Increasing clinical capacity

Transcription

1 pwc.co.uk Increasing clinical capacity How improvements in the out of hospital supply chain means more time for patients June 2018

2 Contents Five building blocks to strengthen community care supply chain 01 Point of use data tracking 02 Control tower 04 Strategic management of the last mile 06 Enhancing supplier partnerships 08 Field force management 10 How we can help 12 Health Industries 14

3 Five building blocks to strengthen the community care supply chain As the pressure of increasing demand alongside financial challenge continues in the NHS there is a broad consensus that, wherever possible, care needs to transfer from the hospital to the community setting. Indeed the Five Year Forward View makes it clear that this is an urgent priority and the expectation is this shift of emphasis will provide better care for patients, cut the number of unplanned bed days in hospitals and reduce costs. This drive to deliver more care at primary and community level is welcome. But with multiple service providers, complex logistics across health and social care economies and significant procurement variance there needs to be a new approach to looking at the supply chain. This, in turn, will ensure variation and complexity is minimised. It s vital that the right supplies are available at the right time in the right location, from the right caregiver delivering the right care. Only that way can patient safety be guaranteed. To make this happen the out of hospital supply chain needs to be well synced and managed. Through our experience of working across hopital and community settings we have identified five building blocks that need to work in together to strengthen of the overall supply chain. This, we believe, will lead to improved services for patients and deliver much needed savings to the NHS. Point of use data tracking Field force management Control tower Five building blocks to strengthen community care supply chain Improved supplier relationships Strategic management of last mile Building the blocks Strengthening the out of hospital supply chain 1

4 Point of use data tracking The demand for community healthcare services to be delivered away from the hospital setting is providing trusts with a new set of challenges. This includes having resources to deliver these services, availability of consumables and coordinating the delivery to ensure the greatest efficiency. Trusts don t have adequate visibility of the services and products being rendered across various different patient locations meaning they are unable to monitor and track their usage. This limited visibility means they do not have the data to act effectively or efficiently and trusts are missing out on opportunities to improve productivity. Procurement decisions are, more often than not, driven manually without the knowledge of stock counts and, in many cases, are taken by service providers with limited time to consider the options rather than by dedicated supply chain staff. In addition, it is not possible to track the costs of procedures which, in turn limits the possibilities for income optimisation. 2 PwC

5 Point of use data tracking User location Data tracked Service providers Decision making Benefits Physicians Inventory management Reduced stock holding in medical facility/ward stock points Patient s home Point of use Home care Community health services Logistics management Point of care decision support Improved and informed patient care Visibility of trends and frequency of use Mental health services Emergencies More clinical time for district nurses GPs Reduced waste and cost savings Consumables/ Inventory How does it work? Sectors such as retail extensively use point of sale data tracking to ensure they are making short and long term strategic decisions to manage their inventory. This ensures they have a full understanding of their stock including where and when to deploy it to best effect for both the customer and the business. Capturing data across point of care: Implementing point of use technologies to track patient level costing, procedure times and demand for medical consumables will give visibility on information. This is the first step to understanding and driving clinical effectiveness. Understanding the demand: Having a clear understanding of which products are consumed quickly and at what rate services are required allows for improved future planning. This, in turn, will reduce wastage, ensure effective use of the procurement budget and optimise limited storage space. Harnessing valuable insight: Using demand forecasting tools and shareable data that is linked to patient schedules and purchasing systems to get end to end visibility of supply chain processes. Data analysis would improve clinical outcomes by identifying when patients are not following their care plan or are over consuming. Freeing up time to care: Generating inventory reports and identifying stock needed reduces the admin load of nurses and care providers thus freeing them up to focus more time on clinical activities. Amazon Amazon has partnered with Perrigo OTC to form an over the counter medicine e-commerce solution. Amazon s Basic Care range includes a variety of branded, over-the-counter medications, like painkillers, cold medicines and nicotine gum. As care shifts closer to home supplies need to be accessible out of the hospital setting. Amazon patients can track their consumption and, as needed, buy the Basic Care products using the Amazon phone app or the instant Dash and Buy Now buttons and have the products delivered direct to their home with prices for many items being significantly lower than traditional pharmacies. Amazon is likely to be a big disruptor in the over-the-counter market and could be a potential challenger to pharmacy retail chains. Building the blocks Strengthening the out of hospital supply chain 3

6 Control tower Within the out of hospital community care sector, by which we mean, for example, care homes, home care, social care etc, there are a myriad of organisations each operating individually and all commissioned through different providers. These individual care providers manage their own business and enjoys a large measure of autonomy and flexibility which inevitably includes stock ordering processes. As a result there is no joined up approach to the supply chain. Order processes for out of hospital services are often reactive and are only fulfilled when stock levels fall critically low. In other instances there will be an excess of inventory at service outposts where stock is repeatedly ordered without reference to existing levels. This random approach not only lacks a strategic focus but is outwith the outcome based model the NHS is moving to. This would mean orders are placed by patients rather than district nurses. This change of approach requires an even greater level of oversight to ensure effective use and to prevent waste. A more collaborative approach between all those operating in a healthcare system would undoubtedly create efficiencies and ensure improved standards of care. 4 PwC

7 How does it work? Modelling the air traffic control tower this ensures a helicopter view of all supply chain activities across a range of service providers from hospital catering through to operating theatres. It has become increasingly popular with logistic providers in recent years as they seek to get a better handle on incomings and outgoings. Many of the health economies that are exploring ACO/ACS models are considering control tower style operations to coordinate the patient pathway but they are not yet looking at the supply chain complexities and how these can be a barrier to delivering affordable. Creating a central hub for multiple providers: Overseeing the processes for multiple providers across the NHS. This creates visibility of actual supply and demand, foresees issues and allows for corrections. Creating efficiencies through improved inventory management: Coordinating activities between the full range of care providers, creating efficiencies and reducing the stockpiling of inventory at different points in the chain. Enabling robust procurement activity: Informing decision making and ensuring data driven demand plans across different service providers. It helps identify opportunities to reconcile supply chain planning across the wider region as well as alter procurement and supply chain activities within any specific area during times of unexpected change. The Range This homeware retailer has recently partnered with DHL to implement a new order management and shipment visibility solution. It has been underpinned by control towers and provides proactive alerts if deliveries can not be met and global coordination of ocean freight so that demand can be matched with the resources available. This has increased the end-to-end supply chain visibility, reduced working capital and improved the availability of products to end customers. Health systems could implement a similar offering for it s out of hospital services, using the control tower to coordinate deliveries and enable course corrections, ensuring deliveries arrive at the right time in the right place and creating efficiencies in this process. Control tower Each of the patients will have care plans driven at the Control Tower PACS/ACOs Strategy Operations Control tower Control tower overlooking resources, patient care plans, delivery of optimisation of drugs etc. Capability Data Policy Field force Field force Field force Point of use data tracking GPs Community health service Home care Mental health service District nurses District nurses Public and patients Public and patients Building the blocks Strengthening the out of hospital supply chain 5

8 Strategic management of the last mile The last mile tends to be the most cost consuming aspect of the supply chain process. Orders are usually placed by nurses after visits, delivered to an intermediate location for pick up and then taken to the patients by the nurses. This alignment of logistics deliveries to visits by clinical staff is inefficient and expensive and not a good use of their time. Nor is it in the best interest of the patient as delivery is often dependent on the availability of the nurse. In some cases local couriers are used to overcome this but poor coordination can drive higher costs with multiple deliveries to patients and their carers. The use of multiple procurement routes including NHS Supply Chain, Bunzl and a range of other private providers means it is difficult to strategically plan logistics for all out of hospital services. 6 PwC

9 How does it work? Strategic management alongside the adoption of emerging retail delivery models could reduce inventory by 25 40% whilst eliminating waste and reducing the burden on clinical staff. Linking inventory to patients: Utilising point of use data tracking, supplier collaboration and control towers would mean drugs could be supplied directly to consumers rather than going through nurses or being held in a central location. This would reduce costs for both suppliers and the NHS as products are in transit for a shorter period of time. Centralised hubs for field force management: Having volume of stock in strategically placed distribution hubs across regions will enable local field forces to tackle the last mile logistics. This will save on clinical time of nurses and keep inventory in check. Changing the order processing mechanism: Allowing patients to order directly will remove the need for distribution centres. This will significantly reduce costs and wastage across the whole system as orders will be linked to clinical need and not assumed stock levels. Route planning and utilising technology: Strategic planning of delivery routes through optimising technology and new age methods such as drones will deliver ensure synergy across the system and different services. This is particularly impactful for high value items and reducing suppliers delivery costs. Logistic providers and order placement Catalogues Procurement Data Public and patients Field force Internal logistics last mile delivery Warehouse stocking units External logistics Suppliers Local parcels Regional areas Transport Strategic management of the last mile Building the blocks Strengthening the out of hospital supply chain 7

10 Enhancing supplier partnerships Out of hospital healthcare procurement typically places limited focus on strategic planning. The planning of consumables, equipment, healthcare professionals and other products and services are not always aligned and coordinated. Procurement decisions tend to be transactional and reactive, based upon historic activity levels and are not well linked to the changing patient demands and needs. The orders are usually placed in bulk through catalogues for short term savings without any correlation to the inventory management or change in demand patterns. The NHS must consider reshaping their relationships with suppliers based on a shared ownership of patient outcomes and an effective risk sharing model. Through the right data and technology, the out of hospital services can create transparency with suppliers, moving their current transactional relationships into long term strategic partnerships that deliver greater value for both the NHS and their suppliers. 8 PwC

11 How does it work? With access to the right data, providers will be in a position to have transparent and trusted communications with their suppliers and take leverage from their relationship. Purchasing based on demand signals and known resource, equipment and consumables requirement captured in a Bill of Materials will reduce unnecessary wastage and supplies expiring before use. Partnerships between community care providers and suppliers, will hold both parties accountable for making outcomes-based decisions and link supply to levels of activity across the economy. Develop a supplier relationship management framework and capability: Establishing the right relationships with suppliers and, in doing so, determine which suppliers are critical and where to invest in strategic relationships. This should be based on the delivery support across hubs and to patient locations. Sharing demand signals with suppliers: Community care providers purchasing medical supplies based on demand signals triggered by data-driven systems. This data could be shared with suppliers, creating a pull rather than a push effect, whereby services are in-control of their stock levels and ordering effectively. This will minimise the influence of the bullwhip effect where such volatility of demand exists. Outcomes based approach: Nurturing relationships based on data on patient outcomes and the efficacy of the product for an intervention. This approach will facilitate effective risk-sharing as both parties focus on improving patient outcomes. Through this, suppliers will be held accountable to the value of their supplies rather than the volume they provide. Wiltshire Community Health Services Wiltshire Community Health Services moved away from prescriptions for its dressings. In addition to cash savings, it reports 18,000 nursing hours per year freed up across their team of 180 district nurses by not having to pick up prescriptions for wound dressings on patients behalf. Use of the e-commerce system, provided a clear audit trail to demonstrate compliance with the formulary (improvements to 95%) which further reduced the administration burden and increased time to be spent on patient care. Shropshire Community Health reviewed the delivery of continence pads where patients were receiving two or fewer pads per delivery. The delivery cycle for these patients was changed to every 24 weeks which, in turn, saved on delivery charges and prevents stockpiling at patient's home. Building the blocks Strengthening the out of hospital supply chain 9

12 Field force management Much of the admin and back office work that sits behind ordering and processing of stocks is carried out by nurses. They are also often responsible for the delivery of items to patients. A more effective approach would be to identify non clinical staff with knowledge of an area or region to oversee the system. 10 PwC

13 How does it work? Field force management uses local area volunteers, community teams and temporary staff to help deliver consumables / equipments to the patient s location on behalf of the community care clinical team. Effective and efficient use of community services: Enabling local teams and volunteers to support effective delivery of care across the community with the same (appropriate) access to the logistics services available to full time staff will saves clinical time and also provides a more effective delivery service as the staff would have better knowledge of the routes and local areas of the specified region. Working in synergy to optimise logistics and delivery: Leveraging control towers and point of use data tracking, tasks are allocated more effectively to the field force and routes are optimised. It means journeys can be better planned, and more effective use of staff through assigning new work orders individually or in batches to staff who may have completed their jobs early. In the situation where field forces are located far away from the central stock location having local stock hubs could also improve efficiency for delivery. Greater control and management of staff and inventory: Field force management improves workforce reporting and inventory control. This, in turn, allows for greater coherence and coordination of agencies, as well as streamlining of routes/tasks. The staff can also take control for reverse logistics to avoid any wastage or incorrect deliveries. NHS Professionals The number of agency hours requested from NHS Professionals has more than doubled from 930,000 in April 2012 to 1,917,000 in January This reflects the increasing role of field force management in optimising logistics for out of hospital services. Building the blocks Strengthening the out of hospital supply chain 11

14 How we can help There is enormous opportunity to make savings and improve clinical outcomes through a more strategic approach to supply chain management. Working across a system with multiple service providers is a challenge but, with the right approach, the impact could be significant. Our team are skilled and experienced in developing practical solutions that can work across organisations to deliver system-wide change. Our team can help you to: identify the opportunities that exist within your system understand how the elements within this document can drive better and more cost effective care model the recommendations to fully understand the impact of change support you all the way through to implementation and realisation of benefits We would be delighted to discuss this with you further please contact one of our team: [Rob Yearsley, Johnathon Marshall ] 12 PwC

15 Contact details Johnathon Marshall Partner, Health Industries Procurement and Supply Chain Management +44 (0) Rob Yearsley Director, Health Industries Procurement and Supply Chain Management +44 (0) Dhruv Shah Manager, Health Industries Procurement and Supply Chain Management +44 (0) Building the blocks Strengthening the out of hospital supply chain 13

16 Health Industries Tomorrow s healthcare today Healthcare matters to us and it matters to our clients. We all want better healthcare, sooner and the potential is there to make it happen. New technology, new breakthroughs, new ideas. But while there are opportunities, there are challenges too: constrained budgets, an ageing population and an increase in chronic conditions. At PwC we re working with clients to steer a course to success in this new health economy so we help improve healthcare for all. We re working with the NHS, nationally and locally, as well as the private sector and the pharmaceutical and life sciences sector to deliver real, workable solutions to today s challenges. We re delivering transformation and integration projects with patient outcomes at their heart. And we re supporting organisations through testing financial times, often developing bespoke operational and digital systems. We give strategic support to organisations across healthcare and pride ourselves on convening different parts of the system to solve problems. We also bring insight and expertise to healthcare as well as engaging in the public policy debate. For more information, sign up for our Health Matters blog at: 14 PwC

17 Quentin Cole Partner, Business Recovery Services and UK Health Industries Lead +44 (0) Lucy Stapleton Partner, Pharmaceuticals and Life Sciences Sector Lead +44 (0) Andrew McKechnie Partner, Private Health Sector and Deals Lead +44 (0) Rt Hon Alan Milburn Health Industries Oversight Board Chair +44 (0) Building the blocks Strengthening the out of hospital supply chain 15

18 Notes 16 PwC

19 Building the blocks Strengthening the out of hospital supply chain 17

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