Global Opportunity | Healthcare 2016 by Global Opportunity

Global Opportunity Healthcare 2016

Editor Sarah Cartledge sarah@inspirepublishing.co.uk

Welcome to Global Opportunity Healthcare 2016

Creative Director Oscar Bowring oscar@inspirepublishing.co.uk Publisher Karen Frieze karen@inspirepublishing.co.uk Managing Director Steve Gardner steve@inspirepublishing.co.uk Accounts Nicola McKelvey nicola@inspirepublishing.co.uk

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IMAGE: ROBERT GRESHOFF

Features Writer Jack Ball jack@inspirepublishing.co.uk Art Editor Nadia Nelson nadia@inspirepublishing.co.uk

| Editorial

Welcome to Global Opportunity Healthcare 2016. Building upon the launch of this publication at Arab Health 2016, the opportunities for UK engagement across the health sector continue to increase exponentially. When we initially launched Global Opportunity Healthcare we discovered that we didn’t have space for all the incredible opportunities, success stories and offerings from the UK across the healthcare sector as a whole. For this reason, we will be releasing a series of special editions covering some of the individual areas of the market where the major opportunities lie. These include the rise in the numbers of private patients coming into the UK, the opportunities for UK organisations to manage health facilities overseas, and a further edition on healthcare education that illustrates the massive area of need overseas, which the UK is well positioned to respond to. Healthcare UK’s successes since its launch three years ago now totals over £4.3bn, an incredible achievement since the successful showcasing of the NHS at the opening ceremony of the 2012 Olympic Games in London. Part of this success has been attributed to NHS trusts beginning to acknowledge the huge opportunities available from working internationally. Central to this growth has been the significant enthusiasm of the UK government in highlighting the overseas opportunities in healthcare, personified by the drive and passion of George Freeman, Minister for Life Sciences and the Minister responsible for Healthcare UK’s impressive success. You can read more about his vision for Healthcare UK on page 12. We also say farewell to the man who started Healthcare UK on its path to success. Former Managing Director Howard Lyons has moved on to retirement and a well-earned

rest after crossing the globe multiple times in the last three years promoting UK expertise. Building upon Howard’s success at the helm of Healthcare UK is the organisation’s current Managing Director Deborah Kobewka, whose thoughts on the UK’s global strength in the healthcare industry can be found on page 30. As a result, Britain’s international presence in the sector is certainly in very rude health indeed. And there is no doubt that the UK’s influence in healthcare globally will continue to grow. We hope you enjoy this edition of Global Opportunity Healthcare 2016. Do look out for our series of major ‘Round Table’ events, and let us know of any great stories of UK success to be shared in our 2017 publications.

Sarah Cartledge Editor, Global Opportunity Healthcare 2016

We will be releasing a series of special editions covering some of the individual areas of the market where the major opportunities lie.’

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Welcome to Global Opportunity Healthcare 2016

011 George Freeman, Minister for Life Sciences Providing healthcare needs globally

Contents

003 Editorâ&#x20AC;&#x2122;s Letter

012 Developing global health The UK has always been a science and health superpower and now is the time to globalise our leadership through the NHS says George Freeman MP, Minister for Life Sciences

16 Finger on the pulse Healthcare UK is in a prime position to identify significant overseas opportunities, ensuring that UK healthcare punches above its weight as an export sector, says Ilaria Regondi, Chief Operating Officer

020 Towards academic collaboration: an ideal scenario? Collaboration based on trust is the most important requisite for successful partnerships, says Chandan A.S. Alam, BSc, M.D; BSc., M.D. Executive Vice President, CSO

024 KPMG: Building global healthcare As the United Nations commits every country in the world to improve its healthcare provision by 2030, there has never been a better time to be involved in the healthcare sector says Mark Britnell, Chairman of the Global Health Practice at KPMG International

030 Exporting healthcare excellence Healthcare UK has already exceeded the targets set when it was established three years ago. New Managing Director Deborah Kobewka discusses the opportunity to build on that success in a changing global climate

034 The Global Opportunity Healthcare Round Table Last October Pinsent Masons and Global Opportunity Healthcare hosted a debate with a panel of experts who discussed the opportunities and challenges of international engagement for UK healthcare organisations

p44 052 Pinsent Masons: Risks and Rewards All overseas business ventures involve risk, but healthcare providers that manage their contractual responsibilities and relationships effectively can open up a world of opportunity in terms of funds, skills and research, says Barry Francis, former Lead Legal Advisor at Pinsent Masons

044 KPMG: Healthy Change Healthcare is going through a period of massive change; every country needs to adopt and learn from other systems across the world, says Andrew Hine, Head of UK Public Sector and Healthcare at KPMG

048 KPMG: Doing the right deal in the right jurisdiction at the right cost Global opportunities abound in healthcare but with the pressures of everyday work taking priority it can be hard to know where to start. Matt Custance, a partner specialising in commercial and financial advisory in the healthcare sector at KPMG, explains how to approach it

050 KPMG: NHS Trusts: taking your services abroad Foreign investment is more than opening a hospital in another country but overseas ambitions could pay off for NHS Trusts says Jason Parker, Head of Healthcare at KPMG

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058 FutureLearn: Social Learning Research has long shown that people learn best through conversation, through a sharing of ideas, says Mark Lester, Director of Partnerships Development at FutureLearn

064 CBBC: Elderly care in China The provision of a comprehensive system of national care for the elderly in China is a huge task. Chris Cotton at the China-Britain Business Council (CBBC) highlights how the UK skillset can help

066 A new future for the treatment of Multiple Sclerosis? Pioneering research into haematology is informing new approaches to the treatment of MS. Co-located in one of the UKâ&#x20AC;&#x2122;s leading NHS teaching hospitals, Harley Street at University College Hospital continues to work with pioneering Consultants to advance treatments, as Professor Anthony Goldstone CBE tells Jack Ball

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Global Opportunity Healthcare 2016

Contents

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Contents

Global Opportunity Healthcare 2016 092 Chelsea and Westminster Hospital: Acute care to aftercare - the complete burns service

Contents

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Chelsea and Westminster Burns Unit offers a state-of-the-art burns service with capabilities across the whole patient journey

097 Mersey Care: A leading light in mental health care Mersey Care NHS Trust is leading the way in mental health care in the UK and overseas. says Dr Joe Rafferty, Chief Executive, Mersey Care

100 Imperial College Healthcare: More than just maternity services Kerensa Heffron, Director of Private Healthcare at Imperial College Healthcare NHS Trust reveals the depth of services the Trust offers and the huge benefits a thriving private patient business offers to an NHS Trust

106 Harley Street Medical Area: Streets ahead Harley Street Medical Area’s world-class medical services are unparalleled and can be accessed with walking distance of each other in the heart of Central London

112 Aspen Healthcare: First-class cancer care Aspen Healthcare operates nine facilities in the United Kingdom, including four acute hospitals, two cancer centres, three day surgery hospitals, and has an impressive record in treatment and care for patients with cancer, says Michelle Martin, Development Director

116 HCA International: London calling Some of the best hospitals in the world covering all types of treatment can be found in London, which makes it a destination of choice for thousands of overseas patients, says Khadija Mouhajer, Director of International Business and Relations at HCA International

122 BUPA Cromwell: The full package Bupa Cromwell Hospital reflects its London location with an international flavour and exceptional care, Ahmed El Barkouki, Commercial Director tells Jack Ball

126 Edgbaston Medical Quarter: Discover a community of medical and life sciences excellence Edgbaston Medical Quarter in Birmingham is emulating Harley Street in its combined medical and training facilities, says Mark Lee, Chief Executive Calthorpe Estates

130 Medacs Healthcare: Reinventing global recruitment Next-generation healthcare service providers are innovating progressive staffing solutions, says David Taylor, Director of International, Medacs Healthcare

132 KPMG NHS Leadership Academy: Leadership development Ground-breaking leadership programmes have been designed by the NHS Leadership Academy and a KPMG led Consortium, using an innovative blended learning approach to promote robust leadership development and improve complex healthcare systems

136 Guy’s and St Thomas’: A unique combination Guy’s and St Thomas’ NHS Foundation Trust is a unique combination of clinical, educational and academic excellence, says Victoria Cheston, Commercial Director

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140 Royal Brompton & Harefield Specialist Care: Finding new ways to treat heart and lung disease Consultants at the Royal Brompton & Harefield NHS Foundation Trust are responsible for several major medical breakthroughs, says David Shrimpton, Managing Director, Private Patients

146 Great Ormond Street Hospital: Harnessing app technology in international healthcare A new app now gives direct access to Great Ormond Street Hospital’s services, says Trevor Clarke, Director of International Services, Great Ormond Street Hospital for Children

148 Great Ormond Street Hospital: Genetic testing at Great Ormond Street Hospital Pioneering research has paved the way for non-invasive testing for complex genetic paediatric disorders at Great Ormond Street Hospital, says Lucy Jenkins FRCPath, Consultant Clinical Scientist

150 Papworth Hospital NHS Foundation Trust: Inside the beating heart of Papworth Hospital With almost 100 years of innovative history under its belt, Papworth Hospital is preparing to enter a new age of heart and lung medicine, says Medical Director Dr Roger Hall

156 The Christie NHS Foundation Trust: Pioneering Cancer Care The Christie is committed to translating cancer innovation and research breakthroughs into very real patient benefits, says Professor Peter Trainer, Consultant Endocrinologist

160 Central & North West London: Using your head Mental health is critical to everyone and spans all generations. Demand for effective and efficient mental health care provision continues to grow, not only in the UK but in developing healthcare systems around the world. In response The Central and North West London NHS Foundation Trust (CNWL) is pioneering the latest treatments and access solutions for some of society’s most vulnerable, says CNWL Chief Executive, Claire Murdoch

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Global Opportunity Healthcare 2016

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182 Premier IT: Staying ahead of the game

Continuing Professional Development (CPD) is critical, not least of all in healthcare as Simon Monkman, Director at Premier IT tells Jack Ball

186 11 Health: From patient to entrepreneur Michael Seres describes how his own frustrations with colostomy bags led to the development of groundbreaking app Ostom-i Alert

188 eIntegrity: Top marks e-learning is now the most accessible format for medical education, allowing students to study any time and any place, says Dr Julia Moore OBE, Founder Chair of eIntegrity and National Director, e-Learning for Healthcare

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191 Vernacare: Reducing the risk 164 Leeds Teaching Hospital: Internationalising NHS expertise Thanks to its wealth of managerial and clinical expertise, the NHS is uniquely able to respond to opportunities for international partnerships says David Berridge, Deputy Chief Medical Officer and Medical Director (Operations) at Leeds Teaching Hospitals NHS Trust

169 Northumbria Healthcare: Innovative emergency medical care With new models of integrated and emergency care, education and training, Northumbria Healthcare NHS Foundation Trust is pioneering the next generation of integrated services across primary, acute, community and social care says Jack Ball

172 Carillion: How to build a hospital Building hospitals involves bringing together the numerous stakeholders and components that not only make a successful facility, but ultimately guide a patient’s passage through their care pathway, says Mike Hobbs, Managing Director of Carillion Health

174 Vanguard Healthcare: Vanguard Healthcare’s Caribbean care mission continues Mobile healthcare facilities are an established part of the infrastructure of UK healthcare and are increasingly being used by hospitals across the continent. Now these mobile fleets are being used in the Caribbean, says Norma Davies, Clinical Contracts Manager at Vanguard Healthcare

Reducing the risk of bacterial cross contamination in hospitals is a global problem, and Vernacare’s single use bedpan systems could be a global solutions says Emma Sheldon, Global Marketing Director at Vernacare

196 Olympus: Clear focus Manufacturers of advanced medical equipment are facing increased pressure to supply more advanced products and innovative models of procurement to NHS and private medical institutions, Stephen Shaw, Regional Sales Manager at Olympus Medical tells Jack Ball

200 Eschmann Equipment: Patient positioning Innovative operating tables set new levels in patient positioning, says George Kennedy, International Sales Director for Eschmann Equipment

202 Nine Health: Supporting the Healthcare Consortium UK Developing mobile technology and big data products is just part of the pioneering work undertaken by British consortium Nine Health

204 Royal College of Physicians: Setting higher standards The RCP is a world leader in postgraduate medical education and enjoys long standing partnerships with medical institutions around the world, says Mairi McConnochie, Head of International Affairs, Royal College of Physicians

176 IHG: Raising the quality of China’s health care IHG has been working in China since 2012 and has major projects in development, says Ralph Dando, Development Director at International Hospitals Group

178 Elior: Delivering on Corporate Social Responsibility through nutrition Fresh ingredients and less emphasis on sugary snacks has been a popular initiative at Elior’s staff and visitor hospital eateries, says Robin Givens, National Sales Director, Elior

206 Occupational English Test: Language confidence Good communication skills are vital to ensure safety and quality in healthcare, and as demand for healthcare professionals grows, so too does the need to ensure an increasingly global workforce has a proven standard of healthcare-specific language proficiency, says Simon Beeston, Director of Cambridge English Language Assessment

210 QHA Trent: Maintaining standards 180 Weqas: Injecting quality into global healthcare As the delivery of healthcare changes worldwide, Weqas’s unique approach provides a complete diagnostic service, says Annette Thomas, Director of Weqas

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Independent accreditation can help ensure healthcare providers are genuinely fit for purpose and standards are maintained at home and around the world, says QHA Trent’s Professor Stephen Green

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Harley Street Medical Area is a world class centre of medical excellence located in the heart of central London. It is home to over 2000 practitioners, small clinics, full scale hospitals and support services covering just about every medical specialism and related profession.

It boasts the largest concentration of medical excellence in one location anywhere in the world. To find out more about this acclaimed medical area read the article here on pages 106 - 110 harleystreetmedicalarea.com @HarleyStMedicalArea

Foreword

George Freeman

Providing healthcare needs globally Since taking up my role as the UK’s first ever Minister for Life Sciences in 2014, with responsibility for Healthcare UK, I have been impressed to see the substantial growth in both the size and scope of business opportunities for the UK’s healthcare sector. Perhaps more impressive still is the extent to which the UK’s health sector is now geared up to respond. Our experience over the last few years confirms that the demand for British expertise to develop and improve health services around the work is strong and growing, and we are now seeing this borne out by the establishment of ground-breaking partnerships which bring together the UK’s health sector – both NHS and industry – with partners overseas to develop world class clinical services. This was demonstrated powerfully during the state visit of The President of The People’s Republic of China, Mr Xi Jinping in September 2015, which was closely followed by the visit of India’s Prime Minister Modi in November. I was honoured to witness signings of several landmark partnerships, with a total potential value of over £2bn during these visits. Partnerships like that between King’s College Hospital and Indo-UK Healthcare to establish the first Indo-UK Institute of Health in New Chandigarh, the first of 11 such centres, all of which will present partnership opportunities NHS organisations. Just as impressively, more than £2bn of healthcare and life sciences trade deals and collaborations were signed between China and the UK during President Xi Jinping’s state visit to Britain in October 2015. Among these are agreements for Glasgow Caledonian University, Kings College London and Annie Barr International to support the training of Chinese health professionals, as the Chinese government aims to train 150,000 doctors and 2,000,000 nurses by 2020 – an ambition that opens up myriad opportunities for UK providers to play a role.

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There is no shortage of such examples, and we have seen similar successes in the Middle East, while opportunities abound from Latin America to South East Asia. Taken together, they demonstrate the leading role that the UK can play in the development of health systems and services around the world, and as we know very well, the benefits of these partnerships run both ways. As this, the second edition of Global Opportunity Healthcare will show, the UK has a huge amount to offer to our partners across the globe. There has never been a better time to choose the UK as your partner in providing for the healthcare needs of your citizens.

George Freeman MP Minister for Life Sciences Department of Health and Department for Business Innovation and Skills

Our experience over the last few years confirms that the demand for British expertise to develop and improve health services around the work is strong and growing.’

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George Freeman

The UK has always been a science and health superpower and now is the time to globalise our leadership through the NHS says George Freeman MP, Minister for Life Sciences

Developing global health A

s the UK’s first Minister for Life Sciences it’s my great privilege to have been asked by the Prime Minister to lead the globalisation of our leadership in health research and care innovation. My role incorporates being a Minister at both the Department of Business Innovation and Skills and the Department of Health. It spans supporting UK industry and helping to bring in investment into the UK, alongside responsibility for the drugs budget, for the cancer drugs fund, for our genomics programme and our informatics programme, as well as being the Minister for NICE, for the regulator NHRI, and Healthcare UK. Through all these roles I’m driving our mission to internationalise our healthcare leadership through the NHS, and it’s a mission I believe passionately in. The UK has always been a great powerhouse of science and innovation – the Cambridge Laboratory of Molecular Biology alone has won 14 Nobel

GEORGE FREEMAN MP George Freeman was re-elected as Conservative MP for Mid Norfolk on May 7th 2015. He grew up on a farm near Newmarket, before moving to Norfolk 20 years ago. After education at Radley College and Cambridge, he spent five years in Westminster as Parliamentary Officer of the National Farmers Union and founder of various campaigns to promote a more vibrant rural economy and renaissance of local government. Now based near Watton, after four years in venture capital he now runs his own small business (4d Biomedical) helping hospital clinicians to develop, commercialise and finance new medical technologies. George returned to politics in 2003 and stood as Conservative Parliamentary Candidate in Stevenage in 2005 with a campaign called ‘Positive Politics.’ In 2014 he was appointed Parliamentary Under Secretary of State for Life Sciences.

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prizes – and the list of groundbreaking innovations that have come out of the UK is endless, ranging from early 20th century work on anti-infectives, to pioneering transplant surgery, MRI, and now to genomic medicine for rare disease and cancers. And in the NHS, we have the world’s largest universal, integrated health system, which remains free at the point of need. The NHS is the fifth largest organisation in the world and was ranked by the Commonwealth Fund in 2014 as the world’s best healthcare system. We’ve found since we launched Healthcare UK, that the NHS and all it stands for inspires huge trust, loyalty and interest all over the world. The reason the NHS featured in the opening ceremony of the London 2012 Olympics is because it speaks to our values in a very profound way; it’s one the greatest assets this country has. It has been running since 1947 and people recognise that you can’t just create a health system overnight. People want to be able to tap into the knowledge that underpins it and be able to build a hospital, a primary care system, or indeed a national health service which draws on that expertise. In short, we have a huge amount to offer to the world, and as this edition of Global Opportunity Healthcare demonstrates, a commitment to building international partnerships.

Industry opportunities It has almost become a truism that health is global, but it remains valid: firstly, there is scarcely a single field of human activity that does not having a bearing on health, and vice versa. Bad health is bad for economic and social development. And secondly, in a rapidly globalising world, many of the main threats to health, and challenges to health systems, are global challenges with little regard for geography. It follows that international collaboration can have a significant positive impact on both the state of healthcare and on the economic and social wellbeing of populations around the world. So, for example, as an aging society we’re facing

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George Freeman

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George Freeman

| pressures that the rest of the world will rapidly come to face as well, and the responses we’re developing - including early diagnosis, smarter treatment, keeping people out of hospital, embracing digital health and new medical technologies – could find applications elsewhere. Just as well, we have a great deal to learn from the innovative approaches to many intractable challenges that are being fostered beyond our borders. To that end, it’s vital that the expertise of the UK’s health sector is accessible to international partners, whether that be in the public or private sector or academia, and whether that be in fields as diverse as the design of health systems, the development of facilities, the training of world class clinicians, digital health and informatics, medical technology, or the development of next-generation services such as genomics and precision medicine. We want the UK’s health sector to be the best networked in the world. When I was a child in the UK, the chances of

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men dying of heart attacks in their 50s and 60s was much higher. This happens much less now because of stent technology, statins, and all the breakthroughs in cardiovascular science. But today’s challenges – not least ageing populations and the rise of long-term conditions - demand that we continue to innovate. Medicine works by dealing with today’s challenge while creating a market for tomorrow’s innovations, and it develops at an astonishing pace. How we make use of data is going to be one of the key enablers of that in the 21st century – and the UK is uniquely well positioned in this regard. In the UK we have nearly 70 million patients, millions of operations taking place every day, millions of interactions between patients and clinicians, and all of this leaves a huge data footprint, a huge collective knowledge about disease and patient conditions and how different patients respond to different conditions and treatments.

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| We have 68 per cent of NHS users with smart phones, by the end of this parliament we will have a paperless NHS, patients booking appointments, accessing their patient records, using data to make meaningful choices about their own healthcare. We want the rest of the world to be able to benefit from that too. If you look at the scale in countries like India and China of how many citizens have a smart phone and how many could use it to access primary healthcare advice, that is a phenomenal opportunity. As in so many cases, it’s a win-win for patients, for the NHS, for our economy and for the countries we partner with. Another example of where we’re doing it is in genomics. The UK is the first country to sequence the entire genome of a 100,000 patients, combine it with our hospital data and form the world’s reference library for genomic medicine. We’re also launching 11 genomic medicine centres here in

‘Our health system has much to gain from engaging internationally. Major collaborations between the NHS and overseas partners develop all sorts of opportunities for skills development and training.’ the NHS and that project is generating revenues today from companies and researchers. We want those revenues to go into the NHS to help fund new cancer and disease treatments. This programme is going to allow us to diagnose and treat and ultimately prevent diseases using insights from the human genome. This is extraordinarily advanced healthcare and we want to be exporting this in the coming years around the world so that other countries can benefit from genomic medicine, not least because as the volumes go up the costs per unit price come down. Sequencing a single human genome cost about US $10bn ten years ago, now we can do it for US $5000 in 24 hours. More countries engaging in genomic medicine will get that down to pence. When you can start to do a human genome for a few pence then you can start to really drive phenomenal insights into global public health for the benefit of us all. Beyond these major, NHS-wide initiatives, the opportunities are innumerable. Only recently I was in one of our leading hospitals, and in just one hour I was shown three extraordinary breakthroughs with huge global potential. One is a machine developed by GEC using Cambridge Medics’ intellectual property that measures in real time chemotherapy impact on the tumour cells of the patient, with the

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George Freeman

potential to take years out of cancer chemotherapy research. Now we want to take that piece of kit, roll it out across the world to other hospitals and countries, so our UK hospital has revenue back from those sales which it can reinvest in new treatments. I went downstairs and met clinicians developing a vaccine for peanut allergy. As cutting edge immunologists in the NHS, they want the service to go global because millions of children worldwide are suffering, with many dying, from anaphylactic shock response to peanut allergy, which is completely unnecessary. Now if the NHS can roll that service out, roll out the diagnostic protocols, upgrade the treatment protocols and receive some form of royalty around the world, a small royalty on a huge volume, that’s not just good for the local hospital to generate revenue but it’s inspiring for the clinicians as well. It’s why people come into medicine, to make a difference around the world. And of course as other countries improve their healthcare they generate demand for new innovations. Our health system has much to gain from engaging internationally. Major collaborations between the NHS and overseas partners develop all sorts of opportunities for skills development and training. It takes front line clinicians in the NHS and gives them access to professional challenges they wouldn’t necessarily get in one UK hospital. UK hospitals partner with overseas territories to generate revenues and training opportunities, and of course to benefit UK patients because these interactions enable NHS hospitals to leverage more resources, and expand and improve training. So the potential is vast, and in Healthcare UK we have an effective mechanism for capturing it. There is already a track record of success: since its launch three years ago, Healthcare UK has secured and inked over £3.5bn worth of deals with countries all round the world. Only recently we signed a package with China worth more than £2bn and made up of 17 individual partnerships. We’ve also signed a £1.1bn pound deal with India. And there is a good deal more in the pipeline. Healthcare UK is particularly active in regions where demand for healthcare is growing fastest, including China, India, the broader Middle East and Latin America. But our focus isn’t restricted to those countries. Take South East Asia for example: in the Philippines, where I worked as Trade Envoy for the Prime Minister, there’s a very fast emerging economy, huge population growth and huge economic growth, which is fuelling increasing expectations and demands on the health system – and a healthy workforce is key to sustaining that growth. So, whether a government, province or a hospital are looking for help with primary care, secondary hospital care, community care, digital health or with a particular care pathway, the UK is the ideal partner. We have the knowhow and the networks needed to put together really compelling, worldbeating propositions with the right package of skills and competencies, drawing on the vast experience of the NHS.

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Ilaria Regondi

Finger on the pulse Healthcare UK is in a prime position to identify significant overseas opportunities, ensuring that UK healthcare plays an important role as an export sector, says Ilaria Regondi, Chief Operating Officer

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Ilaria Regondi

ILARIA REGONDI Ilaria Regondi is Healthcare UK’s Chief Operating Officer. Before joining Healthcare UK in February 2016, Ilaria was Senior Private Secretary to Lord Prior, Parliamentary Under Secretary of State for NHS Productivity in the Department of Health. She has extensive experience of international and domestic healthcare, gained at roles with the World Bank, WHO and the Overseas Development Institute.

ealthcare UK was launched in January 2013 as a joint initiative between NHS England, the Department of Health, and UK Trade & Investment (UKTI). Its core objective is to assist organisations across the private and public health sectors to play a major role in the development of health services overseas. Based in London, Healthcare UK sits at the centre of UKTI’s global network of commercial offices based in British Embassies, Consulates General and High Commissions around the world. Chief Operating Officer Ilaria Regondi believes this positioning is key to Healthcare UK’s growing success. “Being part of the UKTI network gives us a unique platform to gather intelligence on upcoming opportunities and then run programmes of trade missions, events, ministerial visits and so on, to ensure that UK organisations are at the front of the queue when it comes to accessing those opportunities.”

Tailored responses As a small but growing team, Healthcare UK needs to choose carefully where to focus its efforts. It prioritises high growth emerging markets where UK Government assistance can make a big difference, including China, India, the Middle East – in particular the Gulf countries – Turkey and Brazil. Three years on it has recently extended its focus to Asia, and beyond Brazil to the rest of Latin America. With the rise of non-communicable diseases, ageing populations and the squeeze in budgets, most healthcare systems have fundamental challenges in common, but Healthcare UK’s approach takes account of the variation in priorities within and across the regions it works in. “It is difficult to generalise when the variation between countries is so great. In the Middle East for example we’re seeing diabetes as a very high priority, but there is also a real need for improvement in, for example, trauma care and rehabilitation. In China, one of the key questions is about how to

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Ilaria Regondi

‘The NHS is really respected for its values of universal access and being free at the point of care, as well as its association with the really high-quality providers that we’ve got in this country.’ tackle the healthcare needs of an ageing population, while in India it’s often about finding ways of bringing high quality care to remote rural areas, while also catering to a rapidly growing urban middle class with rising expectations. “These are huge challenges, and there is a vast depth and breadth of experience in the NHS that means we can play a role in helping overcome them. The NHS is really respected for its values of universal access and being free at the point of care, as well as its association with the many high-quality providers we have in this country. That is backed up by the global reputation of organisations like NICE, who set the standards that others follow. But we can’t simply take the way things are done in the UK and transplant them overseas; every solution we work on needs to be tailored to local circumstances and ways of doing things. And it also goes without saying that we don’t have all the answers – we have a huge amount to learn from the countries we work with, so the benefits run both ways.”

It will establish the quality and assurance framework to ensure that the delivery of services in India is consistent with the quality of King’s College Hospital in London. “Healthcare UK has worked closely with Indo UK Healthcare Pvt Ltd to bring this exciting partnership to fruition”. The third core proposition area is digital health, focusing on central systems such as national patient records, local ones such as clinical decision support systems, and personal care solutions, such as mobile apps. Fourth is infrastructure, including designing building, operating, and managing clinical facilities of all kinds. “And finally there’s the health systems side of things. This covers what actually goes into running an effective health system from an institutional point of view, the type of regulations you need, how systems can be configured to achieve quality outcomes at lower cost, or to ensure that patient safety is maintained. These are all things that the UK does very well, which is partly down to our making intelligent use of the health data that the NHS, as a unified national system, generates.” “In all of these areas, the capabilities of NHS and commercial organisations play complementary roles. The combination of public sector clinical expertise and private sector reach, scale and commercial acumen can be powerful.”

Identifying commercial opportunities Healthcare UK has a rigorous set of criteria that it uses to identify and qualify opportunities before presenting them to private companies and public healthcare providers. It works closely with UKTI overseas staff and Healthcare UK specialists based

Core propositions Healthcare UK has identified five core areas where it believes the UK has significant strengths that map to overseas needs and demand. The first is clinical services, delivering healthcare overseas, or advising on service delivery. The second is training and education for doctors, nurses, technical staff, management and administrators, at all levels of education and professional development. Ilaria sees particular opportunities in this area. “Backed by £100m of private investment, the first of a proposed 11 Indo UK Institutes of Health (IUIH) is well into its development. These institutes will see high quality hospitals, nursing schools and medical colleges developed across India. When fully implemented, the initiative will amount to a £1bn investment into India’s healthcare system. “The UK and Indian governments have set up an implementation taskforce to ensure closer collaboration and speedy implementation of these and other healthcare projects. These aim to bring the UK’s finest universities, companies and NHS organisations to India. “Kings College Hospital (KCH) has signed an agreement to develop the first medical city for IUIH. KCH’s role will primarily be designing and approving the clinical and governance structure in the hospital.

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| in its target markets to identify which opportunities are worth pursuing, which ones are realistic from a commercial feasibility point of view, and which ones the UK Government can offer distinctive support. “One thing we can’t do as government is to play favourites,” says Ilaria. “If an opportunity comes in and there’s evidently a wide array of organisations that could respond effectively to it, UKTI has tried and tested platforms for sharing information, such as listing opportunities on the Exporting is Great website. “But sometimes the challenge we face is quite the opposite – there are a limited number of organisations that can respond to opportunities in some specific clinical areas, so we rely on our team’s networks and knowledge of the health system to ensure we reach out to the right organisations. “Even where there’s a good fit, capacity can be a real issue, or an opportunity might demand that multiple organisations come together to deliver different aspects of it. So we try to bring together partners who have different strengths that will maximise the UK’s chances of success. For example, given the scale of the opportunities in training and education in China we’ve helped to form a consortium of providers, mostly higher education institutions, to pursue opportunities collectively.” The recently-launched UK International Healthcare Management Association (UKIHMA) asks members, including NHS organisations, to join a grouping of organisations from across the many aspects of healthcare management. This new entity will be able to respond to a wide variety of opportunities which, Ilaria believes, makes Healthcare UK’s job much easier in identifying providers that can respond quickly.

Ilaria Regondi

“UKIHMA is not an exclusive provider and Healthcare UK will continue to work with others, but we hope it will prove an effective way of unlocking the capacity of the sector for international work.”

Strengthening the NHS In the three years of its existence, Healthcare UK has already experienced significant success, despite many challenges. “We’ve seen multiple billions of pounds’ worth of opportunities emerge and have helped to convert some of those into success for the UK. We’ve far exceeded our target of helping to win £1.5bn of business since 2013. Looking ahead, Ilaria continues to see a bright future for Healthcare UK. “We hope that we will go from strength to strength,” she says. “We think that the case is now made that the UK’s health sector can and should compete internationally. Whilst the commercial sector is well placed to win business overseas, we’ve seen NHS organisations competing and winning business too, which was one of our fundamental objectives at the outset, and we’re now seeing more and more NHS organisations coming on-stream.” “There’s no question that the NHS’s core purpose is and must continue to provide high-quality care for UK citizens,” she continues. “But the point we’re trying to make is that working abroad should actually enhance the NHS – the revenues that it generates can be reinvested in patient care. It enhances the reputation and international reach of the NHS in terms of recruitment and retention of high-quality staff. The priority of the NHS needs to be at home but the benefits of international activity should be felt here too.”

Open door policy Organisations that are interested in working with Healthcare UK are invited to get in touch. “One of the first things I would say is just to make contact with us,” says Ilaria. “Email us at healthcare.uk@ukti.gsi.gov.uk and we’ll make contact and arrange an introductory meeting. We need to understand what your strengths are and how you would like to be involved in order to effectively match you with the best opportunities. “The second thing is to watch our website www.gov.uk/healthcareuk and register for our mailing list. The Exporting is Great website (www.exportingisgreat.gov.uk) is a good source of both opportunities and practical advice for exporters, and is a front door to UKTI’s national network of International Trade Advisors, who can provide handson support and advice to exporters in their regions.” “The breadth of expertise within the UK healthcare sector, along with the alignment of our services, makes it the ideal time to work with Healthcare UK. We are keen to share our knowledge and to learn from other countries, for the benefit of all our partners.”

Further information www.gov.uk/healthcareuk

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| Global Opportunity Healthcare 2016

Chandan A.S Alam

Towards academic collaboration: an ideal scenario?

Collaboration based on trust is the most important requisite for successful partnerships, says Chandan A.S. Alam, BSc, M.D; BSc., M.D. Executive Vice President, CSO

hat is academic collaboration? In my mind it is a joint working relationship between two or more otherwise independent bodies. Furthermore, these separate entities agree to co-operate in order to achieve common academic goals. Normally a new organisational structure separate from, yet encouraged by their own institutions, is created to facilitate the collaboration. This new structure’s ‘reason for being’ is to regulate and monitor planning and implementation of the collaborative academic programme. Frequently, this is achieved with joint staff and resources. This ensures that each partner

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will know and acknowledge the role they will play. In the ‘ideal scenario’ this will lead to a collaboration based on and characterised by transparency and accountability. Probably the most important and strongest term that can be used for this is trust. Researchers and academics involved in collaboration should have a genuine and strong commitment to all terms of their academic partnership and its success. Therefore, they should invest their resources in a manner that concretely reflects on research activities. To ensure their effectiveness, this can be regulated both administratively and financially.

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Chandan A.S Alam

CHANDAN A.S. ALAM, BSC., M.D. Chandan A.S. Alam is currently Executive Vice President and Chief Scientific Officer of TDSC. Dr. Alam is also a Founding Director. His main area of interest is the transdermal delivery of drugs and he has completed several successful clinical trials of TDSCâ&#x20AC;&#x2122;s technology. From 2003 to 2009 Dr. Alam was Senior Research Fellow and co-head of the Experimental Pathology group at the William Harvey Research Institute, London, UK. Dr. Alam has published 45 plus papers, posters and book chapters on angiogenesis, various animal models of disease and transdermal delivery of drugs and has presented widely at international conferences. Dr. Alam is co-inventor of two US Patents - No. 5,847,002 and 6,596,703 which have developed and been commercialised from his work. Dr. Alam is a member of the East London and City Medical Ethics Committee. Dr. Alam received his Bachelor of Science (BSc) from London Guildhall University and his MD from St. Georges University School of Medicine, Grenada, WI.

Researchers engaged in collaborative research may also sustain success of their partnership by sending thoughtful signals towards each other through the following simple practices: lE ffective listening by avoiding jumping to conclusions and listening to facts only, and paying attention to verbal and non-verbal messages, showing interest, etc. lG iving and receiving feedback and regular research review with partners. These can be powerful and useful processes only when opinions are fully and directly expressed. However, receiving feedback is only functional when received attentively and appreciatively, taken seriously and exhaustively explored and used.

Commitment can be more prevalent by adhering to obligations mutually agreed upon and carefully planned programmes, particularly as regards the following issues: l Research objectives l Research schedules that are usually divided into: i. Data collection and field reports ii. Analysis iii. Writing and submission of progress reports, annual reports iv. Writing up research-results in a form of comprehensive final report and/or publication.

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Failure of some research partnerships is often attributed partly or fully to the following main difficulties: l Making decisions that all partners endorse lL inking the partnership work with partners mainstream activities and budgets lW orking out whether what is achieved justifies its cost l Keeping all partners actively involved In order to avoid these difficulties, research partners must be aware of their possible occurrence, hence seek means and follow procedures that minimize (if not totally avoid) them. Successful academic partnership and collaboration are based on different, yet closely interrelated factors. Failure to observe any of these may negatively affect both efficiency and continuity of the collaboration and partnership.

Issue 02

| Global Opportunity Healthcare 2016

Chandan A.S Alam

| â&#x20AC;&#x2DC;Researchers and academics involved in collaboration should have a genuine and strong commitment to all terms of their academic partnership and its success.â&#x20AC;&#x2122;

Chandan A.S Alam

research project. Unfortunately, it is often the case that those projects partially or completely fail to meet their objectives due to failure of some or all the researchers to fulfill their academic responsibilities and/or adhere to (some or all) managerial regulation of the project. Therefore, it is deemed necessary that some precautionary measures are exerted in order to minimize (if not totally avoid) inefficient performance, violation of research-regulations, or failure of the collaboration project to meet its target.

Managing differences into strength Equality and Respect Equality and respect must not only be felt among academics going into joint academic work but ought to be regulated and put into concrete practice and as regards the following: a Academics involved in joint research have equal responsibilities, obligations and rights, and hence they should: i. look upon themselves and others as partners in leadership and as equals in implementation and management of research activities. ii. Shared engagement in all stages of research processes ranging from data collection to its analysis and the writing of the final results and publications. iii. Discuss all matters concerning a joint research should be conducted on the basis of horizontal (i.e. equal) rather than vertical (i.e. pyramidal) ranking. Consequently, Decisionmaking and follow up (e.g. research proposals, applications for funding, itemisation and shared distribution of research budget, etc.) should be shared by all and not dictated by few. b Recognition of the value of each resourcecontribution. Resources and research potentials essential for knowledge generation are significant and equal in essence and value to those of advanced scientific and technical knowledge and financial contribution; neither of the two can do without the other.

Ethics Researchers participating in any collaboration should comply with international ethical standards forbidding, e.g. corruption, unacceptable manipulation of research funds, equipment, etc.

Sustainability of Collaboration 1. Conditionality All academics involved in research collaboration are expected to come with a set of conditions attached to their acceptance of collaboration and partnership. In order to ensure their acceptance and its effectiveness, all conditions must be negotiated, agreed upon and regulated during the early stage of initiating the collaboration. 2. Institutional regulations and researchers mandates Charts and regulations are made or accepted and signed by all researchers involved in a collaborative

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People from one country or different countries have different values, beliefs, personalities, interests and cultures. The way people communicate can also be different, e.g. some people are more direct, and others are more discreet. In addition there are different styles of managing people, ranging from autocratic styles to democratic approach. If not managed properly, these differences can have profound disadvantageous effects for collaboration. lA cknowledging differences: Differences occur even among people within the same culture. There can be personality traits and work habits differences. Partners coming from different countries generally have different customs, habits and cultural values. Committed researchers must be perceptive and acknowledge these differences. Ignoring or minimising them can be disastrous for collaboration. l Acceptance: After acknowledging the differences, partners in research must learn to accept them because personality types, communication modes, management styles and cultural background are all ingrained habits. Acceptance involves selfunderstanding, understanding each others strength and weaknesses, learning to take responsibility for actions, being open to advise and willingness to change. l Accommodation: Accepting differences may be insufficient if not accompanied by accommodating differences. Accommodating differences is the ability to recognise that differences may exacerbate conflicts, and hence each one needs to adjust identified differences accordingly. lA ffirmation: it is the ability to recognise and compliment the worth of the individual and their contribution. l Solidarity: it is the ability to share in the joy of success and the sorrow of failure together and willingness to devote hard efforts to ignore focusing on the negatives of the other partner. If genuinely observed, these five suggestions will most likely transform differences of research partners into productive resources. Above all, there should be a degree of fun for all the participants involved in the collaboration.

Further information Honorary Senior Research Fellow, Translational Medicine & Therapeutics Unit, William Harvey Research Institute, University of London, London. EC1M 6BQ. UK

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Mark Britnell

| As the United Nations commits every country in the world to improve its healthcare provision by 2030, there has never been a better time to be involved in the healthcare sector says Mark Britnell, Chairman of the Global Health Practice at KPMG International

Building global healthcare 24

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KPMG

here has never been a better time to be involved in healthcare. Last year’s UN Sustainable Development Goals committed every country in the world to ‘Ensure healthy lives and promote well-being for all at all ages’ by 2030. So over the next 14 years or so all countries, be they developed or developing, will have to enhance their healthcare offering to their citizens. The healthcare industry is the second largest industry in the world with a current value of around US$9 trillion, and by 2030 it’s estimated to rise to US$22 trillion. If you think about that in terms of global opportunities to create better health and more wealth for countries and service providers, there has never been a better time to be involved in the sector. The UK is the first country that created a universal healthcare system, and the NHS continues to be highly regarded and widely revered around the world. Of course there remains a gap between translating that respect into action and implementation, but there is no better country than the UK for exploiting and grasping these opportunities. We have a strong NHS an entrepreneurial spirit a global mindset and a universal language, so some of these opportunities are unrivalled.

Buoyant markets I believe global healthcare will grow at a compound rate of about eight to ten per cent over the next three years, so it’s a highly buoyant sector in a highly buoyant industry. Near term, opportunities in Europe and the US offer perhaps fewer opportunities for British enterprise to enter those mature markets if they are not already there. In the immediate term, the next three years is a fantastic opportunity in the Middle East for UK PLC and over the longer horizon, opportunities lie in Asia where we are very well regarded, with a strong appreciation for the NHS and UK brands. If you look at market growth in different regions of the world, I wouldn’t choose an area that has less than a ten per cent compound growth rate in it for the next five years. You must make sure that you can see a reservoir of need and strong political commitment in the respective country, with a strong financing mechanism that actually backs their words and actions. This requires careful assessment locally of key decision makers, with the political and economic context of a country serving as paramount. I always consider three things when I visit new markets: places, propositions and people. We must think about which places we prioritise, what propositions are most important to that country and not necessarily what we think we can sell to that country, and then whether we have the ground force in terms of people both locally and back in the UK to make sure that we can fulfill obligations.

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Mark Britnell

MARK BRITNELL Mark is Chairman and Partner of the Global Health Practice at KPMG. Since 2009, he has worked in 60 countries, helping governments, public and private sector organizations with operations, strategy and policy. He has a pioneering and inspiring global vision for healthcare in both the developed and developing world and has written extensively on what works around the world (kpmg.com/whatworks). As Chairman for the Global Healthcare Practice, Mark has responsibility for KPMG’s 4,000 health staff across more than 40 countries. Mark has dedicated his professional life to healthcare and has led organizations at local, regional, national and global levels. He was CEO of highperforming University Hospitals in Birmingham and master-minded the largest new hospital build in the NHS. He also ran the NHS from Oxford to the Isle of Wight before joining the NHS Management Board as a Director-General. This frontline experience grounds his approach to empowering, motivating and inspiring healthcare innovation

The Middle East After the Arab Spring in 2011, many Middle Eastern countries wanted to make sure that their citizens felt secure, supported, and that their concerns were being listened to, which resulted in education and health being pushed up political agendas in the last three or four years. In turn this resulted in unprecedented growth in construction of new hospitals throughout the Middle East, which produced great opportunities for master planners and project planners. Because of the relative immaturity of the healthcare systems in some countries, management solutions for smart information systems, good human resource systems, great clinical government systems and also data and analytic capability all present themselves for opportunities. Many countries in the Middle East have learned from what has been successful in the NHS and other social or national insurance systems in Europe, and want to get a good blend of public and private provision. They know that because oil prices have plummeted over the last two years, they cannot always rely on their natural supply of energy to invest heavily in all the services that their citizens want, and getting the right balance between the public and private sector is also something which the NHS over the last two decades has plenty experience of as well. My perception is that many big flagship US hospitals have been quicker than the UK to respond to the market need, but there have been some teething problems in terms of medical education and hospital builds. We need to look, listen, be careful and respectful of the opportunities in the Middle East, which are clearly substantial and immediate.

Issue 02

| Global Opportunity Healthcare 2016

Mark Britnell

| China The Chinese government now allows the free flow of foreign direct investment into the Chinese healthcare system, which offers at least five tremendous opportunities. First, we need to look at our strength in the UK through the symbiotic relationship between healthcare and life sciences. Currently in China there are a number of life science organisations that are starting to acquire state-owned enterprises in China. Second, we know that Chinese management capability is traditionally very weak and as the market becomes liberalised, chief executives and hospital directors need to be much more agile and business savvy. There are tremendous opportunities for us to teach and develop future leaders in China in a way that the UK and the KPMG-led Consortium has been able to do with the NHS Leadership Academy. Third, the growth in Chinaâ&#x20AC;&#x2122;s healthcare has been phenomenal. The country has moved from over half its population being covered by universal healthcare to 98 per cent in the space of four years, which is the greatest movement of universal healthcare in history. However it lacks the medical resources to deliver that healthcare once the basic form of insurance has been provided which offers opportunities for the UKâ&#x20AC;&#x2122;s education and training medical and clinical institutions educations.

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KPMG Four is transactions. Whether it is life science firms buying state owned enterprises or private sector capability going into China, the UK’s merger and acquisition skills, our legal professional skills and our project management skills can all be brought to bear on those substantial transactions. Finally, something I believe we should be proud of is the work that National Institute for Clinical Excellence (NICE) conducted with the Chinese government on protocols, on pathways and on best standards. There is very limited clinical governance in China with very limited clinical improvement and methodologies, and so if the Care Quality Commission, NICE and our improvement agencies can get together we can create a formidable proposition for people and agencies in China. My assessment of the Chinese health reform is that they are trying to make more investments in ICT and primary care. There is a clear staff shortage in urban and particularly rural primary care, including the supply, training and education of staff. The World Health Organisation estimates there are 7.3m vacancies for doctors and nurses worldwide, with many of those coming from Asia, in particular India and China. If we can harness a new model work force through the historic power of our research and education and combine that with e-Learning and e-Health, I think we will have a suite of unbeatable global healthcare propositions. KPMG usually works on a five year time horizon when calculating investment returns in China. The NHS rarely plans this way, but as a £120bn series of organisations it should be able to make future bets that won’t pay off straight away. We have the wonderful five-year forward view from NHS England

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Opposite: Dubai Below (left): Guiyang, China Below: Punjab, India

Mark Britnell

that gives us some certainty in terms of planning, which is why it is important to have the banner of the UKTI wrapped around the NHS so we can develop business in partnership. We need to be patient, precise and confident, and as long as we have all of those attributes we can succeed.

India There are at least three strong opportunities for British businesses and NHS organisations in India. First, the quality of India’s medical and clinical education needs to be upgraded to upscale and up skill its clinical and medical workforce. Second, the Indian know-how in terms of their innovation capability around ICT is legendary; we need to form more joint ventures between our educationalists, our healthcare organisations and Indian ICT companies which can develop business in India and also reverse the innovation back in the UK. Third, after the success of the rural health mission in India, the push is now for urban primary care. The urban healthcare mission in India gives opportunities for general practice. As with China, creating a proper general primary care service is something the Indian government is thinking about very seriously. India is a very tough market in terms of price points. If you come over from Europe bearing European prices in the Indian market, you will be laughed out of the country before the plane has even touched down. You need to think about the price point, but more importantly the volume. Generally Indian prices are lower but the volumes could be potentially much higher, and that where it comes back to the place, the propositions, the relationships and the people. If we think about medical education,

Issue 02

| Global Opportunity Healthcare 2016

Mark Britnell

nurse education, clinical training and clinical governance and the development of primary care, there are going to be a small number of people who can afford to pay big money for volume with a more modest unit price, and we need to think about these relationships very carefully. However this could all change. The exponential growth of the middle class in India is almost without parallel, meaning that the spending power of citizens and governments in India will improve. Over the medium to long term, this middle class movement will stimulate growth and demand for healthcare but also growing affluence and price point relaxation. As well as this, India is very keen to make sure we all understand it’s a global powerhouse. It is a global powerhouse, but when you want to achieve such that status you have to accept global standards. That’s India’s challenge. There is a desire within India to make sure that its best domestic companies can also trade to global standards. As one of the five BRICS, India is spending the least on healthcare within this group. It needs to spend more money to improve public and private healthcare, and I am optimistic that in next three to five years we will start to see more buoyancy in terms of price.

South East Asia Australia educates a significant amount of Asian people by sending its universities abroad, and it’s starting to think the same way about its healthcare capabilities and opportunities. So we had better move quite quickly if we want to make the most of opportunities in South East Asian countries. Although we are excluded from the Association of South East Asian Nations (ASEAN) trade bloc, it does not preclude the development and delivery of healthcare services. However we will have to work a lot harder on our local relationships in countries such as Indonesia, Singapore, Cambodia and Vietnam. In the longer term Asia will want to develop its own capabilities, but because many of these countries are starting from such a low base they need to import a skillset. They require education, training, construction, management and ICT, which are all things we have within the NHS. Although ASEAN is a group of ten different countries, this doesn’t mean the challenge of opening up opportunities in South East Asia has to be daunting. Indonesia in particular is a good example where it has great private and public healthcare needs and where countries such as the UK could help. There are opportunities in places like Vietnam and Cambodia, but these are specific deals around infrastructure and project management. Currently in Indonesia, there are three specific needs. The first involves transactions with its private hospitals now looking for investors, partners and for the proper skillset and know-how, but if we’re not careful it will find support from Australian or US private hospital providers. There is no reason why that support could not be provided by NHS England and its great hospitals. Second, developing primary care in Indonesia is

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‘We were the first country after the Second World War to develop universal healthcare and I have no doubt whatsoever in the next 15 to 20 years we will still be leading the charge for universal healthcare.’

as difficult as in India, probably more so because the number of islands and the geographic dispersion pose greater challenges. It needs methods to address this and develop its primary care offering and we can advise on this. Third are the opportunities around ICT. Indonesia is going to have to make the leap to telehealth and telecare much more quickly than other countries, partly because its pay rates are lower and its geographical dispersion is greater, and also the nature of its communities is much more disperse and fragmented.

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KPMG Hanoi, Vietnam

Mark Britnell

communities within the UK, for example Indian and Chinese communities, with which we can develop relationships. It’s something we need to think about carefully, because understandably there is some political anxiety around drawing more people into our country when the NHS is already under so much pressure, we should be able to do both: provide excellent NHS services to British people and provide good facilities for those that want to pay and receive world-class care. We also need to think about services we can provide in overseas patients’ own countries before referring them back to the UK for treatment if necessary. This is a much better way of developing a local market and if the UK government were to give support to our leadership capability, we should think about bespoke relationships with counties such as Indonesia and Malaysia, for example, which have great medical tourism facilities with government tax breaks, land breaks and incentives to employ different medical and clinical staff. Models like Kings College Hospital development in Chandigarh, India, Moorfields Eye Hospital Dubai and King’s College Hospital Dubai show that we care about overseas patients’ needs as much as our own, and it’s a really smart way to develop healthcare around the world.

Collaboration within the NHS

Indonesia will soon be the world’s largest single payer with 250 million citizens. We should be able to take advantage of this because we developed the first ever universal health system, because our country feels so proud of the NHS, and because it is a great brand ambassador on behalf of our country. We should partner with countries and organisations around the world because it helps develop improved healthcare for the betterment of all civilisations on this planet. That is a great objective that chimes with the UN’s new Sustainable Development goal which requires all countries to improve healthcare for everyone by 2030.

Medical tourism I’ve seen first-hand in Malaysia, Thailand, the Middle East and increasingly in India, how the medical tourism market is growing exponentially because the middle and the upper middle classes want to find the right access point. Of course the NHS has many domestic challenges, but at some stage we are going to have to be much savvier about providing excellent care for British people that pay their taxes and deserve NHS healthcare, and also opening facilities for paying overseas visitors. There is a strong market from the Middle East into London in particular, but there are also many

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Anything that leverages the bench strength of the NHS to compete globally is a good thing. Why do some hares outrun foxes? For the hare it is a question of life and death and for the fox it is merely a question of lunch. We have to decide in the NHS whether we are lunching or whether it is a matter of life or death. In the past the NHS thought that the government will give it more money and it doesn’t have to think about all the fancy stuff like training abroad, but those times are gone. The NHS needs to be bigger and bolder and more ambitious in its thinking. Because of the fiscal position of the NHS for the next five years, this decade will be the most difficult decade its history. The question mark is on our organisational ability to collaborate both inside the NHS and then with other countries and businesses in those countries. We need the professional discipline from firms such as KPMG and also the great “soft-power” that the UK government has developed over centuries in all the countries we wish to do business in. We were the first country after the Second World War to develop universal healthcare and I have no doubt whatsoever in the next 15 to 20 years we will still be leading the charge for universal healthcare, and teaching the world how to develop high quality comprehensive care for all.

Further information www.kpmg.com/perfecthealth

Issue 02

| Global Opportunity Healthcare 2016

Deborah Kobewka

Exporting healthcare excellence Healthcare UK has already exceeded the targets set when it was established three years ago. New Managing Director Deborah Kobewka discusses the opportunity to build on that success in a changing global climate

ealthcare UK was set up three years ago as an initiative between the UK Trade & Investment (UKTI), the Department of Health and NHS England to offer emerging countries access to the clinical excellence of the NHS and the UK’s commercial healthcare sector. Since then Healthcare UK has exceeded all expectations, posting around £5bn worth of contracts signed by UK organisations – with £3.6bn worth signed since April last year alone – and has over delivered on targets for delivering support to UK enterprises, both public and private. “Healthcare UK is a fantastic organisation and in the last three years it’s really established a strong position,” says Deborah. “It’s a privilege when you come into a role and the team has been really

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successful, because you can build on the success straightaway. “The last three years have been an entrepreneurial phase for Healthcare UK. My role is to build on this early success, develop a robust and sustainable operation for the future and expand our activities.”

Identifying demand Deborah has over 30 years’ experience in healthcare, working both in the private sector and the NHS. She brings valuable business experience to her role, particularly in identifying and matching UK value propositions with overseas demand. “Healthcare UK has been instrumental in initiating and winning projects in China and the Middle East, and there’s also been success in Brazil. But I think there is so much more potential to exploit,” she says. “There’s much, much more the UK can offer in infrastructure services, clinical services, education and training, our digital capabilities and expertise in strengthening health systems and as we look to

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| the future, expertise in genomics and personalised medicine. We can take all of these propositions to multiple countries around the world to position the UK’s expertise more strongly and help our companies and institutions secure more business. ” Deborah’s approach is simple and clear: work closely with UKTI offices overseas to understand the healthcare requirements of each country; see how that matches up with what the UK has to offer from the public and private sectors, then prioritise the opportunities and match them with a supply chain in the UK. However, she acknowledges that having a strong UK supply chain as well as a constant flow of accessible opportunity is key to building sustained UK plc export performance. “Delivering a more robust, sustainable export platform requires a much more systematic approach to understanding the demand in other countries. We know in China, for example, that there is appetite to build hospitals with NHS-quality services incorporated into them. If we engage early in the project we can then use that as a platform for pulling through additional services from both the NHS and the private sector.

Trojan horse “Once you establish a presence in a country and create a delivery platform like this, you can then use that almost like a Trojan horse and start to pull through other aspects of healthcare services that enhance and support it.”

Deborah Kobewka

DEBORAH KOBEWKA Deborah Kobewka was appointed as Managing Director of Healthcare UK in March 2016. Deborah has over 30 years’ experience in healthcare, beginning her career in the pharmaceutical industry with Schering Healthcare. Moving to IMS Health she held management positions in client services, sales and marketing, including leadership of the IMS publications business before being appointed to lead the market research business in Europe, then consumer health globally. In 2008 she was appointed President Asia Pacific, based in Singapore, where she led all aspects of the IMS business across this diverse region. Since then Deborah has run her own management consulting company DKK Associates, serving clients in healthcare business intelligence and informatics and worked for GBI Health, a dynamic China based healthcare business intelligence provider where she was responsible for all commercial activities, driving business expansion in China and Brazil. Deborah is a non-Executive Director at Bedford NHS Hospital Trust. Deborah holds a Biochemistry degree from the University Of Sussex and is an alumna of the London Business School.

IMAGES: WWW.SHUTTERSTOCK.COM

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Issue 02

| Global Opportunity Healthcare 2016

NHS brand It’s clear the NHS brand is strong across the globe, with the Commonwealth Fund in New York

Creating consortia This collaborative approach follows on from that of Deborah’s predecessor at Healthcare UK, Howard Lyons, who believed that “the British people have much to gain from an outward-facing health sector – we have as much to learn from others as we have to teach.” As well as supporting healthcare partnerships between the UK and overseas healthcare providers, Healthcare UK is responsible for encouraging partnerships between NHS organisations and the UK’s commercial sector to bid for projects overseas. Deborah explains, “There are lots of partnerships of private sector organisations working with the NHS, and many have been very successful. Often it’s about giving support, taking some of the risk away, and bringing in some of their commercial expertise. I think there is a history there that can be leveraged when exploring overseas opportunities.” To achieve this goal, Healthcare UK helped to establish UK International Healthcare Management (UKIHMA), a membership organisation open to private healthcare sector and NHS organisations and designed to improve the UK’s capability and capacity to respond to overseas opportunities. Deborah believes that creating effective consortia is vital to Healthcare UK’s mission. “There is no reason why consortia can’t be put together now. There is definitely opportunity out

‘Once you establish a presence in a country and create a platform, maybe around a hospital build, you can then use that almost like a Trojan horse and start to pull through other aspects of healthcare services that will wrap around and support it.’

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IMAGE: WWW.SHUTTERSTOCK.COM

Deborah Kobewka

there, and there is an insatiable demand for good healthcare in the developing markets that we focus on. There’s no shortage of demand so it’s all about bringing UK suppliers together in a way that a UK consortia bid can compete against a bid for example from Germany, the US or Japan. That’s really where I see UKIHMA adding value. Having put those bids together, we’re beating other countries and not competing with ourselves or loosing the opportunity to make a really clear and compelling bid.”

“You then establish a long-term relationship for the UK which should go on to develop a business that is sustainable, that creates and leverages resources here in the UK and brings revenue and value back to the UK, whether that’s through consulting revenues or UK jobs, clinicians who are able to go and spend time overseas, get some experience and come back to the UK. Or maybe it’s the reciprocal value for example, where undergraduate medics who are able complete their training in the UK, often filling key vacancies here, then return to their country and take those skills with them. There are a lot of virtuous cycles that we can optimise and that should be one of the goals of these long-term relationships.”

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| consistently rating the NHS as one of the best systems in the world. This is an accolade that Healthcare UK is able to capitalise on. “We have a very interesting project in India to build hospitals that are of a NHS quality,” says Deborah. The ambitious project led by the Indo-UK Institutes of Health is for 11 hospitals with one thousand beds and 89 associated polyclinics. King’s College Hospital NHS Foundation Trust is already linked with the project and Deborah is involved with a team that is talking to a number of other NHS trusts. “It may not be that other NHS trusts can do what King’s has done and take a responsibility for a whole hospital, but they can also work in partnership

Deborah Kobewka

‘The British people have much to gain from an outward-facing health sector – we have as much to learn from others as we have to teach.’ together,” she explains. “So that opens opportunities up, not just the big experienced NHS trusts, but to those who are happy to partner with other trusts of perhaps a similar size.” Deborah sees this Indo-UK project as a great platform for the UK, and the NHS in particular, to establish a strong presence within Indian healthcare. “If you’re involved at the beginning with the building of a hospital, British architects will be designing those hospitals. They will work closely with Indian construction firms to build those hospitals, but at the end of the day you’ve got to pull through and deploy clinical services. This is where the NHS will be strongly involved, with quality and governance, and the NHS trusts that are involved will be able to put their brand on those hospitals. It’s a great opportunity for the NHS to showcase what it can really do in terms of exporting UK capability to other markets.”

Priority markets Deborah is focusing Healthcare UK sights on seven priority markets: China, India, Saudi Arabia, Kuwait, The United Arab Emirates and Brazil. More recently, Latin America has been identified as a priority region, with Chile, Peru, Mexico and Columbia all having strong potential alongside Brazil. “They’re at an earlier stage in terms of identifying and developing opportunities, but I do think the conditions there are quite interesting for us,” she says. “There are always some key markets - China and The Gulf for example - but then we have to be alert to opportunities emerging in other countries too, because even with the best plan in the world something unexpected is going to arise. We need to be ready to respond to that.” So where does Deborah see Healthcare UK in another three years? “For me it’s all about making sure that within our seven priority markets we have a well-established pipeline of opportunities, and a very robust UK supply chain that is able to bid on many of those opportunities and win them. My goal is to make sure that in the future the UK wins a much larger share of the healthcare opportunities coming out of these priority markets.” Sources: http://www.napc.co.uk/article/-national-association-ofprimary-care-/exporting-our-expertise https://healthcareuk.blog.gov.uk/2016/04/13/towards-2020healthcare-uk-moving-forward/

Further information www.gov.uk/healthcareuk

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| Global Opportunity Healthcare 2016

The Global Opportunity Healthcare Round Table

| The Global Opportunity Healthcare Round Table Last October Pinsent Masons and Global Opportunity Healthcare hosted a debate with a panel of experts who discussed the opportunities and challenges of international engagement for UK healthcare organisations

here is a huge “pipeline of opportunities” for UK healthcare organisations overseas. The real challenge is identifying which opportunities are real and which are worth pursuing, said George Wharton of Healthcare UK as he and his fellow panel experts set the agenda for last year’s debate on the global opportunities for the UK healthcare industry. Hosted by Pinsent Masons at their HQ in London’s Crown Place, former Health Secretary the Right Honourable Patricia Hewitt kicked off the debate by highlighting that many overseas countries have very specific opportunities and strengths, but also real challenges and barriers which established organisations in the UK may be able to offer help

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Above (L-R): Barry Francis; Dr Kerensa Heffron; Daniel Sexton; Patricia Hewitt; Emma Sheldon; George Wharton; Andrew Hine

and advice with. For example, the China-Britain Business Council and the UK India Business Council offer not only partner introduction and market research but also a physical home away from home, with a range of support that can be given to both NHS and private organisations looking to embark on this journey. The discussion that ensued covered a wide range of issues including the part played by the NHS and the private sector in this market, intellectual property issues, the type of government help and support available, the barriers and cultural differences UK organisations encounter abroad and how best to collaborate with other UK healthcare providers.

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The Global Opportunity Healthcare Round Table

Public and private sector The discussion started with the premise that the NHS is a large and fragmented body that can be hard to work with. It is often associated with sickness rather than preventative care which can provide opportunities to improve economic growth and productivity and are areas of interest to overseas markets. From the consultancy point of view, Andrew Hine felt that the international organisations he works with sometimes operate under a misconception that the NHS is a corporation or a PLC. They would like to engage with the NHS but in practice the arrangements that work best are inevitably with individual hospitals because this is where the incentive and expertise actually lies. In terms of productivity, some organisations overseas have levels that surpass the NHS in many areas. But what they don’t have is the clinical quality, the depth of clinical expertise and reputation of individual organisations like Imperial and Papworth and many others in the NHS. “The NHS needs to be honest about where it lacks expertise, what it can learn from others as well as what it can teach,” he said. As Chair of the UKIBC Patricia Hewitt has a wealth of expertise in the Indian market. She began by saying that in India there is a focus on public health and there are some important initiatives and discussions taking place around primary healthcare. In her opinion, for organisations that focus on wellness and raising productivity through health, there are some very exciting opportunities in both the public and private sector for British companies

RT. HON. PATRICIA HEWITT Patricia is the chair of the UK India Business Council (UKIBC), the premier business-to-business network that works with the British Government to promote stronger economic ties between the UK and India. She is a non-executive director of EuroTunnel, a member of the global advisory council of the technology and outsourcing firm, Sutherland Global Services, and a senior adviser to FTI Consulting.

BARRY FRANCIS Former Partner, Pinsent Masons Barry is recognised as a leading expert in PPP transactions and other infrastructure projects. He has advised on many joint ventures and outsourcing transactions, as well as on procurement and administrative law matters. He specialises in the structuring of complex procurements and their delivery. As one of the UK’s leading healthcare lawyers, Barry is lead legal adviser on a range of healthcare partnerships.

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In India they are driven to deliver the best possible quality at the lowest possible cost. But getting the lowest possible cost isn’t primarily about wage rates...’ Rt. Hon. Patricia Hewitt

Alongside this lies an ethic that is ties in with the NHS, a desire to look after the poor. There are mechanisms in place to cross subsidise from rich patients to the poor, as well as private charitable foundations that also deliver healthcare. “In India they are driven to deliver the best possible quality at the lowest possible cost. But getting the lowest possible cost isn’t primarily about wage rates - it’s about a complete rethinking of the entire administrative and clinical process and changing the skill base,” she said. However this ethic in some cases sits within a for-profit organisation. “It’s that level of innovation in India that makes me very interested in partnerships between the NHS as well as UK private organisations and Indian organisations, even though it is a challenging market and you have to be realistic about expectations.” George Wharton outlined that the UK spends more of Healthcare UK’s budget on primary care than most countries around the world and certainly more than the majority most of Healthcare UK’s priority markets. The strength of the UK’s primary care systems as a gate keeper is something that Healthcare UK has identified as marketable, but so far the focus has been more on engaging with NHS Foundation Trusts that have the established ambition and programme to enter the international market.

Intellectual property The discussion then turned to intellectual property (IP). As well as the benefits and opportunities for sharing IP, the panel also addressed the issue of what this actually consisted of and whether there should be a commercial advantage in this. In answering the question ‘Is there is a fundamental conflict in the way public policy deals with IP?’ George Wharton underlined that Healthcare UK hasn’t focused on commercialising NHS intellectual property (IP) so much as helping NHS

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| Global Opportunity Healthcare 2016

The Global Opportunity Healthcare Round Table

organisations win consultancy contracts overseas, establishing a presence overseas or forming a training partnership with overseas organisations. That said, he acknowledged there are some interesting opportunities. For example, the National Institute for Care Excellence’s (NICE) guidelines and their health technology assessments are globally respected and used, and they are openly accessible. NICE International has for some time been providing technical support, often on a philanthropic basis, to countries overseas in developing similar approaches to implementing these guidelines and developing the national infrastructure required to do so.The interest lies not so much the IP itself as the methodology around it. He sees the task at Healthcare UK in identifying where the opportunities lie and helping the relevant organisations within the NHS mobilise. Dr Kerensa Heffron from Imperial College spoke about intellectual property in the broadest sense and the desire of overseas partners to have an ongoing relationship with the NHS. The organisation of healthcare and decision making is of particular

The Global Opportunity Healthcare Round Table

Establishing strong relationships at home can clearly help organisations make the most of any opportunities that present themselves overseas.’ Barry Francis

If you’re working on a new opportunity and you’re looking for a partner to collaborate with, we have a very good network and can facilitate introductions..’ George Wharton

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GEORGE WHARTON Former Chief Operating Officer, Healthcare UK Overseeing Healthcare UK’s overseas campaigns and its programme to engage NHS organisations in international opportunities. Currently studying an MSc in Health Policy at Imperial College London, George worked as a Senior Policy Advisor on European and financial services regulation prior to joining UKTI where he devised the strategy that led to the creation of Healthcare UK. Before joining the Civil Service, George worked as an investment banking analyst at Deutsche Bank.

interest abroad, along with the running of multidisciplinary teams. She felt it was about finding a partner overseas organisations can work with on an ongoing basis to access some of the top specialists, as well as creating ways of embedding working practices in which the NHS excels. In Barry Francis’s experience, the question of IP and its exploitation can confuse some organisations abroad who don’t always understand the NHS’s desire to share its knowledge rather than using it as a commercial opportunity. Patricia agreed with him, noting that many NHS organisations as well as individual staff want to create international partnerships because it is a good thing to do and there is learning in both directions. But she also admitted there are NHS organisations that sometimes have an unrealistic expectation that a global approach will help to solve their financial problems thanks to an immediate income stream. Daniel Saxton spoke of the benefit of IP to Papworth Hospital. “The reason we’re very good at cardiac surgery at Papworth is because over the years we have been establishing international relationships and working with partner organisations,” he said. “There’s been a sharing of information free of charge that doesn’t have an income generation target attached to it, but it has enhanced our medical ability which has had a really good impact on our reputation. We shouldn’t forget that collaboration, be it free of charge, has actually been very beneficial to the NHS.”

Financial expectations The debate then turned to financial expectations and what motivates organisations to look at moving into overseas markets. In response to the question ‘If an organisation engages globally, is it realistic to assume there will be a financial return?’ Emma Sheldon said that Vernacare views any investment into a new market as a move that will not pay a return in the near term, but will offer an opportunity to grow the company’s understanding of that market and culture. She went on to say it might not even pay

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The Global Opportunity Healthcare Round Table

rewards because Vernacare might not enter that market. But she felt the value lies in the learning experience and the measured risk is worth it for the potential to enhance their business, despite the cost in tying up much of the senior team in the process. In contrast, Daniel Saxton of Papworth Hospital admitted the primary reason for exploring new markets was indeed income generation. But he felt it also offers other opportunities such as education and recruitment to cope with the massive shortage of doctors and nurses currently in the NHS.

ANDREW HINE

Overseas perception of the UK health sector

Director of Private Healthcare, Imperial College Healthcare NHS Trust Kerensa is responsible for the overall management of Imperial Private Healthcare. As well as being accountable for the operational and business management of their dedicated private units, she is also responsible for the ongoing development of the portfolio of services and the quality of care that the Imperial College Healthcare NHS Trust offer.

The NHS is well known and respected overseas. But it is made up of many brands and while some are exceptionally strong others are less so. This means that organisations that form part of the NHS and which contribute to its success may not be reaping the full benefit of this association. The panel then debated the question ‘How strong do you think the NHS and UK Healthcare brand is?’ For Vernacare’s Emma Sheldon, there can be a tendency in the UK to forget how important the NHS brand is overseas. “Vernacare is in 96% of NHS hospitals, so when we tell potential clients the

The NHS needs to be honest about where it lacks expertise, what it can learn from others as well as what it can teach.’ Andrew Hine

In looking at our opportunities overseas, the ﬁrst thing is to be really clear about why we would be doing it.’ Dr Kerensa Heffron

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Head of Public Sector and Healthcare, KPMG UK Lead Partner for KPMG’s UK Public Sector and Healthcare businesses including public and private healthcare, local and regional government, education, policing, housing and charities sectors.

DR KERENSA HEFFRON

Vernacare system is in NHS hospitals that equals pounds and pence for us because of the strong reputation of the NHS. That makes our business good. The superb products, systems, operations and processes we have in the NHS are highly valued overseas.” Dr Kerensa Heffon felt that the NHS brand is so strong that organisations such as Imperial College Healthcare NHS Trust should look at how to use their individual brands alongside it. “In looking at our opportunities overseas, the first thing is to be really clear about why we would be doing it,” she said. “Money and financial sustainability plays a part, but it can’t be the only answer because that isn’t enough in its own right to dilute the attention to our own core purpose which is to serve the population of the UK. However, it can create learning opportunities through the value that inbound patients can have in their different pathologies, giving a different perspective on research programmes.” She felt from an ethical point of view there is a real desire to provide a good health service to people who perhaps don’t have access to it. This desire speaks to the heart of the NHS as the people the NHS employs reflect the communities it serves. The NHS logo has been a source of debate and for Daniel Saxton there was relief that the logo has been kept as it has been very popular overseas due to the recognition factor. “My advice to any other NHS hospital would be not to underestimate the NHS,” he said. “The one thing that links places like Papworth, Marsden and Moorfields is really obvious - it is the NHS. We are all specialist hospitals and we need the NHS as an institution to support us.”

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The Global Opportunity Healthcare Round Table

Collaboration The debate then moved on to collaboration. A number of organisations have pitched to potential overseas clients and been asked to provide a wide range of services that may go beyond their own specialisms. Having relationships in place with other UK healthcare firms so that they could potentially collaborate in the future is seen as highly desirable, so ‘How can we collaborate if there is interest from overseas that is broader than any individual organisation can respond to?’ Barry Francis felt it isn’t possible to put together a convincing consortium to respond to an opportunity as it requires established relationships to succeed in healthcare, as well as in the provision of legal and consultancy services. Healthcare UK’s creation of UKIHMA (UK International Healthcare Management Association) brings together different NHS and private sector organisations that can respond to these opportunities in a cohesive manner. This view was echoed by George Wharton, who outlined the concept that there would be one universal representative grouping similar to a trade association that would engage widely across the sector, ensuring there is a point of access to Healthcare UK services. As such, UKIHMA is a membership organisation intended to provide a pool of expertise and contacts.

The superb products, systems, operations and processes we have in the NHS are highly valued overseas.’ Emma Sheldon

We shouldn’t forget that collaboration, be it free of charge, has actually been very beneﬁcial to the NHS.’ Daniel Sexton

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EMMA SHELDON Group Marketing Director, Vernacare Emma Sheldon is Group Marketing Director for UK medical products manufacturer Vernacare - responsible for leading marketing and market access activities across 48 countries and six continents. She has led the implementation of a new international expansion strategy, resulting in significant export growth and opening up new markets in southern Asia, the Middle East and across Europe.

DANIEL SAXTON Head of Corporate Services, Papworth Hospital NHS Foundation Trust Daniel is Head of Corporate Services and Papworth Hospital, a leading cardiothoracic specialist hospital, internationally known for its pioneering treatment of heart and lung disease. Daniel has worked in both the private and NHS health sectors and has a background in business development. He is currently leading on Papworth Hospital’s international proposition and overseas the Trust’s income generation portfolio.

Funding and building relationships The final area for debate was the issue of funding and building relationships around the question ‘How can NHS organisations go about winning business in these challenging times?’ This was mainly addressed by Andrew Hine who felt that it was not the role of the NHS to fund relationships, as the NHS brings other aspects which are equally valuable. With international partnerships, organisations will bring finance and funding to the table. If they don’t, there are many ways of raising finance both in the UK and globally as long as there is a really clear, well-thought through and well-detailed business plan. Getting paid in some jurisdictions is very different from getting paid here and in many cases it is very tricky. As to ‘How can you get introductions to other professionals in the UK who may want to team up?’ partnership, consortium and collaboration are commonplace, whereas 10 years ago at KPMG it would have been dealt with in house. Now KPMG primes and maintains an extensive range of partnerships over a long time for opportunities that they don’t know will ever exist.

The Future As the event drew to a close, the panellists were asked to give their closing remarks. Dr Kerensa Heffron: I can sense there’s an appetite to work with the NHS and it would give much more credibility to any bid. It’s true to say that we in the

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The Global Opportunity Healthcare Round Table

NHS would also feel hugely supportive going into those discussions with a partner. It’s much easier for us to envisage sharing the load so we can bring our contribution which is around knowledge and less around capital. In my experience, discussions with interested parties abroad happen with someone who wants everything, and we can only provide part of it. It would be good if we had the partnership discussion first and knew what we could all bring to the table. Andrew Hine: The opportunities are huge but these are not a short-term fix. It takes time to build the collaborative and partnership arrangements that are necessary for success. My view would be collaborate now for the things that don’t exist at the moment. Finally, culture and context matter a huge amount. We need to think very carefully about why certain things work in certain cultures and contexts and don’t work in others. Daniel Saxton: From an NHS point of view we have to play to our strengths. We don’t want to be involved with financing projects; we want to be providing proper good healthcare advice. My advice would be to bring the NHS hospitals in at the right time - we need a firm business proposition in place as we are involved in the daily care of our patients. I recognise that works both ways so we have to determine what we can offer as well. Emma Sheldon: It is overwhelming in some cases the amount of opportunity that is out there, certainly for small and medium-sized businesses and indeed for organisations that are stepping

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into it for the first time. We focus on one market at a time so our staff can really benefit from our success overseas. Some colleagues have talked about a focus for just a few people in the organisation in international business but when the successes come, sharing that and making sure that it’s known across the business is a really important element. George Wharton: If you’re looking to make the move into a new market, make contact with Healthcare UK, your local International Trade Advisor, or the UKTI team on the ground in the market you’re interested in. They’re all there to help you and can be reached via UKTI’s website. and most of the time their support is completely free. If you’re working on a new opportunity and you’re looking for a partner to collaborate with, we have a very good network and can facilitate introductions. We look forward to working with you all in the future. Barry Francis: I’ve been hearing there is a need for clarity as to what people want to get out of any relationship and any proposed business arrangement. It’s incumbent on anyone who wants to engage, certainly jointly, to work out exactly what they want from those arrangements and to identify that honestly with their partners. The opportunities for UK healthcare organisations overseas are clearly huge. Choosing which to pursue and being in a position to benefit fully from these is the challenge. Establishing strong relationships at home can clearly help organisations make the most of any opportunities that present themselves overseas. globalopportunityhealthcare.com

Andrew Hine

Healthcare is going through a period of massive change; every country needs to adopt and learn from other systems across the world, says Andrew Hine, Head of UK Public Sector and Healthcare at KPMG

Healthy change P

opulations in the Western world are ageing, putting ever more burdens on healthcare systems and pushing up the cost of care for everyone. Digital technology is developing at a rapid pace, completely changing the way people interact with each other and services. In many ways the explosion of technology and mobile smart phones has come at the perfect moment for those in the healthcare industry. Countries around the world are beginning to accept that the biggest challenge facing international healthcare is how to enable, require and support patients to contribute more to their care. Technology is fundamentally bound up in the answer to this question. But accepting new practices has not always been easy in reality. Now, adopting practices that work in other countries around the world and adapting to the way our world is changing as a result of technology has to become much more fundamental to the way we run our healthcare system in the UK. Andrew Hine, Head of UK Public Sector and Healthcare at KPMG, shares his view of how these trends are playing out across the healthcare market and explains how the NHS can deliver value for patients and taxpayers by taking advantage of the opportunities they create.

How has the global healthcare market changed over the past few years?

I think we are seeing a dawning realisation across the Western and developed world that societies, people and the healthcare systems are all facing the same problems and challenges. In the past people tended to draw lines by country and talk about healthcare systems in different countries as

being different, somehow as if people were different and their healthcare had to be different. With technology and communications making the world much better connected we’re realising that we’re all fundamentally the same. In the developed world at least societies face the same demographic challenges and need to consider strategies for managing those. That in turn means more commercial opportunity and more joint problem solving. That is effecting a huge change and opening up the market in a way that ten or twenty years ago would have been impossible. Has this shift helped to solve existing challenges in healthcare?

There’s been a realisation in some countries that applying the same solutions we have used time and again, just improving them incrementally each time, isn’t really working. The challenge of, for example, an ageing population is long-term. It requires a wholesale change in approach. We’re looking for innovative approaches, innovative solutions,

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KPMG

and generally, innovation comes from outside established systems rather than from within. Should there be more international sharing of best practice?

Yes. The NHS and healthcare professionals in the UK have a huge amount to offer the rest of the world: we also have a huge amount to learn from the rest of the world. We are renowned for clinical excellence in the UK and other countries want to learn from us. But we’ve been poor at accepting technology developments into the way healthcare is run. There are things that we could and should be learning from. There are fascinating examples in Southeast Asia demonstrating different ways to care for elderly populations. There are great examples in other parts of Europe about how you organise staffing in different ways to support people better, and there are some great examples, particularly in the US and Canada, of the use of clinical and pharmaceutical technologies to improve healthcare as well.

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Andrew Hine

ANDREW HINE Andrew Hine is a Partner and KPMG’s UK Head of Public Sector & Healthcare. He leads KPMG’s businesses across the healthcare, local government, education, social housing and policing sectors in the UK. He is the lead partner for a major multi-year contract KPMG holds for the development of managers and leaders within the National Health Service (NHS) in England. He also leads major programmes of system redesign, cost and performance improvement for healthcare clients. Prior to joining KPMG Andrew worked in the NHS for 14 years.

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Andrew Hine

How do we build relationships with other countries in a way that allows us all to benefit?

The reality here is that healthcare is common across the world in many respects but it’s also distinct to every local setting. What do I mean by that in practice? It’s highly unlikely that any idea, however good it is in one system, will translate perfectly to another context, culture, and society without some kind of adjustment. It’s not about having your perfect solution and trying to sell it to somebody else. It’s about having your perfect solution for your context, putting that together with people who understand another context and have their own approaches, and creating something that’s even better - two plus two equalling five. What challenges does the NHS face when thinking internationally?

The NHS has only relatively recently started having any real form of commercial discipline and transacting within its own market, so to expect it to have all those skills honed on an international basis is probably unrealistic. The NHS needs to do what it is brilliant at doing: designing and delivering highquality clinical systems and solutions and work with other partners, other advisory suppliers, to help it extract the value from that knowledge. The NHS should not be afraid of saying what it has: its ability has a commercial value. Indeed, the NHS has an obligation, in my view, on behalf of taxpayers in the UK and patients in the UK to extract the maximum commercial value from its ability. And by making money that way, it can put money back into the NHS and treat more patients. If, to do that, it needs to share some of that benefit with a commercial adviser that will help them do it brilliantly, then that’s a really good thing to do. Fundamentally patients will benefit. How can KPMG help facilitate that?

These are going to be complex arrangements to set up, to establish, and to run successfully. Organisations like KPMG can help first identify the markets and identify the partners in those markets where there is value. Equally and perhaps more importantly they help structure deals financially (and, through other advisors, legally), in a safe way so that all parties can be protected and get a fair share of value . I wouldn’t expect that expertise to exist now in the NHS, because it is not a sensible use of money for the NHS to try and recruit, retain,

professionally develop and sustain teams of staff to do international deals. But the NHS still needs access to them. Some of the most exciting and interesting things that KPMG is involved in internationally are being done by large, complex consortia that we are part of. It is very unusual these days to find a complex problem that a single organisation can solve on its own. So, the secret is to identify all the different parties that you need to create those consortia and do that before you have a commercial opportunity. How should the NHS approach international opportunities?

‘The NHS needs to do what it is brilliant at doing: designing and delivering high-quality clinical systems and solutions and work with other partners, other advisory suppliers, to help it extract the value from that knowledge.’

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The NHS is in its most challenging financial period ever. It is excruciatingly tough out there. Demand is rising, and although the NHS is protected from the worst challenges of what we term “economic austerity”, it is still under severe financial pressure. Perhaps counter-intuitively that means that the NHS should think more about this, not less. Because out there in the rest of the world, are solutions that can help the NHS deliver its current services more productively and more efficiently, and therefore at

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KPMG

Andrew Hine

that there’s a huge opportunity here and a lot of them are already generating value out of it. There are NHS organisations working with partners in the Middle East, in Southeast Asia and elsewhere, and they are generating value. This will take time. The people who are doing it already are the early adopters, the vanguard. But over time, many organisations and people will get involved. It may well take a decade or more, but this is an unstoppable trend, in my view. What role can the NHS play in global healthcare?

There are some really exciting, large hospital management opportunities around the world, particularly in the Gulf region, at the moment. The whole world looks to the NHS for clinical and medical excellence so there is the opportunity to design clinical protocols, the leadership of clinical teams creating the clinical governments arrangements because these are the things that assure the quality of service. Now the actual management of day-to-day delivery, the putting together of commercial deals, the creation of infrastructure, are not things that the NHS is best placed to do. But stick to the one thing that it is really great at, which is the design and delivery of clinically excellent care and export it. What sort of technologies might be beneficial and help make the NHS more efficient?

lower cost. There are also opportunities to realise commercial income. The key question is: should the NHS pay up front for advice to access that? Arguably and often, no. It is perfectly possible to engage advisors on a benefits-sharing basis contingent on success. That removes most of the risk of doing this for the NHS. If you’re only paying your advisers if it’s successful, why wouldn’t you? Why are so few people doing this then?

There are two fundamental reasons. One is that people concerned about the reaction they’ll get. There is still a view in some quarters that the NHS shouldn’t be doing it; I fundamentally disagree with that. As long as there is benefit to patients, the NHS should be doing this. And secondly, they are anxious about whether they have the skills to do it. My response to that would be arm yourselves with the skills to do it on a sensible commercial basis. Going into this without the skills is likely to cost the NHS money. But working with others with the skills to realise benefit for patients is something that you should do, indeed you must do. Lots of NHS organisations are already realising

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I’ll give you a parallel. If my bank stopped providing internet banking tomorrow I’d be furious, because it’s the way I interact with my bank. Ten or fifteen years ago, that didn’t exist, I had to walk into a branch. So let’s apply that to healthcare. If instead of having to go to a doctor’s surgery, a general surgery or a practice to see my clinician, I could interact with that clinician virtually through my mobile phone, then that’s much more convenient for me, as long as I trust the quality of the interaction. In the early days of internet banking there was concern about whether that was a safe and effective way to transact financially. We’ve generally got beyond that concern now. In the future, healthcare is going to be delivered in very different ways. Some of it fundamentally is about a patient in a bed in a hospital because that’s necessary, but a lot of it is going to be about professional advice to me to maintain my health and to treat myself in the early stages of conditions, with the ability to phone, email, video call my clinicians, my doctors, my nurses, whenever I need to. The UK is not the most promising market for digital-based health solutions at the moment though. Often, digital technology providers who work with the NHS are asked the question: “Show me where it has worked somewhere else, and ideally show me where it’s worked in the NHS.” They’ve struggled to do that. Increasingly it’s becoming acceptable to get the proof of concept internationally, in a system that we can learn from and bring that back to the NHS.

Further information www.kpmg.com/uk/healthcare

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| Global Opportunity Healthcare 2016

Matt Custance

| Doing the right deal in the right jurisdiction at the right cost Global opportunities abound in healthcare but with the pressures of everyday work taking priority it can be hard to know where to start. Matt Custance, a partner specialising in commercial and financial advisory in the healthcare sector at KPMG, explains how to approach it

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KPMG

Matt Custance

MATT CUSTANCE Matthew is a KPMG Partner based in London. He is one the UK’s leading experts on major transactions involving the NHS. This has ranged from property deals, new hospital construction and funding, bids to provide NHS care to mergers between NHS organisations. Matthew has advised on public sector transactions for 20 years and on healthcare deals for more than ten years. He regularly advises on transaction strategy, structuring and negotiation.

IMAGE: WWW.SHUTTERSTOCK.COM

believe the biggest barrier facing NHS trusts considering overseas investment is a lack of deal experience. There are opportunities to generate income by selling the UK’s medical skill to other countries and reinvesting that income into the NHS. But realising those opportunities requires commercial experience and specialist expertise. Generating reasonable returns back to the NHS means doing the right deal in the right jurisdiction at the right cost. I worry that many great opportunities for NHS trusts are being overlooked. It’s no surprise to me – the number and variety of options available means it is hard to know where to begin: Trusts could provide care templates to other healthcare facilities, they could outsource services at lower cost, they could use mobile technology to improve patient experience or they could open facility franchises in other countries. That would be hard enough for an organisation with a track record of successful cross border deals and experienced individuals. It is daunting for NHS organisations facing this for the first time. This isn’t a criticism – the core reason for existence for NHS trusts is delivering excellent patient care. It doesn’t make sense for them to maintain a strategic international investment capability full-time. Instead, bringing in advisors as deals arise is probably going to be a better answer for most trusts. That allows the Trust to pick different teams for different deals, picking the advisor with the best knowledge of the country, the partners or the service. An advisor can also help Trusts navigate the options available. That means challenging the rationale for the deal – what is the goal? What are the overseas partner’s goals? What’s the best way for the deal to meet those? For example, if the goal is to minimise cost then outsourcing might be a logical option. If the Trust is renowned for the excellence in obstetrics care then understanding how to educate and replicate that excellence is where it might focus. Or perhaps investing in using mobile technology allows the

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‘If your goal is to minimise cost then outsourcing might be a logical option. If you are renowned for the excellence of your obstetrics care and want to generate some profit by sharing that expertise with facilities around the world, then understanding how to educate and replicate that excellence is where you might focus.’

trust to improve productivity of clinicians. Only once the priorities are clear can we pursue the next step: to build a strategy towards achieving them. That means assessing which international markets provide the best opportunities for your needs and then accessing the right legal and financial advice at the right time. Ensuring that deals do not topple because a critical party hasn’t been involved early enough in the process can make or break success. There is upside to understanding these risks. Knowing where the obstacles are helps but knowing that you have done the work and can drive forward without hesitation can be just as important. Unwarranted fear of failure and risk aversion hampers progress. The NHS shouldn’t miss out on opportunities for want of the right advice.

Further information www.kpmg.com/uk/healthcare

Issue 02

| Global Opportunity Healthcare 2016

Jason Parker

NHS Trusts: taking your services abroad Foreign investment is more than opening a hospital in another country but overseas ambitions could pay off for NHS Trusts says Jason Parker, Head of Healthcare at KPMG

HS trusts in the UK are between a rock and a hard place: increasing pressure on services comes at a time as deficits are consuming the funds needed to invest in the transformation those services need. So I understand why those in charge of managing trusts for the NHS are reticent about throwing money at projects abroad. The fear of a public outcry if foreign investments backfire, is compounded by a lack of resource and commercial investment experience within NHS trusts. That said, challenges often present opportunities. But I see an increasing appetite among larger teaching hospitals to explore these opportunities. They recognise that better commercial deployment of resources and the opportunity to generate income from sharing their expertise with partners is becoming more important. We are seeing a bit of a shift. There’s a bit of excitement and a bit of caution. I think it’s only natural given the political and financial environment we’re in at the moment. There is an increasing number of trusts either in turnaround or at least

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| Issue 02

facing severe financial challenges, meaning they have to focus very inwardly on cost control. When people think about international development, they think its expansionist and could be seen as a risk. So it’s only natural that a hint of caution comes into the decision on whether or not to do it, even on the face of a very strong business case. The big teaching hospitals already have a significant brand and market presence in the UK and engaging with the idea of investing abroad. And why not? Many of them are already using their competitive advantage to undertake lucrative activities overseas. I think this is where we need to demonstrate that foreign investment can work brilliantly for the NHS. But would this work for other trusts, for example,

globalopportunityhealthcare.com

KPMG

Jason Parker

JASON PARKER Jason Parker is KPMG’s UK Head of Public Sector Healthcare across Audit, Tax and Advisory. He specialises in NHS acute hospital and efficiency/cost reduction and has 18 years of NHS advisory experience. His expertise includes performance improvement, cost reduction, strategy, reconfiguration, mergers and acquisitions, board development, lean transformation and senior stakeholder management. He has led over 100 improvement projects across the breadth of the NHS. Jason is a Cohort Director for the NHS Leadership Academy’s Nye Bevan Programme – leading 49 aspirant leaders through a yearlong development programme.

the district general hospital? While no two hospitals are the same, many of the challenges they face are similar. Many of them will be facing more pressing concerns: they are more worried about sustainability, improving quality and attacking their deficits. But if we think about the money, it is not possible to keep improving clinical productivity while shaving the cost base; there need to be other options for growing or sustaining your organisation. That means looking carefully at income generation opportunities and this is where the international opportunity obviously come in. Hospital trusts with overseas ambition are trying to establish operational strategies in the UK first and then exporting them overseas - effectively overseeing either a franchise or a chain model that benefits

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from the strength of the brand. That’s a strategy that has worked for some large teaching hospitals, but narrowing the focus can provide a lower risk starting point particularly for organisations with less commercial experience. The organisations that have a foundation on which to build are those that have benefitted from bringing overseas patients to the UK for treatment, and have recovered the money and made a success of the exercise. I think there’s something to be gained by taking a service overseas as opposed to taking the whole brand. You don’t have to open a hospital overseas; you can start by taking one pathway that you are super specialist at and renowned for. It could be cataracts or orthopaedics - where there will definitely be market interest. We often think about expanding overseas in terms of building facilities; actually there are fantastic facilities all over the world. What their owners are interested in is your expertise and the pathway design that you can take to them. The stumbling block for many trusts has been a lack of commercial expertise within their organisations. This need not be an obstacle. Trusts can access the necessary expertise by setting up consortia and bringing in external advisers with experience of managing cross-border deals. I think we’re at a cross roads investing overseas. We really know in the UK healthcare industry that we need to do this and want to do this. I understand the concern about getting our finances in order first. But I think overseas expansion could actually help us to become more efficient ourselves. The opportunities are there for the taking – how long can we continue to ignore them?

Further information www.kpmg.com/uk/healthcare

Issue 02

| Global Opportunity Healthcare 2016

Barry Francis

Risks and rewards All overseas business ventures involve risk, but healthcare providers that manage their contractual responsibilities and relationships effectively can open up a world of opportunity in terms of funds, skills and research, says Barry Francis, former Lead Legal Advisor at Pinsent Masons

s one of the UK’s leading healthcare lawyers, Barry Francis is a former Lead Legal Advisor on a range of healthcare partnerships at Pinsent Masons. He is a leading expert in Public Private Partnership transactions and other infrastructure projects, and advises on procurement and administrative law matters. There has always and will continue to be opportunities for UK healthcare consultancy services overseas, including roles for providing equipment and medical support. However we’re now starting the see the main growth area is the actual provision of a wider service. At Pinsent Masons we’ve recently been working with a number of organisations, including NHS and private, to provide a health service. Not providing the hospital, but working within the hospital to provide support in inpatient care and hands-on patient treatment. At the other end of the spectrum we see organisations simply providing medical consultants for specialist services, and this demand will also continue to grow. We’re going to see more patients coming to the UK but also a lot more activity with patients being treated closer to where they live, particularly in the Gulf. The more interesting markets may be in sub-Saharan Africa and potentially in China, but the Chinese market is quite different, a different type of society with different demands. From our offices in the Gulf, China, Singapore, Australia and, of course Europe, we are able to address these cultural as

Global Opportunity Healthcare 2016

| Issue 02

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Pinsent Masons

globalopportunityhealthcare.com

Issue 02

Barry Francis

| Global Opportunity Healthcare 2016

Barry Francis

‘UK healthcare providers in the private and public sectors who are interested in expanding overseas need to think in terms of what they have to sell, and why they would want to sell it. This includes skills involved in how they treat patients as well as the systems around it.’ well as legal differences. In the market in general, we’re seeing an increase in globalisation of the types of services that are needed, and also the organisations providing them. The UK as a provider of ‘high end’ health services, the skills of specific doctors or teams is something we’ve always been very good at, but sometimes we fail to take fully into account that other countries are very good at it as well. At Pinsent Masons we’re now seeing engagement at the more commercial level, where clients including private sector and NHS, are increasingly looking at setting up businesses overseas. We’re getting much more active in putting the UK brand out there, not only brands of particular hospitals, but also exporting the NHS brand. If you read the British newspapers the NHS brand is not as glossy and shiny as it was 10 years ago, and this is for a number of reasons, including the demands on the system. However the underlying skills and systems that the NHS employs are very well regarded around the world, and in this sense the NHS brand is very strong. By providing a more co-ordinated approach to realising opportunities, the UK healthcare sector has an advantage that the NHS can exploit for its own individual members. A huge amount of effort needs to be put in to realise overseas business opportunities for an organisation like a hospital, whose primary job is to look after patients in the UK. We need to see the NHS brand as both something that is recognised outside the UK, and also recognised for its advanced medical and health planning. It would give us a huge advantage to build on this and offer something more than just the individual components within the NHS.

Selling overseas When selling themselves overseas, UK providers need to think in terms of what they have to sell, and why they want to sell it. They have to sell skills not only of patient treatment, but also the systems around the patient treatment. Providers need to raise money, but they need to do it profitably while keeping their focus on the day job, which is looking after patients within the area they serve. Pinsent Masons can help here in a number of respects. We can provide information and contacts, and the reassurance that those contacts are good contacts, as well as looking at different ways the providers can deliver their services. All these things

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help address some of the key concerns that any NHS organisation should have if it’s thinking about foreign venture. So the big issues are reputation management and raising money, but how do you get that riskreward ratio correct? What level of risk should and could an NHS organisation take, and is the potential reward worth it? Even if it’s worth it, is there a point at which the NHS organisation will just not take that risk because it can’t manage it or – quite rightly – will not take that risk with public funds? In this case you’re looking at the potential for partnering, not only in the sense of looking for customers to work with, but also other providers. These other providers could be providing service, skills, money and ability to absorb risk. Those are the sorts of things that any individual organisation starting off in its endeavours to export service would probably need help in, because otherwise the hurdles are just too big. It’s fair to say that, in general, organisations that have significant private patient units and are used to dealing with foreign public and commercial organisations in relation to those units are further along the journey to exporting themselves overseas. There are other organisations that think it’s a good idea but are not sure what to do, and others that think it’s a bad idea. One of the things the NHS can do is to help assess the risks, in terms of whether the risks are really there and will the venture be something that detracts from the provision of NHS services or actually enhances them. There are three main benefits to be gained from exporting health services overseas. One, money, two, increasing interest among the clinical staff in terms of the sorts of activities they can be involved in, and three, research. The research element is a potentially very important one. Some doctors are motivated to a greater or lesser extent by money, but most doctors are motivated to a very significant extent by the desire to do better, and in doing better the access both to populations and cash for research are usually important; there’s a real synergy there. I don’t just see this as just an opportunity to make some money. I see this as an opportunity to potentially improve the health service and research, and that’s a good thing for the UK, the doctors, the hospitals, and the customers. So if you get it right, it is a win-win. The question is: what is the

BARRY FRANCIS Barry Francis led Pinsent Masons Structured Health Solutions business, having spent over 20 years advising and delivering on major commercial and financial projects in healthcare, including 10 hospital PFI deals. Barry’s current and recent experience includes structuring private hospital transactions in England, advising on new delivery vehicles for NHS health provision, financing and building a hospital in The Gambia and various joint ventures in the Gulf.

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Pinsent Masons

hospital and what is the NHS getting out of this? If you take a very short-term view, you could say that a doctor who is operating on a patient in Dubai is not operating on a patient in, say, Sheffield, and therefore the health service is depriving the patient in Sheffield. However the reality is the doctor may well not be operating on the patient in Sheffield as an alternative anyway. The benefits of exporting skills overseas include improving the skills and knowledge of the doctors and raising money for the NHS. It’s

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Barry Francis

not a question of taking one doctor away from the NHS; it’s about organising the services available for the patients wherever they happen to be in such a way that the doctor can do this additional work. The idea that there are 10,000 doctors and that’s it, and they will work in England and they will work in a hospital, and if they don’t do that then they will do something different, and if you don’t give them that opportunity they won’t do something different, is entirely wrong.

Issue 02

| Global Opportunity Healthcare 2016

Barry Francis

Skills and research So what does the NHS gain from working overseas? It’s not going to fill the £20bn or £30bn gap; the sums of money are frankly relatively small. A project I recently signed a deal on with a client will generate nearly £2m or £3m. It’s quite likely to be the basis of some other deals, so let’s just imagine that it generates a profit for relatively low risk, or no risk at all, of around £10m. If you then look at the budget of a major hospital then you’re looking into tens of billions of pounds. That doesn’t get you very far in filling gaps but it does get you some of the way. That’s my point: this is partly an issue for raising cash for the benefit of the NHS, but also as a way of improving skills and research. This idea that we can keep all the skills in England because the skills outside England aren’t as good just isn’t true. And as I said earlier, healthcare is a global practice. For someone with lung disease in Australia, their lungs aren’t that different from those of people with lung disease in the UK. This as part of an overall pattern, and the idea that you can keep all of these skills and expertise within England, Scotland and Wales, and if you don’t expand then somehow this will benefit the people of England, Scotland and Wales is just wrong. There’s a huge benefit in reaching out and providing and receiving knowledge, skills and money – everything. There’s a lot of criticism within the UK of the NHS systems, but collectively these are systems that have grown up over 60 years to meet old challenges as well as new ones. I think there’s a huge opportunity to take all of that learning and knowledge and work with other countries to develop those ideas and systems for the benefit of those countries, but also in that process to learn and improve our own systems. This learning aspect is present alongside the financial aspect, and also the aspect of doctor training – if you train in England, the tendency is to want to use English systems, to refer work back to the UK. I don’t think we should underestimate the financial value of this. In some ways you can compare it to the BBC World Service, with the Treasury taking the view that it’s not to provide immediate value for money, but to speak to many people around the world and hugely enhance our country’s reputation. There’s a real opportunity there; never underestimate the real value of soft value.

Managing risk An increasingly common feature we’re seeing at Pinsent Masons is that the customer wants the whole package, and the customer wants to contract with someone who will manage and integrate the risks of providing that, rather than the customer themselves having to act as a risk integrator. It’s true of healthcare; it’s true of IT systems, and it’s true in a whole range of activities including construction. So that’s nothing new, except perhaps in healthcare. If you look at lessons that can be learnt from the other sectors I mentioned, you need a balance sheet that is willing to take risk and you need people that are able to manage that risk, so that the combination of

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‘There is no reason for the NHS to be afraid of the private sector, so long as it handles the contracting stage carefully, understands the risks it’s taking, and can quantify those risks and work out how they’re going to manage them.’ skill and money provides the ability to integrate the risk. If you just went to an NHS organisation whose primary function in this context is to manage the risk of delivery of healthcare to its local population, it is not something that any NHS organisation is going to be able to deliver beyond a relatively small clinic. To a clinic, the sums of money involved and the level of risk is quite manageable. One deal we’re currently working on at Pinsent Masons involves an NHS organisation providing that clinical consultancy support, helping with recruitment and advising on systems. Separate investors are providing the money and a separate organisation has been set up to coordinate the provision of clinical service

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Pinsent Masons

with the provision of the hospital build, the facilities management and the business side of things. The first stage of the contract was signed very recently and I see this very much as a model for other ventures. So the answer is co-operation. You take a clinical service; you ensure that the clinical service provider is able to manage the risks which it takes on, and you spread the other risks around to organisations which have or can hire in the skills to provide those to manage those risks, and you have the money and the balance sheet to support it. It makes sense in any other industry, so why not health? The NHS has traditionally been comfortable with dealing within the NHS and hasn’t had to be that concerned about the precise wording of agreements and contracts. It’s thought that if something goes wrong then you can get around a table and talk about things. So as soon as you’re talking about large-scale commercial activity and commercial contracts, people are being asked to move outside their comfort zone. So what does anybody do if they are outside their comfort zone but they want to do something? Firstly they should learn, and then they should hire people who know how to do it and who have done it before because it is in their comfort zone. A very simple example is you may not know how to buy a house, but you can hire someone who

globalopportunityhealthcare.com

Barry Francis

knows how to buy a house for you. There is a key aspect here, where I think the NHS often makes its mistakes in commercial deals – and this is internal to the UK, not a global issue – is that NHS organisations often think that having done the deal, having signed the contract, that’s it. There is no reason for the NHS to be afraid of the private sector, so long as it handles the contracting stage carefully, understands the risks it’s taking, and can quantify those risks and work out how they’re going to manage them. They then need to manage those risks going forward. What I’ve seen on so many occasions has been contracts signed, services provided, the service provider or counter-party taking advantage here or there, and then that not being adequately managed or dealt with, so perhaps that counter-party takes a few more liberties, and then you have a mismatch. The absolute key to any ongoing relationship is for both parties to be effectively managing the contract and managing the relationship. The contract is not something to be ignored; it sets out the deal. It’s terribly important that these transactions are seen for what they are; they are transactions, they need to be properly managed, the risks need to be assessed, and the basis upon which they were assessed need to be followed through. Then suddenly it’s not scary anymore, because that’s what millions and millions of people do all the time.

Issue 02

| Global Opportunity Healthcare 2016

Mark Lester

Research has long shown that people learn best through conversation, through a sharing of ideas, says Mark Lester, Director of Partnerships Development at FutureLearn

Social learning T

he nature of learning has always adapted to technological innovations and pedagogy, the theory and practice of teaching, is evolving with it. In the 21st century, many leading higher education institutions today acknowledge the demand for flexible online learning that brings together learners and educators into a shared learning space. FutureLearn is responding to such demands, offering opportunities for collaboration between universities to formulate online courses that cater to specific industry needs, offering opportunity for educators, learners and interested parties to share their experiences and expertise to enhance learning.

An introduction to FutureLearn FutureLearn is a consortium of over 70 top UK and international universities and specialist educational institutions. We were founded by the Open University with the intention of bringing together the best of the internet and social learning. The courses are highly interactive experiences whereby students learn together and share their experiences to develop a richer understanding of best practice, mediated by authoritative content from the leading experts in their field. How does FutureLearn differ from other e-learning platforms?

The FutureLearn platform is not like traditional online learning systems, most of which focus on delivering content. Traditional systems do not offer much interaction with other learners; you sit there, you can watch a video or presentation, you perform an exercise and then test the retention of the knowledge presented. This is the extent of learning. Conversely FutureLearn’s courses contain world-class content with a focus on bringing out discussion and knowledge-sharing amongst groups of experienced learners. This is why FutureLearn call it social learning rather than online or elearning. Research has long shown that people learn best through conversation, through a sharing of ideas, concept testing and application through practical experience. Another advantage to the courses is that they

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are incredibly flexible. The FutureLearn platform was built mobile first so learners can study on the go with bite-sized media content. Generally the courses enable learners to do five to twenty minutes of study at their convenience. These short bursts of learning for busy professionals, where they can post comments and read at their own pace, is extremely practical given their demanding lifestyles. Rather than having people take time out of their jobs for periods of study, they can do it alongside their work. What inspired FutureLearn?

FutureLearn emerged from a movement that began in 2008. George Siemens and a group of educationalists developed what we call “Massive Open Online Courses (MOOCs)”. The original US-based platforms were built upon instructional design principles with content heavily grounded in videos followed by exercises and tests to evaluate mastery of the knowledge. As a world leader in supported distance learning, the Open University decided they wanted to put their own theories and expertise into a new platform that would deliver a much better social constructivist experience; a notion that students learn best when they are debating and sharing knowledge with each other. There is a trust in the Open University’s expertise and they wanted to offer this expertise to universities in the UK and then across the world. This was the primary inspiration for FutureLearn. We have thousands of people who have an interest and knowledge of a particular topic coming together, studying and sharing their views. The amount of content that learners get from sharing their own perspectives can far outweigh the content from articles and videos. It magnifies the learning and presents a real-world application of the concepts being presented.

FutureLearn- how it works How does the comment system work?

The comment system has been designed to facilitate seamless conversation around every item of delivered content (e.g., video, article, etc.) rather than have a separate discussion forum. Learners can post and view responses to their comments.

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FutureLearn They can filter different comments to those that are attracting the most interest and the most lively debate. Most importantly learners do not have to be online to be enjoying the courses together. Moreover all our courses are flexible. You can start late or accelerate to the end before the course is due to finish. The majority of the learners also track where the educator is, enabling that cohort or community to engage in productive discussion. The time a comment is posted is also available to view alongside the name of the person who posted it. The learner can then see the whole thread of the conversation in relation to a particular item that the course is teaching. In other words, a video sample or text can be introduced containing particular concepts. The educator is then able to pose questions and ask for comments based on that specific piece of the course content. People then engage in discussion around that topic and are actively encouraged to bring their own views and perspectives to a specific piece of the course content. It is truly a social media type of learning experience. You can “like” particular comments and filter the most-liked comments and conversations regarding that particular stage of the course. Similar to twitter, you can follow those individuals who you’re learning most from and filter discussions accordingly to include only those you follow. This is the primary aim of the comment section; to help learners find the people that they learn from the most. This can be the tutors who are helping to support the course or other mentors that they’ve got to help, as well as other

Mark Lester

MARK LESTER Mark Lester is Director of Partnerships Development at FutureLearn, the UK-based massive social learning platform, and a member of its Executive team. Prior to joining FutureLearn, Mark headed strategy development at the British Open University, has held senior management positions in the financial services sector and central government, and has been a senior advisor to multinational organisations and governments on innovation strategy, industry competitiveness, business strategy and healthcare policy. Mark holds a Masters of Science degree and a Bachelor of Science degree from the LSE and trained as a teacher at the Institute of Education, London. He is married with two children.

learners whom they share particular interests with. However I do offer a simple word of caution to those reading the comments. People are sharing their experiences. You must acknowledge that it is their perspective stemming from their experiences. It’s not about whether you are right or wrong. Instead the learner should be using this system to broaden their learning and not simply take advice at face value. In other words, the comments system is informing your practice rather than dictating it. How has this changed the way learners engage with educational content?

In a run-of-the-mill online learning system, your

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Issue 01

| Global Opportunity Healthcare Education 2016

Mark Lester

FutureLearn learning derives solely from the content being delivered to the learner. The opportunity for discussion and engaging debate with students simply isn’t there. The London School of Hygiene & Tropical Medicine recently ran a course with us on Ebola. Given the rapid spread of infection across West Africa in 2014, the course was established rapidly to help practitioners in Sierra Leone, and other places affected by the epidemic, learn from each other. I took that course. Whilst the content from Peter Piot, who was one of the discovers of Ebola, was brilliant and very informative, the inspirational parts of the course actually stemmed from the comments of people operating the ground. Although these comments highlighted the technical and practical challenges of fighting the infection, they also revealed the social dimension of medicine through formative discussions over the treatment of people on the ground. How does FutureLearn’s content evolve?

Many of the learners on our courses are experts in the field themselves. Bath University currently runs a course entitled ‘Inside Cancer: How Genes Influence Cancer Development’. Five or six oncologists and cancer specialists deliver the content at different points along the course with PhD students providing additional learning support. The university notes that cancer researchers, nurses specialising in cancer care, doctors and patients were mutually helping each other understand the holistic treatment and experience of cancer. We find big learning communities such as these tend to get most things right. The community generally moderates itself and comes up with the correct answers, although trained educators will typically intervene when the discussion wrongly deviates. What are FutureLearn’s main focuses within Healthcare?

Many of our university partners are often blown away by the quality of FutureLearn’s healthcare offerings. This is due in part to the erudite nature of our audience with researchers, doctors, nurses, patients, families of patients, and carers all participating on the same courses together. This inter-professional medical education is crucial to successful learning, utilising teamwork to solve a variety of problems. This opportunity to engage in a patient-centred education is extremely valuable for healthcare workers. Moreover many of our partnered universities that are running these courses are now developing and integrating them into their Master’s programmes, because their own closed programmes cannot recreate the quality of the experiences, commentary and the sharing that is occurring within our collaborative programmes. This style of medical learning, whereby the patient voice is brought to the learning environment, exemplifies a wider need in healthcare education generally. The collaborative nature of FutureLearn’s offering means the expert knowledge contained within

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Mark Lester

our programmes is shared at the international level. This global nature from a large number of countries across the world enriches the perspectives contained in the courses. To quote Sir Michael Crisp who is the former permanent secretary at The Department of Health: ‘Everybody has something to learn and everybody has something to teach.’ For example, there are some great cost-effective operating practices within India and other parts of the world that Western nations could benefit greatly from. Does FutureLearn have a relationship with the NHS?

In addition to our partnership with top medical schools, we also have a partnrship with the training arm of NHS England and with professional bodies in medicine. We continue to build relationships with these crucial partners and I predict that FutureLearn will become the key partner in delivering and disseminating the best of Britain’s medical expertise from our universities and the NHS. We would certainly support commercial relations with different NHS trusts to deliver education overseas. This process could be fairly straightforward. We would help individual trusts design effective, high-quality courses that are highly collaborative in nature. In future, it is possible that FutureLearn could provide the capacity and expertise to enable groups of NHS trusts to respond to the educational needs of other healthcare systems.

FutureLearn engaging internationally How is FutureLearn partnering overseas?

When we started FutureLearn, our focus was about developing great, high-quality courses for the global community. As the company grows, we are now beginning to question how we can support different countries and their healthcare systems through access to high-quality education from the UK and other international university partners. Exciting opportunities relate to the potential to work with local universities and medical institutions to form consortia to help national or regional healthcare systems develop the skills required.

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Mark Lester

FutureLearn

Mark Lester

Our platform is currently only in English and so our focus remains in English speaking parts of the world. However, we are beginning to diversify into more languages with no part of the world truly offlimits to us. In fact our situation is quite the opposite. We have learners from 190 countries accessing the platform, delivering great learning experiences in any market. The challenge instead is assessing where there is a need for particular content, who is receptive to our new forms of healthcare education, and how it can most cost effectively be delivered at scale. In other words our goal is to seek out those who want to think about creative solutions to scaling up their educational training and then bringing that learned knowledge into their respective workforces. Can you design bespoke courses?

Yes, and we are already are doing so for various organisations. There are two ways we can do this. You can either work with one of our university partners or you bring in your own partner that you would like to work with. FutureLearn can help assess your educational requirements with your chosen collaborator before you decide which course or string of courses are most suitable to your needs. We can then help design and build the course accordingly. Courses can be offered in two ways. We can make the course open and invite the whole world into the learning sphere. Or we close the course and specifically cater to those individuals within one or a string of organisations. We privately invite people onto those courses and all learners obtain the same experience and functionality. Organisations are then able to build a specific community of practice across a series of institutions to deliver a truly unique learning environment catered to the specific needs of the client. The closed nature of the offering means you can run courses at any time you like, tailor them in any way you wish, and deliver tangible value to your organisation.

Partnering All our partners are fantastic. They are all industry leaders in their respective fields and it is therefore impossible to single out anybody in particular or discredit others. However many of our partners do enjoy a global reputation which often translates into a higher demand for their courses. These institutions include University College London, King’s College London, the London School of Hygiene & Tropical Medicine, Birmingham, Cardiff, Edinburgh, Glasgow and Dundee Universities. Our international partners like the University of New South Wales, Monash University, the University of Auckland, the University of Cape Town are also world leaders in health education.

digital format. Consequently the opportunity to mix and match different courses and expertise is now beginning to take shape. For example a specific course at Cardiff could be combined with UCL’s expertise in another field to craft something truly unique. Although in the early stages of partnership development, the only barriers to ensuring success are identifying the deals themselves and the arrangements that one has to devise with partnered institutions. However FutureLearn is supporting this process of collaboration-forming and partnership-building. We bring partners together every few months to discuss areas of collaboration and establish the best ways to bring out their expertise in the most effective manner. What does the future hold for FutureLearn?

I’m confident the future is bright for FutureLearn. Blended learning is now the ‘order of the day’ with educationalists increasingly questioning the extent and effectiveness of solely face-to-face leaning. Given the successful pedagogies of large scale online learning at FutureLearn, institutions are able to rethink their educational modules and focus only on face-to-face learning where required. Moreover our partnered institutions will be responding to demands for greater malleability in learning and mutual support of groups of learners, whether that be in healthcare or other specialties. Universities will be able to routinely scale up and modernise their education for those who are trying to reinvent themselves every few years in accordance with technological and industrial innovation. We bring partners together every few months to discuss areas of collaboration and establish the best ways to bring out their expertise.

How do you promote collaborations between partners?

Universities are increasingly coming together to curate courses and share the workload required to turn their current face-to-face curriculum into a

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Further information partner.enquiries@futurelearn.com.

globalopportunityhealthcare.com

Chris Cotton

The provision of a comprehensive system of national care for the elderly in China is a huge task. Chris Cotton at the China-Britain Business Council (CBBC) highlights how the UK skillset can help

Elderly care in China

t was estimated that by the end of 2014, China’s population aged over 60 would reach 212 million – approximately 15 per cent of the population. This is expected to increase by around 10 million every year. Furthermore, those aged 65 and above hit over 138 million, or approximately 10 per cent of the total population. To address the issues of a rapidly aging population, the Chinese government has, since 2012, introduced a number of favourable policies, laws & regulations to encourage development in what Xinhua has described as “an underdeveloped, overwhelmed sector”. Nursing homes in China also face problems. In May 2015, 38 elderly residents died in a widely publicised fire at a care home in Pingdingshan,

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Henan Province, leading to questions being asked about the overall standards of elderly care provision. Care homes also struggle with shortages of suitably qualified staff. Xinhua reported that, by the end of 2015 the government predicted there would be only 30 beds for every 1,000 seniors, whilst there are just 290,000 nurses that specialise in geriatric nursing spread out across the whole of China. As such, the Chinese central government is championing home-based care and services for those that do not require the support of special facilities. CBBC, working closely with our partners at UK Trade & Investment (UKTI) and Healthcare UK, have been paying close attention to the issues surrounding elderly care in China and how UK expertise in the sector can help address the growing situation.

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China-Britain Business Council Building upon a series of previous successful activities in China and the UK, an Elderly Care and Digital Health Demonstrator was organised in Hangzhou and Shanghai in November 2015, where a select group of British organisations showcased their capabilities to influential project owners and other potential partners. To emphasise the ‘Total Offer” from the UK, these organisations covered a wide range of disciplines including: l The design, development and delivery of elderly care and health facilities, services, and workforce l Elderly care and health service commissioning and operations l Training and education for elderly care l Digital health solutions with an emphasis on elderly care. In the intervening days, meetings were arranged between specific project owners with whom relationships had already been established and those who wanted to learn more about the UK offer. The two events were a combination of seminars and exhibitions where key buyers, influencers and partners were able to effectively discuss commercial opportunities with participating UK companies and organisations. These networking events built upon previous successful UK digital health demonstrators in China.

Chris Cotton

CHRIS COTTON Chris first went to China in 1987 and, with a BA Honours degree in Chinese Studies, he started his career in London with the UK’s major shipping company. He then moved to Hong Kong where he was based for six and a half years, working for the world’s leading B2B trade show organiser running industry-leading events in China and South East Asia across a wide range of different sectors. Chris was appointed Manager for the East of England for the China-Britain Business Council (CBBC) in 2005 and promoted to Director in 2007. Chris has advised hundreds of organisations from a wide variety of sectors on their strategies to develop and grow their business with mainland China. Chris is a regular speaker at China business events and conferences. As well as his senior management & regional commitments, Chris is CBBC’s lead in the UK for the Life Sciences sector (Healthcare, Medtech, Pharma & Biotech).

The 2014 “Healthcare is GREAT” UK digital health demonstration in Zhejiang Province was estimated to have generated £60m worth of business for participating companies to date. In Hangzhou, the capital of Zhejiang province, there are already several major customers and Healthcare UK has a long-standing relationship (and MoU) with the provincial government to work together in developing health and care services there. 80 local government departments from Zhejiang were represented at the Expo with the health and care industry in the province expected to be worth nearly $100bn by 2020. In Shanghai, the Care Expo is well established and is one of the largest multinational business-tobusiness elderly care events in China. Following the activities in Hangzhou and Shanghai, the group had the opportunity to visit Yantai, Shandong Province to participate in the UKShandong Commercial Dialogue on Elderly Care. Supported by the Shandong government, this was a forum for UK organisations to meet with selected local project owners to discuss cooperation on real commercial opportunities. As sector leader for life science and healthcare at the CBBC, I am confident the UK can continue to aid China in its provision of universal elderly care, as part of China’s more general healthcare requirements that will continue to grow well into the 21st Century.

Further information Email: chris.cotton@cbbc.org

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| Global Opportunity Healthcare 2016

Professor Anthony Goldstone CBE

| Pioneering research into haematology is informing new approaches to the treatment of MS. Co-located in one of the UKâ&#x20AC;&#x2122;s leading NHS teaching hospitals, Harley Street at University College Hospital continues to work with pioneering Consultants to advance treatments, as Professor Anthony Goldstone CBE tells Jack Ball

A new future for the treatment of Multiple Sclerosis? 66

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Professor Anthony Goldstone CBE IMAGE: WWW.SHUTTERSTOCK.COM

PROFESSOR ANTHONY GOLDSTONE CBE Professor Anthony Goldstone CBE is a world renowned Consultant Haematologist, he specialises in adult leukaemia, lymphoma and myeloma and other non-malignant haematological conditions. He founded the transplant unit at University College Hospital (UCH) in 1979, and introduced an ambulatory cancer care model at UCH which set a national precedent in care standards. Professor Goldstone was UCLH’s first Medical Director from 1992 to 2000. He was also the Director of the North London Cancer Network from 2000 to 2009. He is the president of the Society of Hematologic Oncology (SOHO) and in the UK he is a Past President of the British Society of Haematology and founder and Past President of the British Society of Blood and Bone Marrow Transplant. Internationally, Professor Goldstone was the founder and Chair of the European Society for Blood and Marrow Transplantation (EBMT) Lymphoma Group and founded its Registry. He has also given education sessions at the American Society of Haematology and at the American Society of Clinical Oncology.

ew methods in treating Multiple Sclerosis (MS) have been reported in recent months, as years of research has led to a breakthrough in understanding this condition. One of the latest pioneering developments is the use of stem cell transplantations, predominantly used to treat blood cancers, being used to treat MS patients, with promising results. Harley Street at University College Hospital, part of HCA Healthcare UK, is the first private facility in the UK to offer stem cell transplant for MS patients. The JACIE accredited facility has been providing stem cell transplants for cancer patients for the last 10 years and has developed a comprehensive world class service, which has now been extended to MS patients.

How it works This treatment has been pioneered following years of research and advances in cancer treatment, which has ultimately led to this treatment technique being used to treat other autoimmune conditions. Autologous stem cell transplant is a process in which the patient’s own stem cells are used to ‘reset’ the immune system and stop it from attacking the body. Patient’s stem cells are collected from the peripheral blood known as ‘harvesting’; these cells are then frozen until they are required. Patients will come into hospital and given high dose chemotherapy and antibody treatment which wipes

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Professor Anthony Goldstone CBE

‘In 1979 the risk rate of not surviving this procedure stood at 20 per cent. Today it stands between just 2-3 per cent; ten times less risky through various evolutions of the process.’ out the patient’s bone marrow and immune system. Following this the frozen stem cells are thawed and reinfused to the patient. Globally renowned as one of the world’s leading haematologists Professor Anthony Goldstone CBE and Medical Director at Harley Street at University College Hospital, has devoted more than 40 years to this area of medicine. As part of the medical team who carried out the first Autologous transplant at University College Hospital in the 1970’s and a prominent consultant in the ongoing advancements in this treatment technique he has first-hand experience of how stem cell transplants have transformed over the years. “In 1979 the risk rate of not surviving this procedure stood at 20 per cent. Today it stands between just 2-3 per cent; ten times less risky through various evolutions of the process” explains Professor Goldstone. “As such it is now the standard treatment in serious haematology units like Harley Street at University College Hospital, for mostly haematological malignancies but also some solid tumours and is established in both adult and paediatric medicine.”

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Professor Anthony Goldstone CBE One of the key components of this MS treatment is chemotherapy, and an area where Professor Goldstone has played a pivotal role in developing dose escalated chemotherapy. Chemotherapy drugs are used to attack a malignancy or in the case of MS the immune system in one of two ways. A single agent approach uses one chemotherapy drug while a multi-agent (combination chemotherapy) approach uses several different types of drugs, normally reserved for treatment during the latter stages of a disease. “In the modern era of combination chemotherapy you could only escalate the combined drugs to a ‘ceiling’ point of dosage,” explains Professor Goldstone. “At this point the normal bone marrow could not tolerate any further rise in the amount of drugs administered. Moving past this ceiling would cause the patient to become ‘pancytopaenic’, meaning all healthy red and white cells, as well as platelets would also be destroyed.” A significant depreciation of healthy cells at this ‘treatment ceiling’ places any patient at enormous risk. As such more aggressive chemotherapy treatment that may be required during the advanced stages of a disease is no longer feasible. Developed over the past 30 years, dose escalated or high dose therapy using stem cell transplantation aims to reduce such risk, allowing higher doses of the required drugs to be safely administered and managed. As Professor Goldstone explains, “Stem cells that make healthy bone marrow are skimmed from the blood taken from a patient and then frozen. Once a high dose of chemotherapy is given, the stem cells are thawed and given back to the patient as a blood transfusion.” An influx of healthy stem cells means a patient can regrow any destroyed healthy cells at a much quicker rate, normally between 10-14 days. This allows a safe recovery from extreme doses of chemotherapy that would otherwise not be possible. Harley Street at University College Hospital utilises chemotherapy drugs in a similar fashion to treat MS, with high doses of chemotherapy used to destroy harmful cells in the immune system, so it no longer attacks the brain and spinal cord which causes further damage and the disease’s debilitating symptoms.

Access to treatment Harley Street at University College Hospital offers advanced treatments led by a team of internationally renowned consultant experts, “We are an independent private provider operating inside an NHS teaching hospital and are working to the same standards,” explains Professor Goldstone. “The experience of stem cell transplant in London at Harley Street at University College Hospital is as high as anywhere in the world.”

Further information To find out more visit http://www.harleystreetatuch. co.uk/multiple-sclerosis-stem-cell-transplant/

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Injeccng Quality into Global Healthcare

Laboratory and Point of Care EQA Services Supporrng Quality Improvement and Accreditaaon Reference Laboratory Traceable Analyycal Services Quality Control (IQC) ConďŹ dence in Laboratory Analyycal Control Educaaon and Training Assissng the Delivery of Quality

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Chelsea and Westminster Hospital

helsea and Westminsterâ&#x20AC;&#x2122;s Assisted Conception Unit (ACU) is one of the largest and most successful fertility clinics within the UK. Offering a range of services such as ovulation induction and In Vitro Fertilisation (IVF), the site also holds capabilities for unique specialities including enabling a safe pregnancy in ageing or infected patients. As it celebrates its 20th birthday, the ACU remains passionate about offering bespoke patient care and the best clinical outcomes. It provides a six day a week service and is located within the private outpatient and inpatient wards on the 4th floor of Chelsea and Westminster Hospital in London. The unit treats NHS and private patients offering private medicine standards with the science-based approach and high ethical standards of an excellent NHS and university-affiliated unit. According to Sir Andrew Dillon, Chief Executive of NICE (National Institute for Health and Care Excellence), one in seven couples in Britain are affected by infertility. At Chelsea and Westminster, new patients are seen within a week of referral, and the size and structure of the unit allows a truly individualised approach. The lead consultants, Mr Dimitrios Nikolaou, Mr Julian Norman-Taylor, Mr Jonathan Ramsay and Ms Paula Almeida, are personally involved in all decisions and treatments. The pregnancy success rate at the unit is currently 55 per cent, where the national average is only 36 per cent. In 2012-13 118 babies were conceived from 349 couples, and 40.3per cent conceived on their first IVF cycle.

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Bringing hope to childless couples worldwide

After years of enabling fertility for couples in the UK, Chelsea and Westminsterâ&#x20AC;&#x2122;s Assisted Conception Unit (ACU) is hoping to bring the miracle of life to many more couples around the globe

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Chelsea and Westminster Hospital

IMAGE: BAGGIO STUDIOS

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Chelsea and Westminster Hospital

DR PAULA ALMEIDA BSC PHD DIPRCPATH Paula is the Laboratory Director and has been a Consultant Embryologist at Assisted Conception Unit since 2000. She has been working in the field of infertility for over 20 years. She has a PhD in Cytogenetic studies in human eggs and embryos from King’s College Hospital London, and has published widely in this field. She is a Diplomate of the Royal College of Pathologists, and a National Assessor for the UK Association of Clinical Embryologist (ACE) Training Committee. She is also the ACU’s Quality Manager From 2012 she became the Lead Healthcare Scientist for Chelsea and Westminster Hospital for London Scientific and Diagnostic network.

MR JULIAN NORMAN-TAYLOR MBCHB MRCOG Mr Julian Norman-Taylor is a Consultant Gynaecologist and a Specialist in Reproductive Medicine. Mr Norman-Taylor is also a lead clinician in the management of fibroids with Myomectomy, Laparoscopic Myomectomy, Transcervical Resection of Fibroids and Fibroid Embolisation. Mr Norman-Taylor graduated from Leicester University with a degree in Medicine and he is a Fellow of the Royal College of Obstetrics and Gynecology. He has held posts at Hammersmith Hospital and later the Royal London Hospital in which he performed East London’s first successful ovum donation pregnancy. He has taken sabbaticals in both Paris and Hong Kong and Mr Norman-Taylor’s interests outside medicine include Modern and Oriental Art and a passion for Fulham Football Club.

The unit offers the whole spectrum of fertility treatments from the simple to the most complex, including ICSI (intracyctoplasmic sperm injection) which is used when sperm quantity or quality is too poor for conventional IVF, and IMSI (intracytoplasmic morphologically selected sperm injection) or optimum sperm selection. Much of the focus is on embryo quality, and the successful management of embryos is at the heart of the unit’s service. The ACU’s laboratories are purpose built and are run by five embryologists who provide assurance that a highly qualified and experienced scientist is making decisions about the patients’ gametes and embryos. Embryo freezing is a key component of the treatment where there are spare embryos. Unlike egg freezing which is a difficult process with few resulting live births worldwide, embryo freezing is more successful and, while not all embryos survive the freeze, it allows the embryo to be implanted during a fresh ovulation cycle. This is desirable as it protects the woman from ovarian hyperstimulation and allows the embryo to implant under the best possible environment. The unit also has particular expertise in the management of older women seeking fertility treatment, as well as young women with early ovarian ageing. Dr. Dimitrios Nikolaou is a specialist in this area. “We have a tradition of managing reproductive ageing. Women are born with eggs but not all women are born with the same number of eggs. Various factors can affect this, the main one being genetics, but women can also lose eggs after sudden weight loss or psychological trauma.” For gynaecologists looking to become fertility experts the ACU has one of the longest and most successful programmes for sub-specialty training

MR DIMITRIOS NIKOLAOU MD MRCOG DFFP CERT ADVANCED ENDOSCOPIC SURGERY Mr Dimitrios Nikolaou is a Consultant Gynaecologist and Specialist in Reproductive Medicine. He is the director of the sub-specialty training programme in reproductive medicine and leads the ovarian ageing and fertility programme as well as the infectious disease programme. Mr Nikolaou is a recognised authority in the areas of infertility in the late 30s and in the 40s, as well as the assessment of the ovarian reserve and management of the early onset of infertility in younger women (early ovarian ageing).He was part of the working group of the Royal College of Obstetricians and Gynaecologists on reproductive ageing and he co-edited the relevant RCOG book, as well as the current for clinical practice and research.

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Chelsea and Westminster Hospital

â&#x20AC;&#x2DC;The pregnancy success rate at the unit is currently 55 per cent, where the national average is only 36 per cent. In 2012-13 118 babies were conceived from 349 couples, and 40.3 per cent conceived on their first IVF cycle.â&#x20AC;&#x2122;

IMAGE: BAGGIO STUDIOS

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Chelsea and Westminster Hospital

Clinical Services

Chelsea and Westminster Hospital

REDUCING THE RISK OF HIV TRANSMISSION One of the unit’s specialities is dealing with patients who wish to conceive where one or two of the partners have a viral infection such as HIV. When there is a HIV positive male a technique called Sperm Washing is used. The infection is carried in the fluid around the sperm and not the sperm itself, which means the fluid can be washed free of infection before being inserted at the appropriate stage. Dr Dimitrios Nikolaou is enthusiastic about the benefits of the technique. “It significantly reduces the risk of transmission. We warn patients that there is a 1 per cent procedural risk of transmission but in reality in the years we have been running the programme I have never witnessed a transmission.” This is very much a unique service, as it is the only facility in the UK to offer this capability. While only 5 per cent of patients currently come from abroad, the significant number of HIV cases around the world means this is an ever-present issue, and Dr. Julian Norman-Taylor is keen for Chelsea and Westminster to assist on a global scale. “HIV conception can sometimes be a sensitive subject, but we have a solution to help,” he explains. “Most of our international patients tend to be African, but the Chinese have an issue with hepatitis at the moment and we would be very happy to form relationships and provide support to anyone. We are very used to welcoming people from outside our own population. We receive referrals from all around the world and are well organised to deal with that.” A joint campaign with a centre in Uganda, a country with a high HIV rate, has also been established. International patients can be scanned locally and then treated at the UK site. “We train local nurses and set up the pathway so the patient only has to come into the UK specifically for the treatment. They can be scanned in their home nation, but to establish the expensive infrastructure for only a small population in other countries is often not feasible.”

for surgery in the UK. This also facilitates innovation and the unit is currently working on a research programme, alongside Imperial College, on the immunology of early implantations. Mr. Julian Norman-Taylor explains: ‘Initial studies are looking into why the embryo is not essentially attacked by the immune system, how is it protected and what is involved in that biochemical process.’ There are of course a number of stand-alone fertility clinics across the country but the Chelsea and Westminster Unit holds a number of advantages over these sites, including their ability to offer the whole pathway to the patient from conception through to aftercare. “On a technical front we treat infection cases with specialised equipment which most other infection centres do not have access to,” says Mr Norman-Taylor. Other reasons for the success of the unit include the quality management of the centre. “It is not that we only take easy cases, we treat everybody. Our success rates are consistently high because every

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decision is reviewed by our consultants and we have an active forum for discussion when a patient does not respond as we thought they would.” Due to these robust processes, 95 per cent of the couples that have undertaken fertility treatment at the Assisted Conception Unit would recommend it to another couple. With fertility problems affecting so many couples, Chelsea and Westminster’s ACU has the best possible facilities to ensure that every couple has the greatest chance of a successful and healthy birth.

Further information Assisted Conception Unit, The Westminster Wing, Chelsea and Westminster Hospital 369 Fulham Road. London SW10 9NH Tel: 020 3315 8585 Fax: 020 3315 8921 Email: acu@chelwest.nhs.uk www.chelwest.nhs.uk

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The Chelsea Children’s Hospital

| The Chelsea Children’s Hospital Simon Eccles, Associate Medical Director at Chelsea and Westminster Hospital talks to Sarah Cartledge about his vision for integrated paediatric care

ocated in the heart of London Chelsea and Westminster Hospital is one of London’s largest providers of children’s services, caring for more than 75,000 children a year. It has been designated as the lead centre for specialist paediatric and neonatal surgery in North West London, carrying out complex surgery on babies and children. In March 2013 the different paediatric services including burns and craniofacial surgery, dentistry, ENT, general surgery, ophthalmology, plastic surgery and urology were brought together as The Chelsea Children’s Hospital. “We are the biggest paediatric unit in North West London and our desire is to grow into the third biggest children’s hospital in London,” says Simon Eccles, the Associate Medical Director. Mr Eccles is a craniofacial consultant surgeon who was formerly Clinical Lead for Paediatric Services. He is a firm believer in reducing fragmentation and providing integrated care for children and young people, many of whom are referred from different parts of the UK. The new

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Above: TRH The Prince of Wales and the Duchess of Cornwall opened the new Chelsea Children’s Hospital in March 2014

Children’s Hospital represents a move to integrate care and develop paediatric services for the future. A major £40m redevelopment has seen four new state-of-the-art children’s operating theatres, improved children’s wards, high dependency unit and burns unit. A new children’s emergency unit is under construction, and the next phase will see a new adolescent ward and an acute assessment ward. The first phase has been completed and by the end of the project all paediatric services will be located on the hospital’s first floor. Creative studio Thomas.Matthews has designed the look and feel of the new wards with an overarching Outer Space theme, where illustrated characters interact with the visitors and give them comfort, reassurance and advice. The Children’s Hospital has a large neonatal unit that covers complex neonatology. It also has a new children’s burns unit with a large outpatients department that has what Mr Eccles describes as ‘a wonderful environment.” It is the only burns unit in London for children that require care in a high

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The Chelsea Children’s Hospital SIMON ECCLES Simon Eccles is a Consultant in Craniofacial Surgery at the Chelsea and Westminster Hospital. He graduated as a Doctor from Charing Cross and the Westminster Medical School in 1992 and as a dentist from the Royal London Hospital in 1985.Following a four year training programme in General Surgery, he became a member of the Royal College of Surgeons of England (FRCS) in 1996. At this time he began his training in Plastic Surgery which lasted for a period of 8 years. During this time he was awarded the McGregor Medal at the Royal College of Surgeons in the Specialist Fellowship FRCS (FRCS Plast). He is a past president of the plastic surgery section of the Royal Society of Medicine, and represents London on the National Commissioning Group for Childrens Specialist Surgery.

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dependency setting. There is also a designated children’s accident and emergency department that provides emergency care for 33,000 children each year. “One of my first tasks when I took over my new role was to secure specialist children’s surgical services here for the whole of North West London,” says Mr Eccles. “We went through a complex bidding process which we won. This process is extremely important as it reduces fragmentation and patients and other clinicians know their referral pathways.” “Often these children have complex facial problems; they have heart problems, gastrointestinal and neurology problems so you need the expertise of lots of clinicians to help you,” he says. “We have multi-professional teams made up of doctors, nurses and other allied health professionals, so the pathway is no longer sequential, which can cause long delays.” In his own area of expertise he attends a monthly craniofacial planning meeting with a wide range

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of specialists to create an optimum treatment plan for patients. “It includes craniofacial surgeons, neurosurgeons, ENT surgeons, oculoplastic surgeons, plastic surgeons, dental and orthodontic surgeons, sometimes radiologists and and most importantly the patient and their parents,” he says. “So rather than going from hospital to hospital to see different consultants the patient should go home with a treatment plan, having had the opportunity to ask questions to a whole range of professionals,” he continues. “As a clinician it gives you fantastic exposure to other people’s abilities. It also reduces the number of procedures as we will often have whole teams working on different areas at the same time.” Chelsea and Westminster is in the process of a proposed acquisition of West Middlesex University Hospital and there are plans to develop a Women and Children’s Institute that will offer teaching, training and research. Research at the maternal level is led by Professor Mark Johnson and investigates the different factors that prevent babies being born prematurely and that encourage maturation. In addition a paediatric da Vinci robot has been acquired to carry out laparoscopic surgery on tiny babies, theoretically giving better results with less healing issues and thus minimising their time in hospital. It is the only such robot in the UK dedicated to babies and children and the £1m machine was acquired through a major fundraising initiative. “Chelsea and Westminster has a caring focus and people recognise our innovation and understand that we are trying to do something different,” says Mr Eccles. “We have a state-of-the-art facility dedicated to providing high-quality healthcare for children and young people in a safe and child-friendly environment.”

Further information www.chelwest.nhs.uk

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The Royal Marsden

LOPPORTUNITY

THCARE 2015

An introduction to The Royal Marsden Professor Martin Gore, Medical Director at The Royal Marsden, on what the world-leading cancer hospital is oďŹ&#x20AC;ering overseas patients

s Medical Director of The Royal Marsden, I am very pleased to see that the Hospital is increasingly becoming a popular choice for overseas patients. The Royal Marsden 01 Global Opportunity Healthcare 2015 5 is located across two sites in Issue Chelsea, London and Sutton in Surrey. We are a comprehensive cancer centre offering the very best in private patient and NHS care across all tumour types, diagnostic techniques and treatment modalities. We are particularly proud of our patient-focused approach to care and have been providing cancer care since 1851, which makes us the oldest specialist cancer hospital in the world. London is one of the great multi-cultural capitals of the world and an international centre of clinical and academic excellence. The Royal Marsden is at the very centre of this academic activity. We are the

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countryâ&#x20AC;&#x2122;s only National Institute for Health Research and Biomedical Research Centre (BRC) solely dedicated to cancer. We are one of the top three cancer centres in the world and are recognised by similar institutions in the US, Europe and Asia for the excellence of our research and contribution to the very latest advances in cancer diagnosis and treatment. We offer our patients access to world-leading diagnostic techniques, treatments and individualised care plans, delivered by internationally renowned doctors and highly skilled nurses.

Global opinion leaders Our professors, clinicians and nurse consultants, are global opinion leaders and speak regularly at international conferences such as those organised

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by the American Society of Clinical Oncology (ASCO) and the European Cancer Organisation (ECO). They also contribute to medical journals and academic papers and many are heavily involved in the UK’s response to cancer research and treatment as heads of professional bodies. Overseas patients will often seek out our doctors because of their academic reputations in the specific tumour types they work in. For example, clinicians in The Royal Marsden’s Breast Unit are making breakthroughs in research and improvements in care all the time. Professor Stephen Johnston, Consultant Medical Oncologist in the Breast Unit, is a member of several scientific committees and advisory board, and is Deputy Editor of the international journal Breast Cancer Research. Dr Alistair Ring, who also works in our Breast Unit, has been published widely in peer-

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The Royal Marsden is one of the top three cancer centres in the world

The Royal Marsden

reviewed journals and is regularly invited as a speaker at national and international meetings. Another rising star from our world-renowned breast unit is Dr Nicholas Turner, who is breast theme lead for NIHR trials, and has been identifying some new targeted therapies for women with early stage breast cancer who are at risk of relapse. A leading breast surgeon who works alongside Dr Turner is Mr Gerald Gui, who is on the steering committees of a number of national training courses and is on the trial management committees of national and international studies in screening moderate and high-risk women. Both are known in their field for excellence and innovation and our patients come from far and wide to be treated by them. Another area where we are excelling at The Royal Marsden is within Gastrointestinal (GI)

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The Royal Marsden

cancer treatment and research. Professor David Cunningham is the head of the GI and Lymphoma Unit and Director of The Royal Marsden/ICR NIHR Biomedical Research Centre, which he represents at national meetings. He has published over 500 peerreviewed publications, 45 in the last year alone. Mr Bill Allum is also part of the GI Unit and is the chair of the Oesophago-Gastric Clinical Reference Group, (NHS England Specialist Commissioning), the European Society of Surgical Oncology (European Oesophago Gastric Cancer Audit) and he is also a council member of the International Gastric Cancer Association. And Dr Naureen Starling, a new medical oncologist and researcher published in the field, is helping to develop the GI Unit’s National and International research portfolio and was recently appointed Research Lead for Upper GI Cancers, South London Clinical Research Network. I am also proud to highlight that The Royal Marsden is leading the way in skin cancer treatment and trials, a notoriously difficult cancer to treat. Consultant Medical Oncologist James Larkin, who specialises in skin and kidney cancer, is a member of the National Cancer Research Institute (NCRI) Melanoma Clinical Studies Group and Chair of the NCRI Renal Cancer Clinical Studies Group. Prostate cancer research is also an area of growth for us at The Royal Marsden, and with the addition of equipment such as the da Vinci surgical system, our prostate cancer patients’ prognosis is getting better and better. We are also leading the way in clinical

‘We offer our patients access to world-leading diagnostic techniques, treatments and individualised care plans delivered by internationally renowned doctors and highly skilled nurses.’ Professor Martin Gore, Medical Director

trials. For example, Professor Johann de Bono has led on the development of multiple important new drugs for prostate cancer, including abiraterone, cabazitaxel, enzalutamide and now PARP inhibitors. He received the prestigious ESMO Award in 2012, has also received an award from the Royal Society of Chemistry for his team’s work in developing the drug abiraterone, and leads the Movember London Prostate Cancer Centre of Excellence. He is also the International Lead for the Stand Up To Cancer Prostate Cancer Dream Team. Dr Chris Parker led the randomised international Phase III trial of Radium 223, also known as alpharadin, in the ALSYMPCA trial for advanced prostate cancer, which has also helped change patient standard of care.

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Clinical Services Each patient is assigned a Clinical Specialist Nurse, allowing them oneon-one support

The Royal Marsden

Dr Shelley Dolan joined The Royal Marsden in 1994 as a Clinical Nurse Specialist and in 2000 became the first Nurse Consultant in Cancer: Critical Care in the UK. As Chief Nurse, she has successfully argued for nurses to lead research studies as primary researchers, and there are now 12 PhDqualified nurses working in the hospitalâ&#x20AC;&#x2122;s health services research unit. Dr Dolan is also Clinical Director for the London Cancer Alliance (LCA). The above are just some examples of the leading cancer specialists we employ here at The Royal Marsden. We really are making a significant impact on the global effort to making cancer a disease of the past.

Individual nursing support The Royal Marsden is also unique in how we approach nursing. Each of our patients is assigned a Clinical Specialist Nurse, meaning that throughout their journey, they have one-on-one support available whenever they should need it. We have always been at the forefront of quality and research in nursing to ensure patients receive the best care. We know that the treatment pathway for our patients can be lengthy and complex, from public education and awareness to diagnosis, acute treatment and living with and beyond cancer. So we pride ourselves on training nurses to the highest standards so that they can nurture patients through every step of their treatment. We are also leading the way in the nursing community by engaging closely with our charity partners. For example we have become the first hospital in the UK to employ an Anthony Nolan Clinical Specialist Nurse, specifically caring for leukaemia patients who have just had bone marrow transplants. This is yet another excellent example of how we are always honing our nurses training and expertise in specialist cancer treatment and care and an example of what overseas patients can expect when they arrive at The Royal Marsden.

Unique approach The reputation of the NHS in quality and outcome is also a key reason why we are continuing to see a rapid growth in overseas patients coming to be treated privately at The Royal Marsden, an NHS Foundation Trust. The Royal Marsden is not only a world leading cancer hospital but is also leading the way in both research and development. The hospital is also unique in its approach to treatment and diagnosis. Every patient treated is discussed in a Multidisciplinary Team Meeting and this approach is continued throughout a patientâ&#x20AC;&#x2122;s time with The Royal Marsden, meaning that experts from across the hospital are all involved in deciding the best course of treatment for the individual. We are one of the only hospitals to offer such unique treatment of our patients. The hospital is recognised around the world for its expertise in treating all cancer types as well as its research and clinical trials into cancer genetics and targeted therapy. All this expertise is available to overseas patients opting for private treatment with us.

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The Royal Marsden

Both the Sutton and Chelsea sites offer unrivalled facilities, cutting-edge technology, a comfortable and modern environment, state-of-the-art surgical theatres and countless private rooms.

Pioneering treatment and technology Our private patients have access to pioneering treatment and leading edge technology. Examples include CyberKnife, an advanced radiotherapy machine which uses image guidance to deliver radiotherapy with pin point accuracy to affected areas; Neo-adjuvant chemotherapy is given to patients before surgery who have been identified as likely to benefit from this through genetic testing, and the minimally invasive da Vinci S robotic surgery system significantly reduces the amount of time it takes patients to recover from operations. Another such example of this state-of-the-art technology which will be available to patients of The Royal Marsden is the MR Linac system. The Royal Marsden and The Institute of Cancer Research will become the first institutions in the UK to own one of world’s most advanced radiotherapy machines, thanks to a £9.6m grant. The MR Linac system combines an MRI scanner and a linear accelerator. Once fully developed for the clinic, it will enable more accurate targeting of tumours immediately before and during treatment, particularly of those that move such as prostate, lung and breast cancers. In addition to the above, the Sutton site houses the internationally-acclaimed centre of excellence for paediatric care, which includes the multi– million pound Oak Centre for Children and Young People. And in Chelsea the Rapid Diagnostic and Assessment Centre (RDAC) is located, which is a one-stop-shop for quick and accurate diagnosis and testing, significantly reducing waiting times for patients. We have also recently invested in the brand new Reuben Imaging Centre, which is equipped with the latest technologically advanced MRI scanners and CT scanners, thanks to £6.9m raised by The Royal Marsden Cancer Charity. MRI scans enable us to look at a tumour in fine detail. They are particularly important for soft-tissue cancers, such as brain, spinal cord, bowel, gynaecological and prostate cancers, as the magnetic resonance uses the properties of the soft tissue to create the detail in the image. And CT scanners use X-rays to produce cross-sectional images of the body. When the images are reassembled by computer, the result is a detailed 3D view of the body’s interior. CT scans can be used to help make a cancer diagnosis or assess the effects of cancer treatment.

‘Researchers ensure that information flows between the laboratory and the clinic to rapidly translate findings into benefits for patients.’ to offer our patients a personalised treatment plan within innovative clinical trials. Researchers ensure that information flows between the laboratory and the clinic to rapidly translate findings into benefits for patients. They also work closely with many of the other themes as part of an integrated approach, usually in collaboration with other BRCs and cancer centres nationally.

Overseas patients services At the hospital we attract many patients from the Middle East and have seen a rise in Arab patients opting to come to us for private care, as well as patients from Russia, Greece and Malta. We employ multi-national hospital staff, with many able to speak and understand Arabic and other languages. The hospital also provides a dedicated Arabic Advocate Service to support those choosing to come to The Royal Marsden for treatment or

Research and drug development We work very closely with The Institute of Cancer Research (ICR) and together have the status of biomedical Research Centre (BRC) – the only one in the UK dedicated to cancer. With Professor David Cunningham, Director of Clinical Research, as Theme Lead, the BRC Clinical Studies Theme harnesses the latest knowledge in molecular pathology, cancer imaging and drug development

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The hospital is equipped with advanced MRI and CT scanners

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The Royal Marsden

diagnosis. We can also put patients in touch with a translation service if required. All staff at The Royal Marsden take part in cultural awareness training on a yearly basis to better understand the range of diverse needs patients from all ethnic backgrounds may have. Multi-faith rooms are available at both the Chelsea and Sutton sites. Our staff can also arrange for local religious representatives to come and visit patients in their rooms or on their wards. Our private care website is also translated into Arabic so that potential patients can research the hospital before admitting themselves, and a Halal menu is available for in-patients. In addition, we also organise taxis between the two hospital sites at no extra cost for our private patients if they need to travel between Chelsea and Sutton for treatment or consultations. And we have great contacts with local hotels and serviced apartments in Sloane Square and the surrounding area where private patients can get preferential rates. The Royal Marsden is also currently in the very early planning stages of developing an International Patient Centre at The Royal Marsden which will further enhance the facilities and services available to overseas patients.

Further information International referral and information line: +44(0)2078082063 International referral e-mail: int@rmh.nhs.uk The Royal Marsden, Fulham Road, London SW3 6JJ

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| Global Opportunity Healthcare 2016

Royal National Orthopaedic Hospital

| A ten-year infrastructure plan and industry partnerships are vital for the RNOH’s pioneering work to continue, says Chief Executive Rob Hurd

Spinal care I

f you ever need specialist orthopaedic care, you’ll be very lucky to receive treatment at the Royal National Orthopaedic Hospital (RNOH). The UK’s leading specialist orthopaedic provider, the RNOH is an International Centre of Excellence. It’s a top 10 UK hospital and in the top three Orthopaedic Centres in the world, delivering on all quality access and financial targets. It has an excellent reputation for care: 95 per cent of RNOH patients rate their care as “good” or “excellent”, and over 90 per cent of staff and patients would recommend the hospital to their friends or relatives (it earned second place in the NHS on this score). The hospital is also proud of its exemplary infection control – it is longest standing hospital in London with no MRSA acquired, and surgical site infections are a fraction of the national average. The RNOH has some of the most up to date medical equipment at its disposal and has pioneered the use of cutting-edge technology such as the O-Arm Scanner which provides a 3D real time image of internal bodily structure such as the spinal column. This is incredibly useful for use in

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complex spinal surgery and The RNOH was the first NHS hospital to use it in the UK. Similarly, RNOH was the first NHS centre to use the PedCAT CT scanner, a low radiation 3D scanner that provides true weight bearing images of feet and ankles to ensure increased accuracy in surgery. Advanced techniques like magnetic spinal growth rods that are used to treat spinal deformity are increasing patient safety and saving the NHS money, and the advances in stem cell treatments are showing the way forward to the next generation of orthopaedic medical breakthroughs. All along the way, the RNOH has been there, leading from the front.

Unique mix of academic and clinical activity Treatments at RNOH range from the most acute spinal injuries, bone tumours and complex joint reconstruction, to orthopaedic medicine and specialist rehabilitation for people with chronic back pain. They have an internationally unique mix of

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Clinical Services

Royal National Orthopaedic Hospital

academic and clinical activity linked to University College London and UCL P Academic Health Sciences Network – a world-leading university with clinical academics and engineers working alongside clinicians. This provides a ‘critical mass’ of expertise in one place, the clinical side and academic science components mutually supporting and complementing each other. The Trust is a national provider. 45 per cent of its patients live in London, 22 per cent are from the remainder of the south east and 31 per cent from further afield in the UK. 2 per cent are international. Its annual income of £121m comes from the NHS (£116m) and private sector (£5m). It employs over 1,300 staff (including 75 consultants) and treats 12,000 inpatients a year, with another 100,000 outpatient attendances. There are 217 beds, 10 operating theatres, 2 MRIs (plus one on the way) and two outpatient assessment centres – one in Central London and one in Stanmore.

The royal connection The RNOH also has an important royal connection. In 2002, when she was 12 years old, Princess Eugenie was diagnosed with scoliosis (curvature of the spine). Corrective surgery for her scoliosis was carried out at the RNOH and her abiding memories of the experience are happy ones: “… everyone there was so warm and friendly, and they went out of their way to make me feel comfortable and relaxed.” However, the RNOH does have one weakness: the poor quality of its estate and buildings. So it has agreed a plan with NHS for an overhaul of its site and the construction of new buildings. The 10-year redevelopment master plan was given planning permission with the local authority in March 2013. It covers improved site access road infrastructure, a new hospital ring road, a multistorey car park, and developing a main entrance

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ROB HURD Rob Hurd has been Chief Executive of the Royal National Orthopaedic Hospital since 2008, after being Finance Director for three years. He is leading the RNOH through a major multi-million pound redevelopment of the RNOH Stanmore campus that will provide new paediatric and adult inpatient wards. Rob previously worked as Deputy Finance Director at UCLH where he was finance lead for the wave 1 UCLH Foundation Trust application. He has experience of leading on the financial aspects of major capital developments and is also Chair of the Specialist Orthopaedic Alliance, a collaboration of major specialist orthopaedic centres, which has a membership of 15 specialist orthopaedic units from across the UK. Extending the knowledge and learning from the RNOH across the NHS, Rob Hurd jointly leads the NHS National Getting it Right First Time programme, which embraces clinical leadership to reduce unwarranted variations in clinical outcomes and hence improve patient experience and improve value for money. Rob and the RNOH are also integral to the Specialist Orthopaedic Alliance, an organisation of 15 leading orthopaedic centres acting as a primary source of support and expertise to the NHS and elsewhere on the provision of orthopaedic services.

to the hospital, academic centre and new NHS building. Site work is already under way and will be completed by 2018. The RNOH has put in place a three-year investment plan to eliminate high risk and significant backlog due to infrastructure, statutory compliance and their buildings’ internal and external physical condition.

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Royal National Orthopaedic Hospital

Clinical Services

Industry partnerships In addition to this, the trust has embarked on important industry partnerships. The Stanmore site is located next to the Centennial Park industrial estate with three manufacturing centres, including Stanmore Implants Worldwide – a spin off from RNOH clinicians and UCL and a global supplier of bespoke implants which piloted an accelerated approach to medical technology innovation, leading to major growth potential in implants. Partnership opportunities have enabled the trust to develop the Stanmore site to expand and improve facilities – planned for 2016-2018. This will lead to rehabilitation expansion and international packages of care: transport, international advocate service, access to multidisciplinary teams through investment in technology, international teaching and training partnerships. Phase 1 of the Stanmore site development begins in August 2016 with £40m of land sales' reinvestment for a UCL Bioengineering hub and new ward block. The funding has come from UCL investment (£15m), donated funds (£15m) and private sector investment (£40m). The new five story ward block will include: ● Adult Acute accommodation of 64 beds over two floors for patients undergoing procedures in theatres, followed by postoperative care and rehabilitation. ● A Children’s and Young Person’s ward of 27 beds for inpatients with complex conditions who may stay for extended periods of time. Treatment will include a mixture of therapy/rehabilitation, education and play and include an external children’s garden. ● Additional allowance for future expansion. ● A comprehensive facilities management department to manage linen, cleaning, catering and storage. ● Engineering Plant The UCL Bioengineering hub will provide purpose built accommodation and facilities for the existing UCL Division of Surgery staff at the Stanmore

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campus, together with UCL Faculty of Engineering teams, RNOH Research & Innovation and Histopathology. The ground floor will feature a public facing area including reception and café areas that flow through into the student breakout area to the rear, giving easy access to the seminar rooms and external breakout areas. There will also be consulting rooms, workshops, together with areas for storage and goods in/out. There will also be showers, WCs and lockers. The first floor accommodates the remainder of the student spaces, meaning that all student activity is maintained to the more public ground and first floors. Teaching labs will be located to the rear of the building and the student library hub will be at the front of the building. The first floor will include teaching and specialist labs, meeting rooms, offices and additional showers and WCs. The second and third floor will feature primary labs, specialist labs, offices and WCs.

Bright future Thanks to lessons already learned over the past 100 years by RNOH, executives are aware that any expansion of their spinal rehabilitation centre needs to be at scale to ensure support. It also needs to be clinically viable, have safety and clinical governance and be viable from a financial point of view. Planning permission is already in place, and options in the new building development space include the completion of Princess Eugenie House (due to be operational within 2-3 years) and new rehabilitation facilities (operational in 3-5 years). The future looks bright for RNOH – and its future UK and international patients. And no one could be happier about that than former patient, enthusiastic Patron of its Redevelopment Appeal, and namesake of the new state-of-the-art facility, Princess Eugenie.

Further information www.rnoh.nhs.uk

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Camden & Islington NHS FT

Safe haven Community based mental health services are key in delivering effective care for patients, says Wendy Wallace of Camden & Islington NHS Foundation Trust

ith the introduction of anti-psychotic medication in the 1980s, the treatment of patients with schizophrenia has moved from mental health institutions, or asylums, into the community. There is a much greater emphasis on patient recovery and movement towards independent living. This presents challenges to both healthcare providers and their staff who need a greater range of skills to develop appropriate care plans, co-ordinate care with other health and social care partners, and assess and manage risk. Camden and Islington (C&I) is an NHS provider which is proactive in developing community-based mental health services. We serve an area with some of the highest mental health need in the United Kingdom. This creates a working environment which values innovation by our clinical staff, who excel in delivering services with improved outcomes, better patient experience and increased productivity.

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Respect and dignity in a safe environment For many people, the concept of recovery is about staying in control of their life despite experiencing a mental health problem. It is a way of living a satisfying, hopeful and productive life even with the limitations caused by illness. Modern health services aim to help people with mental health problems look beyond mere survival and existence. They are encouraged to move forward, set new goals and develop relationships that give their life meaning and purpose. Mental illness and societal attitudes to mental illness often impose limits on people experiencing ill health. Health professionals, friends and families can be overly-protective or pessimistic about what someone with a mental health problem will be able to achieve. Services should emphasise that, whilst people may not have full control over their symptoms, they

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Clinical Services can have full control over their lives. Success is not about hiding problems, but supporting those with mental health illness to establish themselves in the community as independent people with abilities, interests and dreams. C&I successfully works with organisations to implement new models of care which embed the principles of recovery into services. This supports people and gives their lives more meaning.

Camden & Islington NHS FT

WENDY WALLACE

Building a multi-disciplinary approach to care When the UK moved patients from institutionalbased treatment to a recovery-oriented model in the community, staff saw patients in the context of their family, their work, their leisure pursuits and as members of the wider community. It became essential to work with the patient and their families to understand what was important to

Art sessions within recovery therapy are used by C&I therapists to help patients recognise and foster their abilities, interests and dreams

Wendy has more than 30 years NHS clinical and leadership experience. She was appointed CEO in December 2005 and led the Trust to Foundation status in early 2008. Prior to becoming CEO she was Director of Islington mental health services at C&I, where she led the opening of the Highgate Mental Health Centre, our flagship inpatient site. She was formerly an Assistant Director at London NHS Executive and a Director at Bromley Primary Care Trust.

them. Experience in the early years of communitybased delivery made it clear that both the psychological concerns and the social environment of the patient needed to be addressed. This required a wider range of skills than psychiatrists and nurses could provide, increasing the need for collaboration with a wider range of professionals, including occupational therapists, psychologists and social workers, as well as a range of highly skilled non-professionally qualified staff. Eventually, this led to the creation of multidisciplinary teams forming a central feature of virtually all forms of modern mental health care. The effectiveness of these teams in delivering improvements in care and patient experience is strongly influenced by the quality and extent of education, training and supervision. As staff skills increase, responsibility for determining the patient care can be shared across all professions in the team, leading to more flexible forms of service delivery, patient experience and increased productivity.

Delivering recovery in the community C&I predominantly delivers mental health services within the Central London districts of Camden and Islington. The local population contains a wide range of social groups, including wealthy celebrities, politicians and overseas visitors at one extreme and those residing in areas of extreme poverty at the other. There is a large and diverse immigrant population speaking more than 290 languages, and a large transient population of young adults. The area has some of the highest needs for mental health services within the United Kingdom, with a high prevalence of psychotic and non-psychotic mental health problems. We meet this need by delivering evidencebased services, based upon our own innovations and research. We are one of the few healthcare providers within the United Kingdom that was established as an integrated health and social care organisation, allowing us to maximise the benefits of multi-disciplinary teams. Over 40 per cent of our consultants hold joint academic posts and are engaged in research across a wide range of mental health areas. We are a lead provider for educational

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| Global Opportunity Healthcare 2016

Camden & Islington NHS FT

CASE STUDY CRISIS HOUSES IMPROVE PATIENT SATISFACTION The Daleham Gardens Recovery Centre provides a short-term residential alternative to hospital admission. The recovery centre includes three services under one roof – a six bedroom Crisis House, crisis and home treatment team and an acute day recovery programme. Typical users of the service are schizophrenic patients, of whom over 70 per cent have previously been inpatients. Patients can refer themselves, or be referred by a GP or carer, and can then be put in touch with other mental health services. The advantage of the crisis house is a significant reduction in length of stay. An average length of stay is three to four days compared with significantly longer in an inpatient setting. Patients respond well to the Crisis House commenting on the warm, friendly environment and the speed with which they are able to recover from a crisis and return home.

placements in north London and work in partnership with local universities to deliver both education and research projects as well as creating together the workforce of the future This provides a stimulating environment for our staff to innovate and deliver projects which transform care for patients. The Daleham Gardens Recover Centre is also home to one of C&I’s crisis teams. We created the second crisis team in the UK in 1999, and have led service evaluation research into the model of crisis and home treatment teams. Our innovation has led to a reduction in inpatient admissions, and has enabled us to treat 97 per cent of our patients in the community. Our service users find it a safe alternative to hospital and find it a more homely environment which they prefer. C&I and One Housing Group, a leading social housing provider in London, partnered to develop 15 units of high needs supported housing within the Kings Cross development in Central London. This collaboration brings together the housing and support capabilities of One Housing Group and the specialist clinical skills of C&I to deliver a high quality and cost effective service. The service has been very successful in providing a supportive environment close to patients’ families, with patients reducing their need for medication, increasing participation in the community and moving to more independent living more quickly. Young people with behavioural issues who enter into gang culture are challenging to engage. The

CASE STUDY MULTI-AGENCY APPROACH TO TACKLING GANGS Young people with behavioural issues who enter into gang culture are challenging to engage. The violent nature of gangs makes it a risky environment for staff and patients. C&I has developed a multi-agency approach designed to tackle gang activity. The approach engages with young people in the context of their antisocial peer group in an authentically youth-led way, with clinicians using cognitive behavioural therapy techniques with individuals and the gang in street settings. We also work with the services and authorities around them that impact their likelihood to change. The project is multi-agency, with police, local authority, employment and local mental health services. Feedback from local stakeholders is very positive, and police say there has been a reduction in gang-related crime in the area.

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violent nature of gangs makes it a risky environment for staff and patients. C&I has developed a multiagency approach designed to tackle gang activity. The approach engages with young people in the context of their antisocial peer group in an authentically youth-led way, with clinicians using cognitive behavioural therapy techniques with individuals and the gang in street settings. We also work with the services and authorities around them that impact their likelihood to change. The project is multi-agency, with police, local authority, employment and local mental health services. Feedback from local stakeholders is very positive, and police say there has been a reduction in gang-related crime in the area.

Evidence based services Providing an evidence base for services is a fundamental part of C&I’s approach to service development. We have a strategic alliance with the division of Brain Science in University College London and support clinical academics, drawn from medical, nursing and social care backgrounds, who are leading mental health research both nationally and internationally. During 2014 we hosted 48 studies and our staff published 116 articles in

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Clinical Services

peer-reviewed journals. We are also among the first mental health trusts in England to develop nursing research capacity successfully with a joint deputy director of nursing post in research and development. This staff member leads programme grants as well as recruiting nurses to take part in a range of programmes to build their skills, while at the same time growing C&Iâ&#x20AC;&#x2122;s research and innovation capacity.

Working with international partners to develop mental health services Over the last 30 years C&I has been proactive in developing community-based mental health services. We continue to seek out new innovations to improve patient outcomes, patient experience and opportunities to increase productivity. Our staff are working on projects with providers and educational institutions in other countries to help them transition to community-based mental health services.

Further information

Camden & Islington NHS FT

CASE STUDY HIGH NEEDS ACCOMMODATION Finding accommodation for patients when they leave hospital can be difficult, especially for patients with high needs such as those with a forensic history and challenging behaviours. Private sector housing providers are often unwilling to take these patients as the risk associated with them is too high for them to manage safely. C&I and One Housing Group, a leading social housing provider in London, partnered to develop 15 units of high needs supported housing within the Kings Cross development in Central London. This collaboration brings together the housing and support capabilities of One Housing Group and the specialist clinical skills of C&I to deliver a high quality and cost effective service. The service has been very successful in providing a supportive environment close to patientsâ&#x20AC;&#x2122; families, with patients reducing their need for medication, increasing participation in the community and moving to more independent living more quickly.

If you are interested in this article and would like to find out more then please contact communications@candi.nhs.uk

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Chelsea and Westminster Hospital

helsea and Westminster Hospital is the only hospital providing inpatient burn care as part of the national burns network in London and, together with burns services at East Grinstead and Chelmsford, forms the London and South East England Burns Network, which serves a population of 20 million people. The service has a strong regional, national and international reputation for expert clinical treatment, compassionate care and research. Each year the burns service at Chelsea and Westminster treats over 600 new inpatients and 3,000 new outpatients for burns. Each patient requires specialist followup care, often including further surgery, extensive dressing care and on-going therapy support. The burns service has been established since 2001 when it transferred from Queen Maryâ&#x20AC;&#x2122;s Hospital in Roehampton, one of the founding units for burns care. It has a long established history on which they have built the state-of-the-art department in which patients are cared for today. The success of the service is based on strong working relationships within their multidisciplinary team. The burns multidisciplinary team includes dedicated burns consultants, intensive care specialists, anaesthetists, specialist nurses, occupational and physical therapists, psychologists, pharmacist, dietitians and a social support team. The team also call upon the acute services within the Trust, such as pain, acute medicine, surgery and elderly medicine, when needed. In addition there is a burns outreach service for dressings and therapies, and a burn care advisor to co-ordinate education and support for other hospitals in the network. This dedicated burns team aims to meet all of the physical and psychological needs of patients with burns. The adult burns unit reopened in 2014 after

Acute care to after care - the complete burns service Chelsea and Westminster Burns Unit offers a state-of-the-art burns service with capabilities across the whole patient journey

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Clinical Services

Chelsea and Westminster Hospital

Left: Burns Medical Equipment Above: Burns Reception

The patient journey Admission As the specialist regional centre for burns in London and the South East of England, patients are admitted following referral from their GP, local A&E or directly via the trauma services. Surgery Surgery is required when the burns are deeper and do not have the capacity to heal well from the undamaged skin underlying the burned area. The majority of our inpatients require surgery for their burns, as far as possible we manage all burns dressings either in the dressing clinic or as a daycase admission to the ward if the area affected is more extensive and painful.

extensive refurbishment, following on from the opening of a separate dedicated paediatric ward, with increased space made available to ensure all burns care is co-located and meets the national burn care standards. In the new adult unit there are two intensive care beds, two high dependency beds, nine ward beds and three day care beds. All surgery, dressings and therapies take place within the unit at Chelsea and Westminster Hospital.

What the new unit has meant for the burns service What the investment has meant for the service: l Third more space for the unit l Two purpose built, dedicated intensive care rooms l Theatre size increased by 30 per cent l New bay of beds dedicated to surgery patients, closer to theatres l Special rooms built for ventilated patients l Gym on the unit for rehabilitation

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Intensive care If the patient has suffered an inhalation injury from smoke at the time of the fire, or if the area of the burn is extensive intensive care support is required with ventilator support and invasive monitoring. This is also the case for patients with less severe burns but significant co-morbidities. Occupational and physiotherapy The therapists aims to reduce the long term disability from a burn injury, and the need for further reconstructive plastic surgery, ensuring they maximise the physical and functional recovery for the individual. This team provides intervention to patients with a wide variety of burns and plastic surgery conditions and often continue rehabilitation for years after a burn injury is sustained. The therapy team works closely with nursing and medical staff and are actively involved right from presentation to the service with early intervention and rehabilitation of patients, ensuring that impairments are reduced whilst physical and functional outcomes are optimised. An extensive range of treatment techniques are

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used by the team including splinting and positioning, exercises, stretches, massage, restoring the ability to undertake activities of daily living, respiratory physiotherapy, hydrotherapy, pressure garments, scar management, education and advice. Two pressure garment technicians work closely with therapists to make, alter and adjust pressure garments for all adult and paediatric patients who require them as part of their ongoing scar management. The team provides services to all adult and paediatric patients under the burns consultants. The patients are seen on the burns intensive care unit, burns wards, general wards, day surgery and even in their homes following discharge through the outreach service.

Chelsea and Westminster Hospital

Clinical Services

Psychological therapy Chelsea and Westminster Hospital is able to provide all inpatients with burns psychological screening to ensure all patients with severe burns receive psychological rehabilitation if required - something that was not previously available. This is thanks to unique funding by the hospital charity CW+. The charity raised the initial ÂŁ100,000 needed to fund

Interview with Isabel Jones, Clinical Lead for Burns and Surgeon specialising in plastics and burns What makes the burns service at Chelsea and Westminster special? The staff and the new unit together make Chelsea and Westminster a very special service. We now have a purpose built department which meets the national standards and is co-located with everything we need in one place, including the paediatrics burns service, our own burns theatres and dressing clinic. We also have a very dedicated team who are extremely committed to the service. They are all extremely dynamic with a vision for the future of burns care and are continually moving forward. They are a great team with a great ethos of hard work and they always go the extra mile. The team are always striving to improve outcomes. We are committed to research and are very well supported by Imperial College and The Magill Department of Anaesthesia, Intensive Care & Pain Management. We are producing a lot of original work and have recently had a clinical fellow awarded to us. We are able

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Chelsea and Westminster Hospital a clinical psychologist for two years, a service which is now supported by the Trust full-time. Through the screening programme we identify potential psychological issues, address them early and help patients with their emotional as well as physical recovery. In addition any outpatients who have adverse psychological outcomes following their burns are also seen by the psychologists. The service also provides psychosocial assessments for all parents of children admitted with burns. After support All patients with scarring following their burns are seen in the consultant outpatient clinic to ensure their therapy needs are met , and are offered ongoing reconstructive surgery.

Further information If you would like to know more about the service offered by our burns team please contact the general manager for burns on 020 3315 8851. www.chelwest.nhs.uk/burns

to improve services for burns patients through our research work. What specialist skills does your team have? Within the team we have a specialist team of surgeons, intensivists, anaesthetists, nurses and multidisciplinary staff all dedicated to burns, plus a wider hospital team to support us. The burns specialists are not only on the ward, there are outreach nurses and burns care advisors. The nurses on the paediatric and adult unit, therapists and psychologists are all specifically trained for burns care. We also benefit from pharmacists and dieticians dedicated to burns patients as well. We rely on the pain team a lot and are supported by medical and surgical teams within the Trust. What does the new unit mean for patient care? From the patient perspective , coming into a dedicated area that is clean, light and modern really helps to create a positive experience at what can be an extremely difficult time. Patients receive a holistic approach to care with everything in the same place with the same staff. The setup is compact but it has also enabled us to install measures to help with infection control. The new unit also means that we now have day care co-located, which is essential for the way burns care has evolved, to care for short term patients.

A dedicated burns high dependency unit makes a huge difference for patients. We also have a space for families and a confidential room for psychology care. How did you design the new burns unit? We had a look at the previous unit and the national standards and then worked within space available in the hospital. There was a diverse project team, led by estates, with representatives from all areas of the burns team, who came up with a design that did not miss any aspects of care. There had been many previous designs over the years using various architects. The principles from the different designs were distilled down over many years and applied to create the unit we have today. The final design stage took just three months and the build took eight months. What have you learnt from opening a new unit? The biggest challenge was infection control for such a vulnerable group of patients. Keeping the builders to their timeline was also a challenge! I have also learnt to never underestimate the attention to detail you need to apply during the design and build phase as I was surprised by how many small issues came up once we moved in. However, it is all worth it as we have an amazing unit that I am very proud of.

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Clinical Services

Mersey Care NHS Trust Mersy Care NHS Trust

A leading light in mental health care Mersey Care NHS Trust is leading the way in mental health care in the UK and overseas. says Dr Joe Raﬀerty, Chief Executive, Mersey Care

ased in the vibrant and culturally diverse city of Liverpool, Mersey Care is a leading UK mental health NHS Trust with an international reputation. It provides health care for people with mental health problems, and looks after those with a learning disability, acquired brain injury, or addiction issues. Some of the Trust’s biggest strengths are the pioneering attitude of their leaders, the quality of its diverse range of services, and the unstinting dedication and real enthusiasm among staff to build on their high standards.

Striving for perfection This dedication is reflected in their commitment to develop a zero suicide policy within their care by 2020 – the first UK mental health trust to do so. They have also developed a Centre for Perfect Care and Wellbeing, whose mission is to help their staff continuously improve the services they provide, while addressing the mental health and wellbeing challenges of the future.

The Trust encourages staff to innovate in ways that create better quality and outcomes for the people they serve, while reducing costs. They also, through their pioneering ‘No Force First’ initiative, have one of the lowest rates of restrictive and face-down restraint. This last achievement is one the Trust is particularly proud of. While some providers of mental health care use force as a main method of managing patients, they are determined that it should not be the first option, and have had international recognition for this. As Ed Coffey, Professor of Psychiatry and Neurology, Wayne State University School of Medicine, USA, says of Mersey Care: “[It is] using the notion of pursuing perfection to transform the way it provides healthcare. To change from a ‘business as usual’ type of model to a totally different way of working. I think Mersey Care is leading the world in its efforts to eliminate the need for seclusion and restraint – the ‘No Force First’ programme is a benchmark for everyone else.”

Sharing innovation worldwide Mersey Care has a well-established reputation for sharing good practice and innovation at home and overseas. Their online distance learning programme in Somalia is improving the quality and diagnosis

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Mersey Care NHS Trust

Clinical Services of mental health and improving local knowledge and expertise. They are also advising the Turkish Government on the development of a secure services strategy, and are a partner in a £5.4 m Innovate Dementia project developed with partners from the UK, Netherlands, Belgium and Germany. Recovery is at the heart of everything the Trust does. Their Recovery College helps patients to discover and accept who they are, learn life-skills and relate to others in healthier and happier ways – as opposed to simply living with a mental illness. The Trust’s streamlined assessment for admission and discharge also means patients experience very responsive yet efficient care As a result, they have very short lengths of stay; average high secure stay in their care has fallen from over seven years to around five and a half years, and they have similar figures for medium secure stays, with no increased risk of re-offending. (Mersey Care is one of only three organisations to provide high, medium and low secure services nationally – they have unrivalled expertise in providing these and offender health services for patients detained under the Mental Health Act and requiring care in conditions of varying levels of security.) Mersey Care also has expertise in both designing new and preserving and transforming historic buildings so they are fit for the future. Their £25m Clock View Hospital, co-designed with service users and carers, has boosted the economy and acted as a catalyst for growth.

Mersey Care NHS Trust

DR JOE RAFFERTY One of the UK’s most influential health chiefs and named in the Health Service Journal’s top 20 of NHS chief executives. Dr Rafferty has championed patient care including using methods other than restraint for people with mental health problems. He leads our drive for zero suicide among people in our care. Dr Rafferty was previously Director of Commissioning Support at the NHS Commissioning Board, with national responsibility for the design and delivery of the commissioning reforms outlined in the Government White Paper: Liberating the NHS. Before joining the NHS, he had a successful career in cancer research specialising in gene therapy to overcome tumour drug resistance. In this role he published around 55 academic papers and two patents.

including cognitive and psychological/behavioural rehabilitation. Neuropsychiatry and neuropsychology

Assessments and treatments to trauma patients that results in complex mental health problems such as depression, anxiety, psychosis, or adjustment reactions. Early intervention in psychosis

The Trust supports young people who are thought to be experiencing or at risk of developing psychosis. Sex offender service

Some of the services the Trust provides include:

Assessment and interventions for adults considered a sexual risk to children. Group and individual therapy programmes are provided by their highlyspecialised team.

Addictions service

Psychiatric intensive care

Specialist community, inpatient substance (drug and alcohol) detoxification programmes are offered to people with the most complex problems, with a recovery-focused approach to care planning and delivery.

The Trust cares for patients with acute mental health issues who may cause distress or risk to themselves or others.

A broad range of services

Memory and dementia services

Community and hospital-based memory services offer specialist assessment, medication, post diagnostic support, peer support groups and courses for carers. Eating disorders service

The Trust offers specialist assessment, psychoeducation and psychological outpatient therapy to men and women aged 16 and over. Learning Disabilities

The Trust has specialised inpatient and community services for people with learning disabilities and complex needs (including forensic needs). Brain injury and trauma rehabilitation

The first NHS organisation to receive approved provider status by the national brain injury association, it offers assessment, treatment and care for people with an acquired brain injury,

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Psychological therapy services

Evidence-based talking therapies providing assessment and treatment for common mental health issues. Dr Feelwell health and wellbeing programme

This is a new programme of work to promote physical health and wellbeing among people with mental health issues. Community engagement

The Trust works with communities from different ethnic and religious heritages to support them in identifying the needs early, so that they can access the right services in a timely manner.

Further information Please contact Lefteris Zabatis, 0151 471 2257 or Lefteris.Zabatis@merseycare.nhs.uk. www.merseycare.nhs.uk

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Imperial College Healthcare NHS Trust

| Kerensa Heffron, Director of Private Healthcare at Imperial College Healthcare NHS Trust reveals the depth of services the Trust offers and the huge benefits a thriving private patient business offers to an NHS Trust

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Imperial College Healthcare NHS Trust DR KERENSA HEFFRON Kerensa is responsible for the overall management of Imperial Private Healthcare. As well as being accountable for the operational and business management of our dedicated private units, she is also responsible for the ongoing development of our portfolio of services and the quality of care that we offer. After spending two years as a management consultant in the city, Kerensa moved into NHS management where she has worked for 11 years. Most recently she spent five years as the director of private practice at the Royal Marsden, which has the largest private practice of any NHS trust. She moved to Imperial Private Healthcare in 2014, having been impressed by the breadth of service and clinical expertise offered here, and by our hospital’s ability to support even the most acutely unwell patients.

Tell us a little about Imperial College Healthcare NHS Trust and your private offering?

Imperial College Healthcare is a large trust. It comprises five different hospitals: St Mary’s Hospital at Paddington, Charing Cross Hospital, Hammersmith Hospital, Queen Charlotte’s & Chelsea Hospital, and also the Western Eye Hospital, so it’s quite a large organisation. Within that we have dedicated private healthcare provision: we have separate private facilities on the three main sites and also small facilities at Queen Charlotte’s & Chelsea Hospital and the Western Eye Hospital, so across that whole portfolio we’re able to cover a huge range of clinical services to quite a depth of specialism.

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The services we offer reflect the main specialisms of the NHS services on that site, because the consultants prefer to work close to their NHS services where they have the right specialist infrastructure. Hammersmith Hospital is a major centre for cardiac, renal, hepatobiliary, oncology, gynaecology and maternity services. At Charing Cross we focus on complex surgery, including neurosurgery, neurology, and oncology services. At St Mary’s Hospital we are a major trauma centre so we specialise in acute medicine and surgery including trauma and orthopaedics, plastics, and general surgery, and we also offer most general medical specialities as well as a range of paediatric services. St Mary’s is also well-known for obstetrics and gynaecology for both NHS and private patients. Our private facility at St Mary’s is the Lindo Wing, which is particularly well-known for private maternity, but that’s less than half of what we do in that facility – we provide a lot of general surgical and medical services as well. How much of your private work is for international patients?

International work comprises at least a quarter of the hospital’s overall work, and international patients are at least a £10m business for us. Most of our international patients at the moment come from the Middle East, and that’s probably true for London as a whole. We also get patients from China, Russia, other parts of the Far East, India, Europe and North America.

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Why do international patients decide to come to you?

Our component hospitals have big reputations overseas because they’re training hospitals and also very active in clinical research. There are many clinicians abroad who have trained at one or more Imperial site, or who know of Imperial through the pioneering work of our clinical teams. There’s a long history behind our trust. For instance, penicillin was discovered at St Mary’s in 1928; the world’s first heart-lung machine was used during heart surgery at Hammersmith Hospital in 1957 and in 2013, robotic surgery was used at St Mary’s in a world first to remove fibroids. People engage with our reputation at different levels: at clinician level they’ll be aware of our clinical services, including trials and research. Patients will be more aware of the hospitals themselves, for example at St Mary’s Hospital they may have heard of the Lindo Wing, and of our reputation for maternity services. Those services have a high public profile because of some of the famous people who have delivered with us, including the recent births of Prince George and Princess Charlotte of Cambridge. A number of international patients also come through established referral streams, often driven by doctor-to-doctor relationships. For instance, we get quite a lot of patients coming for paediatric haematology through that route because our clinical team, and one clinician in particular, has established links with important treatment centres in the Middle

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East. We also receive referrals from other trusts for those sort of very specialist services. In addition to all of this, we have built good relationships with many of the embassies in the UK and we have a dedicated international patient team to support both patients and the embassies through their treatment with us. We keep embassy staff up-to-date with innovation and new services within Imperial Private Healthcare by providing a quarterly magazine and providing up- to-date information on our clinicians through our annual consultant directory, which are both available on our website. Investing in these relationships has meant that we are seeing more overseas patients through these routes as well. How significant is the NHS brand to your success as a provider of private care to overseas patients?

Being part of the NHS works in our favour as the NHS is hugely respected overseas. People regard it as a highly organised healthcare system with some challenges certainly, but one that has excellent medical education, strong research activity and outputs, and a commitment to patient care that people understand and can really get behind. Working inside the NHS, you can see how impressive and complex it is and, while it has its flaws, the system is immensely powerful. That’s recognised overseas: the number of approaches we get from overseas providers to ask about service organisation and requesting department or speciality visits is incredible.

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Imperial College Healthcare NHS Trust

Private Healthcare

Are there benefits to UK NHS patients from a trust like Imperial providing private healthcare to overseas patients?

As an NHS Trust, we provide services to the NHS as our primary function, but we have separate, ringfenced facilities for the private sector, whether that patient is a UK-insured patient, a UK-self-pay patient, an overseas patient; it doesn’t matter. What matters to us is that we are providing an excellent clinical service, one that is valuable to the patient, and we’re providing it at a tariff that allows us to make a contribution back into the NHS. A major reason that an NHS provider does any commercial or private services is to support its NHS services. There are other advantages, aside from the financial. Consultants spend the majority of their working lives in their NHS hospital, but still make time for their private work. If a consultant chooses to undertake their private practice at one of our private facilities then they’re still on-site even when not working under their NHS contracts, and if their NHS patients need them or if their registrar needs to ring them then they’re much more accessible. Likewise, for our private patients, it means that their consultant is likely to be close by for the majority of their working hours. This is much more reassuring for our patients than in situations where the consultant might be based remotely. Being able to offer our consultants the ability to do their private practice on-site is a huge bonus in terms of recruitment and retention. It also means that

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they continue to have access to their wider expert team for both their NHS and private work. Ultimately it benefits both parties in a way that’s more than the sum of its parts and more than just about the financial side of private practice. And how do you see the future of private care at Imperial?

There are huge opportunities for Imperial Private Healthcare in the future; an opportunity for us to grow our market share in London, and perhaps working with others to grow the London market and increase the amount of inbound work that we win. As a trust we are looking at our clinical strategy and how that will develop. We are currently planning the rebuild our NHS estate and we are looking to plan in expanded private capacity alongside the NHS facilities where required, so it fits naturally with our NHS services. We’re looking to grow our private practice and make an increasing contribution to our NHS practice through private healthcare. We have a huge cadre of excellent consultants and some wonderful nurses and allied health professionals, who are another big part of why people come to Imperial. We have so much to offer and that that gives us a huge opportunity to grow in the future.

Further information www.imperialprivatehealthcare.co.uk

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Harley Street Medical Area

Harley Street Medical Area’s world-class medical services are unparalleled and can be accessed with walking distance of each other in the heart of Central London

Streets ahead H

arley Street’s prestigious name and outstanding reputation may be known worldwide, but it is so much more than a singular street with a rich and colourful history. Nestled between the thriving retail bustle of London’s infamous Oxford Street and the serene contrast of Regent’s Park, is the beating heart of the capital’s resplendent medical offering; the extensive Harley Street Medical Area, a hub of healthcare excellence where no stone is left unturned. The area’s world-class medical services are unparalleled, not only in terms of the quality of care but in the high concentration of clinicians and services situated in one tight-knit community. Housed on one of London’s historic Great Estates - the Howard de Walden Estate - over 2,000 practitioners, clinics and hospitals bring their skills to the fold, and their strength is ever growing as the area continues to develop. With what’s considered to be one of the capital’s most forward-thinking landlords, the Estate has

‘From a professional’s point of view, a post at one of the Harley Street Medical Area’s esteemed clinics is the chance to work alongside some of the world’s greatest minds.’

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a long term strategy for improving and promoting the medical sector, actively working to enhance the mix of facilities and services in the area by identifying any gaps in the current base of tenants, and seeking those who are most respected in their medical fields to join them. Even in excellence, there is room for improvement, and the Estate has invested heavily in providing state of the art facilities to attract the high calibre of practitioners it desires and is currently working with an existing, well respected operator to establish a medical concierge service. The concierge service will assist patients with everything from deciphering the best treatment for their needs to finding the right travel and accommodation for their stay. The Estate also hopes to see its new Proton Beam Therapy Unit open in 2017. It’s perhaps hard to see where the gaps may be in such a comprehensive list of care on offer; a complex mix of medical specialisms, with the best in eye surgery neighbouring life-changing lung cancer treatment, esteemed dentists a stone’s throw from leading IVF experts, specialist paediatric intensive care to first class neurosurgeons. What began with a handful of medics arriving in the mid-19th century is now a network of the clinical elite; pioneering practitioners from all over the world have followed their peers to Marylebone to create a cluster of accessible health services that cannot be found elsewhere. The well-regarded group of facilities include several larger hospitals, such as the London Clinic, the Princess Grace, the King Edward VII, the Harley Street Clinic and the Portland Hospital – which allow patients to experience everything from MRI scans to nuclear medicine should they require it.

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Private Healthcare Harley Street Medical Area

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‘The well-regarded group of facilities include several larger hospitals, too, such as the London Clinic, the Princess Grace, the King Edward VII, the Harley Street Clinic and the Portland Hospital.’

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From a professional’s point of view, a post at one of the Harley Street Medical Area’s esteemed clinics is the chance to work alongside some of the world’s greatest minds; as a patient, you’re safe in the knowledge that should you need additional care, it’s but a moment away, taking the stress and delays away from your treatment. What’s more, related experts have flocked to the area to capitalise on and complement the district’s reputation, with physiotherapists, masseurs, fitness trainers and nutritionists setting up a practice to provide further care for visitors and patients. To choose Harley Street Medical Area is to choose the chance of a 360˚ approach to health care, with varied treatments and disciplines at your fingertips. This presence of some of the world’s very best doctors and clinicians has not gone unnoticed by the medical industry, either; a number of significant medical societies and institutes have positioned themselves in Marylebone to allow the Harley Street Medical Area’s team of talented experts to continue to learn and grow. The Royal Society of Medicine, Royal College of Nursing, Academy of Medical Sciences and the British Dental Association are just some of the houses of knowledge that share the streets of the Estate, offering lectures and social events to ensure the community is ever improving and at the forefront of modern medicine. Of course, it’s not all about stethoscopes and surgical gloves; as well as cutting edge facilities and first-rate care, Marylebone Village has plenty of impressive amenities to offer. Easy to navigate, the streets are very distinctive and in stark contrast to the expansive department stores of nearby

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Private Healthcare

‘If the UK’s proudest accomplishment is its accessible healthcare, the Harley Street Medical Area is certainly its ﬁnest asset and the epitome of that ever so important accessibility.’ Oxford Street, it houses many small, independent boutiques and shops within its charming period buildings. The quaint yet cosmopolitan locale is host to everything from small, family-run cafes to Michelin-starred restaurants, while the accommodation options mirror this diversity thanks to a plethora of guest houses, boutique hotels, apartments and five-star establishments such as the Langham and The Marylebone a few steps away. Need some R&R? The local parks are ideal for a spot of exercise or simply a breath of fresh air away from the hustle and bustle of central London’s noise, while some of the city’s most notable landmarks are just around the corner;

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Harley Street Medical Area

from the majestic Buckingham Palace to the galleries of Trafalgar Square, to Theatre Land in the West End. Should you need to travel elsewhere or escape the city, the Harley Street Medical Area could not be better connected. Eight mainline stations lay within 2.5km of the district, including St Pancras International for the Eurostar, Victoria for easy access to Gatwick Airport and Paddington for Heathrow Airport. Five underground stations are within walking distance, making exploring the rest of London a pleasure. The Harley Street Medical Area is, therefore, truly well connected in every possible sense of the word. If the UK’s proudest accomplishment is its accessible healthcare, the Harley Street Medical Area is certainly its finest asset and the epitome of that ever so important accessibility; a dense, expert-led village of medical maestros, working with each other to give the best possible care, and all on the world’s doorstep. So watch this space, or indeed this postcode; who knows what the next century will bring to the table of London’s number one health haven?

Further information www.harleystreetmedicalarea.com www.hdwe.co.uk

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Aspen Healthcare

Aspen Healthcare operates nine facilities in the United Kingdom, including four acute hospitals, two cancer centres, three day surgery hospitals, and has an impressive record in treatment and care for patients with cancer, says Michelle Martin, Development Director

First-class cancer care A spen Healthcare’s facilities cover a wide range of specialties and healthcare services for individuals seeking treatment overseas in the United Kingdom with particular focus in major cities such as London, Sheffield and Leeds. Aspen Healthcare’s portfolios of facilities within London include Parkside Hospital and the dedicated oncology clinic, Cancer Centre London, both in Wimbledon; Highgate Private Hospital in north London; and Holly House Private Hospital in Buckhurst Hill. Their Claremont Private Hospital in Sheffield and Nova Healthcare based in the Leeds Cancer Centre can provide care provision for patients travelling to this region of the United Kingdom for care.

technology, and is used in managing a range of cancers in the head and neck, lung, gastro-intestinal system, breast and prostate. The technology also facilitates the use of stereotactic radiotherapy (focussed high-dose radiotherapy treatment) for primary tumours or small deposits of secondary disease in bone, brain and other organs. This technology has the ability to continually reshape the radiation beam to the fine contours of the tumour so an extremely precise, higher dose of radiation can be delivered thereby reducing treatment times and preserving healthy tissue. This machine has been described by Aspen Healthcare CEO, Des Shiels, as “the cutting edge of the most recent technology in the provision of radiotherapy.”

Pioneering technology and techniques, reducing longer term health risks

Breast Cancer treatment advances

The United Kingdom is renowned for its prevalence of ground-breaking techniques with a number of medical consultants continuing to pioneer new technology. In 2014 Aspen’s Cancer Centre London (Wimbledon) became the first private hospital in London to provide targeted radiotherapy with the Elekta Versa HD linear accelerator system. This system is the latest advancement in radiotherapy

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More women are now surviving breast cancer - so much so that new methods of reducing the longterm effects of radiotherapy treatment are now being introduced, using machines such as this at Aspen’s Cancer Centre London. Despite an increasing number of cases over the last 30 years, UK deaths from breast cancer have fallen as a result of earlier detection and improved treatment. However, with survivors living longer the long-term effects of radiotherapy treatment are of increasing concern with survivors having up to a one per cent higher risk than average of cardiovascular disease. Dr Anna Kirby, clinical oncologist at the Cancer Centre London says: “There are currently 500,000 breast cancer survivors in the UK. Therefore, even a one per cent cardiac mortality affects thousands of

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Private Healthcare

women.â&#x20AC;? By 2040 there are forecast to be 1.7 million UK breast cancer survivors with radiation-related heart disease deaths likely to increase as a result. The problem is that radiotherapy for breast cancer commonly also irradiates the left anterior descending coronary artery resulting in an increased risk of heart disease. While improvements in radiotherapy techniques, including heart shielding methods, have reduced non- breast cancer deaths among survivors over the last three to four decades, research shows that rates of major coronary events rise with increased radiation doses to the heart. Now new radiotherapy technology and methods are developing that may help reduce deaths from

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Aspen Healthcare

radiation- related heart disease. The most important development is the use of breath-holding techniques. When a patient holds their breath, the heart is pulled backwards and downwards away from the left breast and chest wall area thereby minimising the dose of radiation to the heart and therefore the risk of late radiation-induced heart disease. There are a number of ways to achieve â&#x20AC;&#x2DC;breath-holdâ&#x20AC;&#x2122; but one technique makes use of an active-breathing- controlled device which maintains patients in a breath- hold during radiation treatment. Furthermore, new Versa HD technology, developed by medical technology company Elekta and installed last year at the Cancer Centre London continually reshapes the radiation beam to the fine contours of the tumour and/or

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breast tissue so that radiation can be delivered more accurately and quickly while simultaneously minimising damage to healthy surrounding tissue. This is particularly useful in women requiring lymph node radiotherapy as part of their breast cancer treatment. “Using heart-sparing radiotherapy methods including the breath-holding technique approximately halves the radiation dose to the heart,” says Dr Kirby. “Assuming there are 1.7 million UK breast cancer survivors in 2040, reducing the mean heart radiation dose (Gy) from 3 to 1Gy could be expected to reduce the number of radiation-related acute coronary events in this population from around 19,500 to 6,000 and the number of deaths from ischaemic heart disease from around 9,000 to 2,000.” She concludes: “The use of heart-sparing breast radiotherapy techniques is likely to significantly reduce the incidence of radiation-related cardiovascular disease in survivors of breast cancer.”

Brain cancer treatment advances The Leeds Gamma Knife Centre, part of Nova Healthcare, is based in one of the largest and most technically advanced cancer treatment centres in Europe (the Leeds Cancer Centre). Gamma Knife® Surgery (Stereotactic radiosurgery) is a non-invasive technique that has been proven effective in a wide variety of conditions including brain tumours and arteriovenous malformations. In late 2015, the Gamma Knife Perfexion® was enhanced by the addition of Elekta’s new Icon system meaning the most precise radiosurgery available can be delivered. With stereotactic imaging, online Adaptive DoseControlTM, ultra-precise dose delivery and the availability of frameless treatments, Icon is capable of treating virtually any target in the brain, regardless of type, location or volume. As the procedure is noninvasive there is no incision, no pain, and in most cases, no hospitalisation.

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Outstanding customer service While the concepts of quality and comprehensive healthcare are undeniably essential to any patient, the importance of exceptional customer service for the travelling patient cannot be underestimated. In addition to our first-class medical facilities, Aspen Healthcare private hospitals and clinics also offer first-class patient services. These include a concierge service provided by International Patient Coordinators, who may assist overseas patient with anything from arranging travel to and from the hospital to navigating the healthcare services they require. Not only having access to our interpreting services, our multi lingual patient coordinators are also familiar with healthcare services in general, the consultants and nurses as well as any cultural considerations that may need to be taken to ensure a smooth and stress-free stay. International patients are offered the support of having their UK-based consultant liaise and communicate with their medical team in their home country to ensuring consistent and continuous care regardless of location. Quality private healthcare provision is a process of constant evolution and improvement. Aspen Healthcare not only focuses on constantly improving the clinical offering, but also our hospital and clinic infrastructure. We have learnt that investing in all areas, especially in quality, is essential when it comes to patient satisfaction. Through substantial capital investment in our existing facilities, we are able to offer our patients the best clinical care, in comfortable, safe and world-class facilities.

Further information Tel: +44(0) 208 971 8013 Email: info@aspenlondonhospitals.co.uk www.london.aspen-healthcare.co.uk/contact-us/ treatment-in-uk

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HCA International

London calling Some of the best hospitals in the world covering all types of treatment can be found in London, which makes it a destination of choice for thousands of overseas patients, says Khadija Mouhajer, Director of International Business and Relations at HCA International 116

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s a recognised global centre of excellence, HCA International operates six worldrenowned hospitals as well as a range of outpatient and diagnostic centres in and around central London, offering world-class treatment to patients both from the UK and overseas. The hospitals include The Harley Street Clinic, The Lister Hospital, London Bridge Hospital, The Portland Hospital, The Princess Grace Hospital, The Wellington Hospital, The London Oncology Centre and The Sarah Cannon Research Institute. Part of Hospital Corporation of America (HCA), HCA International continues to lead in the field of pioneering treatments and innovations into the 21st century, offering patients not only the best treatment and outcomes, but also the best overall service for patients, in the knowledge that it must maintain the highest standards and best quality of care every day of the year. HCA International has once again been honoured by winning one of the highest awards for British business: the Queen’s Award for Enterprise in International Trade in 2014. HCA was chosen for outstanding achievement in investment and growth of overseas business. HCA International previously won the Queen’s Award for Enterprise in International Trade in 2004 and again in 2009 and will hold the 2014’s Award until 2019. HCA International also won the IMTJ Medical Travel Awards for 2014 as the Specialist International Patient Centre and in 2015, The Wellington Hospital’s Acute Neurological Rehabilitation Unit was chosen as the Specialist International Patient Centre. “Most of our overseas patients are sponsored by their governments and each case is managed by the medical health offices based in London; these countries are Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and United Arab Emirates,” says Khadija Mouhajer, Director of International Business & Relations at HCA International. “In addition, we also welcome patients from all over the world mainly Greece, China, Ghana, Nigeria, Pakistan, Russia etc.” Currently in the Middle East, there is a massive drive towards improving healthcare and education, including building more hospitals, outpatient and diagnostic centres and medical research centres. Khadija explains how the Middle Eastern patients sponsored by their embassies are assessed for treatment. Once they have been diagnosed, a medical committee in the country of origin will decide if the treatment is available in their own country or whether the patient needs to be sent abroad for further investigations and treatment. Each medical committee may have preferences over certain countries and hospitals such as ones in the UK, Germany, USA, and recently in Singapore and South Korea.

Patient assessment Once a patient’s file has been sent to the UK, the chosen hospital (which is based on the required treatment and consultant’s expertise) is contacted

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HCA International

KHADIJA MOUHAJER Khadija is a senior executive with extensive international experience in the healthcare industry. She is HCA International’s Director of Business and International Relations, with responsibility for all operational and strategic development and relations in the international markets. Khadija’s healthcare career spans over 19 years in both the public and private sector and includes all aspects of hospital management, international business development, medical tourism and business revenue growth and expansion. Khadija’s leadership has significantly grown the international market for overseas patients into HCA hospitals to 25 per cent of total business and contributed to the London economy through medical tourism.

to make the necessary arrangements. Many of our consultants also hold senior positions in leading NHS teaching hospitals, thereby ensuring their patients have a quicker access to the latest diagnostic and treatment technologies in the private sector, says Khadija. Within HCA International, majority of the overseas referrals are sent to our international team to assist in managing the patient’s appointments/admissions etc. and to continue to support the patient and their relatives from the moment they arrive into the UK to the moment that they are discharged back home. HCA International has established and continues to maintain good working relationships with many of the overseas health authorities. “I have regular meetings with International Ministers of Health and their teams who are part of the Overseas Medical Committees” says Khadija. We also participate in Visiting Doctors Programmes that help our consultants to maintain good relationships with the treating consultants in the Middle East i.e., clinician-to-clinician relationship. As part of the Visiting Doctors Programmes, some of our consultants travel overseas for about a week, where they will hold outpatient clinics, perform surgeries and give lectures. “I myself travel to the Middle East frequently and when necessary meet with senior members of the management and some eminent consultants to maintain ongoing relationships with International Health Authorities, establishing new links with hospitals and diagnostic centres to streamline a patient’s journey and to establish new discharge destinations for some of our complex patients, thereby remaining patient-focused at all times,” says Khadija.

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“Although we do not actually manage any hospitals in the Middle East, we continue to maintain a presence by attending regular meetings, ongoing doctors visiting programmes, and exhibitions where we promote our services.”

NHS involvement HCA International has also developed joint ventures with various NHS Trusts such as University College Hospital London at Harley Street , The London Gamma Knife Centre, St Bartholomew’s Hospital in London, a private patient centre at the NHS Queen’s Hospital in Romford and The Christie Clinic, a stateof-the-art private patient unit developed together with the internationally renowned Christie cancer hospital in Manchester. Khadija believes the reputation of the NHS in the Middle East is a huge attraction to overseas patients visiting the UK and HCA International hospitals. “Many of our overseas patients and the international health offices in the UK are aware of the expertise and ongoing research efforts within the NHS. We have over 3,000 consultants at HCA hospitals & diagnostic centres and majority of those consultants hold senior positions within NHS teaching hospitals,” she adds. While the UK continues to receive patients from the Middle East, Khadija believes that the volume of patients has dropped over the past few years. This is due to increased international medical tourism and market efforts from countries such as Germany, Malaysia, South Korea, Thailand, USA and the UAE.

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‘At HCA International we can proudly call ourselves leaders in oncology, haematology, neurology, neurosurgery and cardiology for both paediatric and adults”

“We still have an excellent reputation but we’ve lost a little bit of our market share to our international competitors.”

The international team Khadija has recently set-up International Patient Coordinators headed by International Relations Managers in each of the HCA hospitals and diagnostic centres. It is the role of the International Patients Departments to assist in streamlining the patient’s journey with the clinical teams from point of arrival in the UK to discharging back home. The International Patients Coordinators will care for each and every patient on an individual basis from the moment of their arrival to the point of discharge. The team is trained to understand each patient’s

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Private Healthcare

cultural needs and ensure they and their families feel well cared for and comfortable in their surroundings. Special considerations include religious requirements, food requirements and other cultural needs, which not only contribute to the patient’s personal experience, but also help ensure the best possible outcome of their treatment. “I still cannot forget the words of the tour guide, when I first came to London as a tourist. I went on a London Bus Tour and remember driving down Harley Street, where the tour guide said: “Ladies & gentlemen, this is the most renowned medical street in the world, consisting of specialist consultants and their clinics. For decades, patients have been coming to this street not only from the UK but have travelled from all over the world to seek treatments and consultations from London’s leading consultants. And the reputation of Harley Street, decades later remains the same,” says Khadija.

Further information www.hcahospitals.co.uk

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Bupa Cromwell Hospital

The full package Bupa Cromwell Hospital reflects its London location with an international flavour and exceptional care, Ahmed El Barkouki, Commercial Director tells Jack Ball 122

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Private Healthcare

he UK and London in particular continues to enjoy a global reputation as a centre of healthcare excellence. International private healthcare patients are drawn to the capital’s cosmopolitan nature, its diverse population and the highest standards of clinical expertise within the private healthcare sector. Bupa Cromwell Hospital is situated in the leafy residential area of South Kensington, West London. Having recently undergone a multi-million pound redevelopment, the hospital continues to set the industry benchmark in private patient care, offering an array of world-leading consultants in a superior care environment including four new luxury suites. The facility was built in 1981 before being acquired by Bupa in 2008. Many of those treated at the hospital are attracted by the 500 or more consultants who stem from London’s top teaching hospitals and who are trained to the highest level in over 70 specialties, delivering exceptional clinical care through a unique multidisciplinary team approach (MDT). “Bupa Cromwell reflects its London location. We are a melting pot of nationalities who work cohesively together to provide a unique offering,” says Ahmed El Barkouki, Commercial Director at the hospital. This shared universal standard of expertise, a comprehensive approach to all aspects of care, and a world class newly-renovated modern facility keeps Bupa Cromwell one step ahead of the pack in terms of high level private care.

Unique offerings The hospital is extremely strong in many specialities including orthopaedics, lung, liver, neurological and gastrointestinal care and is regarded as a centre of excellence for oncology, cardiology, paediatrics and complex surgical procedures. With a vast variety of specialisms housed under one roof, the hospital takes a unique approach to ensuring comprehensive patient care. “Almost all of our major specialities have a multidisciplinary team (MDT) attached to them with

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Bupa Cromwell Hospital

AHMED EL BARKOUKI Ahmed El Barkouki’s career spans 16 years in the hospitality and healthcare industries. Before joining Bupa Cromwell Hospital as Commercial Director in 2014 he held senior sales and marketing roles in luxury hotels, including Four Seasons Hotel and resorts, and the Maybourne Hotel Group (Claridge’s, the Berkeley and Connaught). He joined The Savoy hotel as Director of International Sales for its reopening, before setting up his own company to consult companies globally on how to attract high net worth clients from the Middle East, East Europe and South America. Ahmed’s move to the Cromwell came from a desire to bring exceptional service quality to the healthcare industry. He is passionate about culture change to deliver the best customer outcomes, and obsessed with customer service excellence.

the most complex patient cases discussed by a pathologist, a radiologist, a surgeon and a clinician. This environment ensures a decision is not made by one person but a group of peers who partake in that course of action,” says Ahmed. “We have roughly ten multidisciplinary teams and many of our consultants state that our hospital is advanced in multidisciplinary care compared to other private hospitals in London.” Due to the large amount of patient cases requiring discussion, the hospital’s lung MDT is so advanced that they meet every two weeks.

Industry benchmark With over 50 per cent of total patients coming from 144 different countries, the hospital is not content with simply providing an exceptional level of clinical care from consultants and support staff. “Some may think that providing excellent medical care is sufficient. This is increasingly not the case,” says Ahmed. “Many aspects of patient care are non-medical, with the complete hospital experience benchmarked against every customer service experience that our patients may have. Whilst other countries perform well in the area of non-medical care, the UK has some catching up to do.” As part of their effort to redress this, the hospital has redeveloped four of their superior care suitesthe Royal, Presidential, Ambassador and Executive. Patients may range from international business leaders to heads of state with a wide range of services individualised to the requirements of each guest. “There are separate amenities that come with the Royal and Presidential suites,” says Ahmed. “A patient is assigned a team of VIP coordinators similar to personal assistants for the duration of their stay as well as one to one nursing. A limousine service to pick up the patient from the airport is also provided along with medical evacuation from

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anywhere in the world, subject to an additional charge.” Privacy for the most discerning of patients is also guaranteed with the redeveloped suites ensuring the upmost subtlety of care. The suites are in an isolated area on the fourth floor with separate entrances, an outside area for security details, large amounts of storage and a private nursing station that can be accessed externally without the need to enter the suite. The new suites, as part of the wider redevelopment of the hospital, are one element of a wider effort to ensure the finest personal touch in private patient care complementing the superior medical expertise historically associated with Bupa Cromwell hospital.

Emotional wellbeing Equally important is the role of staff in maintaining the emotional wellbeing of an overseas patient who may be unfamiliar with the UK healthcare system. The International Patient Centre at the hospital reflects the wider ability of London to cater to a diverse variety of international cultures and tastes. “The Centre offers free interpretation services to all of our international patients who do not speak English. We can provide a translation service for any language with frequent ones being Arabic, Greek, Russian and Chinese,” says Ahmed. The interpreters

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are integral in easing any apprehension an international patient may have when commencing their treatment at Bupa Cromwell. “Some have been with us for more than 15 years, so they are very experienced and patients and consultants both value them greatly.” Once a procedure is carried out, a patient’s stay at the hospital varies according to their condition or treatment required. “A patient will meet the consultant and when a procedure is scheduled, their stay can vary from two or three days to three to four months,” says Ahmed. If a patient is no longer required to remain in hospital, the staff will help them find accommodation in the local area should they need further follow up care. “We have commercial arrangements with some of central London’s most luxurious hotels, as well as furnished apartments in the local area.” Bringing together these crucial non-medical aspects of care and a unique multidisciplinary approach positions Bupa Cromwell Hospital at the forefront of private patient care, ensuring the hospital competes on a global stage.

Further information www.bupacromwellhospital.com

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Edgbaston Medical Quarter

| Clockwise, from top: Birmingham Dental Hospital and School of Dentistry; University of Birmingham; Queen Elizabeth Hospital, Birmingham

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Private Healthcare Edgbaston Medical Quarter MARK LEE Mark Lee is Chief Executive of Calthorpe Estates having taken up the role in 2012, after joining the business as Chief Financial Officer in 2008. Mark heads up the management team responsible for running the 640 hectare (1,600 acre) Edgbaston Estate, close to the centre of Birmingham, and various other UK property interests. The team focuses on custodianship and sustainable development, and is in charge of a multimillion pound regeneration portfolio including medical, office, residential, leisure and retail developments.

E Discover a community of medical and life sciences excellence Edgbaston Medical Quarter in Birmingham is emulating Harley Street in its combined medical and training facilities, says Mark Lee, Chief Executive Calthorpe Estates globalopportunityhealthcare.com

dgbaston Medical Quarter (EMQ) is at the hub of the healthcare and life sciences revolution taking place in the West Midlands, within the heart of the United Kingdom. Based in Birmingham, just 90 minutes from London by train and with direct international flights to all major global destinations, Edgbaston is home to over 180 medical organisations, 80 hospitals and specialist care centres, 44 GP clinics and routine care facilities and 23 training facilities. With its rapidly growing healthcare and life sciences community, supported by internationally renowned training and educational facilities that sit alongside a vibrant leisure and lifestyle destination, it is easy to see why EMQ is becoming the â&#x20AC;&#x2DC;go toâ&#x20AC;&#x2122; centre for clinical trials, medical and healthcare excellence. Within walking distance of one another, many of the organisations are at the cutting edge of worldclass medical technology. There is a powerful cluster of advanced research centres, healthcare institutions and academic centres within EMQ. It boasts the state-of-the-art Queen Elizabeth Hospital Birmingham, the new Birmingham Dental Hospital and School of Dentistry, The Institute of Translational Medicine, The BioHub Birmingham, The Accelerated Trials Programme, as well the Rare Diseases and Personalised Medicine Centre - which is helping to improve the diagnosis, clinical management and treatment of rare disorders. Owing to its internationally-renowned clinical trial capabilities it is home to Cure Leukaemia and the Centre for Clinical Haematology, which are at the forefront of developing pioneering drug treatments and personalised medicine.

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Range of awardwinning places to eat

Edgbaston Medical Quarter

Private Healthcare Edgbaston Medical Quarter

The presence of so much knowledge and a well-connected community within a small area has enabled various bodies to unite on numerous collaborations, notably the relationship between the University of Birmingham with the West Midlands Genomic Medicine Centre and University Hospitals Birmingham NHS Foundation Trust on the ‘100,000 Genome Project’. As a centre of medical excellence it offers some of the best places to be treated in the UK. Many of the clinics are located in both London and Edgbaston; however EMQ can provide faster access to treatments, as well as deliver care at a great deal less than the cost of London without comprising on quality. Specialist care centres include oncology, mental health, diabetes, addiction, eating disorders and trauma. It was in fact the specialist trauma centre at the Queen Elizabeth Hospital Birmingham, where the Nobel Peace Prize winner Malala Yousafzai was treated in the United Kingdom. The treatment she received was not only instrumental in Malala’s recovery, but Edgbaston and Birmingham also became her home. EMQ has the space to grow and is able to offer a range of medical and clinical accommodation, ranging from new build operator-focused clinics through to medical suites and individual consulting rooms. The area is home to Pebble Mill, a 27 acre world-class healthcare and life sciences site, which has just seen the opening of the Birmingham Dental Hospital and School of Dentistry. It is set to be joined by a Circle Health private hospital and a 62 bed Bupa Care home, along with a state-of-the-art

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A centre for medical excellence, EMQ is home to three-quarters of Birmingham’s healthcare economy and boasts a proliferation of over 180 medical organisations, 80 hospitals and specialist care centres, 44 GP clinics and routine care facilities, and 23 training facilities.

5,000 sq m (53,8000 sq ft) medical facility which Calthorpe Estates is developing on a speculative basis to accommodate additional medical specialists. Alongside its knowledgeable and collaborative skills base, its internationally renowned training and educational facilities including The University of Birmingham and Birmingham City University, this unique location is rapidly establishing a strong reputation for healthcare and life sciences excellence at a regional, national and international level. Set within tree lined avenues with green open spaces within the Calthorpe Estate, the healthcare and medical facilities sit alongside a thriving commercial, leisure and lifestyle community. The area is home to Edgbaston Village, with its many character buildings, award-winning places to eat including Michelin-starred Simpsons restaurant and a growing choice of places to shop and relax. The niche retail and leisure businesses create a vibrant atmosphere which continues throughout the day, evenings and weekend. Whilst in the area you can also take advantage of a wide range arts, leisure and sports facilities including Edgbaston Cricket Stadium. Calthorpe Estates manages the prestigious 640 hectare (1,600 acre) estate in Edgbaston. Family-owned, it is one of the UK’s most forward thinking and progressive property investment and development companies. For 300 years it has been place-making and creating thriving communities within its Estate, to create the best places to live and work.

Further information www.calthorpe.co.uk/emqgh

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Medacs Healthcare

Reinventing global recruitment Next-generation healthcare service providers are innovating progressive staffing solutions, says David Taylor, Director of International, Medacs Healthcare

ith operations spanning five continents, Medacs Healthcare is a leading international healthcare staffing solutions provider with 25 years of expertise. In recent years, the company has developed a strong foothold in global markets with a suite of progressive staffing solutions, which go well beyond typical recruitment services, and sit particularly well within advanced healthcare systems in the Middle East and Asia. David Taylor, Director of International, explains how and why the company’s global expansion is gathering speed.

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Where does Medacs Healthcare operate?

As part of the Medacs Global Group, we operate out of 13 regional offices in the UK, and 8 international offices based across Ireland, South Africa, Singapore, Australia, New Zealand and Canada. The Middle East also forms a significant part of our portfolio. We’ve been placing medical professionals into the Gulf for over 15 years now, and have recently stepped up our operations there, with plans to open an office in the UAE in 2016. What sort of medical recruitment services do you offer and to whom?

Medacs Healthcare recruits the full spectrum of medical professionals on both a temporary and permanent basis, including doctors, nurses, allied health professionals and healthcare executives, across all grades and specialties. We work with a wide range of public and private sector healthcare providers right across the globe, from national and regional healthcare authorities and super-hospitals, to small, independently-run private facilities. We also provide a range of ‘managed services’ designed to help healthcare organisations to better control and manage their recruitment processes and deliver improvements in terms of performance, compliance and profitability. In addition to hospitals we also recruit medical

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Healthcare Recruitment professionals for prison, police and welfare government authorities, homecare workers for local authorities and even teletriage operators for pioneering telehealth programmes in Australasia. How exactly does the service you offer differ from traditional recruitment agencies?

Medacs Healthcare offers a much broader 360o approach to staffing services. As the largest and fastest-growing provider of managed service contracts to the NHS (managing £200m of annual staffing spend), we’ve developed a key understanding of how the entire recruitment process can be streamlined and changed the face of UK healthcare services with a new, improved model. In the Asia Pacific and EMEA regions, our expertise on the managed services side is proving to be an important differentiator for clients, significantly enhancing our core recruitment services. One of the key benefits of working with us is the end-to-end service we provide. Our recruiters are experts with intimate knowledge of their markets and talent pools, trained to value quality over quantity and ensure that potential candidates are properly vetted before they are presented to clients. Medacs’ also prides itself upon an exemplary reputation for both compliance and aftercare. 92 per cent of the overseas nurses we recruit into the NHS are retained in permanent roles (compared to the industry average of approximately 50 per cent). Finally I believe our sizeable global database of over 200,000 healthcare candidates gives us a significant advantage. We have aligned our systems to match the global migration of medical professionals and we use a CRM system which

MEDACS GLOBAL GROUP: FACTS AND FIGURES lobal footprint spanning five G continents worldwide l A leading provider of healthcare staffing solutions in the UK, Ireland, Australasia and Singapore, resourcing over five million hours of care a year l

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loud based talent sourcing C systems holding over 200,000 international medical candidates l L argest provider of specialist healthcare managed services outside of the USA, managing an annual spend of over £200m l

Medacs Healthcare

DAVID TAYLOR David has a thorough understanding of international health and recruitment markets, gained through six years in strategic roles at Director level for both Medacs Healthcare and the Impellam Group Plc, and over 15 years working for some of the world’s largest recruitment agencies. Under his leadership, Medacs Healthcare became the No1 provider of Managed Healthcare Services in the UK and he is now driving global growth across five continents, with a key strategic focus on Asia and the Middle East. David also has strong family values and a keen interest in property investment.

facilitates the worldwide movement of candidates and allows us to operate as a truly international recruitment agency. Our systems are also well aligned with social media channels, which are already playing a huge part in current candidate attraction methods and set to become increasingly important in the future of global recruitment. What is your current involvement in the Middle East?

At present, we provide recruitment services across all Middle East regions including the UAE, Saudi, Oman, Bahrain, Qatar and Kuwait. Our team is led by senior professionals with specialist experience in the region and this year we have taken on a number of new and exciting clients, with a recent campaign for a new client in Abu Dhabi attracting over 2,000 applicants in less than two months! The most exciting development in our expansion is a new corporate partnership with the Emirates Hospitals Association, a not-for-profit body set up to positively contribute to the improvement of healthcare services and patient outcomes in the UAE. Medacs will be working closely with the EHA and its member hospitals to develop a consistent approach to best practice right across the region, and ease common HR and recruitment issues faced by many care institutions. Right now we’re discussing some interesting ideas in the leadingedge field of telemedicine services, and looking at how we can expand the revalidation services we offer in the UK to encompass overseas healthcare professionals working within the Gulf. 2016 will see us establish a much stronger presence in the UAE in particular, meeting with new and existing clients and key industry stakeholders, attending major events such as Arab Health and opening a local office. With the next five years set for massive population growth - and the arrival of Expo2020 in Dubai, it is a very exciting time for the UAE and we’re proud to be involved in shaping the future provision of healthcare services and technologies in the region.

Further information Email: david.taylor@medacs.com www.medacs.com

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NHS Leadership Academy

Leadership development Ground-breaking leadership programmes have been designed by the NHS Leadership Academy and a KPMG led Consortium, using an innovative blended learning approach to promote robust leadership development and improve complex healthcare systems 132

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KPMG

he NHS Leadership Academy (“The Academy”) has responsibility for developing leadership capacity and capability for the NHS in England. With 1.4 million staff the NHS is one of the world’s largest organisations. Following a series of clinical failures at Stafford Hospital and the subsequent public inquiry and report by Robert Francis QC there is now an increasing focus on the development of leadership skills in the NHS. Three years ago the Academy, working with a large international consortium led by KPMG, designed and began delivering a series of innovative leadership development programmes. Over 3000 NHS clinicians and managers have undertaken the programmes and feedback has been exceptional. Now the Academy and KPMG have launched new arrangements which allows other organisations across the world to enrol their staff in the programmes or create their own programmes based on the approach developed in the NHS Leadership Academy.

NHS Leadership Academy and the KPMG led Consortium The KPMG led Consortium was appointed by the Academy, following a major procurement exercise, in 2013. The Consortium includes major global academic expertise from Alliance Manchester Business School, the University of Birmingham, the Harvard TH Chan School of Public Health, Pretoria University and Erasmus University, Rotterdam. It also includes LEO (specialists in online education technology), National Voices (the health and care charity coalition, who helped bring the voices of patients and carers into the programmes) and Cumberlege Eden (a consultancy specialising in media and political relations). The programmes developed by the Academy and the consortium are focused on developing strategic and operational leadership skills in mid-career and senior managers. These programmes are: ● The Elizabeth Garrett Anderson Programme – Leading Care II This 2 year programme is for middle managers (clinical and non-clinical) looking to lead large complex projects, departments or services. This programme is fully accredited, leading to an MSc in Healthcare Leadership and an NHS Leadership Academy Award in Senior Healthcare Leadership. ● The Nye Bevan Programme - Leading Care III This one year programme is for all leaders in healthcare aspiring to an executive director position at board level or equivalent , and leads to an NHS Leadership Academy Award in Executive Healthcare Leadership The approach developed by the Academy and the Consortium is very applicable to healthcare but also to many other sectors and is

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NHS Leadership Academy

RECOMMENDATIONS DR. JOHN E MCDONOUGH, PROFESSOR OF PRACTICE, HARVARD TH CHAN SCHOOL OF PUBLIC HEALTH: “KPMG collaborated with Harvard T.H. Chan School of Public Health to assemble an extraordinary team of academics and practitioners from across the world to develop ground-breaking leadership and management development curricula. The programmes created for the NHS Leadership Academy connected urgent needs in healthcare with patient stories, innovative technologies, new management approaches, and exciting teaching methods to achieve exceptional results. KPMG seamlessly blended world-class academic learning with hands-on experiential opportunities that promoted robust leadership development, improving complex healthcare systems on behalf of patients and consumers. They have created great learning models that can be applied across the globe.” KAREN LYNAS, MANAGING DIRECTOR, NHS LEADERSHIP ACADEMY “The vast majority of our participants have made a significant contribution to healthcare. Equally as importantly, they have empowered others to do the same.”

designed to work both as a complete progressive leadership programme, as well as individual, selfcontained modules. Whatever the challenges facing the healthcare system, individual modules can be implemented to support healthcare professionals on their leadership journey. There has been substantial interest in creating similar programmes based on this example, from clients in the UK and across the world. The agreement presents a number of advantages to KPMG/the Academy and prospective clients, Including access to world class and market leading leadership development learning content a reuseable online infrastructure platform created specifically for learning development the potential for bid support by the NHS Leadership Academy; and the potential to utilise the NHS Leadership Academy’s and the Consortium’s experienced resources in design and/or delivery of leadership development. To maximise learning, the programmes use blended learning techniques including online, residential, action-learning and face-to-face channels. This model is highly innovative, delivering a rigorous learning experience focussed on immediate action in the work place. The Anderson and Bevan Programmes are ground-breaking and were designed and launched in record time. The Anderson Master’s degree was accredited by Birmingham and Manchester universities within just five months; a process that usually takes two years. They are at the heart of a significant change in leadership culture at the NHS, built around the patient to equip the next generation of healthcare leaders with the skills to build a better healthcare future.

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‘These programmes represent an exceptional and innovative approach to leadership development. They blend the views of patients with the best global academic, healthcare and learning technology expertise to create approaches which make a real difference to how healthcare is delivered. Government and commercial organisations across the world are now studying what the NHS Leadership Academy has done to develop similar approaches to meet their own challenges.’ Andrew Hine, Partner and Head of Public Sector & Healthcare, KPMG in the UK

These programmes provide the skills and capabilities for leaders from all backgrounds, clinical and non-clinical, and at all levels to create a more capable and compassionate healthcare system. Both programmes are designed to holistically develop the knowledge, skills, expertise, attitudes and behaviours to support each participant in leading teams to create tangible and positive performance improvement at the front line. Whatever the challenges facing healthcare systems, individual modules can be implemented to support healthcare professionals on their leadership journey. Participants experience flexible learning with immediate impact. Designed to fit around today’s demanding lifestyles, these programmes harness online learning to help ensure that participants can learn at any time and in any place. The practical content and action learning approach means participants can apply new skills immediately to improve performance in their work. ‘These programmes represent an exceptional and innovative approach to leadership development. They blend the views of patients with the best global academic, healthcare and learning technology expertise to create approaches which make a real difference to how healthcare is delivered. Government and commercial organisations across the world are now studying what the NHS Leadership Academy has done to develop similar approaches to meet their own challenges.’ Andrew Hine, Partner and Head of Public Sector & Healthcare, KPMG in the UK

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‘Anderson participants tell us they feel more confident and more empowered, as well as having the satisfaction of knowing that patient care in their organisations has been enhanced. The impact of the programme can be profound and we’re keen to ensure we continue to bring about such positive change across the NHS.’ Louise Scott-Worrall, Director at KPMG

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KPMG

NHS Leadership Academy

RECOMMENDATIONS CHRIS KNIGHT, HEAD OF PROGRAMME MANAGEMENT OFFICE, NHS ENGLAND AND PARTICIPANT: “I finished the Bevan programme in 2014. I was working for Sheffield Teaching Hospitals and by the time I graduated, I was at NHS England in a role with responsibilities for provision and analysis of data that informed commissioning of the £100bn spent by the health service. With a background in private sector consultancy, I was beginning to question whether I wanted to continue working in the sector. The programme completely reenergised and focused me on the privilege and value of working for the NHS. The challenge and support I got from my peers on the programme gave it a value that has lasted well beyond the graduation process. I have a genuine desire, each day, to do everything I can to improve patient care.” DR DURKA DOUGALL, PUBLIC HEALTH CONSULTANT AWARDED NHS EMERGING LEADER OF THE YEAR AWARD 2014 BY THE LONDON LEADERSHIP ACADEMY The Anderson Programme has inspired me to understand the theories of healthcare leadership in its fullest sense and taught me skills for practically using these to improve health and social care locally. It connected me to a fantastic group of people from across health and social care, and highlighted many examples from around the world to learn from. It has given me confidence in my own leadership abilities, enabled me to understand myself and helped me to put things in place that I never thought possible.

Progress to date The Bevan Programme’s first intake graduated in March 2015, with 94 per cent receiving an Executive Healthcare Leadership Award; Intake 2 is due to graduate in March 2016. Intake 1 of the Anderson programme graduated in December 2015, with 87 per cent of participants being awarded their MSc and Senior Healthcare Leadership Award. This number is set to rise when further award allocations are ratified by the Examination Board. 57 per cent received a merit with a further 26 per cent receiving a distinction. These are impressive results for the participants, and demonstrates the quality of the leadership development journey the NHS Leadership Academy are taking participants through. Preliminary data has also been collected from participants about their perception of the relationship between the programmes and their promotion and careers prospects. Approximately 50 per cent of Anderson participants have had some form of promotion during their two years on the programme with most (96 per cent) attributing this to the personal development, credibility and confidence gained

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through participation on the programme. The pioneering virtual campus for the NHS Leadership Academy has scooped numerous awards including a gold award for Excellence in the Production of Learning Content – Public Sector at the E-Learning Age awards and a silver for Best Leadership Programme at the Training Journal Awards. Both of these awards are internationally recognised as a celebration of excellence in the e-learning industry. These latest accolades follow a bronze Brandon Hall Award for the Best Use of Blended Learning in 2014 and a silver Chief Learning Officer award for Excellence in E-learning in 2015, taking the total of industry awards for the NHS Leadership Academy virtual campus to four.

Further information Please contact Andrew Hine at KPMG Tel: +44 (0) 207 694 5125 E-mail: andrew.hine@kpmg.co.uk or Mark Britnell, Partner at KPMG in the UK and Chairman of KPMG’s Global Healthcare Practice Tel: 0207 311 4138 E-mail: mark.britnell@kpmg.co.uk

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Guy’s and St Thomas’

A unique combination Guy’s and St Thomas’ NHS Foundation Trust is a unique combination of clinical, educational and academic excellence, says Victoria Cheston, Commercial Director

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uy’s and St Thomas’ NHS Foundation Trust is a world-class organisation with a proud history stretching back over 900 years. We are a centre of excellence for clinical services, education and research. Our clinical services are delivered from two of London’s best known teaching hospitals, Guy’s Hospital and St Thomas’ Hospital, where the Evelina London Children’s Hospital is also located. Guy’s and St Thomas’ is one of the largest, most clinically comprehensive and high quality hospital trusts in the United Kingdom, and we provide an integrated community care service for the residents of Lambeth and Southwark, the

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NHS Foundation Trust

Guy’s and St Thomas’

VICTORIA CHESTON As Commercial Director, Victoria is responsible for all the commercial activities of one of the largest teaching hospitals in the UK. This covers, NHS: Private sector partnerships and business development, clinical and educational consultancy services, international partnerships and collaborations, education and training as well as intellectual property and commercial research including spin outs. Victoria is a Director of GSTT Enterprises, the 100% owned subsidiary commercial company of Guy’s and St Thomas’ NHS Foundation Trust. She is also a GSTT Member of ViaPath the GSTT LLP for pathology and a GSTT Member Representative on the SSAFA: GSTT LLP Board which ensures the provision of healthcare to all the British Forces based in Germany. Victoria’s background is in Clinical Operations, which complements her commercial experience. She joined Guy’s and St Thomas’ NHS Foundation Trust in 2001 and was appointed to the role of Commercial Director in March 2012, a role she continues to fulfil.

London Boroughs where our hospitals are based. We constantly strive to push the boundaries of the clinical care we offer in a safe and high quality environment which offers an outstanding patient experience. We are part of King’s Health Partners, one of only eight academic health sciences centres in the UK and 66 worldwide. King’s Health Partners brings together world-class research, clinicians with international reputations, education and clinical practice for the benefit of patients, ensures that lessons from research are used swiftly, efficiently and systematically to improve patient care and that we continue to educate the future workforce.

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Together, we: l Provide services across central and outer London locations, covering a population of 4.2 million l Employ 36,000 staff l Educate 25,000 students l Have a combined annual turnover of £3.1bn We are proud of our long tradition of undertaking ground-breaking research and engaging with partners in order to drive forward innovations that benefit patients. Our history of innovation includes: l Conducting the first blood transfusion in 1818 l Tissue typing was invented at Guy’s 1937 l First artificial intraocular lens implantation after cataract surgery in 1949 l Conducting the first kidney transplant in south Thames in 1967 l First European public hospital to use Da Vinci robots to treat skin cancer in 2001 l Pioneering live kidney transplants in the United Kingdom using robots in 2005 l Becoming the first Robotic Surgery Institute in the United Kingdom in 2014 l One of the first Genomic Medicine Centres, delivering the 100,000 Genomes Project, in 2015.

Our international offer Guy’s and St Thomas’ has a history of collaboration and partnership. We work with partners within the UK and internationally across all spheres of our work: clinical, educational and research. We offer

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a breadth and depth of experience and expertise across a wide range of clinical specialties that our partners can draw upon, and offer everything from consultancy services to long-term partnerships. We work with governments, international healthcare organisations, the military and industry and provide solutions that are tailor-made to the client’s requirements, drawing on the expertise of our leading clinicians and operational managers. We have extensive experience in a range of international markets and can tailor our approach according to your local needs, for example:

ENSURING STANDARDS OF CARE FOR BRITISH MILITARY PERSONNEL BASED IN GERMANY Guy’s and St Thomas’ developed a successful Peer Review Assurance Model with an ethos of two-way learning, mutual respect and collaboration between clinical consultants to assess and enhance the clinical quality of care provided in a number of German hospitals. A joint assurance protocol, which underpins the process, was developed in partnership with the German hospitals. Each year, the trust uses its risk management data to identify the priority specialties to be visited in that year. Prior to each visit, a desktop review of assurance documentation takes place. The clinical assurance visit is conducted by an experienced Guy’s and St Thomas’ senior consultant within a peer review model. During the visit they are accompanied by members of our team. The visit itself is led by the German Hospital Head of Department for the specialty. Recommendations which have led to improvements in patient care include: l Introduction of patient identification wristbands

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Changes to patient information leaflets l Review and reduction of postoperative infection rates l Changes to routine follow-up pathway l Purchase of a new ultrasound machine l Introduction of disposable endoscopy forceps. In addition to these specific recommendations, the partnership with Guy’s and St Thomas’ has been a significant factor in promoting the development of quality assurance programmes in the contracted German Hospitals with the appointment of dedicated quality assurance managers and more formal clinical review, significant event analysis and patient questionnaires. The partnership has led to material improvements in the quality of care provided to British services personnel based in Germany, as well as providing enhanced continuing professional development for clinicians. l

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assessing clinical services and joint working with local providers to develop improvement plans l advising on clinical pathways and how to implement best practice including full pathway redesign l providing guidance on clinical workforce development and ongoing professional development of staff to enhance long-term capability l supporting partners in achieving internationally recognised quality standards l advising on healthcare planning including medical equipment l peer reviewing plans for the strategic development of health systems and new services l advising on clinical and corporate governance to enhance patient safety and clinical outcomes We also offer partnerships that lead to long-term and sustainable improvements in clinical services and enhanced capability in the workforce required to deliver them. Guy’s and St Thomas’ possesses a unique combination of clinical excellence, academic expertise and commercial enterprise. Our worldclass expertise is built upon clinical, teaching and research excellence in a variety of settings and across every major medical speciality. This expertise and the partnership experience we have outlined, makes us the ideal partner for any healthcare organisation looking to adopt global best practice. If you wish to work with an organisation of international credibility and repute, contact us to find out how we can assist you. l

Further information For further information on how Guy’s and St Thomas’ can help you achieve your healthcare ambitions, please contact us at commercial.services@gstt.nhs. uk or call +44 (0) 20 7188 9801 www.gsttcommercialservices.co.uk

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Royal Brompton & Harefield Specialist Care

Finding new ways to treat heart and lung disease Consultants at the Royal Brompton & Harefield NHS Foundation Trust are responsible for several major medical breakthroughs, says David Shrimpton, Managing Director, Private Patients

he Royal Brompton & Harefield NHS Foundation Trust consists of two sites, the Royal Brompton Hospital in Chelsea and Harefield Hospital (RB&HH) near Uxbridge. As specialist hospitals, they only provide treatment for patients with heart and lung disease. This focus means our doctors and nurses are experts in their field, and indeed we are the largest heart and lung centre in the UK as well as among the largest in Europe. This expertise means the Trust has developed a worldwide reputation and attracts patients from across the globe The concentrated approach allows for the development of expertise, high standards of care and pioneering research. As a consequence, our consultants have been responsible for several major medical breakthroughs, including performing the first heart and lung transplant in Britain, founding the largest centre for the treatment of cystic fibrosis, and discovering the genetic mutation responsible for dilated cardiomyopathy. We work hard to ensure both sites are accessible for foreign visitors, providing personalised care to ensure a comfortable stay. Our dedicated concierge services provide practical support to patients and their families, paying particular attention to their cultural, religious and language needs. In particular, our overseas patients benefit from multi-faith facilities, interpretation services, diverse menu options and assistance with arranging transport, accommodation and medical appointments.

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International partners As well as welcoming people to our UK sites, we work closely with international partners and hospitals abroad. We want as many people as possible to benefit from our heart and lung expertise. Therefore our team of consultants and senior management executives regularly undertake visits to the Middle East, Europe and Asia to establish relationships with local hospitals, government agencies and independent healthcare agents. They attend conferences and deliver lectures on their area of speciality. The RB&HH Visiting Doctor Programme sees our consultants travel to overseas hospitals to work alongside local consultants, sharing expertise and training local teams. RB&HH also offer a remote second opinion service to overseas patients perhaps not able to travel to the UK. Our experts will review the patientâ&#x20AC;&#x2122;s medical reports and diagnostic tests, and provide their medical recommendation that can be shared with the patientâ&#x20AC;&#x2122;s doctor. We even offer a chance to set up a remote video consultation in order to provide the

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NHS Foundation Trust

patient with even more access to our consultants. RB&HH Specialist Care offers observership and clinical fellowship programmes within our hospitals, enabling doctors to develop their expertise in heart and lung care. We have links with Zhejiang Health Bureau which provides clinical placements for around 40 doctors in their individual specialities per year. Six of our consultants have signed up to oversee these placements at Royal Brompton and Harefield Hospitals. Being able to attract the best medical staff from around the world has been central to our success.

Royal Brompton & Harefield Specialist Care

DAVID SHRIMPTON David Shrimpton has been with the Trust since May 2008, joining from Citigroup where he was the sales and distribution director at the UK retail bank. David spent 17 years at Citigroup holding various positions within the wealth management business working in a number of European and Middle East locations. He has also worked for HSBC and ABN AMRO during the course of his care

Clinical expertise Our specialities manifest themselves in expert care. Our consultant surgeons offer the full range of surgical procedures and have particular expertise in complex cardiac surgery. Valve repair and replacement:

With over 40 yearsâ&#x20AC;&#x2122; experience in valvular surgery, our cardiac surgeons perform hundreds of valve

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replacements and repairs each year with excellent success rates. Our surgeons use the latest techniques including minimally invasive approaches and non-open heart surgery using devices such as Transcatheter Aortic Valve Implantation (TAVI) and MitraClip. AorticÂ programme:

Our hospitals house one of the largest aortic programmes in the UK, successfully treating patients with aneurysms (abnormal swellings), dissections (tears) and other diseases affecting the thoracic aorta. The team further specialise in treating patients who present with combined cardiac and thoraco-abdominal vascular diseases for example, a long-term heart failure patient who develops an abdominal aortic aneurysm (AAA). Our Aortic Team also treat cardiac (and thoracic) interventional inpatients who develop vascular complications preor post-operatively, such as compartment syndrome (where bleeding or swelling occurs within a section or compartment of muscle). Heart failure:

In addition to Harefieldâ&#x20AC;&#x2122;s renowned transplant work, consultants have recently pioneered the use of artificial hearts (left ventricular assist devices) to support failing hearts. Harefield Hospital has the largest number of LVAD patients in the UK, many of whom are demonstrating the highest rate of myocardial recovery in the world.

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Heart disease:

Consultants at RB&HH use the full range of revasculation procedures to restore blood to the heart, including coronary heart bypass grafts (CABG), robotically-assisted keyhole surgery (EndoAcab) and a hybrid approach using EndoAcab and Stenting. In 2013, we started using dissolvable heart stents to treat heart disease and have since treated over 100 patients with excellent clinical outcomes. Inherited cardiac conditions:

Inherited cardiac diseases, such as the heart muscle conditions (Cardiomyopathies) and the inherited arrhythmia syndromes, are important causes of cardiac illnesses in the population. Tragically, these diseases are also the most important causes of sudden death in young ages, often affecting otherwise healthy and asymptomatic individuals, even athletes. Due to their nature, the clinical experience with these diseases is limited in a few centres around the world. The Royal Brompton and Harefield Hospitals in London have a state of the art clinical service and a large research programme. Patients from around the world are attending their clinics every year seeking diagnosis and treatment. Congenital heart disease:

Royal Brompton Hospitalâ&#x20AC;&#x2122;s congenital heart unit is one of the largest in the UK, offering foetal, paediatric and adult services. The adult congenital

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Royal Brompton & Harefield Specialist Care

NHS Foundation Trust

heart disease unit, home to ground breaking research, attracts a large number of clinical fellows from around the world. Respiratory disease:

We diagnose and treat patients with around 50 different groups of respiratory diseases each year. Our areas of expertise include asthma, fibrosing lung disease, occupational and environmental lung disease, chronic lung infection, acute respiratory failure, cystic fibrosis, domiciliary ventilation and sleep disorders. Occupational lung disease:

Our hospitals run the busiest occupational and environmental lung disease in Europe, dealing with occupational asthma, asbestos-related disease, extrinsic allergic alveolitis and pneumoconiosis. Paediatric care:

We have the capabilities to treat patients of all ages, as our foetal cardiologists can perform scans at just 12 weeks, when a baby’s heart valve is just over a millimetre in size, and our clinical teams regularly treat patients well into their 90s. Babies and children are cared for in our specialist paediatric unit. Complex thoracic surgery:

Royal Brompton and Harefield Hospitals are leading providers of complex thoracic surgery, treating more thoracic sarcomas, mediastinal tumours and primary chest metastases than any other centre in the UK. For patients deemed to have ‘inoperable’ tumours, our specialists have pioneered ‘cyrosurgery’ where tumours are frozen and single port surgery for better pain control and shorter hospital stay. We are also the largest surgical centre in the UK for the management of COPD, performing lung volume reduction and bullectomy with a zero percent

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mortality rate over the past 100 cases. Our academic partners are the National Heart and Lung Institute in the Faculty of Medicine, Imperial College London and the Harefield Heart Science Centre. We are also part of Imperial College Health Partners, an organisation bringing together the academic and health science communities across North West London. Research is essential to maintaining standards, and we are Europe’s top ranked respiratory research centre and our cardiac, cardiovascular and critical care teams are rated in the top three most highly cited health research teams in England. Working closely with Imperial College London, our research teams have gained a five star rating for their contribution in finding new ways to treat heart and lung disease.

Further information www.rbhh-specialistcare.co.uk Email: privatepatients@rbht.nhs.uk

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Great Ormond Street Hospital

GOSH Global:

Harnessing app technology in international healthcare A new app now gives direct access to Great Ormond Street Hospital’s services, says Trevor Clarke, Director of International Services, Great Ormond Street Hospital for Children

reat Ormond Street Children’s Hospital (GOSH) in London, one of the top five children’s hospitals in the world, has developed “GOSH Global”, a free-todownload app that allows healthcare professionals and parents seeking treatment for children throughout the world to access their comprehensive database of clinical specialities and world-leading consultants, and make an instant referral of a patient for treatment. With an increase in international patient referrals, GOSH wants to streamline the way patients are referred for treatment. It also aims for healthcare professionals worldwide to be able to view the specialist services and consultants available at GOSH at the click of a button.

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“We know that our partners overseas need an easy way of accessing a database of our services and consultants, and want to be able to refer a patient quickly and efficiently,” said Trevor Clarke, Director of International Services at GOSH. “We provide world class quality paediatric care to patients and now we’re thrilled to be able to extend the process in referring to GOSH”. The International and Private Patients Service at GOSH treats over 5,000 children from over 80 different countries each year; the majority of these

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Great Ormond Street Hospital TREVOR CLARKE Trevor Clarke has been working in healthcare management for the past 25 years in the UK. He has undertaken a number of senior roles in Operational Management, Strategic Development and was Chief Operating Officer/Deputy Chief Executive at Great Ormond Street Hospital for Children. Lately he has taken the role of Director of International Services and has responsibility for the delivery of treatment services for international and private patients in London and the strategic development of education, training and consultancy services overseas.

can also search for a GOSH consultant by name or speciality and then either make an instant referral, email that consultantâ&#x20AC;&#x2122;s profile to another contact, or make an enquiry to the dedicated, multi-lingual GOSH referrals team, who respond to all enquiries within two working days.

Global leader in child health

children are from the Middle East. The service is tailored to the referral and treatment of international patients and the dedicated, multi-lingual team at GOSH ensure a smooth and efficient patient experience. The new free-to-download app will facilitate the easy referral of international and private patients for treatment. Users can browse the wide range of clinical specialities available through the International and Private Patient Service and view an extensive list of world-leading consultants. Users

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Great Ormond Street Childrenâ&#x20AC;&#x2122;s Hospital is a worldclass centre of excellence with over 50 different paediatric specialities and 300 world-leading consultants under one roof. Through pioneering translational research, GOSH provides cutting-edge treatment for the rarest and most complex paediatric conditions. As a global leader, GOSH has top clinical and research experts working every day to find new and better ways to treat children. While breakthroughs and medical expertise are essential to the treatment of patients, GOSH also places great emphasis on the support and care provided for children by nurturing an open and supportive atmosphere, ensuring that parents and patients are well informed and closely involved in the treatment process. Children receive the highest standards of care and attention from the expert team of medical and support staff during their stay at GOSH, and are always treated with respect, trust, concern and openness.

Further information www.gosh.ae

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Genetic testing at Great Ormond Street Hospital Pioneering research has paved the way for noninvasive testing for complex genetic paediatric disorders at Great Ormond Street Hospital, says Lucy Jenkins FRCPath, Consultant Clinical Scientist

reat Ormond Street Children’s Hospital (GOSH) in London is a world class centre of excellence with over 50 different paediatric specialities and 300 world-class consultants under one roof. Through pioneering translational research, GOSH provides cutting-edge treatment for the rarest and most complex paediatric conditions. GOSH is one of the world’s top five children’s hospitals.

External endorsements: The Children’s Hospitals International Executive Forum (CHIEF) rate GOSH as one of the four leading paediatric research hospitals in the world. l For the last three years, GOSH together with the Institute of Child Health, has been in the top five centres in the world for research published. l Between 2010-2014, GOSH/ICH research papers had the highest citation impact of any children’s hospital in the world, as reported by Thomson Reuters. l The hospital is the UK’s only Specialist Biomedical Research Centre in paediatrics and is part of an Academic Health Sciences centre comprising University College London and leading hospitals in London.

(cffDNA) and by testing a maternal blood sample we can analyse the baby’s DNA. This provides a safe alternative to traditional invasive tests. Testing may be offered for the following reasons: l There is a clinical indication in the baby, for example an abnormality seen on an ultrasound scan. l There is a high risk of a genetic condition in the child, usually because the couple already have an affected child and there is a high risk to any future pregnancy.

Non-Invasive Prenatal Diagnosis (NIPD) Prenatal testing refers to genetic diagnosis in an unborn child. Traditionally this is carried out by tests which are associated with a risk of miscarriage due to their invasive nature. NonInvasive Prenatal Diagnosis (NIPD) represents a safe alternative to the invasive prenatal test because it requires only a blood sample from the mother. When a woman is pregnant, there is a small amount of her baby’s DNA circulating in her bloodstream. This is called cell free foetal DNA

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Conditions we can test for: l Foetal sexing (this is only available where the pregnancy is at risk of a sex-linked disorder) l Cystic Fibrosis Paternal Mutation Exclusion l FGFR3-related skeletal dysplasias l FGFR2 related Craniosynostosis including Apert syndrome

Bespoke testing We are able to design a bespoke non-invasive test for families that are at risk of a rare genetic disease. We can test for a paternal mutation or for the recurrence of a new mutation.

The GOSHome Testing is now available at GOSH which covers rare conditions that are known to be caused by multiple genes, and for which it is difficult to make a definitive genetic diagnosis. The GOSHome is a post-natal diagnostic test for children and adults who have an unknown

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Great Ormond Street Hospital

‘The real focus of the non-invasive prenatal diagnostic test is about giving people the option to safely find out if their baby has a genetic disease, which is what our test offers. The GOSHome allows patients to avoid the diagnostic odyssey, where patients with rare conditions affecting multi-organ systems may have to wait years before their condition is finally diagnosed. GOSHome allows us to tailor the test to a panel of genes allowing for a timely result that will not reveal information that is not expected or consented.”

condition, and is designed to help confirm a genetic diagnosis. The test targets around 5000 known disease-causing genes. How does it work? We analyse a subset of the 5000 genes that are relevant to a patient’s clinical presentation in a ‘virtual’ panel. This approach has many benefits: l Avoids incidental findings such as late onset predisposition genes l Ensures a timely and meaningful clinical report l Provides data to analyse further genes if indicated lA flexible design approach means we can add or remove genes from panels as new scientific discoveries are made Fast results Once the sample is received at GOSH in London, test results will be available in the following times: l NIPD testing: 5 days l Bespoke NIPD test design: 8 weeks l GOSHome testing: approximately 4 months For NIPD it is essential that referrals come through an antenatal clinic so that information on ultrasound scans, family history and genetic risk may be provided. This service is only available from nine weeks gestation onwards.

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LUCY JENKINS Lucy Jenkins is the Interim Director of the North East Thames Regional Genetics Laboratory based at Great Ormond Street Hospital and Consultant Clinical Scientist for Molecular Genetitcs. After graduating in Molecular Biology from Liverpool University Lucy undertook clinical scientist training and registration in the Yorkshire Regional DNA Laboratory, Leeds. After 8 years she moved to Great Ormond Street Hospital to take up the post of Deputy Head in Molecular Genetics, obtaining Fellowship of the Royal College of Pathologists in 2006. Lucy became Head of Service for Regional Molecular Genetics in 2009 and Interim Director of the Genetics Laboratory in 2014. Key interests include the genetics of hearing loss, surfactant protein deficiencies next generation sequencing and non-invasive prenatal diagnosis.

Further information For more information or to make an enquiry please email privateinfo@gosh.nhs.uk or call +44 (0)20 77626822 www.gosh.ae

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Papworth Hospital

Inside the beating heart of Papworth Hospital

With almost 100 years of innovative history under its belt, Papworth Hospital is preparing to enter a new age of heart and lung medicine, says Medical Director Dr Roger Hall

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apworth Hospital is a world renowned centre of excellence based in Cambridge, UK, specialising in the treatment of heart and lung diseases. This pioneering institution is now evolving as a bespoke new hospital, fit for its reputation, begins to rise from the ground with ambitions to develop new lifesaving techniques for future generations. Innovation has always been a cornerstone of Papworth Hospital NHS Foundation Trust thanks to Pendrill Varrier Jones who set up not only a hospital but a community in Papworth Everard, a small Cambridgeshire village, to transform the way in which people diagnosed with tuberculosis were cared for. His work paved the way for future surgeons, physicians and nursing staff to set the pace for international care standards in heart and lung medicine. â&#x20AC;&#x153;We have since gone on to perform the UKâ&#x20AC;&#x2122;s first successful heart transplant, the worldâ&#x20AC;&#x2122;s first heart-lung-liver transplant and continue to set the

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Papworth Hospital

DR ROGER HALL Dr Roger Hall has been in post as the Medical Director of Papworth Hospital NHS Foundation Trust since 2014. Prior to this Roger focussed his time on clinical duties as a Consultant Anaesthetist and as a Clinical Director having been at the Trust since 2002. He continues to balance his role as Medical Director with his clinical duties as he feels it is important to stay in touch with his patients and the services Papworth Hospital provides. Prior to his role at Papworth Hospital he worked at Green Lane Hospital in Auckland, New Zealand as a consultant in adult and paediatric cardiac anaesthesia and intensive care.

bar high for fellow cardiothoracic centres across the globe”, says Dr Hall, who is also a practising Consultant Anaesthetist at the Trust. Almost 100 years on the hospital is on the verge of opening a bespoke 310-bed hospital in Cambridge alongside the UK’s only Heart and Lung Research and Education Institute (HLRI). The specialist heart and lung hospital continues to push the boundaries of medicine and offer patients hope when no other option is available to them. Papworth Hospital’s nurses and doctors are experts in their field, enabling them to treat patients of all ages with comorbidities - a service that is able to cope with the growing demands of an ageing population with complex healthcare needs. Internationally recognised by both patients and clinicians, Papworth Hospital has attained a worldwide reputation for its low cardiac mortality rates, reduced inpatient stays and individualised patient care. “Honing specialist techniques is a priority for our

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clinical teams to ensure our patients, both NHS and private, are receiving the best and most appropriate care. It also enables the hospital to meet the growing demands on its services,” says Dr Hall. “An innovative breakthrough in heart transplantation has allowed us to save 50 per cent more lives in 2015. Following many years of research, a new technique was developed and launched earlier this year so that hearts from nonheart beating donors could be transplanted. “In just eight months 10 patients have received a successful heart transplant using this technique and we have now performed more cases than any other hospital in the world. “As well as this procedure and our standard transplant programme we offer bridge-to–transplant devices such as the VAD (ventricular assist device), meaning our patients are able to live with a chronic heart condition while awaiting a transplant.” Other specialist services at Papworth include the pulmonary endarterectomy (PEA) service, led by consultant surgeon David Jenkins. As the UK’s only centre for the provision of this complex form of surgery, patients travel from across the globe to have this treatment for the progressive condition Chronic Thromboembolic Pulmonary Hypertension (CTEPH), a rare form of pulmonary hypertension which affects the lungs. “We are world leaders in this field, as only one of a handful of centres internationally who regularly perform this procedure”, says Dr Hall. However, 40 per cent of patients with CTEPH are inoperable due to blockages that cannot be reached using surgical techniques or due to patients’ comorbidities, so cardiologists at Papworth have introduced a new technique in which these patients can be treated and have gone on to perform the UK’s first balloon pulmonary angioplasty (BPA) in October 2015, allowing more patients to be treated using less invasive methods. Papworth Hospital also offers a wide range of minimally invasive thoracic surgery to our patients including the removal of tumours to Nuss procedures used for the correction of pectus excavatum or funnel chest.

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Papworth Hospital

Dr Hall explained: “The annual Cambridge International VATS symposium run by Papworth, this year in partnership with the Shanghai Pulmonary Hospital, has been a great success. Watching live cases and having open discussions with colleagues around the globe has been very beneficial.”

Patient care When discussing Papworth’s excellent patient care results, Dr Hall emphasised the importance of patient-centred care: “The care our patients receive is just as important as the skill of the surgeon in relation to the patients’ recovery. “Our patients are actively encouraged to enter into a ‘partnership of care’ with their clinicians so that they feel fully involved in the decisions being made surrounding their treatment while also ensuring they prepare themselves adequately for surgery or procedures through healthy eating, exercise and a number of other proactive actions such as quitting smoking and making lifestyle changes where required.” This care plan, the Enhanced Recovery programme, is available to both cardiac and thoracic patients, and has had a fantastic response from patients who are keen to take control of their progress. This has led to an increased improvement in recovery times allowing patients to return to their homes much quicker than if they had not prepared for their hospital stay. It also enables them to make a much better long term recovery. Dr Hall explains how Papworth treats patients with serious conditions when other hospitals are unable to. “Extra Corporeal Membrane Oxygenation (ECMO) is just one of a number of specialist lifesaving services that our leading intensive care teams provide. ECMO is a technique that oxygenates blood outside the body. It can be used in potentially reversible severe respiratory failure when conventional ventilation is unable to oxygenate the blood adequately.

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“The aim of ECMO in respiratory failure is to allow the injured lung to recover whilst avoiding certain recognised complications associated with conventional ventilation. It is high risk and is therefore only used as a matter of last resort in difficult cases. The procedure involves removing blood from the patient, taking steps to avoid clots forming in the blood, adding oxygen to the blood and pumping it artificially to support the lungs.” ECMO is a highly specialised technique, which needs the input of intensive care specialists, cardiothoracic surgeons as well as ECMO-trained nurses and perfusion scientists. As a tertiary cardiothoracic centre, Papworth Hospital has been providing specialist ECMO services for a number of years. The hospital is registered with the international Extracorporeal Life Support Organisation (ELSO) and is renowned for its experience using ECMO for either cardiac or respiratory support. In addition to providing ECMO on site, Papworth has developed a retrieval service to secure the rapid and safe transfer of patients between referring hospital and the ECMO centres. “Our clinicians have also been expanding on the Progressive Care Programme (invasive ventilation weaning programme) within respiratory services at the Trust to ensure patients can be referred for chronic weaning problems.” Patients who are failing to wean from invasive ventilation despite optimal conventional therapy on

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Papworth Hospital

NHS Foundation Trust

Papworth Hospital

critical care units are referred to this service. A multidisciplinary team approach is employed to optimise therapy, and non-invasive ventilation is often used to allow a gradual withdrawal of invasive ventilatory support. The service has been cited as a model for the future provision of critical care step down programmes.

Meanwhile fundraising for the HLRI continues and is vital to its completion, which will unlock opportunities to find treatments and possibly even cures for cardiothoracic diseases, including cardiac disease, a major cause of death in the UK along with many other neighbouring countries.

Sleep medicine

As a world-renowned hospital with a wealth of specialist expertise, Papworth is well-placed to share its knowledge and experience. Papworth Hospital offers bespoke educational packages and observerships across its range of services. It has established international courses for ECMO and CTEPH that use a combination of presentation, practical and simulation sessions taught by the expert multidisciplinary critical care team at Papworth. Many international institutions choose to send their patients to Papworth for treatment in its private patient clinic, where patients are seen and treated by its expert consultant staff in comfortable surroundings.

Papworth Hospital runs one of the countryâ&#x20AC;&#x2122;s busiest sleep medicine centres, diagnosing patients with a range of both common and complex sleep and related-respiratory disorders including insomnia, narcolepsy and sleep apnoea. The Respiratory Support and Sleep Centre (RSSC) is one of the few fully accredited specialist sleep centres in the UK dealing with all non-respiratory and respiratory sleep disorders. It performs more than 100 clinical polysomnographies per month and is actively involved in sleep research.

The future In the future, life-saving innovation will be cultivated and nurtured on the Cambridge Biomedical Campus in a partnership between Papworth Hospital and the University of Cambridge to build a global Heart and Lung Research Institute, which will be built adjacent to the new state-of-the-art Papworth Hospital to create the UKâ&#x20AC;&#x2122;s only cardio-respiratory hospital and research facility. Construction of the new Papworth Hospital is well underway and on target for completion in preparation for opening in spring 2018.

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International opportunities

Further information For further information about Papworth Hospital, the HLRI, educational opportunities or private patient services please contact the Papworth Global team on business.services@papworth.nhs.uk.

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The Christie

Pioneering Cancer Care The Christie is committed to translating cancer innovation and research breakthroughs into very real patient benefits, says Professor Peter Trainer, Consultant Endocrinologist

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NHS Foundation Trust

The Christie

rom its beginnings in the early 1890’s to the present day, The Christie is renowned as a world pioneer in cancer care, treatment, research and education. Based in Manchester in the North West of England, it is Europe’s largest single site cancer centre and the first UK centre to be officially accredited by the Organisation of European Cancer Institutes as a comprehensive cancer centre. Now best known for its two football teams, Manchester also has a proud history of some of the world’s most significant and renowned innovations including: l The world’s first canal l The world’s first inter-city railway station l The discovery of the electron, proton and neutron l The world’s first computer l The world’s first IVF baby and now The Christie continues this legacy as it has been chosen as the UK’s first high energy proton beam therapy centre which will transform cancer care. Today’s work at The Christie is tomorrow’s treatments across the globe.

PROFESSOR PETER TRAINER Professor Peter Trainer qualified in Edinburgh and continued his higher training in St. Bartholomew’s Hospital London, Aberdeen, Utrecht (Netherlands) and Portland (Oregon, USA). He was a senior lecturer at Bart’s in London before becoming a consultant endocrinologist at The Christie hospital (Manchester) in 1998 which he combines with being the Clinical Director of the Manchester Academic Health Science Centre (www.MAHSC.ac.uk) and chairman of Bioscientifica (www.bioscientifica.com). Professor Trainer is an active leader in the international endocrine community and has served on the senior executive committees of the major international endocrine societies. Within The Christie he was previously a divisional director and is currently the Associate Medical Director focused on working with the University of Manchester to grow oncology research in the city, and specifically co-chairs the search committee entrusted with a budget of £35 million to recruit world-leading clinical academics to Manchester. In addition, as chair of the International Strategy Board, he is charged with developing international partnerships with centres aspiring to deliver world class cancer treatment and undertake cutting-edge oncology research.

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The Christie

The Christie has been at the forefront of many world first discoveries: l The world’s first clinical trial of the breast cancer drug Stilboestrol and in 1970 we were the first to trial Tamoxifen. This drug is still in use today and millions of patients have benefitted from it. l The first hospital in the world to use cultured bone marrow for leukaemia treatment. This treatment has reduced the risk of infection for many patients and is still widely used today. l The first place in the world to perform a single harvest blood stem cell transplant. l Invented photo-dynamic therapy for skin cancer, a combination of drug and light therapy that destroys cancer cells without the need for surgery. l The first hospital in the world to use image guided radiotherapy. l Led the trials for Zelboraf, the first personalised treatment for an advanced form of inoperable skin cancer. As part of the world famous NHS healthcare system The Christie is proud to provide first class care to its patients and offers a range of services including radiotherapy, in one of the world’s largest radiotherapy departments and at our satellite centres; we have also been chosen to house the UK’s first high energy proton beam therapy centre. We offer chemotherapy in the UK’s largest chemotherapy unit, as well as at six other hospitals and via our mobile chemotherapy unit and in patients’ homes. We also provide highly specialist surgery for complex and rare cancers along with a wide range of support and diagnostic services. Our survival rates are amongst the highest in the country and our infection rates are the lowest in the UK. We operate a large, high quality, dedicated clinical research environment. Our focus and size enables us to work with International partners to uniquely deliver effective and efficient specialist care offering patients worldwide the best possible outcomes using research. Our expertise is prominent across the globe, with many of our staff leading their field. It is this skill and expertise that allows us to assist other healthcare sectors, across all continents, to progress and develop their services to improve patient care. We have already worked with partners across a number of continents including Europe, North America, Australia and Asia and are currently discussing the potential to expand our services to a number of organisations based in China. The Christie is currently expanding its international commercial and academic partnerships and offers a range of services including: -

commercial partnerships with international organisations: l Care provided for international patients at The Christie clinic l Provision of multi-disciplinary teams for international patients l Specialist advice for international patients l Development of a Christie outreach service Clinical consultancy The Christie delivers more than 100,000 radiotherapy treatments each year through one of the largest radiotherapy departments in the world. Our medical physics department is the largest in the UK providing technical support in a number of areas of expertise, with world leading physicists working alongside medical and electrical engineers.

Patient Care Services The Christie has a successful track record of improving outcomes for patients. Our patient clinic covers all areas of cancer treatment and care including surgery, chemotherapy, haemato-oncology and radiotherapy. We provide a range of services for private individuals through the Christie Clinic or via

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NHS Foundation Trust

The Christie

energy proton beam therapy centres in Manchester. This expertise enables us to assist you to commission equipment, in line with The Christie Quality Standard, in the shortest time possible. We draw on our extensive knowledge and expertise to provide you with the following: l Advice on specialist equipment or service procurement l Advice on build design for oncology services l Support with the commissioning and Quality Assurance of onsite specialist equipment Research partnerships The Christie works closely with The University of Manchester and Cancer Research UK, as part of the Manchester Cancer Research Centre, to take research from the laboratory to clinical trials with patients. This research has been officially ranked best in the UK. The future of cancer treatment is about the development of personalised treatments, based on understanding the molecular and cellular basis of cancer. This progress provides ground breaking opportunities for treatment, and research as The Christie continues to lead the way. As an organisation at the forefront of cancer research The Christie is looking for partners with whom we can work in order to develop further ground breaking treatments.

We have worked with international partners to assist them to develop and deliver bespoke oncology programmes. We provide the expertise to deliver the following services to our international commercial partners: l Service design l Pathway design l Service specification development l Delivery protocol development Technical consultancy With 15 linear accelerators housed either in our main site or in our outreach centres, The Christie has an extensive capital replacement programme. This has resulted in the team reducing the time taken to commission this equipment, by 50 percent. Indeed The Christie’s radiotherapy expertise was one of the key determining factors in the Department of Health’s decision to locate one of the first UK high

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Education The Christie School of Oncology is the first of its kind in the UK. Its programme of activity has been developed with, and benefits from, the input of The Christie’s world leading experts in cancer research and care. The School of Oncology has a unique structure which provides undergraduate and post graduate education, bringing together medical, non-medical, healthcare and scientist education, with vocational, clinical, financial and managerial training. Our extensive programme of events is available to all and is delivered as follows: l At The Christie including both classroom based and patient facing activity l At partner sites l Online The Christie uses the extensive skills and experience gained over the last century, to provide a highly skilled team of consultants who are able to provide a comprehensive suite of services. The Christie is committed to translating cancer innovation and research breakthroughs into very real patient benefits as we continue to work towards a future without cancer.

Further information If you would like further details about The Christie’s international work, then please contact: Email: sophie.kennedy@christie.nhs.uk Tel: +44 (0) 161 918 7099 www.christie.nhs.uk

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Central and North West London

Mental health is critical to everyone and spans all generations. Demand for effective and efficient mental health care provision continues to grow, not only in the UK but in developing healthcare systems around the world. In response, the Central and North West London NHS Foundation Trust (CNWL) is pioneering the latest treatments and access solutions for some of society’s most vulnerable, says CNWL Chief Executive, Claire Murdoch

Using your head C

NWL is one of the largest and most diverse health care organisations in the UK, specialising in mental health care, addiction treatment, physical health and sexual health and HIV services and prisons. In terms of clinical research there has been a massive underdevelopment in the field of mental health, particularly when compared to that of heart or cancer research. But drawing upon its staff of world-leading mental health consultants, CNWL is now at the fore in mental health care with pioneering

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treatments and innovative solutions to increase patient access. “Effective mental health care is increasingly important,” says CNWL Trust Chief Executive, Claire Murdoch. “We all have mental health and we all know that when our mental health is better, we look after ourselves better.” Increasing access, particularly for young people, has also been a central theme of the Trust’s plans. The Trust’s innovative approaches are designed to achieve earlier assessment, earlier diagnosis and more effective treatment for young people sooner. “One in four can expect a serious case of depression in their lives. There are very serious mental illnesses that might start in youth, in adolescence, including major psychotic illnesses

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NHS Foundation Trust

Central and North West London CLAIRE MURDOCH Claire Murdoch is Chief Executive of CNWL and leads the organisation. This includes the Trust’s financial performance and the quality and standards of the clinical services. Claire is a registered mental health nurse and has over 30 years NHS experience. In June this year she was also appointed National Director for Mental Health at NHS England, sharing her time between both positions.

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– it is very common,” Claire explains. “We don’t just talk about physical health to cover all physical ailments like heart disease or diabetes. It’s really the same thing for mental health – there are many different individual mental illnesses.”

Continuing innovation Modern public attitudes to mental health care continue to improve day by day. And the NHS, through initiatives in communities, school and workplaces, has come to realise the inextricable link between treatments for both the mind and the body. “’Mental health’ is a lazy term because it can cover anything from post traumatic stress, eating disorders, obsessional disorders, anxiety, depression to various psychotic disorders,” says

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Claire. “But we’re more enlightened now about how to help people live better, happier, healthier lives, and generally to look after themselves better.” The February 2016 Mental Health Taskforce report for the NHS is symptomatic of this new progressive era of mental health care. It was designed to increase funding and access to areas of mental health care, which may have been traditionally unavailable. The report placed the experience of people with mental health problems at the centre of it, with 20,000 respondents highlighting ‘the changes they wanted to see so that they could fulfil their life ambitions and take their places as equal citizens in our society1.’ “Timely mental health support can unlock all sorts of better outcomes and savings to the economy,” says Claire. “Billions of pounds are lost from days taken off sick due to mental illness. So this is certainly an area where the Trust is trying to make significant improvements.” As part of the Trust’s commitment to improving both the patient and carer experience, an innovative redesign of its mental health services is planned. “In the community we’re really trying to push the boundaries of integrated services, physical and mental healthcare in long term condition management,” says Claire. A new Single Point of Access (SPA) is a onestop access point for the Trust’s adult community mental health services. SPA will bring together GPs, carers, and other statutory and third sector providers to process emergency and routine referrals; it offers clinical advice priorities referrals and signpost patients to relevant services. Such easing of access is critical, particularly when involving mental health care. “Early diagnosis can lead to early treatment and better outcomes in nearly every single mental illness. We have to get much better at raising awareness and spotting the early signs through a large programme of training for people like health visitors and GPs.” The New Home Treatment Rapid Response Teams (HTRRT) is an urgent response facility for urgent and emergency referrals into adult secondary care mental health services, enabling community mental health services to deliver care in line with the Mental Health Crisis Care Concordat. “We’re trying to push the boundaries of how quickly you can get people home safely, because

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most people recover better in their own beds and are less likely to get hospital –acquired infection,” says Claire. “Home Treatment Response Teams (HTTRT) can be dispatched within a hour if the call is locally based. That’s 24/7, 365 days a year.” New Community Mental Health Teams (CMHTs) are also shaping a fresher community wide response to mental health services. Each of the boroughs that make up the Trust now holds local co-production workshops to engage with stakeholders, ensuring that the services on offer are framed to meet local requirements.

And with financial pressures on UK NHS trusts well publicised, benefits of IAPT go further than just their excellent track record and clinical effectiveness. Claire goes on to explain; “When you do a full costbenefit analysis, talking therapies are not expensive at all. They’re really cost effective and help people make the link between what you think, what you do and how you feel.”

Talking therapies When treating mild or moderate mental health problems like depression, anxiety, phobias or post traumatic stress disorders, the Trust is a significant proponent of talking therapies (psychological therapies). Part of the NHS’s drive to increase general access to such therapies has come in nationalised UK talking therapies programme called IAPT, ‘Improving Access to Psychological Therapies’. “It was only a few short years ago that if you had severe depression or anxiety, you wouldn’t be offered systematic or evidence-based counselling and psychological support,” Claire explains. “You might have been able to buy this treatment privately at vast expense but with a phenomenal evidence base, talking therapies can now be accessed right across the country within two weeks in most cases.” “The next big push around talking therapies over the next three years ought to be to increase access and coverage and primary care for people with multiple conditions, which will be better and more cheaply managed and will be more humane with more psychological input.”

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NHS Foundation Trust CNWL International With a commitment to continual clinical innovations at the highest level, CNWL engages with organisations across the world in key healthcare regions like Asia, Africa and the Middle East. Indeed, many CNWL experts have been called upon to contribute to national and international health strategies and policies. “We love to work internationally,” says Claire. “We learn so much from talking to these countries – we like to see global collaboration around some common problems like living longer and living with complexity. The global burden of health has changed – non-communicable diseases were once the main concern. Now it’s depression.” In terms of international development in healthcare, mental health care provision for developing countries can still be an invisible problem, sometimes overlooked or stigmatised as an issue. As such, developing healthcare systems in countries like China and India have much to learn from the Trust’s pioneering treatments and initiatives to increase access. “A quarter of the mental illnesses in the world are in China and India,” says Claire. “In India suicide was the eighth largest killer in 2010. Yet less than one in 10 people get any form of recognition of their illness for treatment. In China the figure stands at one in six.” Consequently, and as part of a raft of new Indo-UK government healthcare partnerships, the Trust is engaged in scoping work as part of the wider IndoUK Institute of Health (IUIH) collaboration to set up 11 healthcare and education sites across India. This project has seen the Trust specifically advise on the

Central and North West London Punjab region and their addictions services. “In the UK the Trust runs the National Club Drug Clinic for many specialised additions, from gambling to ‘club drugs’ and legal highs,” says Clinical Consultant at CNWL, Dr Pramod Prabhakaran. “Although Indian medical training is very good, we need to supplement that with what we emphasise here in the UK. For example the Trust sent a delegation to the Punjab in 2013, in partnership with IUIH, to set up addiction units for drugs and alcohol.” In China CNWL is now running clinical observation programmes for senior doctors and nurses, covering integrated health and social care across the nation’s entire healthcare system. These are designed to engage and promote policy development, and can range from two weeks to three months. “In the last year I’ve been working with a research organisation in China on developing integrated care for the elderly,” says Pramod. “Our work in Shanghai looks at the data of 20 million patients, at different sections of the population and the costs in different years of life.” “All countries across the globe are concerned with a growing elderly population,” Claire explains. “In China particularly, they are not aware of the problem of dementia so the Trust is pushing heavily to promote a better understanding of the disease.”

Future for the Trust As the Trust increases mental health care access for its most vulnerable patients, its future goals are certainly ambitious. But with some of the world’s leading consultants driving its plans, Claire is confident they can be achieved, and even exceeded. “The main point of the Trust’s five-year forward view is to increase responsiveness and access to services, both for adults and young people,” says Claire. “I want to set up some real targets around waiting times and improved access. By 2020 I would very much like to think we’d improved access and reduced waiting times, particularly for children and young people.” “We will also continue to make a big push on IAPT for the treatment of common health problems. This is going to one of the quiet revolutions of our time. Last year the Trust treated 24,000 people with talking therapies. Three years ago, this wouldn’t have happened. I want to see that number grow by at least another 20 per cent nationally because that will lead to a happier, healthier, and more productive nation.”

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Further information Dr Pramod Prabhakaran: pprabhakaran@nhs.net Dr Alex Lewis: alex.lewis@nhs.net www.cnwl.nhs.uk

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Leeds Teaching Hospital

Thanks to its wealth of managerial and clinical expertise, the NHS is uniquely able to respond to opportunities for international partnerships says David Berridge, Deputy Chief Medical Officer and Medical Director (Operations) at Leeds Teaching Hospitals NHS Trust

Internationalising NHS expertise L eeds Teaching Hospitals NHS Trust (LTHT) is one of the largest teaching hospitals in Europe, employing nearly 16,000 staff. This includes around 2,000 doctors and dentists, and more than 4,000 nurses. Operating seven hospitals across six sites, the Trust has an annual budget in excess of ÂŁ1bn, delivering local and regional specialist services for more than 1.5 million patients every year. Virtually every medical treatment and service is provided at Leeds Teaching Hospitals. This range and complexity, coupled with strong academic and research experience, means that LTHT is recognised as a centre of excellence in many areas on both the national and international stage. In common with all NHS organisations, LTHT faces an on-going challenge to ensure the best possible level of patient care within a demanding financial environment. To continue to be successful, the Trust has recognised the need not only to be efficient, but to develop innovative solutions to win additional nonNHS income for the benefit of overall patient care. The international reputation of Leeds Teaching Hospitals means that the very broad range of skills and expertise on hand in the Trust are valuable assets. To many healthcare services abroad, working with hospitals the size of LTHT, and the NHS generally, can enable them to make a step-change in the quality and efficiency of their own services. With strong support from the Board and Executive team, LTHT has identified the development of international commercial opportunities as a key strategic aim and has already been successful in some key areas. In 2013 we identified the prestigious King Hussein Cancer Center (KHCC) in Jordan as looking to develop international partnerships, particularly in advance of their imminent major expansion. Led by the Chair of Leeds Teaching Hospitals, a senior team

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from the Trust travelled to Jordan for what turned out to be, a highly successful visit. A strong relationship was established with senior officials, including the Jordanian Royal Family. A reciprocal visit to Leeds Teaching Hospitals was made by the Jordanian delegation, headed by HRH Princess Ghida Talal. This was an opportunity to show the delegation the highly-innovative Leeds Cancer Centre. Building upon the strong relationship we had now established between our two hospitals, a Memorandum of Understanding between Leeds Teaching Hospitals and the King Hussein Cancer Center was signed. The document is intended to underpin long-term collaboration between LTHT and KHCC. Initially, we have agreed to host a number of clinical fellowships and observerships. This will further strengthen the links between our two organisations and, since the posts are fully funded, there is tangible value for LTHT. More recently, we have been contracted to undertake breast cancer testing for KHCC and are exploring other opportunities within the field of genetics. Longer term, the strategic ambition of KHCH to grow their services in the Middle East may provide Leeds with further opportunities. Another example of success for Leeds Teaching Hospitals internationally comes from a series of

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Leeds Teaching Hospital

DAVID BERRIDGE FRCS (EDIN), FRCS (ENG), DM, FEBVS David has been a Consultant Vascular Surgeon at Leeds Teaching Hospitals for over 20 years, having worked at Queenâ&#x20AC;&#x2122;s Medical Centre, Nottingham, the Freeman Hospital, NewcastleUpon-Tyne and St Maryâ&#x20AC;&#x2122;s Hospital, London. As a member of Trust Board committees with responsibility for finance and performance, risk management, audit and quality, David works closely with executive and non-executive colleagues from across the organisation. David chairs the Trust Cancer Board, the Robotic Committee, Major Trauma Group and the Theatres Board. He also represents the Trust on a range of international, national and regional programmes, including the GS1 Scan4Safety Programme. In addition to responsibilities for the Trust, David has been a key driver in the development of relationships with Jordan, resulting in a Memorandum of Understanding with the King Hussein Cancer Centre, and the recent Oncology developments in Malta. Other developing relationships include those with India and Turkey.

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commercial deals won with Malta. Although it has been an independent country since 1964, Malta retains strong ties with Britain. In 2004 Malta joined the European Union, triggering a planned investment programme in much of the country’s infrastructure, including Healthcare. Part of this investment has seen the building of a new oncology hospital for the island to replace old and inadequate facilities. With substantial EU funding, the €48m Sir Anthony Mamo Oncology Centre (SAMOC) opened in 2015. In 2013 the Government of Malta placed an invitation to tender in the Official Journal of the European Union (OJEU), seeking bids from organisations to train their student medical physicists who would be vital to the success of the new Oncology Hospital. The training requirement is highly detailed, complex and requires organisations that have extensive knowledge of radiotherapy techniques as well as experience of installing and operating complex instruments, including linear accelerators (LINACS). The Maltese Government also required an organisation which had strong academic links. Consequentially, LTHT’s close working relationship with the University of Leeds was a key facilitating factor. The Leeds Cancer Centre has 12 linear accelerators (LINACS). This is one of the highest concentration of such complex and expensive machines in Europe. Uniquely, it includes two machines dedicated to research. The presence of such a large number of LINACS means that LTHT has built a highly experienced and competent team of medical physicists, radiotherapists and scientists. A successful bid was submitted and in July 2013 six medical physicist students from Malta commenced a 22 month training programme at LTHT. The following year we were successful in being awarded a second tranche of nine students, all of whom have recently concluded the demanding training programme. Leeds Teaching Hospitals Trust

is now recognised as a centre of excellence in the training of international medical physicists and we are actively seeking further opportunities in this area. Our relationship with Malta has subsequently developed into other areas, including nurse training. Moreover, in a significant step for the Trust, we submitted a proposal to carry out the commissioning of the three linear accelerators that were being installed in their new cancer centre. This is highly complex work, not only in calibrating the radiotherapy equipment but also integrating them and the attendant software into medical and patient pathways. There are very few organisations that have the depth of expertise and resources to carry out this type of work. However, as one of the largest cancer centres in the UK, LTHT is privileged to have a highly experienced team of scientists and technicians. Having won the contract, some of that

‘The international reputation of Leeds Teaching Hospitals means that the very broad range of skills and expertise we have in the Trust are valuable assets.’ team have spent a number of months travelling to Malta to carry out this work and in the process, have strengthened links which we expect will bring mutual benefit for many years to come. Working in conjunction with Healthcare UK, we have been exploring opportunities that will undoubtedly emerge in Turkey, where a major hospital building programme has been announced. The international reputation of LTHT led to an invitation for the Trust to speak at a Healthcare Summit in Istanbul, where we were able to showcase not only LTHT, but also the NHS generally. We have subsequently hosted a high level delegation from the Turkish Ministry of Health and were able to demonstrate the strength of the Trust across a very broad range of medical disciplines and services. Looking forward, we are receptive to new opportunities and are actively working with key partners, such as Healthcare UK, to develop this future pipeline. Projects in China and India are currently under consideration and we are confident in the Trust’s ability to continue delivering on the international stage.

Further information For more information about Leeds Teaching Hospitals NHS Trust please contact: David.Berridge@nhs.net, Deputy Chief Medical Officer or Roy.charlton@nhs.net, Head of Commercial. www.leedsth.nhs.uk

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NHS Trust

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Leeds Teaching Hospital

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Northumbria Healthcare Northumbria Healthcare

| Staff at Northumbria Healthcareâ&#x20AC;&#x2122;s new hospital at Cramlington

Innovative emergency medical care With new models of integrated and emergency care, education and training, Northumbria Healthcare NHS Foundation Trust is pioneering the next generation of integrated services across primary, acute, community and social care says Jack Ball

utside Europe in developing healthcare systems there is a growing demand to treat a greater number of patients with a limited supply of professional healthcare workers available. With over 65 years of clinical experience embedded within the NHS, there are huge opportunities for these developing healthcare systems to learn from the NHS as they resolve new challenges, build on best practices and avoid costly mistakes and clinical inefficiencies. One example of this success has been Northumbria Healthcare NHS Foundation Trust in the North of England which is leading the way nationally by providing integrated

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care and joining up primary, acute, community and social care services. The Trust is treating more patients outside of hospital, thereby alleviating pressure on hospital admissions whilst also continuing to provide exceptional levels of clinical care and training.

Specialist emergency care When an emergency makes hospital admittance an absolutely necessity, the Trust has pioneered a new model of emergency care. Built in 2015, the Northumbria Specialist Emergency Care Hospital in Cramlington is the first of its kind in England with emergency care consultants on site 24 hours a day, seven days a week in one purpose built facility. Specialists in a range of conditions also work seven days a week. â&#x20AC;&#x153;By travelling those few extra miles to Northumbria Specialist Emergency Hospital, those sick patients

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‘What we found was that we needed to shape our services around the needs of the patient, improve the patient experience and also free up unnecessary hospital admissions.’

Northumbria Healthcare

NHS Foundation Trust

can ensure that they are seen by the right people,” says Dr Jackie Gregson, an emergency medicine consultant based at the new facility. “It is these experts that can ultimately start their pathway of care much sooner than they can at the moment.” The reasoning behind the Trust’s new emergency care hospital is straightforward. Separating serious emergencies from planned and on-going care for non-emergency patients means levels of care will not be diminished by emergency patients whose care must always be prioritised. “From those first couple of hours onwards there will be a senior consultant involved in their care,” says Dr Chris Biggin, an emergency care consultant. “That’s very different to much of the care in the UK.” The Trust’s ambulatory care service at this new facility is also designed to reduce patient admission. Consultant-led with specialist nurse practitioners, the service provides medical care to patients on the same day as they arrive and aims to prevent a patient being admitted to a ward wherever possible. This can help free up bed space for serious cases that require prolonged care in hospital. “The service was set up because patients do not like being in hospital,” says Maria Towart, an ambulatory care nurse practitioner. “What we found was that we needed to shape our services around the needs of the patient, improve the patient experience and also free up unnecessary hospital admissions.” Northumbria Healthcare’s remaining general hospitals now focus on providing planned operations, procedures, tests, outpatient clinics and on-going care. “These hospitals will move to becoming centres for elective care and local community services,” says Trust CEO, David Evans.

‘By travelling those few extra miles to Northumbria Specialist Emergency Hospital, those sick patients can ensure that they are seen by the right people,’

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Northumbria Healthcare

The opening of the Northumbria Specialist Emergency Care Hospital and the redesigning of urgent care services at the Trust’s general hospitals marked the first phase of work to create a ‘primary and acute care system’ in Northumberland, introducing a new model of integrated care. This aims to make it even easier for people to access primary care through extended access to local doctors in the community via polyclinics. This will help to reduce reliance on hospital-based services and see the further development of integrated care across Northumberland to help to deliver healthcare locally and support patient’s wellbeing in their local communities. Northumbria is leading on this work for the NHS.

Excellence in clinical training Specialities in the Trust are extremely broad, ranging from obstetrics and gynaecology to paediatrics and anaesthetics. Comprehensive specialist departments including one of largest orthopaedics departments in the region also carry out thousands of elective and emergency operations each year. Given the superior clinical expertise contained in such facilities, opportunities for unrivalled access to superior medical education and training are abundant. Indeed, results from the General Medical Council’s 2014 national training survey indicated that the North East region was voted the top region in England for doctors’ training in trauma and orthopaedics. As part of their two year foundation training with Health Education North East, hundreds of junior doctors every year also join the Trust as part of the front of house emergency teams, back of house ward teams, working across various clinical environments. Moreover, the survey also ranked North Tyneside General Hospital’s trauma and orthopaedic training top in the country by its junior doctors. In terms of elderly patient care training, June 2014 saw the Trust open a state of the art facility designed primarily to support elderly patients who require inpatient support following illness; Haltwhistle War Memorial Hospital is part of the Trust’s £4.6m integrated health and social care scheme and is one of the first facilities of its kind in the country to provide hospital and social care support under one roof. The Trust’s specialist training centre at Hexham General Hospital also runs specialist courses in laparoscopic (keyhole) surgery to surgeons across the UK and Europe. This work is part of the Trust’s continued commitment to share its expertise within the wider NHS, as well as further afield in countries such as India, which could benefit substantially from the innovative work undertaken by the Trust.

Further information Contact Brenda Longstaff at internationalpartnerships@northumbria.nhs.uk www.northumbria.nhs.uk

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Carillion

Building hospitals involves bringing together the numerous stakeholders and components that not only make a successful facility, but ultimately guide a patient’s passage through their care pathway, says Mike Hobbs, Managing Director of Carillion Health

How to build a hospital

s one of the UK’s leading integrated support services companies, Carillion has huge construction capabilities and an extensive portfolio of Public Private Partnership projects including mental health and acute hospital facilities. Mike Hobbs, Managing Director of Carillion Health, is responsible for the strategic leadership of the health sector, including facilities management contracts for some of the UK’s leading teaching and district general hospitals. Carillion’s success in managing large, complex infrastructure projects such as hospitals is built not only on extensive experience, but also on how the team works with customers and construction partners from design stage to completion, understanding the patient care environment and clear programme management, believes Mike. “All too often we concentrate on a project being about the individual disciplines, rather than it being the sum of the parts,” he says. “From the moment someone has a great project idea it can take years for it to come to fruition, and during that process different stakeholders, different disciplines involved in the design, even in the construction, have different experiences and views. The key role that Carillion plays in developing healthcare facilities taking delivery risk of programme managing the multiple stakeholders.”

Shared understandings Timing is also an important factor. “The more enlightened customers come to market at the development of their project, when it’s still at inception stage. In the UK we have moved to a model that uses a process called competitive dialogue, where the bidders share their ideas with the customer and the customer dialogues with the bidder to come to a joint solution.” Mike believes this form of dialogue leads to longer term partnerships and shared understandings, whereas the more traditional tender race is more about a contractor putting a price on the project and winning it on that. “From a Carillion perspective and in the UK market, we are much more focused on a

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partnership approach which is more based around long term value to the customer, making sure they have a facility that opens on time, making sure they have a system that can be maintained and delivers best value throughout its whole life. We often focus on the construction cost, but that is a very small element of maintaining and running a hospital over its life of 30 to 50 years.”

Patient experience Carillion understands that the most critical factor to consider when building a hospital is the patient care environment. “Ultimately every aspect of what you do in a new hospital links to patient care,” says Mike, “and you rely on your customer and their clinical experts to help guide you on that.” Over the years, Carillion has developed a clear understanding of how patient flows operate, including the need to separate from a privacy and dignity point of view patients who are being moved around hospitals on beds and trolleys. As these flows are separated, infection control needs to be considered. Another consideration is economy of space and how much is given to corridors and communication spaces versus operating theatres and wards. Carillion understands all of these are competing tensions and priorities that need to be considered throughout the design process. Understanding the patient experience is another consideration. “The other thing we all too often forget is that patients take examples of how good

MIKE HOBBS Mike is the Managing Director for Carillion Health which provides health sector customers with a comprehensive range of built environment services including facilities management, construction and a range of other support services. His role includes strategic leadership of Carillion’s health sector activities in the UK and internationally. He joined Carillion in 2003 and led the development of health sector PPP, clinical and FM contracts both in the UK and internationally. Prior to joining Carillion he worked in a number of senior management roles in the NHS. Mike is a member of the Healthcare UK Governance Board.

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Infrastructure

Carillion

as well and comes into a different part of the risk equation. “Understanding that hospitals are not the same as office blocks or hotels is one of the key issues around understanding patient risk, and this should be a consideration from the first moment of design through to construction. For example, when the construction company puts in the duct work, you would hope they are sealing it up so there are no micro-organisms growing in it that might blow out when the first person has their operation. Some organisations bidding on cost might not be thinking through all of those protective infection measures, from the first piece of concrete poured on the site right the way through to handing it over to the operational phase.”

Facilities management

their care has been from far more basic things,” explains Mike. “They don’t understand clinical procedures; they do understand whether they could find the entrance, if the signage was good and if they could find their way around. It’s these design aspects of hospitals that people remember and use as proxies, quite often, for the quality of their whole hospital experience, including their clinical care.”

Managing safety risks Why can’t we produce ways for patients who find it difficult to eat because of swallowing disorders to still have a nutritional experience? I think we should be challenging chefs in hospitals to come up with ways of helping with that nutrition. Designing safely for safe construction is a core Carillion value. While financial risk is obviously an important factor in construction, Mike believes when it comes to healthcare, risk factor consideration should start with safety. “When building healthcare facilities some of the most flamboyant architectural designs we have seen over the years are actually very dangerous to build and maintain,” he says. “Designing safely for safe construction is very important, and it often has another benefit as it means the construction programme is shorter, which has a cost saving

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Southmead Hospital, Bristol

Carillion believes facilities management systems are another important factor that should start at the design stage of a project. Hotel services or ‘soft’ facilities management is increasingly playing more of a key role in patient support, and Mike believes facilities management staff need to understand they are part of the care team that have a direct impact on a patient’s hospital experience. “When a patient enters a hospital, quite often the first person they meet is a facilities management person, whether that is the receptionist or a porter. They are the people who give directions around a hospital and provide reassurance with a friendly conversation.” Often it’s the cleaner who is having the conversation around the patient’s bed, and at the same time is stopping the potential of infection.” Another important aspect of facilities management is catering. “When I go out to eat I don’t have a catering experience, I have a dining experience,” says Mike. “I see no reason why patients don’t deserve a dining experience in hospital. Why can’t patients order their food two hours before it is due to be served? If you order your food just before you are due to eat it, you are more likely to eat it.”

Industry-leading projects Carillion has worked on some of the most successful, industry-leading projects in the world including the William Osler Health System in Canada, the Al Jalila’s Children’s Hospital in Dubai, and St Bartholemew’s and John Radcliffe hospitals in the UK. “Another Carillion project, The Brunel Building at Southmead Hospital in Bristol, UK, has just celebrated its first anniversary. We actually had an eminent healthcare architect in the US who was involved on the customer side of the project, visit after about six months and comment that the UK has now got a hospital that should be on the grand tour of world acute hospitals that should be seen. That is testament, not just to what Carillion is achieving, but what the UK healthcare industry for acute hospital design and construction can achieve.”

Further information www.carillionplc.com

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Vanguard

Vanguard Healthcare’s Caribbean care mission continues Mobile healthcare facilities are an established part of the infrastructure of UK healthcare and are increasingly being used by hospitals across the continent. Now these mobile ﬂeets are being used in the Caribbean, says Norma Davies, Clinical Contracts Manager at Vanguard Healthcare

n the first issue of Global Opportunity Healthcare, Vanguard detailed the delivery of the high-tech facility to the Dutch Caribbean Island, Bonaire. Nine months later the unit has become an integral part of the local healthcare system. Vanguard is the leading supplier of mobile clinical and diagnostic facilities to the UK and Europe. The success of Vanguard’s work in the Netherlands caught the eye of staff at Bonaire’s only hospital, Hospital San Francisco, as they planned to refurbish their facility. In February the theatre unit was shipped direct from Rotterdam and was quickly supplying half of the clinical capacity of the remote island. Vanguard’s mobile facility has greatly improved the short-term prospects for the residents, patients and clinical staff on Bonaire – who were faced with the possibility of having to fly from the island in order

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to deliver or receive treatment. Instead Vanguard brought care to them. The high tech mobile theatre has been warmly received by consultants at the hospital. Being the island’s only theatre has meant that a wide range of procedures have been performed since the facilities arrival earlier in the year. Such variation is not a problem for the versatile unit which can be utilised for even highly invasive procedures such as joint replacements – thanks to the laminar flow ventilation system installed in the operating theatre. In fact a great number of hip and knee replacements have been carried out in the temporary facility. Since the unit’s arrival in February, over 570 procedures have taken place, including 117 orthopaedic procedures and 4 cardiology procedures. Given that Bonaire’s population is around 16,500; nearly 3.5 per cent of the islands residents have already received treatment in the Vanguard unit. Although Vanguard’s units are capable of providing a high quality clinical environment anywhere, they are typically configured for mild European climates,

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Infrastructure Vanguard not the hot and humid Caribbean. As such, special enabling work took place to ensure that airflow on the unit met the required clinical standards by adding further ventilation systems. Our facility has been well received by everyone here at Hospital San Francisco. The consultants have had no problems adapting to their new clinical setting and there has been an impressive flow of patients through the unit. The site team, who already have their hands full with the refurbishment, have gone out of their way to maintain the unit and the area in which it has been installed. Over the course of the contract we have established a close relationship with the hospital staff. We now have a really fantastic understanding of how to support them in delivering the best quality of care in this unique setting. Due to the remote location of the unit it has been very important that we keep regular contact with the hospital staff to keep ahead of any problems that might occur. It has been a great experience for the Vanguard staff who have been supporting the hospital and the islands population during the current refurbishment works and we look forward to continuing to do so. Tristan Botjes, Internal Project Coordinator at Hospital San Francisco said of the project: “As we are past the half year mark in using the Vanguard Healthcare Solutions facility it’s noticeable that it’s integrated in every aspect of the operating department. There is harmony in patient logistics, the procedures and supportive services. The exterior actually gets cleaned every week to make sure our rough climate won’t affect it, and we maintain a clean/sterile first impression when patients arrive. We do feel it comforts a patient when you arrive at a facility that is in prime condition. In a way Vanguard and Bonaire are connected to each other for life now. On the streets you meet people who speak of their experiences before and after a procedure and some even show off their child who was born in it (up to now we’ve had 20

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NORMA DAVIES Norma Davies qualified as a nurse in Northern Ireland and spent the following 36 years working for the NHS in Plymouth, joining Derriford Hospital in 1975 and leaving as a senior staff nurse in January 2001. After leaving the NHS, Norma semi-retired with her husband to a holiday home in Britanny, France, but, missing her job, she returned to full time work, joining the Vanguard team as a theatre crew member in 2004. Norma became a Clinical Contracts Manager in 2007, overseeing the clinical commissioning and training of Vanguard’s units and staff.

births in the unit!). On the other side, the technicians and Vanguard staff begin messaging weeks before the planned maintenance, feeling joy of coming to Bonaire and seeing the hospital staff. I actually think it was the raw enthusiasm and unconditional interest of the Vanguard staff that gave us the confidence in the early stages of the project to take flight; they have now proven that their care goes beyond the theatre. So although we are operating in a harsh climate, and with construction all around, we feel comfortable to work on the future of operating facilities through a strong partnership that protects the continuity of a vital service.” With growing patient demand across Europe, the ability to quickly improve access to services is vital. With this highly successful partnership in the Caribbean, Vanguard Healthcare has proved that its facilities are able to deliver on-demand capacity – whenever and wherever the need arises.

Further information www.vanguardhs.com

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International Hospitals Group

| Raising the quality of China’s health care IHG has been working in China since 2012 and has major projects in development, says Ralph Dando, Development Director at International Hospitals Group

nternational Hospitals Group (IHG) is a British company founded in 1978 and is the most experienced international healthcare company in the world, having successfully completed over 470 projects in 52 countries in both the private and public healthcare sectors. IHG’s clients have included 24 governments, the United Nations, The World Bank, the US Armed Forces, the Saudi Armed Forces and the International Finance Corporation. In November 2015 IHG was delighted to be elected on to the executive board of the new UK International Healthcare Management Association (UKIHMA).

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IHG with support from Healthcare UK, UKTI and CBBC has been working in China since 2012 and has six major health and wellness projects under development, including two under its joint venture company formed in 2014 with a division of China National Railway Company (CREC), for The Sun Valley International Hospital and to develop 200,000 sq metres of residential development – focused on the over 65 market. CREC (China Railway and Engineering Company) a Chinese State Owned Enterprise. It is the 6th largest company in China with 2.2 million employees and revenues of over $80bn. Since 2012 CREC has been invested $1.2bn in a hiqh-quality, low density 20 sq km site for a new leisure, residential, health care/elderly care and commercial development for over 170,000 residents, 15 km from downtown Guiyang and 6 km from the airport. Major new high speed rail links (e.g., Hong Kong

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Infrastructure four hours opened August 2014, Chongqing one hour in 2015, Kunming and Changsha 2016) are being implemented to connect new major new markets to a site with an excellent climate, unspoilt countryside and low pollution. CREC has been given the responsibility to create “The National Healthcare and Senior Care Demonstration Project for China” in its 51 hectare Sun Valley Project within the 20 sq km project. When completed, this project is expected to be replicated around China. IHG and CREC have finalised a Joint Venture agreement to implement part of this development with two anchor projects. (i) a high end residential project and (ii) a leading international hospital with the ability to add further facilities and services on a phased basis.

International Hospitals Group RALPH DANDO Ralph is the Development Director at International Hospitals Group and Vice Chairman of the newly formed UK International Healthcare Management Association (UKIHMA). A chartered civil engineer and lawyer by training, he has over 25 years experience in Development, Project and Construction Management of complex projects, including major teaching hospitals in Europe, Middle & Far East and Africa. He is responsible for all pre-construction activity on IHG’s hospital projects and is currently Project Director for the Qingdao International Hospital being developed with Wanda at their Qingdao Oriental Movie Metropolis in China.

Pooling resourcest

Left: SunValley Below: SAMHIC meeting

On 12th May, 2015, IHG became the first international company to be invited to join China’s premier medical alliance of China’s top businesses involved in healthcare. SAMHIC (Strategic Alliance of Medical and Health in China) was established in Beijing in 2013 to consolidate the strengths in the healthcare sector of several of China’s top private sector companies. Taking advantage of government policy designed to expand and reform the whole healthcare sector, 15 entrepreneurs, led by four of China’s most prestigious entrepreneurs: Liu Yonghao of the New Hope Group, Feng Lun of Vantone, Chen Dongsheng of Taikang Life and Weng Guoliang of Vanhal all agreed to pool their medical technology and expertise, capital and real estate resources. By integrating resources, coordinating cooperation between enterprises, and conducting active dialogue with government departments, the Alliance has since co-invested in training, new technology and funds for significant projects. In March 2015 Chinese Prime Minister, Li Keqiang, at a meeting with SAMHIC Chairman Liu Yonghao, acknowledged the importance of the role that the Alliance is playing to raise the quality and standards

of China’s health industry as a whole, and pledged his full support. In September 2015 IHG signed a 10 year exclusive agreement with Wanda Group, China’s largest commercial property company, which is owned by Chairman Wang Jianlin (China’s wealthiest businessman) to be their partner on all their hospital developments worldwide. In October 2015 IHG and Wanda Group announced the building of a new 200 bed IHG hospital in Qingdao, Eastern China. Opening in 2018 it will be managed by IHG until 2038.

Staying connected IHG has a number of Strategic Partnerships with some of the world’s leading hospitals operating within the UK’s National Health Service (NHS) including the Royal Free. Working with these Strategic Partners enables IHG to deliver the expertise and experience of these major healthcare brands and organisations as part of its offer to clients in China. Medical practice evolves at an ever-faster rate, and many Chinese hospital administrators and physicians have not found it easy to stay connected with international developments. Notably, aside from cash compensation many quality Chinese physicians cite ‘international training opportunities’ as a key priority in their own career development. IHG is partnering with leading UK and Chinabased institutions to facilitate clinical training for China-based administrators and care providers. These collaborations will involve web-based and in-person opportunities, including training at leading UK hospitals. UK institutions also have interest in learning from their Chinese colleagues, and we expect these exchanges to be bilateral. Training courses will be starting in the summer of 2016.

Further information www.ihg.co.uk www.ihg.cn.com

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Elior

Delivering on Corporate Social Responsibility through nutrition

Fresh ingredients and less emphasis on sugary snacks has been a popular initiative at Eliorâ&#x20AC;&#x2122;s staff and visitor hospital eateries, says Robin Givens, National Sales Director, Elior 178

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orporate Social Responsibility is high on the agenda of every organisation. The ultimate purpose of the Department of Health is to improve health and well-being and in doing so achieve better health, better care, and better value for all. There is a clear synergy between being socially responsible and providing healthy eating options. One means by which public, private hospitals and care homes can deliver on Corporate Social Responsibility is by providing healthy nutritional eating options to staff, patients and visitors. As a leading contract caterer, Elior Group understands the importance of its role in ensuring the food used is sourced and delivered to customers responsibly and healthy eating is encouraged. It is

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Infrastructure an international contract catering company formed in 1991 which has become a major player in the contract catering and related services sector, serving 3.8 million customers in 13 countries. In the UK, there are 11,000 Elior people working on 650 client sites with an increasing presence in the healthcare sector. Elior has launched an innovative programme called ‘You & Life’ which underpins its philosophy on health and wellbeing. It lays out its approach to the responsible and sustainable delivery of healthy, safe and great tasting food. The programme focuses on sourcing specific products that would reflect and deliver on the nutritional values promoted by ‘You & Life’. Any dish labelled with this mark has to meet specific healthy eating criteria to ensure consumers get great food, confident of the ingredients included. The concept was highly commended at the Health and Vitality Honours Awards in 2014. Whether in the private sector hospital environment or serving visitors and staff within the NHS, the focus is on putting their customers first and promoting the healthy eating concept. Elior is thus an ideal partner to help any healthcare organisation to achieve their Corporate Social Responsibility objectives.

Healthy eating The company is increasing its market share in the healthcare sector and uses various initiatives to promote healthy eating in hospitals. The Group has enriched its offers of cafes, restaurants and retail outlets open throughout the day for hospital visitors, patients and staff, who are looking for a convenient food solution in a pleasant and relaxing atmosphere. Elior provides catering services for staff and visitors at the two hospitals run by the Nottingham University Hospitals Trust. Two restaurants and ten cafés are operated at the Queens Medical Centre (1,300 beds and 6,000 employees) and City Hospital. The offer at these facilities encompasses a mix of main-street, in-house brands and high street inspired food concepts with 20 per cent of all concept dishes being focused upon the ‘You and Life’ health dishes. Surveys undertaken by both Elior and Carillion at both hospitals scored over 90 per cent, with comments on the improvement of the menu, food standards and the overall look and feel of the restaurants. Some specific initiatives to promote healthy eating which have been adopted in Nottingham include: l Promotion of Red Tractor, home-made and fair trade products which has resulted in the hospital achieving Gold Soil Association Status. This Catering Mark provides an independent endorsement that food providers are taking steps to improve the food they serve, using fresh ingredients which are free from trans fats, harmful additives and GM, and better for animal welfare l Second ‘veg’ for free promotions whereby customers receive an additional portion of vegetables free of charge l Over 25 per cent of products in vending machines are classified as ‘healthy eating’ products l Pop Chips are promoted as an alternative to

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Elior

ROBIN GIVENS Robin Givens joined Elior in 2008, bringing with him extensive UK and International business development experience gained in senior positons within the catering industry. Initially responsible for new business in the city of London, Robin has since developed winning value propositions within the Defence and Healthcare markets. Having aligned the B&I and Defence retail operational solutions, he has been instrumental in taking retail services into new markets. Robin was appointed National Sales Director in 2014, with the responsibility of overseeing strategic growth across all Elior’s business sectors.

crisps. Pop Chips are un-fried potatoes having all the flavour but half the fat of a normal fried crisp brands. Rice cakes have also been introduced which are fat free and low in calories l Fruit is placed in a prominent position at all till points as a substitute for chocolate bars. One World fair trade Products (including flapjacks & brownies) is also offered as an alternative. By buying items from the One World bakery range Elior are supporting growers thousands of miles away. The fair trade mark ensures that growers receive a price above the cost of production for their products which means they have money to reinvest in their businesses l The provision of sugary drinks on offer has also been reduced. 500ml bottles of Coca Cola Original are being replaced with products such as Coke Life that contains a third less sugar and a third fewer calories than Coca Cola original. These measures are replicated in other hospitals where there is an Elior presence including hospitals within the Barts NHS Trust in London. The result of promoting healthier ranges has not had a negative impact and has in fact resulted in increased sales. The favourable feedback received from customers demonstrates that Elior is helping its clients in the healthcare sector to achieve their Corporate Social Responsibility targets by providing healthy, nutritional eating options.

Further information www.elior.co.uk

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Weqas

| Injecting quality into global healthcare As the delivery of healthcare changes worldwide, Weqasâ&#x20AC;&#x2122;s unique approach provides a complete diagnostic service, says Annette Thomas, Director of Weqas

edical diagnostics constitutes around 2 per cent of the global healthcare spend and yet contributes to 70 per cent of the clinical decisions made in healthcare. In the UK alone, NHS Pathology services respond to roughly 200 million requests a year. Laboratory medicine plays an integral role in healthcare, especially in the clinical decision making process, disease diagnosis and management. The delivery of healthcare is changing worldwide with innovative technologies, digital healthcare and alternative healthcare delivery programmes, moving diagnostic testing away from the centralised laboratory setting and much closer to the patient. Weqas provides a specialist service in Laboratory Medicine to monitor and improve performance, assist with compliance to International standards and help deliver world class services that are accurate, reliable and safe.

Weqas services With over 40 years of experience and accredited to International Standards, ISO/ IEC 17043 and 17025, we are the provider of choice for Clinical Laboratory Quality Assurance Support. For laboratories, we provide a sharp focus on quality and maintaining accreditation to ISO 15189, and are a preferred partner of the in-vitro diagnostics industry in provision of bespoke Quality Control Material for diagnostic tests.

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The Weqas organisation provides services in four distinct sectors with appropriate cross support from one to another to allow a synergistic range of services to the customer.

Weqas Managed Point of Care Testing Services Unlike other providers, our vast experience and unique approach to strengthening the Quality Assurance framework in Point of Care Testing (POCT) has successfully secured our position as the leading provider. POCT is defined as tests designed to be performed at, or close to, the site of patient care by non-laboratory trained healthcare professionals. Ensuring the quality of POCT encompasses many aspects: selection and evaluation of equipment to ensure â&#x20AC;&#x153;fitness for clinical purposeâ&#x20AC;?, the appropriate training and competency assessment of all users, implementation of a robust quality management system, including risk assessment, performance

EQA services for Laboratory Medicine and Point of Care Testing

Material production IQC and EQA

Surrogate patient samples, clinically designed to span the analytical and 27000 sites registered pathological ranges for internationally for a range of anaytes. performance management Accurate, independent, across 31 clinical EQA commutable and schemes Education Reference stable and Training Laboratory Annual conference, Accredited, JCTLM scientific seminars, training listed laboratory. days, training guides, report Reference targets interpretation, presentations, with Traceability and clinical cases Uncertainty for the global harmonisation of Pathology results

Pharma monitoring and clinical audit. Participation in an accredited External Quality Assessment Programme can provide valuable information on the performance of the device and reassurance of user competencies. Every month, Weqas distributes 35,000 POCT samples for glucose and ketones testing alone. Weqas services are tailored to our clients’ needs, offering a managed service to a devolved support service entwined with a strong customer care ethos. Weqas training programmes provide robust competency training modules, offered to the POCT manager/co-ordinator and for the end user within the clinical setting. The training can be tailored to suit the individual needs and are offered as webbased or via face-to-face seminars. For sites without the services of a POCT manager, our managed service option provides complete oversight of the EQA process. For each institution (hospital or clinic) Weqas will manage the POCT EQA website for the client. Weqas will process the data for all the clients’ devices (or users), and provide a summary of the institution’s performance at the close of the EQA cycle. Any devices (or users) with unsatisfactory performance or non compliance are highlighted using a simple “traffic light system”. Weqas will dispatch individual performance reports to each of the clinical areas, including contacting the sites that have not returned a result. A follow up trouble shooting service providing WHAT WE DO repeat samples, advice and l Liquid clinical samples, ready to use guidance is provided by the lO nline support experienced Weqas team. lA dministrator Management Support With effective communication l ISO 22870 compliance the clinical sites are given the l Network Performance Reports tools required to ensure the l Training and education POCT service offered to the patient is of the best standard. POCT SCHEMES At Weqas customer care takes l Glucose and Ketones high priority and where possible l HbA1c we will tailor our service to meet l Lipids and Glucose the customer’s requirements. l Urinalysis l Cardiac Markers Global healthcare POCT l Bilirubin best practice l Blood Gases and Co-oximetry Internationally, Weqas is l Urine Pregnancy Testing successfully supporting l Haemoglobin the implementation of Point l INR of Care Testing (POCT) as an l Creatinine alternative to laboratory-based l Drugs of Abuse diagnostic services, by working l Pre-term Labour Markers closely with policy makers l CRP to ensure robust regulatory l HIV frameworks are implemented and are evidence-based, clinically effective, and safe. Healthcare practitioners and providers have a duty to ensure the quality of care is evidence-based practice, and that patients and service users are provided with effective treatment and care, based on national and international best practice guidelines. By prioritising both access and quality, investing in health information and communication technologies, there is no reason why remote patient care delivery models cannot deliver safe diagnostic metrics. When used appropriately,

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Weqas

ANNETTE THOMAS Annette Thomas is a Consultant Clinical Biochemist at Cardiff and Vale UHB with over 30 years experience in Laboratory Medicine, 20 years of which has been in the quality of diagnostics as Director of Weqas. She is also the Clinical Lead for POCT for Cardiff and Vale UHB, representing POCT in Welsh Government Advisory Committees and chair the “All Wales” POCT Co-ordinators Group. She is a past Executive Board member of European Committee for External Quality Assurance Programmes in Laboratory Medicine (EQALM) and chairs the National Audit Committee in Clinical Biochemistry in the UK. She is also a member of the Association for Clinical Biochemistry Scientific Committee, a member of the International Federation of Clinical Chemistry Committee on Analytical Quality (IFCC C-CA) and a member of the European Federation in Laboratory Medicine Working Group on Performance Specifications for EQAS.

POCT can improve patient outcome by providing a faster result and a shorter time-frame to therapeutic interventions, improved patient compliance with treatment, treatment optimisation, fewer hospital visits, increased patient satisfaction, improved outcome and less likelihood of complications and reduced overall cost.

Why choose Weqas The Market Leaders in EQA and IQC. Accurate, reliable and safe. l ISO accredited against standards 17043 (Proficiency Testing EQA), ISO 17025 (Calibration & Testing Laboratories) and ISO 15195 (Reference Measurement Laboratories) l Can assist to compliance to International Standards l T raining: Weqas has a wealth of experience within EQA and POCT, our training sessions allow us to communicate our expertise to people within the industry. The training sessions are tailored to suit the individual requirements of the customer. Training documents are supplied by Weqas; the training can be web-based, performed over the telephone or face-to-face if a more direct approach is required. We will adapt to suit your needs. l EQA Review: Weqas offers easy-to-read reports, using the traffic light system. If a device returns a poor result, performance surveillance can either be undertaken by Weqas or by the POCT Manager. For sites that are non compliant (e.g. if no result was returned) and show poor performance, (e.g. if the results were outside the acceptable limits) reports are generated immediately after each cycle. The reports allow the POCT Manager and the clinical site to quickly see the performance of each area. l Excellent customer care with the service tailored to your needs.

Further information www.weqas.com

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Premier IT

| Continuing Professional Development (CPD) is critical, not least of all in healthcare as Simon Monkman, Director at Premier IT tells Jack Ball

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Digital

Premier IT

SIMON MONKMAN Simon Monkman is the Managing Director at Premier IT – the Westminster-based software house that lead the UK market on all things relating to the appraisal, education and revalidation of healthcare staff. Simon has a career spanning leisure and retail operations for a number of blue-chip companies and the Ministry of Defence but has found the last ten years working alongside the NHS as his most rewarding. As he puts it, “Providing effective software solutions to healthcare professionals that desperately need and prefer to be patient-facing gives huge satisfaction and wonderful motivation.”

edical research and development is constantly providing newer and more effective methods of care for all members of the healthcare industry. Continuing Professional Development (CPD) allows healthcare professionals to build on their expertise and skills on a rolling basis, so that every patient under their supervision can be assured they are receiving the highest standards of benchmarked care. A key player in the healthcare industry’s CPD programme, Premier IT, has come to expand their remit into appraisal, revalidation, and education services. The company now boasts over 200 healthcare clients across the primary care, secondary care and independent healthcare landscape as partners in appraisal and revalidation services for the nation’s doctors, nurses and care support workers. They include leading UK NHS Trusts, independent hospital groups, clinical commissioning groups (CCGs), area teams, medical staffing agencies and Medical Royal Colleges. “Premier IT started about ten years ago, working with some of the Medical Royal Colleges. They were looking to develop e-portfolios around CPD to enable and capture more effective learning. Revalidation was then developed on a platform of learning, training and development needs with an online system that is tangible and can be captured,” Simon explains. “We were probably the pioneers of the very first comprehensive and absolutely validated online system that enabled doctors and specialist career-grade doctors to revalidate, a process that proved they were fit to practice safely.” In short, the revalidation system allows doctors and other healthcare professionals to engage in a series of submissions, on a rolling basis, as well as patient and colleague feedback to ensure that they are trained to the highest possible level to an agreed benchmarked standard of excellence.

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Premier IT

Digital “Revalidation is a five year cycle for doctors,” explains Simon. “On a regular basis, within that five years, doctors would be expected to collect evidence through a multi-source feedback tool, which is driven through our portal. They can collect ratings from up to 20 patients and up to 15 and 20 colleagues, giving them excellent objective as well as granular feedback on their performance. Although some of them don’t like the process, it’s absolutely spot on and their appraiser will use that evidence to have a truly informed conversation about what they might be able to do to improve their working practice.”

E-learning Although this system began as a simple appraisal and revalidation tool, it soon expanded to integrate with other e-learning platforms to create a holistic view of workforce performance within one portal. “Along the journey of appraisal and feedback, doctors, nurses and allied health professionals are able to identify where there are gaps in knowledge,” says Simon. “We can then integrate this with various e-learning tools to blend all the required e-learning together. They can then learn and be educated online within the same portal. Any subsequent submission for appraisal will show not only that there was there a skills gap, but that there was the online education to respond to it.”

Premier IT

Raising standards internationally With some overseas developing healthcare systems still struggling to pinpoint areas of weakness or improvement, the company is now looking to further market its software internationally. “It’s often the case that organisations actually don’t know what their training needs are,” says Simon. “So we have to start with a self audit to understand exactly where the bar is in terms of staff performance and what they need to do to raise standards to meet this agreed level of care.” It is at this point where Premier IT can make a tangible difference by providing a truly configurable solution, particularly if they are advising a brand new facility on their staffing and training needs. “We can help such organisations conduct those audits and show where that initial benchmark sits. If there are no previous systems in place then we can provide the tools to enable their professionals to improve their performance, and enable managers in their organisation to report on how those performances can grow and develop over time.” This process of self-appraisal to formulate organisational benchmarks of care, where one can evaluate individual performance, is also supported by universally applicable questions within the company’s appraisal software. “It’s important to note that everything we do is validated by panels of advisors and experts,” says Simon. “So we’ve got some really strong guidelines about the questions that can be asked and, as you can expect, the rules and regulations are quite stringent. However, these questions allow the user to understand very quickly how they’re doing, and more importantly, how their colleagues and patients think they’re doing.” “Their answers come back in the form of a report, and we join up various elements and actions. We also suggest an online plan to help them improve upon their skills. Should e-learning and training be required, then a system of blended learning is already on hand to help plug any knowledge gaps.” With overseas healthcare organisations looking to UK organisations and the NHS in particular, Simon is confident in Premier IT’s future role in helping to internationalise the universal standards of excellence expected from both the NHS and the UK more generally. “Over time, Premier IT systems will help overseas organisations reach the UK standards and levels,” says Simon. “Our systems are suitably configurable so users can switch on and off elements to make it their own system, unique to them. They are also sufficiently broad enough that you can narrow them down, enabling us to tune in to the real needs of an organisation.”

Further information revalidation.premierit.com

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11 Health

From patient to entrepreneur Michael Seres describes how his own frustrations with colostomy bags led to the development of ground-breaking app Ostom-i Alert

t the age of 12 I was diagnosed with the incurable bowel condition Crohn’s disease. I had multiple surgeries and in 2011 became the 11th patient in the UK to undergo a rare intestinal transplant. As part of that transplant I had a procedure known as an ileostomy, which is where part of your bowel is basically brought to the outside of your body and your waste is collected in a bag known as a stoma bag or a colostomy or ileostomy bag. The problem with that procedure is you lose control of one of the very things you take for granted every day – when you go to the toilet. And not just that. Your clinicians and doctors want to know the volume of output because that determines how your gut is functioning, how your bowels are reacting, and the only way of doing that at that time was to manually empty your bags into jugs. I tried to find some technology that may help me but there was none. So I decided to have a go at making my own. I bought some parts off eBay, watched some YouTube videos, and hacked together a sensor while I was in hospital. That sensor ended up becoming a device getting CE-marked regulatory clearance both here and in the US, and becoming the connective device Ostom-i Alert that we have now.

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In simple terms, Ostom-i Alert is a sensitive device that clips onto the outside of any medical bag. It senses a change of resistance in the bag when output forms and sends that signal via Bluetooth to your mobile phone. On your phone you have a free app that allows you to set multiple alarms to alert you as your bag is filling. So you avoid embarrassing leaks, spills and accidents. From a clinical perspective Ostom-i Alert also captures that output data as volume, stores it in the Cloud and allows your doctors and clinicians to remotely monitor you. Patients with stomas have big issues with dehydration and electrolyte loss because they can’t manage their output, which means that readmission rates are very high. By remotely monitoring, we’ve been able to reduce readmissions and improve patient self-management. My journey from cobbling together a flexible sensor strip from a Nintendo Wii glove, and a

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Digital 11 Health Blackberry battery, to launching a CE-marked device wasn’t quite as easy as it sounds. To turn my clunky hack into a proper device that could be used by patients I needed two things: investment and someone who believed in the project and would take it forward.

Patient-led innovation So, in Dragon’s Den style, I met as many people as I could until I found a lovely guy, Adam Bloom, who invested and together we formed 11 Health. Adam took a real gamble on me, because I was just a patient hacking a product, and there are many regulatory hurdles you need to overcome to get a device marketable, including CE marking, MRHA and FDA clearance. It took us about nine or ten months to go through those regulatory clearances. Once we got through that, we were a year down the line. During that time, we’d done some product testing with patients. We’d also visited America and spoken to the largest community of stoma patients. I used social media too, to find out whether my needs were the same as other patients around the world, and whether my product really made sense to them. The focus of our business, right from the beginning, was patient-led innovation. And because we’d been out talking to them, we picked up momentum very quickly in the patient community; they knew that this was a new technology that could help improve their lives. We also learnt that patients wanted to know if their doctors knew about it, so our product needed to have endorsement from doctors. This meant that we needed to change tack a little bit and work with major centres. Unfortunately, at the moment, the UK doesn’t have as strong a technology path to consumers as the US. So initially our growth has been in the US, where we’ve managed to get the device embedded into major hospital centres

MICHAEL SERES A healthcare social media speaker, adviser, and author born in London, Michael was diagnosed at 12 with Crohn’s Disease. He studied law & politics at LSE before surgery interrupted his studies. After 20 operations and intestinal failure, Michael underwent a rare small bowel transplant in the UK. Prior to transplant, Michael started blogging. His blog is now the official patient blog of the Intestinal Transplant Association. Michael serves on the executive committee of Oxford Transplant Foundation. He is the patient spokesperson for national quality food standards in NHS hospitals. Michael builds online patient communities through social media (facebook. com/groups/bdoneglobalfamily/) and launched the #IBDChat. He’s a Executive board member and Patientin-Residence at Stanford MedicineX.

such as Mayo Clinic, Stanford Cleveland clinic and Massachusetts General. They’ve started to use the device and prescribe it to patients when they go home. Now we’re working with NHS England and the drug tariff to enable the device to be prescribed over in the UK too. Right now we’ve got about 500 units out on the market, the bulk of which are in the US. But we’re just hitting a tipping point where it’s becoming a product that doctors are happy to start prescribing and advising. In the UK there are about 120,000130,000 patients with a stoma, and about 11,000 new patients a year are joining them. In the US there are around 2,200,000 new surgeries a year, so our focus as a business is to get the device embedded in hospital care, so when you go in for that surgery it’s part of your treatment. Once we do that, we think that the business will scale up. The future is looking very bright for Ostom-i Alert, which is exciting as it was never designed to be a business; it was designed to be a product to help myself and then other patients to improve quality of life. We see this product as a connected medical device, and stoma care and ostomy are simply the first bags that the device is attached to. Next year we will go into urology and lay catheter bags and drainage bags – this product can be used on any bag that requires measurement of volume and is used by patients in a hospital or in a home setting. Ultimately we would to be part of the standard of care after surgery for any person that has a bag attached to their body or part of their body. We want our technology to help improve the quality of their life – just as it has transformed mine. I can’t think of a better business goal than that.

Further information www.11Health.com

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eIntergrity

e-learning is now the most accessible format for medical education, allowing students to study any time and any place, says Dr Julia Moore OBE, Founder Chair of eIntegrity and National Director, e-Learning for Healthcare

Top Marks I

ncreasingly sophisticated technology and the rise of the internet have compelled radical changes in the way medical training is delivered to healthcare professionals around the world. At the forefront of this revolution is e-learning, which offers the most flexible, instantly accessible programmes of study to students in clinical environments worldwide. The benefits of e-learning have generated huge demand, especially when delivered through the internet via Learning Management Systems. The LMS market worldwide is expected to grow to over $7bn by 2018 from $2.55bn in 20131. The value of e-learning to individuals and organisations is that it saves money and time, helping them to achieve more for less. It can be blended with other ways of learning and updated instantly. e-learning via the web is also incredibly flexible for users. Busy health and social care professionals who learn through our LMS-based programmes can study at home, in work or on the move. Our eIntegrity e-learning programmes provide 24/7, instant access to educational curricula, advice and current thinking. As well as being convenient, e-learning also minimises the time lost delivering care to patients while healthcare professionals are training.

Written by clinicians for clinicians The advantages of e-learning are legion but finding the right programme can be difficult. A lot of generic e-learning is available globally but eIntegrity is

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one of only a few companies to offer large learning programmes mapped to training curricula. The quality and breadth of our content is a key differentiator. eIntegrity is absolutely focused on supporting the quality of care in the UK National Health Service (NHS) and its world-class experts back up the development of our content. The UK’s medical Royal Colleges and other professional bodies create all our content through our partnership with Health Education England’s e-Learning for Healthcare (e-LfH) programme. HEE is responsible for the education and training of all 1.8 million people working in the NHS. Today, the e-learning we provide is in use by 500,000 NHS clinicians who face the patient every day. As well as those in permanent clinical practice, trainees also use it to support specialist subject training and their professional development.

NHS content goes global The UK’s healthcare training is the gold standard others follow and many nations aim to mirror the country’s achievements. With e-learning from eIntegrity, they now can. Through us, non-NHS organisations across the world can benefit from the UK’s investment in e-learning for healthcare. As more and better quality content is created for our programmes, it is automatically made available to the international market. eIntegrity now licenses more than 30 individual programmes to over 35 countries including Australia, New Zealand, Europe, the Middle East, India, Africa, South East Asia, USA, Canada and South America. Even more countries will benefit as we expand into new markets. To achieve a wider presence globally we are working closely with UK Trade & Investment (UKTI) and several different selling partners across the globe. Renaissance in India,

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Digital for example, is just one ally that has provided eIntegrity with a foothold there.

Making our material relevant Our in-demand programmes range from clinical subjects such as acute medicine to other parts of a clinician’s training including compliance, such as safeguarding children, radiation and laser safety. How do we make all these programmes relevant to different global regions? We have a major advantage: the sheer breadth of eIntegrity’s programmes in terms of number of specialist relevant programmes and the quality of the content, including multimedia. We can create tailored learning paths through our material that gives organisations the power to identify which particular learning section is most relevant to them. This can be blended with existing learning resources, bolstering our national quality assured content with locally relevant material to create a comprehensive solution to training and continuing professional development needs. The e-learning programmes can be widely used as part of training programmes that blend classroom and distance learning. However, the web-based nature of the programmes means they are particularly well suited to training health professionals who would otherwise have to travel large distances for traditional training.

eIntegrity

IN-DEMAND LEARNING PROGRAMMES eIntegrity programmes cover more than 30 specialities, including:  Advanced radio  Anaesthesia  Child health and safeguarding  Dentistry  Dermatology  Electronic Fetal Monitoring  End of life care  General Practice  Radiology  Sexual and reproductive health  Ultrasound. e-Learning for Anaesthesia (e-LA) is one of eIntegrity’s largest and most in-demand programmes. It has won many national and international awards for providing training that meets different learning styles, designed for a workforce with limited flexibility to train.

Speed, adaptability and relevance Crucially, the important link between HEE and eIntegrity is that all our content is written and peerreviewed regularly by practising clinicians and doctors in the UK who know what learners need and the standards required. It’s their professional bodies that quality-assure the content nationally. This continuous updating combined with the ease of publishing online is driving up standards and also means eIntegrity’s programmes are more up-to-date than professionally printed materials could possibly be. Recently, we made changes to one of our programmes within 48 hours of regulations being revised. This would have been impossible to achieve with a book, which is 10 years out of date before you get it to market. Another benefit with eIntegrity is the interactivity of the content, which draws trainers and learners

DR JULIA MOORE OBE FRCA MBA FRCPATH HON MRCR Julia Moore is Founder Chair of eIntegrity and National Director, e-Learning for Healthcare and a Consultant Anaesthetist. In 2004, she led the development and delivery of R-ITI, the award-winning e-learning project for radiology. R-ITI’s successes enabled Julia to establish the nationally funded e-Learning for Healthcare programme (www.e-lfh.org. uk) and its commercial partner eIntegrity (www.eintegrity.org), stimulating a UK-wide commitment to e-learning in health and social care. The programmes work in partnership with UK professional bodies to develop nationally quality assured, curriculum based e-learning to support healthcare training across the UK and drive improvements in patient care, winning multiple national and international awards.

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The Radiology – Integrated Training Initiative (R-ITI) is also a wide-ranging programme, offering more than 800 interactive sessions covering the UK radiology curriculum. Another high-quality resource is Online General Practitioner (GP) training. e-GP covers all aspects of primary care for trainees but it is also ideal for qualified physicians who want to refresh their skills and knowledge. As well as clinical subjects, eIntegrity’s programmes cover important parts of a clinician’s training, including compliance matters. These courses are critically important to organisations’ accreditation and for keeping employees up to date with regulations.

through the material using animation, videos, audio clips and self-assessment questions to embed learning. One of our users in the United States described eIntegrity’s e-learning as “awesome” after experiencing our image interpretation programme. I think that says it all. To make the content even more relevant, real-life case studies are often presented to users so they can see how their decisions compare to experts’. The electronic fetal monitoring programme case study for obstetricians and midwives is one example. Our quality content is supported by selfassessment and formative assessment to ensure knowledge is retained. Consistent checks are made to see whether users have understood the work, so a deep understanding is fostered.

Unmatchable award-winning combination If you ally the level of clinical input with the skills and expertise that e-Learning for Healthcare and eIntegrity have developed in creating fantastic content, you’ll see why we’re in use in 35 countries. There is no programme that is as large as ours in healthcare, with outstanding quality resulting in a raft of national and international awards for all aspects of e-learning. With the UK government driving its Digital by Default programme, e-learning through digital is increasingly the norm. Given the quality and content we provide, eIntegrity programmes should be the first ones that organisations consider when deciding to make that initial leap into digital training. 1

http://elearningindustry.com/elearning-statistics-and-facts-for-2015

Further information To discover our entire range, please visit our website: http://www.eintegrity.org Or to discuss options for licensing, email enquiries@ eintegrity.org

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Vernacare

Reducing the risk Reducing the risk of bacterial cross contamination in hospitals is a global problem, and Vernacare’s single use bedpan systems could be a global solutions says Emma Sheldon, Global Marketing Director at Vernacare globalopportunityhealthcare.com

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ernacare is a leading infection control organisation whose innovative single-use system and award winning products have made it a global leader in human waste management across the healthcare sector. Pioneered more than 50 years ago, Vernacare’s single use system has evolved alongside the NHS and is currently used in 96 per cent of UK hospitals. The system comprises of a human waste receptacle and a disposal unit which greatly reduces the risk of cross-infection, nursing time, and the environmental and cost impact of the alternative re-usable systems. “So many pathogens are transmitted through human waste,” explains Emma Sheldon, Global Marketing Manager at Vernacare. “When you’re using a bedpan, a urinal, or one of those products, they’re very high-risk products to have the risk of cross-contamination from. So replacing it with Vernacare’s single use product can make a really big difference.” Vernacare produces around 150m units per year, manufactured to the highest standards. The single-use receptacles are made from clean overissued newspapers which are recycled into usable containers in a process that involves being broken down into fine pulp and adding wax, before being heated to very high temperatures for sterilisation. Although the Vernacare system is widely used in countries such as Australia, Canada, Singapore and the US, many hospitals around the world still use re-usable bedpan washer systems that carry a higher risk of cross-contamination to the patient. This may occur when re-usable bedpans are not washed in temperatures high enough to kill pathogens such as C. diff or VRE. Using singleuse products reduces this risk because once the receptacle is used by the patient, it is disposed of

Vernacare

Industry Practices in a safe, hygienic and environmentally friendly way. “We believe we can offer something that is really gold standard, to help reduce the risk of cross-contamination,” says Emma. “We are serial innovators and we’re constantly innovating patent protected products to improve what’s gone before. “One recent example is historically there wasn’t a female urinal that could be provided in a single use paper product such as ours, that’s comfortable enough and can contain enough fluid to use. Now that we’ve launched one the response has been quite emotional in the way it’s helped female patients to retain dignity in toileting themselves in hospital, and it’s all done without the risk of cross contamination as well as reducing the risk of catheter-associated infections. It’s really rewarding to make innovations in what are sometimes neglected areas.”

Overseas markets Vernacare has a strong presence in international markets such as Australia and Canada which have similar ward-based systems to the UK. Many of the nurses who work in these wards also have experience working in UK hospitals and have grown up with the Vernacare system. Gaining real traction in other markets required careful research, so Vernacare worked with UKTI to shortlist ten countries that were growing markets interested in reducing the risk of infection, and which Vernacare believed would receive the product well. One of these new markets is Singapore, and Emma explains how Vernacare approached it very differently to those it had worked with before.

Vernacare

EMMA SHELDON Emma Sheldon is Group Marketing Director for UK medical products manufacturer Vernacare - responsible for leading marketing and market access activities across 48 countries and six continents. She has led the implementation of a new international expansion strategy, resulting in significant export growth and opening up new markets in southern Asia, the Middle East and across Europe.

‘In the NHS we know that we’re talking to nurses who carry out patient care, but in overseas markets it might not always be the nurses delivering the care,’

“We made sure our marketing materials were localised; our sales people were there in the market to support any hospital that wanted to get the system on board, and we had a great success converting 16 per cent of the Singapore market within a year which was a significant difference. The whole team has really pulled together to get those sales in, and now it’s also pulling together to sell into other markets. China is a market we’re really focused on, India is another market where we’ve got flagship hospitals that are currently trialling the system very successfully. We’re also focused on entering the French market too.”

UKTI partnerships “Research, research, research was a huge learning curve for us,” admits Emma. “Knowing the market, knowing the people in it, and working alongside others, not just putting everything on our own shoulders, and talking to people like UKTI, Healthcare UK, UK India Business Council; all of those people are really valuable partners and without them I think we’d be a lot further behind than we are.” Emma goes on to explain how UKTI can help businesses that wish to expand their markets overseas. “UKTI North West has created the Export Champions programme, which Vernacare is part of, supporting business-to-business relationships to help others benefit from exporting. We believe that by exporting, ultimately we are sharing the risk of one market not performing compared to another, and our business will be more resilient because of it. So the more businesses that export, the better.” UKTI and Healthcare UK have also helped expose Vernacare to more opportunities. “We’ve travelled to China six times in the last year, and

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Vernacare

Industry Practices

Vernacare

every time relationships have grown,” says Emma. “We’ve signed a memorandum of understanding for £10m with an organisation called Sinophi Healthcare which is a really positive move. I think you’ve got to understand who the players are and who to talk to, and I’d just encourage people to take the time to do that.” Effective training and support is another crucial factor in achieving success in overseas markets. The broad range of experience and expertise of those who carry out patient care, and language and cultural differences are all separate challenges that need to be overcome. “In the NHS we know that we’re talking to nurses who carry out patient care, but in overseas markets it might not always be the nurses delivering the care, it might be the family members, so we’re going through an extra line of training,” explains Emma. “So we have to change our educational materials, we have to make sure they’re very visual in nature, and we have to make sure that the benefits for the family and the patient are clearly expressed.”

Sustainable pricing Another factor that Emma believes is important in rolling out products overseas is mass marketisation. “We always try to have a realistic price,” she explains. “The products we sell to the NHS are used very regularly; they become the ‘bread and butter’ of a hospital because once a hospital has converted to it, it’s a critical product that has to be used every day. We want it to be sustainable and affordable, which means sustainable and affordable pricing across the UK and in the markets we want to enter. “We believe that when you’re comparing our system to the lifetime acquisition costs of bedpan washers, which is the system we’re competing against, we’ll save money for that hospital every time.” Vernacare recognises it has competition in the market. However it believes its constant innovation, 50-year experience working closely with the NHS, and high quality of manufacturing makes it a far better, safer choice than other producers. “There are already cheaper alternatives appearing on the market, but nobody provides the whole system together and nobody is innovating to the same extent or with the same experience that we have,” says Emma. “It’s such a critical area; you really need the expertise. Just to have a manufacturing site that produces a product is a world away from having an expert team who know how to convert hospitals through a transformational change is really important. “The Vernacare System is often specified into new-builds, so we’re working with new build specifiers, architects, and designers to get our systems into the new build hospitals. Looking ahead, we’d like to work with training providers that are already embedded into hospitals so staff and patients can be trained to use Vernacare products in that way.”

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‘The products we sell to the NHS are used very regularly; they become the ‘bread and butter’ of a hospital.’ Vernacare sees itself as part of the fabric of the NHS and, looking ahead, would like to work with other businesses that also work closely alongside the NHS, creating and exporting opportunities and working together to deliver those opportunities. “In the next 10 years we want to grow our business in key healthcare economies across the world; we want to make sure that we’re the standard that’s used, and we want to help healthcare facilities to reduce their risk of cross-contamination,” says Emma. “It’s a scary world out there, we hear scary news about antimicrobial resistance, and our system is a valuable weapon in helping reduce the risk of cross-contamination worldwide.”

Further information Email: info@vernacare.com Twitter @VernacareOffice www.vernacare.com

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Olympus

Clear focus Manufacturers of advanced medical equipment are facing increased pressure to supply more advanced products and innovative models of procurement to NHS and private medical institutions, Stephen Shaw, Regional Sales Manager at Olympus Medical tells Jack Ball

NHS Trust Partnerships As a major provider to the NHS, that has committed itself to make nearly £22bn of efficiency savings by 2020, Olympus has been forced to innovate new financial models and methods for NHS hospitals to acquire new equipment, whilst simultaneously replacing some of their ageing equipment and facilities. “With NHS trust deficits looming and austerity measures beginning to impact the efficiency of many frontline services, Olympus’ latest medical equipment strives to ensure the best possible efficiencies in healthcare to benefit clinicians and patients alike,” says Stephen Shaw, Regional Sales Manager at Olympus Medical. “Many of the issues that the NHS are facing are becoming our issues. So we’re consistently looking to innovate and collaborate solutions that facilitate a

t is no secret that the NHS continues to face the heaviest fiscal constraints since its inception in 1948. Yet the British public’s expectations of care delivered by medical practitioners from both the NHS and private healthcare sectors consistently continues to rise. And it’s not just the medical staff that are under such pressure. Through reports like the 2015 ‘Review of Operational Productivity in NHS providers’, also known as the ‘Carter Report’, the UK Government has explicitly outlined the role of medical suppliers such as Olympus Medical in ensuring the most efficient provision of universal healthcare by the NHS. As a leading manufacturer of digital and optical equipment for intricate endoscopic procedures like colonoscopies, gastroscopies and laparoscopies, Olympus Medical supplies pioneering technology that shape the future of healthcare provision within the UK.

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Industry Practices continuation of the NHS in providing better quality of care,” he says. “They are being pushed to do more with less and we have to be very sensitive to that.” Partnerships between NHS trusts and Olympus are designed to ensure that the digital and optical equipment supplied is used in the most efficient way throughout an entire operational lifetime. With equipment designed for use in a variety of specialist areas such as bariatrics, hepatology, colorectal and urology, Olympus staff are trained to the very highest level on the products they supply. The company’s maintenance agreements with NHS trusts have therefore matured beyond a strict ‘point of sale’ relationship. “Our role now includes arriving first thing in the morning, when the surgery starts and accompanying the surgeon and the surrounding circulatory scrub team to ensure they’re absolutely proficient on the

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Olympus

STEPHEN SHAW Stephen Shaw is the Regional Sales Manager within the Strategic Development Division of Olympus Medical UK. During his 18 year career he has worked and managed commercially in both medical and surgical healthcare markets within the primary, secondary and private care sectors. Stephen has a strong history on delivering improvements in operational efficiency and breaking down barriers between organisations and services. His role within the Strategic Division operates in implementing changes in how services are provided across organisational and commercial boundaries.

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Olympus

| technologically advanced equipment that we supply” says Stephen. “These mutual collaborations with NHS clinicians ensure all parties continue to improve and develop as their partnerships deepen.”

King’s College NHS Trust This collaboration has been taken even further with King’s College NHS Trust. The Trust intended to replace 15 surgical imaging camera systems used for laparoscopic surgery, some endoscopic equipment for colonoscopies and gastroscopies, and were also looking to invest in Olympus’ new integrated theatres. As with any technologically advanced machinery, it remains impossible to guarantee 100 per cent operational reliability. Yet as part of its contract, Olympus provided a 98 per cent guarantee on equipment to ensure that King’s service and procedures would not be hindered by any issues with Olympus equipment.

‘Focus must be on how these products are funded, taking into account the lifetime costs of the equipment and how that can be replaced in a managed way over an agreed period of time.’

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Whilst their equipment boasts an impressive reliability record, Olympus has developed an innovative solution to reduce possible disruption from potential equipment failure. “We have provided an on-site technician who is able to ‘respond immediately and fix it at the first point,” Stephen says. “If a procedure is taking place and an item of equipment fails, they are nearby to rectify the situation.”

Changing Models of Procurement Such innovative solutions are indicators of a shifting business model that is being rolled out across the company. “We can now use our speciality and skillset in the procurement setting to provide discounts, efficiency savings and equipment savings across the entire contractual term,” says Stephen. “NHS Trusts are still being driven by the demands for high quality care from patients who insist on the best treatment and equipment. However we are no longer in the scenario where we demonstrate our new equipment to a surgeon or lead endoscopist, gain their approval and subsequently sell to them at point of purchase,” he continues. “Focus must be on how these products are funded, taking into account the lifetime costs of the equipment and how that can be replaced in a managed way over an agreed period of time. It’s very much in our interest to work collaboratively with trusts to provide financial efficiencies and reduce some of the waste in spend and procurement that we’ve previously seen.”

Next Generation Technology

While evolving models of procurement ensure continuing partnerships with NHS trusts, Olympus are not resting on their laurels. “We’re acutely aware that we have to constantly evolve as a company. We know that if we’re not changing or adapting to the new clinical and surgical environment, we will be

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Industry Practices left behind,” Stephen admits. “This new environment requires constant technological innovation.” Through a collaboration with Sony, which is widely regarded as a leader of digital technology in the commercial market, Olympus has recently released the next generation of 3D integrated theatres with integrated revolutionary 4K display technologies. “This partnership has unified Sony’s expertise in technology and Olympus’s in optics to produce truly unique products like the 4K system that offers four times higher definition for unparalleled precision in surgery,” says Stephen. However, the challenges of developing 3D technology in medicine continue. “Getting 3D technology down a 10mm telescope is extremely complicated when ensuring adequate depth perception,” observes Stephen. To overcome these challenges, partnership with clinicians has once again proved critical. “We’ve worked with one of the leading UK 3D surgeons, Iain Jourdan at the Minimal Access Therapy Training Unit (MATTU), who has long been an advocate of 3D surgery and has published many studies that highlight the benefits of 3D surgery over

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Olympus

conventional 2D. It allows better depth perception, safer surgery and has recently been shown to flatten learning curves among trainee laparoscopic surgeons. Moreover, the benefits of 3D surgery extend beyond increased surgical safety and reduced infection rates. “Many of the benefits you get with integrated 3D theatres include turnaround times, which are generally quicker. When a patient leaves and another one enters theatre, you could probably save yourself 10-15 minutes per procedure,’ Stephen adds. These collaborative advancements in surgical technologies and equipment procurement are just some examples of Olympus’ continued innovation. Whilst the company continues to evolve, their remit remains the same as always. “We need to ensure that we are fully supporting our customers and our clinicians wherever possible,” concludes Stephen.

Further information www.olympus.co.uk/medical Twitter - @OlympusMedUIMEA

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Eschmann

Innovative operating tables set new levels in patient positioning, says George Kennedy, International Sales Director for Eschmann Equipment

Patient positioning

ho better to help with patient positioning in the operating theatre than a British company with over a century of experience? Established in 1830 Eschmann’s expertise and superior quality equipment is trusted by medical professionals throughout the world. Widely known for designing and manufacturing high quality operating tables, Eschmann also designs and manufactures surgical lights, mobile suction, electrosurgery products and benchtop autoclaves. All products are backed by a dedicated support team and a worldwide network of engineers trained exclusively by Eschmann.

Patient positioning in the operating theatre Operating tables are designed to safely support a patient during surgery and to provide optimum clinical access to the surgical site. In addition, the design needs to consider patient comfort, maintenance of normal physiology and protection of important structures. Operating tables should facilitate easy attachment of positioning accessories. They should be intuitive, easy to manoeuvre and adjust, x-ray compatible and provide adequate access for theatre equipment. This should all be underpinned with ease of operation and reliability. Modern operating tables such as the Eschmann TX200 can support substantial weight capacities of up to 450kg. Fully electric tables have an advantage over hydraulic tables as they provide greater accuracy in table positioning, smoother combined compound

movements and no potential for oil spills, which can expose the theatre team to carcinogens or slip hazards. These tables are capable of providing the extreme angles that are now required in modern surgery.

Supine position Probably the most commonly used position with the patient positioned on their back in a straight line from head to toe and legs slightly separated. Dependent on the type of surgery, arms may be secured at the side (including fingers and elbows) or secured onto an armboard with padded, non-conductive straps. The most common injuries associated with the supine position include backache and pressure sores. To minimise injury, pressure reducing or pressure relieving mattresses should be used in combination with gel support pads.

Trendelenburg position (Head Down) Using gravity to move the abdominal viscera away from the pelvic area, this position is frequently used during lower abdominal surgery. The table is typically put into a head down position and shoulder supports are used to prevent the patient from sliding on the tabletop. Operating table mattresses are also available with non-slip surfaces. The Trendelenburg position can cause difficulty when ventilating a patient due to increased pressures in the airway.

Chair position The chair position is typically used in shoulder surgery, plastic surgery and in some intracranial surgery. The patient’s arms must be secured to prevent falling or pressing against hard surfaces. The arms may rest on a large pillow in the patient’s lap with the elbows flexed at 90° or placed on armboards. Patient’s buttocks, elbows, knees,

Eschmann TX200 Trendelenburg Position (Head Down)

Supine Position

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Eschmann

GEORGE KENNEDY George Kennedy is the International Sales Director for Eschmann Equipment. He joined Eschmann in the spring of 2001 and has over a decade of experience with international sales, specialising in the Middle East, Asia Pacific and African territories.

Chair Position

heels and small of the back should be adequately padded using gel support pads.

Prone Position

Lithotomy position/Lloyd Davies Used extensively in gynaecology and obstetrics, lithotomy uses the supine position with the patient’s knees and hips flexed and the hips abducted to allow for access to the patient’s perineum. Typically a pair of leg holders such as the Eschmann direct placement leg holders (shown in the photograph) will be used to support the legs and feet. The Lloyd Davies position is similar to lithotomy with the patient’s legs lowered using a pair of direct placement leg holders. These leg holders mimic the natural movement of the hip, aiding easy and safe positioning whilst protecting the patient against neurovascular complications, post-operative back pain and pressure sores. This position is used extensively in urology, gynaecology and colorectal surgery. The most common injury associated with these positions is pressure sores to the heels. If in the head down position (Trendelenburg), there is also a risk of poor venous return from the lower extremities, pooling of blood in the pelvis, deep vein thrombosis and respiratory compromise.

Prone position The prone position is typically used in intracranial surgery, spinal surgery, colorectal surgery and Achilles tendon repair. The patient is positioned in the supine position and then turned onto their abdomen. Arms should be placed at their side or on armboards at less than a 90° angle at the shoulder with elbows flexed and palms facing downwards. The patient’s head should be in as near to neutral position as possible, with their forehead positioned on a headrest and gel support pad to prevent Lithotomy Position/ Lloyd Davies

Lateral Position

Eschmann has been supporting global healthcare for over 180 years.

The information contained in this article is for guidance only and the imagery has been taken to illustrate basic patient positioning only.

injuries to the eyes and allow airway access. If the patient cannot be positioned such that their toes hang over the end of the table, a gel support pad should be placed under the shins. Potential injuries in this position include respiratory restriction, corneal abrasions, injury to the supraorbital nerve and pressure sores. In the photograph the patient is positioned on a laminectomy pad to allow the diaphragm to move freely and the lungs to expand without restriction.

Lateral position This position is used during nephrectomies, thoracic, hip and shoulder surgery. The patient is placed operative side upwards with the lower leg flexed and the upper leg straight with a pillow placed between the legs and padding under the knee, ankle and foot of the dependent leg. The patient’s upper arm should be secured on a padded armboard in front of the patient and the lower arm flexed and placed on a separate gel support pad. A headrest should be used to ensure the patient’s spine is correctly aligned. A gel head support should be used to support the head and it is important to ensure the ear is not folded over. Lateral supports should be used to support the patient. These should be adequately padded with gel support pads.

Further information Tel: 44 1903 753322 Fax: 44 1903 875789 Email: export@eschmann.co.uk www.eschmann.co.uk

Eschmann Direct Placement Leg Holders

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NHCIC

Developing mobile technology and big data products is just part of the pioneering work undertaken by British consortium Nine Health

Supporting the Healthcare Consortium UK

ine Health CIC is a national and international not for profit Community Interest Company (a social enterprise) created from within the NHS to improve health and wellbeing by accelerating the development and use of innovative technology for patient and public benefit in health and social care. We are a UK NHS data intermediary for Data Services (Big Data, Semantics) and digitalisation; Research and Governance. We support patients,Â professionals, commercials and others through innovative technology product and service development. Nine Health CIC and Nine Health UK Ltd (a new trading arm created to enable our expansion into the Middle East and Asia and to attract more investment in technology development and delivery into new markets) are commercial research partners with a number of EU universities and part of a network of Chinese and UK Universities. We are developing big data products and services, including one of the first intelligent diagnostic primary care IT systems in China with our partners Lantone Technology Company. We are ensuring that remote wearable and mobile sensors and devices link into central information systems and generate clinical data e.g. blood pressure readings, ECG, foetal heart, dementia monitoring and older care. We help develop new mobile technology e.g. remote games for rehabilitation, sensor monitoring systems and collect, flow and process clinical data in the design of SMART clinical buildings (care homes/hospitals) and cities using technologies to create state of the art facilities. We are working with partners, for example the Mitac International Corporation, to ensure that state of the art secure, sterilisable mobile tablets are the central hub of some of our remote services. The tablets are complete clinical workstations and can fit in a pocket. They can have a number of features

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Designed for healthcare integrated barcode scanner and cameras. Antimicrobial. Hot swap battery for uninterrupted use. l Secure Supports access control using smartcard authentication with in-built NFC reader and HF RFID tag reader. Optional MDM solutions. l Connected anywhere Redundant connectivity with 3G*, WiFi and BluetoothÂŽ 4.0 + EDR. l Robust design IP67 ingression protection, 1.2 metre drop resistant and MIL-STD-810G compliant. Nine Health has existing experience of processing millions of health records for clinical research purposes and is already starting to work with Chinese universities and companies in the development of this field. A data partner on a major EU programme, the Virtual Physiological Human across eight countries we are taking the tools and techniques developed below into operational systems to enable machines to process vast quantities of data automatically. l

Further information Information about the Virtual Physiological Human â&#x20AC;&#x201C;Share can be found at www.vph-share.eu and information about more projects using this Insilico Medicine modeling can be found here http:// insigneo.org/

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Industry Practices NHCIC

THE VIRTUAL PHYSIOLOGICAL HUMAN–SHARE PROGRAMME We work with a consortium of companies and others: THE UNIVERSITY OF BRADFORD The collaboration between Dr Peng of Bradford University, Nine Health and other members of Consortium uses the innovative big data approaches/solutions for smart digital healthcare. The advances of the big data approaches are raised from the integration of the human genome data, clinical data, healthcare data, and wearable sensor data. The goal of this big data integration is to achieve optimal management for personalised healthcare and to enhance the safety of clinical practice. Our advanced big data technology can effectively apply to build innovative solutions for smart cities and communities. DWA ARCHITECTS Established in 1988, DWA Architects has become one of the UK’s leading multi-disciplinary Chartered Architects and Design Studios, dealing with a wide range of projects throughout the UK, the Middle East & North Africa, Russia and China. DWA Architects offers the benefits of a fully integrated professional service for the specialist design of Elderly Care projects. The practice has an award winning and highly regarded expertise across all types of Elderly Person Care Homes and Post-Hospital Care environments, Assisted Living facilities and Specialist Elderly Care Village developments within the UK and internationally.

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Our work in China is supported by our Partners, TLD Design Consulting of Beijing. We have recently completed a master plan design for a major Elderly Care and Specialist Assisted Living Village Project in Shunde, Guangdong Province, China which will serve the needs of approximately 750 elderly people across high needs Nursing and Dementia Care and will also provide 450 Specialist Independent and Assisted Living apartments for elderly people. ANNIE BARR INTERNATIONAL We provide high quality training, accredited by the Royal College of General Practitioners, for healthcare professionals in elderly care, primary and secondary care. To date we have trained over 8,000 healthcare professionals across three continents, and always ensure that our training is tailored to a country’s guidelines, culture and healthcare needs. To view some examples of courses we can offer, or to contact us to find out how we can develop training that is specific to your needs, please visit www.anniebarr.com/training/

Further information Contact: Elaine Taylor-Whilde Tel: +44 (0)845 467 3790 www.ninecic.org.uk To speak directly with someone from MiTac please contact Julian Stone Tel: +44[0]7720 090222 Email: Julian.stone@mio.com

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Royal College of Physicians

Setting higher standards The RCP is a world leader in postgraduate medical education and enjoys long standing partnerships with medical institutions around the world, says Mairi McConnochie, Head of International Affairs, Royal College of Physicians

he UKâ&#x20AC;&#x2122;s medical royal colleges and faculties play an essential role in improving patient care through maintaining the highest possible standards of medical education and training. They are also membership bodies which represent and support their members, and advise the government, the media and the public on health matters. The Academy of Medical Royal Colleges was established in 1974 to promote, and where appropriate, coordinate the work of its member colleges and faculties. Established in 1518, the Royal College of

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Physicians London (RCP) is one of the UKâ&#x20AC;&#x2122;s longest established colleges with a membership of over 30,000 doctors in more than 80 countries. In addition to supporting these members throughout their careers, the RCP supports global efforts to improve standards of care through the delivery of a range of capacity-development projects and the provision of consultancy services in high, middle and low-income countries.

Globally recognised examinations The RCP, the Royal College of Physicians of Edinburgh and the Royal College of Physicians and Surgeons of Glasgow (collectively known as the Federation of Royal Colleges of Physicians of the UK) work together to develop and deliver written and clinical examinations to over 20,000 candidates a year in more than 40 countries around

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Training & Education the world. The Membership of the Royal Colleges of Physicians (MRCP(UK)) Diploma and 12 Specialty Certificate Examinations test the skills, knowledge and behaviour of doctors in training and act as an international benchmark. The RCP also houses the National Clinical Guideline Centre (NCGC) – a collaboration between the RCP and other royal colleges which produces evidence based clinical practice guidelines on behalf of the UK’s National Institute for Health and Care Excellence (NICE).

Royal College of Physicians

MAIRI MCCONNOCHIE Mairi McConnochie is the RCP’s Head of International Affairs, responsible for developing strategy and identifying opportunities for international collaboration.

Supporting doctors to train in the UK

training for senior consultants nationally and internationally. In 2015, programmes were delivered in Iceland, Malaysia, Switzerland and the US.

Through its Medical Training Initiative (MTI), the RCP enables international medical graduates to work and train within a UK trust for up to two years before returning to their home country. The RCP’s role is to interview applicants and match successful candidates to posts in the UK, while facilitating General Medical Council (GMC) registration and visa sponsorship. The RCP then supports MTI doctors by providing an induction to practising in the UK and organising an annual symposium. The programme has grown steadily since its establishment in 2009 – there are now nearly 270 junior doctors working in the UK on RCP-arranged placements.

Rehabilitation medicine consultancy, China

An RCP team is is working with a private healthcare provider to deliver training on the provision of rehabilitation services ahead of the opening of a new rehabilitation hospital in Tianjin. Clinical training in West Africa

International partnerships Recent collaborations include: Faculty development programmes

The RCP delivers a range of faculty development programmes in the UK and internationally. Its wide portfolio of expertise includes topics such as teaching and learning in clinical and non-clinical settings, supervision, assessment in the workplace, feedback and supporting the underperforming trainee. There is a major focus on clinical leadership and provision of leadership programmes for doctors in all specialties, delivering bespoke leadership

Opposite: M-PACT clinical skills training course, Dakar Below: MRCP(UK) PACES training, Yangon

The Millennium Development Goal 6 Partnership for African Clinical Training (M-PACT) is a threeyear collaboration with the West African College of Physicians (WACP) and funded by the Togo-based Ecobank Foundation. The project supports the focus of the United Nations’ Millennium Development Goal 6 (‘combat HIV/AIDs, malaria and other diseases’) by increasing access to high quality clinical training on managing these diseases. By the end of 2017, RCP and WACP volunteers will have established 5 training centres in Nigeria, Ghana, Senegal and Sierra Leone, and delivered 18 training courses reaching more than 500 physicians. Supporting a new college in East Africa

An RCP team is supporting a group of senior doctors from East, Central and Southern Africa (ECSA) as they work to establish a much-needed college of physicians for the region. The East, Central and Southern Africa College of Physicians will address the lack of access to welltrained doctors and differing standards of medical education by implementing a new, internationallyrecognised postgraduate medical qualification to supplement the number of doctors currently being trained, and establishing a network of accredited training centres – primarily hospitals serving rural populations. Training at the first pilot sites is set to start in 2017. The RCP team is providing mentorship, technical support and access to a range of experts on curriculum development, strategic planning and fundraising.

Further information Interested in working with the RCP? Please email international@rcplondon.ac.uk. www.rcplondon.ac.uk

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Occupational English Test

Language confidence Good communication skills are vital to ensure safety and quality in healthcare. And as demand for healthcare professionals grows, so too does the need to ensure an increasingly global workforce has a proven standard of healthcare-specific language proficiency, says Simon Beeston, Director of Cambridge English Language Assessment

he number of healthcare professionals signing up to the Occupational English Test (OET) is rising – and with good reason. OET is a standardised test that has been specifically designed to assess the English language and communication skills of healthcare professionals. The test is accepted by the majority of regulatory healthcare boards and councils in Australia, New Zealand and Singapore and is used by many other organisations, including hospitals, universities and employers as evidence of a candidate’s ability to communicate effectively in English-speaking healthcare settings. Simon Beeston, Director of the majority owner of OET, Cambridge English Language Assessment,

explains why the test is increasingly popular. “At some level if you are going to be successful in healthcare you will need to be able to communicate in English. Wherever you go in the world, very often the operating medium is English, whether for research purposes, management, meetings or working with patients. The purpose of OET has always been to ensure patient safety and quality of care. If you can’t communicate effectively with your patients or can’t understand what they’re trying to say to you, it’s impossible to look after them effectively and the potential for making errors becomes significant.”

A reliable and secure test OET is developed in Melbourne, Australia. The content is created and tested by experienced test developers, healthcare professionals and assessment experts, including Cambridge English Language Assessment, to ensure it is relevant, upto-date and technically correct.

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Training & Education OET is also highly secure. Candidates undergo a rigorous ID check on registration and on test day, and there is a strict code of practice for storage and transportation of test materials. All tests are then assessed in Melbourne by trained assessors using double marking and statistical analysis to ensure results are accurate and fair. “As an organisation, Cambridge English Language Assessment has more than 2,000 people working on a range of assessments. We have been running for over 100 years and undoubtedly have a pedigree in terms of understanding educational measurement and assessment processes. This underpins the quality of the value proposition that OET offers in the healthcare sector, and the combination of the two is very powerful,” Beeston explains.

Occupational English Test

SIMON BEESTON Simon has worked in education for 35 years, first as a teacher and teacher trainer, before moving into language assessment and educational measurement. He has held roles in the private sector leading digital learning projects, as well as in international publishing where he developed both the technology and the content for an online computer adaptive English language test. His current role at Cambridge Assessment is leading a team responsible for the delivery of international admissions tests for a number of disciplines including undergraduate medicine, and he has overall responsibility for the Occupational English Test (OET) on which he works closely with the OET CEO Sujata Stead.

OET subtests OET is divided into four subsets – reading, writing, speaking and listening – and offers tests for 12 professions, including dentistry, dietetics, medicine, nursing, occupational therapy, optometry, pharmacy, physiotherapy, podiatry, radiography, speech pathology and veterinary science. “An interesting feature of OET is that the speaking and writing tests are profession specific while the reading and listening tests use general

healthcare scenarios. The listening test involves note taking on a recorded professional consultation and a range of questions on a health-related talk recording. A speaking test could be a patient-doctor role play where the candidate is the qualified doctor and an interlocutor plays the role of the patient or carer with a particular concern,” says Beeston. He continues, “What’s important to note, is that

OET TESTS WRITING, SPEAKING, READING AND LISTENING SKILLS USING REAL HEALTHCARE SCENARIOS.

WRITING (45 min) Writing a professionspecific letter of referral or discharge; or a letter to inform or advise a patient, carer or group.

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SPEAKING (20 min) Profession-specific scenario role-plays with an interlocutor who plays the part of a patient, relative or carer.

READING (60 min) Completion of a healthrelated summary paragraph and multiple choice questions on a longer health-related text.

LISTENING (50 min) Note-taking on a recorded professional consultation and a range of questions on a healthrelated recordings.

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Occupational English Test

CASE STUDY

Ma-Annjit Singh qualified as a nurse in the Philippines, graduating from Our Lady of Fatima University (OLFU). With four years of postgraduate clinical nursing experience under her belt, she migrated to Australia on a student visa with the aim gaining registration as a nurse. Ma-Annjit took the OET test before enrolling in a bridging programme, the Initial Registration for Overseas Nurses course, and says the skills she acquired through OET made the course much easier. “The scenarios used in the OET test gave me a glimpse into different ways of communicating so I knew what to expect. For example, documents are written in a different way in the Philippines,” she said. On graduation from the bridging course, Ma-Annjit gained her Australian nursing registration with the help of her OET results. The Nursing and Midwifery Council of Australia accepts a minimum of 4 B’s in all subtests as proof of English proficiency to register and work as a nurse in Australia. “I’m working as an agency nurse until I get permanent residency, and I’m very confident that the way I’m communicating is correct. OET gave us scenarios that we really do use and it made the transition to working in Australia much easier.”

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Training & Education

the test uses vocabulary, scenarios and skills that the candidate will use in their professional career. In the writing test, candidates are asked to write, for example, a letter of referral on a specific scenario. Use of these real scenarios show why the test is so relevant to the healthcare sector.”

Support materials OET also provides a wide range of preparation support materials, many of which are free of charge. Candidates can access free resources such as a masterclass webinar, free practice resources and free preparation packs. They can buy preparation books from OET and sign up for an online course with a personalised feedback session on writing and speaking as well. Preparation is offered by private training providers who offer face-to-face courses and digital training, ensuring candidates have access to a wealth of support to help build skills that are vital in the workplace and assessed in the test. OET has also made it as easy as possible for candidates to access the test. With online registration, OET has more than 70 test centres in over 30 countries. Candidates can take the test up to 12 times per year, and benefit from the uniform experience provided by trained invigilators and professionals able to run the test efficiently and effectively.

Occupational English Test

Ageing populations and chronic health conditions have caused skill shortages in countries such as the UK, Australia and New Zealand, and foreigntrained healthcare professionals are needed to fill the gap. There is also a growing need for healthcare professionals in medical tourism destinations to be proficient in English, and OET is seeing interest from healthcare providers from the most popular destinations in the Middle East and Asia. As Simon Beeston notes, “Typically, our candidates have graduated in a healthcare profession such as medicine or nursing in countries like India or the Philippines and want to work in New Zealand, Australia or Singapore. Healthcare regulators in those countries usually stipulate a minimum of four Bs in OET to pass the English language requirements for registration. It is crucial for them to be able to pass this test so that they can work and practise in their trained healthcare profession. And, OET is also accepted by the Australian Department of Immigration for all visa categories so applicants only have to take one test to get registration and a visa to work there.” Increasingly, OET is being used by healthcare educators as a minimum entry requirement for language proficiency. Healthcare educators are also exploring embedding OET preparation and testing into healthcare courses to ensure students have work-ready language skills. Embedding OET creates a contextualised learning environment where students learn English based on the healthcare course content. For example, during a unit on asthma management, English is taught using a scenario involving asthma. This generates greater student engagement and development of English skills directly related to their chosen profession.

Leading experts OET is underpinned by 30 years of research by the University of Melbourne and supported by the validation department at Cambridge English Language Assessment. A number of studies have shown that OET prepares candidates to communicate in an English-speaking healthcare setting, and that OET test takers are perceived as effective communicators by colleagues and stakeholders. As the test uses real healthcare scenarios, many test takers recommend it to health professionals because they know the subject matter well and that makes them feel more confident on test day. “We invest time and money to ensure the test is up to date, relevant, valid and reliable, and we’re proud of the high quality assessment we can provide through OET,” Beeston concludes.

Who is taking OET? The number of candidates taking OET has doubled since 2013, and there has been an increasing demand for healthcare professionals for several years, especially in English-speaking countries.

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Further information www.occupationalenglishtest.org/global-opportunity

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| Maintaining standards

QHA Trent

Training & Education

QHA Trent

Independent accreditation can help ensure healthcare providers are genuinely ﬁt for purpose and standards are maintained at home and around the world, says QHA Trent’s Professor Stephen Green

ealthcare has a long history of international collaboration and assistance. It is in everyone’s interests for health standards to be maintained across the globe and while international patients can come to the UK to receive top quality health care, this is not financially viable for all. It is therefore important that the standards of medical and ethical practice in local facilities around the world are kept at an appropriate level. Independent accreditation can help ensure that a “UK standard of care” is brought to the people around the world and enable people to be confident that the healthcare provider they are using is genuinely capable of dealing with their requirements. In the USA the system of healthcare accreditation is currently much more recognisable than it is in the UK. With the majority of health providers working privately, patients and purchasers of healthcare services (e.g. insurance companies) in the USA require a stamp of approval from a genuinely independent accreditation organisation to confirm that their care will be of a high and recognisable standard. QHA Trent is a UK based organisation that delivers this type of accreditation service to international health providers. It uses British-based standards and medical expertise to assist and engage with organisations worldwide that are seeking approval as a mark of standard and as a way of improving their own service. It aspires to be a completely independent and impartial company that seeks to establish whether healthcare provider establishments are genuinely safe and fit for purpose. In the UK, a somewhat similar service to accreditation is provided by a regulatory quango, the Care Quality Commission or CQC, which

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like the NHS is run by departments of the British Government. So there also exists room for independent healthcare accreditation companies to exist in the UK, providing another level of reassurance to international patients and third party payers (e.g. insurance companies) who are used to checking for such accreditation. “If, for example, you were working for a British embassy or an oil exploration company in West Africa and were having a baby, would your wife or partner have to fly back to the UK to best ensure a safe birth? Or could you do it safely there and if so, how would you know where you could do it safely?” explains Professor Green. “It can be extremely difficult for a person or organisation to assess objectively whether a healthcare provider is truly fit for purpose without some sort of yardstick , so in doing what we do we are trying to help raise standards of healthcare provision around the world. Once accredited, this is an indicator that a hospital or clinic is of a suitable level.” QHA Trent currently has a roster of around 50 volunteer surveyors who receive training and are sent abroad, most often during their own annual or study leave (or after retirement), to hospitals and clinics that have requested validation. The company has a policy of charging relatively nominal fees to cover costs, aiming to provide assistance for the many hospitals and clinics that do not have large budgets. “Medicine is one big universal family and we really do favour a collaborative approach between us and hospitals and clinics,” Professor Green says. “The surveyors benefit from new horizons as much as the hospitals and clinics do. We want to encourage the latter to be more adaptable and receptive to change, and to function ethically. We take a very hands-on approach, first looking at what they seek to do then offering advice. It is all about hospitals and clinics trying to be safer, ethical and more self-aware of what is going on in their organisation and beyond.” The ISQua-approved standards hospitals and clinics are referenced against multiple reputable British sources such as publications produced by the Royal Colleges, the UK’s Departments of Health and the Care Quality Commission, as well as universities, professional societies and scientific literature.

Further information www.qha-trent.co.uk

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The healthcare education market is becoming more global â&#x20AC;&#x201C; we have the expertise to help develop opportunities in unfamiliar landscape With a team of specialist lawyers bridging the divide between healthcare and education, we concentrate on complex, high-risk work, adding value to clients with our knowledge of both the healthcare and education markets. Our experience includes advising a variety of higher education institutions, research bodies, the NHS and private sector healthcare organisations on partnering arrangements in relation to medical education programmes, research, healthcare units and hospitals overseas. Gayle Ditchburn Partner - Education T: +44 (0)121 260 4049 E: gayle.ditchburn@pinsentmasons.com

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