Adrian Newland - How diagnostics can drive efficiency within the NHS

1. HOW DIAGNOSTICS CAN DRIVE
EFFICIENCY WITHIN THE NHS
Event: UK DIAGNOSTICS SUMMIT
Presenters: Professor Adrian Newland, Chair, National
Pathology Optimisation Board
Date: 8th November 2018

2. Dunn et al, Deficits in the NHS, King’s Fund 2016
‘..factors such as the growing
and ageing population, patients’
rising expectations and an
increased prevalence of long-
term conditions have increased
demand for NHS services but
without an equivalent growth in
spending to pay for it….’

3. Lafond S et al: Hospital finances & productivity: in a critical condition?
Health Foundation 2015

4. Unwarranted Variation: final report
summary, January 2016

5. The Weighted Activity Unit (WAU)
• The type of treatments provided by acute trusts differ substantially
(casemix).
• This makes it difficult to make robust comparisons between trusts
using simple measures of output.
• Both in the UK and elsewhere (e.g. US, Australia), this issue is
tackled by using a measure of cost-weighted output.
• Cost-weighting is used to adjust for differences in casemix between
trusts.
• Lord Carter has pioneered the use of the Weighted Activity Unit
(WAU).
• One WAU is the equivalent of an elective inpatient admission,
based on the cost of providing that treatment (≈£3,500).

7. Results : The Carter review
• Report saw £5bn
of value
opportunity 2020-
21, if unwarranted
variation removed.
• New Operational
Productivity
Directorate in
NHSI to deliver
report’s
recommendations
09.16)
The opportunity

8. Why does diagnostics need to change?
• Over the last 5 years demand for diagnostic tests
has increased by 26.8%
• The total waiting list has increased by 36%
• The diagnostic standard of 6 weeks has not been
met since November 2013
• Everyone accessing diagnostic services should
receive where possible a diagnosis at first point of
contact
• This would support earlier diagnosis, earlier
intervention with less costly treatments and a
potential change in disease burden

9. Diagnostics and the clinical pathway
• 80% of pathways start with diagnostic services
Primary and Secondary care
• Services deliver over1bn tests yearly at a cost
of ~£9.0bn (10% of NHS spend)
• Effective diagnostics fundamental to
optimising healthcare provision, improving
outcomes and driving efficiencies
• Maximising value from the £17.5bn medicines
spend

10. Diagnostics and the Long Term Plan
Priority areas within the LTP
• Cancer – Rapid diagnostic centres
• Cardiovascular and Respiratory – Early diagnosis and
intervention
• Paediatric and Maternal Health – appropriate use of
diagnostics
• Research and Innovation – support the systematic
uptake of new technologies
• Genomics – accessibility to other diagnostics to
provide integrated reporting
• Primary and Community care – joined up service

11. Why does pathology need to change?
• Wide variations in in quality and service provision
Atlas of Variation of Diagnostic Services
Accreditation of services to ISO standards
Quality Assurance
Access and control of Point of care
• Insufficient data and digital infrastructure
Interoperability impacts on resource utilisation
Over testing and duplicate testing
• Insufficient equipment
• Demand and capacity issues
• Complex and variable commissioning arrangements
Specialised and CCG
Little incentive for efficiency and financial sustainability

12. Background; 2016/17 data
collection
• Case for change
identified through
successive Carter
reports
• Operational Productivity
Directorate
commissioned large
scale data collection
• This data has allowed
for the identification and
quantification of
sources of unwarranted
variation
• Modelling of the data
has identified
opportunities for
efficiency savings

13. 2017/18 Data insights – Changes
2017/8 information
122 Providers
30m fewer tests
£33.6m cost-savings

14. 16 |
• Imaging is an essential part of the vast majority
of patient pathways
• Imaging is critical for screening and assisting
with diagnosis and treatment of patient
pathways
• There is under provision of imaging
capacity within the NHS, exacerbated by
high vacancy rates and the age
demographics requiring both outsourcing and
insourcing to meet demand
• Lack of detailed benchmarking data to date
has prevented opportunities to identify
unwarranted variation
• High levels of variation in radiographer
reporting of plain films (77% to 0%) and in
skill mix
• Variation in the costs per report (Complexity
not accounted for currently)
• High level of clinical service engagement
with 22 Expressions of interest to work with
NHS Improvement to be an ‘Early Adopter’
Imaging Network
Transforming Imaging Services –
Improving Efficiency & Sustainability
£2 Billion Spent
onDelivering
Imaging
Services
Non Medical
Workforce 23,500
(vacancy rates of
15%)
3,000 Medical
Consultants
(vacancy rates 12.5% &
ageing demographic)
£134 Million spent on
Outsourcing &
Insourcing
(to manage demand)*
39 Million
reports
Upper quartile: £69 / Report
Median: £55 / Report
Lower Quartile: £46 / Report
Cost per report
NHS Improvement currently working with
4 Early Adopter Imaging Networks to identify
the benefits of Imaging networks
* Data Collection for 2016/17
(Figure likely to be much higher for 2017/18)
All Staff Update 11/7/18
Diagnostic Services - Imaging

15. Equipment sales and after-market
17
• Aged asset base
According to the industry, 12% of CT and 29% of MRI scanners are >10
years old
• Lack of capital resources
Replacement of imaging equipment competing with multiple other priorities
• Managed Equipment Services
Shortage of clear case studies demonstrating value for money
• Third-party maintenance and service contracts
Little evidence of strong competition in the Imaging equipment market to
challenge OEM dominance

16. 19 |
In 2017/18, Clinical & Workforce Productivity delivered a range of significant
achievements, supporting NHS Trusts to improve Productivity.
30
£78m
£571m
1200+
£327m
Workforce “Deep Dives” completed in Wave 1
across Nursing, Doctors, AHPs and Pharmacy.
Case studies published as part of our Tier 1
offer
Metrics developed for Imaging Services in the
newly published Model Hospital Compartment
Capital funding secured for investment in
Pharmacy infrastructure IT systems and E-
Prescribing systems to improve medication
safety, efficiency and interoperability
Clinical & Workforce Productivity – Highlights
29
saved through the “Top 10 Medicines”,
switching to cheaper generic and biosimilar
medicines, improving patient access
Pathology Networks modelled and mapped and
communicated to the NHS in England
£33.6m of diagnostic services-related cost
improvements delivered by Trusts
of workforce-related cost improvements
delivered by Trusts
£26m
Capital funding secured for investment in e-
Rostering and e-Job Planning systems to
ensure comprehensive coverage (all staff, all
sectors)
All Staff Update 11/7/18

17. Questions?