Health Business Volume 10.6

VOLUME 10.6

www.healthbusinessuk.com

PARKING

ENERGY

HEALTHCARE IT

INFECTION CONTROL

Meeting staff and patient needs in a community healthcare setting

PATIENT SAFETY – Take stock and take control to realise cost savings PLUS MORE

HB Dear Reader

VOLUME 10.6

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Angry patients venting their frustration by demonstrating outside surgeries will be the reality facing GPs according to Dr Clare Gerada, new chair of the Royal College of GPs. She is concerned that GPs will be exposed to lobbying by patients, patient groups and the pharmaceutical industry if they assume control of deciding how £80bn-a-year of health funding is spent, as suggested by health secretary Andrew Langsley.

Central to the White Paper ‘Equity and Excellence: Liberating the NHS’ is the shift of decision-making to be as close to patients as possible by devolving power and responsibility for commissioning services to local consortia of GP practices.

Support is growing for GP commissioning, with 16.7 per cent of GPs and managers surveyed by the NHS Alliance saying they have already joined a consortium. With the date for the end of PCTs set to 1 April 2013 planning really needs to get underway.

PARKING

ENERGY

HEALTHCARE IT

INFECTION CONTROL

Meeting staff and patient needs in a community healthcare setting

PATIENT SAFETY – Take stock and take control to realise cost savings PLUS MORE

Enjoy the issue.

Sofie Lidefjard, Editor editorial@psigroupltd.co.uk

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Health Business | Volume 10.6

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CONTENTS HEALTH BUSINESS VOLUME 10.6

07 NEWS 11 LEASING NHS Supply Chain argues the case for leasing and how its capital programme can help acquiring large scale medical equipment

15 FINANCE The Institute of Credit Management examines how you prove the value of the credit function during these tough times

19 PATIENT SAFETY Are you aware of the significant cost savings and improvements to patient safety that can be achieved through better stock control?

23 INFECTION CONTROL Berkshire East Community Health Services discusses the unique challenges they face as a community health services provider and how they overcome these Blackpool, Fylde & Wyre NHS Foundation Trust explains how it’s minimising the spread of infection to provide the best patient experience for all

33 LEGIONELLA PREVENTION The Water Management Society discusses the problems of legionella in healthcare, how it occurs, and how hospitals can prevent it

39 CLEANING Trained cleaning operatives can help in the fight against superbugs, says the British Institute of Cleaning Science

45 FACILITIES MANAGEMENT Keith Sammonds from the Healthcare Facilities Consortium discusses the key points from the recent Scottish Healthcare Conference The HFC annual conference will stimulate topical discussion about the subjects that matter in estates and facilities management

53 ENERGY

61 HEATING & VENTILATION The Heating and Ventilating Contractors’ Association discusses how to properly ventilate commercial kitchens

63 SIGNS The Health and Safety Sign Association takes a look at the ISO 7010 standard and how this will help convey the safety message

67 HEALTH & SAFETY The Institution of Occupational Safety and Health discusses maintenance budgets and how if they’re slashed they can cost lives

71 CLINICAL WASTE The correct handling of healthcare waste is an issue that must not be overlooked within the NHS, warns the Environment Agency

75 DESIGN & BUILD Jackie Maginnis from the Modular & Portable Building Association discusses the benefits of using modular buildings in the public sector

79 PARKING The British Parking Association explains its Charter for Hospital Parking The Healthcare Facilities Consortium’s Keith Sammonds reviews recent movement within the healthcare parking area

91 SECURITY The Imperial College Healthcare NHS Trust discusses the wider issues surrounding access control

94 FRAUD PREVENTION CIFAS explains how healthcare professionals can protect the financial health of their organisations

97 BUSINESS CONTINUITY The Business Continuity Institute discusses BCM adoption and experiences in the NHS

101 CONFLICT MANAGEMENT NHS Security Management Service writes about how to deal with conflict in healthcare settings

104 MARKET RESEARCH The Market Research Society discusses how gaining insight from audiences and markets can ultimately benefit patient care

106 TRAINING Can lean management principles help the NHS survive the financial crisis?

109 RECRUITMENT The Recruitment and Employment Confederation challenges a number of key assumptions brought to light in a recent Department of Health briefing on managing a flexible workforce

111 HEALTHCARE IT BCS explains how the commissioning model is dependent on transparency of information We preview HC2011, the UK’s largest event for health and social care informaticians, ICT professionals and clinicians

125 CATERING Malnutrition among older people can lead to longer hospital stays, which is one of the reasons for the new Nutrition Standard, introduced by the National Association of Care Catering

127 CONFERENCES & EVENTS Academic venues are a credible venue choice for the meetings, conferences and events market, writes Nottingham Conferences

132 GP COMMISSIONING There is no time to lose in starting to plan for the implementation of commissioning and GP consortia

An increasing number of NHS organisations are taking part in 10:10, a national campaign to reduce greenhouse gas emissions by ten per cent a year

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£10m investment backs NHS apprentice scheme he NHS Apprenticeship programme is to receive a £10 million cash injection in order to expand the scheme by some 6,000 places. The funding for NHS employers will support the coalition government’s commitment to expanding the programme by at least 75,000 more places than the previous administration provided.

NHS apprentices will be in real jobs and receive practical and technical training to improve their qualifications and contribution to the NHS workforce.

The boost to apprenticeships in the health sector comes after a report by

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the National Apprenticeship Advisory Committee (NAAC), chaired by Ron Kerr, chief executive of Guy’s and St Thomas’.

Minister of State for Health Simon Burns announced the funding at the recent NHS Employers Conference in Liverpool.

The coalition government has made apprenticeships a top priority, he said: “So that we can continue to invest in skills for the future in the face of a tough economic climate. The important role of the wider healthcare workforce in the NHS is often overlooked – but they are essential to the smooth running of the service.”

NHS agency staff spend ‘unacceptable’ he Royal College of Surgeons has issued a report showing that NHS spending on temporary staff and locums has risen to more than £750 million. The organisation claims that the introduction of the European Working Time Directive is partly responsible.

Secretary of State for Health Andrew Lansley has responded by saying that: “The scale of increase in the cost of agency staff in the NHS is unacceptable.

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There is also a practical concern about continuity of care for patients.

“It is clear that the European Working Time Directive is having an impact on the number of locum doctors. The coalition government is committed to achieve greater flexibility of the Working Time Directive.

That is why I am working with the Secretary of State for Business, Innovation and Skills in taking a robust approach to future negotiations on the revision of the Directive.”

Medicine bags to increase patient safety asingstoke and North Hampshire Hospital has introduced special green bags so that patients can have their own brought in medication in one carrier – helping both staff and patients to manage their medicines more effectively and safely while in hospital.

Patients will be given a bag for their medicines in either the emergency department or the acute assessment unit and this will be used throughout their stay and for discharge. Each bag will be labelled with a patient sticker.

The aim is for patients to continue to use their bag for all GP, clinic, or pharmacy visits, so improving communication about drugs between everyone involved in an individual patients care.

Ruth Whale, pharmacist manager, explained: “This helps clinical staff get an accurate picture of what medicines patients are already taking and should lead to fewer occasions where there is disruption to their usual treatment.

Keeping all medication together helps us produce an accurate medication history as part of a patient’s ongoing treatment.”

NEWSINBRIEF Campaign on appropriate antibiotic use launched A new drive to raise antibiotics awareness has been launched by the Department of Health to remind the public that antibiotics do not work in treating viral infections such as coughs and colds.

The aim of the campaign is to emphasise the importance of taking antibiotics responsibly by putting an end to their unnecessary use.

The inappropriate use of antibiotics has become a serious problem in Europe which is why there is now an annual European Antibiotic Awareness Day (EAAD).

Posters and leaflets are being distributed throughout the NHS, and non-prescription information pads are being made available for GPs to give to patients to explain why antibiotics are not appropriate for their condition.

Bradford Hospitals offer homeless work placements Bradford’s hospitals have signed up to the ‘Ready for Work’ initiative, which works with local businesses and other agencies to provide training and work placements to homeless people to help them get into work. Bradford Teaching Hospitals NHS Foundation Trust has taken on three Ready for Work clients on two-week work placements in their catering and portering departments. The next trainees will begin working at the BRI this month.

The Foundation Trust’s head of Training, Amanda Hudson, said: “It is important that we have a workforce which reflects the community that we serve and being involved with this scheme helps us to reach people who may not have previously considered a career in the NHS.”

100 million seek health advice online

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While in hospital medicines will be stored in lockable bedside cabinets.

Supplies of medications will be replenished or removed as necessary depending on each patient’s treatment.

More patients than ever before are going online to find health information and selfdiagnose, saving the NHS millions of pounds a year, according to two separate reports.

The NHS Choices 2010 Annual Report reveals that there has been a 10 per cent increase in the number of visits to the NHS website in 2010 compared to 2009, taking the number of times people logged on to the site to well over 100 million.

Meanwhile, Imperial College research found that 70 per cent of patients use the internet to search for health information, with a third deciding not to visit their GP afterwards, potentially saving the NHS £44m a year.

Health Minister Simon Burns said: “More and more people are taking the information they have found online with them when they consult their GP. It is important they can find accurate, trusted information from sources such as NHS Choices. It is vital that every penny spent on the NHS counts, and the Imperial College research shows that tools like NHS Choices can help deliver savings.”

NHS Choices recently topped a Which? investigation into medical websites, with the journal saying the site “excelled for its breadth of information” and contained “medically robust” information.

THE BUSINESS MAGAZINE FOR HEALTH MANAGEMENT

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Health Business | Volume 10.6

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GPs would like more quality time with their patients ine out of ten GPs would like to spend more time with their patients per appointment, according to the results of the latest health of the workplace study.

The survey of 200 GPs

by Aviva UK health found nearly all GPs questioned (97 per cent) said they would like to spend more time with each patient, with nearly seven in ten (69 per cent) stating they would like to see the average

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appointment increased to 15 minutes, and nearly a quarter (24 per cent) wanting more than 15 minutes.

The current NHS standard requires GP appointment times are kept to ten minutes, with GPs spending an average of seven minutes per patient. But over half (57 per cent) of GPs say they have less time to see patients than five years ago and 63 per cent claim to feel rushed when dealing with appointments.

European regulators partner for patient safety edical regulators from across Europe have proposed regulatory improvements governing the movement of doctors across the continent.

The 26 regulators have worked together to identify proposals for the European Commission to consider on the directive that ensures mutual recognition of medical qualifications among European countries ahead of its review in 2012. These include enabling regulators to assess the language and clinical skills of migrant doctors.

The commission has also been asked to consider improving information sharing

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about doctors, making it mandatory for medical regulators to respond to all requests for information from their counterparts, and setting up an alert system so they can quickly inform each other about regulatory actions taken against doctors.

The move follows concerns that regulators are not always sharing registration and disciplinary information about a doctor with their counterparts in other countries. At the moment there are only voluntary agreements between regulators to share information about doctors on their registers.

Pharmacy robot starts work at Eastbourne DGH robot that electronically dispenses medication and reduces waiting times for prescriptions has started work at Eastbourne DGH. The new robot, costing just over £100,000, creates a state-of-the-art pharmacy dispensing system, which will lead to a safer and more efficient pharmacy service.

The robot uses an infra-red scanning system linked to Pharmacy IT software, similar to a bar code system, to log and store the pharmacy drugs. When a patient or member of staff brings a prescription to the pharmacy the staff request the item from the robot via the IT system and it is able to immediately locate where on its shelves it has stored the drugs. A robotic arm then moves to pick up the drug and drops it off to dispensing staff for dispensing before it is then checked against the prescription prior to issue.

The robot is helping to reduce waste by improving stock control and reducing the costs of expired drugs, and also helps minimise any prescription errors.

Amanda Isted, pharmacy operations manager, said: “The idea behind installing the new robot is to speed

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NEWSINBRIEF Increased transparency ensures commitment to patients As part of a drive towards greater openness and transparency, Epsom, Sutton and St Helier hospitals have started to publish data that will allow patients and local people to track how well the trust is performing on a monthly basis.

The trust’s website features the latest information on how well it is serving patients in a range of key areas such as A&E waits, waits for treatment, readmissions, and how quickly the trust responds to complaints. People can also find out how many patients have failed to attend outpatient appointments.

Dr Ruth Charlton, deputy medical director, commented: “These days, being able to get up-to-date information quickly and easily is vital, and as a trust we are committed to making sure our patients and local people know how well we’re doing at any given time.

“We will be adding more and more information to the website over time and would welcome suggestions from the public about the sorts of things they’d like to see.”

Text message reminders cut ‘no shows’ by a third Barts and The London NHS Trust say they are saving thousands of pounds every day through the use of an automated text messaging reminder service, which has reduced the number of outpatient appointment ‘no shows’ by up to a third.

Patients receive two text message appointment reminders – the first a fortnight before and the second three days before. Patients are able to text a reply if the appointment is no longer required, or they wish to reschedule.

Greg Bird, deputy general manager of Outpatient Services, said: “By encouraging patients to let us know if appointments are not convenient, we can rearrange them and also use the now vacant appointment slot for another patient who is waiting to be seen.

Patients tell us that they really appreciate the service, saying it helps them to remember they’ve got appointments and stops them from missing them”.

The system was launched in August and now sends out up to 2,000 SMS messages every day. The average proportion of patients wishing to cancel or reschedule their appointments is 10 per cent. It has meant the number of patients failing to attend appointments has dropped by up to 35 per cent in some clinics, compared to the same time last year.

up discharge prescription times and free up time for pharmacy staff to go onto wards and support direct patient care where they are needed.”

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A Partnership Approach for best value resourcing Having spent many years working for large healthcare recruitment agencies, the founding directors of Red Professional Locums strongly believe in the need for a personalised, partnership approach to healthcare recruitment which is professional, reliable and cost effective. Red Professional locums ultimately centre its company ethos around the relationship between agency, client and locum. For this partnership to be successful it must always be professional, open and realistic. Red believe our ability to listen and then provide tailor made solutions for all your recruitment needs will establish a successful long term working relationship with both our clients and candidates.

Red is built with highly experienced individuals who have worked in the healthcare market for many years. Our team are fully able to effectively manage all levels of volume business such as SLA’s, specific recruitment drives as well as ad hoc requirements and want to inspire you to have complete confidence in our ability to provide you with Locum cover as and when you need it.

At Red we strongly believe that one size does not fit all and that both clients and candidates are unique, each having their own specific reasons for using a locum agency. Our aim is simple; to identify yours and help you achieve your objectives.

CONTACT OUR RECRUITMENT TEAM | 0845 5390077 Tel: 0845 5390077 Fax: 08455390117 Email: info@redprofessionallocums.com

www.redprofessionallocums.com

Health Business | Volume 10.6

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LEASING

A NEW LEASE OF LIFE NHS Supply Chain looks at how its capital programme gives trusts the option to lease high cost medical equipment ALL GOVERNMENT DEPARTMENTS are looking for efficiency savings as the coalition endeavours to reduce the country’s national debt. It has promised to protect the overall budget of the NHS but the service must make efficiency savings of around £20 billion by 2014.

Alongside this; the NHS capital budget will fall by 17 per cent in real terms between 2010-11 and 2014-15 to help fund social care. This will have an effect not only on new hospital builds but more importantly on access to large scale medical equipment such as MRI scanners and ultrasound machines.

VITAL EQUIPMENT New hospitals can be put on hold, but replacing a vital piece of medical equipment cannot. With an ageing population, the demands on the NHS are set to increase, and diagnostic machines are critical to meeting these needs. It is therefore

paramount that effective high spend capital is properly planned for in trusts’ budgets.

PROPER INVESTMENT AND PREPARATION It may sound like a simple task, but acquiring large scale medical equipment can seem like an un-climbable mountain right now; with imminent spending restrictions and a system that is uncoordinated. NHS Supply Chain understands the difficulty that NHS trusts are currently facing and has developed an all encompassing solution to meet their needs.

“Capital medical equipment plays a vital

role in delivering patient care, so proper investment and preparation should be made,” says Andy Brown, managing director of diagnostics at NHS Supply Chain.

“The problem is that asset management is dealt with reactively by the NHS at the moment. This means that the best deal is often not reached. For capital equipment, this can result in overspending by hundreds of thousands of pounds – something that is especially pertinent when trusts are looking for cash releasing savings.”

Financing capital equipment can put enormous pressure on trusts. The process can also be time consuming if trusts have not undertaken the necessary research and forward planning required.

CAPITAL PROGRAMME To simplify the process NHS Supply Chain has made a significant investment to develop its

With an ageing population, the demands on the NHS are set to increase, and diagnostic machines are critical to meeting these needs

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LEASING

to reduce the amount of administration required for the supplier and trust, as we complete all paperwork on their behalf.

“We can provide prospective costs within 48 hours and provide trusts with mini competition results within ten working days. So that trusts can be sure that leasing is the best solution for them, we can also provide a detailed comparison between leasing and purchasing so that they can make a proper informed decision.”

Dartford and Gravesham NHS Trust is currently benefitting from the leasing option. Lynne Clemence, acting capital project manager for Dartford and Gravesham explains: “One of our current projects is for the installation of a second MRI at the trust. I dealt with NHS Supply Chain’s leasing team to obtain indicative costs for the business case. The service was extremely impressive, they provided a very rapid response to our enquiries, and we were kept regularly up-to-date with progress.”

The trust is now about to enter the mini competition stage as a precursor to obtaining firm leasing prices for the new machine.

We want trusts to understand that proper capital planning can provide clear benefits. The idea behind it is very simple: with thorough preparation, substantial savings can be achieved through reduced costs capital offering. Andy Brown explains: “Our aim is to transform the way capital equipment is planned, purchased, financed, maintained and managed in the NHS. We aim to provide a one-stop shop for medical equipment given the vital role that it plays in delivering patient care.”

One aspect of NHS Supply Chain’s capital programme gives trusts the option to lease high cost medical equipment.

This overcomes the problem of having to find the substantial amount of money it would cost to fund such machines.

“NHS trusts are able to procure the most up-to-date medical equipment without any initial capital outlay,” continues Andy.

“Leasing can often be the most sensible choice within the NHS to finance medical equipment as technological advances often outpace the life of the equipment. It gives trusts the peace of mind that they can upgrade to a newer model, should the need arise, without incurring major capital investment.”

Andy adds: “We are helping to drive best practice for lease management and our process ensures full compliance to EU procurement regulations. It can save NHS trusts time and money that otherwise would have been spent through tendering and ensures a competitive market for lease providers.”

Louise Hamilton, chair of the Finance and

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THE BUSINESS MAGAZINE FOR HEALTH MANAGEMENT

Leasing Association’s Healthcare Group, says: “Much of the equipment used to deliver healthcare services could be owned more efficiently by the private sector, saving capital outlay as well as operating cost. Introducing new technology using leasing could also facilitate efficiency improvements, without needing structural reorganisations. NHS Supply Chain has an important role to play in helping trusts with the leasing procurement process.”

COST TRANSPARENCY Through the new contract, 20 companies provide their leasing services to the NHS. Trusts will be able to compare and contrast deals to ensure that they find the most cost effective solution to meet their needs.

The contract offers full cost transparency and complete administrative support from NHS Supply Chain’s specialist team, who complete all price comparisons and the necessary paperwork for trusts. It can be used to fund all types of equipment ranging from MRI scanners to basic equipment.

The capital team provide advice throughout the process and are on hand for continued support throughout the lifetime of leasing agreements.

Cheryl Cordon, senior buyer at NHS Supply Chain says: “Our leasing process helps

IDENTIFYING EQUIPMENT NEEDED To obtain a quote for leasing, trusts identify the equipment that they require for business case purposes. This includes: the capital costs, preferred supplier, lease period required and payment plan (quarterly or annually). The leasing team at NHS Supply Chain then provide the trust with potential costs for the equipment.

Once a decision has been made to go forward with the lease, a mini competition is completed by NHS Supply Chain’s leasing team to obtain the best deal from the leasing providers. The trust can then make an informed decision about which offer is the best.

Andrew Gordon from Plymouth Hospitals NHS Trust tells of his experience: “The team were pro-active in providing the new lease mini-competition processes, along with daily updates on how the tender was proceeding.

Excellent communication throughout.”

The leasing contract forms part of NHS Supply Chain’s wider capital equipment solution that helps NHS trusts prepare for the future. The capital planning service covers the purchasing of equipment as well as its maintenance and ultimate disposal.

Andy concludes: “We want trusts to understand that proper capital planning can provide clear benefits. The idea behind it is very simple: with thorough preparation, substantial savings can be achieved through reduced costs.”

FOR MORE INFORMATION For more information on our range of leasing contracts and how we can help you, contact Cheryl Cordon, senior buyer Tel: 07850 931538 E-mail: cheryl.cordon@supplychain.nhs.uk Web: www.supplychain.nhs.uk

Royal Liverpool University Hospital

“ Thanks to the easy-clean design of the Dyson fan, we have been able to use them in our clinical areas to keep our patients cool.”

Diane Wake, Executive Director of Nursing and Operations Director of Infection Prevention & Control

“Cleanliness and comfort are absolutely essential when it comes to excellent patient care,” explains Diane Wake, Executive Director of Nursing and Operations Director of Infection Prevention & Control.

Previously, the hospital had used conventional desk and pedestal fans but the problem was keeping them clean. The fans needed regular cleaning but the grilles and blades made this awkward and time consuming.

After hearing about the Dyson Air Multiplier™ fan, Diane requested a demonstration. They were what she had been looking for. “I could see the benefits of using the Dyson fan, so I was happy to proceed with an order” she says.

Safe.

No fast-spinning blades.

Easy to clean.

No awkward grilles or blades.

“ Thanks to the easy-clean design of the Dyson fan we have been able to use them in our clinical areas to keep our patients cool. Keeping our equipment clean to reduce the potential of infections is really important,” says Diane.

The bladeless fans also delivered significant safety advantages.

“Without fast-spinning blades, there was no risk to patients and visitors.” says Diane.

The hospital is maintaining its already very high standards of cleanliness, and the reception from staff and patients has been very positive. “I’m happy to extend the use of these fans to other parts of the hospital” adds Diane.

Dimmer-switch control.

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To try the Dyson Air Multiplier™ fan or for more information call or visit: UK 0800 298 0298 ROI 01 475 7109 www.dysonairmultiplier.com

Capital Leasing

Count on us... to add value to leasing visit our website www.supplychain.nhs.uk/capital

With efficiency savings at the top of every trusts agenda, securing best value through your supply chain is vital. And considering the cost of a new MRI scanner can exceed £1 million, capital equipment can be a tough challenge.

But with our range of competitive leasing contracts, you can benefit from reduced costs, improved service and process efficiency, while continuing to access the most up to date equipment on the market.

• no lump sum investment • access to higher specification equipment • simple upgrades and replacements • assets paid for over a fixed period for easier budget planning • better pricing deals • typically no disposal costs at the end of the lease term For more information on our range of leasing contracts and how we can help you, contact Cheryl Cordon Senior Buyer Tel: +44 (0)7850 931538 Email: cheryl.cordon@supplychain.nhs.uk

Delivering savings to the NHS

Health Business | Volume 10.6

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FINANCE

STANDING UP TO BE COUNTED Philip King, chief executive of the Institute of Credit Management, says that in difficult times, credit managers increasingly need to prove their worth THERE HAVE BEEN MANY DIFFERENT phrases coined in recent times to try and express the severity of the current economic recession. Only the BBC’s Robert Peston seems to have found the right words: “… this is no downturn like any we have seen since the Second World War….”

The impact of a recession is more keenly felt within the credit and collection world for several reasons: the role of cash collection itself gets tougher as the movement of cash slows and the risk of bad debt increases, whilst at the same time, internal pressure to control the cost of credit and collections activity also means that efficiencies must be found or productivity boosted.

PROVING THE VALUE OF THE CREDIT FUNCTION Headcount reduction within a credit and risk environment is disingenuous during a recession and probably the best example of false economy that I can think of. So how do you prove the value of the credit function during these tough

times when pressed upon to do so?

To put it another way, there has never been a better time to definitively answer that sometimes-asked question: “So what does the collections team actually produce for the business?” However, is it enough to quote the usual responses to this question: effective cash flow; impact on working capital; improved DSO; mitigated risk; minimised bad debt etc? Wouldn’t it be great to be able to provide a definitive answer to this

question by creating a revenue stream directly attributable to the collections team?

INHERENT TALENT Martin Kirby, AR manager for Bupa Health & Wellbeing (BHW) certainly thought so when, earlier in 2010, he decided to take a look at the generic core skills available to the business via the collections team and concluded that at the very epicentre of those skills was an inherent talent to “use verbal communication

The impact of a recession is more keenly felt within the credit and collection world for several reasons: the role of cash collection itself gets tougher as the movement of cash slows and the risk of bad debt increases, whilst at the same time, internal pressure to control the cost of credit and collections activity also means that efficiencies must be found or productivity boosted

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Finance training for the healthcare sector UORUM TRAINING is a leading provider of finance, taxation, accountancy and regulatory compliance training to the public sector, industry, commerce and the professions.

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INCE THE INCEPTION of NHS operating leasing in 1996, Singers Healthcare Finance Limited has established itself as one of the UK’s leading providers of leasing solutions to the NHS. As an approved supplier to the NHS Supply Chain Leasing Framework, we understand the need to ensure an effective and efficient procurement service.

Today, the business designs, builds and implements on and off-balance sheet asset-based funding solutions for all types of medical equipment.

Our experience crosses all medical disciplines with significant expertise in radiology, oncology, endoscopy and critical care. We also provide funding for non-medical assets including hotel services and estates that are essential to support day-to-day hospital operations.

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FOR MORE INFORMATION If you would like to discuss how Quorum Training can meet your training needs, please contact Simon Dieppe, managing director on 0121 3627536 or e-mail sdieppe@centlaw.co.uk

healthcare finance, have an in-depth knowledge and understanding of these equipment needs and a track record of delivering solutions.

Our aim is to build long-term relationships with NHS Trusts, which includes assisting in the planning of future equipment purchases and replacement programmes. These successful partnerships schedule the finance of equipment, lock into competitive interest rates and support the trust during the whole life of the equipment, through upgrades or extensions at the end of lease.

FOR MORE INFORMATION These are some of the reasons why over 70 per cent of NHS trusts currently lease with Singers. Find out more by calling freephone 0800 0323638 or e-mailing healthcare@singershf.co.uk

Asset finance – a solution to NHS budgetary pressures

Europe’s largest credit management organisation

RECENT REPORT from Siemens Financial Services reveals £1.85bn of capital is currently “frozen” in the NHS. Frozen capital is the result of medical equipment being bought outright for healthcare institutions rather than financed.

With healthcare management required to save up to £20bn over the next three years, one area being examined is equipment procurement and how using alternative finance techniques can improve efficiency, maximise investment and most importantly improve patient care.

But in addition to using finance to purchase new equipment, the report also identifies how using finance solutions can release this frozen capital and inject the cash back into the

HE INSTITUTE OF CREDIT MANAGEMENT (ICM) is Europe’s largest credit management organisation. The trusted leader in expertise for all credit matters, it represents the profession across trade, consumer, and export credit, and all credit-related services. Formed over 70 years ago (in 1939), it is the only such organisation accredited by Ofqual and it offers a comprehensive range of services and bespoke solutions for the credit professional (www.icm.org. uk) as well as services and advice for the wider business community (www.creditmanagement.org.uk).

The services offered by the ICM include: Professional membership grades; recruitment agency; conferences and seminars; professional qualifications and unit awards; bookshop; a network of local branches;

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Medical equipment leasing from Singers Healthcare Finance Ltd

NHS budget, providing the efficiency savings required!

David Martin, Siemens Financial Services Limited UK, comments: “Freeing up frozen capital is becoming increasingly urgent.

There now appears to be growing political support in some quarters to introduce not just capping measures, but real-terms spending reductions. Uptake of leasing and rental will be vital if healthcare systems are to afford the most up to date equipment and medical technology, and improve overall efficiency.”

FOR MORE INFORMATION For your free copy of the Siemens Frozen Capital Report or the Siemens End of Lease Options Brochure please e-mail: info.sfs@siemens.com

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consultancy; training; credit management helpline; online services through icmos; credit management magazine and monthly e-mail briefings; member website forums; quality in credit management accreditation; member benefits and discounts; social networking community.

FOR MORE INFORMATION Tel: 01780 722900 Fax: 01780 721700 E-mail: info@icm.org.uk Web: www.icm.org.uk

Health Business | Volume 10.6

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FINANCE

to control a conversation – with a fixed objective in mind”. He takes up the story: “Core skills analysis is a useful exercise for identifying strengths and development needs across a team. However, consideration is seldom given to where else those skills may prove to be of benefit to the business. An almost ideal idiom might be ‘poacher turned gamekeeper’ (where revenue is the quarry) and I decided that the natural talents of the collections team were as equally suited to an outbound telesales role as they were to a collections role.

“After all, the collections team already have working relationships with the very same corporate customers to whom they would now be selling.

“It’s not that simple of course, as core skills always require refinement to the task at hand, and with this in mind, almost every member of the Bupa Health & Wellbeing AR teams undertook a series of short but focused training courses including product training; sales training; and operating system training (for the purposes of booking health assessments).

“This represented a steep learning curve for most team members and handily addressed another of those common areas that suffer during cost-conscious times: training.

“The people investment at managerial level was very significant as it has to be when driving a behavioural change and shifting paradigms.

The enthusiasm of the team, however, to recognise their own core skills and especially their (potentially) increased value to the business (by cross-skilling) was immense.

“Naturally, core activities of billing, collections, dispute resolution and cash allocation could not be allowed to slide at the expense of making outbound calls for the purpose of securing health assessment bookings, so the teams were asked to undertake their normal roles with their usual diligence and effectiveness with outbound sales calls reserved as an evening overtime project.

INCENTIVISED PROGRAMMES “This black belt project was incentivised on a risk and reward (commission) basis in order to maximise the opportunity and it took the team just three weeks to generate over a million pounds of B2B revenue – achieved by booking almost 2,800 health assessments,” said Martin.

At the time of writing, B2B revenues in excess of £2.5 million have been generated by the team in circa eight weeks. As Martin says, that’s quite a statement on behalf of a team made up of collectors, billing specialists, dispute administrators and cash allocators: “After several weeks of booking B2B health assessments, the team settled into a regular routine of core activity during the day and outbound calls during early evening. During this time, individual ‘closing skills’ were discovered, developed and then finely honed to the point where the team was confident enough to take on B2C outbound calls (for the purposes of booking health assessments)

The team’s success has been acknowledged at director level within the BHW organisation and on an individual level, all members of the AR team are better able to leverage internal career opportunities – well able to champion the newly developed skills they have gained with agility and flexibility at the forefront of those transferrable skills in addition to B2B outbound calls and now, all B2C web leads generated via the Bupa website are dealt with by the BHW AR teams.”

THE CUSTOMER JOURNEY Words such as “opportunity”, “conversion” and “sales lead” (seldom used within a traditional collections environment) became commonplace as did the celebratory “feel” of hitting a sales target with this positivity transferring back into the core function activities on a daily basis.

The fringe benefits of this exercise, Martin identifies, are immense: “The AR teams now have a ‘wing to wing’ view of the entire customer journey from sales order generation to invoicing to collections and finally cash allocation – in fact the full credit cycle. What a great ‘Know your Customer’ statement!”

Relationships with corporate customers now exist on many levels, with the AR team interacting at every single level within a customer organisation – instead of just the traditional finance-to-finance team relationship.

Networking opportunities within a customer organisation are greatly improved as a result of the booking project – creating effective levers that can be utilised where escalation on payment issues may be required.

The AR teams’ knowledge of the BHW business is also significantly improved as a result of their multi-faceted relationship

with the corporate customer and this has enabled the teams to respond more quickly and effectively to invoicing disputes by using new knowledge they have gained.

Furthermore, the number of errors made at the time of booking a health assessment (such as PO number for example) have reduced as the AR team fully appreciate the need for accurate data entry into the operational booking system and are acutely aware (from an invoicing perspective) of the impact of failing to capture all relevant information at the time of booking.

As Martin concludes: “The team’s success has been acknowledged at director level within the BHW organisation and on an individual level, all members of the AR team are better able to leverage internal career opportunities – well able to champion the newly developed skills they have gained with agility and flexibility at the forefront of those transferrable skills.”

So “what does the collections team actually produce for the business?” is a question no longer asked of all those working in the healthcare business – even in these economically challenging times.

FOR MORE INFORMATION Tel: 01780 722900 E-mail: info@icm.org.uk Web: www.icm.org.uk

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A bespoke nurse call system helps the team a pleasing price tag helps the bottom line When staff are under pressure, every second counts.

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Health Business | Volume 10.6

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PATIENT SAFETY

AN EASY ROUTE TO BETTER PATIENT SAFETY Joel Haspel, CEO, Sentient Health, looks at the issues relating to poor stock control and the significant impact it can have on safety, cancelled procedures as well as your finances

Joel Haspel

During one recent NHS hospital stock review we filled two plastic sacks with out of date clinical supplies – some should have been binned in 2005 THERE IS A HUGE GOVERNMENT push to focus on delivering cost savings across the NHS – but it should not be to the detriment of patient safety. In this article I would like to advise trusts how to take stock and take control to realise the significant cost savings that can be achieved through better stock control.

RECENT EVENTS In the past few months the dangers of poor stock control have been underlined by a series of news stories. Medics at Bromley’s Princess Royal University Hospital complained that “crude” cuts led to items running out of date, including sealed chest drains, epidural packs and gynaecological and radiological disposables. In Scotland the Healthcare Environment Inspectorate (HEI)

reported that Caithness General Hospital’s maternity unit held out of date sterile medical supplies, some of which expired in 2002.

During one recent NHS hospital stock review we filled two plastic sacks with out of date clinical supplies – some should have been binned in 2005. Far from being unusual, we have found out of date stock at five of the hospitals we’ve checked this year. The biggest worry is that one hectic day some of these items could have ended up being used on a patient undergoing surgery or in a medical ward, with a disastrous outcome. As the NHS is pressed ever-harder to deliver more for less there’s every possibility that these kinds of risks will grow.

There is evidence that NHS staff want to see changes and improvements in the handling of clinical supplies. A GS1 UK Healthcare

survey found that 63 per cent of nurses and 56 per cent of doctors put real-time views of stock levels in the top three on their IT wish lists. But as an age of austerity spreads across the healthcare sector it’s possible that senior management will be reluctant to modernise their systems because they are too worried about costs. Yet, if this happens, the growing demands on hospitals and increasing complexity of treatments mean their supply chains will become less and less able to cope.

That means we can look forward with some trepidation to an increasing number of news stories about operations being cancelled due to equipment shortages, or staff having to rush to other hospitals to get basic supplies.

Hospital managers will try to explain that they are doing their best, but there will be precious little sympathy when a mum and dad are saying that the drugs or equipment weren’t available to treat their child. Legal actions and large compensation payments will follow, and then we will naturally get into the territory of whether the UK government and devolved administrations are providing enough cash. However, much can be done to avoid this kind of scenario.

EVIDENCE BASED SAVINGS ASSESSMENT When hospitals invite us in to do what we call an Evidence Based Savings assessment (EBSa) we look at what they have in stock and how it’s stored. At that point we sometimes have staff telling us that more space is needed and they are thinking about converting things like nurses’ areas for storage. Closer inspection often reveals that about 20 per cent of what’s on the shelves is stuff that for a variety of reasons – for example it’s a product they no longer use – can be get rid of. Then there are the items that have passed their use-by date.

What’s actually needed is a thorough clearout. It can help with the space problem and, far more importantly, it improves patient safety. Some old stock can even be used for training, however, this has to be separated out so there’s no risk of it getting near patients.

Getting rid of clutter also helps address a frequent complaint that staff end up wasting time because they can’t track down what they need. But this is just the start. Once you have got a handle of what’s overstocked and, more crucially, what’s understocked, you can start making rapid gains that will pay for themselves.

Most of the problems come about because the stock control and distribution systems at hospitals are obsolete. They have not been at the top of the priority list for organisations having to focus on pushing down waiting times and meeting umpteen other targets. The relatively rosy financial times also meant it was a problem that could be lived with. It is not a problem of poor management – quite the opposite. Managers, clinicians and everybody else know full well that there is a real need to deal with supply chain management.

THE BUSINESS MAGAZINE FOR HEALTH MANAGEMENT

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improve patient safety.

E.g. Tall Man lettering is being used to help product identification and differentiation, as evidenced on our cephalosporin product ranges (cefoTAXime, ceftRIAXone and cefTAZIDime).

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Health Business | Volume 10.6

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PATIENT SAFETY

FINDING A SOLUTION Identifying the problem is one thing, finding and implementing the solution is quite another.

An EBSa or equivalent in-house exercise, to look at exactly what’s being ordered and why, is a vital first step. All too often the purchasing process is unquestioning – regular orders go in and supplies turn up, but some remain unused and stock builds up. Alternatively, when something is used a replacement is ordered regardless of whether it’s actually needed.

This is not the fault of any individual; it’s simply that they are stuck with old-fashioned, often paper-based systems that belong to a past era. Healthcare is now so complex, demanding such an enormous variety of equipment and materials, that such systems are simply not fit for purpose. Rather than working in the hospital’s favour, the supply chain actually ends up being a liability, and soaking up money because unnecessary items are being bought. When we carry out an EBSa we can normally expect to identify savings of at least five times the cost of the assessment.

We have never yet been to a hospital where worthwhile savings can’t be found.

If IT is good for anything it’s for stock control, telling you what’s in stock and where it is, following it through the system from storeroom to patient. This gives immediate control over ordering and distribution, driving down costs by cutting waste and raising efficiency by making sure that the surgeons and maternity ward staff have what they want when it’s needed.

CHOOSING SUPPLIER I’m glad to say that Secretary of State for Health, Andrew Lansley, has emphasised that needs vary and has promised that the NHS can have the freedom to choose suppliers and solutions. But I would like to sound a note of caution. There have been cases where

Most of the problems come about because the stock control and distribution systems at hospitals are obsolete. They have not been at the top of the priority list for organisations having to focus on pushing down waiting times and meeting umpteen other targets we have seen that hospital management has tried to improve stock control, but found that the project has run into problems as the staff had raised valid and unforeseen challenges. This is partly because wide enough staff involvement and buy-in hadn’t always been sought from the outset.

It’s very easy to underestimate the extent to which supply chain issues affect working lives and the impact – or the fear – of change.

The fear can be to do with worries about job losses, or about the impact on clinical services.

A prime example of the latter is when surgical teams over-order seldom-used items for fear of one day being caught short by an unexpected demand. What they need to be sure of is that the process is about optimisation not just reduction – or the “crude” cuts of the Bromley example. A good supply chain management system only eliminates unnecessary stock.

It also means monitoring the situation and making sure that older stock gets used first.

The objective is to ensure that the clinician has exactly what they need, when they need it, and that it can be found easily. This is one of the reasons why I would suggest that a full assessment of the existing system is carried out before anything else happens. Once staff are presented with firm evidence of the waste, and both asked and shown what can be done to make things better for them, then the enthusiasm for modernisation found in the GS1 UK Healthcare survey starts to kick in.

SUPPLY CHAIN OPTIMISATION In fact, supply chain optimisation is probably one of the quickest and easiest changes that can be implemented. And it’s something which organisations can approach with confidence as there are people around with lots of experience who can help them get it right. As to the financial implications, we estimate that the NHS could save £300 million over three years – in the current climate that’s a pretty attractive sum.

What would be useful is to see the government push supply chain issues up the priority list. The current, very welcome, consultation on Liberating the NHS: An Information Revolution comments on how effective the retail sector is at recording items at point of sale then following them through the system in a way that generates an abundance of valuable information.

Quite reasonably the main focus of the paper is on the relationship between patients and healthcare providers. But I would argue that an information revolution needs to reach into every part of the health system, and that quality of care is directly linked to clinical supplies. My hope is that this recognition will be firmly embedded in any action that results from the consultation. If that happens, the NHS, and the Westminster government, could end up in the happy situation of being able to push forward together to save money and deliver better services.

Courtney-Thorne leading the way in technology CCOUNTABILITY for care products and staff performance are imperative factors within today’s healthcare industry. CourtneyThorne is passionate about producing care products that maximise staff performance whilst adhering to budget demands.

The need to justify spend is a constant battle for hospital boards and managers. So where does the “money watching” leave front line staff and patients?

Nursing staff and managers must have the products they need to ensure that day-to-day care is cost-effective yet never compromised.

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the touch-screen itself and associated products such as the call point and the patient handset, are all manufactured with lifetime antimicrobial properties.

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Health Business | Volume 10.6

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INFECTION CONTROL

MEETING STAFF AND PATIENT NEED Catherine Greaves, head of Infection Prevention and Control at Berkshire East Community Health Services, discusses overcoming the challenges of infection control in community healthcare GOOD INFECTION CONTROL PRACTICE

is an essential aspect of patient care for any healthcare provider yet it is only recently that the public’s attention is being drawn to community healthcare organisations. The Department of Health has for some years now published data on, and set targets for, healthcare associated infections by acute provider and primary care organisation: the latter encompassing the whole health economy rather than relating to specific NHS community provider organisations.

However, earlier this year that focus turned to community healthcare for the first time,

with the numbers of MRSA bacteraemia and Clostridium difficile infections being published by hospital site on a weekly basis.

MAKING THE RIGHT CHOICES

With this data readily available to the public via the Health Protection Agency’s website, current and future patients can see how their local providers are performing and make choices about their healthcare based on that information. Suddenly, infection control has become as crucial to a community healthcare organisation’s image as it is for acute providers.

The average patient’s home or community centre is not infection control friendly! It’s therefore crucial that community-based staff understand how they can make these environments work for them

That’s not to say community healthcare organisations haven’t taken infection control as seriously as their secondary care equivalents: infection prevention and control is a key component of both the quality and patient safety agendas that all providers adhere to. But with the move towards an “any willing provider” model of NHS healthcare driving competition and government proposals to expand patient choice, it is essential for community healthcare providers (and indeed, acute providers too) to not only maintain good records but also improve where possible, to both attract commissioners and patients.

Like many other NHS organisations, community health providers face numerous challenges including shrinking finances, aging estate, and constant change following the recent White Paper (DH 2010a) and the forthcoming integration of community services with other providers (DH2010b) – not to mention the need to meet targets

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Health Business | Volume 10.6

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INFECTION CONTROL

to reflect diversity in audit plans. Services have different needs and risks, and the same audits are not suitable for all services; they need to be tailored. For example, antibiotic audits are appropriate in inpatient areas but not in school nursing and health visiting: whereas vaccine handling and transportation is relevant to school nursing and health visiting but not to services that do not administer vaccines. Thus recognising service diversity provides meaning for staff and fosters an inclusive approach.

IN PATIENTS’ HOMES

Making use of technology is an effective way to make infection control training available to all staff groups, no matter where they are based or what hours they work and other regulatory requirements. However, providing services in the community brings with it challenges that differ to those encountered by acute trusts.

DISPELLING OLD ATTITUDES

Historically infection control had been seen as the role of the infection control nurse and although those days are long gone the focus on infection control targets and legislation (DH 2006, 2009) within secondary care means many communitybased staff can’t always see how it applies to community organisations: “Healthcare associated infection? ‘Superbugs’? Well they’re a hospital problem aren’t they?”

This misconception requires essential engagement with community-based staff in infection control by making it meaningful to them – identifying how it impacts them, raising their awareness, working with them and giving them practical realistic advice, involving them in the decisions that are made and that they will be required to carry out.

UNDERSTANDING SERVICE NEEDS

Offering a variety of different services, delivering care in a variety of settings is one of the first challenges for community health. Whilst the diversity of services provide richness to the organisation there is a need to ensure mandatory training is interesting and accessible. A one size fits all approach is not workable: nurturing relationships is essential and this begins at training.

Take Berkshire East Community Health Services as an example. The organisation

employs over 1,000 staff, across 40 plus services and departments, based in three unitary authorities. To meet the varied needs of staff, we offer three individual versions of mandatory training: employees are encouraged to attend the one that most fits their developmental needs, which often depends on the service they work in. For example, a smoking cessation adviser does not require the same level of training as a community matron.

Community health services need to consider service location and working hours.

Making use of technology is an effective way to make infection control training available to all staff groups, no matter where they are based or what hours they work. Including infection control as an e-learning module has proved particularly useful when training more hard-to-reach staff members such as out-of-hours district nurses or health visitors, who are based in children’s centres. Despite the success of e-learning, sometimes faceto-face communication is needed – after all, not everything can be taught virtually.

When this is the case, geography and hours of services can make attendance difficult.

Infection control teams need to recognise this and be flexible. Taking a session out to departments or services on request and not necessarily within the standard nine to five office hours, will be far more productive than stipulating an employee must attend one of the scheduled training sessions, only for them not to attend because of workload pressures.

This understanding is not just limited to training. Infection control teams need

Providing care in the community means care being given in schools, community centres and patients’ own homes – in other words, in places where staff have little or no control over the environment.

Forget wipe-able surfaces, laminate floors and the high standard of cleaning hospitals adhere to. The average patient’s home or community centre is not infection control friendly! It’s therefore crucial that community-based staff understand how they can make these environments work for them. All infection control departments within community health services should take an active role in understanding the types of settings their staff are working in, and offer support to community-based teams by accompanying staff on visits to other care settings – including the patient’s home – to give realistic infection control advice.

WORKING TOGETHER

As a relatively small organisation, there are many areas of the organisation that are contracted out, including site services.

This produces a unique challenge for the organisation – and an opportunity.

It’s essential that our cleaning staff understand good principles of infection control and we consider them as part of the wider healthcare team, engaging with them as we do our own staff.

Concerted efforts need to be made to train these members of staff in infection prevention and control: for example undertaking train the trainer sessions on cleaning and decontamination of equipment, as well as ensuring contractor staff are updated with developments in infection control at the same time as your own staff.

Infection control should be considered part of the wider patient environment and an infection control team must work closely with other departments, for example accompanying modern matrons on their rounds to assess environmental issues, patient safety, privacy and dignity (including single sex) and the patient experience as a whole – all of which infection control forms a part of.

Together, modern matrons and infection control specialists need to work closely with

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Health Business | Volume 10.6

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INFECTION CONTROL

services to develop action plans, resolve any identified areas for concern and address issues in such a way that the problem is resolved permanently rather than “just fixed for now”. In a small organisation, resource is a challenge meaning strong relationships and staff understanding must exist so that services feel able to write their own local processes and procedures that they can in turn then monitor themselves.

COMMUNICATION AND ENGAGEMENT

A common thread you may already have noticed in the discussion here is communication. Engaging with staff is what ties this all together and will help a community health service to meet the unique challenges it faces.

Working groups are an excellent way to get different staff groups together, collaborate and take messages back to teams. These groups need to reflect the organisation’s set up. For instance, an infection control working group should consist of representatives from a range of clinical services with different needs, but all with a common purpose and agreed vision: that infection control will become an integrated part of care across the organisation. As well as addressing the basics in this working group (reviewing surveillance data, audit and root cause analysis reports, monitoring action plans policies and patient information, assessing how national initiatives can be implemented), it also needs to act as a forum where staff can confidently share their learning with one another and set a standard for best practice.

A means of achieving this in Berkshire East Community Health Services has been to encourage staff to develop their own infection control work programme that addresses the risks that they have identified (both potential and actual) within their service and demonstrates how they plan to implement initiatives discussed by the group. Not only is this an effective way to get staff to really think about infection control and how it can be uniquely tailored to their service but it also provides an opportunity for shared learning and to inspire others who may be struggling.

WORKING ACROSS DEPARTMENTS

Of course it is also essential that infection control works closely with operational and facilities staff in order to address environmental and facilities issues. A facilities services review group can provide an excellent forum for achieving this. Within our own organisation it has been possible to involve staff in the standardisation of cleaning products, soaps, hand gels and similar products, and implement the requirements of the new Healthcare Cleaning Manual (NPSA 2009), through this group.

Furthermore it enables infection control

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THE BUSINESS MAGAZINE FOR HEALTH MANAGEMENT

to collaborate with the contracted site services and estates teams so that each can understand the requirements and limits of the other team. Together, the teams have also found creative ways to resolve the challenge of aging and listed buildings. For example, one of our community hospital wards is currently undergoing redesign and refurbishment to meet the needs of those with cognitive disabilities. Certain elements the service would like to include in the design does not meet infection control standards, so there’s a balance that needs to be met: with their expert knowledge the estates team often have a solution, so a compromise can be made that ensures the design remains infection control friendly and still meets the unique requirements of the service. Elsewhere, the teams have worked together with radiator guard manufacturers to improve their design for ease of cleaning to better meet infection control standards.

MANAGING INFORMATION

Above I mention the need to take key messages back to services. Champions – or infection control link practitioners – are a simple, yet effective way of achieving this cascade of information and helping to undertake audits and provide simple training to colleagues when something new needs to be rolled out across the organisation. Most importantly, they can help a community healthcare organisation with a small infection control team reach out to loan workers such as district nurses and health visitors.

All the above methods are effective but time-consuming and resource-hungry.

Staff newsletters are a great way of communicating en masse but must be engaging, the aim is not to dictate to staff but to interact with them by offering feedback channels such as an agony column where they can ask that silly question they’re too embarrassed to ask in person

and have it answered anonymously; or a quiz or competition to help launch revised policies or a new product.

Making contact with every single member of staff, wherever they may be based, is perhaps the most significant test for an NHS community health provider to meet the challenges of infection control. Indentifying what infection prevention and control means for the different services, working collaboratively and developing innovative ways to resolve issues as they arise, putting processes and monitoring in place and developing the different approaches outlined in this article, will all help to maintain focus and sustainability. Every member of staff represents the organisation’s image: an engaged workforce will reflect positively with patients and commissioners.

References Department of Health, 2006, ‘The Health Act 2006: Code of Practice for the NHS on the prevention and control of healthcare associated infections’

Department of Health, 2009a, ‘The Health and Social Care Act 2008: Code of Practice for the NHS on the prevention and control of healthcare associated infections and related guidance’

Department of Health, 2010a, ‘Equity and Excellence: Liberating the NHS’ Department of Health, 2010b, ‘Transforming Community Services the assurance and approvals process for PCT-provider community services’

NPSA, 2009, ‘The Revised Healthcare Cleaning Manual’ www.npsa.nhs.uk/cleaning FOR MORE INFORMATION Web: www.berkshire-eastchs.nhs.uk

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QUALITY SOLUTIONS FOR SAFER SURGERY Fusing technology and intelligence to improve patient care AT CAREFUSION we help our customers measurably improve patient care by focusing on two of the biggest issues affecting healthcare, medication errors and healthcare associated infections (HAIs).

With its headquarters in San Diego, California, CareFusion was officially launched on 1 September 2009 and employs 15,000 people in more than 20 countries worldwide bringing together a range of products and services trusted by hospitals around the world.

INFECTION PREVENTION HAIs are one of the biggest issues affecting healthcare today and a core focus for our business. One in seven of all HAIs in the UK are surgical site infections (SSIs)1.

ChloraPrep is a sterile, single patient use skin antisepsis system. It delivers the gold standard solution of two per cent chlorhexidine gluconate in 70 per cent isopropyl alcohol to the skin via a unique applicator which optimises the effectiveness of the solution.

It is available in two formulations, clear and with tint. A recent landmark study in The New England Journal of Medicine showed that ChloraPrep reduced the incidence of surgical site infections by 41 per cent, compared with povidone iodine2. The tinted formulation of ChloraPrep allows clinical staff to see where they have prepped, which makes it particularly suited to use in surgery.

The benefits of ChloraPrep with Tint for surgical procedures are consistent with previous clinical studies which have demonstrated reductions of 62 per cent in catheter related bloodstream infections following the introduction of ChloraPrep3. ChloraPrep is currently the only two per cent chlorhexidine-based product licensed for skin antisepsis prior to medical and surgical invasive procedures in the UK. OPTIMISED PROTECTION SYSTEM CareFusion introduces its new surgical gown portfolio that allows you to “optimise” your gown usage according to your clinical needs.

Our extensive customer research has told us that comfort, protection and cost are the most important criteria when selecting a surgical gown.

Every hospital has a unique combination of clinical requirements based on the procedures it performs. That’s why CareFusion has created its new Optimised Protection System OPS ™ to give you the ideal portfolio that makes choosing the right gown simpler and more cost-effective: • ESSENTIAL™ – adequate protection at lowest cost.

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• Enhanced Fluid Control – highly absorbent, with strong tensile reinforcement ensures prolonged and robust barrier performance • Puncture Resistant – a unique three layer material construction that provides superior strength and puncture resistance during use • Abrasion Resistant – an abrasion resistant fabric created by a unique top layer to film bonding, reducing the threat of cross contamination to you and the patient • Lower Lint – a low linting fabric is created by a unique top layer to film bonding.

CAREFUSION CLIPPER SYSTEM CareFusion Clipper System – now you can glide through hair removal while helping to minimise the risk of surgical site infections with CareFusion Surgical Clippers. You will feel the difference as CareFusion Surgical Clippers remove hair in a single pass for less patient skin irritation

SURGICAL GLOVES Surgical gloves – the Esteem range offers a unique polyisoprene formulation for fit, feel and performance comparable to latex without natural rubber latex proteins or allergens.

Esteem is 100 per cent latex and powder free, made without natural rubber latex proteins or allergens to provide extra safety for you and your patient. This range has recently been increased by the introduction of the Esteem Ortho. The Protegrity range offers a unique protection with three-layer design. It is made of natural rubber latex and nitrile The anatomical design is shaped on a Porcelain mould with independent thumb reduces thumb and palm strain.

TRAINING CareFusion provides full nurse led training and clinical support, as well as online educational material that will help you learn more about our products.

Notes 1. House of Commons Public Accounts Committee. Reducing Healthcare Associated Infection in Hospitals in England. 10th November 2009. London: The Stationery Office Limited.

2. Darouiche R et al. N Engl J Med 2010; 362: 18-26.

3. Garcia R et al. Manage Infect Control 2003; 10: 42-9.

FOR MORE INFORMATION Tel: 0800 1513587 E-mail: info@carefusion.co.uk Web: www.carefusion.co.uk www.bugsonyourskin.com www.chloraprep.co.uk

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Bacteria-ridden remote controls are the likely place for patients to get a cold or flu.

ZAPLEX disposable remote control protectors are injected with an antibacterial compound proven to help hospitals avoid the all-too-common hand-to-remote transferring of a cold, flu or MRSA

The Protector ZAPLEX™ remote control protectors are the sanitary solution to remote control-transferred

germs in hospital rooms. The low-cost, disposable plastic covers also help properties prevent the loss of remote control battery compartment covers and batteries. Following are just a few of the features of ZAPLEX™ remote control protectors:

3 Easy for housekeeping staff to apply; 3 Disposable: Change in seconds with each new guest; 3 Antibacterial-injected compound provides added sanitary protection; 3 High perceived impact at a low-cost-per-stay ratio; 3 Saves on lost batteries and remote control battery compartment covers; 3 Protect remote controls from spills and grime; and 3 One size fits virtually all remote controls.

Global Entertainment Management (UK) Limited Contact us today on 0845 260 2180 or via email: sales@globalentertainment.co.uk

Clean Remote is scientifically tested to carry 99% less Bacteria than other remotes In several studies, TV remotes have been revealed to be a leading carrier of bacteria in patients. Remotes are handled continuously throughout the day not only by patients, but also by staff and visitors. Standard remotes and nurse call pillow remotes have many cracks and crevices, which make it impossible to properly disinfect. The easy-to-wipe nonporous surface of the Clean Remote makes it simple to clean and disinfect.

3 Simple One Touch Set-up (non codes needed) 3 Works Over 200 brands of TV’s 3 No Menu Button (Patients and guests cannot change settings) 3 Hidden Battery Compartment (Helps prevent Batteries from disappearing) 3 Uses 2 AAA batteries

Contact us today on 0845 260 2180 or via email: sales@globalentertainment.co.uk

Global Entertainment Management (UK) Ltd, 401 Centennial Park, Centennial Ave, Elstree, WD6 3TN

Health Business | Volume 10.6

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INFECTION CONTROL

MAINTAINING A BUG-FREE ENVIRONMENT FOR PATIENTS A transformational change in the approach and attitudes of staff towards infection prevention has improved the patient experience at Blackpool, Fylde & Wyre NHS Foundation Trust

PEAT (PATIENT ENVIRONMENT Action Team) is a continuous programme of improvement of the patient environment by a multidisciplinary team which includes a patient representative.

Environment assessments are carried out at ward/departmental level and evaluate from a patients’ perspective: • Cleanliness and tidiness • Food and food service • Environment • Privacy and dignity • Infection control • Access and external areas The assessment results help to highlight areas for improvement and share best practice within the hospital and across healthcare organisations in England.

All annual results are published by the National Patient Safety Agency.

KEY FINDINGS Following the annual PEAT inspections, an action plan is compiled highlighting any areas of concern and funding allocated to improve environmental standards. The action plan is reviewed on a monthly basis, by the facilities lead person for PEAT, who ensures all actions are completed in a timely manner. The action plan is tabled at the quarterly PEAT meeting for progression Blackpool Trust fully complies with the Infection Prevention Section of the PEAT Audit and the team carry out checks during the annual award and continuous mini PEAT audits

across all divisions and hospital sites. These mini PEAT audits ensure that issues around infection prevention, domestic provision and estates are addressed on a regular basis thereby continuing to improve the patient environment. Infection Prevention representation is incorporated into the PEAT steering group work and a robust working relationship ensures the environment is maintained at optimal standard for the patient, combined with a close working relationship with the domestic provision to ensure high standards of cleanliness are upheld.

TOP MARKS FOR INFECTION PREVENTION To achieve ‘excellent’ scores across the trust, a number of initiatives have been implemented to focus on hand hygiene. A fully comprehensive hand hygiene policy and procedure is in place, supported by a robust education programme to raise awareness with all health care professionals.

Additionally there is a close working relationship between estates and infection prevention to ensure there are the correct numbers of sinks in relation to the number of beds, which has led to the number of sinks within the trust being increased. An annual audit of sinks ensures that all wards and departments have the correct number of sinks and also to ensure all are fully accessible and fit for purpose. In the event of any refurbishments or new builds there is a close working partnership with the facilities department to ensure that there are the right ratio of hand wash sinks and beds in line with regulations.

HAND HYGIENE AUDITS The hand hygiene policy and procedure comprehensively explains when alcohol hand rub is the correct mode of decontamination and when it is more appropriate to decontaminate with soap and water. Hand hygiene audits are conducted by hand hygiene champions on a monthly basis. These are based on the World Health Organization’s five moments approach to hand hygiene. Posters are readily available at all sinks to identify the correct way to decontaminate hands.

To obtain a true reflection of practice it is imperative that the audits are conducted as much as possible whilst healthcare workers are unaware, this also assists in reducing the Hawthorn effect, whereby staff alter their behaviour when being observed and revert to normal behaviour when they are no longer being audited.

Additionally junior doctors have been incorporated into the auditing process, and conduct audits on wards and departments completely without the knowledge of healthcare workers.

MONITORING PERFORMANCE Hand hygiene audit results are presented to each division on a monthly basis and are divided into different disciplines of healthcare professionals. If a particular group score in the red, discussions between infection prevention professionals and the managers of the relevant groups take place. An action plan is formulated and progress monitored, in some instances there is a requirement to raise awareness and increase training. If one particular division scores in the red two months in a row, they are required to present their action plan and detail how identified actions will be met, at the Hospital Infection Prevention Committee, which is chaired by the chief executive.

All healthcare workers are encouraged to challenge poor hand hygiene, in instances where the challenge is not well received, names are given to senior staff to address.

AWARENESS TRAINING We have adopted the Clean your Hands campaign and training and education is formulated around the “point of care”. Alcohol hand rub is readily available at the point of care and in additional strategic places around the ward, particularly at the entrance and exit of a ward or department. Hand hygiene leaflets are available at ward level for patients and visitors which denote how staff should be carrying out hand hygiene and what patients should expect.

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Get a grip on healthcare Effective endoscope acquired infections decontamination LLGOOD PLC is the UK’s leading architectural ironmonger in the supply of products to the construction industry. The company specialises in unique fine design and high performance products. In every aspect of the business we strive to provide the best quality and exemplary service, representing real value for money.

Allgood has built a reputation for supplying products of the highest aesthetic standard, matched with guaranteed performance and excellent service. Always looking to innovate, Allgood has developed a range of products for the healthcare market including: • anti-microbial ironmongery • anti-microbial door sets • anti-microbial washroom accessories • anti ligature furniture

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• finger guards As ironmongery is one of the most touched items in a building, it is extremely important to protect these areas from crosscontamination of bacteria and all forms of Healthcare Acquired Infections (HAIs). At Allgood we use anti-microbial technology in a range of products to prevent the growth of bacteria between cleans.

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ERE ARE JUST FOUR possible reasons why the hospital Decontamination Lead may need ‘no strings’ advice from the specialists.

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INFECTION CONTROL

Blackpool Fylde and Wyre NHS Foundation Trust, was awarded the HCAI Technology Innovation Team award in 2009 from Department of Health & National Purchase & Supply agency for the most innovative use of a cutting edge technology to spearhead the trust healthcare associated infection programme and demonstrating a reduction of 78 per cent in MRSA bacteraemia Hand hygiene audit results are also displayed at ward level, for patients, visitors and staff to see. In addition most wards have access to hand hygiene light boxes, which are utilised to train staff in hand hygiene and also to demonstrate to visitors. Hand hygiene is part of all induction, and mandatory updates ensure that all health care staff are trained on an annual basis.

It is also imperative that all patients receive adequate hand hygiene, and hand wipes are routinely used on the wards when patients are unable to access hand wash sinks particularly after using toilet facilities and prior to meals.

A COMMITMENT TO INFECTION CONTROL Infection prevention is an important measure that has been adopted throughout the trust; all healthcare workers are committed to ensuring that healthcare associated infections are greatly reduced. There have been a number of initiatives incorporated, which have led to a change in culture within the trust, including MRSA screening, hand hygiene, MRSA Bacteraemia counter on the trust Intranet homepage and a performance management meetings for all incidences of MRSA Bacteraemia and avoidable incidences of Clostridium difficile infection.

Mandatory infection prevention road shows led by executive directors are presented on a monthly basis for all new starters to the trust; all current 4,000 employees have attended an event. Infection prevention is strongly led from the board to ward to ensure commitment from all staff. Poor practice is challenged in all aspects of infection prevention.

SCREENING FOR MRSA Following a successful six-month pilot, a rapid screening process was adopted to enable swift identification on MRSA positive patients. This test is one of the many strategies employed within the trust to help reduce MRSA infection rates. Since the introduction of the test MRSA bacteraemia rates have fallen by 78 per cent in the first year, and incidences of MRSA bacteraemia continue to fall, with an overall decrease of 80 per cent.

The trust introduced screening for all emergency patients in April 2008. In order to ensure best quality care for patients, the decision was made to utilise a rapid screening

process called Polymase Chain Reaction (PCR).

The test reduces turnaround time for MRSA results from 72 hours to just two hours. By identifying MRSA early, patients are isolated quickly and receive the decolonisation treatment to significantly reduce the risk of transmission to other patients; thereby the quality of care to patients is greatly improved.

The availability of rapid results quickly identifies a patient’s MRSA status, which is used to complement clinical decision making regarding the patient’s management and optimal use of single rooms. The rapid test also assists in optimising antimicrobial therapy and thereby enhancing antimicrobial stewardship. Not only has there been a reduction in the use of certain antibiotic groups, a reduction in MRSA bacteraemia but there has also been a reduction of approximately 33 per cent in MRSA wound infections.

The Microbiology laboratory, operates a seven day service between 8am and 12 midnight, the average turn-around-time of results is five hours (two-eight hours). There has been approximately four per cent of patients detected as carrying MRSA. Rapid identification of positive patients ensures reassurance to the vast majority of patients and provides confidence to the MRSA carriers that targeted infection prevention protocols are initiated for them.

BENEFITS OUTWAY THE COST Although this screening process is more expensive than the conventional use of culture and sensitivity, the investment pays off quickly and the savings are much greater in terms of finance and the quality of care given to the patient.

The introduction of this process has had a significant impact on healthcare associated infections. By using this test the trust is saving lives. The associated benefit to patients and to clinicians is that we rapidly know within a few hours the MRSA status of patients coming into our hospital. This means that we can quickly identify which patients need to be isolated and which patients can be treated on an open ward.

Preventing hospital infections is one of the trust’s key priorities and during the six-month trial of PCR the number of cases of MRSA bacteraemia fell by 63 per cent. The introduction of the rapid

screening test along with a number of other initiatives has maintained the dramatic reduction in MRSA bacteraemia.

AWARD WINNING CAMPAIGNS Blackpool Fylde and Wyre NHS Foundation Trust was awarded the HCAI Technology Innovation Team award in 2009 from Department of Health and National Purchase & Supply agency for the most innovative use of a cutting edge technology to spearhead the trust healthcare associated infection programme and demonstrating a reduction of 78 per cent in MRSA bacteraemia. The Trust has also been sharing best practice nationally and internationally. A team from the trust was invited to the European Parliament in Brussels and to meet the Minister and Department of Health to share the excellent work done at the trust.

Preventing hospital infections is one of the trust’s key priorities as it is one of the biggest areas of public concern. The trust has introduced several initiatives aimed at preventing hospital infections such as the ‘Ban the Bugs’ campaign, Chlorhexidine 2% skin disinfectant, trust wide roll out of aseptic non touch technique, quarterly saving lives audits, a robust surgical site surveillance programme and the hand washing campaign by enforcing strict hand washing standards for staff, patients and visitors.

The ‘Ban the Bug’ campaign was an extensive programme to raise awareness of infection prevention within the hospital aimed at patients, visitors and staff. The eye-catching posters are displayed across the site both internally and externally to raise infection prevention awareness and to aid in significantly reducing the risk of acquiring an infection.

Chlorhexidine 2% was introduced as a skin disinfectant for the reduction of bacteria carried on the skin when inserting peripheral lines, central lines and for taking blood cultures. Aseptic non touch technique is an aseptic procedure which ensures vital parts of equipment are not touched when preparing and administering intravenous drugs, thereby reducing the risk of infection. All these initiatives have assisted in dramatically reducing the levels of MRSA bacteraemia and wound infections.

The appointment of a new director of infection prevention and control, enhanced and cohesive working of the infection prevention nurses, two consultant microbiologists and antibiotic pharmacist have all helped in bringing about a transformational change in the approach and attitudes of staff working in the trust towards infection prevention and healthcare associated infections.

Written by Johanne Lickiss, nurse consultant infection prevention Yvonne Widdows, senior site services manager Carol Gibson, monitoring and residences manager Dr Achyut Guleri, consultant microbiologist.

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Health Business | Volume 10.6

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LEGIONELLA PREVENTION

RESPONSIBLE WATER MANAGEMENT Giles Green, Chairman, Technical Committee of the Water Management Society, looks at legionnaires’ disease in the context of hospitals and other healthcare premises THERE IS NO NEWS IN THIS ARTICLE; the only new thing in the legionella control is British Standard 8580 on risk assessment and that has been circulated for public comment, so it holds few surprises. But suppose we take what we know about legionnaires’ disease in the context of healthcare premises and consider how big a story it really is.

INFECTION STATISTICS Legionella infection statistics are collected by the Health Protection Agency and they

show three very significant oddities: first, the number of cases shows little sign of decreasing, despite greatly improved control over three decades; second, the number of single cases that are not traced to a source is greater than cases in outbreaks where there is a clear common factor (whether that factor is specifically identified or not); third, the age profile continues to show a decrease in cases amongst the elderly, which is not so evident in statistics from some other countries.

The first of these oddities, no overall decline in

Legionnaires’ disease is caused by a bacterium which is common and harmless in the environment, but which, through the criminal negligence of those charged with the care of some of the most vulnerable members of society, grows within water systems and emerges, silent and invisible, and infects the sick and elderly, the weak and infirm

numbers, is often passed over with a comment that diagnosis is improving and more cases are being identified, which masks the improvement.

This may be so, but if there are more cases than are diagnosed, how many more are there and have we any idea whether they are decreasing?

Estimates of under-diagnosis vary from two or three times to perhaps ten times, so it is quite possible that in a bad year (like 2006) there could be over 1,100 to 5,500 cases.

The second oddity, more single cases than outbreak cases, often seems to be dismissed as being too difficult to resolve; presumably caused by showers at home, perhaps after a holiday when the water has remained unused for a couple of weeks. If this is so, how likely are showers to cause legionnaires’ disease and is a holiday necessary or can legionella become established anyway?

Showers certainly have the appropriate temperature, aerosol generation and exposure factors and, with many being supplied via complex bath tap-cum-shower mixer devices, there is potential for water to remain undisturbed within fittings; hidden deadlegs close to the point of discharge, aerosol generation and exposure. Added to that, in healthcare premises, hot water is mixed with cold by fail-safe thermostatic mixing valves (TMVs), quite correctly to control the scald risk, so fittings often cannot reach a disinfecting temperature.

The third oddity, the decline in numbers of cases with increasing age, is thought by some to be a consequence of clinical prejudice; it seems that, in Britain, elderly

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Cost Effective Safe Legionella prevention

Danish Clean Waters water treatment system removes Biofilms and destroys Legionella bacteria cost effectively without the use of costly and dangerous chemicals.

A typical 600 bed hospital using 360 cubic meters of water per day will cost only £1.50 per day to prevent legionella colonisation

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Comparison of technologies UV Sodium Chlorine Hypo- Dioxide chlorite

Ozone Silver Nano Particles

Prophylactic effect

No

Yes

Yes

Limited

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Yes

Destroys biofilms

No

Limited

Yes

Limited

Limited

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Safe for operators

Yes

No

No

Yes

Yes

Yes

Effective against legionella colonization No Environmentally safe

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Yes

Yes

Limited

Yes

Yes

Yes

Yes

Yes

Strong concerns

Yes

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LEGIONELLA PREVENTION

water at incubating temperatures rather than hot water at disinfecting temperatures, the TMVs themselves get warm, cooling the immediately adjacent hot supply and warming the immediately adjacent cold supply. They also discourage use of the unmixed cold taps, creating deadlegs full of stagnant water at thousands of washbasins and baths used by people selected (albeit inadvertently) to be more at risk of legionella infection than most.

Simply knowing that legionnaires’ disease is real and extremely nasty, and that water temperature and stagnation are critical to its control can enable any staff member to contribute people are expected to become ill and even to die, so there is a tendency for less effort to be applied to diagnosis or treatment. This is not the writer stating an opinion, it is one expressed by others in the health protection field, usually with international experience.

Is that a big story? Writing it, it doesn’t seem to be, but then the tone is dispassionate, the information is factual and the mood is not emphatic, but suppose it were rewritten as a news story, adding (as any well researched piece would) that legionnaires’ disease is preventable and that the law (the Control of Substances Hazardous to Health Regulations) covers it.

LEGIONNAIRES’ DISEASE A killer disease could be bringing agony to thousands and death to hundreds, say health experts. Legionnaires’ disease is caused by a bacterium which is common and harmless in the environment, but which, through the criminal negligence of those charged with the care of some of the most vulnerable members of society, grows within water systems and emerges, silent and invisible, and infects the sick and elderly, the weak and infirm, causing sudden and devastating illness, severe difficulty and excruciating pain breathing, often followed by domino-like multiple organ failure and, frequently, death.

The good news, of course, is there within the bad news; legionnaires’ disease is preventable. It is almost 30 years since the principles of legionella control in cold and hot water systems were established following an

outbreak at Kingston in Surrey (which is why these principles are sometimes referred to as the Kingston Controls) and more than 20 since they were published as guidance with the authority of the Health and Safety Executive.

WATER TEMPERATURE What was effective then remains effective now: Legionella bacteria do not occur in high numbers in mains water, they do not multiply below about 20°C and they are killed by temperatures in excess of about 50°C. When they grow, they still grow as slowly as they did in the 1980s and they still struggle to gain much from materials that yield no nutrient. It was true then and it is true now that a well designed, well installed and well maintained water system, which is operated correctly, constitutes a very low risk of legionella infection to a normally healthy individual.

Of course, in practice, design often involves compromise; installation may be imperfect (not least when modifications are made and a practical solution seems preferable to an expensive refit) and maintenance naturally tends to focus more on breakdown than preventative measures.

Then there is the sting in the tail: a conventional system that ticks all the right boxes undoubtedly constitutes a very low risk of legionella infection to a normally healthy individual, but healthcare premises are well known for their populations of less healthy individuals. The use of TMVs for scald protection not only results in warm

WHAT CAN BE DONE? Accepting that practice is rather more complicated than theory and the simple principles of the Kingston Controls may prove difficult to apply in some cases is not the same as allowing them to be disregarded.

Simply providing fairly basic training, staff from all disciplines can be made aware of the risk and can all contribute to control. Simply knowing that legionnaires’ disease is real and extremely nasty, and that water temperature and stagnation are critical to its control can enable any staff member to contribute. Simply taking responsibility to report faults or underuse of facilities and implementing timely corrective action can prevent an anomaly becoming a risk.

Simply denying that the problem is too big, or too remote, to do anything about can mean that many minor actions can accumulate into a significant improvement. Simply refusing to accept what is known to be wrong can exert the pressure necessary to have it put right.

All this, of course, has to fit within a strategy of risk assessment, monitoring, corrective action, record keeping and management and each of these has its own essential components, none of these is more difficult or onerous than much of what makes up most of the routine work in any healthcare establishment. Legionella risk assessments are no different to clinical assessments, they just require different special skills and therefore different specialist assessors; a programme of inspections and monitoring is no more of a task than observing patients to see they are clean and comfortable. It just needs its own schedule, measures and targets; corrective actions could be compared to reviewing medication, for which nobody would consider not keeping records, but which benefits greatly from well designed forms and, no matter how well trained and capable staff may be, they could not operate efficiently for long without someone organising and overseeing them, considering events and making decisions, i.e. management. None of which is news.

FOR MORE INFORMATION The Water Management Society (WMSoc) has a range of publications and guidance pamphlets available to assist establishments to operate their water systems efficiently and safely. The WMSoc can be contacted on 01827 289558, or visit www.wmsoc.org.uk for more information.

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Specialist water treatment solutions

Setting the standard in water quality

CORN CHEMICAL SERVICES LTD is a well established and expanding specialist water treatment company. We concentrate on providing a professional service to all our clients, ensuring that they comply with all aspects of The Approved Code of Practice L8 as part of a complete Legionella Management Regime.

Our services include: • carrying out risk assessments in accordance with the ACOP L8 • temperature monitoring and reporting • cleaning and disinfection of water systems • water sampling for Legionella and other parameters • cooling water treatment packages • boiler water treatment packages • effluent treatment and control • bespoke manufacture of water treatment and industrial chemicals Our clients include the NHS, local authorities and other public bodies as well as private companies, including steel manufacturers, automotive and food industry.

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At Mouchel we’re always looking at ways to help our clients improve the standard of their water quality. We’re the third largest provider of consultancy services to the UK water sector.

Legionella Bacteria is present in all water systems and lies dormant until suitable conditions are achieved. On average there are approximately 200 – 250 reported cases of Legionellosis or Legionnaire’s Disease each year in the UK. That’s why we offer our clients: Legionella risk assessments; Hot and cold water monitoring; Cleaning and disinfection of tanks and down systems; Sampling and facilities management services.

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Acorn is accredited with ISO9001:2008, Investor in People; and is a member of the Legionella Control Association, Construction Line and Safe Contractor.

Our staff are highly trained, competent and professional individuals who are dedicated and committed to the needs of the client. They include Chartered Members of The Institute of Occupational Safety and Health, Members of The Royal Society of Chemistry, Members of The Water Management Society, Members of The Institute of Environmental Management and Assessment.

FOR MORE INFORMATION Mrs Anthea Davies Tel: 01639 641222 Fax: 01639 641999 E-mail: admin@ acornchemical.com Web: www.acornchemical.com

Water treatment services Anti-legionella from TSS Facilities showerheads from T Hydroviron Ltd

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SS FACILITIES’ water treatment department operates across South East England offering services including: • legionella risk assessment • planned preventative maintenance • chemical and microbiological analysis sampling using an UKAS accredited laboratory • L8 training • cooling tower water treatment • clean and disinfection of water systems to L8 and BS6700 standards • installation and maintenance of dosing equipment • chemical sales As a category one member of the Legionella Control Association

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(LCA) TSS Facilities is an approved service provider of the highest caliber as recommended in the HSE’s ACoP L8 The Control of Legionella Bacteria in Water Systems. Our service provider commitments are outlined in our LCA approved code of conduct which can be viewed on our website. All work is carried out in full compliance with the most up to date legionella legislation and guidelines.

FOR MORE INFORMATION For further information on our services please visit www.tssfacilities.co.uk, e-mail us at info@tssfacilities.co.uk or call us on 01273 719111.

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YDROVIRON LTD is the UK distributor for the Prime Water range of anti-legionella showerheads incorporating a patented cartridge membrane filter. The filter is unique in removing all bacteria, including legionella spp. and pseudomonas, with only minimal reduction in water flow. The cartridge unit is replaceable once exhausted, allowing the showerhead itself to be reused. This reduces costs significantly in comparison to other point of use shower filters currently available.

The showerheads are NSF approved and CE marked for use as a medical device.

The filter cartridge will provide sufficient water for up to 150 average shower usages before any noticeable reduction in water flow.

For multiple shower head installations, e.g. changing rooms, where the showers are supplied by a common line, Hydroviron

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can supply the same membrane bundle in a standard ten inch filter cartridge, which can be installed in the supply line and will protect up to eight shower outlets.

In addition to shower protection a range of membrane cartridges are available for the removal of other bacterial contamination, including pseudomonas, and these are ideal for reducing infection risks in vulnerable wards.

FOR MORE INFORMATION Tel: 0870 8742587 Fax: 0870 8742687 E-mail: enquiries@hydroviron.com Web: www.hydroviron.com

Visit the website to view the categorised product finder

Rentokil – for all your cleaning requirements ENTOKIL SPECIALIST HYGIENE offers a wide range of services that includes: • Specialist cleaning • Specialist disinfection • Washroom deep cleaning • Commercial kitchen cleaning • Air management • Drain maintenance • Legionella control and prevention.

Cleaning is at the forefront of today’s healthcare issues as poor hygiene can put lives at risk and threaten productivity. Our aim is to protect people from the harmful influences of poor hygiene standards by tackling difficult and hazardous cleaning problems safely, legally and discreetly.

Our 24-hour specialist disinfection service is a rapid response unit, dedicated to extreme situations, providing

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an essential service throughout health authorities, NHS and Primary Care Trusts, hospital clinics and government laboratories.

You can rely on our team to respond to the ever-increasing demand for stringent hygiene standards. We work with you to ensure patient needs are obtained and the risk of infection is controlled and dealt with utilising the correct procedures.

We fully understand the needs of the healthcare sector and work closely with the NHS and private hospitals, Primary Care Trusts, care homes, dental and GP surgeries.

FOR MORE INFORMATION Contact Rentokil Specialist Hygiene today on 0845 6020900 or visit www.rentokilhygiene.co.uk for more information on all services.

HSE L8 Legionella Management Specialists RITEC ENVIRONMENTAL SERVICES LIMITED has many years’ experience in the field of water treatment and air hygiene management.

Established in 1986 our aim is to provide a safe and healthy environment, with legislative compliance to all types of building.

Water Treatment Services include the following: • legionella management contracts • risk assessments to HSE L8 guidelines.

• disinfections of cooling towers, • disinfections of tanks and water services • water sampling (TVC Coliform/E.Coli/Legionella) • water softener service Air system management services include the following: • air system condition reports • air quality monitoring • air quality investigations • ductwork cleanliness surveys

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• airborne analysis • thermal comfort audits We also offer a number of installation and refurbishment services associated with the above service and management tasks.

FOR MORE INFORMATION

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Process Mechanical Ltd – supporting companies within the public sector HE EXPERIENCE of our team enables Process Mechanical Ltd (Pro-Mech) to project manage, design, supervise and deliver solutions that exactly match what they require, to budget and within the available timeframe, allowing clients to enjoy a hassle-free coordinated process. As an active partnering company we embrace these principles and are currently involved in several large contracts of this nature for a number of schools and hospitals and other national heathcare facilities.

Our Mechanical & Electrical departments have completed projects from simple boiler renewals and rewires to large combined heating and electrical power installations, as well as large scale refurbishment projects for local authorities, universities and healthcare trusts, and many other associations and commercial clients. The comprehensive nature of our range of services enables us to provide a one-stop-shop

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solution for clients, from initial design work through to high quality installations, mechanical and electrical services, project and health and safety management.

Operating nationwide, clients include, Interserve Building and Project Services, Southwest Yorkshire Partnership NHS Foundation Trust, The Mid Yorkshire Hospitals NHS Trust, National Blood Transfusion Services, Greggs Bakers and Bradford & Leeds Universities, to name but a few.

FOR MORE INFORMATION Process Mechanical Ltd Pro-Mech House, Bolling Road, Bradford BD4 7BT Tel: 01274 736866 Fax: 01274 736966 Web: www.pro-mech.co.uk

Swiftclean legionella control for the NHS EGIONELLA PNEUMOPHILIA, the stagnant-water loving dropletborne bacterium that causes Legionnaires’ disease, causes trouble for everybody. If your premises harbour legionella, and somebody gets infected and dies, you could be looking at manslaughter charges.

Under the Control of Substances Hazardous to Health (COSHH) Regulations, all NHS premises must: • identify and assess the sources of legionella risk • prepare a scheme for preventing or controlling the risk • appoint a person to be managerially responsible • implement, manage and record precautions.

Swiftclean has more expertise in legionella control than most and the Swiftclean service includes valuable extras to enhance the

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understanding of your staff.

Services include: • free legionella control training seminars • free quotations and technical advice throughout the UK • all work carried out to the Legionella Control Association’s code by directly employed staff.

• risk assessments and control schemes carried out to L8, BSRIA and CIBSE guidelines • legionella control log books provided • site specific method statements and risk assessments provided • training for your own staff following risk assessment.

FOR MORE INFORMATION Tel: 01702 531221 E-mail: k.thurgood @swiftclean.co.uk Web: www.swiftclean.co.uk

Contact: Scott Harvey – commercial director Tel: 01923 202085 Mobile: 07768 542711 E-mail: scott@tritecuk.com

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Specialist Disinfection Services Our Specialist Disinfection service is a unique and reliable cleaning service for extreme situations. It has been specifically designed to tackle difficult or hazardous cleaning problems safely, legally and discreetly.

Our dedicated experts are available for rapid response, 24/7 365 days a year across the UK. They provide a professional and vital support service for all health and governmental departments, the NHS, emergency services as well as many commercial organisations.

a Needle, syringes & sharps removal a Contagious diseases disinfection a Body fluid and faeces clean up a Emergency services clean up a Death & suicide clean up a Trauma scene clean up a Crime scene clean up a Prison/cell cleaning a Flood damage cleaning a Squatters eviction house cleaninga Sewage damage clean up a Bird droppings clean up a Hospital deep cleaning

For more information on our range of services contact us on: T: 0845 60 20 900 W: www.rentokil-hygiene.co.uk E: specialisthygiene-enquiry@rentokil-initial.com

Health Business | Volume 10.6

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CLEANING

ARE YOUR CLEANING OPERATIVES PROFESSIONALLY TRAINED? We speak to Stan Atkins, CEO of the British Institute of Cleaning Science, to examine why it is so important for healthcare establishments to use trained and qualified cleaning operatives THE HEALTH AND SAFETY OF PATIENTS should be of the utmost importance for any healthcare establishment. Having professionally trained cleaning operatives is crucial to improving hygiene and cleaning standards and reducing hospital acquired infections (HAI). However, cleanliness in healthcare establishments is much more than just having a surface clean. Of course it is essential for the premises to look aesthetically pleasing, but cleaning is also vital for the safety of both the patients and staff.

Stan Atkins, chief executive of the British Institute of Cleaning Science (BICSc), advises there is great potential in improving cleanliness in the healthcare sector by ensuring that staff are correctly trained in all aspects of cleaning.

RAISING STANDARDS BICSc is the largest independent professional and educational body in the cleaning industry.

They have been established for many years now, celebrating 50 years of operation next year.

They have approximately 5,000 members, both corporate and individual, and they have now reached international status. Their mission is (and has always been) to raise the status and standards of the cleaning industry through education.

“BICSc has dedicated over four decades to improving the industries knowledge of cleaning science,” says Stan Atkins. “We are an independent body with members in all areas of the cleaning industry, including local authorities, contract cleaners, manufacturers, suppliers, trainers and by no means least, cleaning operatives themselves.”

With budgets tightening, training cleaning operatives seems to be one of the areas where cuts are being made. This can be counterproductive however, and it is very important that training is maintained to a high standard. BICSc strives to reinforce this message.

“We are working with the government more, to raise the profile of the cleaning sector, with particular regards to training,” Stan says.

“We need to educate the government of the important role cleaning plays in preventing infection outbreaks. For the immediate future we need to raise the awareness of the value of training in all sectors. Training and industry standards are vital to the profile of cleaning being recognised as a valuable service in healthcare and should not be seen as just an added cost. Training is a vital element of any contract. It is how the service is provided.”

Fully trained cleaners will be aware of the dangers that an unclean and unhygienic healthcare establishment can cause. There are many threats to patients and to staff in

hospitals and if your facilities are not being cleaned correctly the consequences can be dire.

INFECTION CONTROL An outbreak of infection could potentially be disastrous. Your patients are vulnerable to viruses and therefore it is vital to protect them by making sure your facilities are professionally cleaned.

Having trained cleaning operatives should be an important part of the infection control process in hospitals and healthcare premises. An untrained cleaning operative will not be aware of the correct cleaning techniques required to stamp out infection.

Infection control is complicated and requires many methods of cleaning to prevent the spread of different germs, and not just traditional cleaning methods.

A trained cleaning operative will be able to combine periodic deep cleans with their day to day cleaning regime. A deep clean will kill viruses and is an important tool in preventing the spread of infection. A trained cleaning operative will also be aware of virus hot spots in hospitals and other healthcare facilities, which an untrained cleaning operative might not necessarily know to target. It is likely that floors and surfaces will be cleaned effectively by an untrained cleaning operative but other areas, which often actually pose

much more of a threat, may possibly be neglected. A trained cleaning operative will be able to target these areas to ensure that the germs are prevented from spreading.

These virus hot spots include bed rails, bed linen, tables, taps, buzzers, monitors, lockers, curtains, light switches and door handles.

THE EVER PRESENT THREAT OF MRSA MRSA can be a dangerous bacterium and can cause serious illness and sadly, in some cases, even death. According to the Office for National Statistics1: “On 19 per cent of death certificates which mentioned MRSA in 2009, this infection was recorded as the underlying cause of death.

This figure varied between 17 per cent and 36 per cent over the 1993-2009 period.”

It would appear that the elderly are the most vulnerable. The office for National Statistics also states: “Most of the deaths involving MRSA occur among older people. For the combined 2005-2009 period, age-specific rates were highest in those aged 85 years and over, at 622 per million for males and 307 per million for females. The lowest rates for deaths mentioning MRSA were among people aged under 45 years with one death per million for both sexes.”

This emphasises just how important it is to reduce the spread of infection through effective cleaning, especially when caring for older patients.

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Local Authority approved ESCC Social Services Rother District Council SAFEcontractor Accredited

m a b a c u s Ltd i n

Regional Contract Services was established by its current working directors as a means to an end, the end was a professionally run cleaning and support services company that operates on an open book policy basis to its staff and clients alike, and is fully aware of its responsibilities to the environment and the planet.

... a service you can count on

Total Cleaning Solutions For all your commercial cleaning

They have put their skills and experience together to form a highly successful operating company, whilst remembering the intention is not merely to emulate previous success in the industry, but to take on board and build on the professional aspects while leaving behind the old philosophies of what is a good service, and so to create a company with a service focussed attitude and the flexibility to accommodate individual clients needs.

Preventing transference of Germs and Bacteria (Clothless Cleaning System)

T 0800 3247819 E info@abacusmain.co.uk W abacusmain.co.uk

Outstanding Cleaning Services

always expertly managed & competitively priced

Telephone: 020 7708 3814 Email: info@regionalservices.co.uk

Rope access is a cost and safety effective alternative to scaffold D ACCESS has many years experience providing innovative cost effective access solutions and carrying out various maintenance, inspection or cleaning work for the construction, commercial and petro-chemical industry.

The use of rope access reduces the time spent setting up and dismantling access systems.

It ensures repairs and surveys are tackled swiftly and with minimal disruption to normal operations. Specialist rope access provides cost saving on projects through the elimination or reduction of costly scaffold.

Our multi-skilled independently trained and assessed technicians solve complex access problems from simply cleaning windows on a multi-storey building through to glazing installation, complex rigging and lifting services, netting services and electrical installations, where conventional methods have proved impractical or too expensive. Once ropes have

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Help Prevent This Happening To Any Of Your Staff, By Calling 020 8880 4091 BLENHEIM & MOORCROFT • We Offer A Professional Cleaning Service & In Some Instances We Prevent Personal Injuries :)

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been set up on a structure our technicians possess the capabilities to carry out a wide range of tasks.

Our quality systems and work procedures insure that we work safely, quickly and effectively, minimising project costs. All of our technicians have a vast amount of experience in industrial rope access and other work at height techniques.

We can provide specialised cleaning solutions for inaccessible places and many other applications.

FOR MORE INFORMATION Tel: 0161 6434019 Fax: 0161 6434018 E-mail: enquiries@3daccess.co.uk Web: www.3daccess.co.uk

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CLEANING

An MRSA infection can spread quickly via commonly touched surfaces, skin to skin contact and shared equipment which has not been properly cleaned. This highlights the importance of using properly trained cleaning operatives to reduce the risk to patients and to staff. A trained cleaning operative will be able to use the right amount of disinfectant and other cleaning compounds to safely remove MRSA from hospital wards, reception areas, washrooms, surfaces, and other commonly touched items and objects.

THE NOROVIRUS The Norovirus can easily spread and an infection outbreak can be uncontrollable. In the past a few NHS hospitals across England had to close some of their wards to new admissions in an attempt to stop the virus from spreading. This is disruptive to the patients and can cost the hospital greatly.

It is essential to maintain extremely high hygiene standards in healthcare establishments to reduce the chances of an outbreak.

will improve the level of cleanliness and thus reduce the risk of an outbreak of infection.

CLOSTRIDIUM DIFFICILE Clostridium Difficile (c. diff) is one of the most common causes of diarrhoea in hospitals.

Specialist cleaning techniques are often required to remove spores of the c. diff bug. Traditional cleaning methods will not necessarily kill the microorganism as it is very resistant. It is believed that traditional cleaning methods can in fact make c. diff form spores, which can spread the infection when breathed through the mouth or swallowed.

This is another reason why it is so important to use trained cleaning operatives in a healthcare environment. A trained cleaning operative should be fully aware of the required specialist techniques required to remove this infection.

The recent enquiry into an outbreak of c. diff between June 2007 and August 2008 in Antrim Area Hospital has led to an increased awareness of the importance of training

A trained cleaning operative will be able to combine periodic deep cleans with their day to day cleaning regime. A deep clean will kill viruses and is an important tool in preventing the spread of infection Outbreaks are often caused in hospitals and nursing homes as the people are grouped together in an enclosed environment for an extended period of stay. A trained cleaning operative will be conscious of the need for good hygiene practices and will be able to properly disinfect contaminated areas to reduce the spread of the virus. Combining good cleaning methods with the right equipment

in the cleaning industry. As a result of the outbreak, cleaning staff at the hospital now take part in a training scheme accredited by the British Institute of Cleaning Science.

ACCREDITED OPERATORS Some cleaning firms and cleaning operatives promote themselves as being fully trained and accredited to an independent body.

BENEFITS OF TRAINED OPERATIVES The benefits of using a fully trained cleaning operative in your healthcare establishment include: • reduction of cross-infections • improved hygiene standards • patient and staff safety reinforced However, this is actually not always the case.

For example, some say that they are BICSc accredited or that they are BICSc accredited training centres, when in fact they are not.

They may be trained or train to BICSc standards but have not actually received certification.

To protect yourself from being misled it is important to make sure your cleaning operatives are actually fully trained and qualified. Always check their credentials and references.

PROTECTING PATIENTS AND STAFF There are two simple options to ensure your cleaning operatives are fully trained to work in a healthcare environment: Option One – employ cleaning operatives who have obtained certification and qualifications in cleaning and cleaning in healthcare establishments.

Option Two – book your current cleaning operatives onto industry recognised courses to teach them the correct processes of cleaning in healthcare establishments.

Notes 1. www.statistics.gov.uk/cci/nugget.asp?id=1067

FOR MORE INFORMATION For further information on BICSc qualifications available please visit www.bics.org.uk

Cleanwise wins BICSc award for excellence in training and assessment S A TRAINING PROVIDER throughout the cleaning industry we also provide training and support to the healthcare services raising standards to ensure a clean, safe and comfortable environment for patients, visitors and staff. We are committed to help reduce the incidence of Healthcare Associated Infection thus creating greater levels of patient confidence.

Ensuring that hospitals are clean and safe is essential in the provision of effective healthcare. A clean hospital environment is paramount to patients and staff alike. It is important from an aesthetic perspective as well as a hygiene prospective that standards are raised and maintained.

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Recent studies have shown that effective training for cleaning staff not only reduced HAI but also helped to reduce costs. BICSc training makes staff focus on both the standards that can be achieved and safe working practices. It provides goals for the team to work to and pride in the improvements made.

FOR MORE INFORMATION If you would like further information on how Cleanwise can help your establishment please contact Lyn Crowther on 07780 976941, Steve Dove on 07976 483707, Training Centre on 01279 723975 or visit www.cleanerthinking.com

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Facilities management for the health sector CS WAS ESTABLISHED in 1992 and has developed unique methods of cleaning, which ensures the highest standard for our clients. Below is the range of services we offer.

High level window cleaning – we include frames and sills as standard which is achieved using our Reach & Wash system enabling us to clean up to 70 feet from the ground. Pure de-ionised water leaves windows spotless and free of residue. This system can also be used to clean signage and cladding.

Internal high level cleans – these are carried out by staff qualified for working at height. We use high powered extraction to remove contamination from all areas of ceilings, high ledges and lighting.

Contract cleaning – colour coded microfibre is used throughout to minimise the use of cleaning agents and eliminate the danger of cross contamination in areas such as kitchens. These colour codes are strictly adhered to and the method of cleaning ensures that floors are dry almost immediately, minimising the risk of slips.

Carpet cleaning – our system

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is virtually silent and carpets are dry in approximately 30 minutes. This system also has a built-in biocidal disinfectant which eliminates dust mites.

We are members of HVCA and qualified to clean all forms of ductwork including operating theatres, kitchens, heating and ventilation. We can also carry out tests and inspections, and report on contamination such as legionnaires and particulates.

FOR MORE INFORMATION Tel: 01933 652053 E-mail: brenton@acscleaners.com Web: www.acscleaners.com

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ROVENTEC HEALTHCARE is the growing name for infection prevention and patient safety within the healthcare environment.

Using proven technologies integrated into a single portfolio, Proventec Healthcare provides hospitals, care homes and primary care facilities with a comprehensive range of microbiologically validated hygiene solutions conveniently available from a single source.

Through field researched, clinically proven and innovative product developments by subsidiaries Contico and OspreyDeepclean, Proventec Healthcare is making ever greater strides in the prevention and control of HCAIs. The company’s latest ergonomically designed Dry Steam Vapour equipment, utilising task-specific cleaning tools and advanced ‘3D’ microfibre, elevates routine cleaning into daily decontamination procedures.

The award-winning Healthcare Steam Cleaning Tools have been validated in cleaning and decontamination performance

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Would you use your hospital’s public toilets?

HE BRITISH TOILET ASSOCIATION is recognised as the unique expert source of information and support in all matters related to ‘away from home’ or public toilets across all market sectors including private and public healthcare.

Public health and hygiene issues are constantly in the news, with increasing media interest in all matters relating to publicly accessible toilets. Many healthcare premise toilets do not conform to best practice.

Toilet hygiene is particularly critical as infection risks must be identified and any opportunities for cross contamination eliminated.

Toilet design, functionality, facilities, cleaning practices, maintenance and monitoring of hygienic conditions all form parts of BTA Best Practice Advice.

By joining the BTA your hospital will benefit from access to solutions for all toilet related issues from the experts in toilet design, the latest toilet

Proventec Healthcare – for all your hygiene and patient safety needs for all typical hospital surfaces and against a host of HCAI pathogens including MRSA and Clostridium difficile spores.

Due to its high degree of “grab” and adsorption, the new 3D microfibre demonstrates superior performance in soil removal without the use of environmentally damaging biocides. Disposable versions provide the optimum performance with no need to launder and no concerns about possible cross contamination.

Combine the two systems, microfibre and steam, and it is clear that no other approach to healthcare cleaning and hygiene even comes close.

FOR MORE INFORMATION Tel: 0845 6029981 Fax: 0845 6029366 E-mail: sales@proventec healthcare.com Web: www.proventec healthcare.com

Avanti – cleaning solutions designed for the professional user VANTI CLEANING SOLUTIONS is a supplier of cleaning, hygiene and janitorial products to the South West of the UK. A privately owned, family-run business, we operate from our 14,000 sq ft warehouse in Bristol, and stock an extensive product range from some of the leading manufacturers in the industry.

We only stock products from carefully selected, qualified suppliers who meet our strict requirements for quality, service, reliability and technical support. Brands stocked include Jeyes Professional, Deb, GOJO®, Robert Scott and Sons, Salmon Products, Diversey Ltd and Tork. We have close relationships with our suppliers and our team benefits from in-depth product training and technical backup, all of which help us offer a better service to our customers. All chemicals are supplied with Safety Data Sheets in line with COSHH regulations.

We are proud to be members of

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equipment, and products and services meeting current legislative requirements and designed to minimise opportunities for cross contamination.

The BTA Consultation Service is independent, reliable and cost effective. It is available to members and non-members and provides advice to management on all toilet related issues.

BTA also promotes Loo of the Year Awards that recognise the very best publicly accessible toilets and provides the Loo Monitor service.

FOR MORE INFORMATION Tel: 01403 258779 E-mail: enquiries@britloos.co.uk Web: www.britloos.co.uk

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the Cleaning and Hygiene Suppliers Association (CHSA) and the British Institute of Cleaning Science (BICSc), as testimony to our high standards in the conduct of our business.

With 30 years experience in the cleaning industry, we can give you professional, impartial advice on any cleaning or hygiene issue.

We supply a diverse range of clients, including local councils, leisure centres, community centres, schools, nurseries, nursing homes, and commercial organisations large and small.

FOR MORE INFORMATION Tel: 0117 9633629 Fax: 0117 9635070 E-mail: sales@avanticleaning solutions.co.uk Web: www.avanticleaning solutions.co.uk

Health Business | Volume 10.6

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CLEANING

CLEAN VENTILATION SYSTEMS – NEVER MORE ESSENTIAL Richard Norman, managing director of Indepth Hygiene Services Limited, the UK’s leading company for specialist cleaning of ventilation systems, talks about the importance of ensuring they are thoroughly cleaned THERE HAS NEVER BEEN A PREVIOUS time when those responsible for the maintenance of ventilation systems had more reason to ensure they are maintained in a clean and safe condition. On a fundamental level the National Health Service is charged with the responsibility in its own constitution to ensure “patients are treated by an organisation that provides its services in a clean and safe environment”.

The very air that patients, staff and visitors breathe must be safe and unpolluted. Since the essential functions of a ventilation (air conditioning) system is to circulate clean safe air it is indisputable that those with a particular responsibility for maintaining ventilation systems should ensure that all possible steps are taken to do just that.

INFECTION CONTROL Dr Ghasson Shabha of Birmingham City University has published extensively his findings on the link between uncleaned ventilation systems and the spread of HCAI. He firmly maintains that temperature and humidity

no action. There’s too much evidence to show that to ignore the state of the air conditioning system puts all hospital occupants at risk.

Without even committing to expenditure it must be part of the estate or facilities manager’s responsibility to fulfil the duty of care to have the system professionally audited and a detailed report provided, including results of tests on contamination levels. He will then have an accurate assessment of risks in the system and will have the typical management task of balancing competing priorities for financial resources. Not to put himself in a position to know how serious the problem is, is to fall short of meeting his responsibilities. Indepth will carry out a detailed system survey and provide the report with a recommended action plan quite free of charge.

It is not only air conditioning systems which warrant special attention to meet the overriding obligation of providing a clean and safe environment. Grease extract ventilation systems, invariably linked to the catering facilities, are a potential source of danger to hospital patients, staff and visitors. As grease particles

Since the essential functions of a ventilation (air conditioning) system is to circulate clean safe air it is indisputable that those with a particular responsibility for maintaining ventilation systems should ensure that all possible steps are taken to do just that conditions typically found in ventilation ducting provide excellent opportunities for bugs to thrive. Dust and debris on internal surfaces of the ducting invariably contains human hair and skin flakes – ideal nutrients for the growth of micro-organisms such as MRSA and C. difficile.

In fact there has been evidence in recent hospital surveys of the presence of MRSA microorganisms in ventilation systems. As a result of remedial ductwork cleaning it has been shown that these micro-organisms can be eliminated.

The Healthcare Technical Memorandum stipulates maximum recommended bacterial contents of 10 cfu/sample for sterile areas and up to 50 cfu/sample for general areas.

These levels will not be achievable without regular cleaning so in today’s world of limited financial resources there simply has to be a compromise, but that compromise is not to take

from the cooking operation cool and settle on the internal ducting surfaces they present a fire hazardous risk requiring only a spark or flash flame from the cooking operation to ignite, with results which have been very well illustrated by recent fires in public restaurants.

The Fire Safety Order (The Regulatory Reform [Fire Safety] Order 2005) places responsibility for protecting building occupants from the dangers of fire firmly on those responsible for managing premises – and this applies to hospitals as much as to any other occupied premises.

FIRE RISK At a recent seminar, a Fire Authority spokesman stated: “these installations are probably the highest fire risk in buildings where there are catering facilities”. There is therefore both a duty of care and a legal requirement to have in

Richard Norman

place a cleaning regime which will ensure that potentially flammable grease deposits, which accumulate in the ducting, are fully removed.

As with air conditioning systems, uncleaned grease extract systems will use more energy. The more grease deposits are allowed to accumulate in the ducting the harder the fan has to work to maintain extract efficiency. The harder the fan has to work the more energy it consumes.

So the legal requirement to clean ventilation systems to eliminate risks carries the additional benefit of reducing system energy costs.

BEST PRACTICE In order to provide the facilities or estates manager with a reliable standard by which to assess the effectiveness of a ventilation cleaning programme, the Heating and Ventilating Contractors’ Association has produced a Guide to Good Practice: Internal Cleanliness of Ventilation Systems TR19. It is accepted as the industry standard of excellence to which ventilation systems should be cleaned.

All Indepth Hygiene ventilation ductwork cleaning is carried out in accordance with this standard so that responsible managers can be confident their ventilation systems will fully perform their essential function of providing safe and hygienic conditions in healthcare premises.

FOR MORE INFORMATION To arrange for a ventilation system assessment of risk survey to be carried out free of charge call Indepth Hygiene Services on 020 8661 7888 or e-mail ductclean@indepthhygiene.co.uk.

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FACILITIES MANAGEMENT

DELIVERING QUALITY AND EFFICIENCY IN HEALTHCARE The Scottish Healthcare Conference addressed the need to drive efficiency savings without compromising the good work achieved over recent years within healthcare facilities departments. The Healthcare Facilities Consortium’s Keith Sammonds summarises the key points AT THIS TIME OF YEAR I would normally be writing a review of all the facilities and estates conferences that we had attended through the season. This year our own event has been put back from September 2010 to March 2011, partly because we felt that the autumn programme of events was getting a little congested.

The HefmA and AHCP events from the summer have been reviewed elsewhere and for me the focus of recent activity has been around the Healthcare Estates, British Parking Association and Scottish Healthcare conferences all held within a few weeks at the end of October and into November.

SCOTTISH HEALTHCARE CONFERENCE The Scottish Healthcare Conference, held at the Crieff Hydro on 4 and 5 November 2010, looked at delivering quality and efficiency in healthcare and the programme content very much reflected this. The event provided an opportunity to gather knowledge of best practice, new techniques and technologies and to network with colleagues working in and across the estates and facilities spectrum both within healthcare systems and the private sector from across Scotland.

It was very interesting to note Paul Kingsmore, director of Health Facilities Scotland (HFS), saying in his introduction to the Scottish event:

“The changes in the economic climate have had a dramatic impact on the world economies. Within healthcare we are proud of the significant achievements which we have made but now understand the challenges ahead. Money is tighter yet expectations are greater. The public rightly expect us to obtain the optimum value for money.

“On the positive side NHS Scotland Estates and Facilities professionals and our colleagues in the private sector working with us continue to drive forward new initiatives and deliver improved facilities making important contributions to the reduction in healthcare associated infections (HAIs), reduction in our carbon footprints, delivery of new and innovative initiatives and supporting access to a wide range of clinical services.”1

EFFECTIVE FACILITIES IN TOUGH TIMES The programme was very much built to reflect this thinking and the important topics it generates. From plenary sessions, including one with the Minister for Public Health and Sport, through the streams and on into the exhibition, the drive for efficiency savings without compromising the good work that has been achieved over recent years was pre-eminent. As always at such events it is easy to get hit with information overload and I have tried to capture the gist of key sessions in a few phrases.

DUTY OF CARE Shona Robison MSP, Minister for Public Health and Sport addressed what is being done in Scotland to assist the health boards in meeting their duty of care commitment

The event provided an opportunity to gather knowledge of best practice, new techniques and technologies and to network with colleagues working in and across the estates and facilities spectrum both within healthcare systems and the private sector from across Scotland

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Martin Keirnan was a superb choice of speaker for the opening session of day two, as his approach certainly made sure all who made it to the conference hall were properly awake to deliver facilities fit for purpose within a restrained economic environment in the context of three key areas: • Capital planning and effective delivery of capital • Efficiency of delivery using asset management • Role of facilities management All this within the aims of the Quality Strategy – to embed the need for well designed, sustainable and safe healthcare environments as an integral part of service delivery.

One point that really caught my attention was when the Minister noted: “Best practice dissemination is key in these time of austerity. Focus investment in the areas where it will have the maximum impact on the services we provide.”

Unfortunately the Minister had to leave immediately after her talk and so there was no opportunity for the delegates to ask her questions on some of the points of interest and

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particularly the more contentious issues.

That noted, the talk was well received and it was refreshing to see that in Scotland the Minister was not only willing but keen to address the staff who actually make sure that healthcare premises are fit for purpose and clean and safe for daily use.

LEARNING FROM OVERSEAS The second plenary session of the opening day was presented by Bruce Kominske, chief, new hospital design and construction at the Children’s Memorial Hospital in Chicago. Bruce spoke with obvious enthusiasm about their new development on a small footprint site in the centre of Chicago, what he described as a “vertical hospital.”2 His talk focused on the importance of creating a unique healing environment by engaging the community in the design and construction of the new hospital facilities. He cited specific examples

from the new hospital where over 20 of the city’s cultural organisations, including museums, the aquarium, zoo and ballet all volunteered their creative talents. Importantly this input was at no cost to the project and has helped in the creation of a very special healing environment, if the photographs and schematics he showed are anything to go by.

Bruce specifically mentioned the healing impact of art and gardens and showed examples from previous projects as well as how a garden is being included half way up the new build. This can be accessed as a public area but is also overlooked by a number of the patient areas, providing benefits for those who cannot have access to the area. He also talked about the need to provide “direction and diversion in the lobby” – a phrase that came from a long term child patient’s mother. She simply made the point that to her arrival in the hospital lobby provided two requirements: • Direction: She needs to know where to go without having to hunt for signage • Diversion: Something to divert her daughter’s mind from why she is here This has lead to a number of innovative design features being built into the reception and circulation areas on different floors including a fire engine and a mother whale with her calf. The challenge to us all has to be how

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FACILITIES MANAGEMENT

we can gain the active involvement of the local communities at a very early stage in such projects, not just new build but also refurbishment. Developing such innovation in design of the healing environment with the philanthropic support of benefactors will be a very real challenge but surely one to rise to and also one which the current UK Government should be actively supporting as part of its “big society” ethos.

INFECTION PREVENTION The evening of day one saw an excellent formal dinner and charity event raising some £3,000 for Cancer Research UK and Martin Keirnan was a superb choice of speaker for the opening session of day two, as his approach certainly made sure all who made it to the conference hall were properly awake. Martin is infection prevention lead for Southport and Ormskirk Hospitals NHS Trust and spoke with authority on the subject of “Infection Prevention in an Era of Austerity”. His talk was informative and eminently entertaining, full of facts and also dispelling some of the fiction around HAIs. I really liked the way he even challenged his own job title – infection control nurse – noting that in reality he controls nothing at all!

The whole conference was interesting and informative and supported by a reasonable sized and very relevant exhibition. With 48 companies and associations covering everything from automated vending to thermal imaging cameras there was plenty of new technology as well as cost effective use of current facilities and technologies to be seen.

ESTATES MONITORING The real benefit of such events was emphasised to me by the very last session that I attended.

This was quite literally the last session of the conference, one of four streams run before lunch and because of the number of questions being asked the last to finish. The topic was ‘Estates Monitoring – Past and Present’ and was presented at short notice by Richard McManus because the planned speaker had been unexpectedly called away. The presentation was actually about the Domestic Monitoring Tool implementation programme that has been running for a number of years in Scotland using an Excel spreadsheet for the submission of nationally collected data.

This has been developed to include scoring of the estates elements that impact on cleaning services and some of the feedback provided was very enlightening. Looking to the future it is planned to introduce a web based system in 2012 with the use of hand held devices that link so that data re-entry is done away with.

CLEANING REPORTS Looking similar in approach to the project undertaken by Welsh Health Estates for the Welsh Assembly Government in 2009 and implemented this year, the objective is to provide a supported route for consistent

The drive for the whole of the NHS is to keep HAIs at the lowest level possible and the concern is that the drive for savings may result in cuts to such fundamental services that result in an increase monitoring and reporting of cleanliness throughout Scotland. Key points made were that the monitoring has to be underpinned by three core requirements: • Accuracy • Honesty • Integrity Training has been provided for the staff who carry out the monitoring so that there is a consistency of approach throughout Scotland.

It pleased me to see that the information that should be collected for local management and monitoring of services is going to be used for reporting to government; this should provide a high level of ownership to the data collected and thereby raise the quality of the information reported from it.

FEEDBACK Having noted the level of the question and answer session at the end it was refreshing to hear questions at all levels relating to the monitoring toolkit and its use. Trying to distil the enthusiasm, scepticism and high level of interest voiced in this time into a few words is very difficult; but perhaps the following will give you a feel for the level of involvement healthcare facilities teams feel for their role in supporting healthcare delivery: “The collection of such information should be used to support business cases and a National Scoring regime should drive funding for business cases.”

“There is a need to review scoring and weighting so that higher activity and higher risk areas are correctly reflected in the reports.”

“Such systems must integrate with other systems used in organisations so that the information supports proper response times and does not delay responses.”

“It is important that one staff group is not set against another by such information reporting.”

The enthusiasm shown extended to some interesting conversations over lunch before the long drive home and it was particularly interesting to hear the Scottish response to the Welsh project. This has adopted Credits for Cleaning, a system originally funded by the English Department of Health to support the implementation of the NHS Cleaning Manual, as the system of choice for Wales so that all Welsh healthcare premises now use the one system for managing and monitoring cleaning services. The drive for the whole of the NHS is to keep HAIs at the lowest level possible and the concern is that the drive for savings may result in cuts to such fundamental services that result in an increase.

We all have a responsibility to provide premises that are safe and clean and fit for purpose; the purpose being to provide high quality healthcare to the nation in an efficient manner.

Notes 1. Scottish healthcare Conference Programme – delegate introduction 2. For more information on the new hospital visit: www.childrensmemorial. org/newsroom/newhospital.aspx

FOR MORE INFORMATION Web: www.hfc.org.uk

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FACILITIES MANAGEMENT

AUTOMATIC WASHROOMS Dorset County Hospital NHS Foundation Trust (DCH) improves hygiene and save water with No-Touch products from Dart Valley Systems THE ESTATES DEPARTMENT AT DCH headed up by Keith Butler is keen to provide first class facilities that are energy and water efficient. Such focus not only helps with the DoH emission and sustainability objectives but also reduces the hospitals’ costs for utilities. One of Keith’s initiatives was to invest in a bore hole that provides 20 per cent of the hospital’s water – a second bore hole is now under consideration.

Keith invited Dart Valley Systems Ltd [DVS] to carry out a water survey throughout the site with focus on the washrooms, patient ensuites and clinical hand washing.

WASTE Water audits on the DoH estate have indicated historically that circa 11 per cent of hospital water is used for hand washing. DVS considered that, taking everything into account, the use of no-touch taps may reduce the hand washing water by circa 30 per cent giving a total reduction of around 3.3 per cent, which equates to around £5,000 per year. The savings per hand wash are nearer 55 per cent but due to the ease of use DVS believes that hand washing compliance normally increases thus taking some of the savings. This was the view of Linda Horton, infection control manager at James Paget Hospital where they have had over 600 no-touch taps in operation for around eight years. A site trial conducted by DVS at another hospital also indicated a significant increase in hand washing compliance.

The second opportunity was on the WC flushing. The DVS no-touch WC Flushvalve efficient operation can generally reduce water used when replacing siphons by around 30 per cent. Audits have suggested that 24 per cent of hospital water is used for flushing WCs. Using these calculations the water saving would be 7.2 per cent equating to around £11,000 per year.

BENEFITS DCH decided to carry out an initial installation of DVS No-Touch products in March 2005 to establish the benefits in terms of water savings, ease of use, reliability and infection control.

Following this installation the response from all staff and in particular infection control was extremely positive and the hospital embarked on a programme to retro-fit no-touch products throughout the hospital over a number of years subject to availability of funds. This programme is now well advanced with no-touch products fitted throughout most of the hospital.

DCH is very focused on patient safety and the importance of combating HCAI (Healthcare Associated Infections) which is a high profile topic within the UK and at DoH.

Whilst the introduction of no-touch products was initiated by a desire to reduce water, DCH regard the major benefits relate to assisting the infection control team combat HCAI. It is universally acknowledged that hand hygiene is the single most important infection control discipline to reduce HCAI.

IMPROVED HAND HYGIENE Clearly effective infection control involves a whole series of disciplines and no-touch taps and toilet flushers alone will not achieve the required standards of hand hygiene. They are, however, one step in making it easier for healthcare workers and others to improve it.

If it is easier to use taps then it encourages hand washing. There is no argument, if you do not have to touch levers with hands or arms it reduces the risk of cross contamination.

The No-Touch taps have safe pre-set water temperature using TMV3 [D08] approved thermostatic mixing valves. There is no need to touch any part of the tap, just place hands under the spout and water is delivered at the required hand washing temperature for as long as required.

Whilst the complexities of a large building with variable water requirements make it difficult to exactly quantify water savings the indications have been that the reductions in water use have been more or less as predicted. Having significant amounts of Reverse Osmosis and a hydrotherapy pool that uses 42M3 adds to the total water requirements of the hospital, nonetheless, DCH has achieved an efficiency that is in the

lower quartile for small acute hospitals.

With regards to the views from an infection control perspective, Anne Smith, infection control nurse consultant, stated: “I am very impressed with the No-Touch products. They are easy to use for clinical hand washing and help to avoid cross contamination. They are also very good in patient areas and ideal for sluice areas where we have replaced pull chains for flushing with no-touch sensors and lever taps with no-touch taps.”

Not surprisingly the handles on sluice equipment can be a prime source for harbouring bacteria and this is a good example of further use of no-touch products to help reduce cross contamination.

DCH has achieved some reduction in HCAI during the last three years and continues to strive to reduce further and the hospital has ambitions to be one of the most highly regarded NHS healthcare providers in the UK.

FOR MORE INFORMATION Tel: 01803 529021 Fax: 01803 559016 E-mail: sales@dartvalley.co.uk Web: www.dartvalley.co.uk

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ORNE LABORATORIES is the only independent company in England that for over 35 years has manufactured and distributed a comprehensive range of reagents and associated products for blood transfusion, immunology and serodiagnosis.

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FOR MORE INFORMATION Lorne Laboratories Limited Tel: 0118 921 2264 Fax: 0118 986 4518 E-mail: sales@lornelabs.com Web: www.lornelabs.com

The specialists in the healthcare estates sector HE INSTITUTE of Healthcare Engineering and Estate Management (IHEEM) is a professional engineering institute, a specialist institute for the healthcare estates sector.

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FACILITIES MANAGEMENT

DEBATING THE FM AGENDA The HFC annual conference at Old Trafford in March 2011 will tease out some of the real issues affecting facilities teams throughout the UK health sector THE HEALTHCARE FACILITIES Consortium (HFC) has held its annual conference for at least the last 25 years and is the longest running Healthcare FM themed conference in the UK. Lately branded Flourishing FM the event is used not only to showcase their own services and products through a unique exhibition but also those of the companies they partner with, most of whom offer discounts exclusively to their subscribers. In more recent years, with the re-focusing of HFC’s company objectives, the event has been opened up to all providers of estates and facilities management services and products for the benefit of delegates who can now appraise the wider market alongside HFC’s specially negotiated deals.

HIGH PROFILE SPEAKERS When it comes to speakers, HFC draws on their contacts from the Departments of Health, commercial companies and the NHS itself, whether it is a facilities director presenting a case

and its service support directorates have developed the HFC has maintained the ability to keep pace with these changes and always reflect current NHS and facilities drivers as the theme for each conference.”

FACT OR FICTION? Day one of the conference will be looking at the ‘Fact or Fiction?’ issue breaking into three work steams following the opening sessions, calling the three groups together later to review the outcomes of their individual sessions. The purpose of this is to help us all understand what is fact and what is fiction in the current climate as even now there are stories circulating which are clearly not founded on fact.

One of the worries is that the fiction gets so much attention it starts to appear to be reality and people start working with the fictional statements in their minds and it is all too easy to make wrong decisions based on incorrect or misleading statements and information.

During the conference, the HFC will be looking to tease out some of the real issues affecting Facilities teams throughout the UK health sector. The theme for the conference ‘Doing more with less – Fact or Fiction? Reality or Hype?’ Will address these questions over the two day event, providing relevant speakers on key topics study or someone from the Department of Health discussing national healthcare policy that affects us all. HFC tries to keep the topics they cover as diverse as possible to cover the wider scope of facilities management subject areas whilst providing something of interest to everyone.

The HFC annual conference, sponsored by Integrated Handheld Solutions, will take place on 7-8 March 2011 at the Old Trafford in Manchester. During the conference, the HFC will be looking to tease out some of the real issues affecting facilities teams throughout the UK health sector. The theme for the conference ‘Doing more with less – Fact or Fiction? Reality or Hype?’

Will address these questions over the two day event, providing relevant speakers on key topics.

Speakers include Liz Jones, head of patient environment, Department of Health; Kevin Oxley, director of operations, North Tees and Hartlepool NHS Foundation Trust; Chris Green, partner and business centre manager, Weightman LLP; and Paul Donlevey, national counter terrorism security office (NaCTSO).

Paul Kingsmore, director, Health Facilities Scotland says:“As the NHS has developed

Bob Heavisides, director of facilities and core clinical services, Milton Keynes NHS Foundation Trust says: “The programme in recent years has tended to cover the wider FM agenda than before and has introduced some interesting developments in this field which always stimulates debate.”

TOPICAL DISCUSSIONS The three work streams will be built management/knowledge, built environment/ buildings and staff management solutions. The management/knowledge stream will be chaired

by Alan Cooper who runs the Management Development Centres for the NHS Facilities staff.

This group will look at the issues of knowledge management and how this impacts on our day to day management of issues and staff.

The built environment/buildings stream will be chaired by John Kelly from E C Harris. This stream will be reviewing the facts and fiction behind the kind of savings that can be made through the use of our buildings and how the built environment can be adjusted to better suit the changing needs of the service at this time.

A representative from Macdonald & Company will lead the staff management solutions group which will be looking at the issues around staffing, recruitment and retention, and some of the alternative ways of meeting the workforce requirements when we are under pressures to save costs but still manage and maintain premises to the required standards.

These sessions are not lectures or even talks; the people leading the sessions will be looking to draw out from the delegates the reality of the current situation and how it is impacting on the issues being reviewed.

Within the groups, HFC will seek to address some of the issues raised and look at how good management can help us all resolve some of the conundrums we are sure will be generated from within the discussions. The Chair of the Day will then draw the three threads back together and summarise the findings with assistance from the three groups.

Core issues raised will be collated into a post conference summary which will be shared with key stakeholders including all the Departments of Health equivalents, the NHS Confederation and appropriate professional bodies and associations as well as our subscribers.

FINDING SOLUTIONS HFC’s main focus has always been to provide quality, value for money solutions to the everyday problems faced by estates and facilities professionals in healthcare. With that in mind pre-funded places are available to all HFC subscribers and discounted/ sponsored places to non-subscribers.

Attendance at the conference covers everything from the conference sessions to the exhibition and even the conference dinner.

Declan Toal, information and technology manager, Health Estates Northern Ireland, said: “The conference has offered me much more than this through the opportunity to network and share experience. The contacts gained and the sharing of experience has undoubtedly contributed to the success of information projects in Northern Ireland as we have been able to identify and resolve problems in the light of similar projects within the UK.” The HFC Annual Conference is affordable, worthwhile and is the annual event for you to attend.

FOR MORE INFORMATION Full details on the conference including booking forms for delegates and exhibitors can be found at www.hfc.org.uk or if you have any questions concerning attendance at the conference e-mail conference@hfc.org.uk

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ENERGY

BRINGING TOGETHER INDIVIDUAL ACTIONS FOR THE GREATER GOOD NHS trusts, hospitals and surgeries are using the 10:10 campaign to engage staff and adopt an ambitious, yet achievable target for emissions reductions MANY NHS LEADERS are already meeting the climate change challenge head-on by implementing decisive carbon reduction plans. As well as helping to meet regulatory requirements, plans for reducing emissions also present an opportunity for extraordinary financial savings: the NHS Sustainable Development Unit (SDU) estimates that the NHS can save at least £180 million per year just by reducing its carbon emissions.

TALKING ABOUT CARBON A strong communications strategy can help to unlock the full value of a carbon reduction plan. Beside investment-led measures to improve equipment and infrastructure, NHS organisations can save ten per cent on their energy spend simply by encouraging staff to take everyday action to cut energy usage.

Energy awareness campaigns like the one being run by NHS Stockport, have reduced carbon emissions by focusing staff attention on the use of lighting, heating and lifts in the workplace, by promoting minimised or low-carbon travel, and by encouraging home working and better use of technology.

Longer-term reputational benefits also accrue from a well-communicated carbon campaign. The NHS is a major player in the debate on carbon emissions and climate change. Engaging staff and the wider community in a discussion about climate change, and encouraging low-carbon activity enhances the reputation of the NHS among patients, partner organisations, existing and prospective staff, and external suppliers.

THE 10:10 CAMPAIGN An increasing number of businesses, education bodies and health organisations are joining the 10:10 campaign, using it as a platform for communicating their carbon reduction policy to key audiences, and thus getting the most from their carbon reduction plans.

Founded in 2009 by the makers of climate docu-drama ‘The Age of Stupid’, 10:10 has swiftly become the foremost dedicated climate change campaign in the UK. Conceived with the aim of getting all sectors of society to cut their carbon by ten per cent in 2010, the campaign has so far attracted the support of around 90,000 individuals, 3,000 businesses and 4,000 public and non-profit organisations.

The momentum behind the campaign has boosted the carbon-cutting activity of businesses and organisations like Tottenham Hotspur FC, the Royal Opera House and Microsoft.

As well as helping to meet regulatory requirements, plans for reducing emissions also present an opportunity for extraordinary financial savings: the NHS Sustainable Development Unit (SDU) estimates that the NHS can save at least £180 million per year just by reducing its carbon emissions

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ENERGY

Following on from this success, 10:10 is set to continue into 2011 with the same central message – that anyone can cut ten per cent off their carbon footprint through simple everyday actions and energy awareness.

Whether or not you have an established carbon reduction plan, 10:10 can help.

The campaign’s inclusive approach helps to bridge the gap between carbon-cutting in the workplace, and the more personal environmental commitments made by individuals and households. This makes it an invaluable tool for sustainability coordinators and communication officers alike. 10:10’s bold, positive message and focus on everyday actions can help to translate the sometimes arcane language of sustainability planning into one that is easily understood by both staff and stakeholders.

IN THE PRESS Canny organisations and businesses have used 10:10 to give a sense of cohesion to their carbon action plan – which might cover areas as diverse as travel planning, procurement and energy usage – and to foster engagement at all levels of the organisation. A recognised campaign with extensive mainstream coverage,

Whether or not you have an established carbon reduction plan, 10:10 can help. The campaign’s inclusive approach helps to bridge the gap between carbon-cutting in the workplace, and the more personal environmental commitments made by individuals and households 10:10 has also been useful for organisations wanting to advertise their carbon cutting achievements to a broader audience. As well as sharing case studies on its website, the 10:10 receives regular media attention, thanks to partnerships with the Guardian newspaper and with lifestyle magazines such as Cosmopolitan, Reveal and Men’s Health. In parts of the country such as Gloucestershire, the 10:10 campaign has also been championed enthusiastically by the local press.

TRAVEL Implementing travel plans across the NHS could reduce its carbon footprint by around 90,000 tonnes a year. Adjusting the way we

get around (for example by replacing some cars with bicycles or public transport) can cater to the so-called ‘triple bottom line’, improving health, the environment and departmental finances.

Technology is also helping to reduce the number of journeys which might be seen as essential. The SDU estimates that if five per cent of business miles travelled

by NHS were displaced by video and teleconferencing, the NHS could save £14 million in time, petrol and parking costs.

John Simpson, director of estates and facilities, the Nottingham University Hospital Trust, “As part of our 10:10 pledge, we’ve aimed to reduce the amount of travel required

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Visit the website to view the categorised product finder

PowerSave Dynamic Voltage Optimisation

Energy monitoring and targeting solution

OWERSAVE™ is an innovative technology that helps organisations make some of the biggest financial savings possible on their energy bills by reducing and regulating the mains voltage used to power electrical equipment. PowerSave™ products deliver energy savings of up to 25 per cent – they are proven, highly efficient, and achieve a return on investment with minimal ongoing maintenance requirements.

PowerSave™ is a division of UK based Claude Lyons, the longest established company specialising in voltage control technologies.

Backed by more than 75 years of experience in the field of high quality power control solutions, the technology is very much of its time as organisations look for new ways to save money and demonstrate their commitment to the environment.

With extensive experience in the global medical industry, Claude Lyons works with companies such as Toshiba Netherland, GE China, Varian and Elekta, and hospitals across the UK rely on its voltage

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stabilisation technology to protect sensitive medical equipment from power supply fluctuations.

Through a comprehensive site survey that includes an equipment assessment, power supply analysis and three-phase electricity logging, PowerSave™ develops a bespoke energy saving strategy for each site that achieves maximum efficiency and stability without disrupting day-to-day operations.

FOR MORE INFORMATION Contact: Oznur Lawrie Tel: 01992 701556 Fax: 01992 788000 E-mail: olawrie@ claudelyons.co.uk Web: www.powersave technology.co.uk

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Scheme and the aspiration of zero carbon public buildings by 2018, the health sector is under increasing pressure to reduce carbon emissions.

In order to identify energy saving opportunities, you need to know exactly how energy and utilities are used within your buildings.

Endress+Hauser takes you one step further by transforming this data into the knowledge you need to reduce energy usage and meet those CO2 targets.

We offer a free site assessment where we will show you how our energy monitoring systems can reduce your energy costs by up to 20 per cent. We’ll visit your site and demonstrate our complete energy monitoring solution, which includes: • utility metering • automatic interval data collection • data analysis and reporting • audits and consultancy The system includes eSight energy analysis software. This

browser-based application automatically analyses your data and highlights energy saving opportunities across your estate.

Energy monitoring from Endress+Hauser is simple, adaptable, easily incorporated into new build and refurbishment projects, and can be retrofitted into existing buildings.

Most installations see a return on investment within two years.

FOR MORE INFORMATION Call us today to arrange your free site assessment and demonstration.

Tel: 0161 286 5000 E-mail: info@uk.endress.com www.uk.endress.com/esight

Health Business | Volume 10.6

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ENERGY

of staff and patients moving between the trust’s two busy campuses. We have put on a free bus service in partnership with the council, linking it with Nottingham’s tram system and its park-and-ride scheme. When a nearby multi-storey car park was closed, it provided a well-established alternative transport infrastructure that helped prevent 800,000 car journeys, or the equivalent of 300 tonnes of CO2 a year. We’ve also introduced sustainable procurement. Now each of the 7,000 pints of milk consumed by the hospitals each week is sourced through contracts with local farmers, which has reduced food miles by at least 90,000 miles. And in addition to food, pharmaceuticals and equipment must meet stringent energy standards.”

nearly 50,000 tonnes in carbon emissions.

Trevor Payne said: “We estimated that computers left on overnight waste up to 75 watts of electricity per machine. Across a network the size of ours, this really adds up. Although our energy awareness projects have had considerable success, some employees forget to switch their computers off at the end of the day.

“Energy wasted by unused computers costs around £300m and produces 3m tonnes of CO2 a year. On top of this, the heat generated by unused computers puts an unnecessary extra burden on the air conditioning system.

Our solution was to install an automated power management system, designed to turn off PCs when they’re not in use.”

PROCUREMENT Without a doubt, the most carbon-hungry activity that the NHS must engage in is procurement. Carbon associated with the extraction, processing, assembly, packaging, transport, storage and handling of products and materials accounts for 60 per cent of carbon emissions for the whole of the NHS. Selective purchasing and waste minimisation in pharmaceuticals alone can produce £90 million a year in cost savings, as well as saving the equivalent of 22,000 tonnes of CO2 every year.

Trevor Payne, University College London Hospitals said: “At UCLH, procurement accounts for around 76 per cent of our carbon footprint. We have sought to embed carbon considerations into our purchasing activities, alongside those of quality and price. In particular, we work with so called neutral vendors who collect, store and distribute efficiently from a central hub.

As well as this, staff are constantly involved in thinking of new ways to minimise the environmental impacts of what we do. For example, our kitchens recently held the 10:10 Low Carbon Challenge to see who could cook the most environmentally friendly meal.”

STAFF ENGAGEMENT The SDU has recommended that NHS organisations should “pursue an active communications strategy to raise awareness about sustainability at every level of the organisation.” As well as producing surprisingly large cost and carbon savings through behavioural change – the SDU estimates that staff energy awareness could save the NHS £5 million a year – communications campaigns such as 10:10 generate ideas and foster a sense of pride and involvement among staff, patients and the wider community.

Jilla Burgess-Allen, NHS Stockport said: “We decided we would put staff engagement at the heart of Stockport’s 10:10 campaign.

We’ve drafted a team of 20 voluntary ‘green champions’, to share carbon cutting ideas and support their colleague’s efforts. Staff can find a green office guide, an eco-footprint quiz as well as all kinds of carbon tips on our intranet, as well as getting a 10:10-themed bulletin e-mail which gives them some ideas about what they can be doing that month to cut their ten per cent.

We’ve found incentives and rewards to be more effective than punitive approaches, so this year we are introducing a new green staff award, and we’re planning a 10:10 picnic to celebrate our achievements – and our fantastic local food!”

ON SITE ENERGY USE Any NHS organisation with an energy spend over £50,000 will qualify for a free energy audit from the Carbon Trust. This will show up the opportunities for energy saving measures, either in the form of ‘invest to save’ schemes, or lower cost staff engagement. The opportunities are huge. Simply reducing the NHS thermostats by one degree could save it £2 million a year and

FOR MORE INFORMATION Sign your organisation up to 10:10 and join the national campaign to reduce our emissions ten per cent at a time.

Go to www.1010uk.org/organisations

10:10 NHS TRUST CHECKLIST n Lead from the top: Get Board endorsement, task the management team, identify a senior 10:10 project lead and prepare a baseline carbon-footprint. n Everyone’s talking about it: Tell all your staff, students, suppliers and patients about 10:10 and work with them to cut your emissions.

Keep them informed and shout about your joint success. n Save ten per cent on bills: Cut ten per cent of your energy, waste and water and save £££s. Book a Carbon Survey from the Carbon Trust, join the Carbon Trust NHS Network and the Carbon Trust Carbon Management Programme. n Save ten per cent on travel: Get a Travel Plan including: lift-share, cycle to work, parking charges, public transport, video/phone conference, driver training, new vehicles. Take up the help available from the Energy Saving Trust. n Nursing power: Get all wards using the 10:10 ward checklist to save ten per cent on energy, travel, consumption and waste. Make sure no newspapers or sterile packaging go in the clinical waste bins – get them recycled! Do your nurses run car-share schemes and win prizes for the greenest ward? n Medics on board: Pharmaceuticals and medical kit make up one-third of the NHS carbon footprint so clinical savings are big savings. Get departments looking for low value investigations and include carbon impacts in clinical audit.

Ten per cent of clinics done by telephone? We’re impressed. n Save ten per cent on procurement: 60 per cent of the NHS carbon footprint is in procurement. It’s a tough one but if we can do brain surgery we can crack low carbon procurement.

Sign up to Meat Free Mondays, ban bottled water, buy local seasonal food, recycled paper etc. Get help from PASA and the Carbon Trust. n Money makes the world go round: Are you ready for Carbon Accounting and the Carbon Reduction Commitment?

Carbon is king. Interest free loans are available from Salix Finance. n Policy heaven: Review your policies and make sure they all include cutting carbon and sustainability. Borrow from NHS Gloucestershire’s Sustainable Development Impact Assessment. n Report back: Let 10:10 HQ know how you got on with cutting your carbon emissions via the 10:10 online reporting tool.

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CP Electronics works on the cutting edge of control technology and our customers benefit from innovative, class-leading products designed and developed to save you energy and money.

Presence Detectors A wide range of passive infrared (PIR) and microwave presence detectors for the automatic control of lighting, heating and ventilation.

Light Level Controls Intelligent photocells provide switching and maintained illuminance. They are suitable for use in internal and external applications.

Lighting Control Systems Vitesse Modular™ is a state of the art lighting distribution system that can be used in a wide range of applications.

OEM and Integrated Products CP Electronics offer a wide range of products and integration expertise.

Call us today +44 (0)333 900 0671 or visit our website

www.cpelectronics.co.uk CP Electronics, Brent Crescent, London NW10 7XR, United Kingdom

Your Energy Saving Controls all under one roof

Visit the website to view the categorised product finder

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Deliver on your CRC commitments with the McCaul Group

Schneider Electric – supporting the healthcare industry

HE MCCAUL GROUP is an independent and fully accredited energy consultancy company employing qualified and experienced building services engineers and energy consultants. Two companies make up the McCaul Group; Patrick McCaul Environmental Consulting Engineers, highly qualified and experienced M&E consultants, and Renewable Building Technologies Ltd., dealing specifically with energy management, energy efficient design and renewable technology installations for all commercial sectors. The Group is focused on providing high quality, high value professional services by creating strategies for success tailored to suit client needs.

The introduction of the CRC Energy Efficiency Scheme means that it is now even more important that the healthcare estate becomes more focused on reducing energy consumption, associated costs

LOBAL ENERGY management specialist Schneider Electric offers a wide range of solutions for the healthcare sector to help save money and generate revenue.

By implementing energy saving solutions that will reduce consumption, hospitals will be contributing to the UK’s constant drive towards lowering carbon emissions. In addition, using less energy will result in financial savings, and this money can be better spent on improving services and facilities to offer the best level of patient care.

Schneider Electric’s experts can also offer advice about how existing systems can be improved.

For example, by using a Schneider Electric converged building management system, hospitals can integrate heating, lighting,

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and carbon emissions. There must be robust strategic energy plans in place to deliver up CRC. We can provide the specialist support and advice that is needed to help reduce energy consumption and carbon emissions and with the added value of achieving financial savings on a recurring basis. We can help with the energy management and planning that will now be required.

FOR MORE INFORMATION Address: Bankmore Business Park, Omagh BT79 0BE Tel: 02882 251155 E-mail: energy@pmccaul.com Web: www.pmccaul.com

Ready for the climate change challenge?

POWER W ESTERN DISTRIBUTION’S long established metering business has been refocused to help our customers face the challenges of climate change and increasing productivity.

The WPD Smart Metering team provide metering solutions to business customers on a national basis. With a strong reputation for operating HH sites, we now also offer a national solution for NHH sites to deliver to businesses: • automatic remote meter readings and accurate to the minute billing • energy management data and reporting with notification of overconsumption • a consistent national metering service, e.g. to manage the new connection process • integration of remote logging from sub-metering and other utility meters.

When you choose the Western

Power Group for your smart metering, you have the confidence of working with a company with many years’ experience of helping UK businesses manage energy more efficiently.

As an independent company, WPD Smart Metering works with your supplier on behalf of your business to deliver a firstclass service – from low cost installation of the latest smart meter technologies through to full maintenance and support.

access control, intruder detection, IPCCTV and a fire management system, for efficient operations.

With years of experience in providing products and services for the healthcare industry, Schneider Electric is a name that can be trusted as a complete solutions provider which truly understands the sector.

FOR MORE INFORMATION For further information on Schneider Electric and the wide range of healthcare solutions on offer, please contact 0870 608 8 608 or visit www.schneider-electric.co.uk

Tinytag loggers for temperature critical areas INYTAG DATA LOGGERS provide reliable cold chain temperature and humidity monitoring solutions in a wide variety of applications within the healthcare and laboratory industries.

Tinytags do a thermometers job but also record the data for later compilation and display of results for analysis and validation. Small, lightweight and cost effective, the loggers are ideal for monitoring the temperature in vaccine cabinets and other temperature critical areas.

With a large memory and user defined alarms that indicate a breach of temperature, these units can be left to monitor your application for extended periods of time without the need for regular manual checks.

Tinytag data loggers are used to: Improve the safe storage of vaccines in accordance with statutory regulations; Monitor temperature of fridges and freezers, cryogenic applications and culture rooms;

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Record temperature and humidity for independent verification of ethylene oxide sterilisation; Monitor temperature conditions of highly sensitive consignments, such as blood products or body organs; Record conditions that must comply with Health and Safety regulations.

All loggers are compatible with the Tinytag Explorer software; you can easily download, monitor and create reports when you need to. Our new self-configuring, wireless data logging system is ideal for monitoring remote locations such as storage of pharmaceuticals in large warehouses.

FOR MORE INFORMATION Gemini Data Loggers (UK) Ltd. Scientific House, Terminus Road, Chichester, West Sussex, PO19 8UJ, UK. Tel: +44 (0)1243 813000 Fax: +44 (0)1243 531948 E-mail: info@tinytag.info Web: www.tinytag.info

FOR MORE INFORMATION Tel: 0870 448900 E-mail: smartmetering@ westernpower.co.uk Web: www.wpdsmart metering.co.uk

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Supporting your gas analysis needs

Specialist ventilation products for healthcare

NALOX SENSOR TECHNOLOGY has developed innovative gas sensors and analysis equipment ideal for use in hospitals, both in locations where gases are stored, and where they are used in the care of patients.

Analox has more than 14 years’ experience in gas analysis. Its products are used around the world in several niche market sectors: hospital, laboratory and industrial safety; hospitality venues; sport and commercial diving; and military.

Within a hospital, gases are stored and used daily. It is essential that leaks can be detected immediately and that the gas supplied to patients is free of any contamination. The highest quality gas analysis equipment will ensure the safety of both patients and staff, potentially preserving lives.

Analox is recognised as a

OSPITALS are an important institution providing medical and surgical treatment, as well as nursing care for sick or injured people.

Ventilation is used extensively in healthcare premises for primary patient treatment in operating departments, intensive treatment areas and isolation units. It is also installed to ensure compliance with quality assurance of manufactured items in pharmacy and sterile supply departments and to protect staff from harmful organisms and toxic substances, for example, in laboratories.

Protective ventilation measures are required in a variety of hospital room applications, from operating theatres, emergency treatment, nursery, critical and intensive care rooms to recovery, radiology, laboratories, X-ray and darkrooms, where patients are susceptible to contamination and infection.

Elta Fans provide a wide range of ventilation products for hospitals and health care buildings, from air handling systems to extract

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specialist in the field of gas analysis. The firm has developed high quality sensors for use in the detection of gases including oxygen (sufficiency and deficiency), carbon dioxide and carbon monoxide.

The company can supply sensors for use in all gas detection equipment, working with you to ensure that your equipment is delivering what you need. It also has a range of products available, both fixed and portable, to address your gas analysis requirements.

FOR MORE INFORMATION To discuss your requirements, contact Analox Sensor Technology on 01642 711400.

Open doors with Tekadoor Air Curtains INCE THE FOUNDATION in 1981 Tekadoor develops and builds aircurtains with high functionality, comfort and service friendliness. Always striving to the optimal solution for our customers we became the leading manufacturer of door- and port aircurtains. Our strong market position is primarily due to the balanced price-performance ratio.

With the aim of saving energy and minimising energy loss, we offer our customers the highest level of climate comfort in entrance areas of buildings and shops of all kinds, where the partnership relationship with operators, plant designers, and planners is at the heart of our business philosophy. We respect each other and promote ourselves in a

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liability-driven communications.

Our corporate structure is of an innovative and dynamic organisation, where team spirit and teamwork in the foreground.

The working climate is marked by praise, recognition and criticism.

The bundling of our experience, our technical production capabilities, our know-how, our team strengths and close cooperation with our customers is the basis for our success. We will continue our achievements and further optimise work processes, taking into account cost and revenue benefits, which will benefit our customers. Hospital double doors can save £200£300 per year on energy bills.

FOR MORE INFORMATION Web: www.tekadoor.co.uk

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fans, all designed to provide the precise specifications to meet the necessary ventilation requirements for greater comfort in the hospital patient care environment.

Elta’s products are available worldwide, either through appointed distributors or companies manufacturing under licence, several of which are also part of the Elta Group.

FOR MORE INFORMATION Tel: +44 (0)1384 275800 Fax: +44 (0)1384 275810 E-mail: bs@eltafans.co.uk Web: www.eltafans.com

Climate control – what’s right for your environment?

T’S NO FUN if you get it wrong. That’s why it’s good to know that Middleton Air Conditioning offers expert advice and a consistently reliable service when it comes to air conditioning and ventilation. Our service and maintenance programmes will help keep your estate running smoothly and also reduce energy. With a 24/7 reactive breakdown service featuring a four hour response for business critical functions such as kitchens, close control, data rooms etc., and annual or planned service provision throughout the UK, Middleton Air Conditioning covers all your HVAC needs.

Our fully trained engineers hold industry recognised qualifications, including in the new F-Gas regulations. As a company we are ISO9001:2008 accredited and members of both the HVCA and Refcom.

Middleton Air Conditioning has experience of working on all types

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of systems and manufactures equipment including packaged Uunits (gas fired) VRV/VRF systems, multi/single split systems, LPHWS, door heaters/curtains, gas electric water generators, extract and air supply equipment, Dakin, Toshiba, Lennox, Carrier, Sanyo, LG, Mitsubishi (for who we are approved installers) and many more.

FOR MORE INFORMATION Contact: Costas Ioannou Tel: 0845 3005969 Fax: 0121 3285758 E-mail: helpdesk@middletonmaintenance.co.uk

Health Business | Volume 10.6

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HEATING & VENTILATION

IF YOU CAN’T STAND THE HEAT, THE VENTILATION ISN’T PERFORMING A revised industry specification is providing valuable guidance on how designers and specifiers can ventilate commercial kitchens, says the Heating and Ventilating Contractors’ Association IN A COMMERCIAL KITCHEN, adequate ventilation is essential in order to control health, safety and hygiene risks. Admittedly it’s a challenge to properly ventilate this environment as it requires designers and specifiers to extract and replace large volumes of air through ductwork and place equipment in very restricted spaces, however, there are minimum standards that we must adhere to.

The Health and Safety Executive (HSE) highlights a number of objectives that commercial ventilation systems should achieve.

They must: dilute and remove cooking odours and other by-products of combustion; provide sufficient air for safe combustion at gas burning appliances; introduce cool clean air and remove hot air to ensure a comfortable working environment; be able to be kept clean from fat residues to avoid efficiency loss and fire risks; and only feature canopies made from non-combustible materials.

When specifying a commercial kitchen it is the job of a ventilation engineer to consider not only kitchen usage, the building limitations and equipment capacity, but also factors such as extraction, make up air, ventilated ceilings, odour control and fire suppression.

ENDORSED STANDARD To inform this task, building on the core HSE guidance, is the industry specification DW172 Standard for Kitchen Ventilation Systems, which is not only endorsed by the HVCA, but also recognised by CIBSE, HSE, BSRIA, the Association of British Insurers and the Loss Prevention Council. The successor to the original DW171 guidance, the new specification includes legislative changes, new standards and all the requirements for design, installation and maintenance of kitchen ventilation systems.

When it comes to extracting air, it’s not just a case of looking for the simplest way possible. For instance, scientists have learnt that the degradation of certain organic materials generate carcinogenic fumes. Therefore it’s important to design a system that avoids extracting air through the breathing zones of staff operating the cooking equipment.

Calculating extract flow rates should be done using the Thermal Convection Method, which acknowledges each piece of equipment, its surface area and fuel type.

Coupled with the type and style of canopy used, this method gives an accurate and consistent extract flow rate. It also generates

the supply air flow rate, which should be a maximum of 85 per cent of the extract rate.

Make up air, to replace the contaminated extracted air, should be mechanically introduced, filtered and tempered to assure a minimum entry temperature of 10°C when delivered via a canopy, and 16°C when delivered via ceiling grilles. A fan powered system provides positive control and, therefore, is the preferred method to use.

The most common way to introduce make up air via a canopy is through a perforated front panel, allowing cool air to tumble onto those operating the cooking equipment.

There is a common design that introduces air inboard of the canopy, this method has various names including ‘induction’, ‘entrainment’ and ‘capture air stream’. These methods can improve the capture and containment of a canopy, but any inboard air shall be added to the calculated extract flow rate.

GAS SUPPLY Both the British Standard BS6173:2001 and the HSE require that commercial ventilation systems are interlocked with the gas supply to ensure safe operation. This means the ventilation system has to be proven to both extract and replace air before the gas supply can be activated. This interlocking system also cuts off the gas should the extract or supply air system fail during operation. The kitchen ventilation contractor is specifically responsible for providing the air proving mechanism.

Regarding the dimensions of extraction equipment, there should be a minimum 300mm to the front, side and, where appropriate, back of any canopy. The front dimension should be extended to 600mm for combination ovens and certain bakery ovens. This ensures that the large quantity of steam emitted when opening oven doors of this type is contained within the canopy. The underside of the canopy should be between 2,000mm and 2,100mm above the finished floor level.

CLEANING FILTERS For the grease filter, the minimum distance between the lowest edge of the filter and the top of a cooking surface should be 450mm. This avoids the risk of excessive temperatures or fire in the filter which could cause the extracted grease to vaporise and pass through to the ductwork. Only stainless steel is suitable for the canopy fabrication as it is non-combustible, and mesh filters can

only be used as a secondary method of grease extraction as they offer no fire barrier.

Ventilated ceilings are becoming a popular alternative to canopies and have gained favour with catering colleges, training kitchens and some government properties. There are two types of ventilated ceiling available – modular cassette and plenum. They can vary between 2,200mm and 3,500mm in height, but generally 2500mm is optimum. The new specification states that open plenums should not be used as part of an extract system where grease laden air is being extracted.

Material used to manufacture a ventilated ceiling should also be stainless steel. Some manufacturers use aluminium in the supporting frame, this form of construction should meet with the approval of the client or specifier.

ASSESSING RISK Operators of commercial kitchens have a duty under health and safety law to assess fire risk in the ventilation system, particularly those created by excessive build up of cooking oil deposits. If suitable precautions are not undertaken, and in the event of personal injury or death resulting from a fire associated with a poorly maintained system, charges of corporate liability or manslaughter may be brought against the kitchen operator.

The considerable amount of flammable grease and related particles within extract systems, combined with the chance of fire ignition caused by cooking equipment, create a hazard level above that normally encountered in other ventilation systems. It is imperative that kitchen ventilation provides adequate protection to ensure the safety of occupants and fire fighting personnel, and limits property damage.

There is increasing demand for odour control systems within commercial kitchen ventilation.

Each site needs to be considered on its own merits, as one solution is not a cure-all. Various filtration systems are available, including three stage filters, electrostatic precipitators, activated carbon filters and UV-C light.

Kitchen ventilation systems represent one of the largest uses of energy in a commercial food service facility. With this in mind, adhering to an approved standard for designing and specifying these systems is paramount if we are to maximise efficiency, comfort and safety.

FOR MORE INFORMATION Web: www.hvca.org.uk

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An all-in-one Digital Signage solution

LG SuperSign, is the first Digital Signage solution that’s a combination of hardware and software in an easy-to-use package – providing a cost-effective, professional and user-friendly way to deliver content.

Using the LG Media Player and SuperSign Manager programme, this solution provides templates for users to drag and drop video, audio, documents and Flash files – to create and manage a scheduled display across one or many LG screens. Quickly, easily and consistently.

For more information call 01943 850 800

Email: info@innovations-av.co.uk web: www.innovations-av.co.uk

Health Business | Volume 10.6

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SIGNS

EFFECTIVE SIGNS FOR INCREASED SAFETY ISO 7010 is being implemented as best practice to ensure that only graphical symbols with the highest comprehension credentials are used to communicate safety messages, writes Jim Creak, chairman of the Health and Safety Sign Association ISO 7010 IS being implemented as best practice throughout the world. It will communicate the safety message using graphical symbols that transcends the barriers to good safety management created by different languages and are universally understood.

The International Standard Technical Committee (TC145) is responsible for graphical symbols and has worked continuously for over 20 years to develop the very best safety

nature of the hazard and the measures to be taken for the collective protection of occupants within the working and public environment under their control.

Safety procedures, practice and policies will require building managers, property owners and estate managers to identify hazards and mark the location of emergency equipment and life safety appliances. Safety managers have an obligation to inform and educate

Worldwide, safety managers are required by their domestic legislation to ensure that all personnel are aware of hazards, the nature of the hazard and the measures to be taken for the collective protection of occupants within the working and public environment under their control signs to convey critical safety information.

The main categories of safety signs are in line with the needs of international requirement for occupational health and safety management and are incorporated in workplace safety legislation.

IDENTIFY, LOCATE, INFORM, INSTRUCT Worldwide, safety managers are required by their domestic legislation to ensure that all personnel are aware of hazards, the

all occupants about risk control, prohibit certain behaviour and give mandatory instruction to ensure collective protection.

THE DOMESTIC STANDARD ISO 7010 is to be adopted as a European norm and will be automatically adopted as the domestic standard within all member states of the European Union. All workplaces, including merchant and passenger vessels will be required to implement and display the new

graphical symbols for safety communication.

The objective is to ensure that only graphical symbols with the highest comprehension credentials are used and to ensure we are not playing ‘Pictionary’ with peoples lives.

A plethora of graphical symbols are currently being used without these credentials; they have little meaning and are untested in accordance with ISO 9186 to ensure comprehension. It is essential that if graphical symbols are to be effective, only standardised symbols should be used.

Whilst slight variation in public information symbols may cause, at worst, slight delay in finding a service, or cause embarrassment if you misinterpret the more abstract toilet sign, a mistake in the interpretation of escape route signs causing delay may ultimately lead to death.

CONFUSION Considerable confusion has been caused by the use of so called “Eurosymbols” for fire exit signs. Pure illustrations from way back in 1977 have been used, which have no comprehension credentials and fail the basic understanding that is a function of known and effective safety wayguidance convention.

Best practice International Standard ISO 7010 graphical symbols for escape route and ISO 16069 safety wayguidance convention ensure that an evacuee is progressed using a known convention through the escape route to a place of relative safety.

High quality DDA compliant signs at cost effective prices HE MOST SIGNIFICANT piece of Equality legislation for years received Royal Assent on 8 April and commenced in October 2010.

The Equality and Human Rights Commission welcomed the passing of the Equality Bill, which contains a series of measures for tackling inequalities that the commission feels will help make Britain a fairer society and improve public services.

A quick and easy way of showing a positive, customer focused method of meeting the legal requirements is by displaying large, well defined Braille & Tactile signs positioned at a consistent height around the building so that they are accessible.

Equality signs provide a complete turnkey

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service, from concept to completion. This service is aimed at providing high quality DDA compliant signs at cost effective prices.

Simply contact our dedicated, experienced and very helpful sales team to discuss any requirements you may have and we will be more than happy to assist you in any

way or give any advice where necessary.

FOR MORE INFORMATION Tel: 0161 273 5252 Fax: 0161 273 5255 E-mail: sales@equalitysigns.com Web: www.equalitysigns.com

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SIGNS

The risk assessment regime required to manage occupational health and safety will determine requirements for safety communication across areas of reflective management.

The areas are outlined in international obligations for employers under occupation health and safety legislation. These obligations start with the identification of hazard, the identification of safety equipment, including escape, and the identification of fire fighting equipment including alarms.

Employers are further required to locate hazard and safety equipment, including escape route and appropriate fire fighting equipment.

Identification and location are the cornerstones of effective safety communication and are specific requirements of workplace legislation.

Following location and identification, a good communication strategy will include measures to reduce and control risk.

The control of risk will include the prohibition of behaviour or an activity that is likely to have an adverse effect on the risk matrix or may exacerbate the consequences of an incident.

The control of risk and the collective protection of building occupants will require employers, building managers and authority personnel to instigate and

enforce mandatory measures to be taken.

Finally and probably most important is that safety signs, their meaning and the action to be taken or not taken following them are part of a formal training, instruction and education process for public buildings, hospitals, schools, colleges, universities, and the workplace.

THE NEW STANDARD The Health and Safety Sign Association has announced that all members, listed on the HSSA website, www.hssa.co.uk, will implement the changes required by the adoption of ISO 7010 as a European standard. Members are required to withdraw all graphical symbol designed safety signs that do not conform within their standard product offering by January 2011.

References: • BS EN ISO 14001:2004 – Environmental management systems – Requirements with guidance for use.

• BS ISO 16069:2004 – Graphical symbols and signs – Safety signs – Safety wayguidance systems (SWGS) • BS ISO 17398:2004 – Safety colours and safety signs – Classification, performance

ABOUT THE AUTHOR Jim Creak, editor of the Means of Escape Publication, is an active member of the BSI technical committee and Chairman of the Health and Safety Sign Association (HSSA).

Jim has over 25 years experience in researching, contributing and participating in task groups on the subject of Safety Wayguidance Systems (SWGS) for marine, industrial and high rise building application. and durability of safety signs.

• ISO 7010:2003 – Graphical symbols – Safety colours and safety signs – Safety signs used in workplace and public areas.

• ISO 9186:2001 – Graphical symbols.

Test methods for judged comprehensibility and for comprehension.

• ISO 3864-1:2002 – Safety colours and safety signs – Part 1 safety signs in workplaces and public areas.

• ISO 3864-4:2009 – Graphical symbols – Safety colours and safety signs – Part 4 colorimetric and photometric properties of safety sign materials.

• EC Safety Signs Directive (92/58/EEC).

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The company provides innovative audio visual solutions for hospitals, postgraduate medical centres and regional training facilities throughout the country.

Core business areas include: Saville integrated AV/IT systems combine the latest in multimedia display techniques, digital control technology and bespoke furniture craftsmanship. Projects are designed and built entirely in-house, ensuring consistent high quality and reliability.

Saville provides videoconferencing solutions for NHS departments, working closely with BT and world leading manufacturers Polycom, Tandberg, Lifesize and Radvision.

The company also provides nationwide technical support plus managed network services.

HARM PROVIDES fully tailored and off-theshelf audio visual, digital signage and content solutions to hospitals, surgeries, schools and businesses throughout the UK. From sophisticated conference hall and training rooms to complex signage network facilities or stand alone information screens, we’re here to help. Digital signage is quickly replacing static signs, notice boards, banners and posters as the most effective method of communicating key information.

Used correctly it can help convey detailed messages to almost any audience, anywhere, anytime.

Unlike traditional printed signs, digital signage can be updated instantaneously, allowing you to capture current events and suit the demands of the moment. It also eliminates the high ongoing cost of creating and distributing printed ad campaigns. Whether you intend to build a brand,

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Saville conference and live event services are regularly used by the NHS, including stage-set design, lighting, sound and projection plus audience voting, event recording, streaming and webcast facilities.

Saville accreditations include ISO14001 (Environmental Management) and BSOHSAS 18001:2007 (Health & Safety).

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influence behaviour or simply provide useful information to visitors, staff or patients, the dynamic visual experience created by digital signage helps get your message across.

Our Signage Servers are based on established and extremely stable technologies designed to be active 24/7. They require little or no maintenance once installed – a true “fix and forget” service. To learn more about how Charm can help please get in touch.

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Health Business | Volume 10.6

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HEALTH & SAFETY

SECURING MAINTENANCE FUNDS Safe maintenance is a healthcare budget essential for patient safety, says the Institution of Occupational Safety and Health a well-functioning healthcare organisation.

It ranges from architecture and engineering services – how buildings and wards are designed and equipment installed – to site services, on-site roads and car parks. All these must be put in place in a way that makes them easy to maintain to ensure they are kept in a good, fit for purpose and safe condition.

Medical gas pipeline and hot and cold water systems are all the responsibility of an estates and facilities department. There have been past examples where lack of, or poor systems of maintenance have lead to patient fatalities and interruption to trust services, such as cases of legionella or faulty medical devices.

Heating, ventilation, electric services and lifts can also fall foul of poor maintenance systems and processes. Sometimes simple lack of maintenance is a root cause of fire incidents, which can mean loss of facilities, equipment and essential services.

By its very nature, maintenance is the effort to keep everything in safe and efficient order, clean and in good repair. Within the context of patient safety, that is simply not something that should be ignored, avoided or left under-resourced PATIENT SAFETY must be a priority for all healthcare providers, but to an untrained eye, safe maintenance is often not seen as an integral part of that agenda. While the NHS may not have borne the brunt of October’s Government Spending Review, its finances are constantly being squeezed so much so that it was told in June that it must find £20bn savings by 2014, putting some of its frontline services at risk.

By its very nature, maintenance is the effort to keep everything in safe and efficient order, clean and in good repair.

Within the context of patient safety, that is simply not something that should be ignored, avoided or left under-resourced.

Maintenance isn’t a headline grabber and that’s because it shouldn’t be. It should be the pacemaker that keeps the vital organs of a hospital working, without anyone other than

the people who are directly concerned with it actually noticing what it does. At its very best, it is an invisible, essential function of a trust.

PROTECTING PEOPLE Healthcare employers have a duty of care morally and legislatively to staff, patients and visitors, to make sure facilities and equipment do what they should and don’t pose an unacceptable level of risk. The very things which should be assisting people in recovery or better health shouldn’t risk causing them harm. To do this, every member of staff, including the board, needs to be assured that everything within the organisation from the medical devices, equipment and furniture, to the fabric and structure of the care and working environment are maintained to the highest standards.

As this suggests, maintenance rears its necessary head in every conceivable area of

LEGAL IMPLICATIONS Hospitals have faced prosecution and claims for compensation issues in the past where one or more of these functions have failed. In 2007, Bath’s Royal United Hospital (RUH) was fined £80,000 because of a patient who died from a disease he caught through the shower system.

This was linked directly to poor maintenance.

In 2009, patients at Royal Blackburn Hospital, Lancashire, were evacuated when sulphuric acid used to clean a drain leaked through a pipe into a ground floor store room. Fumes from the chemical affected electrical wiring and the damage repairs caused a huge amount of additional pressure on trust resources, not to mention stress to staff and to patients who had to be moved to the second floor of the building to safety.

When hospitals experience similar incidents, the long-term damage to reputation and the confidence of patients, relatives, people in the local community and healthcare economy can be hard to repair. There is often a big price to pay for under-resourcing the maintenance needs and requirements of healthcare organisations.

The courts have and will penalise hospitals when they fall foul of the essential standards needed to keep people safe from the effects of poor hygiene, disrepair and bad maintenance.

Where a director is prosecuted under health and safety legislation, they can also be banned from holding that position for a number of years.

SUPPORTING MAINTENANCE COSTS This said, it cannot be denied how difficult it is for some trusts to balance and prioritise spending with so many factors impacting on resources. The conflicting pressures

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Health Business | Volume 10.6

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HEALTH & SAFETY

created by trying to preserve budgets without risking patient safety do sometimes fail. Where cuts in maintenance are made the possibility of incidents happening in some areas may appear to be minimal, but nevertheless, the risk is ever-present.

We are now in a position where it is time to drive home the message that the cost of maintenance must be absorbed, supported and ring fenced. This will be far less painful than the cost of legal bills, damage to trusts’ reputations, loss of directorships, not to mention lives caused by accidents.

The law requires that facilities, equipment, devices and systems are maintained (cleaned as appropriate) in an efficient state, working order and good repair. What some organisations may fail to understand is that “efficient” in this case means from a health, safety and healthcare, rather than a productivity or economic perspective.

Hospital furniture needs to be well maintained to prevent it from reaching a point of disrepair.

The NHS shouldn’t wait until equipment like this needs replacing, but ensure regular maintenance saves this cost by earlier and more timely intervention. In a recent health and social care prosecution, a vulnerable patient fell out of an unsafe and ill-maintained wheelchair and lost their life, due to the fact that the brakes no longer worked.

ENSURING CLEANLINESS It’s not just how and whether equipment works that can become a maintenance issue – cleanliness must be considered in the same bracket. Thorough cleaning means harmful bacteria and dirt is constantly removed rather than left to a point where it will never be able to be recovered back to a safe state.

Generally, the NHS is good at making sure hygiene standards are met and it has done a lot to ensure harmful virus strains like MRSA are no longer easily able to thrive within a healthcare setting. Good hygiene maintenance means trusts have less chance of falling foul of infectious outbreaks

and the accompanying bad publicity.

Maintenance covers a variety of medical equipment from heart monitors and surgeons’ microscopes to resuscitation equipment, both of the latter having been involved in patient death incidents in the past. There are sufficient legislation and healthcare standards available which make very clear the responsibility to maintain medical and general equipment.

The consequences of breaking the law through use of hazardous equipment should not be the only factor that exposes the importance of healthy maintenance coffers. It should be the threat of the devastating effect that poor maintenance can have on people’s lives that rubber stamps its value in ensuring a safe patient journey and experience. However, the law does show the need for the NHS to fulfil its duty of care to all in this area.

DUTY OF CARE The Corporate Manslaughter and Corporate Homicide Act 2007 is clear on what a breach of the duty of care constitutes where a company or organisation has a responsibility to keep people safe from harm. In the context of the NHS, if the way a hospital is managed or organised causes a death, it becomes a gross breach in its duty of care because it has not taken the steps reasonably required to safeguard staff, patients and any other visitors.

Similarly, the Health and Safety at Work etc Act 1974 is clear that buildings, equipment and the systems that affect them are maintained properly – this is part of the duty of care trusts should show. Workplace Regulations 1992 takes a comparable line that the maintenance of equipment, devices and systems should leave them in an “efficient” state.

Even the Provision and Use of Work Equipment Regulations (PUWER) 1998 says that the medical devices and equipment it covers must be maintained in an efficient state. The issue of maintenance has also been identified as part of the Care Quality Commission (CQC) essential standards. Regulation 15, outcome 10, relates to safe facilities and regulation

16, outcome 11, to safe equipment.

All these laws and regulations make the same point under different guises; patients and staff shouldn’t be put at risk by the buildings, functions and equipment that they trust will work as a matter of course.

FOLLOWING PRACTICES When a trust is successful in ensuring that people stay truly safe, it is partly because the equipment they provide is maintained as part of an everyday, integrated, regulated activity.

Systems and processes need to be in place to ensure this will be followed in practice by everyone concerned and those maintenance systems and processes are monitored, audited and reviewed on an ongoing basis.

All this considered, it is then imperative that the NHS does not bring its axe down on its maintenance budgets.

Things will break down and go wrong – this is a part of life, but if patient safety is compromised because of poor maintenance, poor control procedures, and inadequate management of those whose job it is to ensure maintenance, organisations and individual managers will have no defence.

Patient safety, including indirect patient safety must sit at the top of any trust’s agenda.

Healthcare organisations must strive to retain funding to service maintenance needs, even in economically challenging times.

Well-maintained maintenance budgets will ensure NHS hospitals have the ability to continue to provide safe, efficient, quality services and do not pose a risk to the very patients’ health that they are trying to improve.

About the author David Halicki is a chartered member of the Institution of Occupational Safety and Health (CMIOSH) and member of the national IOSH Healthcare Group Committee

FOR MORE INFORMATION Web: www.iosh.co.uk

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You can even get departments and sites undertaking their own local audits and assessments directly on the web.

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Need help with CLINICAL WASTE ?

Grundon provides a Total Waste Management package to hospitals, clinics, laboratories, care homes and PCTs, comprising some or all of the following: Clinical waste from medical, nursing, dental or pharmaceutical applications. Sharps containers, yellow sacks and colour-coded 660 & 770 litre lockable wheeled bins to comply with HTM 07-01 Radioactive waste low level waste from teaching or R&D labs

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Practical solutions From experience

Health Business | Volume 10.6

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CLINICAL WASTE

HAZARDOUS WASTE HANDLING Mishandling clinical waste presents a very real risk to human health, advises Gill Ross-Jones, policy adviser for hazardous waste at the Environment Agency THE CORRECT HANDLING of healthcare waste is an issue that must not be overlooked within the NHS. Although the necessary procedures are not particularly complex or challenging, significant effort is required by management to ensure systems are set up properly and then monitored to ensure they continue to run effectively.

ENVIRONMENTAL IMPACT The Environment Agency monitors all types of waste producers and their output with the aim of reducing the impact of that waste on the environment. In the case of clinical waste – almost all of which is classified as hazardous waste and where mishandling presents a very real risk to human health – the emphasis is on ensuring safe as well as efficient treatment or disposal.

The Environment Agency seeks to achieve this by working with healthcare establishments to promote and support best practice. Working

in partnership with industry is the preferred option and has been found to be the most effective. However, as the environmental regulator, the Environment Agency also has enforcement powers to discourage infringements of the law, which can be used to impose fines on persistent offenders.

Best practice in managing healthcare waste would see employment of a fulltime environment manager who oversees trained staff, ensuring complete waste

segregation, keeping accurate records and employing a fully compliant waste contractor. There are several measures that are comparatively simple to implement that can help trusts move towards this ideal.

WASTE SEGREGATION Segregation is the key to effective waste management as mixing hazardous wastes with non-hazardous wastes means it all has to be classified as hazardous. Trusts are

Best practice in managing healthcare waste would see employment of a full-time environment manager who oversees trained staff, ensuring complete waste segregation, keeping accurate records and employing a fully compliant waste contractor

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Health Business | Volume 10.6

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CLINICAL WASTE

Waste management is not meant to be difficult, however, it does require some resources and management to ensure that there is no risk to the environment or human health reminded that this is not optional and that the law requires waste producers segregate materials through the Hazardous Waste (England and Wales) Regulations 2005.

This prohibits the mixing of a hazardous waste with any other category of hazardous waste, non-hazardous waste or other substances (unless authorised to do so).

Guidance on this is available in the government’s Health Technical Memorandum, Safe Management of Healthcare Waste (HTM 07 01). This is available on the Department of Health’s website and explains how to segregate waste in order to meet legal requirements.

Implementing waste segregation is not difficult, particularly as most people sort their household waste already. Trusts that have implemented outstanding segregation procedures have done so by ensuring the following measures were in place: • The support of senior management • Trust-wide training and induction of all staff • Careful placement of properly labelled bins • Use of internal audits and ward champions to monitor performance • A coordinated programme of change.

The message behind this is that staff will segregate effectively if you provide the tools, training and support for them to do so. A few posters and e-mails will probably do little to bring about change.

Packaging and labelling is another vital aspect of segregation. The segregated waste must be kept in appropriate containers that are clearly labelled, identifying both the waste contents and the source department or unit. This is particularly important for pharmaceutical wastes, anatomical wastes (particularly from pathology laboratories), and chemically contaminated wastes.

Furthermore, the packaging must meet the requirements for the carriage of dangerous goods to ensure it can be transported by the waste carrier, or internally, without the risk of leakage. Advice on this should be sought from your dangerous goods safety adviser.

AUDIT YOURSELF Segregation is rarely going to be perfect.

But what is important is that management systems are in place to prevent serious failures, to monitor performance and identify where improvements can be made.

An effective audit system would see each ward, unit or department having its own waste champion who supports local staff and audits performance each month. The trust

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could form a committee of these champions and the waste manager would then advise and coordinate a consistent approach.

Internal auditing is a major part of the Health Technical Memorandum and many disposal sites now demand this as a prerequisite for receiving waste from medical practices.

WASTE DOCUMENTATION Clinical waste from medical practices, with the exception of the small sub-waste stream of non-hazardous medicines, is always a hazardous waste. This means it must be accompanied by a consignment note when it is removed from a practice. If your waste contractor does not provide a hazardous waste consignment note you should seek advice from the Environment Agency immediately.

There are two problem areas surrounding consignment notes that are all too common.

Firstly, the waste producer is often unaware that completion of key parts of the note remains solely its legal responsibility. This can lead to the second issue: producers tend to let the waste contractor complete it for them. Although this is acceptable in some circumstances, producers are reminded that the legal responsibility remains with them.

It is the legal responsibility of the waste producer to provide a detailed written description to the contractor of the composition of each clinical waste stream. Management should be aware that each time waste is collected a legal declaration is signed on behalf of the trust certifying that the description is correct.

Transport is another important issue. Waste producers have a duty to ensure waste is packaged properly for transport. The Carriage Of Dangerous Goods Manual, available on the Health and Safety Executive’s website, forms the basis of standards for this.

Primary Care Trusts should be particularly aware that the requirements for the carriage of loose bagged waste (‘in bulk’) can be fundamentally different to the carriage of waste in wheeled carts or other suitable rigid containers. If your contractor is collecting bagged waste ‘in bulk’ the Environment Agency would recommend checking this is packaged and loaded onto the vehicle in accordance with the relevant requirements.

FINAL DESTINATION Historically, clinical waste has been sent to incinerators operating at hospitals. These incinerators were considered suitable for

almost all clinical wastes and so poor segregation was not such an issue.

In recent years, however, the number of clinical waste incinerators has declined significantly, creating greater demand for the reduced incineration capacity.

In the last decade there has also been a rapid expansion in alternative treatments.

Often these are based on the well established principles of the laboratory autoclave and the most modern of these devices use state of the art technologies that are very effective at killing bacteria and viruses. They represent a substantial, innovative and forward-looking investment by the clinical waste industry and now form a large and essential part of the treatment and disposal infrastructure.

Unfortunately, these alternative treatments have no recognised performance against chemicals and pharmaceuticals, are not used for anatomical waste for ethical reasons, and can be prone to mechanical problems if they are fed large metal implements. They are, therefore, not normally authorised to process certain clinical waste streams.

This point highlights further the increasing importance of segregation by the producer, to ensure that optimum use is made of the remaining incineration capacity, and that unsuitable wastes are not sent for alternative treatment.

RECORDS AND RETURNS As producers you are legally required to keep a register of hazardous waste records.

This must include consignment notes (and related documents) and consignee returns provided by the destination waste management site to confirm the waste arrived and detail what was done with it.

If the destination waste site has not provided this confirmation, the trust’s register is incomplete, something which should be addressed with some urgency.

Management should also be aware of how far their duty of care extends. Each producer has a duty of care that continues after waste has left the premises and been transferred to a waste contractor. To discharge this, trusts should take reasonable measures, in addition to those mentioned here, to ensure that the company you transfer waste to is appropriately authorised to deal with it.

Waste management is not meant to be difficult, however, it does require some resources and management to ensure that there is no risk to the environment or human health. If things goes awry, the producer may have some liability that could result in a substantial fine. The Environment Agency hopes to avoid this through working in partnership with the healthcare industry to ensure waste is properly disposed of. This would benefit the healthcare industry and help improve the broader environment for all of us.

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Specialists in laboratory chemical disposal Solutions for a safe, secure workplace ETON IS A LEADING mail order company providing more than 57,000 health and safety and facilities management solutions to promote a safe, secure workplace.

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The safe disposal of hazardous waste and compliance with environmental regulations are a necessity that all companies face, and an onerous task essential to the success of any organisation.

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Seton, PO Box 77, Banbury, OXON, OX16 2LS Freephone: 0800 585501 Fax: 0800 526861 E-mail: sales@seton.co.uk Web: www.seton.co.uk

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Phoenix Building Systems Ltd are a family run nation wide supplier of high quality portable buildings, together we have many years experience working in the modular building industry. Incorporating offsite modular building techniques into your projects offers huge benefits to clients and contractors alike. We will help shape your ideas to ensure that you take full advantage of what offsite modular construction can offer.

Maximise the potential benefits that are available by speaking to the modular building experts.

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Health Business | Volume 10.6

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DESIGN & BUILD

MODULAR BUILDINGS MEET MODERN CONSTRUCTION NEEDS Today’s modular buildings are made of the highest specification materials that comply with the new building regulations, writes Jackie Maginnis, chief executive of the Modular & Portable Building Association WE ARE ALL AWARE of the increasing pressures being bought to a country that for years has taken its environment for granted.

Clear indication of what to expect now and in the future regarding carbon reduction has become very apparent this time with the new building regulations as from 1 October 2010.

Pre-fabricated is a term that we are unable to shake from the description of our modern day hi-tech modular buildings. It is most unfortunate, as historically that description has not always been the subject of good press. Very few will recall that this was a method of cheap post war housing built with what was then a cost-effective material of asbestos. The materials used today have to be of the highest specification to meet the requirements of the regulations, but also an important fact is that clients today are looking for much more attractive buildings that are also environment friendly.

The MPBA working with government is

fully aware that within the next ten years zero carbon will not just be someone’s ideal; it will become reality for the future of our planet that we take so much for granted.

Increasingly local authorities and NHS trusts are turning to the modular sector to provide anything from a small basic extension to a complete major rebuild project. As an industry with years of experience, we understand the need and suitability of modular buildings and are fully capable of providing a complete service. From the start of an idea on paper to final completion and handover, the skills are all there to give the clients what they need, when they need it.

WHERE THEY’RE BUILT Off site construction appears now in almost every publication that we read. The question is, do many of the end users understand what that means, and more importantly why?

Modular buildings are all built off-site in

a factory environment, thus giving more control to the whole process. Manufacturers are able to keep waste to a minimum.

During 2008 the MPBA worked on a project funded by DTI known as BeAware, this research confirmed that modular was the most effective means of controlling waste (free download report available on the MPBA website). The opportunity to also maintain the project on time by not being controlled by our unpredictable weather is also a key driving factor to the use of modular systems.

Clients have the opportunity to visit the manufacturing companies to discuss their requirements and see the whole process of how it all works. What better way to understand what goes into the building?

HEALTHCARE PREMISES Space at existing hospitals is becoming more and more of an issue; how often do we hear the public complain about not having

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Visit the website to view the categorised product finder

Elliott Off-Site Building Solutions

Is your building fit for purpose?

LLIOTT OFF-SITE Building Solutions, acting as concept designer and Principle Contractor, has completed the new medical research centre at Manchester Royal Infirmary (MRI) for American drug research company Icon.

The company used its hybrid construction system to overcome the many challenges presented by this complex 26 week build programme.

Elliott Off-Site was required to work alongside and maintain access to the live X-ray department and to the ‘blue light ‘route for ambulances.

Added complexity was created by poor ground conditions and seven weeks of severe winter weather at the start of the year, although the company’s off-site system enabled work to progress when it may have delayed traditional build.

Along with the speed and quality advantages of its system Elliott Off-Site demonstrated its commitment to meeting the critical completion date by working two

S YOUR BUILDING fit for purpose? Do you need more space with a limited budget? Do you need to relocate but don’t know where?

Cayford Architecture is a friendly design company, experienced at helping clients work out project visions and space requirements.

Clients include West Herts Hospitals NHS Trust, Department of Health, & Perfect Image Consultants.

We are well versed in the specific technical needs of advanced healthcare facilities, and our extensive workplace experience ensures maximum staff productivity and retention.

Paul Cayford has a fine track record of large scale property strategies, in delivering award

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12 hr. shifts towards the end of the project helping to reduce the final programme by four weeks.

“There was an excellent understanding of both the client and end user needs to produce a building of high quality under tremendous time pressure. It was a pleasure working with the delivery team and their help with the surrounding user groups was greatly appreciated and sensitively delivered. Well done on a good job!” said Dan Parry, Deputy Head of Estate Development at MRI.

FOR MORE INFORMATION For more information on Elliott Off-Site Building Solutions, visit www.elliottfastrack.co.uk or call: 01274 863221.

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winning buildings, and is an accredited RIBA Client Advisor.

We understand how a smaller proposal will fit with the bigger long term development strategy.

We have a pragmatic view of adapting existing buildings, and we are experienced at obtaining all aspects of planning and building regulation approvals.

Let us inspire you to create a healthy sustainable development to reduce running costs, improve staff morale, and have healing outcomes for patients.

FOR MORE INFORMATION Tel: 020 88406690 Mobile: 07900 906020 E-mail: info@cayford.com Web: www.cayford.com

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DESIGN & BUILD

enough car parking facilities? Modular building gives the client opportunities of utilising every space available with the flexibility of size and configuration. Buildings can be lifted into spaces that in the past have not always been accessible; today we also have the advantage of building higher then in the past thanks to modern technology.

With the reduction in public spending and capital expenditure being limited, a way forward is the hire devision of our industry.

These companies will be able to bridge the gap with the urgently required facilities.

Companies have a hire fleet of buildings that can be made available to fulfil either short or longer-term requirements in the difficult times ahead. As part of the new building regulations, energy performance certificates now apply to all of these type of buildings including modular. This will not be a stumbling block as the industry has worked together to ensure that the required documentation will be in place. This has been done with confidence in the knowledge that the buildings do what they say and tick all the boxes.

The MPBA also has in place an accreditation scheme which is now available to all companies.

Details can be found on the MPBA website, alongside the Generic Scheme for Hire which is also available to non members.

CASE STUDY – NEW BUILD Sunderland Hospital is one of the latest in a long line of hospitals to benefit from the experience of a member of the the Modular & Portable Building Association.

With a unique bespoke approach to design, with no set module sizes, the manufacturer ensured the client gained all the benefits of offsite construction including speed without having to make changes to the complex design.

The 9,000sq m care unit project consisted of 106 steel frame modules, some of which are up to 19 metres in length and include

Increasingly local authorities and NHS trusts are turning to the modular sector to provide anything from a small basic extension to a complete major rebuild project the latest technologies for robust floors.

Typically 80 per cent of the units were finished before being moved to site and in some cases many were 100 per cent complete. Quality Assurance checks by the dedicated team of personnel were key throughout the build process, from tendering through to design and manufacture and ultimately to erection on site.

As ever the clients benefited from less environmental impact, reduced waste and timed organised deliveries, all contributed to a satisfied client with professional service by the supplier.

With this new building, Sunderland Royal has an addition of 120 in patient beds, and a state of the art Integrated Critical Care unit. Other benefits from this new building are advanced infection control and privacy for patients, featuring more space for family and friends.

Staff who played a part in assisting to design this new unit will also have the benefit of new changing areas and training room.

Case Study provided by Britspace.

CASE STUDY – PRE-OWNED Coventry Primary Care Trust chose Pre-Owned modular buildings to fulfil their requirements, when additional facilities were required. The temporary modular building consisted of six no plasticoted steel modules with doubleglazed Upvc windows. The building also has a plasterboard-lined ceiling and walls and a double thickness plywood floor.

The used modular building was decorated internally, cleaned externally and reinstated electrically to the latest regulations. It was provided by an MPBA member specialising in pre-owned buildings, with the ability to

provide a complete turnkey package.

The temporary modular walk in centre building complied with Part L2A 2006 building regulations and is extremely environmentally friendly as it only uses three per cent of the energy required to manufacture an equivalent new modular building. (Note building supplied prior to 1 October 2010) Even though the modular building was preowned, the supplier still provided a 12 months guarantee with the building. This is a classic example of the confidence in the industry sector that provides the reuse of modular buildings.

Coventry Primary Care Trust was given complete peace of mind throughout the process, from attending meetings, reviewing health and safety plans, to the supply and installation of the used modular buildings. Crane arrangements, transportation and temporary traffic management to enable the building to be off-loaded from a road adjacent to the site was undertaken as part of the contract.

This project ticked all the boxes; sustainability, recycling, relocating embodied energy, with the added advantage of being dealt with by one point of contact. Case Study Provided by Portable Building Sales Limited.

FOR MORE INFORMATION Web: www.mpba.biz

Qube modular buildings for the healthcare sector EALTHCARE BUILDINGS in the UK tend to range from the new style sterile, soulless boxes that bolt together like a child’s giant Meccano toy set, to the old imposing brick buildings that are tired, run down, out dated or worn out. Neither of these types of buildings is conducive to the very best healthcare services, for patient or client treatment or recovery environments. Patient and client services are best served in a well designed, modern, light, comfortable space that has the patient and client needs and services built in to the design and fabric of the building.

Embracing new building methods and technologies, Qube Structures have an

and satisfy the specialist needs and requirements of the patients that rely on the function of these health care buildings.

All Qube Structures are not only rapid build, fast track and cost effective but they are bespoke in design to meet the challenges of each and every individual health services requirement or application.

No two buildings are the same because in most cases no two health buildings house the exact same set of patient or client services.

H

alternative building solution that cannot only satisfy the needs of the organisations or clients commissioning and managing these healthcare buildings but also service

FOR MORE INFORMATION Tel: 01604 785786 E-mail: info@theqube.co.uk Web: www.theqube.co.uk

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Land Rover S1

Urgentys

Pass Training Consultancy Ltd – Delivering Professional Training to the Private and Public Sector Industries Business Review is delighted to present Pass Training Consultancy Ltd with the highly accredited Company of the Month Award.The company has received this accolade due to its dedication to educating our society and providing high quality courses.

Pass Training Consultancy Ltd offers a variety of course packages such as: • Conflict Avoidance Training, • Welcome Host Customer Service Training, • Welcome Line Telephone Customers, • Welcome All Disability Awareness, • Customer Care Training, • Telephone Customer Service Training, • Notice Processing Training, • Civil Enforcement Officer Training, • Appraisal Training, • Fire Safety Training, • Manual Handling Training, • Supervisory Training, Health and Safety Training, • Vehicle Immobilisation Training, • Parking Shop Training

• Car Park Officer Training • Basic Deaf Awareness • Basic British Sign Language • First Aid at Work 3 Days (FAW) • 1 Day Emergency First Aid at Work (EFAW) • 1/2 Day AED Defibrillator & Emergency Oxygen • Care for Children (First Aid) courses • In Case of Emergency (‘ICE’)

Mark Cox from Pass Training Consultancy can now supply lone worker devices.

There are many things to consider when doing this and one of the most important is communication.

For lone workers it is important to ensure that they have the necessary means of communication to get assistance when they need it and to ensure that you can contact them throughout the shift as a means of welfare checks. Mobile communication devices such as the Urgentys, GEM-Shield and Land Rover S1 Phone are now available for less than the price of a mobile phone. They are lightweight, durable and designed to operate in all outdoor environments.

CALL US NOW ON

0843 2895581 info@passtraining.co.uk

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PARKING

BETTER SERVICE AND SAFER PREMISES Hospital visits can be difficult enough without the added stress of poorly managed parking spaces. Here, the British Parking Association explains its Hospital Parking Charter, which has been published to raise standards and deliver a professional service to the public MANY PEOPLE WHO ATTEND NHS hospitals, either as patients or visitors, expect car parking to be free. However, given the limits on space, the costs involved and the demand for spaces, car parking needs to be managed properly. Often the most effective way to do this is by charging for parking. This recognises the value of a car parking space; the needs of other users of the hospital; the environmental impact of driving; and the need to maintain and improve car parks by reinvesting income.

To strike the right balance between being fair to patients and others, including staff, and making sure that facilities are managed effectively for the good of everyone, the British Parking Association (BPA), backed by the NHS Confederation and the Healthcare Facilities Consortium, has published a Hospital Parking Charter, which is aimed at both NHS Trusts and car park operators.

RAISING STANDARDS The Charter, following a period of consultation in 2009 canvassing views and opinions of all involved and affected by hospital parking – from NHS Trusts to patient groups – has been refined to create a robust document which will help guide

hospital parking management in the future.

The resulting document strives to raise standards in the parking sector and deliver a more professional service to the public.

The guidelines will help the health sector with parking management issues. There has been much debate about parking at

Providing, managing and paying for hospital car parking needs to be seen in the context of delivering a better and fairer service to users. Both NHS Trusts and car park operators recognise the importance of car parking policy, both in terms of the wider transport strategy and the need to manage traffic and parking in line with demand and environmental needs

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In an ever more demanding world, Variable Message Signs Limited combines innovation, experience and technology in strategic and urban driver information. Our road traffic product range covers applications in the strategic , urban, and traffic management equipment sectors.

We offer a full range of services to suit individual client requirements from design, manufacture, supply, installation and commissioning of LED driver information systems, including fully UTMC compliant systems and all for clients, which include the Highways Agency, Transport for London, Local Authorities, Local Health Authorities, Hospitals and others.

We have supplied and installed a number of hospital sites which use our Safewatch range of vehicle activated signs for road & patients safety, by advising and reinforcing the speed limits and other hazards, such as pedestrian crossings, side roads and car park entrances and exits, etc;

Our range of car park guidance and information signs advise drivers where the car parks are on site and the number of spaces left within each, providing information and choice for drivers entering the site, and via our TRAMS car park management software package, the hospital / customer has control over all the listed car parks, the number of displayed / available spaces as well as providing various management reports and helps reduce emissions by keeping traffic moving and avoiding queuing.

Variable Message Signs Limited now introduce for the very first time, Pegasus our new range of urban dual colour full matrix signs. The sign’s attractive and slim design is especially suited to today’s urban streetscape, where it will deliver driver and pedestrian information.

The sign is offered in three sizes, with high resolution matrix areas suitable for the display of four lines of text with character heights of 160mm, 100mm, and 50mm. All variants are capable of displaying combined text and pictogram information and employ a dual-coloured, amber and red, matrix.

A special feature of the new sign system is the ability to mount it in a landscape or portrait format, with five mounting options for landscape fixing and three for portrait fixing.

VMSL The sign of the times; There’s no substitute for quality:

Variable Message Signs Limited Unit 1, Monkton Business Park North, Mill Lane, Hebburn, Tyne & Wear NE31 2JZ T 0191 423 7070 F 0191 423 7071 E ghutton@vmslimited.co.uk W www.vmslimited.co.uk

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PARKING

hospitals and we hope our Charter will provide some much needed direction for this particular sector, and therefore the BPA is encouraging all NHS Trusts to sign up.

Providing, managing and paying for hospital car parking needs to be seen in the context of delivering a better and fairer service to users. Both NHS Trusts and car park operators recognise the importance of car parking policy, both in terms of the wider transport strategy and the need to manage traffic and parking in line with demand and environmental needs. They also recognise the importance of professionalism in delivering their services and providing a high standard of customer care. In particular, it is essential to provide safe car parking for hospital users.

The Charter is designed to help and encourage NHS trusts to provide parking management systems that are fair for all. The issue of parking management at hospitals is a hot topic, regularly debated, and in response to this the BPA has produced guidelines to help Trusts and car park operators deliver effective and efficient parking for users – many of whom have particular needs.

Bringing together the interests of hospital car park users (staff, visitors and patients), government, local authorities and commercial organisations, the Charter will be circulated to all NHS Trusts across the UK. Some NHS Trusts, including Blackpool, have already indicated their support for the Charter, are expected to be amongst the first to sign up, and many parking operators have already added their name to the Charter.

CHARTER RECOMMENDATIONS The recommendations made in the charter will commit NHS Trusts, and their parking contractors, to: • Do their best to provide a high standard of management and customer service in their car parks • Provide good lighting; high standards of maintenance for structures and surfaces; payment systems and equipment that are easy to use and understand; signs that are clear and easy to understand; and clearly marked parking bays • Do their best to ensure that car parks offer a safe environment for all users and aim to meet the Park Mark® standard • Ensure that parking tariffs and tariff structures are reasonable, reflecting supply and demand, and the cost of maintaining the facility and providing the service. Tariff structures should be set to reflect local conditions, local tariffs and the needs of all hospital users. They should take account of the hospital’s environmental policy. Also, systems need to be in place to protect the legitimate use of hospital car parks. Tariffs should also take into account what the impact on local residents would be if the level of charges drove motorists to park in local streets

THE BRITISH PARKING ASSOCIATION APPROVED OPERATOR SCHEME (AOS) The AOS was set up by the BPA in 2007 as a response to concerns about the management of private car parking and parking on private land, and because there is no government regulation of the sector.

Members of the scheme must comply with the BPA’s Code of Practice, which sets out requirements for signs in car parks, the levels of charges and what customers can do if they feel they have been treated unfairly. The Code can be viewed on the BPA website www.britishparking.co.uk The BPA is an Accredited Trade Association of the DVLA (Driver

& Vehicle Licensing Agency). The DVLA will only release ‘registered keeper’ information to members of the Approved Operator Scheme. The government is intending to legislate to license clamping companies so that they must also agree to comply with a Code of Practice. The government has also said that an independent appeals service should be introduced as a further option for members of the public who are unhappy about the enforcement action taken against them. The BPA wholly supports that proposal.

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Parking and forecourt management solutions tailored to your individual requirements

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CS IS A LEADING supplier of Transport Revenue Systems worldwide. The transport revenue division is a core business serving customers and end users in parking systems, ticketing and transport toll management. Affiliated Computer Services (ACS) is now a Xerox Company with over 130,000 employees, supporting client business critical operations in 160 countries.

ACS provides unmatched business process and document management solutions worldwide to world-class commercial and government clients.

In February 2010 Xerox acquired ACS and we now offer a deeper and broader set of products and services all over the world.

ACS has more than 35 years of experience in comprehensive parking solutions, with some 1,000 sites equipped all over the world. ACS holds a world leader position for large airport car park systems from Sydney to New York. The North America industry leader for major airport parking solutions, ACS has installations at over 40 per cent of the North America’s busiest airports.

The best off-street parking solutions are seamless and convenient for both the individual and the entity managing the

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operations. Our customers need robust and reliable products, competent project management, as well as comprehensive service and support. For over 35 years the ACS staff of professionals has delivered just that to the world’s busiest car parks.

The car park is the first and last experience the customer will have in any retail or hospital environment. Knowing this, ACS has designed the new Light & Reflex range of equipment to not only look good but be easy for customers to use, easy to install and have the flexibility

to meet the demands of a modern 21st century parking operation.

Each application is designed to meet the unique requirements of that particular location. Reliable, comprehensive parking solutions can start as early as the highway with Parking Guidance Systems/ Variable Message Signs directing customers to open facilities.

With a multitude of access and payment options, the entry and exit process is quick and efficient.

Revenue shrinkage is averted with auditing tools such as automatic License Plate Recognition (LPR). Reporting and facility management is easy and accurate with robust and comprehensive back office management solutions. ACS has a proven track record of implementing and supporting thousands of off-street parking installations, offering value and flexibility to customers around the world.

FOR MORE INFORMATION Tel: +44 (0)1276 807100 Fax: +44 (0)1276 807101 E-mail: paul.gillespie@acs-inc.com Web: www.acs-gts.com

Health Business | Volume 10.6

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PARKING

• Consider the best practice advice available from organisations such as the BPA, Parking Forum, NHS Confederation and the Department of Health. In particular, information about costs and any income associated with running car parks should be clear, straightforward and published • Tell patients who are eligible about the Healthcare Travel Costs Scheme, and encourage them to claim back their charges • Provide concessionary parking to the following people if public transport may be impractical for them or if parking charges could become a burden over time: patients with a long-term illness or serious condition needing regular or long-term treatment (for example, people having dialysis, radiotherapy or chemotherapy), and people who need to visit patients regularly • Work together to make sure that maximum

WHAT IS THE PARK MARK®?

To raise the standard of safety in car parks, the BPA manages the Safer Parking Scheme (SPS) on behalf of the Association of Chief Police Officers. Its aim is to reduce the fear and perception of crime in parking areas. Police-accredited assessors carry out a risk assessment for each site, and look at how the site is managed and maintained. The parking operator must put into place measures appropriate to the surroundings that help to deter criminal activity and anti-social behaviour, in this way doing everything they can to prevent crime and reduce the fear of crime in their parking area.

Park Mark® is the brand of the Safer Parking Scheme, designed to set the standard for parking areas across

the UK, both for the public and their vehicles. National statistics show that around 22 per cent of vehicle crimes happen in car parks. Many parking facilities with the award have seen a dramatic drop in crime. Or, if they had not suffered from vehicle-related crime, they have been able to create a safe and non-threatening environment that encourages customers to keep coming back. Car parks with the award can use signs showing the distinctive Park Mark® tick, so drivers know exactly where to go for safer parking. There are almost 4,000 Park Mark® car parks in the UK. The public can search for them and get directions to them from a dedicated website www.parkmark.co.uk

Cost neutral parking solutions for hospitals NFORCING PARKING regulations at hospitals can be a sensitive issue. To strike the right balance demands professionalism and expertise.

At UK Parking Control (UKPC) our uniformed wardens are trained in conflict management and conduct themselves with tact and diplomacy whilst maintaining and protecting the client’s image, brand and reputation.

We know how important it is to keep access ways clear for ambulances, make sure disabled bays are only occupied by genuine badge holders and that parking areas fulfil health and safety requirements.

Operating Nationwide, we are one of the most

major retailers, local authorities, educational establishments and commercial premises.

We provide a comprehensive range of services which, in most cases, are cost neutral and we operate to the highest industry standards and are approved by the British Parking Association, DVLA and the Police.

E

FOR MORE INFORMATION experienced and reputable companies within the parking management sector. We are already in partnership with NHS clients including Nuffield Orthopaedic Hospital, Barts, The Royal London and The London Chest Hospital along with

For more information about our intelligent and commercially driven services and solutions please call Marc Browne on 0844 800 8710 or visit our website at www.ukparkingcontrol.com

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PARKING

publicity is given to such concessions and that they are taken up by eligible patients • Consider the needs of disabled users for whom other types of transport may be impractical. Trusts and operators should make sure that there are enough disabled parking

spaces and, if payment is required, that payment systems are adapted to make them easy to use • Design systems used by car park operators to recognise the unavoidable, unplanned and unpredictable nature of visits to hospitals.

Enforcement action should be designed not to penalise people whose contravention of the parking rules could not have been foreseen by them. There should always be an appeals procedure. Policies should cater for the needs of patients and visitors separately from those of staff, where different circumstances may apply • Ensure that any enforcement is to be proportionate, with a focus on encouraging compliance. Operators should all be members of the BPA Approved Operator Scheme, and read the Charter alongside the AOS Code of Practice, particularly what it says about signs, the levels of charges and what customers can do if they feel they have been treated unfairly.

Parking charges can help to pay for maintenance and management services, and prevent these from becoming a drain on healthcare budgets. Therefore, we encourage NHS Trusts and car park operators who manage hospital car parks to sign up to this Charter and to abide by its letter and spirit.

FOR MORE INFORMATION Tel: 01444 447300 Web: www.britishparking.co.uk

Alligator teeth in hospital car parks

An alternative solution to wheel clamping

N INCREASING NUMBER of NHS hospitals car parks are installing Alligator Teeth Systems made by Entry Parking Posts to enforce mandatory traffic direction control at car park exits and entrances.

Alligator Teeth, which are bolted into steel trough in the roadway, are lowered by vehicle tyres moving in the approved direction. This allows continuous movement of vehicles without the need for power supply and maintenance contracts associated with raising arm barriers.

Alligator Teeth are 115mm above road level but can be made at 100mm and also fitted with shock absorbers for faster

W car park management

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speed of 25mph at entrances from the highway. The Trough and Drainage system allows for easy cleaning and greasing.

The surface fixed Alligator Ramp System is an alternative to the road level Alligator Teeth or Jaws and can be bolted to roads to save site work.

A new Alligator Teeth Silent Action unit will be available November 2010 from the Entry Parking Costs range. Job references are available on request.

FOR MORE INFORMATION Contact: Anthony Prosser Tel/Fax: 01564 773188 E-mail: entryparkingpost@aol.com Web: www.alligatorteeth.net

E ARE A LEADING national

company, specialising in a revolutionary new concept pioneered over recent years as an alternative solution to wheel clamping, which is soon to be outlawed. The system we operate is based on the issuing of parking charge notices and is very diverse and flexible. It can be applied to any size car park from 1 bay to 10,000 bays, from permit schemes to total no parking enforcement.

This system has proved highly successful in achieving very quick results in solving parking issues.

We are members of the British Parking Association and are proud to be one of few who have achieved ‘Approved

Operator Status’ that allows us to obtain DVLA keeper details.

Our customers range from large organisations such as Newcastle Airport and Wembley City Estates to national retail chains such as B&Q as well as medical centres, hotels, offices and residents associations. All have found that our solution has been successful in deterring and eradicating unlawful parking on their land in a non-confrontational, ethical and legal manner.

FOR MORE INFORMATION Tel: 08707 203807 Fax: 08707 203808 E-mail: info@parkingpatrol.co.uk Web: www.parkingpatrol.co.uk

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PARKING

HEALTHCARE PARKING: PAIN, PROBLEM, PROCESS OR POTENTIAL? The Healthcare Facilities Consortium’s Keith Sammonds reviews recent activity within the hospital parking area including how the health service is moving things forward A RECENT NEWSPAPER front page article was covered by the headline: “£2.6m for just four extra car spaces at Bronglais!”1 The article, in the Cambrian News, was the only ‘news’ on the front page with just a small pointer to a page three article on someone who was “lucky to be alive after explosion.” It is interesting to see how the media in general still responds to healthcare parking issues and the priority that is given to this issue, which is in reality a side issue to the real purpose of the NHS – providing healthcare. On page six of the same paper is an article on the ombudsman’s report about a ward sister who falsified an entry in a deceased patient’s records.

HOSPITAL REDEVELOPMENT For those who don’t know, ‘Bronglais’ refers to Ysbyty Cyffredinol Bronglais (Bronglais District General Hospital), Aberystwyth and the above mentioned £2.6m is the cost of an enabling scheme, including provision of a new multi-storey car park, for the major phase two redevelopment of the hospital site by the Hywel Dda Health Board. This Board runs this important hospital on the West Wales Coast that serves a massive area of central Wales.

The £2.6m expenditure does not provide four extra car parking spaces; it provides for the diversion of major services, enabling works for the main scheme and the re-provision of car parking spaces to be lost.

Having recently had my third grand daughter born in this excellent hospital facility I know the parking problems here only too well. The site is in the only major town in the area is surrounded by rural communities that are almost totally reliant on the car to access the hospital and is fully enclosed by residential and University buildings so any work has to be carefully planned to ensure that service provision can continue without unnecessary interruption.

AFFECTING HEALTHCARE PREMISES These are issues that we face constantly throughout the UK healthcare sector as we strive to improve the quality and functional suitability of the premises in which our healthcare is provided.

Whilst the acute hospital based issues will often hit the headlines the same issues are equally applicable on a smaller scale to all other premises used to provide our healthcare. This includes Community and

This photo is Copyright HFC and used with permission

The involvement of patient and visitor groups is vital if, as healthcare providers, we are to aspire to meet our clients’ needs. An example of this is at our local acute hospital where a very nice sculpture has been placed in the centre of the roundabout at the main road entrance to the site Mental Health Hospitals, drop in centres, GP and dental surgeries and many others. With 30 million cars registered with DVLA and car usage increasing there is pressure on all healthcare providers to manage down their staff and visitor reliance on the motor car.

Clearly there is a conflict as our expectation to drive and park easily increases but the political pressure, quite rightly, is that we should be looking to more sustainable forms of transport.

This is effected through planning applications and sustainable transport plans that have to be produced by both healthcare providers and local authorities – and these two have to align with each other. So it was with great interest that I attended the British Parking Association (BPA)

Hospital Parking Special Interest Group meeting at Sandwell Hospital on the 18 November 2010.

CHARTER FOR HOSPITAL PARKING The BPA launched its Charter for Hospital Parking in March this year along with the NHS Confederation (NHSC) and the Healthcare Facilities Consortium (HFC). Patrick Troy, CEO of the BPA has been interviewed on national media and also on Focused FM TV2 outlining the purpose of the charter.

Following on from this there has been so much interest that BPA and HFC decided that there was merit in calling together the providers and operators to see what can be developed by sharing experiences and

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PARKING

good practice from around the country and the wider parking industry. To say the day was intense is an understatement and many topics were covered and concerns aired.

Importantly David Pennington, from the Department of Health, gave an overview of how car park charges came about in the NHS and further developments including the impact of devolution with Scotland and then Wales abolishing charges on hospitals within their countries.

Whilst the intention was to abolish charges completely this has not been fully possible because of contracts already in place, especially on PFI sites, as a speaker from one of the large Welsh Health Boards noted later in the day.

AUTONOMOUS ORGANISATIONS From the English side of things the government had responded in October to the consultation instigated by the previous administration and the real outcome of this is “local autonomy”. As another speaker pointed out later in the day the NHS is actually made up of a number of independent autonomous organisations providing healthcare under the NHS brand through central funding. Some of the points raised from the consultation process are interesting to note: • There is a dislike of hospitals making profit from patients • Individual patients want free parking • Patient advocate groups recognise the need to cover the costs of parking provision • Concessions are variable and not well publicised The government position is that the NHS must: • Provide fair concessions for regular patients • Be transparent • Be accountable (for policy) to the local community Whilst government will not provide guidance on car parking policy it is clearly expected that local standards and policies for healthcare parking must be built on the codes of practice already available (BPA), good and best practice (NHSC and HFC) and that the implementation of these will be influenced by Patient Choice, Local Communities (through Foundation Trust board involvement and local networks), national and local campaigns (Macmillan and WHICH? for example) and national and local media as hospital parking in particular is an easy story.

AIRING CONCERNS We had three presentations from hospitals in Sandwell, Cardiff and Leeds on their issues and progress and it was interesting to note that in Wales some £5.45m of car parking income has been lost – so the costs related to this provision are now having to come from the healthcare budget rather than being self funded.

Putting this into the previous day’s announcement from the Welsh Assembly Government of a 7.7 per cent cut in budget

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for the NHS in Wales, this clearly shows a problem in the making. In all three areas income from car parking across the wider organisations funds the in house management of parking and related security including CCTV upgrades, and in Sandwell contributes to the Facilities Cost Improvement programme for the Trust. However, as car parking technology has moved on users expectations rise and they have to look at new payment processes and equipment including pay by mobile phone, credit card, and so on.

It was interesting to note the use of a salary sacrifice scheme approved by HM Revenue and Customs for the staff permit scheme. Leeds, which has been cited by WHICH? as being bad for issuing enforcement notices, noted that the majority of these had been to staff. Patients did not seem to have issues with the charges but rather the lack of spaces, which is a problem of having city centre sites. Issues of transparency and fairness were cited as important in their enforcement programme. The Trust has recently been granted the Park Mark® award, noting good practice in car park safety and security.

PARKING PERMITS Travel Plans are central to car parking policy because, as Chris Hanley from Colin Buchanan noted, ‘travel’ is the cause of the problem, ‘parking’ is only a symptom.

Studies have shown that best value for permit schemes comes from emissions based charging for annual permits with occasional use permits for staff who do not need to use a vehicle all the time.

The importance of this kind of integrated planning was reinforced by Dr Wyn Hughes from the Addenbrooke’s hospital in Cambridge; a site which is often cited as a prime example of good practice. He noted that subsidised bus travel had been funded by ring fenced income from car parking and that staff parking fees had risen from 20p in 1999 to £1.40 in 2006. This had been tracking the cheapest local bus service return trip. Where Addenbrooke’s have been running park and ride schemes with the local authority and bus service provider they recently acquired their own vehicles for a service and Leeds has also recently leased two buses to provide inter-site transport which has reduced staff journeys and alleviated parking pressures in the city centre.

GOOD PRACTICE Looking forward, the issue of good or best practice was raised and a new Healthcare Parking Good Practice Guide is being developed as number 11 in the series of Facilities Management Good Practice Guides originally funded by the Department of Health in 1999 and published in 2001. A skeleton document has already been circulated to interested parties and initial feedback has been both positive and constructive.

The guide will cover all aspects of healthcare

parking and one concern is if this is too wide a remit. As with other good practice and guidance in the healthcare sector, where there is area specific guidance the healthcare guide will refer to this and so the BPA Charter is a starting point and all organisations are encouraged to sign up to this.

The NHS Confederation Best Practice document ‘Fair for All; Not Free for All’3 cites several examples of good practice in a number of differing areas and the Park Mark is an example of what every provider should be aspiring to. The current problem with moving things forward is going to be the constraints of budget as new technology comes with an associated cost and car parking charges may not necessarily cover this short term.

MEETING CLIENT NEEDS In closing, it is often easier for a visitor to a site to point out what is not as good as it could be. The involvement of patient and visitor groups is vital if, as healthcare providers, we are to aspire to meet our clients’ needs. An example of this is at our local acute hospital where a very nice sculpture has been placed in the centre of the roundabout at the main road entrance to the site. This sculpture is often used by the trust in their publicity with a beautifully taken photograph from the grass to the left of the roundabout looking across towards the buildings. The shame is that from the drivers seat of a car the sculpture hides the very large sign that indicates where the car parks are and which ones have spaces. Once on the roundabout a driver can only see the sign through their sunroof, if they have one. The photograph on the previous page shows the sculpture – note the parking symbol at the top right of the sculpture. Also note the car driving onto the wrong side of the road; this small section of road is two way where the rest of the main drag around the site is all one way. Why? Because emergency vehicles have to run contra to the main flow in order to gain access from a site boundary slip road onto the road network.

An accident waiting to happen. The second shame is that since they changed car parking contractor the sign has not been functioning.

It can be very easy to get something wrong by simply not noting all the aspects of what is being done and very difficult to put it right.

Notes 1 Cambrian News – 21st October 2010 2 Focused FM TV Article available at: www.focused-fm.tv/node/249?sid=4532 3 Fair for All; Not Free for All was published by the NHS Confederation in 2009 and can be downloaded from their web site.

FOR MORE INFORMATION Web: www.hfc.org.uk

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TPS – the number one for UK parking solutions ITH OVER 30 YEARS’

W combined experience at Total At TPS we understand the unique demands associated with each sector and provide clients with bespoke parking solutions 4 Established market leader as a professional car park management operator 4 Our customer focused approach has resulted in an outstanding level of growth 4 Key sectors include NHS, Local Authorities, Retail and Leisure facilities 4 TPS operates efficiently throughout the whole of the UK

n Controlled limited stay periods n Pay and Display n Pay on Foot n Pay on Entry/Exit n Barrier Controlled Systems n ANPR (Automatic n Number Plate Recognition) n CCTV and Security Personnel n Park and Ride n Marshalling and Special Events

Total Parking Solutions Ltd, SATRA Innovation Park, Rockingham Rd, Kettering, Northants NN16 9JH Telephone: 0845 257 3540 Fax: 0845 257 3541 info@totalparking.co.uk www.totalparking.co.uk

Security and parking enforcement services ARKING IS AN EMOTIVE ISSUE. Drivers demand fairness until they themselves flout the rules and get caught. Then fairness becomes unfair as it is not in their favour. Even though acting fairly, establishments and businesses still risk press frenzies unless we give special treatment that makes a mockery of any scheme in place.

We at 14 Services are dedicated to the adherence of site rules and to real equality. Caving in to pressure by the press gives succour to such methods, sets dangerous legal precendents and is appalingly unfair to those that are too private, too ill or too busy to use the publicity route to “get their own way”.

There is need for extra sensitivity in some car parks. We believe this

P

must be in line with fairness for all drivers and with consistency.

Parking control is necessary nowadays. 14 Services operates on private land and offers a free service to landowners/ managing agents 24 hours a day, 365 days a year. We issue Parking Charge Notices in accordance with site rules.

We also offer mobile patrols, dog training, key holding, security dog patrols, alarm response, lone worker support, staff searches and much more.

If you wish to discuss any of these services or anything else we look forward to hearing from you.

FOR MORE INFORMATION Tel: 01452 546984 E-mail: info@14services.com Web: www.14services.com

Parking Solutions, managing is not simply about fulfilling a contract it is constructed around a thorough understanding of our business and the goals of our clients.

Meeting those goals means harnessing some of the most advanced technical products and systems, experience, knowledge and resources that are available to us.

A major player in UK parking, TPS can offer our extensive knowledge and experience to provide an economically efficient operation and high quality service to its customers. What distinguishes TPS is our genuine commitment to the continuous improvement of our services and the range of services being offered to our clients.

Our operations comply with the British Parking Association Code of Practice and quality management structure focused around the BSI ISO 9001 standard. TPS team members understand the company’s quality policy and objectives to ensure consistency and competency.

Adopting this philosophy has enabled us to provide effective parking services to the NHS sector to a variety of applications, from Pay on Foot systems, Pay & Display, restricted and permit parking areas including enforcement control.

As a professional operator we understand the environment and are committed to strike a balance between efficiency and sensitivity. Our aim is not only to meet with, but to exceed customer expectations.

FOR MORE INFORMATION Office: 0845 2573540 DDI: 0845 2573542 Mobile: 0778 7165525 Fax: 0845 2573541 E-mail: tito@totalparking.co.uk Web: www.totalparking.co.uk

Spray away ice control issues with SnowEx ROADWOOD INTERNATIONAL, UK distributor for the SnowEx range of salt and grit spreaders, has responded to the increasing popularity of liquid brine solutions for use in snow and ice winter maintenance applications by introducing the SnowEx VSS range of liquid de-icing sprayers.

This increasingly popular practice is particularly suitable for sensitive areas where salt may corrode fittings or machines, or may damage foliage surrounding the area to be spread.

“One of the real beauties of spraying is that the operator can apply ice-melt product with pin-point accuracy, and in a quick and efficient manner,” says Roy Wolfenden, general manager at Broadwood.

“Salt spreading clearly has an undeniable place, but we’re seeing spraying as an increasingly popular practice, particularly with landscapers and in sensitive areas such as airports.”

B

SnowEx sprayers are available for the 2010/11 winter in 378, 757 and 1135 litre formats, giving operators plenty of choice depending on the vehicle they wish to use a VSS sprayer with, or demands of their application. Ideal for use on a pick-up bed or trailer, the VSS system is a versatile, reliable and accurate de-icing system for the 21st century.

FOR MORE INFORMATION Broadwood International Oakhanger Road Bordon, Hampshire GU35 9HH Tel: 01420 478111 Fax: 01420 483000 Web: www.broadwoodintl.co.uk E-mail: info@broadwodintl.co.uk

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Out of sight, out of mind? Not with KAT Communications’ lone worker safety solution

T

HE FACTS ARE SIMPLE, the more you or your workers are in lone worker situations the higher the exposure to health and safety risks. More than six million people in the UK work in isolation or without direct supervision, which can create health and safety risks. If you employ lone workers, or are self-employed and work alone, these risks will need to be managed.

Under the Corporate Homicide and Manslaughter Act introduced in April 2008 and the Health & Safety (Offences) Act 2008, employers are responsible for the security of their workforce. Employers have a duty of care with their employees. They must assess possible risks to lone workers and take steps to avoid or control these risks where necessary. These responsibilities cannot be transferred to any other person.

Anthony Temperton of Kat Communications said: “The biggest challenge we face with our partners is educating organisations as to the definition of a lone worker, we speak with organisations on a daily

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basis that unintentionally are not doing enough to protect their staff.”

A KAT Communications provided lone worker solution not only ensures that all legal obligations are met but the services are extremely cost effective and easy to implement. All products are accredited to the new BS8484 standard, making our systems a trusted and assured product.

The KAT Communications approach to lone worker safety is a simple one, in that we try to match our solutions to the people, the risks and the culture of the organisation we are working with. Lone worker safety is not just based on employers complying with legislation but it is

found to be good for the employees with improved staff morale and welfare.

Anthony Temperton adds: “At KAT we recognise that the major role in lone worker safety is played by the individual lone worker themselves. It is that individual who needs to be able to manage the situation, to react in accordance with procedures, to recognise unacceptable levels of risk and to know how to move away from dangerous situations to safety.“ “Lone worker protection through KAT Communications does provide peace of mind and ensures a Duty of Care is met. However, the individual approach goes much further than that and our ongoing training encourages employees to be vigilant and to recognise their abilities and limitations in regards to safety.”

FOR MORE INFORMATION For more information and for details of a free trial of our solutions to readers of this magazine contact KAT Communications on 0844 474 0004 or via www.katcommunications.co.uk

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SECURITY

ACCESS CONTROL: THE WIDER ISSUES Brian Pender, head of security at Imperial College Healthcare NHS Trust, considers what makes an effective access control strategy within healthcare settings across the UK

part of an integrated security model that incorporates such other functions as effective CCTV monitoring and critical alarm systems. The deployment of signage, advertising that such systems are in place, can be an effective strategy sending out a clear message with the aim of reassuring those with legitimate access.

Equally, these environmental cues may serve as a deterrent influencing potential offenders when they assess the risks of offending.

THE PRINCIPLES AND METHODOLOGIES associated with access control as a key security measure have evolved throughout the ages to meet the ever changing threats to life and property.

From the basic locked door, moat and drawbridge approach of centuries past to the latest biometric technology, those charged with protecting both persons and assets have witnessed an increasing deployment and sophistication of these systems both within the domestic and work environments.

Whilst the emergence of the ‘gated communities’ model and other security control measures within our society is evidence of the concerns that many have for their safety in the domestic environment, it may be argued that there still remains an element of complacency amongst those responsible for the funding and daily use of such projects in the workplace.

This is a source of obvious frustration for the professional security practitioner. The deployment of these measures in the domestic setting stems from a strong desire to protect oneself and/or family and possessions.

However, in many industries the transfer of those security anxieties and practices to the workplace environment may be considered as being more problematic for a variety of reasons. One of the factors that inhibit the effectiveness of access control in the workplace is the reluctance demonstrated by some staff to fully embrace the principles of this element of security with a conscientious and consistent response, focusing more on the perceived

ASSESSING THE INTERNAL THREAT Such systems can serve to confront both the external threat and the threat from within.

The issues in addressing the external threat are invariably more straightforward where all the crime prevention layers can be called into play. Addressing the internal threat is far more complex and access control must be accompanied by such functions as continuous behaviour observation.

The integrated approach requires that access control systems should be capable of interfacing with a panic alarm, lone worker alarm and asset management tracking systems to support a variety of emergency responses.

This would include the ability to initiate an urgent lock down and/or lock in procedure that an organisation may need to deploy in the event of an internal untoward incident or an external incident that may impact adversely on the organisation’s activities, such as the threat from activists. However, discretion needs to be applied in all such eventualities. The deployment of electronic methods to restrict an offender’s escape could induce panic with the potential for the incident to escalate to a hostage situation within the workplace. Other health and safety issues could equally apply.

Therefore, in keeping with the modern threats and the range of potential adverse outcomes, such systems should be part of a robust resilient programme which should be the subject of regular review including penetration testing.

The process of educating users is fundamental to the success of such initiatives. Regardless of how sophisticated a system may be the potential to undermine such measures as a result of human error or omission is ever present. All users must be educated as how to respond when others seek to gain access on their individual transaction; commonly referred to as ‘tailgating’. The consequences of such carelessness can be very serious.

However, security practitioners should legislate for the possibility that the member of staff may be acting under duress to facilitate unlawful entry into a critical area containing assets of high value or substances of high risk. Consideration should be given to the installation of panic alarms at such locations.

Other breaches may occur, when staff for the sake of convenience leave doors open and unattended for lengthy periods. Such doors should be fitted with a local audible alarm that activates after the door has been open for more than an agreed period. This would alert those in the immediate vicinity

inconvenience as opposed to the benefits.

Access control manifests itself in a variety of different ways and operates on a variety of different levels. The label can be applied to any process that seeks to control or qualify entry to premises or access to information based on certain criteria. It is seen by the security practitioner as a significant element in that part of the crime reduction approach referred to as primary prevention, adhering to the principle of ‘defence in depth’, referred to in a previous article by Nick van der Bijl, aptly entitled ‘Let the right one in’ (Health Business 9.6). As a fundamental element in the ‘target hardening approach’ it supports the Home Office principles of crime prevention. It is central to the concept of ‘defensible space’ and serves to increase the effort that a potential offender would require to achieve their objective.

TYPES OF ACCESS CONTROL It incorporates a range of features including the use of biometric and other forms of technology and hardware embracing password and personal identification (PINs) in computer systems to entry phones. From a healthcare perspective, access control can integrate with infant and vulnerable patient electronic tagging systems and the security of controlled drugs, monitoring the movement of assets, human or otherwise, within a location and beyond the agreed parameters.

Regardless of the complexity and sophistication of any such system, it should, in keeping with smart security practices, form

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MEDI-SIGN

iNTRODUCING tHE SIMPLE and secure digital signing in system Following on from the success of Entry Sign from Osborne Technologies comes a new and innovative system named Medi-Sign, a simple and secure solution to staff and visitor management.

Medi-Sign comes packed with many features including: w Easy to use touch interface w Customised reporting w One click reporting w Enhanced Safety Procedures w Simplifies the Signing in Process

Medi-Sign has been developed with safety in mind and can log movements in and out of the building. The simple and intuative 'Touch Screen' system has complex reporting features that will put a wealth of safety information at your fingertips, instantly without the need to scramble for your signing in books.

You can add a touch of professionalism by pre-booking visitors so all they need to do is click one button.

Osborne Technologies Ltd Unit 4 Wortley Court Fall Bank Industrial Estate, Dodworth, Barnsley, South Yorkshire, S75 3LS

Tel: 0800 037 2904 Fax: 01226 294790 info@osbornetechnologies.co.uk www.osbornetechnologies.co.uk

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SECURITY

that a security breach is taking place.

This alarm should also feed through to a security control room. Such breaches provide the opportunity for the security practitioner to emphasise the fact that all users have both a moral and contractual responsibility to support the principles associated with the concept of a safe and secure environment PLANNING MAKES PERFECT Planning is critical to the success of any project that seeks to introduce or add to an existing access control system. In such cases where a system has been modified the new installations should have the facility of backwards compatibility with the capability of interfacing with existing systems. Such initiatives must also embrace the best principles of project management.

Besides cost, other prime considerations will include the initial risk assessment that informs the decision making process along with the element of disruption that will arise in the installation process. The safety and security of all who interact with the organisation and the security of assets are other prime considerations, along with an understanding of future capital projects that may impact on security.

All projects, security or otherwise, are vulnerable to the ‘fools rush in’ approach. The step from theory to practice can be a major leap littered with problems. In their study ‘Theorizing About Security’, Manunta and Manunta (2006), suggest that the nature and setting of the asset to be protected along with the resources and existing defences around that asset, incorporating technology and working practices, are fundamental to any decision.

Further critical issues for consideration include compliance with relevant legislation, including fire regulations, organisational culture, management, operational and economic factors. Success is determined by the quality of the analysis of the control measures with a systematic reasoned approach to the task. Any unplanned changes can make the difference between success or failure or not achieving the total desired outcome. With these factors in mind, there needs to be a clear coordinated strategy involving collaboration with all client partners as part of the process of buying in to the programme. Hopefully such an approach will ensure a relatively seamless transition.

Once the capital bid for a new access control system has been granted, the security practitioner, if fulfilling the additional role of the project manager, should consider commissioning an independent consultant to evaluate the specific requirements and ensure that the principles of best value are central to all project considerations. This will apply at the stages where consideration focuses on design specification, terms and conditions and ensuring that effective after sales support is in place with an appropriate maintenance contract to ensure sustainability of the product and functions. The principles of due diligence must apply and as

custodians of public or private funds, security practitioners should ensure, within their remit, that the organisation’s interests are safeguarded at every stage of the negotiating process.

A duty of care extends to all parties in the negotiation to guarantee that organisations are not locked in to punitive contracts that only benefit the provider as opposed to the client. The regulations relating to the tendering process are key considerations along with the need for openness and transparency.

The process of due diligence also dictates that the right choice of contractor, hardware, technology products and methods of installation accompanied by the need to comply with standards are critical to any project of this nature. They must be the subject of considerable research and scrutiny and all aspects of the work must subscribe to the relevant British Standards. The installation stages are key elements for consideration to ensure the integrity of the product and process. It is important to emphasise that good administration in the collation and retention of all records of communication between parties to the negotiation is of paramount importance. This will include copies of agreed minutes of meetings and all miscellaneous notes. In the event of any litigation arising from the breakdown in negotiations, alleged breach of contract or failure in the product, the integrity of such record keeping is critical to the process and can make the difference between success or failure.

In the final analysis business and professional ethics, accompanied by good management practices are central to the successful outcome.

EASY MONITORING At the implementation stage each organisation will experience its own problems unique to its environment and core services. In order to maximise the potential from and minimise the monitoring of access control systems, every attempt should be made in the planning stages to identify the best locations and routes to channel staff and visitors. This will assist in auditing and monitoring traffic and any subsequent response and/or investigation in the event of an untoward incident. Within the healthcare environment the problems are both unique and multi-fold. Security practitioners cannot just apply the ‘gated’ or ’lock down’ approach without serious consideration or collaboration with client partners. Given the physical characteristics of many public sector healthcare institutions, patient treatment areas are often immediately adjacent to locations where strict access control is paramount. This has the potential to inhibit the development of an integrated security access control programme that is easy to monitor.

LOOKING AFTER LONE WORKERS This feature has particular significance for the lone worker who may be employed at locations close to areas where patients and visitors would have legitimate access. In

challenging the security risks that confront this group, organisations need to address a variety of issues before adopting or modifying any access control system.

Whether such lone working is carried out on an ad hoc or pre-planned basis, security practitioners should collaborate with the relevant departmental managers to identify those locations and members of staff (contract or otherwise) to whom the issue of lone working applies. In addition to any access control system, it may be considered that ideally such areas should be the subject of a zone alarm system covering the periphery but obviously not the specific location where the lone worker is sited. This would alert the lone worker and the security department in the event of any breach by a potential offender or any unplanned visit by a person with legitimate access.

Regardless of whether these locations are adjacent to public areas or not, access control systems should be configured to address the need to monitor the lone worker both at the time of entry and up to the time of departure.

Alerts can be interfaced with CCTV and the audit element of the programme catering for the last person remaining rule.

At the point of exit from any workplace, signage should be displayed posing the question, “Are you leaving anyone on their own?” Ultimately, if for whatever reason, such areas cannot be effectively secured then good practice would suggest that the lone worker should be provided with a personal electronic alarm in keeping with the latest technology and interfaced with the access control system. The other alternative is that the risk to the lone worker should be removed by relocating them, either on a temporary or permanent basis, to a more secure location that provides the opportunity for both formal and informal surveillance techniques In conclusion it must follow that an effective security system cannot rely on technology alone but be complemented by a process of ongoing observations and systems evaluation as part of a comprehensive corporate security strategy linked with robust policies. No one organisation can claim that their standards of security are excellent. We have more to achieve and the sharing of experiences relating to incidents, products, contractors and methodologies will support the continued development of best practice.

Sources Manunta, G. and Manunta, R. (2006) ‘Theorizing About Security’ in M.Gill (Ed), The Handbook of Security: London: Palgrave Macmillan Schneider, R.H. (2006) ‘Contributions of Environmental Studies to Security’ in M.Gill (Ed), The Handbook of Security: London: Palgrave Macmillan

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FRAUD PREVENTION

IDENTIFYING & PREVENTING FRAUD Peter Hurst, chief executive of the UK’s not-for-profit fraud prevention service CIFAS, describes how you can protect the financial health of your organisations by rooting out the enemy within IN ANY CONVERSATION about what makes British people proud to be British, it does not take long before our National Health Service is mentioned. The NHS has become part of our national consciousness. Created in 1948 by Aneurin Bevan with a budget of just £437 million (£9 billion in today’s money), our NHS promises healthcare for all based on need and not upon the ability to pay. Over 60 million of us rely on it and today it is the largest employer in the land with 1.7 million employees working in over 350 health trusts with a national budget of over £112 billion.

FRAUD AND THE NHS With so much money to spend it should come as no surprise that the NHS attracts fraud. Crime and organised crime in particular gravitates towards those areas of our economy where the financial opportunities are greatest.

That is why the NHS set up its CounterFraud Service in 1998. Widely recognised as one of the most effective public sector fraud initiatives, the Counter-Fraud Service has created a national infrastructure for the identification of fraud within the NHS and its subsequent prosecution. A look at some of the recent news headlines shows just how effective it has been at detecting fraud: “University of Edge Hill graduate jailed for £27K NHS bursary fraud” “Hospital kitchen porter sentenced for £87K NHS fraud” “Civil Servant who claimed dead man’s £137K expenses jailed” “Dover and London GP practice manager jailed for £300K theft” “Senior Manager defrauded NHS of £245K” “5 years jail for Leicester NHS bereavement adviser’s £753K fraud” TYPES OF FRAUD These are high profile cases but are they typical of fraud in the NHS? Thankfully they are the most newsworthy. Far more typical are the frauds that could so easily be prevented if trusts followed basic best practice. But as you would expect in such a large and complex organisation, there is a similarly complex range of criminality and as many areas in the NHS are susceptible to fraud, the solutions have to vary.

Patient fraud includes: • prescription fraud – claiming falsely to be exempt from charges • altering or forging prescriptions to obtain items that have not been prescribed • identity fraud – multiple registrations using aliases with GPs to obtain controlled drugs • health tourism whereby people

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enter the UK to receive free treatment to which they are not entitled.

Staff fraud includes: • expenses frauds • payroll frauds involving ghost employees, overtime frauds, shifts claimed but not worked • qualification frauds involving false or exaggerated academic or professional qualifications • sick pay frauds involving working at other jobs while on paid sick or special leave from the NHS • invoice/ordering fraud involving the over-ordering and theft of goods for personal use or re-sale • theft of NHS equipment.

Professional fraud includes: • altering prescriptions or writing prescriptions for their own use • pharmacists substituting an expensive drug with a cheaper version and claiming the higher amount • claiming for work not undertaken • claiming payment for ghost patients • undertaking private work in NHS time or using NHS facilities for private patients and expecting the NHS to meet the cost.

Procurement/supplier/contractor fraud includes: • bogus requests for payment • collusion with staff to obtain contracts • price fixing.

BIG BUSINESS Let no-one be in doubt – NHS fraud is big business. In 2009 one dentist was struck off for claiming £1.9 million for emergency treatment of ghost patients.

Private healthcare also suffers from some of the same fraud issues. Health insurers have to be alert to being invoiced for work that has not been undertaken and to overcharging, as well as to receiving fake invoices from patients seeking reimbursement. It does not take that many cases – either in the NHS or the private sector – for fraud prevention measures to prove highly cost effective.

Many trusts will already have a fraud prevention policy and rigorous procedures in place. Those who don’t should, in essence, undertake a thorough analysis of the potential risks, consider where processes might make them vulnerable, and implement procedures to eliminate those risks. This should lead to fraud prevention becoming part of the organisational culture, with everyone taking responsibility, and should include: • thorough fraud screening at recruitment stage • fraud prevention training at induction • regular monitoring

• training in how to deal with instances of fraud • clear reporting processes • involvement of law enforcement, where necessary • ensuring that professional and other staff involved in fraud cannot move unchallenged to a new employer to commit further fraud.

RECRUITING THE RIGHT PEOPLE Best practice starts with the recruitment of staff – all staff, irrespective of whether they are permanent or temporary, full-time or parttime and irrespective of who their employer is. If they are working on your premises, you need to be sure that they are not there to commit fraud against your institution. All new staff need to be screened, for example: • confirmation of identity • confirmation of residential address history • sight of a bank statement for

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FRAUD PREVENTION

verification and for payroll purposes • originals of all educational certificates to be seen to verify the qualifications claimed. Alternatively, letters from the educational institutions confirming results. If there is any doubt, contact the institution to verify the details • confirm that the applicant has the right to work in the UK • Criminal Records Bureau check when applicable to the post • verify the employment history by contacting previous employers • ensure that all interests (relationships to existing staff) are declared.

The NHS has its own particular problem in that there is no single NHS employer. There are over 350 employers and staff dismissed by one trust regularly get a job with another trust. There is a solution to this and it is unique to CIFAS. HELP FROM CIFAS CIFAS is able to help responsible employers to prevent fraudsters from gaining employment with their organisation. This is achieved by a data sharing scheme called the CIFAS Staff Fraud Database. At present, staff who resign

during disciplinary proceedings or who are dismissed for fraud by one public or private sector employer have little difficulty moving to another employer. The database prevents fraudsters moving unchallenged from one organisation to another. Employers use this database for the purposes of recording data about their staff fraud cases and for accessing staff fraud records filed by other Members during the recruitment process.

The Information Commissioner’s Office was consulted during the development of the database as were the Trades Union Congress (TUC), Confederation of British Industry (CBI) and the Chartered Institute for Personnel and Development (CIPD). In 2011, the UK Border Agency plans to join CIFAS and a range of new datasets will become available to the database that will make it even more effective.

SIMPLE STEPS TO PROTECTION Once staff are employed within an organisation, employers need to secure any procedural weak points. In healthcare these tend to be in many of the areas listed as vulnerable to fraud above. The steps to protect against fraud are very simple, so simple that they

Peter Hurst

are often overlooked. Best practice dictates that there should be segregation of duties, reconciliation procedures, receipts for all cash, and good physical security. No single person should manage or carry out an entire process.

In addition you should have a gifts policy and a hospitality policy to guard against inducements being proffered and accepted in return for favourable procurement treatment. Procurement processes should involve panels and be written to ensure that no single person can exert an unreasonable influence over the selection of a supplier or suppliers who are invited to tender.

Under the Serious Crime Act of 2007, the government designated CIFAS as a Specified Anti-Fraud Organisation (SAFO). This enabled public sector organisations to become Members of CIFAS and to reap the same benefits as the private sector. The Act provides a legal gateway for the sharing of fraud information both with other public sector organisations and with organisations outside the public sector.

CIFAS had to go through a comprehensive review process before its application to become a SAFO under the Act was approved.

A number of public sector organisations are poised to join CIFAS in the coming months. They will benefit not just from the private sector’s fraud data, but also from sharing their fraud data with other public sector organisations through CIFAS. The burning question for the coalition government is: with CIFAS Members last year reporting an average return of £268 in prevented fraud for each £1 that they paid to be Members of CIFAS, which parts of the NHS could afford not to be part of something that generates such high returns on investment? We hope to welcome NHS Trusts into membership and help them to direct more of the money to NHS front-line services that they currently lose to fraudsters.

FOR MORE INFORMATION E-mail: publicsector@cifas.org.uk

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Phoenix Private Ambulance Service Ltd

Specialised Passenger Transport Based in Warwickshire we provide a uniformed and specialised private ambulance service to meet the needs of those with impaired mobility for whom safe and comfortable travel is difficult.

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For example: n Transfers to and from hospital outpatient appointments n Transfers to or discharges from hospitals n Moves to and from care, retirement or nursing homes n Local and long distance disabled and patient transport nationwide Our CRB checked team pride themselves on providing a careful, understanding, prompt and comfortable service and we have gained a reputation for providing consistently high standards.

Our vehicles are regularly inspected and maintained to a high standard. Stretcher vehicles are equipped with stretchers and lock systems tested to meet BS EN 1789:2000 standards. Wheelchair restraints conform to the dynamic test requirements of ISO 105421. Our fleet is based in Leamington Spa and although most of our work is centred around the Midlands we are able to provide transport anywhere in the UK.

Please visit www.phoenix-ambulance.co.uk or call 01788 816192 for more information

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and the M3 the back, Southern Country Ambulance Service is ideally located from our base in Micheldever between the historic city of Winchester and the ever growing town of Basingstoke, to serve our current and new clientele, being only 45 minutes from the heart of London and within easy reach of the main UK airports, and main shipping ports on the South coast.

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In their distinctive Blue and Yellow uniforms our qualified technicians under take a range of services for both the NHS and PHS hospitals and clinics which include: Patient Transport Services (PTS) both local and long distance, high dependency transfers, maternity transfers, ICU/ITU transfers etc. and in line with our British Ambulance

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Southern Country Ambulance Service is a family run business dedicated to offering a service of excellence, if you feel that we can be of assistance to you then please give us a call, we will be more than happy to discuss your requirements with you in confidence.

FOR MORE INFORMATION Contact: Jimmy Ball Address: Highways House, Highways, Micheldever, Winchester, Hampshire, SO21 3DW. Tel: 01962 774 999 Fax: 01962 774 260 E-mail: scas999@yahoo.co.uk

Health Business | Volume 10.6

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BUSINESS CONTINUITY

IMPROVING RESILIENCE IN THE NHS Lee Glendon, head of Campaigns at the Business Continuity Institute, looks at the progress being made when it comes to incorporating business continuity into strategic and operational planning ONE YEAR ON FROM A MAJOR PUSH

in the NHS to embed business continuity into mainstream strategic and operational planning, what progress is being made and how do the recently announced changes in primary care configuration alter the way the NHS may approach business continuity?

According to Liza-Marie Turner, business continuity officer for NHS Salford, an area covering 230,000 people, progress has been good. The Salford programme has benefited from chief executive level support and sufficient resource investment with a dedicated role for business continuity.

In Greater Manchester there are ten Primary Care Trusts, all sharing common services and methods, which enable much closer cooperation to address business continuity issues. In this model, one of the PCTs is assigned as the ‘Lead PCT’ to ensure that the resilience agenda is progressed in each NHS Trust. Liza is the appointed business continuity officer in the Greater Manchester region and therefore able to focus solely on business continuity management (BCM) without it being part of an emergency preparedness role, which is the more common approach, where resources are not shared as in Greater Manchester.

Liza-Marie explained that the business continuity programme is structured so that there is a high level business continuity plan that sits as an umbrella over the directorate and site plans. This is the overarching incident management plan, which includes command and control information. A Business Continuity Management System framework is in place, which is ratified by the executive team and guides programme management.

UP TO STANDARD

In terms of working to standards, the PCTs in Salford have aligned themselves with the NHS variant of the British Standard for BCM, BS NHS 25999, which only varies from the original to the extent that it includes specific NHS examples to aid effective implementation. The original BS25999 is well regarded in both the for-profit and not-for-profit sectors in many countries around the world. The Department of Health has since funded development of further guidance on resilience with PAS2015. This guidance draws on existing emergency planning and BCM methodologies into a form of meta-framework on resilience.

Two key success factors in BCM are making

Two key success factors in BCM are making sure those with business continuity roles are trained appropriately, and secondly raising awareness of the need for and benefit of business continuity planning across the organisation sure those with business continuity roles are trained appropriately, and secondly raising awareness of the need for and benefit of business continuity planning across the organisation. Julie Drysdale, business continuity manager at NHS Lothian emphasises the need for a structured education programme: At Lothian they use e-learning modules for self-learning and development of all staff, with more in depth training for managers who have assigned staff and systems responsibility.

For those staff with business continuity responsibilities, these are included in their role specification and appraisals.

Lothian has also set out a six-point checklist as part of their awareness raising activities: • be aware of what your key services are • be aware of the activities and resources to deliver these services • be aware of local plans to recover your key services • be aware if these plans have been exercised • be aware of what lessons have been learnt from conducting exercises • be aware of who is involved from your business area in business continuity plan development.

One of the original reasons for emphasis on business continuity planning in the

NHS related to ensuring that the NHS was able to continue to deliver its services even if impacted by the same incident that had generated the civil emergency. This has tended to explain the reason why business continuity and emergency planning functions have often been combined. However, while they share common objectives, the two disciplines are quite different.

For a start, BCM is not just about dealing with emergencies, there are plenty of other sources of disruption that are not emergency-related. This partly explains, for example, why many organisations developed pandemic plans as separate activities to business continuity programmes, rather than as incremental aspects of business continuity.

Secondly, business continuity needs to be tightly coupled with risk and crisis management and integrated within strategic and operational decision making across the organisation. Emergency planning may not be an automatic stakeholder in certain business decisions, where business continuity thinking would be essential.

For example, in looking at outsourcing, the driver for such decisions is often one of cost savings, however, such decisions are rarely cost free, and BCI research indicates

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that organisations that choose outsourcing experience higher levels of disruption than those that do not. By analysing activities in BCM terms, organisations can make better informed outsourcing decisions and not just bring in the BCM team to work on the recovery strategy.

SUPPLY CHAIN

Outsourcing is one reason why supply chain resilience is such a hot topic in BCM. Most organisations have some level of dependency on suppliers and BCM is an excellent method to identify and qualify the importance of specific suppliers, not just in terms of spend or difficulty to replace at short notice but also in terms of validating where your organisation’s needs fit in their priorities, should they face a disruption.

In Salford, supply chain is not only the pens, paper and clinical suppliers for frontline services but also the services commissioned. GP, community, dental and hospital services are commissioned by the PCT and are therefore considered as suppliers to their health economy.

GP PRACTICES

GPs are not under any obligation to have business continuity plans, a problem which has been flagged up as an issue when BCM came to prominence last year. Nonetheless, Salford NHS has undertaken a number of initiatives to get GP practices on board.

According to Liza-Marie Turner one of the challenges is that many GP practices are quite small and GPs do not have the staff or time to develop BCM arrangements. Many GP practices also host other health and social care services from the same building and they may not have a good overview of how these other services may be affected by their own business continuity decisions.

Salford’s solution was to supply the GPs with a business assessment template that was

As the process of change unfolds in the NHS, vigilance is required to ensure that the good work and investment in BCM is not lost in transition based on Salford’s Business Impact Analysis.

The template encouraged GPs to identify high, medium and low risks and their impact, and get them thinking about what they would do if the practice had to shut down.

The template also served to prompt them to think about who they rely upon, and included a call list of emergency suppliers. Practices are also encouraged to buddy up and support each other; this approach was developed as part of the NHS Salford’s pandemic response.

FUTURE DIRECTIONS FOR BCM

The recent government White Paper for health services has indicated that commissioning responsibility will pass largely to GP consortia, and PCTs will cease to exist from the end of March 2013.

However, at time of writing the complete commissioning model is yet to be confirmed.

Community health services such as district nursing, health visiting, and podiatry are currently under transition throughout England with PCTs becoming commissioning only bodies ahead of the changes described in the White Paper. PCTs are expected to pass commissioning responsibility for all services apart from primary and highly specialised care to GP consortia. Community services across England are transferring to various settings including hospitals, mental health trusts or social enterprises.

In Salford, the majority of community services are likely to transfer to the local acute hospital. As they are a Category One responder under the Civil Contingencies Act, they already have the duty to perform BCM. Some community services in Salford

are transferring to the local authority, again a Category One responder, so both of these organisations will have a duty to expand their programmes of BCM work. However, not all PCT community health care functions are transferring into a Category One organisation, which poses a degree of risk to the overall BCM picture, in regard to losing the legislative driver to maintain standards.

So the transition of PCT responsibilities to GP consortia holds a degree of risk in terms of which entity will carry the statutory obligation to implement and maintain BCM. Clearly, the successor entity will need a thorough understanding of BCM and its importance to the health economy.

MAKING PROGRESS

In conclusion, good progress has been made with introducing BCM into the NHS. Some of the gaps identified in the past, such as GPs practices not being obliged to have business continuity plans, are being tackled creatively with promising results.

The proposed changes to commissioning, which involve a transfer of BCM responsibilities from PCTs to GP consortia, is at first sight, a cause for concern, given the immaturity of GPs in matters related to business continuity. As the process of change unfolds in the NHS, vigilance is required to ensure that the good work and investment in BCM is not lost in transition.

FOR MORE INFORMATION Web: www.thebci.org

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Health Business | Volume 10.6

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BUSINESS CONTINUITY

DEVELOPING OUR FUTURE LEADERS AND ORGANISATIONS People Opportunities is an innovative management and organisational development consultancy that is making a significant contribution to supporting leaders and organisations as they engage with the challenges facing the NHS

PEOPLE OPPORTUNITIES is a management and leadership consultancy that is committed to the ethos of public service generally and the NHS in particular. We have a history of working highly successfully with NHS individuals and organisations. Our consultants bring together a wealth of knowledge, skills and experience and have worked in health both nationally and internationally. We are results focused and ensure our solutions are tailored to meet individual client needs. Our approach is to do what works, which means keeping our clients needs in focus at all stages of the bespoke design and delivery process.

SUPPORT Our speciality is working with actual and potential leaders. We help them develop the insights, knowledge, skills and self-awareness that they will need to enable their part of the NHS to successfully transition in this time of great instability and change. We seek to connect with the deepest aspirations of those we work with and support them in finding ways of integrating these values into their professional practice in practical and productive ways. We recognise the tremendous levels of commitment of people that work in the NHS. Our work is to help them translate commitment into effective outcomes for patients, colleagues and the wider NHS. We believe that given the right conditions, people can give of their fullest potential at work. Over the years we have developed a variety of ways of helping leaders create the conditions for unleashing the potential of their people and achieving sustainable success.

One of these ways is dynamic coaching at all management and leadership levels. Our approach is pragmatic, flexible, supportive and challenging. We have had outstanding results with leaders at all levels helping them develop, clarify and implement strategy. Part of this work involves them in developing self-understanding and learning how they can embody and communicate the outcomes they are seeking to implement in meaningful and effective ways.

We believe that what has been successful in the past and present provides a solid foundation for thinking creatively about possibilities for the future. Focusing on the outcomes that you are seeking, rather than on the problems that you are facing has proven to be an effective way of moving individuals, groups and organisations forward. We work with individuals and teams to increase their capacity to engage in this manner with the huge complexity they now face. This evidence-based approach has proven its value to the hundreds of people that we have worked with over the years in the NHS and has had a deep systemic impact.

PREPARING FOR THE FUTURE One of the most effective ways to prepare for the future is to ensure that your organisation has the requisite variety within it to increase capacity for meeting the challenges posed by that complexity. Diverse teams and organisations have been shown to out-perform homogenous ones if led and managed in ways that recognise and utilise that diversity.

Our work has helped boards, leaders, groups, teams and whole organisations engage in a positive manner with increasing their

inclusivity and therefore their diversity and consequent capacity for successful evolution.

We are a diverse organisation with people from different ethnic, gender, faith, class backgrounds and experience of disability leading the work of the organisation. We are passionate about equality and work from perspectives that draw upon the insights and experiences of the breadth of diversity that comprises our society. We have an outstanding track record of delivering projects and programmes that have led to real sustainable success.

We believe that our success is built upon the fact that we integrate an organisational development perspective into our work. Our management team and facilitators have senior management and leadership experience within the public and private sectors to draw upon.

We deliver innovative training programmes but we always see these as part of deeper organisational interventions. This means we work with the wider system, the human dimension of organisations, to ensure that resources are not wasted and that the training actually delivers the benefits it was commissioned to.

ACTION LEARNING We are one of the largest suppliers of action learning sets in the country, facilitating hundreds of sets a year. The action learning sets provide space, information, critique, strategy development and peer support to assist set members to seek and take advantage of opportunities and to engage positively with the challenges, emotional, personal, political and organisational that they face.

Over the last four years People Opportunities has been proud to be the provider of the action learning set element of the NHS Graduate Management Training Scheme.

We believe that we can be effective partners with those that want to transform the lives of those they serve and those they work with.

FOR MORE INFORMATION Dr Eden Charles PO Box 1099, Doncaster DN10 4WL Tel: 08444 631281 Web: www.peopleopportunities.co.uk

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Corporate Harmony provides the complete Conflict Management package to clients across the UK. We provide Professional Development Workshops, In-House Dispute Resolution Training, Telephone Coaching, Face-to-Face Conflict Coaching and Full Mediations.

OUR AIMS To inform, educate and facilitate employees to develop conflict resolution skills for use in their day to day management and co-worker relationships.

To encourage organisations to embed Conflict Management into the HR policy and strategy.

To encourage clients to make use of Corporate Harmony resources as early as possible in the conflict cycle to avoid the potential implications of conflict entrenchment.

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Health Business | Volume 10.6

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CONFLICT MANAGEMENT

THE RIGHT TO A SAFE WORK ENVIRONMENT The NHS Security Management Service examines the many occasions where it is necessary for staff to de-escalate a situation where a patient, relative or visitor becomes abusive or aggressive FOR THOSE WHO WORK OR DELIVER services in the NHS, managing conflict is an unfortunate but regular part of the job.

All too often, NHS staff have to deal with individuals who are drunk or under the influence of recreational drugs. They may have to calm patients and relatives in highly charged emotional situations and manage incidents of aggression or abuse in areas of care where the individual is not responsible for their actions because of their medical condition. There are many occasions where it is necessary for NHS staff to use their skills to de-escalate a situation where a patient, relative or visitor becomes abusive or aggressive.

Figures published by the National Audit Office in 2003 revealed the level of violence and aggression in the NHS. With 116,000 reported incidents of violence and abuse in 2002/3, it was unacceptably high.

In 2003, the NHS Security Management Service (NHS SMS) was created to progress work to tackle abuse of NHS staff. Amongst its aims was to quantify the nature and scale of violence in the NHS in England. The most recent figures show that, in 2009/10, 56,718 physical assaults were reported by NHS staff. Figures are not held centrally for the number of incidents involving verbal abuse but the annual Care Quality Commission NHS staff survey highlights under-reporting as an issue, suggesting that there are at least as many incidents of verbal abuse as there are physical ones.

RIGHT TO SAFETY Physical violence is an unambiguous form of abuse, with tangible consequences, but repeated incidents of verbal abuse can equally create stress and a difficult and insecure working environment for staff. The NHS Constitution asserts the legal right of NHS staff to a healthy and safe work environment, free from harassment, bullying and violence, and the positive impact of such working conditions on the delivery of patient care.

Tackling violence against staff who work in or deliver services to the NHS continues to be a specific area of responsibility for the NHS SMS. To help achieve this, the NHS SMS has delivered a number of initiatives including: • A Legal Protection Unit (LPU) to support NHS trusts in tackling violence and abuse; the LPU provides guidance and legal support for criminal and civil cases against alleged offenders. • A standardised national reporting for physical assaults was introduced, along with clear

Physical violence is an unambiguous form of abuse, with tangible consequences, but repeated incidents of verbal abuse can equally create stress and a difficult and

insecure working environment for staff

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definitions to be used consistently across the NHS for physical and non-physical assault.

• The role of the Local Security Management Specialist (LSMS) was created so that each NHS trust had a professionally trained and accredited specialist to support the investigation of incidents of violence or abuse and support victims.

PROACTIVE ACTION All of these initiatives contribute towards a safer and more secure NHS. But dealing with the aftermath of incidents is not sufficient; proactive action needs to be taken as well.

With this in mind, the NHS SMS launched a conflict resolution training (CRT) programme for the NHS in England in 2004. CRT was developed as a preventative measure, to give NHS staff the ability to deal more effectively with violent and abusive situations. Almost seven years later, this training continues to equip staff with the skills and understanding required to confidently de-escalate potentially violent situations and resolve them effectively.

The overall aim of CRT hasn’t changed since the course was developed: to ensure that staff can recognise all aspects of conflict that they might encounter and understand, and employ different methods to resolve conflict situations. NHS organisations are required to provide CRT to all their frontline staff and the training must cover ten factors, as established in guidance developed by the NHS SMS: • common causes of conflict • types of communication • communication breakdown • communication models that can assist in conflict resolution • patterns of behaviour during different interactions • warning and danger signs • impact factors • use of distance when dealing with conflict • “reasonable force” in the conflict resolution context • methods for dealing with possible conflict situations.

The basic training programme focuses on non-physical intervention techniques and includes customer service, recognition of warning signs, de-escalation models and cultural awareness. CRT has now been implemented across the NHS and more than 400,000 staff have been trained so far.

DIFFERENT CHALLENGES It was clear from the outset that NHS staff in mental health and learning disability settings and those in the ambulance sector faced different challenges in terms of conflict situations. To address the resulting variation in training needs, the NHS SMS developed and delivered the Promoting Safer and Therapeutic Services (PSTS) programme in 2005, a national training syllabus designed specifically for NHS staff working in mental

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health and learning disability settings. The aim of PSTS is to ensure that all frontline staff working in these environments receive the most appropriate training, developed in line with their specific requirements and delivered to a nationally recognised standard to ensure consistency across the NHS. Then, in 2007, a set of learning outcomes for those working in the ambulance sector was devised by key stakeholders, including the Ambulance Service Association, the trade union UNISON and the NHS SMS. In common with the aims of PSTS, it is intended that these bespoke preventative measures are introduced to tackle violence against professionals working in this area and to complement reactive measures already in place.

OPPORTUNITIES FOR DEVELOPMENT This suite of CRT has now been established for a number of years and recent research into the delivery of this training has shown evidence of success as well as some ideas and opportunities for development. The research was conducted to assess the progress of the training to date and provide a baseline to support the development of a quality assurance programme for the delivery of CRT in the NHS. This programme is designed to assess the quality of delivery based on the learning objectives set out in the guidance provided by the NHS SMS. This research has demonstrated that, in addition to giving staff the necessary skills to de-escalate conflict, CRT has had other benefits.

Those NHS employees who responded indicated that the training has also alleviated their fear of violence. This is an important benefit of CRT for health bodies as the fear of violence is as much a contributory factor in staff absence as injuries resulting from any actual physical assault.

Of those respondents who indicated they had dealt with conflict following the training, 96

per cent stated that CRT had been of benefit to them. Furthermore, the sector-specific syllabus and learning outcomes designed for the mental health, learning disability and ambulance settings have been widely embraced because the survey demonstrated that the highest level of CRT adoption has been by the mental health and ambulance sectors.

An additional bonus for NHS organisations identified from the research was that the delivery of CRT supports the training already provided by health bodies for staff who interact directly with customers, such as those delivering customer care or managing equality and diversity.

TRAINING FIT FOR PURPOSE The NHS is vast; to put its scale into context, only the Chinese Red Army, Walmart and the Indian Railway are larger organisations. Given its size and diversity, the introduction of such an ambitious training programme to the NHS was a challenge. However, six years on, the culture of CRT and bespoke sector-specific training programmes are now embedded in the staff development process across the NHS. Reviewing these programmes and developing the quality assurance process to support their delivery to NHS staff ensures that training in this area remains fit for purpose. It is important that the success of these programmes is maintained and built upon, to ensure that NHS staff receive the best possible training to support and protect them when they are dealing with potential violence and abuse. In doing this, we can meet the overall aim of the NHS SMS: to protect NHS staff so that they can better protect the public’s health.

FOR MORE INFORMATION E-mail: conflictresolution@cfsms.gsi.gov.uk Web: www.nhsbsa.nhs.uk/security

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Enhancing skills for working with conflict

Preventing and managing challenging behaviour

ANDLING CONFLICT is one thing at which almost everyone wishes they were more skilled. Whether it is dealing with aggressive behaviour from a member of the public, improving performance in a dysfunctional team, handling a sensitive negotiation, dealing with a difficult member of staff, or managing a personality clash between two people that has a negative effect on the general work environment, conflict management skills are certainly an essential part of the tool-kit of anyone who wishes to be more effective at work.

Chris Rose, a psychologist and former psychiatric nurse, has specialised for the past 15 years in helping people who work in the public sector to develop their ‘people skills’.

He is an accredited mediator with CEDR, Europe’s leading conflict resolution body, and an NLP Master Practitioner and Trainer. He has a wealth of experience in helping people

ECURICARE HAS been at the forefront of training in the prevention and management of challenging, aggressive and violent behaviours since the early 1990s.

The training is accredited and can be externally certificated.

SecuriCare is an Institute of Conflict Management Quality Award Centre ICMQAC. The training covers the following core learning objectives and meets the requirements of the NHS National Conflict Resolution Training Programme: Describe the common causes of conflict; Describe different forms of communication; Give examples of communication breakdown; Explain three examples of communication models that can assist in conflict resolution; Describe patterns of behaviour they may encounter during different interactions; Explain the different warning and danger signs; Give examples of impact factors; Describe the use of distance when dealing

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working with conflict situations.

Not surprisingly, then, Chris is much in demand both as a trainer and as a coach. If you are interested in exploring how he might help you to provide your staff with the best support you can offer, he will be delighted to hear from you.

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with conflict; Explain the use of ‘reasonable force’ as it applies to conflict resolution; Describe different methods of dealing with possible conflict situations.

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The experts in project management training

Controlling corporate manslaughter risk

O YOUR PROJECT teams refuse to talk to each other? Do they always end up arguing or just ignoring the project manager? What are you going to do? Particularly now that your funds have to be used ever more efficiently and effectively?

For project managers working in central government organisations, the UK Government recommends professional membership of the Association for Project Management (APM). Their qualifications cover those aspects of project management considered fundamental to the professional management of projects.

The Management Skills Centre is an Accredited Training Provider for the APM. It provides open and in-house courses for both the Introductory Certificate (2-day) and APMP (5-day) qualifications.

These courses complement the Prince2 methodology by emphasising those aspects excluded or only partially covered by Prince2.

“For leadership positions emotional intelligence

OLLOWING THE recent drastic increase in the consequences for firms contravening health and safety legislation, Tom Morton, CEO of Argyll, the UK’s largest lone worker solutions provider, advises how to mitigate corporate risks associated with lone working.

In addition to the existing threat of civil actions and the costs of defending this, the Sentencing Guidelines Council has now recommended a fine for any corporate manslaughter prosecution of at least £500,000 or greater. In addition to this unprecedented fine, organisations may also be burdened with a remedial order requiring them to address any specific health and safety failures and, potentially the most damaging element, a publicity order. The reputational damage caused by this could end up costing far more than any financial penalty the court can issue.

Technical solutions are both affordable and widely adopted.

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competencies account for up to 85 per cent of what sets outstanding managers apart from the average.”

So in addition, the MSC provides in-house courses on Team-building, Negotiation and Conflict Management, Motivation and Leadership. A simple fourdimensional tool of proven worth may be used to analyse team and individual performance.

Workshops and coaching can be provided where necessary.

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services and all offering apparently ‘similar’ products, whoever is charged with overseeing health and safety within the organisation should seek professional advice to ensure compliance with the tightening legislation.

The British Security Industry Association has recently published a guide to BS8484, a new lone worker devices and services standard, that will assist employers manage their exposure to risk.

BS8484 is already adopted by quality lone worker solutions and the Association of Chief Police Officers (ACPO) has amended its policy to only permit police response to compliant solutions.

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VALUE AND IMPROVED SERVICE RESULT FROM EFFECTIVE INSIGHT Genuine insight from research into audiences and markets can yield significant benefits for health professionals both in terms of budgets working more efficiently and better patient care THE ADVENT OF THE COALITION government after May’s general election has heralded sweeping changes for the health service. Once again GPs will have more control over service management, procurement and funds, and more competition will be brought into the foundation trusts system. The role of those at the local service delivery level will become even more critical and it is essential therefore, that health service and care providers are confident that they are making the right decisions.

This is where social, market and opinion research can add value, offering accurate insights to decision-makers.

The Market Research Society (MRS) is the regulatory body for social, market and opinion research in the UK and can help health sector organisations identify how to use research to achieve the best results. “Good, ethical research – which is much more than just quick surveys – can change much of what our clients do for the better, making delivery and decision-making both more effective and more efficient,” says Andy Cumming, founding director of Curiosity Research and Engage2change, specialists in public sector health research.

Cumming continues: “Research can deliver real benefits. It can add value across the board, from service evaluations to service configurations. Insights into patient experience are becoming ever more important given the focus on patient choice – research offers decision-makers information on which parts of the service to prioritise and protect, an essential activity given the financial climate.”

BENEFITS OF RESEARCH There are a number of potential uses of insight and research within the health sector including: • Effectiveness and efficiency – ensuring funds are directed to solutions and services which will directly benefit those who need it, whilst removing the risk of wastage.

• Attitudinal – enabling organisations to assess different perceptions and opinions relating to customer and patient satisfaction and preference in the provision of services and products.

• Policy development, implementation and evaluation – evaluating each stage of the complex process of health policy development.

• Communications – enabling a two way dialogue with key stakeholders and informing the selection of effective channels of communication.

• Public relations – helping health

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organisations understand the behaviour and attitudes of target audiences to inform messaging and branding.

• Product and service development – identifying which products and services are performing well and which are not.

CHOOSE A CREDITED SUPPLIER To ensure that research is both accurate and meaningful, it should be commissioned from accredited suppliers who meet industry guidelines on delivering robust, ethical and representative findings. MRS upholds a number of rules and guidelines to ensure good practice across sectors. Individual professionals that are MRS members and organisations like Curiosity Research, that are MRS Company Partners, have to abide by the MRS Code of Conduct, which sets the rules for conducting fair and ethical research.

The Code, along with the Data Protection Act of 1988 – which members/Company Partners are compelled to adhere to – offer a strict

quantitative and qualitative, and both have their own specific purpose. MRS Company Partner organisations and those organisations with MRS members can help advise on what sort of research suits a specific requirement.

Quantitative research generally involves using larger samples of respondents for major policy development and funding decisions whereas qualitative research is smaller-scale and more personal, focusing on issues such as patient journeys, service evaluations and behavioural change campaign strategies.

Often a combination of both methods is the key to good insight for practitioners.

The MRS website is a good starting point to find out more about how research could benefit you. It includes A Newcomer’s Guide to Market Research, as well as the annually updated Research Buyer’s Guide (www. theresearchbuyersguide.com), which lists MRS Company Partners and organisations with MRS members, their contact details, geographic area and industry specialism. All

Good research will deliver what the client really needs – accurate insights that policy and decisions can be reliably based on set of parameters that restrict malpractice in research. At a time when concerns around data privacy and information security are at a high, this helps deliver the necessary safeguards health professionals need.

“Good research will deliver what the client really needs – accurate insights that policy and decisions can be reliably based on. Often findings can change strategies dramatically for the better when research is at the heart of decision-making,” says Steve Lowery, group head of Custom Healthcare at Synovate, a Company Partner. “In this way, research can ensure excellent outcomes.”

“Research delivers a clear return on investment, whether it’s used when making decisions about which services to protect and prioritise, or when attempting behavioural change in patient groups. This is critical when it’s taxpayers’ money that is being spent,” Lowery adds. “If you are forced into tough choices about services you need to understand likely service uptake, potential return on investment and how the service will play out with stakeholders.”

There are broadly two types of research,

organisations and individuals listed in the Research Buyer’s Guide are committed to adhering to the MRS Code of Conduct.

USING SURVEYS FOR CONSULTATIONS In addition, LARIA (the Local Authorities Research & Intelligence Association), has its own website (www.laria.gov.uk) and works closely with MRS. LARIA can offer bespoke advice specifically to local, public sector, healthcare providers. In 2005, MRS and LARIA issued Using Surveys for Consultations as a joint guide for local public sector organisations looking to conduct market, social or opinion research. The document complements the MRS Code of Conduct and offers advice specifically on researching public and social opinion on issues of local importance, such as the various types of health service provision.

More information on this and broader public opinion issues can be found at www.mrs.org.uk/standards/guidelines.htm.

“The move to local funding is full of opportunities for improving service delivery but this relies on those at the local level knowing what is needed and understanding the patient

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community. Using an accredited supplier to ensure ethical standards are upheld through the MRS Code of Conduct is important in this sort of research and this is where the MRS can help,” Andy Cumming concludes.

“This way our clients know the decisions they are taking on the back of research are credible and protect patients’ rights.”

Further advice on how to commission research that complies with the MRS Code of Conduct can be found on the MRS and Research Buyer’s Guide websites.

CASE STUDY ONE A recent study of how research can prioritise activity and focus improvements was evidenced in an evaluation of an Intermediate Heart Failure Service.

Curiosity Research developed a ‘patient journey’ by speaking to patients and key stakeholders such as staff and providers. This patient journey is essentially a pathway with a series of key touch points from the patient perspective. It considers more than medical interventions and could for example include initial communications, through appointment setting to results feedback and follow up.

Once they had an agreed patient journey they measured the performance of the

service at each point and the importance of each point to the patient from the perspective of driving customer satisfaction.

This technique allowed them to recommend where scarce resources should be prioritised.

For example, the findings showed that having continuity of staff was more important to patients than more regular visits.

Frieda Rimmer, clinical services manager at the Wirral Heart Centre, NHS Wirral, said: “This technique has really allowed us to focus on those areas that we know will drive improvements for the patients. We now have the information to make informed decisions.”

CASE STUDY TWO Using their HealthACORN methodology, health location analyst CACI and market research company Kantar have examined the coalition government’s plans for a new health premium to improve population-wide health and reduce health inequalities. The government’s aim is to reallocate NHS funding to local authorities on the basis of the existing health of their residents.

The research involved an analysis of Britain’s 1.9 million postcodes to produce a detailed picture of current and future health trends in local areas. The objective was to determine whether allocating funding purely on the basis

of existing health would be adequate to enable authorities to cope with future demand.

Using a unique combination of lifestyle surveys, market research and Census data identifying 287 lifestyle variables, CACI and Kantar produced an accurate impression of future health trends in each of the UK’s 354 local authorities.

This allowed for local authorities to be ranked according to their future health problems alongside the current health of the population. The research revealed the discrepancies between both rankings – the London Borough of Tower Hamlets is ranked number 155 for current health problems, but the HealthACORN analysis put it at two when future health problems are taken into account.

John Rae, director, CACI, said: “Our study shows that using information about existing health problems is not a sufficient basis for achieving the coalition’s objectives. The task for the government is to ensure that, as its reforms are introduced, directors of public health are able to channel funds appropriately and in to areas of greatest need.”

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ITH BUDGETS UNDER

W increasing pressure, it is

critical to ensure best value from market research. Bob Peters, MD at 2020 Research has the following advice: Focus on the core information you need to know – shorter surveys avoid respondent fatigue and improve the overall quality of information.

Make the most of more cost-effective methodologies and systems, including online and computer-aided telephone interviewing.

Maximise the value from research data, and look for real insights through professional analysis and detailed statistical approaches.

Utilise the knowledge among management and employees – often many useful suggestions for service and process improvement can be found within the organisation.

Work closely with the research agency throughout, to get their full input into design,

analysis, interpretation and subsequent implementation.

FOR MORE INFORMATION Tel: 01226 767120 Fax: 01226 767130 E-mail: info@2020research.co.uk Web: www.2020research.co.uk

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BOOSTING EFFICIENCY IN THE AGE OF AUSTERITY Lean management principles can help the NHS survive the financial crisis, says Mark Eaton DESPITE THE CROWD pleasing announcements in the comprehensive spending review that NHS budgets would be protected, the reality is that the increase in spend from £98.7bn in 2010/11 to £109.8bn in 2014/15 represents a real growth of only 1.3 per cent when inflation is taken into account.

Within this small increase is the need to identify £20bn worth of real efficiency savings.

While large chunks of this will be achieved through the wholesale removal of some nonfrontline services such as SHAs and a variety of arms length bodies, there will still be a need for individual organisations to deliver a substantial part of the overall savings required.

TRANSFORMATION Delivering front-line efficiency improvements can be achieved in one of three ways – the unilateral closure or reduction in services, under-investing without reducing capacity, or transformation. Of these three options the first two are the easiest to implement but don’t necessarily lead to the best outcomes for patients and staff.

The third option, transformation, is focused on changing the way that services are planned and delivered. Helping teams to move forward needs some form of structured approach and the rapid adoption of Lean within the healthcare sector over the last six years shows that it provides a useful transformational change framework if used effectively.

The starting point with Lean is that any use of resource which does not create value is wasteful and should be challenged. To be successful, healthcare managers have to overcome their limiting beliefs about risk, performance and accountability.

The problem is that the adoption of Lean to date has predominantly been localised within individual organisations or even within individual departments. The use of Lean to drive whole system transformation has been hindered by a pseudo-competitive market that has prevented organisations from working together to transform, rather than just tinker with, existing systems. This localisation of Lean has produced islands of excellence that are difficult to sustain. Often, problems are simply transferred upstream or downstream because of the failure to involve partners and providers outside of the initiating organisation.

DELIVERING THE QIPP AGENDA The financial crisis is providing uniform pressure on health and social care organisations to transform performance.

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Transformation, is focused on changing the way that services are planned and delivered. Helping teams to move forward needs some form of structured approach and the rapid adoption of Lean within the healthcare sector over the last six years shows that it provides a useful transformational change framework if used effectively

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However, this should not just be about delivering the same services for less money. The successful application of Lean can simultaneously deliver all aspects of the QIPP (Quality, Innovation, Productivity & Prevention) agenda. Lean can change the whole system so that care is provided in the most appropriate setting, duplication and delays are eliminated, patients are engaged and pathways are streamlined.

CAPABILITY, CONFIDENCE, CULTURE The opposing pressure to the use of Lean to support whole system transformation is related to the ‘three Cs’ – capability, confidence and the organisational culture.

Capability is concerned with having access to the skills internally to initiate and lead a Lean programme without creating a dependence on external organisations and advisors. This means assigning people a role in leading transformation rather than tacking it onto existing responsibilities, and then training and supporting them to lead transformational change programmes. This will require as much thought as you would give to the appointment of a senior manager or clinician because if you get the wrong person the whole process is undermined.

Confidence is about not getting stuck in the analysis trap.

Whole systems transformation brings with it the need to work

across organisational and funding boundaries. This increases the probability of calls being made for in-depth analysis before any real change can occur, but the production of reports costing hundreds of thousands of pounds are more often used to stifle innovation and prevent progress rather than accelerate it.

While Lean obviously requires some scrutiny before implementation, it also requires you to address the underlying issues that lead to the brakes being applied through excess analysis. Typical concerns include loss of control or income, allocations of additional work without corresponding changes to funding, and differences in organisational priorities. Overcoming these requires a lot of work to be put into managing relationships and creating an overall Transformation Map. DIFFERENCES IN CULTURES Perhaps the biggest barrier to the successful adoption of Lean across whole systems is caused by differences in organisational cultures.

Within this area probably the most damaging issues are where there has been a history of adversarial relationships or where there is an underlying perception that one organisation or another is out of touch or worse. These perceptions are rarely true and often very unhelpful.

One of the most beneficial aspects of the successful application of Lean is the requirement for it to be delivered by teams of people working together, cutting across boundaries and through stereotypes.

While the root cause of the current financial crisis cannot be placed at the feet of any individual organisation, the solution can, with the right support and using a Lean approach, be in their hands.

Mark Eaton is managing director of Amnis UK

FOR MORE INFORMATION Web: www.amnis.uk.com

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RECRUITMENT

MAKING EFFECTIVE USE OF FLEXIBLE STAFF We look at how the Recruitment and Employment Confederation responded to a DH briefing on managing a flexible workforce

rather than using an external provider is also one that does not tally with past experience.

Providing an initial reaction to the briefing document, Tom Hadley, the REC’s director of Policy and Professional Services, said: “We fully agree that a mix of substantive and temporary staff is the best way of delivering high-quality and cost-effective care to patients.

It is crucial to recognise the importance of flexible staffing arrangements and there is no doubt that agency workers make a huge contribution to the delivery of frontline services.

“The concern is that reduction of agency spend is still seen as an end in itself. The end-goal must surely be to develop costeffective resourcing models – ultimately, this could result in more flexible staff rather than less. The development of a national strategy for temporary staffing within the NHS should not start with the blinkered view that agency staff is an unnecessary cost that should be systematically cut.”

MANAGING COSTS “Of course, costs must be managed,” Hadley continued. “However, they must also be weighed against the cost of employing more permanent staff on full pensions and entitlements or having internal NHS staff replicate the work of specialised agencies in sourcing, vetting and placing suitably skilled temporary workers.

“The assumption that it is automatically cheaper to run an in-house bank rather than using an external provider has been widely discredited. The other assumption is that temporary staff create an inherent safety risk. This is not the case if the temporary workforce is properly managed. In fact, previous data has shown that more agency staff have the proper CRB clearance than those in substantive posts within the NHS.”

THE DEPARTMENT OF HEALTH has launched a specific briefing on managing and cutting the costs of flexible staffing within the NHS. The Recruitment and Employment Confederation (REC) welcomed some of the messages within the briefing, but also challenged a number of key assumptions and the systematic focus on the cost of agency staff rather than on the benefits they bring to the NHS. The aim of the Department of Health briefing is to encourage NHS Trusts to review the way that flexible staff are managed and to help drive

down expenditure. Specific messages include recognition that a flexible mix of substantive and temporary staff can deliver cost savings and a high-quality patient experience, and that trust directors must understand future workforce needs to plan ahead effectively.

CHALLENGING ASSUMPTIONS The briefing also makes a number of assertions on the cost and safety of using agency staff that the REC will continue to challenge. The assumption that it is automatically cheaper to run an in-house bank of temporary staff

THE BIGGER PICTURE “A modern and efficient healthcare service must make effective use of flexible staffing. There is real benefit to be gained by looking at how this is managed and how the contribution of temporary and locum staff can be maximised. This cannot be all about slashing costs and driving down agency fees,” Hadley said.

“Cutting specialised external providers out of the picture would not only cost jobs at a time when the private sector is being relied on to create employment opportunities, but would also jeopardise an effective and proven way of getting the right skills at the right time to the NHS‘s frontline.”

The REC is represented on the NHS Flexible Workforce Forum and will continue to engage with NHS Employers and the Department of Health on flexible workforce agenda. The input of REC members within the Medical and Nursing & Social Care Sector Groups will drive the REC’s ongoing campaign on this issue.

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HEALTHCARE IT

INFORMATION TRANSPARENCY What does the market need to do to support an information revolution? asks Matthew Swindells, Chair, BCS Health

THE MODEL OF COMMISSIONING outlined in the government’s White Paper ‘Equity and Excellence: Liberating the NHS’ is dependent upon transparency of information. The Secretary of State went so far as to describe the need for an “information revolution”. In fact, you could argue that the entire transformation programme envisaged by the government is dependent upon the delivery of information and IT – a kind of worrying thought.

CHANGES AHEAD The control infrastructure that has overseen the NHS for the past ten years is being torn up. Once there existed national targets set and monitored by the Department of Health (DH) and performance managed by SHAs and PCTs. Now performance will be set and monitored by GP commissioners and the NHS Commissioning Board. The whole system will be held to account by the public through choice of provider and commissioner, voice (public protest) and the legally enforceable NHS constitution.

The government believes that constantly pulling up the plant to see if the roots are growing has damaged the NHS and set itself a self-denying ordinance that means that the Secretary of State won’t know about every bed pan dropped, for the first time since the NHS’s foundation The DH bureaucracy kept itself informed through an extensive data capture exercise covering everything from waiting times and waiting lists through to healthcare acquired infections and service changes. When the going got tough in the NHS, the DH would monitor directly the hot issues, such as the availability of paediatric intensive care beds in winter, and intervene if local performance was damaging the national position.

Targets are being abolished. Central reporting

is being reduced. The DH and NHS management are being downsized. The government believes that constantly pulling up the plant to see if the roots are growing has damaged the NHS and set itself a self-denying ordinance that means that the Secretary of State won’t know about every bed pan dropped, for the first time since the NHS’s foundation. However, the removal of a supervising authority without empowering GPs and the public with the information they need, runs the risk of simply

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HEALTHCARE IT

recreating individual self regulation – hidden waiting lists and the level of service that the provider feels is appropriate and deliverable.

Successful transition from the old state to the new will require the government to make a number of things happen.

1. The right data needs to be collected, of a high enough standard in order to be able to measure quality and value.

2. National and local data-sets need to be made available to commissioners, patients and the public in a variety of forms that will allow interrogation for decision making and accountability, directly and through third parties.

3. Data should be benchmarked against UK and international comparators to create an environment of competition and striving for excellence.

4. Core applications like hospital EPRs, GPs systems and Choose and Book need to be opened up so that they can communicated with by third party applications to create competition in user applications.

The think tank 2020 Public Service Trust argues: “A crucial element to providing the information expertise that commissioners need and inspiring the public to hold the NHS to account is breaking the virtual state-monopoly on the publication of NHS performance data.

A market must be created in information analysis, so that world class support can be offered to commissioners and analysis that is relevant to individuals is offered to the public.”

Also, in the White Paper the Secretary of State said: “We intend to make aggregate data available in a standard format to intermediaries to analyse and present it to patients in an easily understandable way.”

OPENING DOORS So, industry should be pushing an open door in demanding a market in information. What do suppliers need to do to make this a reality?

The first thing is to recognise the economic climate. In this environment no one is going to buy a product that adds to the administrative burden or has a payback period measured in years rather than months. If the industry is going to make the information revolution happen it will need to demonstrate that it understands the environment and the financial pressures, and has products that can really contribute to delivering an annual four per cent productivity improvement very quickly.

The second thing is to be specific about the data you need in order to deliver the transformation you are proposing. If the data is in the public domain already and all it needs is imagination to productise it, splendid. However, if the data exists but is locked away, such as incapacity benefit data, which would allow commissioners to target NHS interventions to patients off work and receiving benefits and thereby reduce NHS and welfare costs, you need to be specific.

The NHS lags behind the rest of the world, which has itself only scratched the surface of the possibilities, in providing patients with the technology and support to self medicate and monitor Part of the government’s problem is that it has so much data that it doesn’t know where to start and ministers are daunted by the size of the transparency challenge. Help them decide what to release, whilst they get into the habit.

The third thing is bringing good products together around identified markets and having enough confidence that you can make a difference that you are prepared to share the risk and benefits. Recycling old products will not be good enough when new customers need new products. There are a number of different constituencies with information needs: If they are going to be effective the GPs

need to be enabled to operate as a board rather than an executive – more like multifunds than fund-holders, for those with long memories. This means that they will need a set of back office services that lifts them out of the bureaucracy of invoice matching and payment clearance and into thinking about how to improve the health of their population.

They will need management information systems that allow them to see variations in performance of their hospital and outof-hospital providers and of their GP colleagues, so they can focus their board meetings on discussing what action to take,

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not worrying about the absence of data.

As commissioning consortia start to try to align their expenditure with health need and maximum impact, they will need population health analytical tools to understand health need against usage, segment their population, forecast the cost of interventions at an individual patient level and track whether expenditure and outcomes have shifted as planned.

As the NHS attempts to shift care out of hospitals into community and home based services, the real cost and productivity of hospital and community services will come under greater scrutiny. At present the understanding of community services’ costs is so poor that the hypothesis that increased use of community services will reduce NHS costs is simply a “bet” based upon a limited number of studies in other health systems.

Systems that allow analysis of real costs in settings outside hospital, over periods of time rather than per intervention will be necessary.

GPs will have responsibility for the quality of the services they buy on behalf of their patients, so will require quality monitoring systems. They will need to be at least as well informed as their patients when they are asked for advice about choices.

THE PUBLIC The public is being challenged to hold the NHS to account. If they are to do this they will need access to information that they have never had before – comparative clinical quality and satisfaction information at specialty team and consultant level. Surely the government commitment to allow patients choice of consultant is meaningless rhetoric if the patient is not allowed to know about the clinicians’ performance?

It will be hard, though not impossible, to create a business model for the supply of this information directly to the public, but two potential businesses may emerge. One

If we keep delivering the same products in the same way, we should not be surprised if we get the same outcomes – underachieving implementations, dissatisfied customers and a lack of an inclination to invest in IT when the going gets rough is a business-to-business information supply operation, pulling together the mass of data that exists, creating interesting new connections and supplying it to public facing organisations such as patient charities or media businesses.

The second is to be one of those public facing health information organisations. It is only necessary to read women’s magazines and the middlebrow newspapers to know that the public desire for health stories is insatiable.

The websites that become established as interesting, relevant and reliable in this space potentially have huge markets.

PATIENTS AND CARERS The government is committed to patient empowerment, not simply in the choice of services, but also in the management of their care. For this to be real the patient will need access to systems that tell him or her what they should expect from their healthcare provider so they can hold providers to account and systems that allow them to undertake common transactions remotely like appointment checking and changes from a range of applications.

They will need access to their clinical record so that patients are an equal partner in the decision making involved in their healthcare.

How can there be an equal partnership if only one of you can see the record? Furthermore, choice is meaningless if only your current GP or your local hospital has timely access to your records and any other provider has to re-establish your medical history and undertake

another series of expensive, invasive tests.

Finally, the technology to support co-production of healthcare is likely to be one of the big growth areas in the coming years. The NHS lags behind the rest of the world, which has itself only scratched the surface of the possibilities, in providing patients with the technology and support to self medicate and monitor. Many conditions offer the opportunity for patients to take the burden off the NHS, empower themselves and provider a cheaper and better NHS. Just as those on the outside looking in say to the NHS that it must change the way it works if it is to harness the potential of information and IT and achieve a better, cheaper NHS, so must the industry. If we keep delivering the same products in the same way, we should not be surprised if we get the same outcomes – underachieving implementations, dissatisfied customers and a lack of an inclination to invest in IT when the going gets rough. The NHS needs innovative partners in transformation who can help them leverage the central informatics platforms that have already been put in place; it just doesn’t necessarily know this yet. The companies with great products that are prepared to make the market rather than wait for it have a tremendous opportunity in this time of change.

FOR MORE INFORMATION Web: www.bcs.org

Speech recognition, dictation and workflow from G2 Speech 2 SPEECH is the market leader in speech recognition, digital dictation and workflow management solutions for hospitals and other healthcare organisations.

Using efficient and highly accurate digital technologies created specifically for the medical environment, G2 Speech solutions improve workflow efficiency and deliver significant reductions in cost.

As a leading global specialist in its field, G2 Speech is highly customer-focused. It offers strong support to its client base, providing complete solutions which underpin their way of working.

G2 Speech works with more than 93 per cent of hospitals in the Netherlands and the company’s implementation, training and support services are expanding

and distributing their consultation notes and other information almost instantly.

Medical speech recognition solutions are delivering such impressive returns on investment for NHS trusts, GP surgeries and other healthcare organisations that G2 Speech would be glad to arrange for you to talk with or visit customers who have implemented speech recognition or digital dictation across their departments and trusts.

G2 Speech – doing more with speech.

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rapidly across the UK and Belgium.

The impressive accuracy rates (up to 98 per cent) achieved with MediSpeech – G2 Speech’s speech recognition software – mean that healthcare professionals are now recording

FOR MORE INFORMATION Tel: +44 (0)208 5396541 Mob: +44 (0)7711 872753 E-mail: info@g2speech.com Web: www.g2speech.com

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HEALTHCARE IT

CAPTURE AND SHARE DATA IN REAL TIME In healthcare the Digital Pen is mightier than the iPad

IT SEEMS THAT EVERYONE wants a piece of the Apple iPad action with sales reaching over seven million. Rupert Murdoch announced recently that it was a “game changer”, joining the PC, laptop and smartphone family of desirable computing gadgets. But questions are being raised about the suitability of the iPad – and indeed tablet PCs in general.

In this article, Petter Ericson, chief science officer at Swedish technology company Anoto AB, discusses the issues and examines whether such devices could become mainstream business tools in the healthcare and social care sectors.

It was interesting to read that hospitals in Victoria in London will start trialling the use of iPads. The real question though is whether the tablet form factor is appropriate or even practical enough for this type of tough and often unpredictable environment.

Looking at the positives, iPads are certainly lighter and more portable than laptop computers and more readable than smart phones; they also have a whole universe of apps to make content and features easier to access; and the functionality is familiar to most of us

and therefore relatively straightforward to use.

So far so good, but then again most healthcare environments such as hospital wards, treatment rooms and outpatient clinics, do not need immediate access to lots of webbased content, or revolutionary cutting edge design. On a more practical level, what about the threat of damage? For doctors and nurses, midwives and care workers, mobility could be a real concern – it is not just a question of where to put it, but the constant worry about dropping it, spilling fluids on it and damaging it. This has always been an issue for laptops and Personal Digital Assistants (PDAs), so it is unlikely to be any different for an iPad. Then there is the issue of theft. iPads are desirable pieces of technology. Not only are they expensive to replace, but also the information stored on them, such as sensitive patient data, could be invaluable, perhaps even life saving.

KEY MEDIUM In healthcare environments where paper is still the key medium for capturing information, there is a clear need for a more practical and

low cost solution for capturing and transmitting data, particularly for a largely mobile workforce.

Digital Pen and Paper technology is continuing to win over many healthcare trusts, hospitals and care organisations by putting usability and simplicity over IT wizardry and cool design.

It offers a simple but effective alternative to screen and keyboard and tablet PC solutions and can quickly capture, process, interpret and transmit information in real time.

Digital Pen and Paper automatically captures handwritten information in medical or care forms – such as physiotherapist treatment forms, midwives’ consultation notes or care workers’ visiting notes – and digitises that information, eliminating the need to manually type it up later.

The pen looks like a normal ballpoint pen with a tiny infrared camera at its tip, and stored data is synchronised via a docking station or mobile phone and Bluetooth with back-end systems, rather than remaining on the device itself. For healthcare workers, this means synching and backing up data to patient record systems and other repositories easily and quickly, reducing the number of potential manual errors.

For those who require duplicate paper reports or documents for regulatory or administrative purposes, Digital Pen and Paper solutions provide the answer.

Unlike most technology, users require little or no training and can be up and running almost immediately. A Digital Pen is also practical and robust, extremely light and portable (it can easily fit into a pocket or bag) and because it looks like a normal pen is not typically a target for theft.

PRACTICALITY OVER AESTHETICS When introducing new technology to critical health and social care services, the first consideration should always be the needs of the users and the underlying processes. Tablet PCs like iPads can be a valuable asset – they are mobile, highly functional and provide a great user experience in most situations.

For executives in the boardroom, there is little doubt that they can be a real benefit, but when it comes to more practical uses, especially in healthcare and social care environments, it is a different story. Adopting the latest cool technology may seem appealing, but the question remains whether it is relevant and appropriate – if not, it will almost certainly cause headaches further down the line.

FOR MORE INFORMATION Web: www.anoto.com/healthcare

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WHO WILL YOU TRUST TO

SECURE THE

PRIVATE CLOUD? EMC2, EMC, RSA, the EMC logo, the RSA logo, and where information lives are registered trademarks or trademarks of EMC Corporation in the United States and other countries. Š Copyright 2010 EMC Corporation. All rights reserved.

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HEALTHCARE IT

CYBERCRIME AND THE HEALTHCARE INDUSTRY Providing better access to healthcare data so strongly demanded by patients and providers is fast becoming a target of scrutiny and risk HEALTHCARE ORGANISATIONS and agencies are a newly favoured target among data thieves because of the wealth of personally identifiable information they collect, which can be turned into cash and used to commit identity theft. The question remains as to what can be done to halt the hard reality of a successful cybercriminal network turning its attentions to the healthcare sector.

THE VALUE OF HEALTHCARE DATA Data thieves are turning their attention beyond the banking industry. Essentially, any organisation that holds credit card data or personally identifiable information is a likely – and lucrative – target. For a data thief, gaining access to data available in healthcare records is attractive for a number of reasons: • It is easy to steal. The portability and increased exchange of healthcare data has created another point for cybercriminals to gain unauthorised access.

• It is quality data. According to Javelin Strategy and Research, the volume and quality of data available within health records can be used to commit fraud and identity theft for four times longer as compared to other types of identity theft.

• It increases the value of other stolen data. The personally identifiable information available in healthcare records enhances the value of other data for sale by cybercriminals. For example, research at RSA’s Anti-Fraud Command Center shows that a single credit card, when sold with a full set of personal information, can command a price up to ten times more than just the value of the credit card data itself.

HEALTHCARE DATA IN THE BLACK MARKET Cybercrime in the healthcare industry is particularly heinous because the cybercriminals target not just consumer data but also information from healthcare providers, government departments, and pharmaceutical manufacturers and distributors. Using phishing, Trojans, and other malware infections, cybercriminals are able to gain access to internal systems to steal data. The Qakbot Trojan, which infected more than 1,100 employees within the National Health Service in April 2010, serves as just one example of how healthcare organisations can be put at risk.

One of the ways in which cybercriminals are committing healthcare fraud is by filing false patient claims. By gaining access to patient data, a cybercriminal can use that

information to bill for services that were never rendered. For example, some posts in the black market reveal cybercriminals seeking to buy stolen information from healthcare providers and samples of completed medical claim forms to exploit for this purpose.

There is also a growing demand for pharmaceutical data in the underground.

Cybercriminals can use this data to order prescriptions at multiple pharmacies and then attempt to resell them online. Criminals can also acquire prescriptions using a patient’s account and reroute it to be delivered to a mule (a person who is tricked into accepting goods or money on behalf of a cybercriminal and then directed to reship it to a location outside of the country). Physicians’ information is also valuable to cybercriminals because they can use it to write fake prescriptions to facilitate schemes involving the purchase and resale of prescription drugs.

Consumers of healthcare services are also affected in many ways by having their medical records exposed or breached.

Some of the risks they face include: • personal data being used by criminals to open new credit accounts in their name • being wrongly accused of abusing medical services due to criminals filing false claims using their information • threatened with blackmail or extortion from criminals threatening to expose sensitive medical or health details.

ADDRESSING THE CYBERCRIME THREAT The same cyber threats that have been used by criminals to attack financial institutions for years – including phishing, Trojans, malware, and other schemes – are now being leveraged to target new sectors. The challenges facing healthcare organisations are many, both in terms of the range of security risks posed by cybercrime and introducing and educating on the threat within a culture that has not traditionally had to accommodate such imperatives.

Security risks and issues that need to be addressed within the healthcare sector as they push for the electronic exchange of healthcare data include: • secure enrollment to ensure that first-time users to a portal are who they say they are before granting access to various applications • secure access to online portals to prevent the loss of patient’s personal and healthcare information • secure access for physicians to clinical applications that contain patient data

BIOGRAPHY – SAM CURRY Sam Curry is CTO, Global Marketing at RSA, the Security Division of EMC. He has over 18 years of experience in security product management and development, marketing, quality assurance, customer support and sales.

Sam is a frequent speaker on security topics and trends and has appeared in Forbes, Bloomberg, CNET, Technology Review, PC World and Computerworld.

• secure access for payees and other third parties to sensitive data required to perform their job • educating employees on the risks of phishing and malware.

CONCLUSION Together, patients and providers should be aware of the potential cyber risks they face.

Cybercrime in healthcare is just starting to evolve, but could quickly become a devastating industry, economic, and societal problem. Any solution must start with healthcare organisations themselves recognising the potential impacts of cybercrime and taking aggressive steps to protect the sensitive information they create and exchange with the same commitment they bring to protecting patients from harm.

FOR MORE INFORMATION Web: www.rsa.com

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IntroducIng FIrStLight

The medicines reference tool for more informed decisions

gEt connEctEd to rELIABLE drug dAtA FIRSTLight is the innovative reference tool for every healthcare professional, giving you a faster link to comprehensive medicines information.

• Modern, intuitive user interface • Instant access online or via iPhone or iPad • Up-to-date medicines information from a single, trusted source

Register on www.firstdatabank.co.uk/firstlight now for a FIrStLight free trial

www.firstdatabank.co.uk

Powered by

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HEALTHCARE IT

MORE INFORMED DECISIONS First DataBank, the UK’s leading provider of drug databases and active clinical decision support, launches new product – FIRSTLight FIRST DATABANK, the UK’s leading provider of drug databases and active clinical decision support, recently launched an innovative new product – FIRSTLight, designed to reduce medication errors by providing clinicians with instant access to reliable medicines information.

First DataBank’s core business has been providing expert drug information to healthcare professionals in the UK for over 30 years.

Headquartered in Exeter, Devon, First DataBank employs over 65 staff, including a highly skilled editorial team drawn from clinical, pharmacy and other healthcare backgrounds.

KNOWLEDGE BASE First DataBank is mostly known in the UK for its drug knowledge base, the Multilex Drug Data File (Multilex DDF) which is integrated into the majority of UK clinical systems in use today. In 2009 the overall NHS expenditure

adding massive, avoidable costs. FIRSTLight has been developed specifically for electronic search and display, making it very easy and very quick to find the information clinicians are looking for – which will save valuable time, reduce ADRs and drive costs down.

“The third most common patient safety incident relates to medication errors. The key benefits that FIRSTLight will provide to clinicians are a one-stop-information-shop about how and when to use, or not to use, a medication; as importantly it can be used by nursing staff, technicians, pharmacists and doctors to answer a range of medication queries in a wide variety of care settings. The versatility of accessing FIRSTLight from a desktop computer or when on the move via an iPhone and iPad could dramatically reduce medication errors that arise when treating patients in the absence of appropriate information about a drug.

FIRSTLight is a tremendously exciting industry innovation which we anticipate will take the healthcare profession a significant step closer to eliminating adverse drug events on medicines was £12.3 billion. The Multilex DDF drug terminology holds clinical and commercial information on more than 75,000 pharmaceutical products and packs, and provides active clinical decision support and referential medicines information for all healthcare professionals, as well as endorsing and reimbursement support for community pharmacists and dispensing doctors.

With the introduction of FIRSTLight, First DataBank has launched a product that can offer the breadth of its trusted medicines information on demand from any point in the clinical workflow in consultations or on the move.

A unique stand alone resource, FIRSTLight is designed to deliver information that supports safer, faster clinical decision making.

ELIMINATING ADVERSE DRUG EVENTS Darren Nichols, managing director of First DataBank, took some time to chat with Health Business about FIRSTLight. “FIRSTLight is a tremendously exciting industry innovation which we anticipate will take the healthcare profession a significant step closer to eliminating adverse drug events. 50 per cent of medication errors have been found to be a direct result of insufficient information1, whilst one in 16 hospital admissions are as a result of an adverse drug reaction (ADR)

“Not all hospitals have fully integrated clinical systems in place leaving clinicians resorting to paper based references or mainstream search engines. Currently, 10.8 per cent of patients experience an adverse event on medical wards.

We can, with the launch of FIRSTLight, now offer hospital staff a trusted resource that is researched and authored by our team of clinicians and health informatics specialists.

“First DataBank is offering cost effective organisation licenses to hospital trusts for department or hospital wide rollout in early 2011.

Used in this way FIRSTLight can be launched directly from staff desktops with no log-in required providing ultimate ease of access. First DataBank is also inviting clinical system vendors to embed a link within their clinical system enabling one button launch of the product with a drug in focus. And, to complete the picture, FIRSTLight will also be available to individual healthcare professionals via a nominal online subscription.”

FEATURES Some of the specific drug information available via FIRSTLight will include: • how, when and when not to use a medication including ingredients, indications, doses, routes and administration advice • when to avoid using a medication, including information about allergies

Darren Nichols

and safety of use with other concurrent conditions, drugs and food • tests, measures and observations required while using a medication including what should be done about any resulting changes, along with information about managing expected side effects and what to do in cases of over-dosage • reproduction, pregnancy and breastfeeding advice including whether taking the medication can affect fertility, relevant recommendations for use of contraception and any risks associated with pregnancy or breastfeeding while taking the medication.

Notes 1. Leape LL, Bates DW, Cullen OJ, et al. Systems analysis of adverse drug events. JAMA 1995;274:35-43

FOR MORE INFORMATION Interested trusts and clinicians are being invited to sign up via the FIRSTLight website www.firstdatabank.co.uk/firstlight to receive the free trial of FIRSTLight due to start in December. The preview trial will allow individuals to log on, view the content and get a feel for the unique user interface and search functionality.

Full launch will follow in early 2011.

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HEALTHCARE IT

IMPROVING QUALITY WHILST CONTROLLING COSTS Healthcare organisations are now faced with the challenge of meeting the high level of quality demanded by regulatory bodies, standards and patients, while also delivering improved efficiency savings across the whole organisation WITH MANY HEALTHCARE organisations having to meet an increasing number of different compliance regulations and standards, a question often being asked by healthcare management is: “How do we meet these quality standards and regulations as efficiently as possible?”

In order to comply with these standards, healthcare organisations have traditionally used paper and spreadsheet based Quality Management Systems, and usually with each department developing their own individual quality management processes in order to meet their individual regulatory needs. While these systems deliver a certain level of quality, they have proven to be highly ineffective in delivering efficiency, providing scalability and giving a holistic view to healthcare management across the organisation.

This lack of input of quality and compliance information to management also can be seen as a serious issue to healthcare organisations, as quality is now deemed as an important aspect of healthcare management. As a result of these issues with traditional systems, more time is spent by staff on the bureaucracy of quality management and less time on carrying out key activities such as delivering frontline and clinical services.

Deploying an Electronic Quality Management Solution (eQMS) allows healthcare organisations to significantly decrease the time spent on key compliance activities, whilst also helping to reduce costs, increase productivity and dramatically increase the visibility of quality to healthcare management.

KEY COMPONENTS There are many areas to consider as part of Compliance and Quality Management, such as policies, procedures, audits, identifying corrective and preventive actions, asset and supplier management, staff competency, incident and risk management etc. By utilising an eQMS, healthcare organisations can improve their ability to manage all of these areas – for example by using the eQMS to centrally manage all documents such as manuals, policies and procedures, with full visibility of version control and staff acknowledgement. With an eQMS, documents can be easily retained digitally, removing the requirement for long term paper storage.

Other areas that are required by regulatory bodies, such as training and personal

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development can be scheduled and managed by the eQMS – allowing visibility of staff competency to meet the level of training required by the standards bodies.

The right eQMS should have the ability to manage all of these key components of Compliance and Quality Management.

CHOOSING THE RIGHT SOLUTION While the core components of Compliance and Quality Management may be the same across all standards, the eQMS must be flexible enough to be tailored to meet an organisation, or departments, individual requirements in order to meet specific regulatory requirements. In addition to offering this flexibility, the eQMS should also be scalable to allow it to be easily deployed across the whole organisation.

By automating the processes involved with compliance and quality management, such as automatically setting follow up reminders and escalation e-mails in the organisation’s e-mail system, the time spent on chasing up identified actions can be dramatically reduced. Also, by using an eQMS that can be accessed easily by each member of staff, ownership of quality and compliance is taken by all individuals across the organisation.

The right eQMS will not only carry out the above improvements, it should also deliver the ability to carry out analysis and feedback on all of the components of quality managementsomething that cannot be easily carried out with traditional paper and spreadsheet systems.

Finally, while having the ability to cover all aspects of quality and compliance management, the eQMS should easily allow the export of key data plus allow the ability to deliver quick reporting of quality and compliance findings to any member of staff.

WHY CHOOSE AN EQMS? As healthcare organisations face the task of making efficiency savings, while improving quality, an eQMS can easily be seen as a simple way to reduce the amount of time spent by staff on the bureaucracy of quality management and increase the time spent by staff on frontline and clinical services – while giving management a simple way to get access to the quality and compliance information they need.

Sample feedback has shown that by implementing the right eQMS, a healthcare organisation can gain up to 50 per cent staff

ABOUT GAEL LTD Founded in 1995, Gael Ltd is the UK’s leading developer and supplier of Electronic Quality Management Solutions – Q-Pulse.

Q-Pulse is currently in over 250 installations in the healthcare sector, and over 2,000 organisations worldwide choose to use Q-Pulse as their Electronic Quality Management Solution. efficiency savings when carrying out their quality and compliance tasks – and when analysed over a four year period, this saving can quickly become tens of thousands of hours to an organisation.

FOR MORE INFORMATION E-mail: health@gaelquality.com Web: www.gaelquality.com

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HEALTHCARE IT

PREVENTION IS BETTER THAN CURE

Southampton University Hospitals NHS Trust opts for SecurEnvoy’s tokenless two-factor authentication

DATA SECURITY within the public sector is crucial. With sensitive personal information being handled on a daily basis, governmental agencies need to use the best security systems without taking huge amounts of cash from the public purse. The NHS’s many regional trusts need tight data security that protects staff and patients, and in the past, token-based two-factor network authentication methods have added an extra line of defence to stop hackers and cybercriminals gaining unauthorised access to sensitive data. Unfortunately, using physical tokens also creates complications.

One example of an NHS trust taking security and cost seriously is Southampton University Hospitals NHS Trust (SUHT). Up until 2007, SUHT used physical tokens to provide users with a secure method of remotely accessing SUHT’s network. The tokens themselves were proving to be a burden, as many were being lost or broken through general use, as well as being limited by their battery or licence agreement to a lifecycle of only three to five years.

A SHOT IN THE ARM FOR NETWORK SECURITY Under the old authentication system, 100 SUHT staff were issued their own physical tokens, but as the cost per token was over £50 just for hardware, SUHT could not justify expanding the number of users. SUHT began

looking for more flexible secure access options, but it was SecurEnvoy’s SecurAccess that outshone the competition. SecurEnvoy was the only company to offer two-factor tokenless authentication with the passcode delivered via SMS to users’ mobile telephones. Ryan Hewitt, senior network and security systems engineer at SUHT, said: “We don’t issue organisational mobile phones so loading software onto each user’s personal device was not an option, we needed an authentication option that could deliver each passcode via standard SMS. SecurEnvoy was the only provider that could do this, so for us it was an obvious choice.”

SecurEnvoy, the pioneers of tokenless two factor authentication using mobile phones, provided the perfect remedy for SUHT’s data security issues with SecurAccess. “SecurAccess sends the next passcode to the user’s phone immediately after the previous code has been used. This is a crucial detail – other systems send passcodes on request, which may not work for some of our users logging-on in areas with poor mobile coverage. The way SecurAccess works avoids this problem.”

Southampton and South West Hampshire.

SUHT also arranges specialist services such as neurosciences, cardiac services and children’s intensive care to more than three million people in central southern England and the Channel Islands. The organisation employs over 7,500 staff, treating more than 112,000 in-patients, 375,000 outpatients and over 110,000 emergency cases.

Cost was also a major factor for SUHT said Hewitt: “The difference in cost is huge. SecurEnvoy’s subscription cost is four times less expensive than our previous authentication solution, with no compromise on the quality of the security. The potential cost of supplying all 4,500 users with physical tokens costing £50 a time makes SecurEnvoy’s tokenless system even more appealing.

“With increasing pressure on the NHS to provide more for less, we have to make sure our decisions around implementing IT and technology are the most efficient and costeffective options. Presenting cases for IT spend to the board can be a challenge, but when it comes to security and patient confidentiality, it’s imperative that the system is flawless.”

EASIER FOR USERS AND IT STAFF SUHT integrated SecurAccess easily and quickly with its Novell eDirectory system, resulting in minimal administration time needing to be dedicated to each user setup. Even user mobile numbers are encrypted to ensure tight security. With SecurAccess, the Trust now has 4,500 user licences due to the new system’s significantly reduced costs and ease of use.

SUHT’s choice of SecurEnvoy also resulted in some unexpected benefits said Hewitt: “I estimate we have the same amount of calls into our helpdesk in one year using the SecurAccess sytem that we had in one month under the previous system.”

This not only allowed Hewitt’s team to concentrate on other more important issues, but has also removed the hassle for users. “Most of our users are medical professionals and are not expected to be IT experts. SecurAccess is simple and easy to use, both for users and for us in the IT team. We have been using SecurAccess since 2007 and have had almost no issues at all – it is incredibly low-maintenance.”

FOR MORE INFORMATION To find out how you can reduce your costs and reinforce your network’s defences by implementing SecurEnvoy’s tokenless two-factor authentication system, visit www.securenvoy.com or call 0845 2600011.

GIVING FINANCES A CLEAN BILL OF HEALTH As one of the UK’s most successful healthcare organisations, SUHT provides local hospital services to over 1.3 million people living in

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HC2011 – Health Informatics Congress is the UK’s largest, most powerful & rewarding event for health & social care informaticians, ICT professionals & clinicians.

A three day conference & exhibition, combined with an innovative range of events & opportunities, is designed to challenge & engage all those working in health informatics & social care, including commercial organisations & other major stakeholders.

Debating the key issues surrounding NHS re-structuring and transformation NHS Leaders that will speak include: • Christine Connelly ( Director General for Informatics for the Department of Health) • Mike Farrar (Chief Executive, NHSNW) Special focus on professionalism and leadership,

• Attendance by high quality delegates and visitors, guarantees that exhibitors meet those who make and implement operational and purchasing decisions • Opportunity to meet with other important exhibitors, in order to establish mutually beneficial commercial relationships/partnerships • Increased exhibition space will accommodate

with an all day master-class supported by:

returning and new exhibitors wishing to join the

• Michael West (Executive Dean Aston University)

expanding HI community gathering at HC2011

• Aidan Halligan (Director of Education University of London College Hospital) • Professor Rachel Munton (East Midlands Leadership Academy) Conference delegate registration is now open!

• Exhibitors will benefit from HC’s established reputation, by enhancing their presence with a sponsorship package

Exhibition visitor registration is now open!

Contact Dennis Wheatley, Sales Manager, Citadel Events T 01423 526971, E dennis.wheatley@citadelevents.co.uk, W www.hcshowcase.org

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HEALTHCARE IT

THE POTENTIAL OF INFORMATICS Health Informatics Congress, run by BCS, The Chartered Institute for IT, will once again push the boundaries when it comes to addressing the issues facing the health informatics community

INITIATIVES ON GP COMMISSIONING, increased focus on public health, regulation and accountability will all impact on the way healthcare services are provided and health informatics will have to respond and react.

HC2011 in April is ideally timed for us all to look at the emerging picture and map out the key lines of development for ICT services. It’ll be a chance to ensure that there is “no decision about us, without us”.

Mike Sinclair, chair of the organising committee, adds: “Next spring will be a very interesting and challenging time for everyone in the public sector. More than ever we must do everything we can to support health and social care services in making the most out of information and informatics services.

Not only are the usual incentives there (care and treatment, safety and experience), but the service has to continue providing, and improving these whilst making efficiency and productivity savings like never before.

HC2011 will do everything it can to support this complex and challenging agenda.”

KEYNOTE SPEAKERS ANNOUNCED Senior government speakers will use the forum provided by the event to discuss the new direction for healthcare information following publication of the White Paper.

Consultations on the Information Revolution and Choice will be near completion. Keynote speakers from the NHS leadership include: • Christine Connelly (director general for

Informatics for the Department of Health) • Mike Farrar (chief executive, NHSNW) There will be an all day masterclass with a special focus on professionalism and leadership, supported by: • Michael West (executive, Dean, Aston University) • Aidan Halligan (director of Education, University of London College Hospital) • Professor Rachel Munton (East Midlands Leadership Academy) Practical sessions for individuals to learn and gain skills that will be of direct use in their day to day working life (including free coaching and mentoring sessions) will run throughout the event.

With the NHS seeing some potentially dramatic changes in the way it engages with and utilises informatics services and systems, two provocative academics have been invited to promote innovative thinking in the area: • Professor Terry Young (chair of Healthcare System, Brunel University) • Professor Andy Stirling (Science and Technology Policy Research Unit, University of Sussex) As in previous years the event includes special focus sessions on best practice in the local NHS, with a regional showcase from the East Midlands, chaired by Dave Marsden, director of Strategic IMT (CIO), NHS East Midlands and NHS East of England.

With information becoming a more significant part of the health service and how it works,

a parallel set of streams will run during the conference, looking at the implications for the service, and examining patient and public use of information, culminating in a debate on how to manage the tension between the two perspectives. Keynote speakers in these sessions will include: • Richard Hamblin, director of Information, the Care Quality Commission.

• John Newton, director of Public Health, South Central SHA There will be four conference streams over the three days and other key topics to be debated will include: • The ASSIST national conference – with special focus on personal and professional development • Open source/open data: a session and exploration on how to best utilise open source systems in the new NHS • Effective Informatics: how informatics services and systems can contribute to the massive need to increase productivity and efficiency in the NHS • Sessions from BCS Health, including updates on the policy and strategy group, and from the nursing and primary care specialist groups • Links and representation from the academic world (including the Faculty of Health Informatics and NHS HE) • A special international session supported by UKTI and Intellect.

DYNAMIC EXHIBITION EXPERIENCE BCS, The Chartered Institute for IT, and Citadel Events have created an alignment and connection between the conference content and the commercial sponsors and exhibitors, with a view to facilitating relationship building and business development opportunities between all sectors of the HI community.

Hall 3 at ICC Birmingham will form the focus of the exhibition, but with space now very much at a premium adjacent areas are being opened up to satisfy demand. Returning companies to HC pledge their support based on their positive experience of the 2010 event interfacing with senior, high quality visitors and delegates. A high percentage of new companies are also contracting on a daily basis. Interested parties should contact Citadel Events on 01423 526971.

FOR MORE INFORMATION HC210 takes place from 5-7 April 2011 at the ICC, Birmingham.

Conference delegate and exhibition visitor registration is now open at www.hcshowcase.org

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CATERING

NO ONE SHOULD GO HUNGRY The National Association of Care Catering has launched a nutrition standard to help older people receive a meal service they deserve AIMS & OBJECTIVES OF THE NACC • To promote and enrich the standard of catering within the care sector, whether that catering be provided by social services departments or other caring agencies.

• To provide a forum for debate among individuals, companies and organisations of all kinds involved in catering for the care sector.

• To facilitate the exchange of information, experience and expertise.

• To promote the development of professional standards among those involved in catering for the care sector.

• To commission research into matters relating to catering for the care sector.

• To publish guidelines, policy papers and authoritative statements on all aspects of catering for the care sector.

ONE IN TEN OLDER PEOPLE IN THE UK are at risk from malnutrition according to a report launched recently by the National Association of Care Catering (NACC). With figures showing that by 2033 an estimated 23 per cent of the UK population will be aged over 65 and a further 3.2m aged over 80, the number of older people suffering from malnutrition is set to rise even further.

Malnutrition among older people can lead to increased hospital stay, increased readmission rates and increased transfer and admission to care homes, all of which cost the government money. Investing in the care catering sector rather than cutting these services will actually help save money in the long term. For example, research in Australia has shown that spending £1 on good nutrition is likely to save £5 on the health budget as care packages are reduced.

In order to tackle the issues raised in the report the NACC has announced the launch of a Nutrition Standard, which will provide an up to date guideline for those providing community meals services.

SINGLE NUTRITIONAL STANDARD In a bid to improve meal services for the whole of the UK the NACC and the Caroline Walker Trust have agreed a single Nutrition Standard to be used by all in the sector, helping improve the nutritional content of food. Using two nutritional guidelines has led to problems for local authorities in regulating services, causing large variations in nutritional care throughout the UK. The new Standard not only provides a clear benchmark for the nutritional content of food, but also gives guidance on hydration, food intolerances, special

dietary requirements and food labelling.

Current government nutrition guidance does not give clear nutritional advice for older people. Recommendations from the Food Standards Agency (FSA) include all ages from 65 upwards, but the needs of older people change with increasing age. There is little guidance available on the risk of being underweight for the elderly. In order to tackle the problem of malnutrition the government is urged to support the Nutrition Standard and recognise the role of good nutrition for the elderly.

Derek Johnson, NACC chairman said: “The Nutrition Standard will ensure consistency in the nutritional content of food provided throughout the care catering sector. The launch of the standard builds on the ’10 Key Characteristics for Good Nutritional Care’ initiative. It is, however, still vital that government support this standard and are committed to providing care for the elderly, not only allowing them a real choice in care services, but also saving the NHS money in the years to come.”

CARE SERVICE PROVISION The report, compiled from a roundtable discussion chaired by Baroness Greengross, points out good nutrition is not just about food, but also about care service provision.

To give older people the support they need, community meal provision and access to food should be considered as a core part of the social care package provided for all older people.

“The report identifies those working in the care catering sector as being in an ideal position to monitor the health of older people and encourage them to eat well, lowering the risk of malnutrition,” explains Derek Johnson.

“Regular delivery of meals to the home is

key to ensuring older people have regular contact with others. However, the need for local authorities to cut costs due to slashed budgets has led to a reduction in these services, with personalisation reduced to the lowest common denominator in some cases, meaning social interaction and its vital role in good health is ignored. The government must support both a Nutrition Standard and the 10 Key Characteristics to ensure older people get the type of care they need.”

REFERRAL PROCESS Changes in how older people are referred for care catering services has also had a negative impact on the number of older people at risk from malnutrition. When considering who needs the service only those who are already suffering from malnourishment are recommended, leaving the number at risk from malnourishment growing.

As a result the NACC believes the referral process for community meal provision needs to be opened up to include older people who are at risk, preventing them from falling into the cycle of malnutrition. Using a screening tool such as the British Association for Parental and Enteral Nutrition’s (BAPEN) Malnutrition Universal Screening Tool (MUST) will help to identify the risk, and lead to services being put in place to prevent further deterioration.

By investing in these recommended changes the NACC believes the government will be securing the care of older people both now and in the future. This will not only provide a Nutrition Standard, ensuring all food in the care catering sector is of a good nutritional content, but will also introduce a joined up service where the health and wellbeing of older people is crucial.

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CONFERENCES & EVENTS

A STIMULATING ENVIRONMENT Choosing an academic venue to hold your conference or event offers value for money, without a compromise on product or service, writes Kirstie Danzey, Nottingham Conferences UNIVERSITIES WITH CONFERENCE facilities are suitably placed to offer event organisers a viable venue option in the current economic climate. Based throughout the UK, their main reason for being is to provide a varied, accessible and stimulating learning environment.

Ranging from those traditional universities steeped in history, featuring impressive architectural surroundings to a new raft of universities with modern state of the art facilities, they offer not just something for the student population, but are also a credible venue choice for the meetings, conferences and events market.

LIVING UP TO EXPECTATIONS These stimulating environments at universities provide inspiring locations for event organisers but do the facilities and service provided live up to expectations?

Traditionally, academic venues have been favoured by the association, sports and notfor-profit sectors. Limited availability of facilities and varying standards has not always painted a positive picture for event organisers looking for an inspiring location with facilities and a service that meets their expectations.

However, many of the larger universities now offer meeting facilities and overnight accommodation all year round. They have continued to invest heavily in their meetings facilities even in the current economic climate to keep up with the requirements of students and conference organisers. This has enabled them to retain a competitive advantage compared with other conference venues, boasting a healthy ratio of repeat business.

Those universities with year round meetings facilities but limited overnight accommodation out of student vacations develop strong relationships with adjacent hotels to offer a complete residential conference package all year round.

As well as benefitting the university, there is a significant economic impact on the local economy. The two ‘customers’ for the universities generally complement each other.

Those universities with purpose-built, all year round facilities often employ specific teams dedicated to the needs of the event organiser.

For those with limited availability, students clearly take priority during term time but when they leave for vacation, they also leave often in excess of 1,000 bedrooms which the conference teams actively sell to larger organisations. The more traditional association, sports and not-forprofit sectors often require a large number of bedrooms to be reserved which hotels are not always willing to do a long way in advance.

POSITIVE FEEDBACK

Ranging from those traditional universities steeped in history, featuring impressive architectural surroundings to a new raft of universities with modern state of the art facilities, they do offer not just something for the student population, but are also a credible venue choice for the meetings, conferences and events market Strong award-winning marketing campaigns have helped to raise the profile of academic venues to a wider audience, earning them a credible place in the meetings, conference and events market. The consortium VenueMasters provides a collective marketing opportunity for academic venues as well as networking opportunities for the venues to learn best

practice and keep up to date with current market conditions. But do the facilities and service provided by academic venues live up to the promises made in their marketing drives?

Recent research carried out by VenueMasters with 200 buyers, 73 per cent of whom had used academic venues suggested that they do. 53 per cent of these buyers who had

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The perfect place for your next event Situated in the stunning, recently transformed Grade II* listed building at Nottingham Trent University, Nottingham Conference Centre offers an exceptional setting for any event.

• Executive boardrooms, meeting rooms and large lecture theatres

• Dedicated event management, delivering bespoke events every time

• Fully integrated audiovisual technology in all meeting rooms

Find out more about Nottingham Conference Centre, arrange a visit or contact us to discuss your next event.

• Unique and beautiful rooms for that very special occasion

• Competitively priced, all-inclusive packages • Outstanding catering from gala dinners to private dining

+44 (0)115 848 8000 enquiries@nottinghamconferencecentre.co.uk www.nottinghamconferencecentre.co.uk Nottingham Conference Centre, Burton Street, Nottingham NG1 4BU

5825b/10/10

Egrove Park, Oxford Egrove Park is Saïd Business School’s purpose-built executive education centre situated in 37 acres of parkland two miles from Oxford city centre. Service, flexibility and personal attention are the keynotes at Egrove Park.

Facilities include: • Wide range of meetings rooms – from a lecture theatre seating 112 to smaller syndicate rooms for break-out sessions • The latest high-tech and multimedia facilities and full IT/AV support from our Microsoft Certified Technicians • 63-en-suite study bedrooms • On-site gym, sauna, squash courts, an all-weather tennis court, a croquet lawn and a snooker room • Award-winning food and drink • Easy accessibility by road or rail with plenty of free, secure parking To find out more call Jill Grieveson on 01865 422757, email conference.egrove@sbs.ox.ac.uk or visit www.sbs.oxford.edu/conferencing

London

Training Meetings Conferences T: 020 7631 8306 E: conference@pccc.co.uk W: www.pccc.co.uk

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CONFERENCES & EVENTS

used academic venues thought their facilities were the same or better than hotels and 58 per cent believed they were the same or better than conference centres. And all buyers rated value for money as the most important factor when selecting a venue.

Looking to the future, although these buyers are predicting an increase in the number of events being planned for 2011 compared with 2009, the increase in expenditure predicted did not necessarily match, suggesting that value for money would continue to be a major decision-making factor.

Good news then for academic venues, often able to offer a variety of options for an event organiser, especially if budgets are tight. The wide range of different facilities available at an academic venue can also offer a number of options to an event organiser, without compromising on the overall quality of the event.

ACADEMIC FACILITIES IN NOTTINGHAM The conference facilities at the University of Nottingham were re-branded under the collective ‘Nottingham Conferences’ banner in May 2008. Prior to then, the same set of facilities had been promoted either under the purpose built all year round banner of the East Midlands Conference Centre or the University of Nottingham Conference Centres, which reflected all of the conference facilities available over three campuses in student vacations.

A confusing picture then for the event organiser and the team selling both products?

Two years on and now that the Nottingham Conferences brand is established, the team have effectively been able to market their complete range of products to a wider market and offer options for clients depending on their requirements. They still have a number of clients in the association, sports and notfor-profit categories but have found that corporate clients are now considering not just the year-round East Midlands Conference Centre, but also facilities based on Jubilee Campus and Sutton Bonington, where on-site accommodation can also be offered.

Teaching facilities continue to be invested in on all campuses, and on University Park current ongoing building work totaling over £10 million is a combination of brand new teaching buildings and extensions to existing facilities. This will provide a new 380-seat tiered curved theatre and a number of small meeting rooms for 2011, to further complement the existing offering.

SPECIFIC ACADEMIC FIELDS For event organisers looking to attract speakers who are experts in a specific academic field, universities often offer a wealth of relevant resources. And with ongoing research being carried out, they offer a unique resource for a conference. Experts in their own field are also

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UNIVERSITY OF WALES INSTITUTE, CARDIFF

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Situated at a prime waterside location the Innovation Centre in Chasewater Country Park offers fully equipped training and conferencing facilities that are available for hire weekdays and weekends Easy access from the A5 and M6 Toll (T6 Burntwood) For more information contact: Chasewater Innovation Centre, Chasewater Country Park, Pool Road, Brownhills, WS8 7NL.

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CONFERENCES & EVENTS

often keen to showcase the university where they are based and conference teams based at universities can help organisers to find a relevant speaker from sources on campus.

Award-winning chefs are now commonplace in academic venues, allowing a range of high quality menu choices to suit a variety of different events.

Profits generated from conferences held at academic venues are reinvested into the university. As well as providing a source of income for keeping these meetings facilities up to date, revenue can also be invested back into other learning facilities. At a time when the funding of higher education is being reviewed universities are recognising the importance of the revenue streams that hosting conferences and events can generate.

INVESTMENT IN THE FUTURE In November of this year the EMCC, Nottingham Conferences flag ship venue will be celebrating its Silver Jubilee. Rather than hosting a lavish celebration, the conference team decided to work alongside the community partnerships team at The University of Nottingham to develop a range of activities with local school children. In

February the teams launched a competition to develop a logo to celebrate the anniversary that will be applied to certain publicity materials linked in with the celebrations.

Rather than paying a graphic designer to design a logo, the team developed a project in partnership with three local primary schools.

In May, 115 pupils from Dovecote Primary, Whitegate Primary and Milford Primary schools in Clifton, Nottingham visited the East Midlands Conference Centre to find out the winner of the competition. The winning team were presented with their certificates

by Chris Jagger, chief estates and facilities officer at the University and then went on to spend a morning at a local design studio to see their winning design transformed onto the website and a new advertising campaign.

After the summer break, the same children who are now in year six were presented with the second part of the project.

Ian Litchfield, head chef at the East Midlands Conference Centre visited each of the schools to launch a competition by asking them to design a healthy sandwich. After inspiring them with knowledge gained over his 15 years experience at the East Midlands Conference Centre, Ian left the teams to consider their

New conference and events facilities at UWIC SPECTACULAR new building opened for business at UWIC Llandaff Campus in September 2010.

Built around a central atrium with a garden terrace and views of Llandaff Cathedral, the venue comprises more than 20 seminar and meeting rooms, five tiered lecture theatres and a purpose built Hospitality and Conferencing Suite.

All seminar rooms and lecture theatres are equipped with the latest audio visual equipment along with sound systems in larger rooms and Wi-Fi access available throughout the building.

An extensive ground floor area will accommodate exhibitions and catering for large scale conferences.

The Hospitality and Conferencing Suite is a contemporary and flexible venue furnished to a very high specification suitable for corporate events, meetings, training and presentations.

Available to hire for private functions the Suite has a restaurant and a comfortably furnished lounge

choice of bread and filling, paying particular attention to presentation and ease of eating along with a full ingredient listing and costs and an illustration of their creations. Entries will be judged by Ian and a panel of colleagues and two teams from each school will be shortlisted to return to the EMCC’s kitchens to prepare their designs from scratch in a ‘Ready Steady Cook’ style event at the end of November.

THE COMPLETE PACKAGE Nottingham Conferences represents the entire range of conference facilities at The University of Nottingham and incorporates the East Midlands Conference Centre, University Park, Jubilee Campus and Sutton Bonington. A flexible range of facilities are available for conferences meetings and events across the four locations, all supported by dedicated event coordinators, on-site audio visual support and award winning chefs. Accommodation is available on site during student vacations or in adjacent hotels via a dedicated hotel reservation service.

FOR MORE INFORMATION Web: www.nottinghamconferences.co.uk

Ideal venue choice for your

Healthcare Events in London accommodation I conferences I exhibitions I dinners I meetings & seminars

A

bar area. With formal and informal dining options, and a licensed bar available, the venue will be perfect for family celebrations and memorable occasions.

Easily accessible from the M4 and close to Cardiff City Centre, this prestigious new facility will be an ideal venue for a variety of corporate events and private functions. Whatever your requirements, our dedicated conference team will be available to assist in all aspects of your event.

FOR MORE INFORMATION Tel: 029 20416181 E-mail: conferenceservices @uwic.ac.uk Web: www.uwic. ac.uk/conferences

Imperial College London, South Kensington Campus, London SW7 2AZ www.imperial.ac.uk/conferenceandevents conferenceandevents@imperial.ac.uk +44(0)20 7594 9494

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GP COMMISSIONING

GRASPING THE GAUNTLET OF CHANGE – THE CHALLENGE FOR GPs There is no time to lose in starting to plan for the implementation of commissioning and GP consortia, says Mark Johnson, managing director of TPP Law A BRISK TIMETABLE IS BEING SET by the Secretary of State for Health as the NHS is marched inexorably towards the brave new world where GPs are in the vanguard of shaping and driving the “what” and “how” of health service delivery. Despite some forthright objections from GP organisations, the coalition government is determined to effect a radical change in NHS services and realise its long-term vision for the NHS as set out in the White Paper ‘Equity and Excellence: Liberating the NHS’.

At the heart of the change is the shift of decision-making to be as close as possible to individual patients by devolving power and responsibility for commissioning services to local consortia of GP practices. PCTs will be wound up by 1 April 2013. This fundamental change in system architecture will bring together responsibility for clinical decisions and for the financial consequences of these decisions.

STATUTORY BASIS The White Paper indicates that GP commissioning will be put on a statutory basis, with powers and duties set out in primary legislation, due to be published in a draft Bill early in December. Consortia of GP practices, working with other health and care professionals, and in partnership with local authorities, will commission the great majority of NHS services for their patients. However, they will not be directly responsible for commissioning services that GPs themselves provide.

The new NHS Commissioning Board will calculate fair share practice-level budgets and allocate these directly to consortia. The consortia will hold contracts with various providers and may choose to adopt a lead commissioner model. GP consortia will need to include an accountable officer, and the NHS Commissioning Board will be responsible for holding consortia to account for stewardship of NHS resources and for the outcomes they achieve. In turn, each consortium will hold its constituent practices to account against these objectives. Every GP practice will need to be a member of a consortium, as a corollary of holding a registered list of patients.

A BRISK TIMETABLE Practices will have increased flexibility within the new legislative framework to form consortia in ways that they think will secure the best healthcare and health outcomes for their patients and locality. The Department has said it wants implementation to be bottom-

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up, with GP consortia taking on their new responsibilities as rapidly as possible and early adopters promoting best practice.

The Secretary of State announced on 21 October a programme of pathfinder consortia, which will be supported to develop their ideas and form a learning network. Andrew Lansley said: “There will be no complex approvals process. Simply show that you have local GP backing, strong clinical leadership, engagement with your local authority and are fully signed up to the Quality and Productivity agenda locally.”

GPs now need to start designing appropriate arrangements to respond to this new agenda. Mr Lansley wants 2011-12 to be “a year of substantive development of consortia relationships, engagement, leadership and identification of preferred support arrangements.”

BUILDING CONSENSUS AND LEADERSHIP It seems unlikely that the government will prescribe a model for GP consortia. GPs have the opportunity to seize the initiative

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GP COMMISSIONING

and craft something that works for their locality. The White Paper was not clear on whether consortia would be statutory public corporations, or could instead be independent social enterprises.

Whichever is adopted, there is merit in starting to put in place governance structures now which facilitate leadership, cooperation and decision-making across a large group of practices. This includes choosing and developing a leadership team with a clear mandate to plan for the future and defining

the organisation’s mission and values.

My experience in shaping PBC consortia is that it can take two years to get buyin from practices, populate the board and agree the work programme. There is no time to lose in starting this process to full implementation by 1 April 2013.

A key aspect of successful consortia will be their ability to drive behavioural change.

In the PBC consortia I have assisted, an attractive feature for members has been an extensive programme of education and

The new goal for GPs and their commissioning consortia is to deliver a radically different health system, where GPs understand what is being spent and the outcomes being achieved; and crucially, it must cost less to run

training to help influence behaviour on referrals and prescribing, coupled with an incentive scheme which rewards success. These could be crucial ways to achieve wider buy-in.

GOVERNANCE ISSUES As stewards of public funds, consortia will need to demonstrate robust policies and procedures. A particular area of risk will be the management of conflicts of interest.

Written policies will be required to ensure that GPs who have an interest in the letting of a contract to their practice or a provider in which they have a stake, must absent themselves from decision-making on this issue.

Consortia may find it beneficial to clearly separate the functions of care pathway design, from those of actually letting and managing contracts. Accountable officers will need training on their legal duties and how to manage a wide range of risks, from financial overspend to clinical incidents and compliance with equalities legislation.

LEGAL AND COMMERCIAL TRAPS One key risk for consortia to consider is the extent to which consortia will inherit liabilities from outgoing PCTs. These could stem from two main sources. Firstly, the cost base and liabilities associated with any staff transferring from PCTs. Consortia must consider carefully whether support services could be outsourced to mitigate this risk or instead provided in-house by former PCT staff. If the former, then TUPE Regulations could apply to transferring PCT staff. Particular care is needed in assessing the payroll, pension and other costs (such as historic claims or enhanced redundancy rights) associated with these staff.

Secondly, consortia will need to avoid unwittingly taking on any structural debt or long-term liabilities associated with contracts or assets that may transfer when PCTs are wound up in 2013.

Consortia should develop or source skills to run tender processes, let, manage and, crucially, enforce contracts with a diverse range of service providers. Advice will be required on compliance with public procurement regulations for certain types of contract.

NEW GOAL The new goal for GPs and their commissioning consortia is to deliver a radically different health system, where GPs understand what is being spent and the outcomes being achieved; and crucially, it must cost less to run. Prospective consortia should begin preparations now, and keep an open mind on how to deliver this daunting challenge.

FOR MORE INFORMATION A free report on how to prepare for GP commissioning is available at www.tinyurl.com/tpplaw

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ADVERTISERS INDEX The publishers accept no responsibility for errors or omissions in this free service 14 Services

Elta Group

60

Pavillion Publishing

126

105

Endress & Hauser

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People Opportunities

99

3D Access

40

Entry Parking Post

85

People Resolutions

Abacus Main

40

Environ Consulting Engineers

59

Phoenix Building Systems

74

Acorn Chemical Services

36

Fiat

OBC

Phoenix Private Ambulance Service

96

Acquaint Consolidated Services

42

First Data Bank Europe

118

PHS Group

73

ACS BPS

82

First Signs & Labels

64

Premier Life Skills

96

Action Assist

48

Flexiform Business Furniture

48

Pro-Mech

37

Acute Ambulance & Medical Services

IBC

G2 Speech UK

114

Progress Through People

20

Advanced New Technology

69

Gael

120

Prominent Fluid Control

32

20/20 Research

Advantage Healthcare Group

108

100

Global Entertainment Management UK

28

Proventec Healthcare

42

Alchemize

73

Green Street Berman

20

Qube Structures

77

Allgood

30

Grundon Waste

70

Quorum Training

16

60

Haigh

30

Analox Censor Technology

Radio Tech

56

Angel Human Resources

108

HC2011

122

RED Professional Locums

10

Anoto

115

Health Surveillance Services

107

Regional Contract Services

40

Rentokil Specialist Hygiene

38

ROCC Computers

20

Avanti Cleaning Solutions

42

Helix SMS

110

Bemrose Booth Paragon

84

Hydroviron

36

Blenheim and Moorcroft

40

Imperial College

BPS Projects

34

Indepth Hygiene Services

43

Saville Audio Visual

65

Brady Corporation

73

Innovations in Technology

62

Schneider Electric

59

Braille Signs UK

63

Institute of Healthcare

Brandon Medical Company

48

Engineering & Estate Management

50

Singers Healthcare Finance

16

British Independent Utilities

4

Kaba Door Systems

48

Southern County Ambulance Service

96 100

131

RSA Security

Securenvoy

116

121

British Toilet Association

42

KAD Environmental Consultancy

66

Specialist Services Training Solutions

Broadwood International

89

Kat Communication

90

SRCL

73

BWA

44

Lorne Laboratories

50

Swiftclean

37

Carbon Energy Solutions

54

McAvoy Group

76

Tekadoor

60

Carefusion

27

McGowan Transcriptions

Teknomek Industries

50

Cayford Architecture

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Middleton Air Conditioning

60

The Powerworks

50

Charm Office Solutions

65

Mitrefinch

98

The UK Parking Patrol Office

85

Chasewater Innovation Centre CitroĂŤn

130

Monodraught

105

8

The University of Leeds

130

TPS Parking Solutions

89

Tritec Environmental Services

37

6

Mouchel Group

36

Claude Lyons

56

MRN Mediation

100

Cleanwise Training and Management

41

MĂźller Dairy

Cordtape Energy Management Systems

52

New Generation Parking Management

Corporate Harmony

100

NHS Supply Chain

TSS Facilities

36

84, 86

2

UKPC

83

14

UWIC

130

Courtney Thorne

18

NISI Staffing

108

Variable Message Signs

CP Electronics

58

Nottingham Conference Centre

128

Victory Services Club

130

Dart Valley System

49

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Acute Ambulance & Medical Services Providing a range of options to satisfy your patient transfer needs.

3 Specialise in Renal Transport 3 Excelling in Transfer of Care 3 Inter Hospital Transfers 3 Post Treatment Transfers 3 Repatriation Work 3 Out of Hours Transfers 3 Cardiac Transfers (including monitoring) 3 Paediatric Transfers 3 Out Of County Transfers 3 Wheelchair Transfers A.A.M.S tailor our services to meet your specific requirements, utilising a range of highly trained staff, including Technicians, Nurses and Paramedics. Our rates are competitive and we are regulated by NAPAS.

Please call 0845 686 0301 for a quote today.

On call 24 hours a day 365 days a year and respond within 90 minutes (subject to availability).

Ambulance Stations: Bletchley & Andover Head Office: Arrows Business Centre, 39a Barton Road, Bletchley, Bucks MK2 3HW www.aams-amb.co.uk