Author: Mike Wilkinson

United Lincolnshire Hospitals NHS Trust is one of the largest trusts in the country. They provide a comprehensive range of hospital-based medical, surgical, paediatric, obstetric and gynaecological services to the people of Lincolnshire and beyond, through 3 main hospitals and 90 other locations.

With a turnover of more than £400m each year, they invest millions in improving clinical services by replacing and upgrading medical equipment, modernising facilities and improving the IT infrastructure.

To ensure maximum benefits from these investments, costing is a business critical issue.

We spoke to Assistant Finance Manager, Robin Solly at United Lincolnshire on how their use of CACI’s flagship solution Synergy 4 is helping them reach their goals.

The challenge

For the United Lincolnshire Hospital Trust, costing had always been an exercise undertaken purely for the purpose of the national cost collection. For the teams involved, the manual process of extracting the data and getting the required outputs was extremely difficult, meaning the data was rarely used for operational or strategic purposes.

A new push for change came as the mandated costing requirements for acute trusts changed and CACI was appointed to deliver a solution that would enable all of these improvements.

The solution

Once CACI had identified Synergy 4 as the best solution, a nine-month implementation phase began.

Robin Solly from United Lincolnshire’s finance team commented on the approach that was taken to ensure the solution was built with the trust in mind:

“Our implementation phase had superb on-site support from a CACI consultant, who spent considerable time in understanding our organisation so that the construct of our costing model reflected the way in which the Trust’s activity is delivered.” Robin Solly, United Lincolnshire

Ease of use for the costing practitioner was an important aspect to ensure the Trust could get maximum benefit in an efficient way. Synergy was implemented for the trust to be able to automate processes that had previously been manual, time consuming exercises, which in turn removed a significant amount of time from the costing process.

Outcomes for United Lincolnshire

Since the implementation of Synergy 4, the trust has been able to produce quarterly PLICS reporting. A summarised model of income against expenditure, by specialty and point-of-delivery has been made available to clinical service managers and patient level outputs available to local finance teams.

Robin explained that the ability to drill down into the detail help support the key insights revealed at the summary level.

“PLICS data is now a key analysis tool used in our acute service review process with a number of specialties specifically requesting detailed patient level financial analysis to understand which clinical activities are generating a positive / negative contribution margin and why.” Robin Solly, United Lincolnshire

Robin went on to recount a recent example of a department seeing direct benefits from this solution:

“There was the specialty who, as a result of our patient level analysis, realised that a whole strata of their activity was not being charged to our commissioners due to an administration error that precluded its inclusion in our SLAM reports. Without PLICS, this would not have happened and has resulted in substantial additional income for the Trust.” Robin Solly, United Lincolnshire

Empowered with detailed insights, the United Lincolnshire Hospital trust continue to work with CACI on how they can take further steps to generate more insight from their data and improve outcomes across the trust.

Somerset NHS Foundation trust (SFT) is the first trust on English mainland to provide community, mental health and acute hospital services. We spoke to Peter Fry, Head of Costing and SLR, about the recent trust changes and how Synergy is helping them join up their costing data.

Background

In 2017, Somerset Partnership NHS Foundation Trust and Taunton and Somerset NHS Foundation Trust formed an alliance designed to support a close working relationship between the two trusts. Later that year, the trusts moved to working from a single, joined up set of objectives that spanned across all services.

As this approach progressed and colleagues reported on the benefit gained from working in this way, they sought to go a step further and formally merge. This came to fruition in April 2020, where the trusts merged to become Somerset Foundation NHS Trust.

Prior to the merger, Peter had come from working on the mental health and community costing side at Somerset Partnership NHS Foundation trust, and since the merger is now is working with an income and costing team of six, who work across all services (acute, mental health and community) and cover costing, service line reporting (SLR), contract and reporting.

Choosing a single costing solution

Initially, both trusts had been using different costing solutions, and so a decision had to be made on a sole solution to take them forward.

Peter explains “When we merged and we were considering which solution to go with, during our search we spoke to a lot of other trusts who told us their stories around how they were using CACI’s recent developments in Synergy and the good experience and improvements they were able to make through using it”.

There were a number of factors that impacted the decision to elect CACI and Synergy as their costing solution, and flexibility with complex data, was a high priority on the list.

“Having worked with Synergy before, we knew the way worked would fit our needs for flexibility. Unlike other providers, with Synergy you get given the software, you get given the training and then you can go away and develop it yourself and build it out however you need. That flexibility for a trust like ours which covers acute, mental health and community was incredibly important. We needed a solution that made sense for our organisation – and Synergy makes complete sense for us”

Peter goes on to describe the benefit, both technically and financially, for the costing team of being able to develop and build in Synergy.

“We’ve got a really good costing team in house, so we weren’t looking for a provider who would go away and do all of the work for us. In addition to the high costs involved of a provider doing it all for us, we wanted to build it ourselves so we know how it works, and when we share the data with people we know how each and every cost has been arrived at, and can communicate that effectively. So, when we sat down to review which solution to go with, it was very clear that Synergy was the logical decision and would work better with our requirements”.

Finally, Peter talks about how the outputs from Synergy will become extremely important in the coming months and so this was also a big factor when choosing a solution.

“The output is also something that’s really important, and the ability to output data into other front-end analytics solutions like Power BI, means Synergy delivers even more value and cost savings to the trust – none of the other providers we were looking at could do that. This also means, as our information team already use Power BI, we’re not having to force others to use a different tool in order to look at our costs.”

Getting Synergy up and running

The costing team at SFT are currently getting everything ready for their submission in September and Peter tells us that the feedback has already been positive from his colleagues.

“My team really enjoy using Synergy. We’re still developing our costing model to reflect what we’re doing as a trust, and we’re looking forward to the outputs we want to get out of it and how we can use those going forwards”

Other aspects such as training received and the interaction with the CACI customer care team, have meant Peter’s costing team, who don’t come from a costing background, have been able to hit the ground running.

“The training on Synergy was great, especially for a new team who aren’t traditional costing professionals; we have a junior doctor, a graduate and a colleague from management accounting. The customer care team has also been really good, responsive and very helpful. I really couldn’t have asked for more from CACI”.

What does the future hold?

SFT have shown themselves over the past few years to be a progressive trust that are willing to make real change that improve the wellbeing of patients across all of their services. So, what’s next for them?

“We’re looking forward to the next steps, working with CACI team to start building our dashboards and getting insights out of the data that we can use to support decision making across the trust”

“Long term, as an integrated trust we want to be rolling out analytics such as looking at patient pathways across all of the different services. So, for example, if we invest in a mental health team, does that decrease the number of A&E contacts and meaning less people have a need for those acute services. Costing data will really help with that”

About Synergy

Alongside Somerset NHS Foundation Trust, NHS trusts across the UK are choosing CACI and Synergy as their partner and costing solution to help drive patient outcomes, redesign services and much more.

Humber NHS Foundation Trust and Croydon Health Services NHS Trust have also shared their stories on how Synergy is helping make improvements.

Salford Royal is an integrated provider of hospital, community and social care services, with some 750 beds and over 6,900 staff
providing a range of services to the 240,000 population of Salford, as well as specialist services to Greater Manchester, the North
West and nationally.

The challenge

Management reporting around patient admin data had become cumbersome and slow, and led to poor and often inaccurate reporting. Resource was often spent fixing current problems, rather than finding new solutions and previous attempts at building an in-house data warehouse had failed. The Trust needed a single source of reliable and accurate data that they could gain real insight from.

The solution

CACI’s InView data warehouse provides a single source of information from across PAS, radiology, pathology and EPR modules, with data extraction and loading fully automated, and reports produced daily using SAP BusinessObjects. Qlik dashboards are also being used in A&E, offering a live view and analysis of patient data with predictive capabilities.

The results

The role of data has completely changed. Time is now spent analysing results and developing innovative approaches to data handling to drive real-time insights. A&E can predict patient attendance, likely arrival modes and emergency admissions numbers, per weekday and hour. The self-serve model
has helped greater engagement and understanding from all departments.

“Data quality was a major concern – not any more. A single source of all trust data, with easy to use reporting and visual analyses, has given us huge potential to accurately analyse, predict and improve clinical outcomes.”
Joseph Frost, Head of Business Intelligence, Salford Royal NHS Foundation Trust

Oxford Health NHS Foundation Trust operates across a large region of the South West of England providing physical, mental health and social care.

As a valued customer of CACI, we spoke to Head of Costing, Paul Vincent about some of the challenges his team faced and the improvements they’ve made through effective use of their costing solution Synergy 4.

Tackling time challenges

The teams at Oxford Health were burdened with time consuming cost calculations that could only be produced at a high level – nowhere near their requirements for team and patient level activity-based costing.

Due to the work involved, Paul describes the costing process as being too admin heavy.

“Most of the costings were produced using excel and time was spent processing the data rather than analysing the data.”
Paul Vincent, Head of Costing, Oxford Health

When CACI were appointed, a key deliverable was to implement a solution that allowed Oxford Health to focus on data analysis in order to take actions to improve apportionment and allocation of money, as well as to kick start improving activity data by identifying gaps or lack of recording.

Implementing the right solution

In order to meet the core requirements of an efficient alternative to costing calculations, as well as providing opportunities to analyse the data and gain insight, CACI’s proposed solution was Synergy4.

An NHSI Healthcare Costing Standards compliant, patient level costing solution for end-to-end reporting and management.

As one of the hurdles Oxford Health was facing was that they weren’t able to report at a detailed level, Synergy would help the trust overcome this challenge by allowing activity to be costed at the lowest level and mapping to the trust’s own user defined hierarches to produce the outputs they needed.

Paul told us this is aspect has proven to be key for Oxford Health.

“The amount of detail that we can cost is extremely useful, if the activity data is robust, as we can cost by different criteria e.g. Referring GP and GP Practice, Consultant, Member of Staff that carried out the consultation, age and many more.”
Paul Vincent, Head of Costing, Oxford Health

Outcomes for Oxford Health

Since the implementation of Synergy4 Oxford Health have seen a number of improvements. The time saved on manual processing of the data mean they are now able to focus on data analysis and turn the insights into actions within the trust that directly impact funding.

Paul explains:

“It is now easy to produce costing data by commissioner using patient activity data and we can therefore calculate if a contract is in surplus or deficit. This has helped us as a Trust to negotiate with our main commissioner for further funding. We can also compare costs by geographical areas for the same service using clinical team or postcode.”
Paul Vincent, Head of Costing, Oxford Health

Oxford Health continue work with CACI to maximise the benefits of Synergy and generate insights that help improve outcomes for staff and patients across the trust.

Long standing CACI customer, Humber Teaching NHS Foundation Trust, provides a range of community and in-patient mental health services, learning disability services, community services, children’s and addictions services to people living in Hull, the East Riding of Yorkshire and North Yorkshire.

We spoke to Costing Manager Clare Jacklin and Costing Accountant Adam Copley to understand how they are using CACI’s financial insight solution Synergy, to help drive change across their service lines.

Synergy to overcome costing challenges

In order to obtain business insights, it’s imperative for teams be able to easily work with all the data they need, at the point in time they need it.

One of the early challenges the Humber costing team faced was manually managing large volumes of data with limited functionality. This in turn meant they could only get a very high-level view of the business. Clare and her team knew that they needed a solution that would provide them with specifics on patients and the ability to slice costs into smaller chunks which would show them the impact of changing one element rather than everything.

Alongside the need to get a more granular view on their data, the costing team knew they would need a future proofed solution that could meet their requirements to complete the mandated mental health submissions when they came into effect.

After speaking with the CACI team about these developing requirements, Humber decided to upgrade their solution to CACI’s end to end NHS costing reporting and management solution Synergy4.

“The biggest thing for us as a CACI customer” explains Clare, “has been taking some of the things to more detailed and granular level, more than other trusts have done so far, with the way that we allocate pay and resources. CACI’s Synergy team worked with us to achieve that”

The Synergy4 upgrade, supports the Humber team from day one and importantly on an ongoing basis for all future National Cost submissions changes.

“Coming from a mental health and community services side of things, many of the tools out there have historically been fairly acute based. But working with CACI on Synergy, rather than being given a solution for acute trusts, we’re able to develop what we need for mental health and it answers the questions that we have in these areas”

Improving the submissions process

One clear priority for the costing team is to be able to complete the submissions process as efficiently as possible, with confidence that your data is accurate.

Adam Copley (Costing Account for Humber) gives us his view on how Synergy4, along with its embedded market leading analytics, is supporting them through their submissions:

“The calculations and the process overall is so much quicker. With Synergy4 I can do 2 calculations a day, so when you’re up against it, trying to get submissions in, the ability to do multiple calculations in a short timeframe is really helpful. It allows you to quickly make a change and see how that change impacts everything else.”

He adds how the addition of embedded analytics has enabled them to quickly identify outliers and rectify issues,

“With the Qlik Sense dashboard there’s added output from what you put into the model, so it’s easier to reconcile what’s in there, and check that what you’ve put in, allocation methods and the rules you’ve put in are working in the way you expected, we’re able to interrogate a lot more.”

Using Synergy to impact patient delivery

Since the latest developments in Synergy4, the costing team at Humber have been able to produce reports and analysis that feed into various projects, departments, and will ultimately impact how services are delivered and improved.

Clare shares some details about how costing data extracted from Synergy4 and integrating with analytics and reporting is already being used for a number of improvements.

“The latest Synergy4 development has really helped us. The advancements around Qlik Sense and how we can extract data from Synergy4 enables us to use it in PowerBi.”

She goes on to say “We can now use our data for small projects around things like frequent flyers, where we work with acute trusts, looking at the costs of patients that come back to you time and time again, and using that data and insight we can work out service redesign. In this particular case we were able to provide the costs of specific patients, and support and input that information into the project team that redesigned the liaison services that we had within the trust. Being able to redesign a service like that improves what we deliver to patients.”

What is next for Humber?

Through use of Synergy4 and PowerBi, the team have developed reports for service users that they hope to soon be rolling out across the trust. These reports have been specifically designed with the aim of informing the service decision making.

“We’re going to be reporting on the cost of delivering care to specific types of patients and services and combine that with the ability to dice that by age of patient or type of care that they are receiving” Clare describes, “Plus, the ability to fulfil all of these reporting requests a lot quicker than we’ve ever been able to do before should help our decision making process”

Adam adds “Once we start rolling out these reports and continue to inform changes and improvements (which helps improve our costing even more), this in turn should help us achieve further buy in from other sources within the trust”

With increasing engagement from departments around the trust, CACI’s business insights team are partnering closely with Humber to continually evolve Synergy.

“The team are still working with us to continue to develop some of the things we want to be able to do in the future. So, Synergy isn’t an out of the box solution, CACI take you on the journey with them to continuously improve the product, so it works better for all of us.”

The future of how Humber’s services lines are delivered and how they can be improved, is supporting by the costing data and analysis obtained through use of Synergy and the trust’s other business intelligence tools.

Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust (WWL) are a major acute and community trust dedicated to providing the best possible healthcare. Operating across 5 hospital sites and numerous community locations, they invest around £300m each year, in order to design their services around the needs of their patients.

The challenge

In 2014, WWL saw an opportunity for change. After years of working stuck between two data warehouse versions, the WWL team were consumed by delays, hours of manual processing and a solution that was unreliable and not fit for purpose. As Mark Singleton, Associate Director of IM&T at the trust would later describe, “the future didn’t look bright” – they needed something better.

As increasing mergers and collaboration between trusts was starting to take place, the business case for a new solution emerged, one that would meet all of their requirements, starting with a single version of the truth.

WWL looked at their options, knowing they needed a single data warehouse solution and while in the past this may have been done in house, the trust concluded this wouldn’t meet the timeframe objectives, and with that in mind went out to tender for a partner to help bring in this solution.

The solution – A first implementation of InView

CACI were initially appointed by WWL to implement their proposed solution: InView Express.

The InView data warehouse solution was specifically designed for the NHS market and in December 2014 when CACI were appointed by WWL, it had already been implemented in trusts across the UK.

WWL could see the design of InView had incorporated the complexities required for an NHS data warehouse. It would allow them to produce the trust’s national datasets and statutory returns and bring all siloed data sources into a single data warehouse, providing an accurate and co-ordinated view of the trust’s services. Plus, with the intuitive environment of InView, users across the trust would be able view and analyse the data easily, and subsequently make effective decisions in an efficient way.

Thinking of the future ahead, WWL took the decision to take on all of the InView modules at the beginning, providing the capability to grow as they took on new data sources. This would provide an invaluable decision in 2019 when the trust took on community and mental health services.

Growing data volumes

After benefiting from the InView solution for a few years and expanding its use, a new challenge appeared ahead: an increase of services. WWL were to take on Community and Mental Health services, and this was a significant increase to their services and data.

Mark Singleton (Associate Director of IM&T at WWL) explains that “it’s not everyday that you’re being asked to grow services by 20-25%”, and that taking on these new areas would bring with it many different national datasets that the trust had never dealt with before.

With additional returns and outputs due in a short space of time, WWL turned to CACI’s experience in working with Community data to help them develop these new datasets in order to meet the national standard.

Outcomes for WWL

Since implementing InView and later expanding it to support the new trust requirements, WWL now have a reliable foundation which frees up capacity to focus on analysis of data and more strategic goals.

The team no longer spend time troubleshooting issues or hours processing data manually and can take on proactive improvements in house such as developing SQL.

WWL are making the most of the robustness of InView, with their database projected to be almost 2tb by 2021. For the trust this is invaluable, as with some tables containing over 150 million records, they are able to record and manage vast amounts of historical data.

As CACI have invested and improved InView over the past few years, WWL are also utilising the regular updates in order to continually improve and evolve their reporting. Recently WWL have been looking at semantic reporting as a next step to improving the consolidated view of data across the trust and will be further enhancing their deployment by using the new InView Extensions functionality

By optimising their use of InView, focusing on data analysis and striving to be a data-driven organisation through continual improvements, WWL are empowered to make efficiency savings, and improve the quality of care for the patients across Wigan.

To find out more about InView and our work in the NHS, read more here.

The Challenge

North Bristol NHS Trust (NBT) is one of the largest hospital trusts in the UK with an annual turnover of £532 million.

NBT was struggling with NHS statutory changes, reporting pressures, disparate systems and data quality overheads. In order to solve these challenges NBT looked to implement a trust-wide data warehouse and business intelligence solution.

The core requirement for this solution was to ensure it would be the primary reporting function for the whole trust. NBT wanted to provide all data needs to any department across the Trust through a centralised BI function that would have this solution at its heart.

In addition to the data warehousing solution, NBT had many disparate reporting tool options and it was important to implement one solution where any member of staff could go to source any report or dashboard output.

Following implementation, NBT needed the solution to be maintained under a managed service offering but built in a way to ensure self-sufficiency in the Trust’s team, so that the solution could be extended in line with new and changed requirements

The solution

NBT chose CACI to provide and implement a new data architecture including a Trust-wide data warehouse solution, Managed Service Support, and deployment of leading BI software.

The solution integrates a vast quantity of data from many disparate sources including administrative, clinical and finance systems. Additionally, the solution incorporates business logic in order to calculate and model the trust’s income. The solution is fully maintained by CACI through the provision of a managed service and a structured product release schedule.

The solution incorporates a layered database architecture incorporating integration, Operational Data Store, translation, star schema and semantic data mart layers.

This design reduces ongoing maintenance costs and increases flexibility to new requirements or interface changes. Historical data integrity is preserved through the implementation of an efficient slowly changing dimensions design and a full data quality process is built into the data flow enabling reporting and resolution of data quality issues. Both row and column level security governance is built into the design along with NHS privacy measures.

The logical design of the solution along with its interfaces is documented along with physical database design features to achieve optimal performance on the operating platform.

Data was migrated and re-factored from legacy solutions to maintain data history, and particular attention was made to how the cut-over point was implemented.

NBT benefited from CACI’s experience in promoting outcome-based dashboards for the healthcare sector. This enabled NBT to set up the best possible framework and method for rollout of BI analytics across the organisation, ensuring high stakeholder engagement for outcome alignment and adoption of change. Experience in the use of data science has allowed the Trust to further exploit its data to help improve patient outcomes through accurate predictions.

The results

Since implementation, NBT has been able to centralise its BI function and source all data through the single-governed version of the truth. It has ensured data readiness, completeness and accuracy is in place and always available for reporting.

NBT’s income is comprehensively calculated on a daily basis, with data quality issues managed and corrected in a timely fashion. The accuracy and completeness of this process has delivered a significant financial benefit to the Trust and an early return on investment.

Data is readily available and accessible to stakeholders across the Trust via a centralised portal, with most data updated on a daily basis and some updated every two minutes, allowing near real-time decision making. This has been especially valuable for the ED department and the ED clinicians as David Hale, Assistant Director of Informatics: Business Intelligence, IM&T at NBT, explains:

“They were able to see on arrival and refreshed every two minutes, the wait time in ED, attendances, discharges and performance… and they could see that information benchmarked against how other EDs were performing as well. We’d never been able to do that before. For the consultants, it has completely changed their approach to work. It’s become a platform on which we intend to build further real time reporting.”

Following a jointly executed project, training and knowledge transfer, the NBT team are fully empowered and self-sufficient in using and future expansion of the solution. This covers construction of analytics and addition of new data sources.

Through the innovative design of the CACI solution, NBT benefits from a fully-maintained core product, yet retain the flexibility to expand the solution to meet local and future needs (e.g. adding new data attributes, entities and rules).

NBT are part of the CACI NHS user community and benefit from the sharing of content and ideas with other trusts, as well as benefitting from CACI’s commitment to and investment in the NHS.

After working with CACI for 2 years, NBT was faced with the challenge of responding to Covid-19, when it was asked by NHS England to host the new NHS Nightingale hospital being built at the University of the West of England’s (UWE Bristol) Frenchay campus. The relationship built with CACI over time meant that they knew they could pick up the phone and reach out for support on this time-sensitive project. You can read more about the Nightingale project here.