The NHS faces many challenges when it comes to service efficiencies

The arrival of Integrated Care Systems (ICSs) demonstrates the importance of ‘whole system’ conversations on health outcomes for patient populations, with the need to provide equal access to medicines and reduced unwarranted variation.

In addition, COVID-19 service displacement has not only caused increased waiting times for outpatient appointments and elective surgery, with the elective waiting list rising to 7.07 million in September 2022 and the highest on record1, but also fast-tracked innovation such as digital appointments.

“As pressures mount on the NHS with the background of COVID, long elective waiting lists and staff shortages, integrated care systems will need to look towards service efficiencies to improve delivery of services. A lot has changed over the last two years, with once unheard-of innovations such as virtual clinics now becoming commonplace, and which offer the opportunity to radically improve our model of care. Although optimising service delivery is nothing new, the post-COVID world offers an opportunity to refine resourcing so that patient pathways can provide the best outcomes for our patients and to prioritise those who are most in need.”
Dr Simon Wan Yau Ming, previously an NHS doctor and now a Clinical Consultant at CorEvitas

At the same time, further advancements in both pharmacotherapy and surgery have rapidly changed the landscape for many diseases in recent years. These new medicines and devices have the potential to improve patient outcomes and reduce healthcare resource use and cost, but only when the right patient is offered the right treatment at the right time.

To achieve optimal patient care, equity of healthcare provision and reverse clinical inertia, we need to aim for consistency in the implementation of the NHS care pathway in localities across the country, addressing the specific local challenges.2

Challenges associated with mapping patient pathways

To initiate change or service transformation within the NHS, it is crucial to map and visualise the complex real-world patient pathways and compare the ‘as-is’ scenario with a gold-standard solution in terms of capacity, cost, resource use or patient outcomes.

As this is an enormous challenge that the health and care system cannot address alone, pharmaceutical and medical device companies have the opportunity to support clinicians and commissioners with tools underpinned by real world evidence, to support decision-making and the co-design of the optimal solution relevant to a locality. Not only is it crucial to provide proof of the value of a new intervention in order to create confidence in new technology and medicines, but stakeholders demand models that consider the local characteristics and differences in population demographics, service capacity, prescribing practice and more. This provides them with the ability to visualise and test the impact of any changes on patients and healthcare providers in a no-risk environment.

In addition, real-world data offers valuable insights into service performance and achievements. Whilst healthcare has witnessed a great deal of technological advancement, more can be done to truly embrace it in the way other industries have to optimise workflows and outcomes. Often, critical decisions are still based on a pathway mapping exercise with sticky notes or using a whiteboard. The solutions found and put into practice provide key learnings but the success stories and more so, the failures, are often not spoken about enough.

“How do we find ways to understand complicated individual needs and allow the service to be customised to patients in a way that doesn’t let costs spiral out of control? Understanding through data is one of the ways to do that, along with equipping people with the tools to manage their own health more effectively.”
Sarah Wilkinson, Chief Executive, NHS Digital3

How can we get better at sharing best practice? How can we support decision-making with innovative modelling tools? How can we make best use of the available real-world evidence that holds information on patient profiles, outcomes, disease burden and costings, e.g., Hospital Episode Statistics (HES) data, covering all NHS hospitals in England?

Ophthalmology service redesign with Vantage® Simulations

CorEvitas (formerly Health iQ), has pioneered simulation models for more than 10 years and has successfully established the use of simulations for pharma, medical devices manufacturers, and NHS clients.

As an example, ophthalmology services now have the opportunity to treat previously untreatable common eye conditions with new retina therapy options. However, this adds significant pressure on eye clinics, especially since the increasing demand for eye clinic appointments comes from patients with chronic diseases such as macular degeneration, glaucoma, and diabetic eye disease which require long-term treatment and monitoring.

CorEvitas’ Ophthalmology Service Redesign Model visualised a general wet-AMD clinic pathway quantifying and demonstrating the bottlenecks and delays related with differing medication posology but also the insufficient capacity that clinics currently face. Providing the flexibility of local pathway variation via altering the administration and associated resources available for each touchpoint, the model allowed users to examine how inefficiencies and delays could be avoided and importantly to evaluate the downstream effect on the clinic capacity. Based on expert knowledge from several frontline NHS clinicians and staff, real-world data to inform population data as well as clinical studies to inform the assumptions around patient outcomes, the model supported widespread engagement with UK ophthalmology departments to identify bottlenecks and inefficiencies in the system.

Summary

Simulations enable the investigation of the real-world impact of a multitude of changes such as medication or device choice, service arrangements, resource use and capacity in a risk-free environment. Typical use cases include:

  • Quantify and compare the effects of a new treatment intervention vs. standard of care
  • Demonstrate service improvements through a new treatment intervention or changes in delivery of patient care
  • Understand the down-stream impact of treatment choice not only on patient outcomes and related aftercare but also consider patient satisfaction or environmental impact

Vantage® Simulations have proven to be successful in facilitating change within UK and European health systems, through a highly customised solution that brings together a wealth of knowledge from multiple disciplines, such as clinicians, pharmacists, commissioners, health economists, data scientists, and simulation specialists.Scenarios can be developed for the local health economy, and support finding answers in partnership to achieve the best outcomes for patients and provide the most efficient and best service for local systems.

  1. NHS England, Consultant-led Referral to Treatment Waiting Times Data 2022-23, https://www.england.nhs.uk/statistics/statistical-work-areas/rtt-waiting-times/rtt-data-2022-23/
  2. South East Clinical Senate (2016). Reducing avoidable hospital based care: re-thinking out of hospital clinical pathways, https://secsenate.nhs.uk/wp-content/uploads/2020/06/Reducing-avoidable-hospital-based-care-rethinking-out-of-hospital-clinical-pathways.pdf
  3. Davies, M. (2020). Rethinking Healthcare in a time of COVID-19, IBM and Watson Health, Europe, Middle East and Africa, https://www.ibm.com/downloads/cas/5YAM9A6D

Parita Patel is Vantage® Product Director and Eva Fuchs is Simulations Solutions Specialist at CorEvitas. Go to https://www.corevitas.com/vantage/simulations