GHP September 2015

ghp

September 2015

Research, Translation, Commercialisation

www.ghp-magazine.com

e-Health – The Future of Healthcare

Alcohol Related Brain Damage Examining the condition and the most effective ways to treat it.

Telford Gets TACT How the Telford After Care Team are not only helping former substance abusers, but changing the way councils provide services to help addicts in their communities.

Enhancing The NHS/Pharma Relationship How can pharmaceutical companies cultivate a better relationship with both the NHS and consumers?

editor’s note

this month’s features

Welcome to the September edition of ghp magazine.

In this issue, we spotlight addiction, examining alcohol related brain damage in a piece from David Swain at Pulse Addictions. We also examine the work done by the Telford After Care Team on changing the way addiction is treated in the area.

Funding in healthcare is also under the spotlight this month, with Silicon Valley Bank exploring global trends in healthcare investment. We also look into future trends in M&A transactions in the health and pharma industries and analyse new data from Baker & McKenzie, which shows an increase in this area over the next five years.

Elsewhere, Dr. Sue Paterson and Joan Kingsley explore bullying in the NHS, taking a closer look at how it affects victims and their work and how it can be dealt with effectively.

Alcohol Related Brain Damage (ARBD) We find out about a new initiative that can improve cognitive functioning in patients with ARBD. Page 36

Exciting new technology also comes to the forefront this month, with new monitoring equipment set to change management of blood pressure issues for the better, while Farzad Henareh delves into the world of health technology apps to examine how they are changing regulation in the industry.

Lisa Lundgren and Gustav Söderlund from Norrbotten County Council in Sweden explore the topic of e-health in the remote county and detail how it is changing the lives of the elderly population.

Plus, this month’s edition also includes our September Health and Social Care Special, exploring the major issues affecting the rapidly evolving UK health sector.

We hope you enjoy this special issue.

e-Health –The Future of Healthcare We spoke to Lisa Lundgren and Gustav Söderlund at the Department of Research and innovation, Norrbotten County Council to find out how this sparsely populated area is establishing itself as a leader in eHealth. Page 16

inside this issue 04 News 10 Enhancing the NHS /Pharma Relationship 14 First JLABS Incubator Outside of United States Planned in Canada 20 Hypertension Management – What Are We Doing Wrong?

24 Your Starter for Ten 26 New Data Shows M&A in Pharma and Healthcare Set to Average Half a Trillion Dollars per Year for Foreseeable Future 28 Using Shares to Keep Your Staff Motivated and Committed 30 Health Tech Apps are Muddying the Already Unclear Regulation Waters 32 Silicon Valley Bank 38 Telford Gets TACT 40 Anti-Bullying Policy at Worcestershire Acute Hospitals NHS Trust

“Although the industry has seen a lot of consolidation, there remain opportunities for corporate activity in the pharma space and there is almost certainly more room for consolidation amongst the medical device and technology companies.”

Jane Hobson, Global Healthcare Leader, Baker & McKenzie.

Global Health & Pharma, 39A Birmingham Road, Blakedown, Worcestershire, DY10 3JW Tel: +44 (0) 1234 567 890 | Email: info@ghp-magazine.com | Web: www.ghp-magazine.com

news

Telephone Answering Company Sees Record Rise in Healthcare Clients TELEPHONE answering specialist Moneypenny has reported a record year to date in terms of the number of healthcare clients seeking telephone answering support, as well as the volume of calls answered on behalf of the sector.

The company’s team of specialist healthcare receptionists is growing fast to meet demand, with a 40% rise in the number of its healthcare clients, and a 51.47% increase in call volume, as compared to the same time last year.

Moneypenny clients range from small cosmetic and dental practices through to large private hospitals, with calls handled either on an overflow or fully outsourced basis. Each has their own Moneypenny Receptionist, or a team of receptionists, specialising in the healthcare sector; someone they know and trust who looks after calls, as and when needed, as if based in-house.

Founded in 2000, Moneypenny now handles around 9.5 million calls a year for over 7,500 UK businesses as well as a fast-growing number of US businesses since the opening of the company’s South Carolina base earlier this year. For those clients requiring round-the-clock support, Moneypenny Receptionists are based in Auckland, New Zealand to ensure, thanks to the time difference, that every call is answered during the daytime.

Channel Manager, Stephanie Vaughan-Jones, who works closely with the healthcare sector, says: “At present 80% of our healthcare clients require us to capture their overflow calls, while 20% have chosen to fully outsource their reception to us.

Healthcare is now our third largest sector after legal and property and is one of our fastest growing. This highlights just how many new business opportunities would have been missed, how many enquiries would have gone unanswered, and how many customer service contacts could have fallen short if the correct resources hadn’t been in place.

“Our service is particularly popular with self-funded cosmetic departments who are concerned they may be missing consultation enquiries, as well as clinics that want to extend their perceived opening hours or need temporary assistance to cover staff sickness or holidays. Similarly improving customer care is a top priority for many clinics and hospitals, so having a friendly voice, rather than an answer phone to speak to can make a huge difference to the overall patient experience.”

Mark Greene, Hotel Services Manager for The London Bridge Hospital and the Lister Hospital in Chelsea (part of HCA), explains why he engaged with Moneypenny: “We knew we needed assistance with some of our in-coming lines as we were potentially losing business. Our patients need to speak to a real person, not a voicemail, so it was vital we found a solution to support our in-house team.

“We took a trial with Moneypenny, with any calls we were struggling to get to, over-spilling to Zoe, our Moneypenny Receptionist. We felt the difference straight away and were amazed at the immediate uplift in calls, which not only meant that we weren’t missing any from existing patients, but were converting more new business opportunities too.”

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Pharmaceutical Packaging Equipment Market to Reach US$8.1bn by 2021 Transparency Market Research published a new report “Pharmaceutical Packaging Equipment Market - Global Industry Analysis, Size, Share, Growth, Trends and Forecast 2015 - 2021”.

According to a new market report published by Transparency Market Research titled “Pharmaceutical Packaging Equipment Market - Global Industry Analysis, Size, Share, Growth, Trends and Forecast 2015 - 2021”, the market was valued at US$5.1bn in 2014 and is expected to reach US$8.1bn by 2021, at a CAGR of 6.8% through the forecast period. Technological innovation and integration and development in manufacturing process of pharmaceutical products are some of the major factors fueling the pharmaceutical packaging equipment market globally. Moreover, increasing demand for anti-counterfeit measures, product protection and patient compliance, among others, has significantly resulted in production of innovative packaging equipment with better tolerance limit, reliability, and accuracy. Abrupt rise in the number of manufacturing utilities owing to patent expiration of vital drugs is also expected to drive the market for pharmaceutical packaging equipment indirectly.

In terms of package types, the global market for of pharmaceutical packaging equipment is bifurcated into primary packaging equipment and secondary packaging equipment. Primary packaging equipment held the largest share in the market in 2014 and is expected to remain the market leader throughout the forecast period. Increasing preference of end users for unit dosage forms is one of the major factors boosting the demand for primary packaging in the forecast period. The global pharmaceutical packaging equipment market has been classified into four regions, including North America, Europe, Asia Pacific, and Rest of the World (RoW).

North America acquired the largest share in the global market in terms of revenue in 2014 and accounted for more than 30%. The market in North America is primarily driven by increasing demand for innovative drug delivery techniques and sophisticated packaging along with rapid growth of the pharmaceutical industry

The pharmaceutical packaging equipment market has shifted from conventional packaging to automated, modern, flexible and integrated packaging lines. In addition, development of novel drug delivery systems, such as personalized drugs, and regulatory variations regarding packaging of pharmaceutical products are anticipated to play an important role in the growth of the market during the forecast period from 2015 to 2021. Furthermore, high import duties along with need for cheaper manufacturing facilities create a remarkable opportunity for the pharmaceutical packaging equipment market in developing countries such as India and China. However, usage of revamped packaging equipment by small scale manufacturers is inhibiting the growth of the market. The global pharmaceutical packaging equipment market has been segmented by product type broadly into liquids packaging equipment, semi-solids packaging equipment, and solids packaging equipment. Liquids packaging equipment held the largest share of the market globally in 2014 and accounted for more than 45% of the market owing to increasing applications of liquid packaging equipment in efficient, reliable, and coordinated filling and packaging of liquid products.

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in the U.S. and Canada. Asia Pacific held the second largest market globally and accounted for close to 30%. The market in this region is driven by increasing investments by existing pharmaceutical equipment manufacturers in the high-growth markets of India and China, among others. Some of the major players in the pharmaceutical packaging equipment market are Korber A.G., Mg2 S.R.L., IMA S.P.A., Robert Bosch GmbH, Multivac Group, Bausch and Strobel Maschinenfabrik Ilshofen GmbHCo. Kg, Optima Packaging Group GmbH, Marchesini Group Spa, Uhlmann Group, and Romaco Pharmatechnik GmbH. The market is fragmented, with a large number of players operating in the global market for pharmaceutical packaging equipment. The report provides indepth analysis of the global pharmaceutical packaging equipment market along with the market estimates, in terms of revenue (US$mn) for the forecast period from 2015 to 2021.

e X p o s e / Shutterstock.com

news

£120k Software to Help Dementia Sufferers Private company wins competition to work with Anglia Ruskin University on support app.

Anglia Ruskin University will work closely with private firm POW Health to develop a first-of-its-kind software application to help dementia sufferers prolong their independence, thanks largely to funding from Innovate UK.

“The loss of personal identity and the frustration of those living with dementia and their carers is a growing challenge. This project will directly address this and it will also save vital money for frontline service providers.”

POW Health won a competition which looked at ways to use personal data to make it easier for people to use interactive platforms such as apps. Its winning submission, called Independence, aims to create a daily planning tool to help patients with early and more advanced stages of dementia, and their carers.

Ifty Ahmed, Chief Executive of POW Health, said: “We are thrilled to have been chosen to work with Anglia Ruskin University on a crucial project which has potential to help millions of people. Dementia costs society around £26billion per year, more than cancer, heart disease or stroke.

The company will create an information portal where dementia patients nationwide can use tools to help them live an independent life, find out more about their condition, how it is likely to progress and what support is available to them.

“It is vital that we use advances in technology to help deal with the problems that an ageing population will suffer and we specialise in supporting people who are managing long-term health conditions such as dementia.”

Currently 70,000 people in Essex live with dementia and caring for their needs costs more than £390mn per year. The burden will increase in the coming years – the number of people over 65 in Western Europe is projected to double between 2001 and 2040.

The project will cost £120,000, with £76,591 provided by Innovate UK, and forms part of Anglia Ruskin’s Smart Living Accelerator programme launched last year. This is a partnership between academics, frontline services, healthcare commissioners and technology companies, working on pilot projects using technology to manage the care of an ageing population.

Professor James Hampton-Till, Deputy Dean for the Faculty of Medical Science at Anglia Ruskin University, said: “At the moment the only tools available to people living with dementia are static apps or paper-based systems which cannot be easily shared or accessed by care or service providers and do not take into account the complex needs of each individual.

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New Study Will Attempt to Confirm Biometric Identifier of ASD Stemina Biomarker Discovery launches largest ever clinical study of metabolism of children with autism.

Stemina Biomarker Discovery Inc. has announced the launch of the largest clinical study of the metabolism of children with autism spectrum disorder (ASD) ever conducted. The Children’s Autism Metabolome Project or “CAMP” study will enroll 1,500 subjects from six sites across the country.

CAMP will attempt to confirm that sets of metabolic biomarkers can detect subtypes of ASD. This new study is an expanded version of Stemina’s three pilot studies of more than 500 children. CAMP is also designed to contribute to identification of new biomarkers with the goal of advancing a panel of tests for earlier diagnosis and more precise treatment of ASD based on the metabolism of patients.

Metabolomics is the study of differences in a person’s metabolism as genomics is the study of differences in a person’s genes. Metabolomics focuses on identifying normal and abnormal patterns of small molecules which indicate the presence of illness. Altered metabolism of patients offers more insight into the individual patient and potential treatments that may be effective based on the patient’s own metabolism. Stemina’s proprietary metabolomics technology is capable of identifying not only biomarkers associated with disease, but also metabolite patterns associated with toxicology and cellular response to drugs or chemicals this may be used in future studies to try to identify environmental factors associated with autism and other neurological disorders.

other neurodevelopmental disorders without autism and 500 typically developing children in the 18 to 48 month age range.

The research has the potential to enable earlier diagnosis and individualized treatment of children with ASD from a small blood sample. Stemina has conducted three independent proof-of-concept studies with more than 500 patients with ASD from the MIND Institute and Arkansas Children’s Hospital Research Institute. The first study was published in PLOS One in November with collaborators from the MIND Institute.

“We are excited about participating in CAMP and continuing our work with Stemina. Confirmation of findings from our previous two pilot studies would be an important step towards developing an early diagnostic marker of ASD. Metabolomics may be the key to detecting clinically meaningful subtypes of autism,” said Dr. David Amaral, Distinguished Professor of Psychiatry and Research Director of Research of the MIND Institute at UC Davis.

“Autism is a very complex disorder, really a series of disorders. CAMP has the potential to deliver some important diagnostic tools as well as to increase our understanding of these subtypes of autism from a metabolic perspective. Earlier diagnosis can lead to earlier intervention resulting in the most effective reduction of symptom severity.”

Stemina has received a $2.7mn grant from the National Institute of Mental Health (NIMH) to support CAMP. The study is also supported by a $2.3mn investment from the Nancy Lurie Marks Family Foundation (NLMFF). Children are being enrolled at the MIND Institute at the University of California – Davis, Arkansas Children’s Hospital Research Institute in Little Rock, Vanderbilt University in Nashville, Cincinnati Children’s Hospital, Nationwide Children’s Hospital in Columbus, and the Melmed Center in Phoenix. CAMP requires the enrollment of 500 children with autism, 500 with

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Diagnosis of ASD at an early age is important for initiating the most effective intervention. Today, behavioral therapy is the standard of care for children with ASD. It is important that intervention begin as early as possible to achieve optimal outcome. Patients can be reliably diagnosed through behavioral testing at age 2 at health care facilities with expertise in diagnosing autism and yet the average age of diagnosis according to the Centers for Disease Control is 4½ years. Stemina’s goal is to significantly reduce the average age of diagnosis through a diagnostic panel of metabolic biomarkers being refined through the CAMP study. This will offer both improved and earlier diagnosis as well as the potential for individualized therapy and better outcomes for patients and their families.

“Stemina’s proprietary metabolomics platform technology will revolutionize the way ASD is diagnosed and treated,” said Elizabeth Donley, Chief Executive Officer of Stemina. “Autism is a spectrum disorder from a cognitive and behavioral perspective.

Stemina’s work is demonstrating that it is also a spectrum disorder from a metabolism perspective.

By diagnosing ASD based on the patient’s metabolism, we hope to understand what is different about the metabolism of children with ASD and each subtype compared to typically developing children.

This approach will open up a whole new frontier for understanding the disorder and how to treat it.”

news

NHS England Improves Healthcare Delivery with OpenText The global leader in Enterprise Information Management (EIM), has announced that NHS England’s Health and Justice Department has implemented OpenText Analytics to improve management, procurement and benchmark delivery of healthcare services.

NHS England’s Health and Justice Department is responsible for commissioning healthcare such as medical services, dental care, mental health service and nursing to patients detained in prisons and other prescribed accommodation across England.

By using OpenText Analytics, NHS England is able to collect and analyse data from multiple sources on one platform. Data from individual prisons, including immunizations and vaccinations, substance abuse treatments and waiting times are uploaded on the system, providing NHS England with the necessary information to more effectively commission and monitor services that reflect the needs of patients, and improve reporting of key performance indicators back to the Department of Health.

Michael McGonnell, deputy head of commissioning for NHS England in Cumbria & North East commented.

“The ability to understand data is beneficial to managing health and justice. Prisoner patients tend to have very specific health needs which have to be taken into account when procuring and delivering our services. This solution gives us the ability to turn very complex data into very valuable information, which enables us to significantly improve how we commission our services.”

OpenText Analytics allows NHS England staff to easily access information, without the need for specific analytical skills. The secure, hosted, OpenText solution provides key stakeholders, from analysts to commissioning managers, with immediate access to key data insights. Through simple, intuitive dashboards, NHS England’s Health and Justice Department can compare data from prisons to benchmark how services are delivered, produce insightful scorecards and run deep analysis on the impact of any changes to healthcare provision.

Michael McGonnell added: “Going forward, access to this insight means we can make any necessary improvements, to continue to ensure healthcare for prisoners is delivered to the highest level.”

Helping organizations simplify, transform and accelerate their business results by providing greater insight from information, OpenText Analytics and Reporting is part of the OpenText EIM strategy. The strategy, based on five comprehensive and integrated product suites including Content Suite, Process Suite, Experience Suite, Discovery Suite, and Information Exchange as well as Analytics, enables organizations to discover and manage information to spur growth and innovation and increase time to competitive advantage.

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New Treatments Could Revolutionise Treatment of Therapy-resistant Tumours OncoRx Pharmaceuticals, Inc. has announcing its launch as an early-stage pharmaceutical company focused on the development of drug therapies that control the progression of therapy-resistant malignant tumours.

The firm has exclusively licensed the patent rights for drugs that target and control the proliferation and invasiveness of self-renewing cancer stem cells, aggressive metastatic mesenchymal cells, and brain tumours through two complementary pathways for re-activating tumour suppressors. Re-activating tumour suppressors causes tumour cells to “self-regulate” the out-of-control proliferation and invasion associated with metastatic-specific cell surface glycoprotein remodelling and epigenetically-controlled DNMT1/G9a/EZH2 methyltransferase chromatin remodelling.

plasma and the brain. OncoRx is now planning to initiate preclinical testing on its lead compounds for the treatment of paediatric diffuse intrinsic pontine glioma (DIPG) and glioblastoma multiforme.

Mr. Barbeau commented, “Despite some recent successes of targeted kinase therapies and the immunologic therapies, the unregulated growth and proliferation of drug-resistant malignant tumors in patients was not in sight until now. This is not surprising when one considers that invasive drug-resistant malignant tumour cells have completely

The Company’s lead drugs have demonstrated marked in vitro effectiveness in epithelial cells of primary and locally invasive tumours, as well as mesenchymal tumours having increased expression of cell surface glycoproteins that affect cell cycle dysfunction, tumour migration and angiogenesis.

Donald L. Barbeau. President and co-founder of OncoRx Pharmaceuticals, commented, “Unlike non-invasive primary tumours, the growth, proliferation and invasiveness of therapy-resistant tumours are not effectively controlled with conventional cancer therapies or the newly introduced targeted kinase inhibitors. This inability to control the progression of therapy-resistant metastatic tumours is believed to be responsible for 90% of all cancer related deaths; yet, the only drugs we see getting approval are ineffective against these therapy-resistant malignant tumours.”

In vitro studies performed by the Company’s licensor have shown effectiveness against malignant melanoma tumours having the BRAFV600E mutation, estrogen-negative breast cancer tumours, tumours having downregulated tumour suppressors (e.g. PTEN, PP2A and Egr-1), and tumours with self-renewing cancer stem cells. In vivo studies are consistent with minimal cytochrome P450 biotransformation to known toxic metabolites, a relatively long plasma half-life, and the rapid achievement of clinically-relevant plasma concentrations in both

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different biological properties than drug-sensitive tumour cells. We are excited about our partner’s research studies with drug-resistant malignant tumours, and the unique ability of their lead drug to markedly penetrate the blood-brain-barrier. As newcomers in a crowded field, it is imperative that we have unfettered access to this compelling science and strong intellectual property surrounding it if we hope to be successful.”

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industry insight

Enhancing the NHS/Pharma Relationship In seeking inspiration for this article I thought I’d have a look around to catch the latest happenings in the pharma/NHS world; and so I hopped on to Google…. as you do! Yet, time and time again I was stopped in my tracks by a curious incongruity in what I was reading.

What I’m talking about here are probably the two most important groups of movers and shakers for protecting health on the Globe. Both Pharma and the NHS are constantly striving for the same thing – benefits to patients - but if I didn’t know what I was looking at, it could have been a set of rules for keeping gift bearing window cleaners at arm’s length! Always in the same direction; never the other way round.

I exaggerate, of course, to make the point but something would seem to be missing in the relationship between these two and that something is trust. But it’s more complicated than that, because the NHS Leadership has been quietly working away at developing a strong trust base in the public psyche.

As I write this article, one of our most revered hospitals has just been put into special measures. To which the universal response from both public and press alike is that the hospital will pull through, things will be okay and that the staff are absolutely wonderful. i.e. forgiven on every front – trusted.

But what happens when pharma are alluded to in the press?

Reports on NHS budget overspend often refer to the excessive cost of drugs. Which do you believe to be the most likely reaction from the public? i. Yes, drugs are expensive but these wonderfully innovative pharma companies need to recoup their investment in order to get funding for the next drug [trusted] or: ii. They’re just out to make money [not trusted] Most recently, we have begun to see suggestions that antibiotics’ days are numbered and we may be plunged back into the dark ages. Which do you believe to be the most common response across the land?

i. To be fair, how can pharma companies justify years of research and development without seeing a clear way of recouping their investment [trusted] ii. They don’t care. If it won’t make money, they won’t do it [jury’s out!]

WHY DOES THIS MATTER? We all know that the NHS is facing huge difficulties but the leadership teams have been doing something very right.

As a nation, we love our NHS and we trust every single organisation and person in it. Not only us, but staff are fiercely loyal, working long shifts with shrinking resources, turning out to emergencies wherever and whenever required. And when we see that, we forgive them when something doesn’t go quite right; repeatedly offering the benefit of the doubt!

By contrast pharma companies have always had a certain mystique; shrouded in secrecy and security, as they are, with people in white coats developing drugs that will change the world! We actually know very little about them - other than rumours from the past about how they promoted of their drugs.

Whilst things have undoubtedly changed, pharma are still facing an uphill climb to escape the sentence of being not quite trusted.

WHAT IS TRUST? All of us trust, to a greater or lesser degree, according to the context being defined. Trust underpins and affects the quality of our every waking moment; our relationships our communication, every effort in which we are engaged. But there are implications too for the wider world.

A recent survey conducted by British sociologist, David Halpern revealed that whereas only four decades ago in Great Britain, 60% of the population

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industry insight believed other people could be trusted; today it is down to 29%. You have only to look at our major institutions, the banks, MP’s, the police, social media, the Internet – VW! People simply don’t know who to trust any more.

Leadership in the NHS has worked hard to build trust as evidenced by the permanent Friends and Family Test that runs across all departments; large or small.

Whilst maintaining an understated and hardworking presence, no one is in any doubt of what the NHS stands for and what we can expect.

With the rise of social media, public opinion is being given ever greater credence. Of course it’s a complete nonsense to say we “trust the NHS”. The NHS consists of thousands of organisations from the largest hospital to the smallest practice. Yet we lump them all together in our decision to trust.

And we’re doing the same with pharma. I doubt many people could list 10 companies or explain anything about their values, their beliefs, their top achievements. With pharma off the radar, the nation knows nothing about the crucial ‘other half’ of the NHS. Historically that may not have mattered, but trust is a measure that you are delivering value. Standard sales wisdom states that where value is missing, it’s all down to the cheapest option; which is where we would seem to be with drugs for the NHS. LEADING THE TRUST MOVEMENT In a world of rapid change, some individuals, teams and organisations consistently succeed while others are in a never-ending struggle. The common denominator that separates the two is sustainable trust. When your company is trusted by its customers, it naturally attracts repeat business – often through word of mouth.

There are five different factors of trust, and our reputation is built around which of these others can trust us the most. These five factors are based around the degree to which the individual, team, or organisation can be consistently relied to do the following: • • • • •

INNOVATION: come up with creative solutions and plans COMMUNICATION: share information and listen effectively SERVICE: look after customers and team members MEASUREMENT: measure and refine own performance RESILIENCE: remain resilient and positive.

The most important word in the above is ‘consistently’.

As soon as the whole organisation presents a consistent approach and behaviour, trust begins to rise.

tion] can always be trusted to come up with new ideas but not always to complete on time or to reliably follow through on routine tasks.

It just so happens that the area we are most trusted in is also the area we naturally move to because it’s what we love the most. Building teams that enable us to trust each member’s natural strengths, while supporting each on their challenges, grows trust at the level of the team and further to the company. From there, trust can sweep through the organisation.

We have a series of online trust tools that can be implemented at leadership, manager and staff levels to enable you easily to launch and monitor trust.

If you are interested to see where you are personally most trusted, here is a link to our staff profiler – The Frequency Test. Click here http://bit.ly/FrequencyTest and we will be delighted to send you a token.

LEARNINGS Pharma companies are absolutely crucial for worldwide wellbeing. They are the rock upon which the NHS stands. Without many of the drugs, patient life expectancy would be zero. Things have changed, and I believe it’s time to make people more aware of your presence and the invaluable work you do.

We are all being encouraged to see our doctors less and take care of ourselves. By increasing levels of trust, you can unleash the very real prospect of not only enhancing your relationship within the NHS but also of becoming the go-to source to support the nation’s health.

AUTHOR: This article was written by Caroline Day: Director of Wellbeing Dynamics. Caroline is an influential authority on trust and leadership and a regular contributor in professional publications. She is the inspiration behind the Wellbeing Dynamics range of online business tools: including the Frequency Test and Corporate Trust Audit.

If you are interested to see where you are personally most Trusted, here is a link to our staff profiler – The Frequency Test. Click http://bit.ly/FrequencyTest and we will be delighted to send you a Token.

For The Frequency Test.

Click http://bit.ly/FrequencyTest If you would like to comment on this article or discuss solutions, please contact us:

t 020 8213 5898 e info@wellbeing dynamics.com w www.wellbeingdynamics.com

TRUSTED LEADERSHIP Wellbeing Dynamics believe that trust is best implemented top-down, inside-out. That is because, when the leadership teams are exhibiting trusted behaviours, word spreads both down the line and out to customers and clients. A company takes its identity from its leaders and the first step is to profile the top team.

Every profile has a different area of the five in which they are naturally trusted, and specific areas where trust breaks down. For example, a creator [innova-

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First JLABS Incubator Outside of United States Planned in Canada

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industry insight Participating hospitals pledge support for start-up funding.

The Ontario Government, University of Toronto, and MaRS Discovery District (MaRS) today announced a collaboration with Janssen Inc. to launch the successful Johnson & Johnson Innovation, JLABS incubator model in Toronto. The new facility, called JLABS @ Toronto, will open in spring of 2016 at MaRS Discovery District and will support start-ups with lab space, programs, and potential investment partners as they work to build important, successful early-stage companies.

“The arrival of the Johnson & Johnson Innovation, JLABS model to MaRS’ West Tower reinforces Ontario’s position as one of the world’s leading life sciences clusters,” said Brad Duguid, Minister of Economic Development, Employment and Infrastructure. “JLABS @ Toronto will support researchers and entrepreneurs across the province and accelerate the development of Ontario companies while connecting Toronto to potential Johnson & Johnson collaborators and investors.”

“Research and innovation are fundamental to the mission of the University of Toronto,” said Dr. Meric S. Gertler, President, University of Toronto. “We host a vibrant entrepreneurial ecosystem featuring nine campus-led accelerators under the umbrella of our Banting & Best Centre for Innovation and Entrepreneurship. The addition of JLABS to this ecosystem will further propel the creation of new companies and new jobs, and ultimately new healthcare solutions that will benefit individuals and our society for years to come.”

“Toronto is home to a vibrant and prolific healthcare and life sciences community led by academic hospitals, world-class research institutions, top scientists, and a strong start-up ecosystem. For these reasons, Toronto is a natural choice for our first international expansion of JLABS,” said Melinda Richter, Head of JLABS. “The Johnson & Johnson Family of Companies has long been active within the Toronto Ontario community, forming many important collaborations. Today we are pleased to begin an even deeper relationship with this important community. Our new location, within a University of Toronto site, close to our hospital collaborators, and neighbouring the financial centre of Canada, will deliver great opportunities and impact for emerging biomedical technology entrepreneurs.”

When complete, the 40,000-square foot facility will include cutting-edge, modular and scalable lab space, equipment, with access to scientific, industry and capital funding experts. The space — which will be licensed to companies by U of T — will also feature JLABS’ inaugural device and digital prototype lab that will provide entrepreneurs with access to highly specialized tools as well as skills building programs to design and develop smart health technologies. This program will be replicated at other JLABS sites.

JLABS @ Toronto is a collaboration among Johnson & Johnson Innovation, The University of Toronto, MaRS Discovery District, Janssen Inc., MaRS Innovation, and the Government of Ontario. Hospital participants include: Centre for Addiction and Mental Health, The Hospital for Sick Children (SickKids), Sinai Health System, St. Michael’s Hospital, Sunnybrook Health Sciences Centre, and University Health Network.

“The arrival of JLABS deepens the resources available to the health and life science community at MaRS and will catalyze the addition of new industry players,” said Dr. Ilse Treurnicht, CEO of MaRS Discovery District.

“It further speaks to the critical mass of health and life science commercialization opportunities emerging across the region and underscores the key role MaRS plays in advancing the transformative technologies of Ontario’s researchers and entrepreneurs.”

“There are systemic efforts underway to translate the basic R&D funding that Toronto’s research community receives each year into marketable companies, products, services and license deals,” said Dr. Raphael Hofstein, President and CEO, MaRS Innovation.

“By situating JLABS @ Toronto at the epicentre of the commercialization renaissance already underway, JLABS is joining and building on existing partnerships that will help Canadian innovations to succeed on the global stage.”

Construction of JLABS @ Toronto will begin in 2015, and is expected to be ready for occupancy by mid2016. Over the coming months, best practices pioneered at other JLABS will be adopted to accelerate the impact and success of this new collaboration, with further details on start-up admissions and foundational programming due to be shared over the coming months.

As the first JLABS to open outside the United States, JLABS @ Toronto joins a network of life science facilities that are based throughout the United States in San Diego (flagship), San Francisco, South San Francisco, Boston and Houston. These facilities are home to over 100 early-stage companies advancing bio/pharmaceutical, medical device, consumer and digital health programs. JLABS @ Toronto will be located at MaRS Discovery District, occupying one floor of the West Tower.

JLABS @ Toronto will provide start-ups with many of the advantages of being part of an established innovation centre — such as access to talent and mentors, large existing firms and research universities, capital and convergence opportunities with other sectors.

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Above, a doctor performs an echocardiography by remotely controlling a robotic arm at the health care center in Arvidsjaur, Norrbotten, Sweden.

This allows personnel to conduct the examination without leaving the hospital and save the patient a four hour round trip to visit the hospital.

Photo courtesy Anders Alm

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innovation and technology

E-health – The Future of Healthcare Norrbotten County covers 25% of Sweden’s surface and approximately 250 000 inhabitants reside here (about 3% of Sweden’s population), which makes it a large and sparsely populated area. As many other regions in Europe, Norrbotten is undergoing dramatic demographic changes. In the next ten years Norrbotten foresees an increase of residents between the ages of 65-79 by 50%, from 42 000 to 63 000 in addition to its share of elderly being already 3% higher than the Swedish average.

While many would view this as a significant problem, we consider it an exceptional opportunity for future growth. By taking advantage of our unique geography and demographic composition and utilizing our regions strong academic presence, thriving industries and tech savvy population we can develop inventive healthcare concepts, improving our health and expand the innovation capacity in Norrbotten.

Even though we today have 20 years of experience in eHealth and distance spanning technology, a lot of the development has been based on personal initiatives and was implemented only in smaller scale. To address this lack of a distinct and focused direction, Norrbotten has worked diligently to develop concise strategies for eHealth and shape strong relations between healthcare, business, academia, political parties and our citizens to create an environment where Norrbotten have been able to establish itself as a leader in eHealth. eHealth is also question of democracy and equality, says Agneta Granström vice Chair of the County Councils Executive Committee with a special interest in eHealth issues. She believes that when it comes to healthcare, public services and infrastructure such as broadband and mobile service, users should be able to expect the same access no matter if you live in urban or rural environment. eHealth today In recent years eHealth in Norrbotten has grown into a much more structured endeavor and it is now an expressed priority starting from EU, national and regional strategies down to local action plans and the day to day operations. It is possible see it impacting not only in policies and regulations but also in the quality of life for every patient who benefits from these new ways of providing healthcare. For example, the strategy for distance spanning healthcare in Norrbotten has outlined clear paths to transition from connecting only different healthcare units towards also enable patients to connect from home and to their healthcare contacts for follow ups, health advice or treatments. The results of this increased focus is now very visible in the way day-to-day healthcare is being carried out in every hospital, healthcare center, home care and retirement home in the region.

For Norrbotten to maintain a leadership in eHealth, the Norrbotten County Council has reorganized and formed an interdisciplinary R&D unit with expertise in innovation management, continuous improvements, service development, IT, e-learning, transnational collaboration and of course a diverse group of healthcare professionals to work with eHealth on a strategic level and create the necessary conditions that allows the organization to succeed. We have also partnered with Luleå University of technology to create the Centre for Innovation and eHealth (EIC). It is a center of excellence in the areas of health and wellbeing, where information and communication technology (ICT) is used to innovative new eHealth solutions.

The EIC has three main focus areas: - Collaboration between healthcare providers, patients/ consumers and their close relatives - Remote communications and consultation - Availability of healthcare information for patients and citizens Norrbotten County Council has a long tradition of carrying out projects and initiatives that increase the cooperation between the council, the municipalities, national level initiatives and other European regions in order to learn from others and ensure that our knowledge and innovations not stays in Norrbotten, but is shared with the rest of Sweden, Europe and the world. Some of the more prominent examples are: COGKNOW, Cross-border Healthcare in Torne Valley (Sweden/ Finland), e-Home HealthCare at North Calotte, MobiHealth, epSOS – Smart Open Services for European Patients , MOMENTUM, Renewing Health, FIA, Future Innovative Work Practices in healthcare in the home, RTF-Regional Telemedicine Forum, RemoDem and STAR - Skills Training and Re-skilling for Carers of People with Dementia. Currently we have joined forces with the EIC, the Norwegian Center for integrated care and Telemedicine, the Society of local Authorities in Norrbotten, the University of Stirling and the National Health Service in the Shetland and Western Isles in a project called RemoAge. This collaboration is co-funded by the European Union’s Northern Periphery and Arctic Programme, and will tackle the increasing challenges limited personnel and financial resources has brought to supporting frail older people living in the our respective regions remote and sparsely populated areas. The Partnership has a firm belief that we can address some of these issues through innovative use of new technology and by increasing the community involvement throughout the care process.

For example the project will develop and implement services utilizing distance spanning technology, GPS positioning, e-learning and smart homes, but also make broader initiatives like adapting communities to better suit the needs of our older citizens.’

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innovation and technology Written By Lisa Lundgren Project director, Department of Research and innovation, Norrbotten County Council Gustav Sรถderlund eHealth Strategic Officer, Department of Research and innovation, Norrbotten County Council

Digital public services Back in 2012 we started working in the Sustains Project (Support USers To Access INformation and Services) a collaboration between Norrbotten, Uppsala County Council and seven other European regions in order to develop new digital healthcare services. For example provide our citizens with online access to health records and support online interactions between patients and healthcare professionals, thereby empowering patients to take an active role in their own health and care. Some of the key learnings from this project can today be found in a similar nationally services Norrbotten works with today called Vรฅrdguiden (healthcare guide) Through this multi-channel platform you can call in to get health advice, read quality assured healthcare information or access a rapidly developing range of digital services all available for free 24/7. The implementation of 1177 is creating dual benefits, on one side it is giving people an opportunity for greater control over their own health, with greater access to information they can acquire deeper insight of their own health and make more informed decisions and also take an active and participatory approach to their own health. It also provides concrete support for healthcare professionals, who can direct patients to the right information and it reduces administration which, in the end creates more time for personal interactions with patients.

The future healthcare Our aim is to ensure that we provide the right services at the right time delivered in the right way based on the individual needs of all people in Norrbotten.

Through a conceptualization of our implementation of tech based solutions we have been able to transfer any good practice from one part of the organization to another and to step by step inch by inch turn around the organization to wide adoption of distance spanning technology and not only for internal communication and information exchange, but also for patient interaction and integration of our systems with co-actors in healthcare delivery says Stefan Carlsson, IT-strategic Officer. He also envisions the endless possibilities that useful, usable and well-designed digital public services can bring in the near future and thinks it is one of the most important success factors for eHealth going forward. Living in a digitalized society has become the new normal says Susanne Anderson Development Manager for digital services at Norrbotten County Council. Almost daily, she talks to the people of Norrbotten and she notices an increasing demand for digital healthcare services that can enable citizens to better manage their health, they want better insight and control over their own health status. While the healthcare sector in Sweden has long been slow to adapt to the digital society, it is now rapidly moving forward, creating the future of healthcare Our daily operations in hospitals and healthcare centers is already using state-of-the-art technology but one of our biggest challenges is to truly open up the healthcare system so that I as a citizens can become an equal partner in the planning and delivery of care.

The way we carry out healthcare today has proven somewhat successful in terms of each of us living longer, richer and healthier lives. However with limited future resources and an aging population we can only assure fulfilling all needs, if we provide citizens with the power, knowledge and confidence so that they can partner with us and lead an active role in their health and care. Innovative use of modern technology to achieve this that is what ehealth is all about says Agneta Granstrรถm vice Chair of the County Council Executive Committee

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Hypertension Management – What Are We Doing Wrong?

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research and development Germany has the biggest market in the world for blood pressure monitors. Last year alone, 2.8mn blood pressure monitors were sold in Germany. From the point of view of a manufacturer of blood pressure monitors, this is wonderful. It is good business.

However, we must also ask a question that has an unpleasant answer… Is this also good health management? Unfortunately, from a person who prefers to view blood pressure monitors as useful only if used in the context of a managed healthcare program, the answer is an emphatic no. Do German people who buy a blood pressure monitor have a better cardiovascular risk profile than those who don’t? The answer is “not really”. The reason for this is that many people who buy a blood pressure monitor do so to assuage their guilt about their poor lifestyle but do not really change their lifestyle.

In the healthcare industry, “management” is a magic word that blankets all manner of excuses and that often fails to address basic issues such as “disease education”, which is the axis on which healthcare should be balanced. There are as many definitions of disease management as there are disease management programs. The confusion is perhaps rooted in a fundamental paradox: In disease management, we really should try and manage patients, not diseases.

of individual patients. Measuring and analyzing patient-centered data can help meet this challenge.

All managed healthcare programs should have a common goal. They should focus on an integrated, pro-active approach to delivering healthcare services to patients who have a particular disease to achieve good outcomes at the most reasonable cost. It is absolutely pointless to tell a patient to purchase a blood pressure monitor and to monitor himself regularly if the patient is not made aware of what he is attempting to control and what his parameters are. As a manufacturer of BP monitors, receives information regularly informing us that patient’s blood pressure has fluctuated by “four whole points” in a day or that doctors are informing patients that their BP was 120/80. Some users of our technology ask why the Microlife Blood Pressure Monitor tell them that their BP is 128/74? This could mean that they do not understand their disease and that they therefore cannot control it. We believe that an understanding of the parameters of hypertension is essential to its eventual successful control.

Armed with clinical and patient-centered data, doctors can design and implement structured plans matched to the individual needs of their patients. Hence, disease management need not be viewed as an inflexible “cookbook” approach to healthcare.

Health is more than just the absence of disease…

Doctors, treating one patient at a time, have to focus on the unique needs of each individual patient.

Some South African doctors are fighting with South African medical aids using the contentious argument that standardized guidelines promote a “cookbook” approach to patient care that cannot account for the variation and complexity they encounter in the examination room.

The challenge for medical aids is to find a practical way to implement standard guidelines with the flexibility for doctors to tailor-make plans for the needs

Doctors are more likely to support disease management methods if they allow for doctors to consider the needs of individual patients. And vice-versa, patients are more likely to benefit from disease management if guidelines can be tailored to their specific circumstances and experience.

The single most important step for doctors treating hypertension is to enlist their patients as partners in their own healthcare. If a doctor recommends that patients take their BP measurements at home, they must make sure that the patient is doing it right, making sure that they are testing their BP at the same time every day and ensuring that the patients use monitors that are validated by the BHS or the AAMI. Since the medical use of mercury is being more and more restricted around the world, the calibration and accuracy of non-mercury devices is becoming increasingly important. The doctor must compare the patient’s readings with theirs to determine accuracy.

Blood pressure values obtained by home measurements are several mm/Hg lower than those obtained by office measurements with home blood pressure values of around 125/80 mm/Hg corresponding to clinic pressures of 140/90 mm/Hg; home blood pressure measurements also provide numerous values on different days in a setting closer to daily life conditions than the doctor’s office. It also favorably affects patient’s perceptions of their “hypertension” problems and improves adherence to treatment.

A new plan due to be unvieled soon aims to reduce the cost of blood pressure monitors by over 50% in South Africa. This program will also be aimed at improving patient compliance to drug medication sched-

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research and development ules. At the moment, research shows that only 8% of all patients with hypertension are completely controlled. Most patients do not realize that hypertension is a “silent killer” with no symptoms to remind them of the need for continuous treatment until the swift strike of a stroke or other devastating complication.

classification chart for adults set by the World Health Organization:

Good communication between the physician and the patient lies at the core of the successful management of hypertension. Good information about blood pressure and high blood pressure, about risks and prognosis, about the expected benefits of treatment and about the risks and side effects of treatment is essential for satisfactory life long control of hypertension.

So what is your blood pressure, really?

Important Information: Many doctors use rounded figures for blood pressure and will use the number 120/80 for any value considered as being in the normal range, so instead of telling you that your blood pressure is 134 over 76, he will quite often just tell you that you are 120 over 80.

* Ranges may be lower for children and teenagers.

Talk to your child’s doctor if you’re concerned your child has high blood pressure. ** These recommendations address high blood pressure as a single health condition. If you also have heart disease, diabetes, chronic kidney disease or certain other conditions, you’ll need to treat your blood pressure more aggressively.

Blood pressure is the measure of the force that the blood exerts on the inside walls of your arteries. Blood pressure is expressed as a ratio (ex 120/80). The first number is called the systolic pressure, and is the pressure in the heart when it is beating. The second number is the diastolic pressure, and is the pressure in the heart when it is resting (between beats).

In general, it is better to have a lower blood pressure than a high one. With high blood pressure, the heart works harder, your arteries get damaged and your chances of a stroke, heart attack, or kidney problems are greater.

Blood pressure is historically expressed in mmHg, or millimetres of mercury, even though there is no longer any mercury used in electronic devices. It is interesting to note that in most French speaking countries, blood pressure is expressed cmHg, or centimetres of mercury, which means that the doctor would express your blood pressure as 12/8 (twelve over eight) instead of 120/80.

Blood pressure fluctuates greatly in the course of a day. Many factors, such as exercise, conversation, alcohol, stress, movement, food or smoking can cause your blood pressure to rise and fall temporarily. This is why it is important to always measure and record your blood pressure at the same time and under the same conditions every day and to be completely relaxed when you measure your blood pressure.

Averaging of results

And how do connected blood pressure monitors help?

It is also interesting to note that most doctors use rounded figures for blood pressure and will use the number 120/80 for any value considered as being in the normal range, so instead of telling you that your blood pressure is 134 over 76, he will quite often just tell you that you are 120 over 80. One could almost say that 120/80 is a generic number for normal blood pressure. We have noticed over the years that this is often a cause of complaints from patients who do not understand that the doctor is using this number (120/80) as a reference only. Over the past 15 years, we have received hundreds of letters from patients telling us that they think that their device is inaccurate. An example is Patient X who states that she would like a refund on her blood pressure monitor because “it is giving me a result of 133 over 84 and my doctor told me that I was 120 over 80”. In fact the result of 133/84 of Patient X is much more accurate than the doctor’s estimation, but it is of no medical consequence because both results are perfectly normal. In this case, the doctor of Patient X just gave her the “generic” figure for a normal blood pressure, which is 120/80.

In 2009, iHealth had the idea of connecting blood pressure monitors to a smartphone (originally Apple, but now the products are also available in Android).

This today seems like an obvious thing to do, and indeed, for Uwe DIEGEL, CEO of iHealthLabs Europe, the company responsible for the sudden epidemic of connected devices, this is the case. “I have never really considered that connected devices were an invention. I was making blood pressure monitors, and I simply added the connection. For me connected health has always been a natural evolution of technology”, says Diegel.

The one thing that connected blood pressure monitors do, is to bring better comprehension about the disease to the end-users. The smartphone makes it easier for the end-user to track, manage and share his vital data, because the results are displayed in easy to understand displays (everybody understands that green is good, yellow less god and red is dangerous) and allow the user to follow the evolution of blood pressure over time.

When the blood pressure is measured, it should ideally fall within a specific range. Knowledge of this range and of your blood pressure should allow you to better manage your health. This is the blood pressure

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Your Starter for Ten 24 | ghp September 2015

research and development Cambridge has long been a historic university city and the birthplace of innovations in almost every industry. Life science real estate specialists BioMed Realty believe it could potentially be a hub for the life science industry in the future. We speak to Director Doug Cuff about why the firm is investing heavily in the area.

Cambridge has the potential to become a hub for life science work, as it is already the largest life science cluster in all of Europe despite being a relatively small city.

The city’s economy is based firmly around the University, with ideas being created there and transferred to private companies through funding and the employment of former students. Cambridge University and in particular the Babraham Research Campus provide a perfect platform for nurturing talent in the area and providing a springboard for new ideas which can then be taken further by the introduction of industry partners.

The University has created the intellectual space for these young companies to start to grow by creating innovators from its students, but they require the infrastructure to succeed in the area, such as laboratories and companies willing to fund research.

This infrastructure is already growing, with the Cambridge Science Park, which was founded in the early 1970s being key to this. The park allowed innovators in life sciences from the University to grow and expand their activities, creating larger firms and more infrastructure and making Cambridge a key talent base in the industry. Lack of space to develop ideas is a critical issue in every research-led industry and Cuff believes that Cambridge could hold the key to helping the life science industry expand in the future, bringing together companies with innovative ideas in one space.

“I believe that Cambridge has all the essential elements needed to become one of the world’s leading life science cluster markets. It has a foundation of worldclass research institutions led by Cambridge University, an ample supply of millennial workers that life science companies need to grow, support for local and national U.K. government and great access of transportation with Stansted Airport and Central London close by.

“The lack of available lab space is becoming a acute in the U.K. as small and mid-sized companies are unable to find the necessary space to grow and conduct their ground breaking research. It is critical that companies continue to invest and develop more space that will allow Cambridge to meet the growing demand for life science real estate. This effort will require commitment and partnership between the government, research institutions like Cambridge University and the private sector such as BioMed Realty.”

Although London is the capital city and has a high concentration of research centres, Cuff is keen to emphasise that growth in Cambridge will produce a city which will become central to the British life sciences industry.

“London currently has approximately 80,000sf of commercial space located in various incubators around the city. With the academic and entrepreneurial clout being created at the powerful London universities such as UCL, Kings and Imperial, as well as top-flight research institutions including The Crick Institute (soon to open), the Institute for Cancer Research and Cancer Research UK; there a growing scarcity of space to allow collaboration to grow into companies and then to scale that growth.

“There are a number of examples of companies such as Retroscreen, and Polytherics that get started in London; but then move to Cambridge where they can scale their business. Additionally, the Mayor of London, Boris Johnson, has recognized this and has created a group, ‘Med City’, to help grow and retain the life science industry in London. One of Med City’s focuses is to try and identify areas around London to help foster a Life Science Cluster.

“A number of large firms which developed out of the University chose to stay in Cambridge because of the wonderful talent base. As they grew, more and more developers began to seize this opportunity. Today, the University of Cambridge is such a large attraction; AstraZeneca has decided to put its corporate HQ adjacent to Addenbrooks Hospital. They are currently building a brand new campus. As they are building this campus, AZ is moving many groups down from Cheshire and renting any and all space (office and lab) in the market, which has the effect of limiting supply in the Cambridge market in the short term.”

BioMed Realty has supported numerous firms within the life sciences industry including Illumina, Regeneron and Bristol Myers Squibb to focus on bringing lifesaving new drugs to the market without having to worry about a lack of infrastructure or laboratory space for development, and has invested heavily in Cambridge based projects in the process.

Cuff explains what the company believes is needed for the city to establish itself as a centre for life sciences innovation: “Cambridge needs to continue to develop life science real estate and knowledge communities that will help recruit and retain biotech companies by creating environments that foster and grow new life science companies, which will bring in fresh ideas and invigorate the industry.”

Overall, further investment is needed to ensure a firm base but early work has already created a good environment for life science innovation to grow.

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New Data Shows M&A in Pharma and Healthcare Set to Average Half a Trillion Dollars per Year for Foreseeable Future

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funding and investment Report shows upward trend in global M&A across the industry.

The Pharmaceutical and Healthcare sectors will continue to see significant merger and acquisition activity over the next five years as aging demographics in major countries, the demand for new drugs and new technology players continues to fuel deal-making, reveals a unique new forecast by Baker & McKenzie published in association with Oxford Economics.

The report predicts an estimated US$510 billion in completed pharmaceutical deals in 2015, up from $115.8 billion in 2014. Strong activity of more than $300bn per year is expected to continue in 2016 and beyond as pharmaceutical companies use M&A as a key growth strategy to acquire new drugs and expand into new markets. Healthcare M&A will reach $150bn this year, dip slightly in 2016 and then hit a peak of over $230bn in 2017.

Baker & McKenzie worked with leading international economists Oxford Economics to produce the report, which is primarily a Flagship annual report forecasting global and regional trends for M&A and IPO. Oxford Economics produced the data for the report by linking past transactions activity in each of the 37 countries various factors including GDP growth; equity prices; trade flows; money supply; legal structure and property rights and freedom to trade.

For each of these 37 markets, they then predicted GDP growth along with anticipated changes to the other criteria above to predict future transactions activity. Alongside this, Baker & McKenzie analysed the data by sector and discovered that Pharma & Healthcare is predicted to lead in M&A transactions for the foreseeable future.

The Forecast was created to assist users within the market to better prepare for future industry changes and provide insight at a global, industry and country level, arming users with content that works in their local market as well as globally There is a particular relevance to this data because there is currently no comprehensive quantitative analysis available that correlates past and future global transaction activity with the macro-economic forces that are driving these shifts in pharma now and over the next decade.

Jane Hobson, Global Healthcare leader, commented on the importance of this data within the healthcare industry and the key areas of growth for the future.

“Forecasts and predictions for activity in a particular sector help us as a law firm to identify areas of focus and ensure we are staffed as best as possible to serve our clients. From an industry perspective, whilst forecasts must always be taken for what they are - predictions that may not come to fruition if unexpected external factors are in play - they do help organisations within an industry focus business planning and in some circumstances change behaviour to respond to market dynamics.

“Although the industry has seen a lot of consolidation there remain opportunities for corporate activity in the pharma space and there is almost certainly more room for consolidation amongst the medical device and technology companies. As companies strive to provide more return for investors, we are also continuing to see companies considering carving out or spinning off whole businesses.

“We will see even more growth in the medical technology/ digital health area, as technology companies enter the healthcare sector with both products (such as wearable diagnostic devices) as well as services (such as patient monitoring and support). While a lot of this technology is being developed by companies whose business has not traditionally been focused on healthcare, these products and several companies will become targets for the large pharma and device companies.”

The report highlights a number of markets predicted to grow the fastest in terms of overall M&A in the next five years which include China, The Netherlands, Mexico, India, UK, Germany, Indonesia, Saudi Arabia and the UAE. Tim Gee, Baker & McKenzie’s Global Head of M&A explained why these countries could potentially lead the way for future M&A deals in the healthcare industry.

“Many US and European companies have accumulated large cash balances available for acquiring new businesses. Financial sponsors also have the potential to boost global transactions, with private equity firms sitting on a record US$1.1 trillion in un-invested capital. Cross-border transactions will play a significant role as companies look to gain market presence in high growth markets.”

There are always external factors which could affect the data. Like any prediction, known risks and unforeseen circumstances could disrupt global recovery and cause a drop in transactional activity, such as recent talk of the European economic issues, Chinese investment falling sharply, and the US Federal Reserve raising rates faster than expected. Whilst these could affect the findings of the report it outlines the six macroeconomic trends that will drive global economic growth over the next few years, with these cyclical trends, along with structural factors and business sentiment, forming the basis of the reports predictions for how much M&A and IPO activity will rise or fall over the next five years.

Jane added a final comment on the results.

“By providing this outlook, we aim to provide corporate leaders and investors with a forward-looking overview of the economic and investment environment they are likely to face around the world. Armed with this knowledge, we hope they will be better prepared for the future.”

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Using Shares to Keep Your Staff Motivated & Committed The key to the success of any company is its people and keeping them motivated (and stopping them leaving) is a crucial task for any business owner or manager. Staff retention can be particularly important – and challenging – in the pharmaceutical industry, because of the long term nature of the planning and product development in this industry. In this highly competitive world where head-hunters will know the name of your key people, your organisation’s culture, and your approach to management and employee support will be major contributors, but giving your key employees a structured stake in the business is also worth considering.

Judith Harris, Postlethwaite Solicitors jdh@postlethwaiteco.com www.postlethwaiteco.com

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funding and investment There are various ways to incentivise staff, but research has shown that share schemes can be a key motivator, for two reasons. First, participation in a share scheme can enable an employee to feel like an owner of the business and this can have a subtle but profound impact on the way they work and their focus on business performance as a whole. Secondly, the promise of a – possibly life changing, or at least life-enhancing - cash reward at some point in the future, should the business succeed, would make most employees think twice about leaving, especially where a large part of that lump sum may be subject to a low level of taxation.

There are various different types of share scheme, some of which can be used if you want to include all of your employees, and others which will be more appropriate where you are planning a reward for a select few.

First, though, here is a summary as to how a share scheme works.

How a Share Scheme works – and some terminology explained One of the most common approaches, and the one used by most companies for their key or senior employees, is to grant them share options. Instead of being issued with shares directly, your employees (or employee) will be granted a right (an option) to buy shares in the company at a certain point in the future.

If those employees decide to buy the shares at that point (exercise their option) the price that they will pay (their exercise price) will be the price agreed at the outset. This will typically be the value of those shares at the date when the option is granted. So, if the share value has risen in the meantime, the employees will buy those shares at what will effectively be a discounted price. If they are able to sell those shares (for example if the company is sold) they will make a profit. (That will be their option gain).

Their reward is therefore directly linked to the performance of the company and the amount by which the shares increase in value.

Factors to think about if you want to set up a Share Scheme • Who you want to include. This could be all of your employees or one or more select senior employees.

• When the employees should be able to exercise the option and buy the shares. This could for example be upon an exit (a sale or flotation) or after a certain period of time has elapsed. This will depend upon what your long term goals are.

So if you are working towards selling the business, you may want to provide that the options can be exercised upon a sale. Or you may be taking a longer term approach with no specific plan to sell your company and be looking to bring your employees into the ownership.

• What price you would want your employees to pay for their shares. The exercise price can be the value of the shares when the option is granted, or if, say, you wanted to reward past performance, a lower value.

• Whether you want to impose any performance targets. If so, the employee would only be able to exercise their option if they achieved those targets.

• How you would want to treat leavers. They may

forfeit their options or, in certain circumstances, be permitted to retain them and either exercise them then and there or at a point in the future.

Types of Share Scheme and Tax Treatment These can be broadly divided into Tax-Advantaged and non-Tax-Advantaged Schemes (these used to be called Approved and Unapproved Schemes). Another distinction is between all-employee and key employee schemes.

For Tax-Advantaged Schemes, the clue is in the name. They carry tax advantages but there are qualification provisions for these. Non-Tax-Advantaged Schemes can still act as incentives for employees but any option gains made by employees through Non-Tax-Advantaged schemes will be taxed as income tax (and national insurance may also be payable).

The starting point for a smaller business would generally be to consider an Enterprise Management Incentive (or “EMI”) Scheme as these are the most flexible and tax efficient. Employees will only pay tax when they eventually sell their shares and then (provided that the exercise price is no less than the market value of the shares when the option was granted) at CGT rates, which are lower than income tax and National Insurance. As an added bonus, they may also be able to claim entrepreneurs’ relief, which will make the tax rate 10%. Compare that to the income tax rate of 45% for a higher rate taxpayer, and that’s before the addition of employees’ and employers’ national insurance contributions.

EMI is however only available to businesses which pass a qualification test. So, for example, your business would need to employ fewer than 250 employees and have total gross assets of less than £30m. Certain types of business are excluded, although pharmaceutical companies would generally qualify. You will need to check the position carefully though if much of your revenue arises through the receipt of royalties.

If your business doesn’t qualify for EMI, or it is not appropriate for you, there are a number of other schemes which can be considered, including a Company Share Option Scheme (known as a CSOP); an arrangement under which employees can receive free shares if they agree to give up certain employment law rights; and two share schemes for all employees: a Share Incentive Plan (a SIP); or a Save as you Earn Scheme (an SAYE).

International companies UK employees can be offered options over shares in a company where the parent company is based overseas. All types of share scheme – including the Tax-Advantaged schemes – are available to companies offering shares in a foreign-owned parent to UK employees, although some special considerations will need to be taken into account.

Employees who are based overseas can participate in a UK option scheme, but will only benefit from the tax advantages if they are UK taxpayers. It is often possible to design an employee share scheme that, by being flexible as to how it operates in a given country, is able to take advantage of any tax incentives offered by that particular country. Not all countries do offer tax incentives for employee share schemes, though, and the United Kingdom provides a suite of tax incentives that will be generally hard to match in most other countries.

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regulation and policy

Health Tech Apps Are Muddying the Already Unclear Regulation Waters

By Farzad Henareh, VP Europe at Stericycle ExpertSolutions.

From cardiac devices to knee implants, millions of consumers across Europe rely on medical equipment to improve their health and overall quality of life. The sector is now growing more complex as it moves to embrace health apps: software programmes that have been developed to provide a wide range of services from monitoring life threatening conditions to reminding users to take critical medications. With this growing complexity, it becomes more important than ever for manufacturers to be prepared and maintain regulatory compliance.

In August 2015 alone there were eight separate medical device alerts registered by the Medicines and Healthcare products Regulatory Agency (MHRA), ranging from syringes and insulin pumps through to home-use blood glucose monitoring systems and surgical hair clippers. The previous month this figure was even higher. As we’ve seen in recent recall events, there are a variety of reasons that can cause a recall to occur and manufacturers should be keenly aware that recalling a product could be necessary at any time.

Looking at recalls in general, fault device connection is often the leading cause. As technology continues to advance it is likely that connection and software errors will continue to increase which will have a significant impact on the notification and recall landscape. To add to this, as we highlight in the Stericycle Recall Index for Q2 2015, the medical apps market is also challenged by product classification issues, so it has become incumbent on developers of these products to inform themselves about the regulations that they must comply with.

tients that they have a medical appointment come into the consumer application category. It’s not difficult to see how apps could be put into the wrong category.

This would not only cause confusion and probably prompt a recall, but it will also expose brands to reputational and operational damage and, even more worrying, present a health risk to consumers.

Whether it’s a consumer app or a faulty wheelchair, manufacturers across the sector will find that executing a recall is no easy feat and requires plenty of preparation. With increasingly complex domestic and international supply chain arrangements, and strict regulations, it is critical that manufacturers have best practices in place to address the challenges of recall execution. For instance, documentation and traceability are two key areas that manufacturers should be focused on for regulatory compliance reasons and staying prepared ahead of a potential recall event.

This should be a major component of a product recall plan designed to streamline recall response and ensure the organisation is prepared for the eventuality of an issue.

In addition, all stakeholders from manufacturers and developers to distributors and even consumers must take ownership to ensure product safety. This collaboration is critical, particularly when you consider that looking across all categories of products, the number of safety notifications and recalls has been on an overall upward trend since 2003, and 88% of those incidents were classified in the most serious threat category. It’s time for us all to work together.

Both the MHRA and the European Commission have issued guidance on whether a healthcare app can be considered a medical device based on specific keywords. If an app is designed to ‘diagnose’ or ‘monitor,’ a patient’s condition it will be regarded as a medical device. However, apps that, for example, remind pa-

ghp September 2015 | 31

Trends in Healthcare Investments and Exits – First Half 2015 Update For this mid-year update, we analyzed private, venture-backed healthcare activity from January-June 2015. The pullback in global equity markets in late August has impacted this sector, however we believe that the fundamentals of the healthcare venture market continue to be strong. We will be carefully watching to see how IPOs now in the pipeline perform and if investing patterns by crossover investors change.

Key Takeaways Biopharma

Device

There are many very large private financings, mostly involving non-VC crossover investors and typically including groups of two or three crossovers per deal. With 24 IPOs in 1H, we see the robust activity showing no sign of slowing down. IPO optionality translates to a high number of early 1H M&A deals (10).

Round sizes are up, helped by new crossover investor attention. IPOs are set to outpace 2014, with seven in 1H. M&A heated up in Q2 after no activity in Q1, as Medtronic gets back in the game.

Dx/Tools

Except for two large rounds (Adaptive and Natera), Q2 was a slow quarter. Compared to 2014, M&A activity in 1H dipped, but IPOs appear on pace to match.

Biopharma Private Financings

M&A • The volume of Q2 M&A remained steady with four exits, building on the seven in Q1. This sets the stage to top 2014 M&A transactions (14).

Top 15* Biopharma Venture-Backed Financings Range

$56M - $500M

Median

$76M

Biopharma Crossover Activity: Participated in 13/15 Financings Series A 7%

Phase I 13% Pre-Clinical 60%

Phase II 27%

Series C+ 47%

Biopharma Clinical Phase

• Deal size in M&A has held relatively steady in comparison to the last two years, with median upfront at $200M and median total deal value at $400M.

Series B 46%

IPO

Biopharma Round of Financing

• We remain firm on our prediction in March 2015 of 45-55 biopharma IPOs for the year.

*Top 5 financings from Q1 and top 10 from Q2 to focus on most recent trends

Exit Activity Biopharma Exits by Quarter 2013 2014 2015

Q1

Q2

Q3

Q4

IPO

3

10

11

8

32

M&A

3

3

4

4

14

Total

IPO

24

12

17

13

66

M&A

3

4

6

1

14

IPO

11

13

24

M&A

7

4

11

Source: CB Insights, press releases and SVB proprietary data

• Q1 M&A saw earlier stage assets (3/7 pre-clinical), and Q2 continued that trend with 3/4 pre-clinical or Phase I. IPO optionality is at play, as acquirers look to snap up early-stage companies with compelling technology and large markets prior to an IPO (see Q1 example Flexus).

• Eleven of 24 IPOs 1H had participation from crossovers. Of the six IPOs that raised more than $100M, five were backed by top crossovers (lone outlier was Seres).

• IPO breakdown: pre-clinical (4); Phase I (6); Phase II (11); Phase III (2); FDA approved (1); over 40 percent IH early stage (pre-clinical + Phase I). This activity mirrors what we saw in 2014.

Device Private Financings

M&A • There were four device acquisitions in Q2 after a surprisingly inactive first quarter that saw no activity. 2/4 acquisitions were

by Medtronic, which appears to have gotten over its integration of Covidien and is back in the market. (We also saw the company make some equity investments.) Four M&A deals in July prime device to approach last year’s record number of transactions.

Top 15* Device Venture-Backed Financings Range

$20M - $57M

Median

$35.3M

Device Crossover Activity: Participated in 4/15 Financings Development 13%

• Average deal value was $112M, with a fairly defined range of $63M – $175M up front. This could be considered a cautionary tale for the companies raising $35M+ in equity, as so far there seems to be a fairly limited range in exit values.

Series B 27% U.S. Commercial 40%

C.E. Mark 47%

Series D+ 53%

Device Development Stage

Series C 20%

IPO

Device Round of Financing

• There were four device IPOs in Q2, building off increased volume in Q1 (3 IPOs).

*Top 5 financings from Q1 and top 10 from Q2 to focus on most recent trends

Exit Activity Device Exits by Quarter 2013 2014 2015

Q1

Q2

Q3

Q4

Total

IPO

0

0

0

2

2

M&A

1

2

6

2

11

IPO

1

5

1

3

10

5

2

18

M&A

2

9

IPO

3

4

7

M&A

0

4

4

• In 2014, there were 10 device IPOs, so the trend line here is very positive for an up-year — which matches our March prediction in the sector.

• 2/4 had participation from crossovers in Q2, compared to no activity in Q1.

• It is healthy to see crossover activity fuel IPOs, and the three large financings by crossovers in Q2 create a nice potential IPO pipeline.

Source: CB Insights, press releases and SVB proprietary data

Comments on the report from Nooman Haque, Director of Life Science UK “The first half of 2015 has seen a continued growth in healthcare investments and exits in both the UK and US markets. According to Silicon Valley Bank’s mid-year update on “Trends in Healthcare Investments and Exits”, this progress has been driven for the most part by non-VC crossover investors with a desire for biopharma and device businesses preparing for an IPO. The report, analysing venture-backed healthcare activity between January and June 2015, shows that the healthcare venture market is not just solid, it’s growing. With 24 biotech IPOs taking place within the first half of the year, a quarter of those raised more than $100 million. These are impressive figures, and have fuelled M&A activity in the sector. This activity however, has remained focused on early-stage businesses, with six out of the 11 M&A deals at the phase 1 or pre-clinical phase. As well as this, big pharmaceutical companies are increasingly keen to buy up innovative businesses developing new drugs and devices due to dwindling internal R&D pipelines.

Driven by investor confidence, healthy access to capital and exit optionality, it looks as if 2015 will be the third consecutive year of strong activity for the healthcare sector as the ‘biotech boom’ is showing no signs of slowing down.”

Dx/Tools Private Financings

M&A • No M&A deals in Q2, so we are lagging 2014 activity.

Top 15* Dx/Tools Venture-Backed Financings Range

$9.7M - $195M

Median

$20M

IPO • Both dx/tools IPOs in Q2 were commercial stage diagnostics.

Dx/Tools Crossover Activity: Participated in 4/15 Financings

• Of three additional deals in the IPO pipeline at the end of Q2, two are backed by crossovers, including Natera, which went public in early Q3.

U.S. Commercial 7%

Development 13%

Series A 20% C.E. Mark 80%

Series C+ 67%

Dx/Tools Development Stage

• With three IPOs in 1H, we are roughly on pace to match 2014 (7).

Series B 13%

Dx/Tools Round of Financing

*Top 5 financings from Q1 and top 10 from Q2 to focus on most recent trends

Exit Activity Dx/Tools Exits by Quarter 2013 2014 2015

Q1

Q2

Q3

Q4

IPO

1

0

1

1

Total 3

M&A

1

1

1

0

3

IPO

2

2

3

0

7

M&A

2

3

0

5

10

IPO

1

2

3

M&A

3

0

3

Source: CB Insights, press releases and SVB proprietary data

Note: Equity refers to private, venture-backed equity financings, using data from CB Insights. M&A refers to private, venture-backed M&A in device and dx/tools of at least $50M upfront, and in biopharma at least $75M upfront. IPOs refer to private, venture-backed companies that raise at least $25M in an IPO.

Written by Jon Norris Managing Director, Healthcare Practice jnorris@svb.com 650-575-137

Paul Schuber Associate pschuber@svb.com 415 764 2463

This material, including without limitation to the statistical information herein, is provided for informational purposes only. The material is based in part on information from third-party sources that we believe to be reliable, but which have not been independently verified by us and for this reason we do not represent that the information is accurate or complete. The information should not be viewed as tax, investment, legal or other advice nor is it to be relied on in making an investment or other decision. You should obtain relevant and specific professional advice before making any investment decision. Nothing relating to the material should be construed as a solicitation, offer or recommendation to acquire or dispose of any investment or to engage in any other transaction.

Learn more at svb.com ©2015 SVB Financial Group. All rights reserved. Silicon Valley Bank is a member of FDIC and Federal Reserve System. SVB, SVB FINANCIAL GROUP, SILICON VALLEY BANK, MAKE NEXT HAPPEN NOW. and the Chevron device are trademarks of SVB Financial Group, used under license. Silicon Valley Bank is the California bank subsidiary and commercial banking operation of SVB Financial Group. Corporate Headquarters Address3003 Tasman Drive, Santa Clara, CA 95054 B-15-14377 Rev. 09-01-15.

Comments on the report from Nooman Haque, Director of Life Science UK “The first half of 2015 has seen a continued growth in healthcare investments and exits in both the UK and US markets. According to Silicon Valley Bank’s mid-year update on “Trends in Healthcare Investments and Exits”, this progress has been driven for the most part by non-VC crossover investors with a desire for biopharma and device businesses preparing for an IPO. The report, analysing venture-backed healthcare activity between January and June 2015, shows that the healthcare venture market is not just solid, it’s growing. With 24 biotech IPOs taking place within the first half of the year, a quarter of those raised more than $100 million. These are impressive figures, and have fuelled M&A activity in the sector. This activity however, has remained focused on early-stage businesses, with six out of the 11 M&A deals at the phase 1 or pre-clinical phase. As well as this, big pharmaceutical companies are increasingly keen to buy up innovative businesses developing new drugs and devices due to dwindling internal R&D pipelines.

Driven by investor confidence, healthy access to capital and exit optionality, it looks as if 2015 will be the third consecutive year of strong activity for the healthcare sector as the ‘biotech boom’ is showing no signs of slowing down.”

Alcohol Related Brain Damage (ARBD)

36 | ghp September 2015

health and social care Mike is 52. I was asked to see him a few months ago on a mental health inpatient unit in my health board.

Mike has Alcohol Related Brain Damage (ARBD) and when I first saw him his cognitive function was extremely poor, his capacity limited and his ability to self care virtually non-existent. Continuing Healthcare funding was being considered for a long term placement in a residential home for adults with acquired brain injury (quite a costly placement) and I was asked to contribute to the assessment. In my report I pointed out that, although a significant degree of supervision was required for Mike at that time, with the correct intervention, things could improve to the point that he would need a less supportive environment.

Today I went back to see Mike. The inpatient team decided to keep him on the ward so that he could be given the ‘intervention’ there and, as a result, his cognitive function has indeed improved. Now we are looking at supported accommodation in the community, a much more prudent option saving the NHS around £350 per week.

What is this amazing intervention that can improve cognitive functioning in patients with ARBD? Is it something incredibly technical? Is it a new drug with a big price tag?

Let me leave you in suspense a little longer while I first explain what ARBD is. ARBD is an umbrella term for a number of conditions where excessive alcohol consumption leads to cognitive impairment.

Many clinicians will be aware that one of the cardinal features is short term memory impairment but there is evidence to show that frontal lobe dysfunction is the earliest sign. Hence, in addition to short term memory problems, sufferers experience difficulties in decision-making, goal-setting, action-planning, impulse control and motivation. The root cause is the direct toxic effect of alcohol on the brain combined with difficulties in repairing the damage because of a deficiency of the vitamin thiamine. Thiamine is found in whole grains and various vegetables, something the diet of a dependent drinker is fairly deficient in, but the additional problem is that alcohol blocks thiamine’s absorption from the gut.

For a number of patients the condition develops slowly in the community but episodes of alcohol withdrawal (particularly if not treated or inadequately treated) will speed up the deterioration. Many people do not realise they have signs of ARBD. In fact Bates et al (2002) estimated that 50-80% all patients presenting to standard alcohol treatment services have some evidence of cognitive impairment - and a lot of them are unaware. Think back to that list of frontal lobe symptoms as these are the ones that often go unrecognised and we can instantly see how they might impact on the ability of an individual to engage in treatment. Treatment services expect them to be motivated, to set goals, plan how they will achieve goals and then sigh in despair when they fail to control impulses to drink.

So let’s get back to my remarkable intervention.

What can prevent this terrible condition deteriorating further and, in up to 75% of cases, actually improve cognitive function (Smith and Hillman, 1999)?

Abstinence and a good diet rich in thiamine. That’s it. Nothing more complicated than that. In fact, the

development of ARBD is a process and that process offers us several points for effective interventions. For instance, identifying when individuals start to become problematic drinkers and delivering brief motivational interventions at that point, a remit for primary care perhaps? Adopting a more assertive outreach approach to those referred to treatment services due to their problems engaging. Ensuring dependent drinkers not ready to achieve abstinence are prescribed supplemental thiamine. Identifying those at risk of alcohol withdrawal when they get admitted to hospital and ensuring their withdrawal is managed adequately.

Making sure those at risk are prescribed parenteral thiamine during withdrawal. Identifying complicated forms of withdrawal (e.g. delirium tremens, Wernicke’s Encephalopathy) at an early stage and implementing the correct medical management. Picking up on signs of ARBD as soon as possible and placing patients into supportive environments where they can be protected from the effects of alcohol (possibly using legislation such as the Mental Capacity Act, 2005). Developing clinicians with expertise in the management of established ARBD and specialist residential placements for those with no further scope for cognitive improvement (able to provide cognitive rehabilitation).

And only a small proportion of that menu of interventions requires specialist services. The majority depends on awareness raising amongst existing health and social care staff and education on the cognitive effects of dependent alcohol consumption. This would require a small investment for a significant health gain. But not only a gain in the health of the individual and the chance to return a family member to a more independent level of functioning - the financial gains can be significant. On average even non-complex patients with late stage ARBD requiring residential placements cost around £700-800 per week. With appropriate interventions the same patients end up costing around £200-300 per week - and the savings are even greater for the complex needs patients (Prof Ken Wilson, personal communication).

If we were claiming an intervention that would improve cognitive function in up to 75% cases of Alzheimer’s dementia there would be no hesitation in investing. Those with ARBD are often younger adults with years ahead of them and with the help of some awareness raising those years need not be spent in a haze of unknowing.

Dr Julia Lewis is Consultant Addiction Psychiatrist and Clinical Director for Adult Mental Health and a Director of Pulse Addictions Trainingwww.pulseaddictionstraining.com. Pulse Addictions Training provide training and consultancy to professionals to various sectors, agencies and organisations in all areas of substance misuse.

References Bates M, Bowden S and Barry D (2002) Neurocognitive impairment associated with alcohol use disorders: implications for treatment. Experimental and Clinical Psychopharmacology 10: 193-212 Department of Health (2005). Mental Capacity Act. London, HMSO. Smith I and Hillman A (1999) Management of Alcohol Korsakoff Syndrome. Advances in Psychiatric Treatment, Vol 5, pp 271-278.

ghp September 2015 | 37

Telford Gets TACT Telford and Wrekin Borough Council won the NICE Local Government Chronicle Public Health Award for their work with the Telford After Care Team (TACT). We spoke to TACT’s founder Rob Eyres, on how the community interest company is changing the way addicts are treated across the Midlands.

38 | ghp September 2015

health and social care Since 2013, councils have been responsible for the public health of their local populations, which has led NICE to produce local government briefings to help them with this role, with 26 having been published so far.

which often form the underlying cause of addiction issues and the way addicts are treated at healthcare centres such as hospitals and GP surgeries.

NICE also supports the Local Government Chronicle Public Health Award in order to encourage local councils to seek excellence in the provision of healthcare to their residents.

They also provide a lot of prevention work in schools, sending former users to discuss alcohol and drug issues at Staffordshire and Stoke University, teaching second year nurses about addiction and how to deal with it. Eyres is keen to emphasise that this approach is vital to reducing the number of addicts.

Telford and Wrekin Borough Council won this year’s award for its work with the Telford After Care Team (TACT). Substance misuse is among the key public health priorities at the council and as a result they supported TACT to help people recover from addiction to improve their health, wellbeing and independence.

“We aim to turn peer pressure into peer support. For the first time we have got people telling young people not to abuse substances rather than encouraging them to do it.”

TACT is a community interest company aimed at supporting addicts, not just in getting clean, but in moving on and rebuilding their lives. The service was founded in 2012 by Eyres, a former heroin addict, and staffed exclusively by volunteers who are all former addicts.

The centre is immensely popular, attracting as many as 60 people a day seeking support. TACT also offer other support services designed to help addicts rebuild their lives, for example running a weekly women’s group and operating a woman only safe house in the area. There are also fishing, swimming, gardening and art groups all designed to offer a supportive and enjoyable environment and provide service users with the opportunity to develop their lives further than just leaving behind their addiction.

Working together with the council and Clinical Commissioning Groups (CCG) in the area TACT helps to design the strategy for supporting those with drug and alcohol problems for the next three years. In order to do this effectively TACT consulted service users who they were supporting in order to gauge how services could more effectively meet the needs of addicts.

Other groups offered by TACT include a health drop in which offer advice on healthy eating; a housing, benefit and debt advice drop in service and a weekly employment group which helps people who are ready to gain employment by offering help with tasks such as writing their CV and cover letter, job searching and providing advice on interview techniques.

The TACT team’s founder, Rob Eyres, was keen to stress that this form of collaboration between the council and a service user led organisation like TACT was key to the initiative’s success.

The organisation has become highly influential, with Eyres now sitting on numerous Clinical Commissioning Groups and board for clinical governance in the area, discussing a variety of public health issue not limited to substance abuse, including improving care in the community and GP services.

The council used its public health grant to support TACT, and to develop an evidence-based strategy to help reduce the use of drugs and alcohol within the borough.

“We are a service user led organisation and we are partnered with the local health authorities in Telford and Wrekin. By working together for possibly the first time ever we have taken the voice of the people who have been through the system for years and working that experience into the strategies that the local authority abide by.

“So this is not about simply working with other groups to educate people, this is the first time we have taken the initiative and with the help and support of the steering groups that we have organised with the council we are getting the information from people who have been stuck in the system for years and using it to make the system better. Telford and Wrekin has a really good outcome-based system which is all because of going back to the grassroots and seeing what needs to be done.

“I think that the strategy we had before that was photocopied, like it is in a lot of areas. Every year they would just take the old one and photocopy it and change it a little. We actually sat down and pulled that apart, we ripped it up and made a new one using service user consultation to reflect what treatment should look like in Telford and Wrekin.”

The organisation is not strictly focused on ending a person’s substance abuse, with other issues around this also focused on, such as the prevalence of illnesses such as hepatitis c in addicts, mental health issues

Every week the service gets feedback from their users and write reports on how local services can improve.

Eyres himself will be hosting workshops in November as part of a conference for every CCG in the midlands, highlighting how far reaching the impact of the service has become.

Ultimately, Eyres highlights the fundamental importance of the TACT service in improving the quality of the health service by using the experiences of the service users.

“It is all about using people’s experiences, getting people who have had these problems and are now doing well, to say what they feel works best and what doesn’t work. Being listened to is another big thing that means a lot to our users, although we do have to follow guidelines our service is all about using their experiences and really listening to the people who have had these problems and letting them help to change the system for the better.

“I once had someone say to me that you can’t reinvent the wheel. I said ‘No, but sometimes the wheel needs a new tyre’. That’s what we do. The service still works the same but with a different perspective added, like a new tread on a tyre.”

ghp September 2015 | 39

40 | ghp September 2015

health and social care

Anti-bullying Policy at Worcestershire Acute Hospitals NHS Trust

By Dr. Sue Paterson and Joan Kingsley

Recent press articles have highlighted how a report by the Good Governance Institute into the anti-bullying policies at the Worcestershire Acute Hospitals NHS Trust, particularly their ‘Dignity at Work’ policy, is ‘not fit for purpose’. The report elaborated by saying that the approach taken at the Trust was ‘inconsistent and confusing’ and failed to take staff concerns seriously.

Another issue raised by the report was that there was confusion about what bullying actually is.

Bullying Bullying can manifest itself in many forms, but the outcome is always that the bullied person feels under threat. A threat at work is invariably to do with losing something of importance. David Rock’s SCARF model (Rock, 2008) is a useful framework to use to categorise the different types of bullying behaviour in the workplace. The framework gives an overview of what people at work most fear losing: • Status: Bullying can mean belittling a person, causing public professional humiliation, or making accusations of lack of effort.

• Certainty: Bullying can mean preventing access to opportunities, or withholding information.

• Autonomy: Bullying can mean failing to give credit where it is due, giving out meaningless tasks, removing responsibility, or shifting goal posts.

• Relatedness: Bullying can mean calling people names or insults, teasing, or isolating them.

• Fairness: Bullying can mean making unjustified accusations, showing lack of respect, or increasing the workload substantially.

As well as these relatively subtle practices, bullying can also take more overt forms, like aggression, violence, punishment and generally vindictive behaviour.

The brain and bullying When under threat, the brain’s response is to focus on ensuring survival. Keeping on the alert for dangerous bullies all the time generates fear and anxiety, which leads to high levels of stress and all the subsequent health and emotional problems that this entails.

Bullies at work are dangerous, and can damage co-workers health as well as destroy a team’s performance. If staff do not feel safe, or do not believe that they are valued or respected by their own management, they will find it difficult to deal effectively and compassionately with patients and with each other every day. This is why it is critically important to confront and deal with bullies promptly and effectively in the workplace.

Although the Good Governance Institute investigation found no evidence of ‘endemic’ bullying at the Worcestershire Trust, a large number of the more than 700 staff interviewed said they were concerned about ‘speaking out’ and that morale was generally very low. One of the key characteristics of an organization full of fear is that staff do not feel able to ‘speak out’.

This fear culture was confirmed by one of the medics interviewed who was quoted as saying “The culture at Worcester is very pressured, the culture in Redditch is one of palpable fear…it is paranoid.”

Bullying flourishes in organizational cultures suffused with fear. Research suggests that bullies behave in this way because they enjoy the feeling that power over others brings, or they may feel envious or threatened by their victims. Sometimes, the bullying behaviour stems from physically or psychologically abusive events in the person’s family or personal background.

ghp September 2015 | 41

42 | ghp September 2015

health and social care The eight basic emotions Neuroscientific research is underlining the damage that bullying does to the human brain; neuroscience is beginning to give insights into how organizations can become fear-free and reduce the incidence of bullying.

Our recent book (‘The Fear Free Organization – vital insights from neuroscience to transform your business culture’) explains how fear is one of the eight basic emotions that underpin all actions, thoughts and feelings. It is one of the five emotions related to ‘survival’ (the others being anger, disgust, shame and sadness).

Brains are wired to survive: to scan for threats. When a danger is perceived, the brain will focus on dealing with it until it is resolved, to the detriment of all other activities. Effectively, the brain is managing the energy that is available to it, ensuring that survival is paramount.

Of all the emotions, fear is the one that is most easily triggered. This is because it is designed to help keep the individual safe from danger, such as bullies at work. A culture full of fear is easy to establish, but it is extremely corrosive. It generates high levels of stress, costing companies money and time to deal with the damage done to employees, businesses and reputation. Ultimately, fear in an organization is capable of destroying both people and businesses.

Two of the eight basic emotions are related to ‘attachment’ – these are trust/love and excitement/joy. The eighth emotion is surprise, and it can be concerned with either ‘survival’ or ‘attachment’ depending on the circumstance (surprise/horror or surprise/delight).

When trust/love is present at work, extraordinary things can happen. The brain is released from looking out for danger and can focus entirely on the job in hand. Trust/love is the antidote to fear. Productivity increases, as does efficiency. Communication is open and effortless. Relationships flourish. The organization is easily galvanized into action to deliver its purpose.

When excitement/joy is in the workplace, people will use their energy innovating and having fun. In combination with trust/love, truly remarkable innovation can happen, alongside growth and positive relationships.

When organizations are characterised by the attachment emotions, bullies cannot survive. Honest and open communication means that bullies are dealt with promptly and fairly. Trustful relationships mean that staff are listened to with respect and can bring the best of themselves to work. Excitement and joy is expressed and both patients and workforce benefit daily.

Conclusion Whilst policies are useful to give guidelines to staff on how to proceed when relationships breakdown as a result of bullying at work, it is much more important to prevent the bullying in the first place by establishing a culture based on trust/love and excitement/joy, and making sure that fear stays out of the workplace altogether.

Joan Kingsley and Dr Sue Paterson are authors of The Fear-Free Organization: Vital Insights from Neuroscience to Transform your Business Culture, a pioneering new book that draws attention to the need for senior staff to appreciate how fear may be ruling their businesses and how this is affecting their teams, prohibiting the development of new ideas, creativity and unlimited potential. Available from £29.99 from all good booksellers and the Kogan Page website.

ghp September 2015 | 43

ghp

September 2015

Health and Social Care Special

www.ghp-magazine.com

Research, Translation, Commercialisation

Leadership and Managment in the NHS Identifying The Challenges

Spotlight on Guy’s and St Thomas’ Trust Exploring the innovative projects and life saving research conducted in the heart of London.

Assistive Technology for Dementia Sufferers

How exciting new products are revolutionising care.

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Health and Social Care Special

editor’s note

this month’s features

Welcome to the ghp’s special Health and Social Care Supplement!

Over the coming pages, we spotlight Guy’s and St Thomas’ Hospital Trust, exploring exciting new technology in the form of their molecular diagnostic syndromic panels, as well as analysing how the trust’s charity helps to fund new innovations.

We speak to Vinayak Bapat about the extraordinary technology and techniques changing the way heart surgery is performed in the UK. Leadership within the NHS is also an important topic this issue, with management numbers in the organisation examined, and an interview with Ruth Warden, in which she explains more about the work of her organisation, NHS Employers.

Are You Leading the NHS to Success?

Identifying the challenge in the NHS. Page 62

Caroline Day of Wellbeing Dynamics explores how staff wellbeing and management within the NHS are intrinsically linked, and we take a closer look at dementia-friendly environments and the importance of assistive technology to sufferers and their carers.

We also explore the issues surrounding primary care and how this can be provided with regard to the stipulations of the Five Year Forward View.

We hope you enjoy this special supplement.

Multiplex PCR Panels at the Point-of-Care MiniLab empowers clinicians with molecular diagnostic results on demand. Page 50

inside this issue 48 Guy’s and St Thomas’ Charity: A Hub for Innovation 50 Multiplex PCR Panels at the Point-of-Care 54 GSTT Funds Pioneering Heart Operation 58 Growing Management Numbers in the NHS. Is This Fact or Fiction?

62 The Five Year Forward: NHS Employers Prospective 64 Are You Leading the NHS to Success?

68 Substance Abuse: The Frontline 70 Public Inaccuracy and Habitual Self-Interest Represents a Substantial Cost for the NHS 72 The Importance of Designing Dementia Friendly Care Environments 74 Value of Assistive Living Technologies in Providing Care Outside of the Traditional System 76 Increase in Diabetes Cases

in UK 78 New Ways for Prevention 80 Primary Care in the Post Five Year Forward View World

“Many come to St Thomas’ to watch us because the hospital is well known for being forward thinking and innovative, as well as very welcoming to overseas experts.”

Vinayak Bapat , Consultant Cardiothoracic Surgeon Guy’s and St Thomas’.

Global Health & Pharma, 39A Birmingham Road, Blakedown, Worcestershire, DY10 3JW Tel: +44 (0) 1234 567 890 | Email: info@ghp-magazine.com | Web: www.ghp-magazine.com

Guy’s and St Thomas’ Charity: A Hub for Innovation

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health and social care The charity funds innovative and exciting projects, working closely with the Guy’s and St Thomas’s Hospital Trust to deliver ground breaking new solutions in healthcare. We spoke to Oliver Smith, Director of Strategy and Innovation at the charity, on how the funding works and how the programme has been so successful.

The charity prides itself on funding innovative projects to help change the face on the NHS, working principally with Guy’s and St Thomas’s Trust as well as further afield, working within local communities to help transform healthcare for the benefit of both patients and healthcare workers.

There are three priority areas for the charity when considering funding: cancer research, population health and system transformation. These are very broad areas and the charity is always keen to fund projects which have good ideas regardless of the area of research.

£20 million a year is invested in projects by the charity, primarily through the Health Innovation Fund.

Projects which receive money from the fund are chosen through a two stage process, with the initial stage involving a concept note, a three page brief designed to provide the charity with enough information about what problem they are looking to solve and what impact they think their solution will have.

The charity is funded by an endowment which has been building up over around 100 years, as well as fundraising and donations.

The second stage of the process requires the fulfilment of a number of key criteria which ensure that the project has significant potential benefit and that it has a specific audience and a means of being funded further once it is implemented. Additionally, the charity asks how the project will be evaluated, how patients and hospital staff will engage with the project and what their plan is and how they intend to deliver it.

The team is also looked into, with the charity examining whether they have the correct assortment of skills to do perform all the tasks required within the project. The final aspect of the project that is addressed within the plan is value for money, and whether the potential benefits of the proposed project are enough to justify the cost of it as well as examining their budget and what other organisations the team has sought funding from.

Oliver is keen to emphasise that the plan is not designed to be rigidly adhered to: rather, it is an overview which highlights the skills of the researchers.

“Because we are asking people to do quite innovative things and be really ambitious we know that that in most cases a project plan is going to be wrong. After all, how can you know at the beginning of a three year project, when you are doing something that is really cutting edge, exactly how it is going to work?

You probably don’t. Why we ask them to give us this project outline is so we know they can plan, so we know they can think about risks and take into account all of the various elements of a project.”

Ultimately the charity is looking for projects which are not just innovative, but which could potentially make a vast difference within the health service, whether that be solving a particularly large problem or helping an existing aspect of the service to run more efficiently.

Oliver made it clear that overall there was one key word to encapsulate what the charity was trying to achieve: “Basically, we like to test ideas with big ambitions”.

Projects recently funded by the charity include the purchase of a 3D scanner for Evelina, the children’s hospital at St Thomas’, to cut down on the time taken to conduct heart surgery by making a model of the heart to practise on prior to the procedure.

There is also an initive currently undergoing testing called Transforming Outcomes and Health Economics Through Imaging (TOHETI), which is an initiative which aims to show how better use of imaging technology can improve patient care. This project aims to make imaging technology more accessible to patients by changing the system through which it is provided to them, as well as adjusting how this technology is applied so that it is used to its full potential.

A major part of the reason so many ground breaking initiatives come through Guy’s and St Thomas’ is because as a teaching hospital and a tertiary centre it attracts some of the best healthcare staff from around the world which, when combined with an experienced and dedicated leadership and the resources to facilitate through testing, gives these staff the ideal environment to develop these innovations.

Oliver believes that ultimately, both the Trust and the charity have a vital role to play in the future of the NHS. “As we look to the future of the NHS, clearly times are really tough across the entire system, I think in times like this there is an even greater premium on organisations that are willing to innovate because it is really easy for hospitals to develop a fortress like attitude and decide to simply weather the storm and take care of themselves, so I think what the Trust is doing, to ensure it is still innovating and still working with others, is really vital work. The Trust recognises is not a standalone organisation but a part of a wider system and I think the need to still be innovative and search for new ways of doing things in order to help not just itself but the wider NHS, is very admirable.”

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By Jessica Barrett

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health and social care

Multiplex PCR Panels at the Point-of-Care MiniLab empowers clinicians with molecular diagnostic results on demand.

Clinical laboratories are increasingly using molecular diagnostic tests for infectious diseases, since they generally provide higher sensitivity and specificity along with a shorter turnaround time than traditional methods.

Due to the increasing acceptance and demand, manufacturers are developing a range of platforms that have evolved from manual to fully automated sample-to-result systems requiring less training, experience and technical skills. Molecular diagnostic tests have evolved from clinicians ordering a series of tests to detect single pathogens to simultaneously detecting multiple pathogens along with their drug resistance that are associated with infectious syndromes using one patient sample.

These molecular diagnostic syndromic panels enable accurate etiologic diagnosis by reporting comprehensive results simultaneously for multiple pathogens associated with infectious syndromes; however, the downside for physicians is that they wait 6 to 48 hours to receive these results from the central laboratory.

For critical care patients, time to diagnosis is precious.

Enigma® Diagnostics is focused on empowering physicians with comprehensive actionable molecular diagnostic results on demand by providing a range of syndromic panels for the MiniLab, an easy-to-use Point-of-Care (POC) highly multiplex PCR platform.

Enigma Diagnostics’ MiniLab is the world’s first POC Highly Multiplex PCR platform that provides clinicians 24/7 access to laboratory-quality molecular diagnostic results using a range of highly multiplex PCR syndromic panels for the simultaneous in vitro diagnostic detection of pathogens reducing test result waiting times to about one hour.

The easy-to-use sample to results MiniLab has a small footprint. It is well-suited for a range of clinical settings where fast laboratory-quality results are imperative. Its fast comprehensive actionable on demand results empower clinicians by providing molecular diagnostic results at the POC thereby eliminating the long wait time associated with sending specimens to the central laboratory. Another benefit is that these comprehensive results do not require interpretation. It is well documented that an accurate fast diagnosis and targeted treatment improves clinical outcomes while reducing costs and supports good antimicrobial stewardship, since the team can act on results in real time.

The MiniLab features a fully integrated Control Module that has a touch-screen computer for user input, display of operating status and results, barcode reader to scan the users’ identification, patient specimen and type of cartridge, as well as a printer and connection for data transmission. The MiniLab display provides on screen feedback and animations at each step in the process assisting the operator thereby reducing the chance for mistakes. The MiniLab carries out built in checks, such as ensuring that the user is approved to run the test, quality control checks are up-to-date, cartridge is not expired and more. These checks are configurable to meet the needs of different clinical settings. Additionally, the Control Module has a number of configurable options, such as whether to print and/or transmit the results.

The MiniLab’s lowest throughput configuration is a single Processing Module attached to the Control Module making the adoption of this inexpensive platform attractive. The MiniLab’s throughput is easily expandable by adding up to a total of six Processing Modules, which can run different syndromic panels simultaneously with independent random access.

Each Processing Module is fully automated from sample preparation, nucleic acid amplification and target detection using single-use dedicated cartridges without requiring the operator to be familiar with PCR technology. These single-use cartridges contain all of the reagents required for sample processing and nucleic acid detection. These comparatively inexpensive cartridges can easily be stored next to the MiniLab, since they are stable at ambient temperature.

The easy-to-use fully integrated and automated MiniLab requires simple training and has nil operator variance.

It is designed to be used in developed and emerging health care programs. In developed health care programs, the MiniLab provides the central laboratory with a cost-effective method of decentralizing their services by providing clinicians with short test result waiting times when time is precious, especially for critical care patients. A faster test result waiting time allows patients to be tested, isolated and treated before they are able to spread the infection to other patients resulting in reduced outbreaks. In emerging health care programs, it enables rapidly-expanding health care systems the opportunity to build a diagnostic health care architecture that is cost-effective and patient-centric across multiple testing sites, unconstrained by traditional laboratory costs and limited physician availability.

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health and social care The MiniLab platform and Influenza A/B RSV Panel are CE marked in compliance with IVD directive 98/79/EC. The company’s first syndromic panel is for detecting respiratory viral pathogens, especially since respiratory infections have a high morbidity and mortality rate and patients present with similar clinical symptoms making it difficult for clinicians to determine the causative pathogen(s). Despite respiratory infections causing high morbidity and mortality for all age groups, very young pediatric patients and patients with comorbidity factors have higher mortality rates. The MiniLab enables clinicians to test patients presenting in the emergency department to quickly determine optimal treatment, send the patient home or admit the patient. In a few months, Enigma Diagnostics plans to launch a more comprehensive respiratory panel that includes Influenza A, Influenza B, RSV and Rhinovirus.

Currently, the company is developing a range of high value yet cost-effective syndromic panels targeting the large and high growth area of infectious diseases for critical care patients. The list of syndromic panels includes a Respiratory Viral Panel, Respiratory Bacterial Panel, Bacterial and Viral Meningitis, Carbapenemase Producing Organisms, Multi Drug Resistant Tuberculosis, Pneumonia, Sepsis directly from blood and others. The plans are for several panels to be launched each year.

The benefits of using syndromic panels measured in clinical evaluations, includes improved outcomes and increased satisfaction for clinical staff, as well as patients and their family. Enigma Diagnostics is working with key opinion leaders to identify needed syndromic panels, as well as clinically evaluate them.

Enigma Diagnostics was founded in 2004 to develop and commercialize technology and intellectual property from the United Kingdom Government’s Defence Science and Technology Laboratory (Dstl).

Leveraging its extensive range of proprietary technologies and intellectual property, the company developed the MiniLab combining the speed and sensitivity of PCR with the simplicity needed for clinicians to use it without changing their workflow.

The MiniLab benefits from global manufacturing and supply chain providing scalability and an attractive cost base enabling Enigma Diagnostics to forge a solid leadership position in developed and emerging molecular diagnostic health care markets.

As molecular diagnostic testing is replacing conventional methodologies for the diagnosis of infectious diseases and syndromic panels are replacing serial pathogen detection testing, Enigma Diagnostics is now pioneering the use of molecular diagnostic syndromic panels in the POC to empower clinicians with the high value comprehensive molecular diagnostic results that they need on demand to quickly initiate targeted treatments. The new paradigm of using molecular diagnostic syndromic panel testing in the POC will quickly increase with the advent of easy-to-use cost-effective platforms, such as the MiniLab. The MiniLab provides physicians with the much needed decentralized solution for accessing quick comprehensive results for patients, especially critical care patients, whose clinical presentation make it difficult to determine the causative pathogen.

Note: MiniLab Products are CE-IVD marked not FDA cleared.

Jessica Barrett is Commercial Director from Enigma Diagnostics Limited.

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GSTT Funds Pioneering Heart Operation

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health and social care Earlier this year, the heart team at St Thomas’ Hospital replaced competitive strongman, Kamil Wojniak’s leaking aortic valve through an anterior right thoracotomy, a 5-6cm keyhole opening in the chest. The operation left Wojniak able to return to competition without issue. We spoke to Vinayak Bapat, the trailblazing surgeon who performed the operation, to find out more about the operation and how it has paved the way for greater understanding of the revolutionary technique in the wider NHS. Tell us more about the operation you performed on Kamil Wojniak.

Bapat: Traditionally, when heart valve surgery is performed we have to split the breastbone down the middle. From there, we can then access the heart, which we connect to the heart-lung machine that, in turn, allows us to isolate and stop the heart while keeping the rest of the body alive. When the operation is complete, everything is sewn back into place, the heart reconnected and the machine removed.

Alternatively, we can split the breastbone halfway, allowing us to access only the top portion of the heart – the only part needed for an aortic valve replacement – and we connect the patient to the heart-lung machine either through the groin, the leg muscles or the top of the chest.

In my opinion, the keyhole procedure is the better option, as it does not require us to damage the breastbone at all.

We begin this procedure by analysing the CT scans and from these we can see exactly how close the aorta is to the breastbone and the ribcage. We then make a small cut of around five to seven centimetres, which allows us to enter between the ribs.

By doing this, we access only what we need to and we are able to connect the patient to the heart-lung machine through the arteries and the vessels in the leg.

This is a very safe option when it comes to connecting the machine. It is also possible to do this through the keyhole itself, however this can raise complications as this is where we would be performing the operation.

Of course, inherent in this method are a number of significant challenges. Among them is the fact that, as this is still a fairly new technique, those looking to carry out the operation must train with an expert surgeon who is experienced in performing the procedure, however, there are currently relatively few anywhere in the world.

How has Guy’s and St Thomas’ Trust supported you on the road to developing and popularising this operation?

Bapat: First of all, the American surgeon from whom I learned this technique came to visit me at St Thomas’ to learn the technique in which I specialise, TAVI (a heart valve procedure, involving the use of a catheter).

The idea for this project started from there.

Many come to St Thomas’ to watch us because the hospital is well known for being forward thinking and innovative, as well as very welcoming to overseas experts.

Following the meeting with this expert, I decided I wanted to take my team to America to learn the technique. At this point, I required some funding from the hospital and some additional money from the charity and the industry.

Upon returning from America, we were faced with needing to buy extra equipment – usually traditional instruments converted with a long handle so you can operate through a small hole - and this required some initial investment also. The trust very generously spent around £30,000 on buying three sets of these instruments.

The Trust was more than happy to do this as they understood immediately that it was a good investment.

They saw the huge potential in bringing in experts to learn this technique and realised that it would go a long way to establishing the programme, which will, ultimately save lives and greatly reduce discomfort for patients.

The technique seems to possess myriad advantages for patients. Why, until now, hasn’t it been more widely performed in the UK? Bapat: There are many reasons for this, one of which is that you need an experienced surgeon to take this technique on. The surgeon needs to be experienced enough both to do the operation and, if required, to call it off if they do not believe that it is progressing in a satisfactory manner.

The technique also requires a great deal of skill and patience, both from the performing surgeon and their team. Every surgeon attempting this technique needs a good team who understand the procedure fully. If the team do not know the procedure well enough, it can greatly compromise the operation and reduce the chances of complete success.

This is why the support from Guy’s and St Thomas’ hospital trust has been so vital. They have provided us with all the time, equipment and training we needed to ensure the project has been a success at all stages and levels of its development.

Thank you for speaking to us, was there anything else you would like to add?

Bapat: I think an important aspect of all this is that patients should be aware of the options open to them. We are working hard to address this issue and increase awareness through contact with GP forums, cardiologists, patient forums.

Our overall aim is to increase and expand this programme, not only in St Thomas’ but in additional centres also.

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health and social care

Growing Management Numbers in the NHS. Is This Fact or Fiction?

In the build-up to the 2015 general election, David Cameron referred to NHS Management as “a bureaucrat with a clipboard”.

Media coverage has questioned the comparison between the numbers of doctors, nurses and other clinical staff with the high numbers employed in management of the NHS. National reports show that the perception of bullying behaviours is increasing in the NHS. Could this behaviour in any way be connected to the increased disparity between the numbers employed in management and those responsible for the medical and clinical needs of the NHS? Is it also one of the reasons for an abundance of whistleblowing cases?

In the build-up to the 2015 general election, David Cameron referred to NHS Management as “a bureaucrat with a clipboard”. Media coverage has questioned the comparison between the numbers of doctors, nurses and other clinical staff with the high numbers employed in management of the NHS. National reports show that the perception of bullying behaviours is increasing in the NHS. Could this behaviour in any way be connected to the increased disparity between the numbers employed in management and those responsible for the medical and clinical needs of the NHS? Is it also one of the reasons for an abundance of whistleblowing cases?

What happened to the NHS structure and culture?

How could an organisation that was launched in 1948 out of the ideal that good healthcare should be available to all, regardless of wealth, reach a position of so much negative publicity and behaviours?

Is the growing number of clipboard holders fact or fiction? Has the growth of managerial bureaucrats been responsible for a growth in perception and belief of bullying behaviours? Above all, would the NHS be better for patients and the tax payer if non-clinical managers were instead replaced with clinicians who were empowered with leadership skills?

To answer these questions we need to take a step back, remove the rhetoric and consider some of the facts.

The NHS Confederation stated in their July 2015 statistics that managers and senior managers accounted

for 2.67 per cent of the 1.388 million staff employed by the NHS in 2014. It stated that the number of managers and senior managers increased slightly in 2014, having declined in each of the previous four years. This data suggests that the growth of managers in the NHS is not significant.

In contrast, the findings from a 2014 survey of two thousand NHS staff by the King’s Fund revealed a consistent disconnection between the views of executive directors and of other NHS staff. For example, 63% of executive directors said there was a “pride and optimism” among staff although only 20% of nurses and 22% of doctors felt these emotions.

Alongside national reports, social media contains a plethora of personal experiences about bullying in the NHS. According to the findings of a 2015 inquiry led by some of the most senior British doctors, infighting amongst overworked departments and disciplines in Trusts has led to trainees feeling “bullied and undermined”. When the word “whistleblowing” is used we see a similar effect.

Lord Rose, in his June 2015 NHS Leadership Review titled ‘Better Leadership for Tomorrow’ demonstrated that the level and pace of change in the NHS is unsustainably high. This demonstrates that significant, often competing, demands are placed on all levels of its leadership and management. The administrative, bureaucratic and regulatory burden has already become insupportable and shows no early signs of abatement. With David Cameron’s electoral pledge to make the NHS a truly 24/7 service surely the pressure

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health and social care will only increase to breaking point. Rose identifies three areas of particular concern. Firstly, that there is a lack of “One NHS Vision” and of a common ethos.

Secondly, that although the NHS is committed to a vast range of reforms, there is insufficient management and leadership capability to effectively deal with the scale of challenges associated with these changes.

Finally, there is a need for a specific direction and development for careers in managerial roles across the medical, administrative and nursing cadres.

“…although the NHS is committed to a vast range of reforms, there is insufficient management and leadership capability to effectively deal with the scale of challenges…”

Lord Rose, Better leadership for tomorrow, NHS Leadership Review, June 2015 In 1948, three principles were established to guide the newly formed NHS. In 2011, these three were increased to seven principles by the Department of Health. These were derived from extensive discussions with staff, patients and the public. The third of these seven principles states: “Respect, dignity, compassion and care should be at the core of how patients and staff are treated – not only because that is the right thing to do, but because patient safety, experience and outcomes are all improved when staff are valued, empowered and supported.”

In 2015 Hillcroft House, the research and training provider, conducted surveys which asked 220 managers in the NHS if they were aware of the seven core principles. Did they know principle three? The findings showed that 100% were unaware of its existence.

More concerning still, 100% were unaware that their employer, the NHS, has seven core principles that underpin its core values.

Further surveys, again by Hillcroft House, have found that the majority of NHS front line staff value thoughtfulness, teamwork, humility, stability and harmony. In contrast, the majority of NHS managers value results, independence, achievement, decisiveness and success.

ing to HSIC figures for 2012 for total sick leave, and irrevocable damage is done to service provision and morale. Human beings on all sides suffer. Trust in one another is lost.

Case studies have shown that when people invest time to understand their own behaviours and their effect on others, they are able to create a culture of success which breeds further successes.

Frances Tippett heads up the South West Integrated Personal Commissioning (IPC) programme (a national demonstrator site for NHS England, Local Government Association and TLAP (Think Local Act Personal). The South West IPC team invited Hillcroft House to assist them with understanding differences in communication and behaviour styles and the impact on team and organisational dynamics. They believe this is essential if they are to successfully tackle the cultural changes needed for teams to give people choice and control over their care. Tippett said, “Although no one local area, organisation, or team has got all the answers, between us we have many of the elements needed to make it happen here. We need to enable teams to learn from each other, challenge positively and rapidly adopt changes that will benefit the people we are here to support. To do this we have to invest in increasing our peoples’ self-awareness and understanding of the impact of their behaviours. By communicating more effectively they are more likely to positively influence colleagues from a different professional discipline or organisational culture, breaking down barriers to integration”.

“…we have to invest in increasing our peoples’ self-awareness and understanding of the impact of their behaviours…”

Frances Tippett, South West Integrated Personal Commissioning (IPC) programme Perhaps extensive reports like Francis and Berwick will initiate a review of the self-awareness levels of all the committed people within the NHS. Maybe learning from the work of South West IPC will lead toward better behaviours, cleaner communication, greater trust, improved patient care and a demise of the extensive negative publicity that the NHS receives. Could the solution be as simple as Adam Crizzle, MD of Hillcroft House, believes “Understanding behaviours makes outstanding people, creating extraordinary organisations”?

The detailed work by Hillcroft House shows that the way people behave and communicate dictates which of these values are of highest priority. The impact of this can result in significant misunderstandings. Frustration, combined with low levels of self-awareness can lead to unacceptable behaviours. For example, people felt they were being bullied even though, after investigation, it was found that this was neither the intention nor the motivation of the other party. When bullying appears rife, stress levels rise, absences escalate and the duvet days increase. Approximately 9.5 sick days per year per employee are lost accord-

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The Five Year Forward View: NHS Employers Prospective

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health and social care We spoke to Ruth Warden, Assistant Director of Employment Services at NHS Employers about how the NHS can support staff through the changes inherent in the implementation of the five year forward view.

The Five Year Forward View is an initiative developed in 2014 by NHS England which sets out how the health service needs to change, arguing for a more engaged relationship with patients, carers and citizens in order to ensure the NHS is capable of promoting wellbeing and preventing ill-health in our modern society.

The forward view examines numerous aspects of the NHS with regards to how it will have to adapt to cope with future challenges. Changes to models of care moving forward are an integral part of the concept, with Warden explaining that these changes will have an impact on NHS staff and that NHS employers is working to support the staff as they look towards implementing these changes.

“Our role with regards to implementation of the Five Year Forward View is examine how the workforce needs to shift to support the delivery of the new models of care. This means looking at whether staff need to do perform slightly different roles, whether additional training is required, whether staff need to work across different boundaries or work in new teams etc.

We are helping employers within the NHS to think about these workforce implications of the Five Year Forward View and then helping them put the required actions in place so that the workforce is fit to deliver the models of care outlined in the Forward View.”

Warden works primarily within the education and shape of workforces within the health service, and finds that projects beginning now with regards to the Forward View often focus on examining whether new job roles are required, which means Trusts are examining the possibility of new training for staff, with possibilities such as adding new competencies onto roles so existing staff can perform a slightly broader role and do more tasks within their job.

Staff experience is also a vital issue which NHS Employers is working with Trusts to address, so that employees working within the health service can be more positive and open to change, as well as reducing stress related staff absences within the service, which is an issue Warden feels is important and needs to be addressed moving forward.

“The NHS is an inherently stressful environment to work in, which is part of the challenge staff face and part of the reason many of them chose to work there in the first place. When you add this to the challenges being faced by the service at the moment such as financial challenges, increased demand and the changes to how the service delivers being outlined by the Forward View then it increases the stress in the working environment.

“As a result of this what we are seeing, what Trusts are telling us, is that sickness absence which is attributed to stress is on the increase. We need to keep the NHS workforce healthy so what we are doing to help this is looking at how we can support NHS organisations to make the changes which are happening within the

organisation as stress less as possible and acknowledging that any type of change will be stressful for the staff.

“We are also working with NHS Trusts to analyse how they can support people who are unwell and help them get back into the workplace. It is about creating an environment where people don’t feel that they have to be off work sick with stress but if they do chose to take time off for stress related sickness, then we have to facilitate their return to work as quickly. Evidence shows that the longer someone is off work sick the harder it will be for them to return to work.

“As the NHS invests a lot of money and time hiring highly qualified staff they are keen to have them in work supporting the service ad helping patients. This is why supporting people who are off sick and creating an environment to reduce stress related sickness is very important to the health service.”

The Government’s constant efficiency strategies for the NHS also contributes to stress in the health service, Warden adds.

“Messages are coming through that the NHS has to be more efficient, that it has to change the way it is doing things, and this is challenging on number of different levels and puts staff under a variety of different pressures.”

A particular challenge NHS employers have is around opening up a dialogue among staff around mental health issues, with problems often being exacerbated by stress. NHS Employers is supporting the health service to ensure that line managers and senior staff feel competent enough to deal with mental health issues and staff feel comfortable with having these conversations. Warden stressed that these conversations are vital to ensuring staff do not become so ill that they have to take time off work.

“There is still quite a stigma around mental health, both in the NHS and in society as a whole. This is one of the major challenges that we have found and we are working with employers within the NHS, with Trusts and other organisations to support staff in the NHS to start talking about their emotional wellbeing and the stress of working within the organisation.”

Some key ways to reduce this include supporting line managers so they can support the staff working under them and improving the health of the overall NHS staff. Simon Stevens, chief executive of NHS England, has recently announced a health plan for NHS staff to reduce levels of absence. By creating a healthier workforce the NHS will be better placed to deliver the best possible patient care as well as reducing costly sickness absence, which recent figures from HSCIC put at 4.72% in January this year.

Change of the sort proposed by the Five Year Forward View will cause a great many issues for the NHS in the future but with active engagement with staff the changes will run smoother and cause fewer problems.

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Are You Leading the NHS to Success?

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health and social care Leadership is a priority for the NHS as evidenced by the last 10 years’ rise in management positions to 1.4 million. There have also been massive changes post Francis Report, with the areas of wellbeing, mindfulness and making people “want to change” being particularly topical.

Yet absenteeism is still high, stress is still high and whistleblowing rears its head from time to time.

At the risk of being controversial, much of the stress could easily be lifted.

IDENTIFYING THE CHALLENGE IN THE NHS However we look at it, most staff would seem to love the caring for patients side of their job but we cannot ignore the fact that there are three commonly quoted areas of discontent, each of which could be significantly eased with a different approach. They are: 1. Management Style 2. Paperwork 3. Stress

FILLING THE GAP I’m going to present an idea that may sound familiar, but we are going to look at it differently here. That idea is one of Accessible Leadership from all management levels right down to the Team Leaders.

MANAGEMENT STYLE When I think back to the various managers I have had during my career, I have to say they were a mixed bunch! Of course, the way I’m assessing their success – or not – is by how happy I was in the job: how motivated I was, how optimistic I was, how much I had the opportunity to learn, how supported I felt, how much I belonged to my team and how much I looked forward to going to work. I would say that some of the managers were good (i.e. met my needs) and some weren’t.

But this is fearsomely subjective. After all, the list of what might make me happy and content at work is likely to be quite different from what would make another person feel that way. And unfortunately we don’t come with a User Guide!

PAPERWORK It is a fact that some people are better at paperwork than others. It is also a fact that notes have to be written up. But speaking to many people in the NHS, I’m not convinced that paperwork per se is the issue.

I think there are two competing problems here. The first is Time (or most usually the lack of time) to enter the information into the system. The other is a heartfelt Incongruence, where professionals are utterly torn between completing paperwork and seeing clients.

If we go back to my previous managers, you’ll remember that I gauged their success by how happy I was at work; and the challenge is that many people in the NHS are not happy at work. So I decided to unpack what one of my particularly ‘good’ managers – we’ll call him Barry – did and how he did it.

Firstly, he consistently adopted good management practice whereby I bought into and was excited by his vision for the team, understood how my role fitted in and supported both his vision and the rest of the team.

Secondly, Barry had a unique (in my experience) ability to bond with his reports both separately and as a team, so that each of us trusted him and pulled together to meet targets and fulfill the vision. We did work hard. We did enjoy it. And there was very little absenteeism as we wanted to come to work.

People skills are of course valued in management. But how do you transport standard management practice to a level of Leadership Expertise that will unleash momentum and performance?

“Managers Solve Problems, Leaders Create Momentum” - John C Maxwell

STRESS This is still causing huge problems in both the delivery of care and also the cost of covering absenteeism – not to mention the opportunity for some of the Press to exploit the new and creative ways that are being adopted to ease the pressure! The opposite of Stress is Flow.

ACCESSIBLE LEADERSHIP Anyone managing or leading a team is only too aware that that we’re all different. Now, different can be good, but it can also mean that people face elements of their job where they struggle to deliver and are not happy. Yet in other parts of their job, these very same people will do amazing things with consummate ease and enjoyment. A good example of this is paperwork.

Personal flow comes from following your natural path.

Team momentum comes from each team member following his or her natural path. A team member out of their flow - or managed in a way that is outside their preference – is likely to experience stress.

Right back to the days of Aristotle, it has been acknowledged that individuals are different in four specific ways: Thinking – which can be Intuitive or Sensory, and Action – we are predominantly Introvert or Extrovert.

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health and social care DRIVER, EXPRESSIVE, AMIABLE and ANALYTICAL are four ‘frequencies’ that lead individuals to notice, interact and respond most frequently in quite different and predictable ways. We all have some of each frequency but are typically strongest in one.

For example, DRIVERS make the best Leaders of new departments and teams as their focus is to create the service and align themselves with the community. EXPRESSIVES are the best Leaders for consolidating departments and teams that are growing their reputation, as they will forge strong relationships with co-workers, patients and clients.

AMIABLES are perfect Leaders for the successful departments and teams who have a trusted niche and a busy schedule, as they will naturally focus on quality of care and patient support. ANALYTICALS are the best Leaders for departments and teams with a demanding community base who would benefit from a keep a keen eye on stretched budgets.

One of the biggest errors made – and this applies across all industries – is putting the wrong person into the wrong position, with the choice being based more on their qualifications and knowledge than their natural passions and talents.

“Everybody is a genius.

But if you judge a fish by its ability to climb a tree, it will live its whole life believing that it is stupid.”

- Albert Einstein

Down at the grass roots are the professionals and staff carrying out the work of the NHS, and they can be loosely profiled too. But each of the frequencies requires a different foundation to flourish. You may already be wondering which of the four frequencies you and your staff are. See if you can recognise yourself from these slightly tongue in cheek descriptions.

Drivers are great at starting things. Ask them a get a new project going or launch a new idea and they will take off like Google Earth envisioning the big picture.

Trouble is they’re not so good at finishing things and there could be many loose ends; but then there’s always an exciting new project just over there...

Expressives love talking to people. They’re great at building and working in teams. Mind you, they can be difficult to locate because they hate to be tied down and they walk around a lot. Trouble is that sometimes they’re not so good at the spreadsheets and detail part of the job.

Amiables are fabulous at being well-organised and always deliver on time! Richard Branson (Driver) may have started an airline, but it’s the Amiables in his company that get the people on the plane. With the clarity of Google Street View, they’re good at noticing things others may have missed. But you wouldn’t choose them to envision and launch a new initiative.

for monitoring performance and budgets.

But they’re not so hot on the people side of things; which can be a challenge if you are a manager.

How does it work when a particular type of manager has different frequencies in their team? The answer is that by recognising their predominant frequency and that of their staff they can adjust their communication style easily and effortlessly.

HOW DOES THIS ADDRESS THE THREE AREAS? MANAGEMENT: By understanding your own frequency and those of your staff, Leaders can begin to bond with the individuals and the team. This helps build trust and confidence in the manager, and will encourage staff to feel they belong. The ripple effect of team bonding is lowered absenteeism as staff enjoy coming to work.

PAPERWORK: This is a classic example of where being a particular frequency doesn’t let you off doing those parts of your job you may not enjoy. One of the main problems though is people randomly switching frequency rather than selecting the right one to do the task in hand!

Trying to fit in the paperwork around answering the phone or caring for patients is exhausting. Setting aside some quiet time to get it all done will make the job more manageable and enjoyable. Mind you, enlisting help from an Analytical would make it even easier…

STRESS: The opposite of stress is Flow. When you are in Flow, big problems become insignificant as you solve challenges and see opportunities at a different level. We’ve all experienced this in our life, when we cope so well despite the demands made upon us.

Identifying the areas in which you will always excel and handling issues from your preferred style is the fastest way to lift stress.

NEXT STEP To identify your real strengths and talents - and have a complete understanding of why certain things are more challenging – is nothing less than liberating. And as it all begins to make sense within the team there can be a huge sense of relief as people are able to increase their support for each other; because they know instinctively when they are the best person to help.

But there’s another really good reason to identify team frequencies – and that is because it’s a real FUN thing to do. Of all our work, this is the one where there is most laughter, most bonding, most co-operation and most optimistic planning for a great future.

If you would like to increase your ability to bond with and lead your team, the best place to start is by taking The Frequency Test. Click [http://bit.ly/FrequencyTest] for a Token to The Frequency Test.

To comment on this article or discuss solutions, please contact Caroline directly on: t 020 8213 5898 e info@wellbeingdynamics.com w www.wellbeingdynamics.com

Analyticals are fantastic at knowing exactly where things are and keeping track of figures. They’re perfect

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health and social care

Substance Abuse: The Frontline As the Government increasingly moves frontline care from the community to private homes, we examine how agencies urgently need to educate their staff on how to recognise and interact with substance abusers.

Substance abuse is a particularly difficult to deal with, as addicts tend to have their perspective skewed by their need for a particular substance and a loss of inhibitions which can easily be misinterpreted as aggressive behaviour or another illness.

However, these could equally be confused with other illnesses, leading carers or other professionals sent to an addict’s house to take them to hospital needlessly or expose both themselves and the patient to unnecessary stress and potential harm.

In particular, substance misuse alters behaviours, with figures by the Health and Social Care Information Centre from 2014 showing that there were 7,104 admissions to hospital with a primary diagnosis of a drug-related mental health and behavioural disorder.

This is an 8.5% increase from 2012/13 when there were 6,549 such admissions.

Alan Long, the Managing Director of the Mears Group, which provides home care workers in various fields, such as care and property maintenance to local authorities, as well as offering some services to private clients, commented on how his firm ensures the safety of its staff.

There were 13,917 admissions with a primary diagnosis of poisoning by illicit drugs. Overall there has been a 76.7% increase since 2003/04 when there were 7,876 such admissions.

Overall, between 2003/04 and 2013/14 admissions have decreased by 11% to from 7,869 to 7,104.

Alarmingly, these figures also showed that there were 1,957 deaths related to misuse of illicit drugs in 2013, which is an increase of 321 from 2012 when there were 1,636 such deaths.

This is a stark warning of the effects of substance abuse, which can often be addictive, with substances such as alcohol, cocaine and heroin all particularly addictive with the potential to cause patients serious harm. The report found that cocaine, ecstasy, LSD and ketamine use had increased between 2012/13 and 2013/14, all of which are potentially addictive substance.

“Before sending any of our employees into a situation we always conduct a risk assessment first. When we feel that we are able to continue with the care or the repair of the property or individual then we do so. Our visiting officers are trained on all aspects of risks that our care worker might come across, whether that be a dangerous dog or if the property is unsafe, through to substance abuse or the individual having a particular form of mental health problem.”

These risk assessments are vital to ensuring that carers know what they are dealing with when entering a property to deal with a patient.

Ultimately homecare industries, including but not limited to care, need to ensure that staff are provided with full training to ensure they deal with substance abuse correctly in order to ensure the safety of their staff as well as the patients they are caring for.

The full report from HSCIC, entitled Statistics on Drug Misuse, England 2014 is available online here.

However, the symptoms of drug abuse and addiction can often be overlooked by those visiting homes, for example home carers, who may potentially misdiagnose addicts and treat them incorrectly.

For example, the National Institute on Drug Abuse highlights the symptoms of heroin withdrawal as such: “Symptoms of withdrawal include restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes with goose bumps (“cold turkey”), and leg movements.”

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Public Inaccuracy and Habitual Self-Interest Represents a Substantial Cost for the NHS Benenden National Health Report 2015 reveals public perceptions about the cost of NHS care.

The UK public routinely underestimates the costs of many common NHS procedures and habitually prioritises its own needs when it comes to treatment, the National Health Report 2015 reveals.

The report, compiled by mutual health and wellbeing provider Benenden, questioned 4,000 people across the UK asking them to put a cost to some common procedures and treatments – ranging from natural child birth to liver transplants, while at the same time enquiring if they believe some of those treatments should be funded, at least in part, by the individuals on the receiving end. It also explored attitudes surrounding the public’s prerogative to those same NHS treatments, revealing disproportionality between what people believe others are entitled to and their own entitlement

When it came to judging the cost of procedures and treatments, liver transplants were estimated to cost £12,279 per operation, when in fact the true cost is £70,000; abdominal hernia surgery, of which 7,489 low risk ones were carried out last year, were thought to cost £1,609 rather than the £2,281 in reality; almost half (48%) of respondents thought less than 2,500 gastric bands, gastric by-passes and gastric balloons procedures were carried out by the NHS each year, far shy of the real figure, which is double that at 5,443, costing the NHS in excess of £25m in 2014.

IVF comes low on the list of NHS priorities as far as the public is concerned, with more than three-quarters of those questioned stating that people should either contribute towards the cost of IVF or foot the bill entirely, with only 22% of recipients believing it is a treatment that the NHS should offer. One round of IVF treatment on the NHS costs between £1,287 and £6,000, with women under 30 years of age being offered up to three rounds, and women over 40 given just one round on the NHS. The younger the recipient, the more likely they are to believe that IVF should be

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health and social care funded by public money: 28% of 25-34 year olds think the NHS should pay in entirety for the treatments, while only 15% of 65-74 think the same.

Keeping to the topic of pregnancy, it is apparent that the public is naive when it comes to the cost childbirth, with almost half of people (47%) thinking it costs less than £500 for women to have a natural birth in hospital, without any complications. Even taking all survey respondents into account, the average cost of a natural birth is estimated to be £1,288 by our respondents, which is more than £500 short of the true figure of £1,824.

Commenting on the findings of the report, Medical Director of Benenden, Dr John Giles, said: “The issues surrounding NHS funding is an extremely contentious subject and disparity between the actual and perceived costs of treatments on the NHS needs to be addressed. As a nation we have lost touch with the role we should play in our own health and wellbeing, with a large proportion of the population relying on the NHS to maintain our health even if our own lifestyles are detrimental. This has led to a damaging culture whereby we are happy to point the finger when it comes to saying who doesn’t deserve treatment, but we take little responsibility on the individual impact we are all having on the NHS.” Despite being naive when it comes to certain treatments, the public is accurate when judging the cost of cosmetic procedures on the NHS. The average cost of a ‘nose job’ is £2,498 for adults over the age of 18 and slightly more for teenagers at £2,582, which the public estimated quite accurately. The younger the respondent, the more accepting they were of cosmetic produces on the NHS to help those suffering from self-esteem issues: 38% of 16-24 year olds thought it was acceptable, while just 25% of 55-64-year olds thought cosmetic surgery courtesy of the NHS was OK, with the percentage dropping to just 18% in the 75-84-category. Shockingly, nearly one in 10 admitted to either lying to their doctor or knowing someone who’d lied about being depressed or suffering from low self-esteem in a bid to get free cosmetic surgery, with this trend much more common in the younger respondents.

The survey revealed that the public will take a hard line when it comes to treatments needed as a result of excessive lifestyle choices. The number of people who believed making poor health choices, including, obesity, drugs or alcohol, should result in not being treated by the NHS hovered around 51%-53% in each case.

Last year more than 1.4m people used NHS drug and alcohol services, including rehabilitation, at a total cost to the NHS of £136m – and Benenden’s survey respondents were unforgiving: just 15% thought treatment for alcohol abuse should be offered free-of-charge on the NHS, while 85% of respondents believed patients should either pay for their own treatment or make a contribution towards it. Similarly, one in 10 Brits think that if you need a liver transplant as a result of abusing alcohol, then the NHS shouldn’t provide it and a further 23% believe alcoholics should contribute towards the transplant. A more generous 43% thought they should get liver transplants for free providing they are alcohol free for three or more months prior to the operation.

When it came to looking at their own attitude to the NHS and what they feel they are entitled to, the public was more relaxed. Three-quarters (75%) of those questioned admitted they didn’t consider the cost of a procedure or worry that the free treatment they were receiving could be taking treatment away from someone in greater need, despite 62% expressing concerns that the NHS was under strain.

Another area where views on cost proved to split opinion is prescriptions. Currently in Scotland, Wales and Northern Ireland, prescriptions are free to all citizens.

However, in England, unless you fall under certain exemptions then you are expected to pay for prescriptions. The Benenden report reveals that almost four in 10 (37%) thought the current system was unfair and that people in England should get their prescriptions for free, with an almost identical number believing it is the systems in Scotland, Wales and Northern Ireland that should change and start charging.

Dr John Giles commented: “These findings are somewhat worrying as they offer a perturbing insight into the sense of entitlement of the British public.

This manifests itself in an enormous cost to the NHS, which is not helped when people abuse the system.

Yet, unfortunately the burden often rests with healthcare professionals and the NHS itself.

The selfishness displayed by the public when it comes to looking at their own attitude to the NHS and what they feel they are entitled to is contributing considerably to the strain the NHS is currently under. If the public was more aware of the cost of appointments, treatments, operations and prescriptions, and really took responsibility for their own health, using the NHS only when absolutely necessary, the crisis the service finds itself in today would be significantly lessened.”

Benenden is the trading name of The Benenden Healthcare Society Limited and its subsidiaries.

Based in York, our vision is to be the leading health & wellbeing mutual community in the UK. The Benenden Healthcare Society is a friendly society, founded in 1905. It offers affordable, discretionary healthcare services that complement rather than replace the care offered by the NHS. For £8.45 per person, per month, members can request a range of healthcare services, with no exclusions for pre-existing medical conditions or upper age restrictions. It is a fivetime winner of ‘Most Trusted’ healthcare provider at the 2011-2015 Moneywise Customer Service Awards.

Also part of Benenden are the wholly-owned subsidiaries of The Benenden Healthcare Society: • Benenden Wellbeing Limited, which offers a range of other wellbeing products including health assessments, health cash plans, travel insurance and home insurance; • The Benenden Charitable Trust, which aims to help people who find themselves in financial difficulty due to sickness, disability, infirmity or any other medical condition; and • The Benenden Hospital Trust, which provides treatment to members of The Benenden Healthcare Society, those who wish to fund their own treatment (directly or through insurance) and NHS patients through the NHS Choose and Book scheme.

Read the Benenden National Health Report here.

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The Importance of Designing Dementia Friendly Care Environments

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health and social care It is estimated that there are 800,000 people with dementia in the UK and this number is expected to double in the next 30 years.

The proportion of people with cognitive problems and dementia in general hospitals continues to increase and the need to make the physical environment of health and social care buildings more dementia friendly is now widely acknowledged. This article outlines some of the key features of dementia friendly design and introduces a suite of environmental assessment tools for care settings.

The scale of the challenge In 2009 an Alzheimer’s Society report (1) estimated that over 25% of people accessing general hospital services were likely to have cognitive problems or dementia. This figure is now believed to be an underestimate, with hospitals reporting nearer 40% of the over 75 year olds receiving hospital care being affected though many will not have received a formal dementia diagnosis. Unfortunately too many of these patients still lose the ability to undertake activities of daily living while in hospital and are unable to return home. An outcome that is both devastating for them and their families and has cost consequences for the care system.

The Prime Minister’s challenge on dementia 2020 (2) and the Dementia-friendly Health and Social Care Environments Health Building Note 08-02 (3) both attest to the need to continue to develop more dementia friendly care environments. However, there remains a significant knowledge gap about the critical role that relatively straightforward and inexpensive environmental improvements can play in improving care and supporting the independence and well-being of people with dementia.

Why are dementia friendly environments needed?

Normal ageing has an impact on the senses, particularly sight and hearing, and this is exacerbated by the distortions in perception associated with dementias such as Alzheimer’s disease, the most common form of dementia, and poorly designed care environments can lead to further disablement.

People with dementia may therefore experience increased agitation, disorientation and distress in hospitals as they are likely to: - be confused and agitated in unfamiliar environments particularly if they are visually over-stimulated for example by a plethora of signs and notices - be unable to see things, for example, handrails and toilet seats if these are the same colour as the wall or sanitary ware - experience shadows or dark strips in flooring as a change of level and therefore try to step over them - resist walking on shiny floors because they think they are wet - want to explore and walk around.

However, if hospital environments are appropriately designed it is possible to reduce confusion and agitation, encourage independence and social interaction, and enable people with dementia to retain their ability to undertake activities of daily living.

Developing dementia friendly design principles Key principles for dementia friendly design have been

developed by The King’s Fund through a Department of Health commissioned programme (4). Working with over 25 clinically led multidisciplinary teams from NHS trusts, each of which included estates managers and carers, a set of overarching principles were developed and tested.

Each team completed an environmental improvement project based on the principles which involved: de-cluttering; maximising natural light and improved lighting; laying matt flooring; easing way-finding using colour and contrast, art and better signage. Large nurses’ stations have been removed with the staff now working in bed bays making them more visible and easing distress. Creating social spaces and better access to gardens has improved general well-being as well as providing opportunities for meaningful activity.

Estates colleagues report that incorporating these design principles has cost no more than similar sized schemes, provided better value for money and improved sustainability. The completed schemes also demonstrate how the care experience for people with dementia can be improved and show how cost effective design can help to reduce falls and incidents as well as supporting increases in non-pharmacological approaches to managing challenging behaviour. There have been consequent improvements in staff morale, engagement, recruitment and retention.

Dementia friendly environmental assessment tools As a result of the programme a suite of evidence based, practical, assessment tools have been developed which focus on those aspects of the physical environment known to impact on people with dementia. They assess not only the physical environment, such as floor coverings and use of paint colours, but also the way that the environment encourages people to behave and interact.

A service user led approach was taken to their design so that the assessments can be undertaken by people with dementia, family carers and staff together. Over 8,500 copies of the tools have been downloaded and they are in use nationally and internationally. They have evaluated very positively and have helped to educate staff and to secure increased funding for environmental changes.

Further development of the tools, including an application for smartphones and tablets, is now being taken forward through the Enabling Environments Programme by the Association for Dementia Studies, University of Worcester.

For further information and to download the tools for wards, hospitals, care homes, health centres and specialist housing, free please visit http://www.worcester. ac.uk/dementia

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Value of Assistive Living Technologies in Providing Care Outside of the Traditional System

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health and social care We examine how assistive technologies can enable care to take place outside of hospitals, for example in private houses or care homes.

Home care and assisted living can bring about a number of problems for security, both external and internal, with patients often struggling to take care of certain tasks such as turning off appliances or locking doors.

A solution to this is assistive technology, which is designed to support aspects of wellbeing, safety and independence in people with disabilities and help their carers to take care of them remotely; reducing stress to the person they care for as well as allowing the caregiver more time to take care of other tasks.

An example of an assistive technology platform is Tecomms, the flagship product of Talking Eye Limited.

The platform is an always-on, always-cloud-connected monitoring device that can be used for assisted-living as well as for security and appliance automation.

Tecomms consists of a powerful central unit that connects to the cloud through wifi or cellular with battery-backup. The central unit can interface with a wide range of sensors and devices, extending the choice of many applications to be available and used.

The product provides a number of features which enable assisted care, such as providing alerts, so that when unusual occurrences or emergencies such trips, falls, unwanted callers to the home at unexpected times occur, the carer is made aware of this remotely and is able to use other functions such as the remote communication function or the monitoring function to solve the issue.

The Tecomms patented technology is unique in providing voice-to-voice and data communications from the front door to anywhere in the world, over mobile networks, which means that consumers have access to technology from Talking Eye Limited that cannot be purchased from other firms.

The product is easy to use and requires little instruction, with set-up options designed to personalise the features and ensure that the product provides assistance to individual needs. There is also the option to remotely control other electrical appliances in the home remotely, enabling users to turn on or off any electrical appliance or device in their home that has been paired to the Tecomms system.

Tecomms also integrates with the majority of other technology solutions already established in the home.

The product has been built on an ‘open platform’ making it compatible with a range of platforms and devices (Apple and Android, for example, and across all UK mobile network operators). This allows customers to use the platform with their existing devices rather than purchasing new ones to use on the product.

This open platform is a major part of Talking Eye’s ethos, with the company being dedicated to developing highly innovative solutions that work within existing mobile networks, allowing for greater application of the technology for customers. Since incorporation, the company has invested more than half a million pounds in Research & Development to ensure the

technology is the best it can be.

An important element in the firm’s product development for Tecomms was an independent consumer survey, conducted across six consumer groups, to determine how people would react to the product.

The company was keen to emphasize the far reaching appeal of the technology among a range of customers.

“Tecomms has strong appeal and interest across all age ranges, with a particularly high intention to purchase from the Empty Nesters/Grey Market. This group accounts for 65% of UK Homeowners.”

The survey outlined what customers thought of the technology, with key highlights including: • 97% of those surveyed expressed an intention to purchase • Product concept was exceptionally popular and performed remarkably well.

• They were very interested in purchasing the product as it covered a particular lifestyle need that no other product in the market offered • They confirmed the features were valuable • Consumers understood the device and all its functions very quickly and easily • The perceived cost was considerably more than actual cost The research also focused on both the functionality and convenience of the Tecomms, with the fact that the technology is easy to use and the ability to identify visitors remotely without having to open the door being highlighted as important by those surveyed.

The product allows peace of mind for the carers of vulnerable people, particularly the elderly for whom safety can often be a major issue. This is also a major issue for those with memory affecting diseases such as Alzheimer’s and dementia. The Alzheimer’s Society estimates that there are 850,000 people with dementia in the UK, with numbers set to rise to over 1mn by 2025 and 2mn by 2051.

Carers of people with the disease could use assistive technology such as Tecomms to help them juggle their schedules with taking care of their friend or relative, particularly in cases where the carer does not live in the same house as the person they are looking after.

Additionally, the technology has a place in care homes, where it could be used by staff to ensure the wellbeing of residents, for example ensuring that their appliances are all switched off after they have gone to bed without entering their room and frightening the resident.

Therefore Tecomms can be used to ensure peace of mind for the caregiver and safety and reassurance for the person they are caring for. It has far reaching and important potential in the assisted living environment, with the potential to revolutionise the way in which care is provided to the elderly and vulnerable outside of hospitals. Caring for people in their own homes can improve their peace of mind and make them feel more secure.

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health and social care

Increase in Diabetes Cases in UK The number of people living with diabetes in the UK has soared by 59.8% in a decade, according to a new analysis by Diabetes UK.

The new figures, extracted from official NHS data and analysed by the charity, show that there are now 3,333,069 people diagnosed with diabetes, which is an increase of more than 1.2 million adults compared with ten years ago with figures from 2005 showing that there were 2,086,041 people diagnosed with the condition. These statistics do not take into account the 590,000 adults estimated to have undiagnosed diabetes in 2013-2014.

Barbara Young, Chief Executive of Diabetes UK, commented on the alarming figures.

The charity is warning that this exponential growth in numbers reflects an urgent need for effective care for people living with diabetes, as well as highlighting the importance of prevention and that failure to act on this threatens to bring down the NHS.

“We need to see more people with diabetes receiving the eight care processes recommended by NICE. It is unacceptable that a third of people living with the condition do not currently get these, putting them at increased risk of developing complications, such as amputations, heart attack or stroke.

At present only six in ten people with diabetes in England and Wales receive the eight care processes recommended by the National Institute for Health Care and Excellence (NICE). These are the checks identified as essential in high quality care for people with diabetes and include getting blood pressure and blood glucose levels measured, as well as the kidney function monitored, otherwise poorly managed diabetes can lead to devastating and expensive health complications such as kidney disease, stroke and amputation.

Diabetes UK made it clear that it is now critical that the government takes urgent action to ensure that everyone with diabetes receives the eight care processes, reducing their risk of further health complications and the costs these incur for the already strained NHS budget.

“Over the past decade, the number of people living with diabetes in the UK has increased by over 1 million people, which is the equivalent of the population of a small country such as Cyprus. With a record number of people now living with diabetes in the UK, there is no time to waste – the government must act now.

“Diabetes already costs the NHS nearly £10 billion a year, and 80 per cent of this is spent on managing avoidable complications. So there is huge potential to save money and reduce pressure on NHS hospitals and services through providing better care to prevent people with diabetes from developing devastating and costly complications.

“The NHS must prioritise providing better care, along with improved and more flexible education options, for people with diabetes now, and give them the best possible chance of living long and healthy lives. Until then, avoidable human suffering will continue and the costs of treating diabetes will continue to spiral out of control and threaten to bankrupt the NHS. Now is the time for action.”

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health and social care

New Ways for Prevention The Palatinate region braces itself: Roads to resilience - a Palatinate initiative for the promotion of preventive approaches beyond the health care system Strategies based on prevention improve the population’s mental health. Nevertheless prevention programmes are given less than 7% of the overall health system budget in Germany.

With regard to the treatment of the mentally ill, with complex needs, we have decided to think in a radically new way.

Our idea is to strengthen resilience on different social levels such as individuals, families, enterprises and communities.

The ability to advance personally in times of crisis and not to be broken by these crises, to be able to cope well with changes and with the ups and downs of life – this is what is known as resilience. Resilience is of utmost importance both for individuals and organisations.

Resilience at an individual level, i.e. the strengthening of an individual’s mental resistance, is a key aspect of the services provided by the Pfalzklinikum für Psychiatrie und Neurologie - AdöR (Service Provider for Mental Health). Around 30,000 people are treated and cared for at their 12 locations annually, either as in-patients, in day clinics or as out-patients. In order to boost their mental health on a long term basis and to counteract any further increase in mental illnesses, the main focus of the efforts has to be on prevention.

The preventive fostering of individual resilience will therefore play a central role.

Preventive measures concerning this topic are very important in working life and in daily social situations but also in the context of professional training and leisure activities. Especially at work there is a high risk that, due to permanent excessive demand, you are trapped in a vicious circle of chronic stress and the resulting risk of a mental disorder. Stressful working conditions can even make those people ill who are very robust by nature since innate and acquired stress protection can also fail under permanent stress.

Therefore it is the responsibility of almost all social institutions and employers to create healthy social conditions and labor practices as well as positive environmental factors.

ger crisis situations. These situations are cropping up in organisations such as companies or administrations ever more frequently. Such situations almost invariably call for rapid and comprehensive change to ensure a company’s survival.

We also have to think about ways to improve resilience on a community level. These three levels (Individual, Organisation & Community) are helpful to build a powerful and sustainable prevention strategy.

To achieve this, we have brought together experts from different institutions in the field of science and practice (sociologists, anthropologists, economists, pedagogues, psychiatrists, communication scientists, ergonomists and so on) in order to promote salutogenesis at community level through the thematic fields of work/school/leisure (instead of pathogenetic approaches on which the health system has mainly focused so far).

The foremost requirement for this is preliminary, comprehensive, communication research aiming at the identification of stigmatising attitudes and their replacement by new relevant information (for example by means of metaphors). It is only sound knowledge of how communication works or does not work that offers the possibility of establishing a broad know-how of resilience-promoting factors and framework conditions among citizens.

The results are reflected in a binational project with a similar, newly founded initiative (Blackpool Better Start) in Blackpool, Great Britain.

With this concept we also tread new paths when designing the context of health communication.

The Palatinate region braces itself/you initiative as a socio-ecological and multi-agency approach is aimed at building networks for “knowledge mobilisation“, establishing action alliances and learning platforms and various projects to be presented using the example of resilience in enterprises and resilience promoting programmes in schools and at a community level.

Above all, however, there is need for action in the fostering of organisational resilience. Technological advances, growing market dynamics or aging workforces are just a few examples of megatrends that may trig-

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Primary Care in the Post Five Year Forward View World 80 | ghp September 2015

health and social care The NHS, its financial position, its sustainability and its services, are at the centre of attention and the subject of copious column inches in both the general and specialist press. Primary care is very much at the heart of the NHS, focussing around the concept that everyone in the population has access to a family doctor through the system of registered patient lists.

GPs are, however, facing a tidal wave of issues: a steadily growing requirement for accountability leading to greater administration and more paperwork; regulation by the CQC; pressure to open seven days a week and for extended hours; a reducing number of GP candidates; a partner recruitment crisis and a general diminution in financial returns despite the increased hours and increased stress.

It is vital that we do not forget or underestimate the importance of primary care. One of its great strengths is its geographic accessibility and, for the patient, a practice to which they “belong”. Many would probably say that their GP is at the core of their access to medical care and that the “free at the point of delivery” concept is fundamental to healthcare in this country.

The importance of primary care is acknowledged in some of the new models of care which have been identified in the Five Year Forward View. Both the Multi Speciality Community Provider (MCP) and the Primary and Acute Care Systems (PACS) anticipate the integral involvement of primary care. The models in the Five Year Forward View are not prescriptive and the MCPs and the PACSs are described in such a way that gives flexibility. Indeed, there has been speculation that in due course the two models could well morph into one.

There are already examples of new structures. Southern Health, a community and mental health trust and one of the MCP vanguards, has announced a model which includes opening a shared branch surgery to deliver eight am – eight pm access seven days a week to support the local GP practices, as well as arrangements with GP practices where there have been recruitment crises. Lakeside Healthcare, also an MCP, is a growing partnership of GP practices with ambitions to expand its combined list to 300,000 patients. In Birmingham and Sutton Coldfield “Our Health Partnership”, although not officially one of the vanguard new models of care, is embracing the opportunity to look at new structures, new approaches and new services.

Reading comments in the specialist press about these new models reveals GPs’ concerns. Expressions such as “the end of general practice as we know it”, “privatisation”, and practices “ripe for the picking by the chaps in red braces” abound, and there are concerns that patients won’t like it.

two objectives which resonate with patients. Today, however, that means a closer relationship between primary and secondary care and breaking down the barriers between health and social care. In turn that means rethinking structures of delivery, for the longer term benefit of the patient.

The transition may not be easy. No-one knows what primary care is going to look like post the Five Year Forward View. However, now is the time for GPs to get involved in shaping the future.

The move towards GP federations in many areas has enabled GPs to take better control of their destiny. As a federation they can present themselves as a unit, for external purposes, whilst retaining their autonomy as far as their patients are concerned. Whilst many want to continue to run practices from premises in their existing localities, there are others for whom the responsibilities of premises and funding are not attractive.

They may want the federation to employ them, take on their premises and de-risk their practices to enable them to survive. A federated structure allows flexibility.

For those who want to retain their “independence”, membership of the federation can provide back office support, remove the administration and allow GPs to focus on clinical services. The federation’s ability to employ specialist staff means that all member practices can offer a wider range of services to their patients.

The federation can also be a single entity which can enter into arrangements with NHS Trusts, Foundation Trusts, voluntary organisations and others to deliver a more joined up service for patients.

And what of the concern that patients won’t like a new model of care? If patients are receiving good quality clinical care, free at the point of provision, have access to a wider range of services and therefore less visits to hospital for out-patient services, and an ability to book an appointment within a sensible timescale, they are likely to be happy. That may involve some changes to the patient experience – on-line booking of appointments, checking in on a computer screen on arrival at the practice, triage, more nurse practitioners. That does mean patient education particularly by the practice.

However, if patients can see that they are getting what they need and are introduced to the changes in an appropriate way, they are more likely to accept them.

It is important that we do not confuse structure with substance. Times have changed since 1948 – bigger population, growing percentages of elderly patients, more chronic illnesses. The reality is that the nation’s health and care budget has to do more for more people.

GPs don’t want to work in a land of corporates but they need to be involved, both for their own benefit and for their patients, in the change process. By embracing change now and helping to shape the offering, they stand a far better chance to remain in control of their own destiny.

GPs want to retain their clinical autonomy and be able to deliver the best available care for their patients,

Mary Chant is a partner in the health and social care team at Blake Morgan

ghp September 2015 | 81