Four Case Studies to Explore the Added Value of Oxford AHSN

The Oxford Academic Health Science Network (Oxford AHSN) wishes to demonstrate the value of the various projects and programmes that the network has developed and implemented since it was established in 2013. In order to do this, OHE Consulting and RAND Europe conducted scoping assessments of six pre-specified case studies and organised a workshop with the Oxford AHSN management team to explore methods of attributing the value of the Oxford AHSN. Based on the workshop, four case studies were selected for further analysis as 'phase two' of the project: --1. Anxiety & Depression Clinical Network: A targeted 5% improvement in recovery rates; --2. Maternity Clinical Network: Improving referral pathways for preterm babies; --3. Energy project: Quantifying the value of energy savings and carbon reduction; --4. Intermittent Pneumatic Compression (IPC): increasing utilisation of IPCs in immobile stroke patients. The four case studies were chosen as examples of areas in which the Oxford AHSN has played a crucial role in improving patient care, and areas in which analysis of added value is feasible. The analyses were designed to assess the added value of the Oxford AHSN in relation to the case study projects, and not to assess the 'cost-effectiveness' of the treatments being used. The Oxford AHSN Improving access to psychological therapies (IAPT) programme aimed to increase recovery rates in adult IAPT services by 5%. This has been achieved and surpassed. We estimate that from January 2014 to November 2015 the project has enabled an additional 3,199 patients to recovery (compared to what would have been expected if the national recovery rate had applied). Further, we estimate that two years after the end of treatment, an additional 1,631 people are still in recovery in the Oxford AHSN region as would have been had national recovery rates applied. The project has also led to an estimated net saving of £750,000 of NHS money, mainly through reductions in physical healthcare needs, and has helped an estimated 384 additional people return to work, as compared to the employment numbers if national recovery rates had applied. (Note that this estimate is subject to a lot of uncertainty: national data does not show a strong effect of IAPT therapy on employment status). These individuals will contribute to the economy, receive income, pay taxes, and may require lower disability benefits; such benefits go beyond the quality of life gains felt by the patients and their friends/family, and the aforementioned estimated monetary savings to the NHS from estimated reductions in physical healthcare needs. The Oxford AHSN has therefore has added significant value in this area, by improving patient lives, cutting NHS costs, and contributing to the wider economy. The second case study looked at Oxford AHSN's project to improve the referral pathway the likelihood of survival of 5.2% percentage points (compared to survival rates before the project began), which translates into an increase of approximately 4 additional babies surviving per annum. Set against modest cost increases (or on the 'best case' assumptions cost savings after three years), this project represents good value for money compared to conventional thresholds at which healthcare interventions are typically considered cost-effective. The third case study examined Oxford AHSN's contribution to supporting the decision of five NHS hospital Trusts to work with partners to deliver investment in energy infrastructure and sustainability projects. Our study showed that there was a high degree of certainty about the value of these investments, in terms of energy and carbon savings, as well as a high financial rate of return. Assuming that the investment would not have gone ahead without Oxford AHSN's input, then set against the modest costs incurred by the Oxford AHSN, this project represents good value for money. The fourth case study was of the Oxford AHSN's IPC implementation project which aimed to increase the utilisation of IPC therapy amongst adult stroke inpatients. The results show that the project was successful, leading to utilisation rates that are higher than elsewhere in the country. On the basis of the higher utilisation rates and evidence of the clinical effectiveness of IPC therapy, we estimate that the project prevented 22 DVTs, two PEs, and 12 deaths within an 18 month period, all for an estimated additional cost of approximately £31,000. Overall, compared to conventional thresholds at which healthcare interventions are typically considered cost-effective, this programme appears to have delivered good value for money, illustrating positive added value from the Oxford AHSN. The limitations of all of the case studies mainly relate to data availability. Conservative assumptions were made where possible, meaning that overall we are more likely to have underestimated rather than overestimated the added value of the Oxford AHSN. In addition, the analyses of the three clinical projects (IAPT, maternity and IPC projects) were conducted from an NHS perspective, which means that there are additional societal benefits which have not been included, although we have given an estimate of the potential employment benefits of the IAPT programme. Finally, our analyses are based on only four cases studies. There are many more projects being undertaken by the Oxford AHSN. This means that we have not analysed the overall costs and benefits of the Oxford AHSN, but rather a sub-set of successful projects. What this report therefore provides is evidence that the Oxford AHSN is capable of promoting high quality NHS care and delivering projects which improve patient outcomes, at a cost that appears to represent good value for money. Some projects, including at least one of the case studies presented here, have not only improved patient lives, but also saved money for the NHS.