Clients & References
We have worked with a range of blue chip Healthcare clients at all stages of the Healthcare, Pharmacy and Lifesciences Value Chains. Our clients include over 30 of the 50 largest NHS Trusts in England, who have engaged us on an individual and collaborative basis, a number of leading Private Hospital Groups, a collaboration of Diagnostic and Pathology Service providers and a number of manufacturers and service providers who supply into the sector.
We have included a sample of brief case studies below to give you a flavor of our capabilities and recent work. Please get in touch directly (contact details below) if you are interested in knowing more about how we could help you.
Procurement and Supply Chain Transformation for leading NHS Foundation Trust
Cambridge University Hospitals (CUH) is one of the largest and most renowned Trusts in NHS England with a commitment to deliver care which is kind, safe and excellent. The Trust is the heart of a leading Biomedical Research Centre and is one of the five Academic Health Science Centres. At the time of the project, the Trust employed c. 7k people, delivered care for 70k inpatients and 460k outpatients, operating 1k beds across 52 wards and delivering 40k surgical procedures. CUH’s turnover was c. £660m, of which c. 30% was non-pay.
Our consultants were engaged to deliver a Procurement Cost Reduction project followed by a full-scale Procurement and Supply Chain Transformation to equip CUH with an enhanced level of capability that would sustain the Trust’s ability to deliver value over the long term.
Successful Healthcare Procurement Transformation requires a phased approach to 1) identify, quantify and prioritise the value potential, 2) deliver the value and 3) sustain the value.
We brought a number of methodologies, tools and experiences to support the client through each stage of the Healthcare Procurement Transformation journey, including a proven Procurement Transformation approach that addresses all areas of capability (People & Organisation, Process and Systems), Healthcare-relevant Category Intelligence (client experience, market studies etc.) and real world experience of what works and what doesn’t.
We completed a full Spend Opportunity Assessment to identify and prioritise areas of opportunity: The assessment looked at all categories of spend including clinical and non-clinical goods and services, low to high clinical preference. Categories were profiled and benchmarked, key requirement understood, supplier markets evaluated and strategies developed. Recommended strategies were taken forward in a wave sourcing programme that would yield significant results once implemented.
Our consultants led the delivery of a wave sourcing programme focussed on key Clinical Goods and Services including Sutures, Laparoscopic products, Orthopaedic Implants, Clinical Managed Services, IT Products, Soft Facilities Management Service, Catering and Laboratory Consumables.
We led the implementation of a new organisation including redefinition of roles and recruitment of new team, new governance and processes, a number of new Procurement and Supply Chain Systems, including Catalogue and Inventory Management systems and an Assisted Buying Solution.
We delivered recurrent incremental savings averaging 5% of spend under management in each year of a three year programme. Within this, savings as a percentage of addressed category spend were frequently double digits.
Our consultants equipped CUH with sector leading Procurement capability (People & Organisation, Process and Systems) to sustain and find new savings.
CUH was highly commended in the 2014 Health Service Journal Awards for improving efficiency with technology for an aspect of the Transformation Programme.
Design and Implementation of a sector-leading Inventory Management Solution for leading NHS Teaching Trust
Cambridge University Hospitals (CUH) is one of the largest and most renowned Trusts in NHS England with a worldwide reputation and a commitment to deliver care which is kind, safe and excellent. The Trust is the heart of a leading Biomedical Research Centre and is one of the five Academic Health Science Centres. At the time of the project, the Trust employed c. 7k people, delivered care for 70k inpatients and 460k outpatients, operating 1k beds across 52 wards and delivering 40k surgical procedures. CUH’s turnover was c. £660m, of which c. 30% was non-pay. As part of a wider Transformation programme, we delivered a number of step-change improvement projects focussed on inventory management in 1) Wards and Clinics (annual turnover £10m) and 2) Theatres (annual turnover £20m).
Our consultants conducted a segmented analysis of the Trust’s Supply Chains, which were characterised by fragmentation of responsibilities, processes and systems. Clinical areas were often served by more than one supply model and clinicians were heavily involved replenishment processes.
We brought extensive cross-sector experience of designing and implementing optimal supply chain models. This included experience of leading Supply Chain and Inventory management practices, a number of methodologies and tools, including experience of Hospital Supply Chain Maturity Frameworks, Market Studies of Healthcare Inventory Management and Procure-to-Pay systems and Change Management.
Our consultants gathered and analysed spend, contract and activity data from across the organisation to build a detailed ‘cost-to-serve’ model. We engaged with clinical and operational stakeholders to understand the current situation, key challenges and requirements.
We modelled a range of programme delivery options and jointly, alongside key stakeholders, developed a recommended supply model which reduced costs and improved service levels. We designed a sector leading process that maximised data capture and accuracy, while minimising the clinical burden in the process by applying an integrated, demand driven approach to balance efficiency with flexibility to accommodate the needs of a leading Teaching and Research body.
We developed a framework for an integrated approach to CUH’s supply chain incorporating GS1 and leveraging deployment of EHR. We led the implementation of recommendations which included a deployment plan, initiated by our consultants alongside the internal team, before transitioning to the client team to complete the rollout and operate.
We designed and implemented a new Theatres Supply Chain solution, the Procedure Kitting Solution, integrating procedure kitting, RFID and top-up solution to ensure right products, right time, right place, right presentation.
As such, a complete closed loop Theatres replenishment solution was created including full patient level costing – by patient, by procedure, by surgeon, to make the Supply Chains GS1 ready.
Delivery of a Collaborative Procurement Programme for the Shelford Group
The Shelford Group is the largest collaboration of hospitals in the NHS, consisting of 10 leading multi-specialty academic healthcare organisations employing over 100k people and with a turnover of over £10bn. It was formed in 2011 to share practice in patient care, clinical research and education, and to represent the NHS and engage with key stakeholders. Shelford Group trusts are facing an unprecedented level of financial pressure. At the same time, demand for their services is increasing and the challenge of doing more with less has never been greater.
We were engaged by the Shelford Group to explore how to optimise the group’s collective buying power and clinical reputation from its combined annual spend of £3bn, to deliver a step change reduction in third party spend and drive wider total cost efficiencies.
We brought extensive Healthcare and cross-sector experience to deliver this programme and proven proprietary methodologies including our 7 Step Clinically-Led Category Sourcing Methodology and Opportunity Assessment Approach.
Our consultants undertook a detailed spend analysis and opportunity assessment, requiring an innovative and pragmatic approach to the many challenges associated with handling and analysing this volume of data and information – £3bn of spend, 650k Purchase Orders and 6.5m invoices.
We developed a 5-year sourcing plan and sourcing methodology for the group including a detailed long-term savings forecast. We also completed a detailed assessment of organisational capability, best practice and peer review across the Shelford Group.
Our consultants provided a central Project Management Office and training and delivery support.
We identified, developed and supported the delivery of strategies for 28 high priority clinical categories with a goal of delivering net savings of at least £192m over five years through third party spend related efficiencies including sourcing, procurement and supply chain.
These strategies ensured that the Shelford Group always has access to the best price and is well positioned to drive clinically- led standardisation and other innovations such as patient pathway optimisation. Furthermore, the opportunity assessment helped extend procurement influence beyond its traditional scope into temporary staffing, capital, estates and facilities, integrated supply chain and pharmacy.
Collaborative Pharmacy Supply Optimisation
The six trusts that make up the West Yorkshire Association of Acute Trusts (WYAAT) are working collaboratively to examine new approaches to medicine management. Together, they manage almost £500m of medicines spend and along with other Trusts in Yorkshire, were collaborating on medication procurement in order to reduce unwarranted cost variation in drugs.
Pharmacy was identified as a major area of opportunity in the Carter Report, which identified collaboration and shared functions as a major source of future value for the NHS.
The medicines value chain is inherently complex. We set out to analyse the supply channels in a way that captured the complexity while allowing stakeholders to take actionable decisions through the project process. The project identified the opportunity to reduce Pharmacy operating costs at Trusts individually, and across the group as a whole through consolidation of inventory and activity, and aggregation of transactions. The process identified other services (e.g. management of shortages) that could be more efficiently delivered by a joint function.
We developed a number of analytical tools to accelerate the scenario modelling and business case development including Pharmaceutical warehousing and transport models, tipping point models for evaluation of manual vs. automated activities and a top-up performance model.
Our consultants gathered and analysed Pharmacy spend, contract and activity data from across WYAAT Pharmacy operations, segmenting and baselining costs by segment and provider. We engaged key stakeholders from across WYAAT Pharmacy’s to understand current arrangements, key challenges and risks, and customer requirements.
We led the engagement with leading providers, incumbent and competitor, to understand the leading Pharmacy supply models and to identify relevant value opportunities. We completed a detailed options appraisal, modelling a range of delivery options and developed a recommendation.
We documented an Outline Business Case, which was approved to move the project from the design phase to the procurement process.
We played a key role in delivering a pioneering collaboration project for a pharmaceutical network that could achieve recurrent efficiency savings of over £17m with a one-off saving of £4.5m through consolidation of stockholding as well as further operational savings of £13m through the proposed operating model.
Key tangible benefits include inventory reduction of 15-25%, a net operating cost reduction of 10-15%, an incremental reduction in waste, improved regional contracting and supply chain performance, improvements in visibility and quality control, enablement of more complex supply models (dose banded products) and aggregated demand planning to take place as well as reduced risk throughout the hospital pharmacy value chain.
Development of Business Cases for Scan4Safety Demonstrator Sites
In 2014, the Department of Health (DH) commenced an ambitious program, Scan4Safety, to transform the way that the NHS manages the numerous interventions that take place in NHS Providers at all points of care delivery everyday, both internally and externally with suppliers. The DH invited outline business case applications from NHS Provider Trusts interested in being one of six NHS demonstrator sites, who would be awarded investment of up to £2m to act as early adopters and communicate the benefits of Scan4Safety.
Working with a large top-tier Consultancy, we were engaged as a subject matter expert to deliver four of the final 12 Outline Business Cases, leveraging our direct experience of delivering transformational projects in the NHS involving technologies and solutions covered by Scan4Safety. We worked with a number of leading academic NHS Trusts around their process maturity and eProcurement capabilities. Our directors have presented on the topic at a number of events in the UK and the US, on behalf of GS1 and other organisations.
The benefits of Scan4Safety adoption are significant: improved transactional efficiency, improved traceability and risk reduction, inventory and wastage reduction, released clinical time to patient care – all of which lead to improved patient outcomes and safety.
We have extensive experience of Scan4Safety relevant technologies including a number of Use and Enabler cases. We brought a number of methodologies and tools, including Hospital Supply Chain Maturity Framework and Diagnostics Tools, Financial Modelling and Market Studies of Healthcare Inventory Management and Procure-to-Pay systems.
We analysed submissions from applicant NHS Providers. We engaged key stakeholders in organisations at all levels up to an including Executive, to validate the ambition levels within each of the four Trusts.
We developed a comprehensive business case framework for the final applications, based on the HM Treasury Blue Book methodology. We worked closely with applicant Trusts to complete the comprehensive business cases This included engagement with external suppliers, modelling of solution options as well as development and costing of implementation plans to take forward if successful.
We then developed four final recommendations and business case applications for DH Board approval.
Three of the four applications validated by us were successful in securing investment of up to £2m, as part of the six NHS providers selected as Scan4Safety demonstrator sites.
Laboratory Diagnostics Non-pay Cost Reduction Programme
NHS Pathology Laboratories in England process nearly 800m blood specimens per year. Working on behalf of a vanguard Pathology Services Collaboration (following the Lord Carter report) involving 8 Hospital providers, over 400 community sites and over 28m reported tests, we were engaged to evaluate current testing costs, baseline non-pay, diversity and opportunities to consolidate Diagnostic and Laboratory Equipment portfolio, Consumables and Services with the aim of delivering efficiencies and cost reductions across the newly formed Pathology operation.
As in any post-merger cost reduction situation, the key to success is to rapidly bring together data and information from a number of disparate sources and organisations and develop a working view of the merged reality that allows the client to understand which areas of spend are addressable, which are committed and for how long, the opportunities to drive value and what needs to happen to enable and maximise these opportunities.
We used a number of methodologies and tools, including Opportunity Assessment, Financial Modelling, Category Workbooks for Pathology Equipment, Consumables and Services and Programme Planning to understand the current situation, identify cost reduction opportunities and recommend a cost reduction programme.
Our consultants gathered and analysed spend, contract and activity data from across the newly merged organisations to baseline costs. We engaged key stakeholders in the Pathology Laboratories and Hospital Customers to understand the current situation, key challenges and customer requirements.
We led the engagement with leading providers, incumbent and competitor, to understand leading technologies/ solutions and identify relevant value opportunities. We modelled a range of programme delivery options and developed a recommendation which best met the client requirements.
We led the implementation of our recommendations which included development of specifications, sourcing and implementation of Managed Pathology Services for Biochemistry platforms and consolidation and sourcing of Research Consumables. We also provided the client with a toolset to track benefits.
We delivered a savings programme that yields annualised savings averaging 8% on an total non-pay spend of £22m. Sub-category initiatives delivered savings ranging from low single digit to high double digits.
We supported the implementation of Hub and Spoke strategy delivering a Diagnostics Platform strategy that consolidates and standardises test platforms over three years.
Optimisation of Diagnostic Specimen Collection Network
NHS Pathology Laboratories in England process nearly 800m blood specimens per year. Of these, c. 50m tests (6%) originate from the 7,800 GP practices (av. 6,440 tests per GP practice) the others originate from Hospital Provider network and other sources.
We were engaged by a number of Pathology Service Providers, individual providers and regional collaborations, (the largest handling up to 1.75m samples from almost 400 GP practices and community locations operating Phlebotomy services) to assess, design and implement efficiency improvements to the Community Specimen Collection Network.
Like any network, the Specimen Collection Network is dynamic and evolves over time. It quickly begins to change as individual GP practices and community care providers makes changes to their practice locations, opening hours and service locations and new providers enter the market providing Phlebotomy services.
We used a number of Network Modelling methodologies and tools, combined with our sector experience, to understand the current network and design a solution which best met the customer and Laboratory requirements (better service, reduced collection cost per reported test result, etc.).
Our consultants analysed the volumetric, activity and financial data from across the network to baseline costs. We engaged key stakeholders in the Pathology Laboratory and sample of key GP and community customers to understand the current situation, key challenges and customer requirements.
We led the engagement with local and national Transport and Technology providers to identify relevant solution options. We modelled a range of solution options and developed a recommendation which best met the customer requirements.
We led the implementation of our recommendations which included the development of specifications, competitive tenders and the implementation of change management providing the client with a toolset to track benefits and monitor volumetric going forward.
We delivered savings ranging from 9% to 17.5% (reduced collection cost per reported test result, reduced carbon footprint) through the consolidation and redesign of collection routes and times whilst keeping within the critical four hour collection-to-test window.
We improved the customer service and provided enhanced sample traceability (sample collection to test) and further ensured that the efficiencies are sustainable and would enable the Pathology provider to keep apace with future developments of the network.
Facilities Management Cost Reduction
Guy’s & St Thomas NHS Foundation Trust (GSTT) comprises two of London’s best known teaching hospitals, St Thomas’ Hospital and Guy’s Hospital, providing a full range of hospital services to the local community and specialist services nationally. GSTT is one of the largest Trusts in the UK with a turnover of almost £1.5bn and 15k staff, treating over 2.4m patients per year, including 88k inpatients,103k day cases, 1.2m outpatients and 800k patients in community services.
GSTT operates a wholly owned subsidiary, Essentia, which provides Facilities Management (FM) for GSTT. Essentia was challenged to deliver cost savings, improve service quality and manage an aging asset base to maintain uptime through a blend of in-house and externally contracted services. Akeso&Co were engaged by Essentia to complete a total cost review of the Hard Facilities Management service (Engineering and Building Maintenance) to identify near term and long-term cost reduction and operational efficiency opportunities in 3rd party spend and the internal service.
Essentia was challenged to deliver cost savings in addition to assuring service quality and maintaining an aging and diverse asset base, with very limited funds for investment. We brought a number of methodologies, tools and experiences to support the client through each stage of the project including a proven Opportunity Assessment approach, Capability Development (People & Organisation, Process and Systems) and Hard Facilities Management-relevant Category and Market Intelligence.
In Phase 1, our consultants led the process to identify the value through benchmarking GSTT to peer Trusts in terms of scale/ size and location using latest Estates Return data from NHS Digital.
We completed in depth reviews and analysis for a number of key product and service contracts with the client and incumbent providers to evaluate fulfilment of requirements and to develop strategies to improve performance and leverage benefits where suppliers were failing to meet performance standards.
We then prepared a Board level recommendation for a Programme Delivery setting out a range of tactical and strategic options.
In Phase 2, we designed and led a joint Consultant:Client delivery program to implement the recommendations.
We developed and ran multiple Tenders, which included soft supplier market engagement, the development of output based specifications and the design of contract models that would permit the involvement of local SME providers.
We finally designed and costed a detailed process improvement plan to transform the end-to-end Hard FM Callout process handling 50k callouts per year.
We established and mobilized a structured Trust-wide improvement programme which delivered savings and improvements across all areas of Engineering and Building Maintenance to improve customer service and regulatory compliance and reduce cost to serve.
Delivering Procurement and Supply Chain Value from Sustainability and Transformation Partnerships
The Greater Manchester Health and Social Care Partnership, is the largest of the 44 Sustainability and Transformation Partnerships (STPs) defined by NHS England, covering a group of 12 NHS providers (acute, mental health and community), with a non-pay spend of over £2bn per annum, covering a population of 3m and 480 primary care practices.
As part of the Greater Manchester devolution agenda, we were engaged to identify and validate in detail the incremental benefits that could result from formalization of the existing collaborative model and from leveraging the transformational changes from the implementation of the Greater Manchester STP. The project scope included Sourcing and Procurement and Supply Chain of Goods and Services and Pharmacy.
Whilst the core aim of “ensuring the availability of Goods and Services required to deliver effective and efficient Patient Care to the regions population” will be common to all Healthcare providers in a region, the distribution of this activity and the way in which it is delivered can be very different for each provider. Whilst the benefits of regional working are compelling (greater scale, more cost efficient delivery, sharing of best practice and standardisation, pool investment in technology), understanding each provider’s strategy, their relative areas of focus, priorities, strengths and Procurement capabilities is a crucial first step in the collaborative journey.
Our consultants brought a number of methodologies, tools and experiences that have been developed and refined in a Healthcare context, including Capability Assessment and Organisational Diagnostics Tools, a proven Procurement Transformation approach that addresses all areas of capability (People & Organisation, Process and Systems) and Category Intelligence (Client experience, Market Studies etc.).
Our consultants conducted a detailed analysis of resources and costs, capabilities, governance, process maturity and technology to develop a detailed as-is view of the current Procurement Operating Model across providers in the region, identifying areas of commonality and difference.
We conducted a total 3rd-party spend analysis with opportunity assessment, analysing four key areas in depth, that would most benefit from a regional approach across Clinical and Non-clinical spend on Goods and Services and Pharmacy.
We evaluated a range of options to maximise the return on the collaboration and developed and socialized a Board-level paper which set out the options we had evaluated with a recommendation, underpinned by a HM Treasury 5-case business model.
We developed a fully costed recommendation that reflected the optimal balance between commercial ambition and cost, operational capability and efficiency, and overarching provider strategies.
A number of key initiatives from overarching strategy have been taken forward on an advanced basis. We continue to play a role in the delivery of these projects.
Supply Chain Value Assessments for two Private Hospital Providers
We have been engaged separately by two leading Private Hospital Groups who were keen to explore the potential value of taking a more integrated approach to the supply chains serving their networks of Healthcare facilities. The two projects were delivered independently and confidentially.
Like public sector Hospitals, private operators have to deal with the receipt, handling and onward distribution of a diverse range of product supplies and equipment. Unlike their public sector counterparts (who until very recently were focussed on Hospital operations within a city or a very concentrated area), private sector Hospital providers have been grappling with the challenge of how to secure supply chain network efficiencies over a wide geographic area for some time. This is compounded by the faster pace of change to their businesses and the need to turn a profit.
Our consultants brought extensive Healthcare and cross-sector experience to these projects including insights on leading supply chain and inventory management practices and established methodologies including a Hospital Supply Chain Maturity Framework, Cost-to-Serve models and Market Intelligence on leading sector Logistics and Solution providers.
We confirmed the scope of supply chain relevant activities, gathered and analysed spend, contract and activity data from across the organisation to built a detailed ‘cost-to-serve’ model for the entire Hospital provider network. We benchmarked the activity and practices to public sector and cross industry (Fast-moving consumer goods, Retail and Automotive) comparators. We engaged with clinical and operational stakeholders to understand the current situation, key challenges and requirements.
We modelled a range of value enhancing supply chain options (using segmented flow models) and jointly, alongside key stakeholders, developed a recommended supply model which reduced costs and improved service levels.
We then developed a final recommendation that achieved the best balance of client and stakeholder requirements, including a full detail business and investment case to take forward on subsequent phases.
We developed an implementation roadmap with interdependencies and priorities clearly specified and mapped. This included a central control capability established to enable benefits to be sustained and tracked over the longer term.
We identified, quantified and developed a series of initiatives that would yield c. 30% to 40% in one-time inventory benefits and 25-35% savings in recurrent supply chain costs, thus reducing average cost-to-serve.
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