Health economic analysis

Following the introduction of digital consent across the UK from 2020, supported by funding from NHS England, further funding was provided by SBRI Healthcare and NHS England to undertake a health economics analysis, to understand the financial implication of moving to digital consent by default nationally.

Health economists at QC Medica led on the work, in partnership with Portsmouth Hospitals University NHS Trust. The key output from this work is an economic model comparing total system costs of the paper consent process and digital consent process, which can be modified to the individual organisation’s context.

We can make the model available to organisations considering digital consent, and to support business case preparation. To help you navigate around the model, we suggest an initial 60-90 minute session with a member of the Concentric team.

Key findings

• Concentric is generally cost neutral or cost saving from the point of transition to BAU (the estimate across NHS Trusts being a cost saving of £0.81 per consent episode)

• The amount of cost saving is dependent on a number of different factors, such as:

  • whether paper consent forms are currently stored or scanned,
  • rate of 1-stage vs 2-stage consent, and therefore the rate of retrieval or printing/re-scanning, with cost saving for digital consent increasing with a shift to 2-stage consent – as per best practice,
  • how many other paper processes continue to exist within the organisation, and therefore how much of associated process costs such as scanning, patient folder preparation, portering of patient records, can be attributed to the paper consent process,
  • costs of existing paper consent forms, and Concentric tier purchased (per consent episode cost reduces with increased volumes).

The economic analysis showed no significant difference in consultation time between paper and digital consent pathways, although there is some evidence to show that the administrative elements of the process are quicker with the digital process. The hypothesis is that this time may be utilised in the shared decision making conversation, rather than reducing consultation time.

Device requirement can have a significant impact on costing, and is linked to digital maturity, with digitally mature organisations not usually requiring additional devices – Concentric simply becomes one process that is completed on existing devices.

Out of model scope

1. Human resource implementation costs

For the purposes of a business case, for an average organisation of around 50,000 consent episodes per year, the requirements are generally considered to be:

• project manager for 9 months to BAU, between 0.5-1FTE depending on deployment complexity and that organisation’s digital maturity,

• integration resource for approximately 5-15 days, depending on integration scope.

2. Litigation costs

Whilst work done by QC Medica concludes that savings to the NHS could be substantial from preventing litigation claims, there is further work to be done to assess the real-world impact on claims.

3. Patient information leaflet process

Many organisations have historically had processes in place for generic patient information leaflets to be shared with patients, across a selection of treatments. These have either been managed internally or via a third party provider.

In the majority of cases, when Concentric is introduced the historical patient leaflet process is removed or amended. Whilst this will be associated with cost savings, it was outside of the scope of the economic model.

4. Increased activity-based revenue from increased efficiency

Depending on the organisation’s funding model, increased activity may translate to increased revenue. Implementing Concentric has been demonstrated to reduce day-of-surgery delays and cancellations, with the potential for these to be translated into increased activity.

Due to the variation in funding models, and further work that needs to be done in demonstrating that the reduction in delays and cancellations can translate into a significant change in activity, this was omitted from the model.

Simplified worked example

• Consent episodes per year: 60,000
• Paper consent form cost: 50p per carbon-copy consent form
• Device requirements: 1 tablet per 1,000 consent episodes/year
• Current 1-stage vs 2-stage consent split: 50:50
• Concentric licence cost: £65,000 excl. VAT/year

The output of the model in this example has digital consent being around 50p cheaper per consent episode, representing a £30,000 cost saving per year for the Trust following transition to BAU.