Our team brings together
- Modelling and decision analysis
- Impact assessment
- Business planning and service improvement
- Forecasting and simulation
- Demand analysis and capacity planning
- Govemance and performance improvement
- Programme evaluation
- Survey design and analysis
- Change management
This enables us to support
decision makers to:
- Decide between priorities
- Allocate resources more effectively
- Develop and implement plans
- Consult with stakeholders
- Identify and realise benefits
- Manage risk
- Evaluate what works
- Sustain improvement
Research into specialist nursing care for people with secondary breast cancer
Apteligen is delighted to have supported Breast Cancer Care on its research into nursing care for people with secondary breast cancer in England, Wales and Scotland. The report shines a light for the first time on the level of specialist nursing care available for people with life limiting breast cancer across the three nations. It presents the findings from our survey of nurses in every acute NHS Trust in England, and every Health Board in Wales and Scotland, and provides comprehensive analysis of our in-depth research in a selection of hospitals.
The report sets out a number of recommendations for policy-makers and those responsible for commissioning and delivering breast care services, and makes a compelling case for change – to ensure that every person with incurable breast cancer can get the care and support they need to live well with the disease for as long as possible.
Read the report here.
Impact evaluation of the Healthy Communities programme in London
A pan-London transformation unit – Healthy London Partnership – was established in 2015 to undertake a range of collaborative transformation programmes on behalf of all of London’s Clinical Commissioning Groups and NHS England.
The Prevention Programme is one of 13 Healthy London Partnership Programmes supporting the overarching goal for London to be the healthiest global city, where Londoners are empowered to maintain their own health and are supported to be as healthy as they can be.
Apteligen, in association with Delta Public Health Consulting and delivery partner Uscreates, was commissioned to undertake an impact evaluation of three Healthy Communities initiatives aimed at tackling the rise in childhood obesity. The evaluation was undertaken using a mixed-method formative design, combining qualitative and quantitative data collection methods. Data collection was based around a theory of change at the programme level, and aligned to each of the three pilot projects. It sought to assess the ongoing validity of the ideas as new evidence emerged, and to focus on those things that were most likely to generate the intended outcomes over a longer time period.
The project has shown that it is possible to deliver health outcomes outside the formal health system, and has evidenced how big businesses, social enterprises and the voluntary sector can positively affect health. In only a short amount of time, the three local initiatives demonstrated the potential to reduce childhood obesity within their neighbourhoods and – should they scale – across London.
“Apteligen have been brilliant from start to finish. They have been so patient and responsive to the evolving needs of the project, proactively communicating throughout, and have delivered a high quality end product” – Project Manager, Prevention, Healthy London Partnership
Read the report here.
You can also find out more about the Healthy Communities programme here.
A process and impact evaluation of Third Sector Health and Social Care Brokers in West Wales
Apteligen recently completed a wide-ranging process and impact evaluation of the role of Third Sector Health and Social Care Brokers in West Wales. The Broker role is operating in three counties across Wales and we used a theory of change approach, supported by a mixture of qualitative and quantitative data collection methods, to assess the extent to which the role supported more integrated working across sectors, and built capacity in community and voluntary services. As part of this work we ran a number of learning and exchange events to provide practitioners with opportunities for improving how they work. We also estimated the return on investment of the Broker role, which showed that the potential savings to the public purse, including from improved well-being, are likely to be greater than the investment in the roles over the short to medium term.
An impact evaluation of Spice Time Credits
Apteligen has recently completed a two-year evaluation of the impact of Time Credits, on behalf of Spice Innovations. Spice has developed agency-based Time Credits as a systematic, low cost and sustainable methodology for engaging many more people in communities as active participants, volunteers and in ‘co-producing’ public and community services. Our evaluation looked at the outputs from the programme (what happened as a result of Time Credits), the difference they made (outcomes) as relevant to the different stakeholder groups, and identified lessons for the future.
The main objective of the evaluation was to measure the impact on the community, which meant measuring a number of different elements that the Time Credits scheme set out to positively impact, including:
- Community engagement
- Levels of voluntary participation
- Health and well-being – especially amongst vulnerable people, and
- The capacity of organisations and groups to deliver better services for local people.
The scheme now runs in a number of different localities across England and Wales, and is still expanding. It was therefore also important to test the transferability of Time Credits when different variables (such as, in this case, locality) were applied.
We measured the scheme’s impact using a number of methods, including interviews, workshops and surveys. We designed an approach that recognised the need to collect robust evidence, with all stakeholders participating in practical and meaningful ways, and which focused on local issues as well as the broader strategic view.
Apteligen has now been commissioned to undertake further research on the changes observed within Spice’s partner organisations. This is so that Spice can more effectively support organisations to use Time Credits as a co-production tool for designing and delivering public services in the future.
The 2015 update report on the impact of Time Credits is also available here.
Supporting People options analysis and alignment of resources
The team was involved in undertaking a project to help a local authority manage the reduction in funding for supported housing whilst minimising the impact on vulnerable adults. The work began with an analysis of the current and future demand for housing related support services for vulnerable adults in the area, and used this to inform the development of a set of options regarding how savings could be achieved across different services. Apteligen was particularly involved in providing quantitative and technical support. This included producing and presenting benchmarking information, and modelling different financial scenarios to help the Council to better understand the impact of the different savings options on each of the client groups.
The project started with work to consolidate numerous data returns from each the services, including information on sources of funding, throughput, utilisation and outcomes. We then designed an Excel tool which allowed users to view all of the information about different client groups and services in one location for the first time. This provided insight into the overall and relative performance of different services. We also modelled the various scenarios in order to produce a set of options for the Council for future funding of services, and worked with the Council to determine the preferred approach.
Contact Sam or John for further information.
A national study into the costs of the family nurse partnership programme in England
“The research and analysis carried out by Apteligen was very thorough. The output document is accessible to stakeholders from a variety of backgrounds and we are very pleased to be publishing the report. The Apteligen team were accommodating to all additional requests.”
Apteligen was commissioned by the Department of Health in England to undertake a study into the costs of providing the Family Nurse Partnership (FNP) Programme. The study brought together, for the first time, a comprehensive dataset of local costs associated with delivering FNP and a more in-depth understanding of the main cost drivers locally. This included understanding the reasons for variation in delivery costs across the existing FNP sites. The results of this study will facilitate more effective planning for the expansion of the programme over the coming years and enable providers to look at where there might be inefficiencies in the system that could be addressed in the future. It will also provide a solid baseline against which future financial performance of the programme could be measured.
The Apteligen team designed a standardised data collection tool for the study, which was completed by nearly two thirds of FNP sites in England. The information from the data collection tool was then analysed and combined with the findings from a series of follow-up interviews with senior managers and FNP supervisors, in order to understand how and why costs vary across the country. A summary of the final report is available here.
Contact John for more information.
Modelling theatre requirements for a large NHS Trust
Within the context of its current operating theatre refurbishment plans, our client was looking to understand changes in the number of theatres required based on different variables. These included: current and future activity, growth in demand for services, and theatre utilisation, productivity and throughput.
In order to do this, Apteligen was commissioned to develop a theatre modelling tool.
Given the scale of capital investment required for the project, the model was developed to take account of the impact of factors that may change longer term demand, not just immediate activity. Though only seen as a first step in developing a more comprehensive understanding of theatre requirements and the impact of different variables on the amount of space needed, the tool was required to be as robust as possible given the information available. It needed to reflect changes in the local population, possible growth in catchment area, and changes in the type and complexity of procedures likely to be undertaken. The tool enables end users to edit simple assumptions in order to explore the impact on the number of theatres required.
Our work has shown that there is potential for the organisation to need more theatres than it had originally expected. Early identification of this potential will allow more effective planning to be undertaken now, and will inform the financial analysis required to explore the costs and benefits of additional theatre capacity, as well as the impact of this volume of work on other facilities such as general wards and the intensive care unit.
This project demonstrates our ability to handle complex data and information, and to build an interactive tool that is relevant and useful for planners, clinicians and senior decision makers.
Contact Sam for further information.
Providing technical skills & advice for a major transformation programme
Apteligen supported a number of different improvement projects in a large acute teaching hospital. These were part of a major transformation programme to improve the efficiency and effectiveness of diagnostics services through better and more accessible information, and improved customer service.
The hospital provides a full range of diagnostics services for both internal and external customers, and benefits from a close association with clinical academic and teaching departments in order to adopt more innovative approaches and to improve the quality of the services provided. The Trust has set-out a clear strategy for how these services need to develop and evolve in order to respond to today’s challenging healthcare market.
Specifically, Apteligen’s work included:
- support to engage a wider audience, including the Trust’s management board, in the vision, benefits, and high level work plan for its strategy for diagnostics transformation;
- development of a coherent project plan which brings together the various strands of work and sets out how this should be communicated with key stakeholders;
- guidance on the establishment and implementation of a Trust-wide joint governance board that takes responsibility for strengthening corporate governance arrangements for diagnostic services; and
- undertaking an evidence review for pathology demand management initiatives;
This project demonstrates our understanding of acute hospital services and the role of diagnostics in supporting a more efficient and patient-centred care pathway. It also demonstrates our ability to provide technical advice for senior decision- makers, plan effective stakeholder engagement activities, and bring together relevant evidence and information to support a major change programme.
Contact John for further information.
Review of Closing the Gap through Clinical Communities: The Health Foundation
“John and Sam worked collaboratively with us, making sure that the survey met our needs, and were also flexible in terms of any changes or adaptations we wanted to make. John and Sam are easy to work with, were approachable and flexible to our needs. The work we commissioned was delivered on time, to a high quality and was excellent value for money.”
Apteligen was commissioned by The Health Foundation to carry out a review to understand the extent to which the learning and development support package on one of their largest quality improvement programmes – Closing the Gap through Clinical Communities – was meeting the needs of individuals and project teams involved.
Our role involved seeking the views of over 100 individuals through an online survey and using the findings from this to advise The Health Foundation on how well this approach to delivering support is working. It also involved developing recommendations for how the support package can be changed or improved in the future.
Apteligen designed and disseminated the survey using a web-based tool, and achieved a response rate of over 65%. The survey included a mix of forced and free text responses and was analysed using a combination of quantitative and descriptive analysis. Two reports were produced which enabled the findings to be shared easily with the survey participants and other senior stakeholders, whilst a more detailed report was provided to support the findings and recommendations.
This project demonstrates our ability to design, disseminate and analyse surveys, and to implement a process to achieve good response rates. It also shows our ability to present findings in an accessible format for different audiences, and to work with clients to provide insightful and pragmatic recommendations.
Contact us for further information.
Mapping models of integration between diabetes health and social care services in London
In order to understand the extent to which care services in London are truly joined up for people with Diabetes, London Councils commissioned Apteligen in partnership with the Public Health Action Support Team (PHAST) to undertake a comprehensive study of the current models of care for Type 2 Diabetes in place across the Capital. London Councils works to secure more resources for London and to get the best possible deal for London’s 33 councils. This research provided an important step forward in making the case for closer working and more integrated service provision between the NHS and local authorities, within the context of the Government’s proposed policy reforms.
The project focused on demonstrating the benefits and impact of interventions for people living with or at risk of diabetes, encompassing the following areas:
• integrated service provision across health and social care
• services aimed at bringing care closer to home
• supported self-management, and
• prevention and early intervention
We undertook a rapid and wide ranging stakeholder consultation exercise alongside an in-depth review of relevant documentation such as commissioning plans and care pathways, in order to build a picture of the existing models of care in London, and to set out the main barriers to full integration from a practical perspective. This was set alongside a review of the recent published literature on integrated care. We followed a structured data collection and analysis process so we could identify the key features of each model and to map out those which were most predominant.
Using data gathered from senior leaders across London’s NHS and Councils, we also built a detailed cost benefit model to assess the financial opportunity associated with greater integration in London.
This project demonstrates our ability to apply pragmatic and robust research methods in a complex and rapidly changing policy area. It built on our extensive and recent experience of evaluating integrated models of Diabetes care in London and our understanding of the drivers and incentives for greater adoption and spread of integrated ways of working. The partnership between Apteligen and PHAST brought together a team with a proven track record in research, an ability to engage with a wide range of stakeholders, and an ability to develop concise, meaningful and high impact outputs. For this work, we also drew on our substantial analytical expertise, including the design and development of cost benefit models for this and other disease areas.
Developing a costing model for pathology services
Apteligen is currently engaged in the development of an activity-based costing model for pathology services in a large acute teaching hospital. This forms part of a wider transformation programme aimed at improving the efficiency and effectiveness of diagnostics services, through better and more accessible information for the clinical teams.
The hospital currently provides the full range of pathology tests for both internal and external customers. It benefits from a close association with clinical academic and teaching departments in order to adopt more innovative approaches and to improve the quality of the services they provide. This project aims to develop a baseline costing model which will provide more robust information about the costs incurred for the provision of different tests, and establish a platform from which the pathology services can work to improve efficiency and to offer a more competitive service to the current client base. The project involves:
- cleaning, coding and interpreting trust data, including financial data such as accounting ledgers, workforce and activity data and other resource data;
- developing data collection tools to gather more bespoke information;
- undertaking workshops and interviews with senior management staff to develop an activity profile and to define how to allocate costs;
- developing the costing model in the specialist software Prodacapo®;
- creating Excel and Access tools which support the trust in updating the costing model independently in future.
In addition to the costing model, Apteligen is also providing:
- ad hoc analysis to support other transformation workstreams; and
- developing a database tool to collate and facilitate the analysis of imaging data.
This project demonstrates our understanding of acute hospital services and the role of diagnostics in supporting a more efficient and patient-centred care pathway. It also demonstrates our expertise in:
- the development of data collection tools;
- database development using MS Access;
- designing tools which automate data cleaning and analysis processes;
- engaging with data providers to explain complex modelling in a way that they can interact with and make a positive contribution to;
- the pragmatic use of information and data to develop fit for purpose tools and approaches.
It also demonstrates our experience in providing both guidance and practical outputs to support clients now and into the future.
Contact Sam for more details.
Methodological advice and data analysis of police datasets
Apteligen was commissioned to provide quantitative advisory and analytical support in a piece of research being undertaken for wards within two police forces. We supported a phase of work which involved developing a profile of victims and offenders of violent crime and burglary and developing greater understanding crime hotspots and patterns in crime. The work was to be used to ensure appropriate targeting of key local priorities for a set of new interventions. In particular, our role involved:
• A review of the existing analysis plan and advice on the proposed analysis / additional analysis to address the research questions. We identified risks and limitations associated with some methodologies, as well as proposed other approaches.
• A detailed analysis guide to identify specific data sources and fields to undertake the research questions.
• Support on quality assurance and on data anonymisation.
• Analysis and presentation of results. As part of the presentation of the data we designed a series of charts to show different ways data may be presented to aid different audiences in engaging with the analysis.
Contact Sam for more information.
Assessing the potential benefits of The Health and Social Care Award finalists to the wider NHS
The NHS Institute of Innovation and Improvement and the Department of Health sponsor the annual Health and Social Care Awards, to highlight innovation and excellence and to encourage collaborative working across Health and Social Care. Given the number of high quality submissions for the awards the Institute wanted to understand the potential benefits if these projects were scaled up to the wider NHS.
Our work involved a number of stages:
- Reviewing the submissions from the finalists to explore which interventions had the greatest potential to scale-up nationally and to make real savings and improvements;
- Interviewing representatives from finalist sites to:
- - understand more about how their innovation had been implemented;
- - develop a set of modelling assumptions;
- - make an assessment of the extent to which impacts could be attributed to the interventions they made;
- Developing user-friendly Excel models (before and after the interventions) to examine the true benefits of the changes at a local level and the potential impact if applied nationally. These models were used to provide range estimates and explore sensitivities to modelling assumptions;
- Translating the findings in order to provide advice and guidance on the critical success factors for each intervention.
The interventions modelled included areas such as:
- Falls reduction interventions and the impact on bed day requirements;
- The impact of interventions to reduce carbon emissions in a Trust;
- The introduction of an outpatient management system;
- Different models of care for plastic surgery;
- New models for end of life care; and
- The use of out of hours services to support GP services respond to patient home visits.
The focus of the work was on achieving cashable savings and measurable quality improvements, rather than just theoretical benefits. The analysis and models produced were used to inform further work in this area, both at a national and local level.
This project was undertaken by the Matrix Knowledge Group prior to the formation of Apteligen, and was managed by Sam, who also led on the delivery of modelling and analysis. John provided delivery support for interviews with stakeholders, and in relation to translating findings.
The project demonstrates our experience in developing and providing user-friendly tools which can be used on an ongoing basis, in addition to a one-off report. It also demonstrates our ability to model and interpret analytical findings across a range of different healthcare areas.
Contact us for more information.
Evaluation of the Orthopaedic Rapid Improvement Programme
This project was a retrospective evaluation of the NHS Institute’s Orthopaedic Rapid Improvement Programme. The programme was designed to facilitate rapid and sustainable improvements in the provision of elective and emergency orthopaedic healthcare services across the NHS. We used a mixed method approach involving both qualitative and quantitative data collection and analysis, focused on addressing the following questions:
- Did the rapid improvement programme make a difference?
- In what ways?
- Were the benefits sustained?
- What were the challenges and downsides of the interventions and how can they be minimised?
- What are the implications for similar programmes in the future?
Our approach involved semi-structured interviews with key people from a representative sample of organisations that participated in the programme. This covered equally two care pathways: fractured neck of femur and primary hip and knee replacement. The findings from these interviews were then tested and explored further with people who were involved in delivering the programme at a national level. This was supplemented with quantitative analysis of trends in key performance indicators. The initial approach had been that we would use local level dashboards to produce this analysis, and to provide context and evidence to support the qualitative findings. Much of this data proved to be unavailable, and therefore we were able to revise the approach to make use of HES data for this aspect of the review.
In addition to answering the questions set out above, the final report included a series of recommendations which will ensure greater impact from future programmes.
This project was undertaken by the Matrix Knowledge Group prior to the formation of Apteligen, and was managed by John who also led on the qualitative aspects of the evaluation. Sam led on the quantitative analysis and provided delivery support for translating findings and developing recommendations.
It demonstrates our experience of specific areas of healthcare and our ability to work with a range of different organisations to extract comparable information. It also demonstrates our ability to combine qualitative and quantitative information to provide a more rounded and meaningful set of findings. Finally, the project demonstrates our experience in analysis and presentation of HES data, and our ability to anticipate issues around the availability of data and to develop innovative ways to minimise the impact.
Contact us for further information.
Developing a board performance management tool
A London PCT, serving a population with considerable health and well-being challenges, needed a tool which would give board members and senior managers greater understanding of their performance with respect to key national targets, and the mechanisms available to them to make both immediate and longer term improvements. The aim of the tool was to enable the senior team to make more evidence-based and informed decisions about the top priority areas for action, the risks, and where they could exert greatest influence to meet their objectives both in the short term, and over the coming 5 – 10 years.
The project began with a focused review of information flows within the PCT, followed by a facilitated workshop with the senior team from the PCT to develop an action plan for tackling immediate issues. Following this, we developed a performance management tool, providing a single repository for performance data, and to monitor progress more effectively highlighting variation from targets and expectations. The focus initially was on the existing commitments and national priorities which made up the annual health check, however, the tool was developed so that it could be replicated to cover performance management arrangements more generally and across other areas of commissioned activity.
In conjunction with relevant staff in the PCT, we also completed an audit of governance and performance management arrangements, including:
- the quality of information in reports to the board and senior management team;
- processes for collating and producing those reports;
- an assessment of the extent to which performance reports supported intelligent management decision-making.
The audit informed a series of improvement recommendations for the board and senior team.
This project was undertaken by the Matrix Knowledge Group prior to the formation of Apteligen, and was led by John. John supported the design and facilitation of the stakeholder workshop and led the audit of governance and performance management arrangements. Sam provided delivery support and expert input in relation to the development of the data collection and reporting tool. This included the development of functionality to add new indicators and to model different improvement scenarios.
This project demonstrates our understanding and insight into performance management in PCTs, particularly in the context of the drivers of world class commissioning. It also demonstrates our expertise in developing practical and effective tools which can be used at the very top level of an organisation to help prioritise action, improve the quality and use of information, and make better decisions to meet corporate objectives.
Contact John for more information.
Undertaking an evaluation of a collaborative model for primary care
Apteligen worked with the Matrix Knowledge Group to deliver a 12 month evaluation of an innovative, collaborative (‘networked’) model of primary and community care. The aim of the model is to improve access to a diverse and wide range of high quality services, local to the people who need them, and joined up between health and social care. Within this there is an important objective also of empowering patients to make more informed choices about their health and well-being, and to experience the level of personalised care that meets their needs.
This was a formative evaluation which involved a mixed-method approach, carrying-out and drawing on insight from interviews, focus groups and workshops, alongside data on a range of clinical outcomes and process measures. The focus of the programme to date has been on delivering more consistent and evidence-based care for those with diabetes, however, the evaluation methodology was developed to ensure that it can be replicated as further packages of care, for different disease areas, are rolled-out.
An important priority for the evaluation was to understand the extent to which the conditions for effective, equitable and patient centred delivery of primary care were being established. It was therefore focused on looking at the following high level questions:
- To what extent are the structures and processes of the programme establishing the conditions for effective formation and functioning of primary care ‘networks’?
- Is the implementation of the care package for diabetes patients establishing the conditions for delivering consistent, best practice and patient centred care to all people in the local population with diabetes? What is the evidence for impact on outcomes?
- As further care packages are rolled-out, how can evaluation be built into their implementation and for the programme as a whole?
John managed this project from its inception through to delivery of the final report. This included:
- The design and delivery of interviews with managers and clinicians, focus groups, and stakeholder workshops;
- Thematic analysis to extract findings;
- Translation of qualitative and quantitative outputs to formulate recommendations;
- The development of interim reports and a final report.
Sam oversaw the quantitative aspects of the evaluation including data collation and analysis, interpretation, and the development of accessible outputs.
This project demonstrates our in-depth understanding of the primary care market and the drivers for improvement. It shows our ability to design and deliver robust research methods in order to disseminate learning, and our experience of handling both qualitative and quantitative data and combining this to produce more meaningful, practical recommendations.
Contact John for further information.