commissioning and procurement that provides a PCT's commissioners and procurement staff with guidance and resources covering the full commissioning cycle. Avail also developed eight examples of good commissioning practice to help PCTs better understand the potential across the NHS to improve care and reduce costs.
And, finally, the consultancy developed an overarching statement of commercial strategy, endorsed at an executive level within the PCT and aligned to its strategic priorities.
Specific improvements that Avail has helped the PCTs design and implement will save each PCT hundreds of thousands of pounds a year across each of the three pathways. And these are improvements that can be replicated across other pathways and by other PCTs. Since there are 152 PCTs and 340 care pathways, the total potential saving to the NHS is estimated to be several billion pounds.
'Avail's approach to working is highly professional, always demonstrating the key values of excellent customer care,' says John Warrington, senior responsible officer at the Department of Health's procurement, investment and commercial division. 'Having a strong team ethic, they quickly became valued members of the PASA team and were able to easily manage the tensions - always present for consultants - in taking personal responsibility for delivery, along with creating an environment where other team members were supported to deliver for themselves. We would not be where we are now without them.'
Commissioned by the Department of Health to work with four primary care trusts on improving particular patient care pathways, Avail carried out wide research before arriving at a replicable methodology. It also piloted a toolkit for better evaluation of procurement capability, and a good-practice framework to take PCT staff through the procurement cycle. If replicated across the board, these innovations could save the NHS several billions of pounds.
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