Efficiency – International

Alliance Medical

We continue driving clinical efficiency to deliver a cost-effective solution to our patients, which remains an important measure of performance within Alliance Medical.

Clinical efficiency measures¹

Average turnaround times	Year-on- year trend %	2020		2019	2018
Receipt of referral to scan (days)		5.1		4.8	6.6
Scan to publication of clinical reports (days)		3.2		4.9	4.6
Did not attend rates (%)		6.4		6.3	7.2

1	These measures relate to the UK only, with the roll out of standardised measures across territories to be implemented as part of Group integration.

Within Alliance Medical's UK business, we continued to roll out static facilities to serve our PET-CT contract with the NHS, with the final site now operational. This enables us to serve more patients per day compared to mobile clinics. We also partnered with a supplier to develop an innovative new mobile imaging solution, which enhances workflow and enables a better patient experience. This solution was introduced to the market during the year.

COVID-19 presented Alliance Medical with both challenges and opportunities. One of the most significant challenges was access to suitably qualified incumbents. We employed temporary staff, who are generally both costlier and less effective than permanent employees, to ensure we continued offering the services our patients needed.

Once patient levels increased, we implemented social distancing and additional cleaning protocols to protect our employees and patients. These measures are non-negotiable, but had an unavoidable impact on our average turnaround times. This, along with the cost of additional PPE, placed increased pressure on margins.

We proved to be agile and changed our operating model despite these challenges. We introduced a training programme for approximately 50 radiographers to perform COVID-19 scanning on a CT scanner. We also introduced a flexible staffing model across our sites and mobile units.

Procurement

We continued to develop our capital expenditure optimisation programme during 2020. We are working towards a future of distinctive capital stewardship where we leverage our scale to create buying power. This process primarily focuses on the following levers:

• Delivering a multi-year procurement strategy to consolidate capital equipment volumes, and to ensure acquisitions are competitive and prices optimised across the Group – achieving a reduction in prices of between 15% and 20%
• Implementing a multi-year optimisation process to rationalise the demand of every asset and reduce the volume of new assets by optimising upgrades and relocations

The timely and cost-effective sourcing of appropriate PPE proved challenging during the year. We mitigated this by partnering with the southern African team, leveraging their scale to source global suppliers to support our business across western Europe.

Information management and technology

We continue evaluating methods of using technology to enhance our service offering to our patients. This year, we also focused on internal governance and audits. Our audit partner completed several audits on our information security, change control and project management processes. We are addressing the shortcomings identified during this process.

We continue investing in technology to inform our decision-making and increase efficiency. We developed a BI tool during the year that captures and compares operational metrics across different regions. Alliance Medical is also starting to explore the opportunities created by AI. As part of this, we worked with Oxford University and a strategic partner this year to develop a new tool that could increase the efficiency and accuracy of PET-CT radiologists. We will develop this further in the next financial year. We also pursued additional strategic partnerships in the AI space to enhance our competitiveness.

Within our Irish business, 1Alliance was rolled out across all 27 sites, providing senior management with a real-time operational view of several performance metrics and facilitating financial billing and data analytics. 1Alliance proved to be extremely useful in gauging patient confidence, improving data integrity and enhancing efficiencies.

We continue supporting Phase II clinical trials on our TAU and FBB products. We installed the first of three digital PET-CT scanners as part of our PET wave 2 contracts with the NHS, with the second digital scanner in advanced stages of planning. These efforts continue enhancing our national digital platform and are a testament to how we leverage our scale to improve our resilience, efficiency and quality.

We invested significant resources in developing full electronic interfaces for local NHS trusts over the past few years. The first of these interfaces was implemented during the year and proved to be a useful tool to improve data exchange speed and accuracy between Alliance Medical and the relevant hospital. Ultimately, these tools will reduce human error and improve patient care.

Scanmed

Scanmed continued to implement various initiatives aimed at improving clinical efficiency, with substantial progress. The business successfully completed the restructuring of the Rudolf Weigel Hospital in Blachownia, which increased diagnostic imaging efficiency, improved operating theatre utilisation, and deployed a more effective procedure mix in theatres.

Procurement

Scanmed's centralised procurement function continues to monitor savings, prices and opportunities to enhance efficiencies and strengthen relationships with suppliers. We support our purchases by regular tender processes which, in turn, are guided by best practice standards. Our procurement processes are also informed by our specialist doctors, as well as the heads of medical specialisations across the Group.

Information management and technology

Our IT department focused on several projects to improve our security, user experience, and medical and back-office system performance. We implemented and optimised tools such as diagnostics systems and applications for automated doctor settlements to reduce potential process errors and further support business efficiency. We also improved our internal platform for remote training.

We trained our employees on how to comply with cyber-security requirements, data protection and how to identify potential threats. We also improved security on our internet domains and modernised network devices and systems in our facilities to increase efficiency and streamline daily operations.