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DESIGN & BUILD Modular buildings provide value and quality

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HEALTH & SAFETY – Making lone workers’ health and safety less of a solo effort

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DESIGN & BuILD

Modular buildings provide value and quality

pLuS

Find workable built environment solutions at Future Health & Care Expo

HEALTH & SAFETY – Making lone workers’ health and safety less of a solo effort

Comment

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DEAR READER There have been worrying reports that waiting times for x-rays, cardiology tests and ultrasound scans are increasing, sharply. David Cameron on the other hand recently promised to ensure that waiting times do not rise, making this one of his five personal pledges to voters on the NHS. But with a tight financial situation, how will this be met?

Other targets trusts need to meet are those on infection rates.

Scarborough and North East Yorkshire Healthcare NHS Trust is showing impressive results in the fight against C. diff after establishing an executive led outbreak committee and implementing an action plan. Turn to page 11 to find out more.

The current economic climate is presenting facilities and estates managers with some tough challenges. They have a significant role to play in supporting the drive towards greater efficiency, and the right skills must be in place to deliver this, says Asset Skills, the Sector Skills Council for Facilities Management, on page 19.

Enjoy the issue.

Sofie Lidefjard, Editor editorial@psigroupltd.co.uk

P ONLINE P IN PRINT P MOBILE P FACE TO FACE If you would like to receive 12 issues of Health Business magazine for £95 a year, please contact Public Sector Information Limited, 226 High Road, Loughton, Essex IG10 1ET. Tel: 020 8532 0055, Fax: 020 8532 0066, or visit the Health Business website at:

www.healthbusinessuk.net PUBLISHED BY PUBLIC SECTOR INFORMATION LIMITED

226 High Rd, Loughton, Essex IG10 1ET. Tel: 020 8532 0055 Fax: 020 8532 0066 Web: www.psi-media.co.uk EDITOR Sofie Lidefjard ASSISTANT EDITOR Angela Pisanu PRODUCTION EDITOR Karl O’Sullivan PRODUCTION DESIGN Jacqueline Grist PRODUCTION CONTROL Julie White ADVERTISEMENT SALES Jasmina Zaveri, Beverley Sennett, Kim Fouracre, Amanda Frodsham, Duncan Riggs, Matt Eaton, Neil Sharma SALES ADMINISTRATION Jackie Carnochan, Martine Carnochan ADMINISTRATION Victoria Leftwich, Alicia Oats SALES SUPERVISOR Marina Grant PUBLISHER Karen Hopps GROUP PUBLISHER Barry Doyle REPRODUCTION & PRINT Argent Media

© 2011 Public Sector Information Limited. No part of this publication can be reproduced, stored in a retrieval system or transmitted in any form or by any other means (electronic, mechanical, photocopying, recording or otherwise) without the prior written permission of the publisher. Whilst every care has been taken to ensure the accuracy of the editorial content the publisher cannot be held responsible for errors or omissions. The views expressed are not necessarily those of the publisher. ISSN 1362 - 2541

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CONTENTS 07 NEWS

32 FIRE SAFETY

11 INFECTION CONTROL

If you don’t have a fire strategy in place that complies with current legislation and provides a safe patient environment, there is no time to lose

Scarborough and North East Yorkshire Healthcare NHS Trust explains its successful infection prevention and control strategy

15 PROCUREMENT 2011 will see a new era for sustainable procurement, says Action Sustainability

19 FACILITIES MANAGEMENT Developing the skills of facilities managers is crucial in these tough times, writes Asset Skills

25 DESIGN & BUILD Being able to add a modular building without the day-to-day disruption of onsite construction is critical for the health sector, argues the Modular & Portable Building Association Future Health & Care Expo brings together key stakeholders to find workable built environment solutions as a means to improve patient care

31 ENERGY How can innovative solutions like voltage optimisation help reduce a hospital’s energy consumption?

35 HEALTH & SAFETY Making lone workers’ health and safety less of a solo effort is the responsibility of the employer, says the Institution of Occupational Safety and Health

39 AMBULANCE SERVICES West Midlands Ambulance Service scooped two awards at this year’s Emergency Service Awards.

We find out the secret behind the two winning projects

45 MOBILE TECHNOLOGY Nick Hunn from the Mobile Data Association looks at how the health sector is embracing the humble mobile phone to transform the way it works

51 INFORMATION DESTRUCTION The British Security Industry Association discusses the need for effective information destruction to counter security breaches

Contents

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55 HOSPITAL ENTERTAINMENT With an array of services available there is no reason not to provide a good patient entertainment solution whatever your budget

57 RECRUITMENT The NHS will need to embrace different recruitment models to ensure that budget reductions do not mean cuts to service, urges the Recruitment and Employment Confederation

61 CONFERENCES & EVENTS Known as the Garden of England, Kent offers a selection of remarkable conference venues in both new and traditional settings

64 FINANCE Can healthcare organisations unleash untapped liquidity potential with a sustainable equipment purchasing strategy?

68 CUSTOMER CONTACT Paul Smedley, executive director of the Professional Planning Forum, uncovers the secrets behind five recent success stories in public sector customer contact

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Health informatics: an emerging discipline, an emerging profession

Health Informatics is a new discipline concerning how ICTs are used within healthcare (Bath, 2008). Several definitions of health informatics have been proposed, including the “knowledge, skills and tools which enable information to be collected, managed, used and shared safely to support the delivery of healthcare and promote health” (UK CHIP, 2010) and the “the use of information and information and communication technologies (ICTs) to improve the quality of care and health and well-being of patients, their families and carers, and the general public” (Bath 2008, p. 505). These definitions indicate the vital role of health informatics in healthcare.

Interest in health informatics within the NHS increased following the publication of ‘Information for Health’ (Burns, 1998); since 2002, the National Programme for IT (NPfIT) has invested over £12 billion in developing new systems to improve patient care, including the NHS Care Records Service and the Choose

and Book Service. Most health professions are involved in, or are affected by, developments in health informatics, as systems are developed and implemented through NPfIT. Health informatics is an emerging multidisciplinary profession, including those from IT and information specialties, healthcare professionals and managers. The educational and training needs of these groups can be met by post-graduate courses. For example, the MSc in Health Informatics at the University of Sheffield attracts students from a wide range of professions including hospital doctors and GPs, nurses, pharmacists, public health specialists, librarians and IT specialists (Bacigalupo et al., 2002; Booth et al., 2003). This multi-disciplinary course emphasises the need for collaboration within health informatics.

Health informatics education must cover not only technical aspects, such as information system design and electronic record development, but also the human and management aspects

Information School.

of developing and implementing ICT solutions within healthcare, e.g., leadership and the management of change. Ensuring that the health informatics training and development needs of these professions are met will be important in the success of health informatics initiatives within the NHS in the 21st century.

References Bacigalupo R, Bath PA, Booth A et al. (2002) Studying Health Informatics from a distance: issues, problems and experiences. Health Informatics Journal. 7.3/7.4:138-145.

Bath PA (2008) Health informatics: current issues and challenges. Journal of Information Science, 34 (4): 501–518.

Booth A, Levy P, Bath PA et al. (2005).

Studying health information from a distance: refining an e-learning case study in the crucible of student evaluation. Health Information and Libraries Journal 22 Suppl 2:8-19.

Burns F (1998) Information for health: an information strategy for the modern NHS 1998-2005. A national strategy for local implementation, NHS Executive, Leeds).

UK CHIP (2010) Professionalism in Health Informatics. Available at: http://www.ukchip. org/?q=page/Professionalism-HealthInformatics (Accessed March 2010).

FOR MORE INFORMATION Tel: 0114 2222636 Fax: 0114 2780300 p.a.bath@sheffield.ac.uk www.shef.ac.uk/is/index.html

MSc in Health Informatics

via distance learning.

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For more information about this, or any of our range of programmes, please get in touch or visit our website:

www.shef.ac.uk/is - is@shef.ac.uk - 0114 222 2630

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HEALTH BUSINESS MAGAZINE Volume | 11.6

News

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NEWS IN BRIEF Online staff engagement toolkit now available

EMERGENCY CARE

NHS 111 halts increase in A&E visits Emergency departments involved in the pilot of the 111 phone number for non-emergency care saw four per cent fewer patients in the first five months of the scheme, researchers have found.

The report from Sheffield University on the pilot in NHS County Durham and Darlington looks at the impact of the NHS 111 service on the wider emergency care system. Calls to the non-emergency free phone number are triaged using NHS Pathways software linked to a directory of local services.

Researchers found a 2,553 drop in attendances

at the area’s two accident and emergency departments from August to December 2010 compared with the same period the previous year, against a national increase of two per cent.

Attendances at urgent care centres and calls to GP out of hours services also fell by four per cent.

The number of ambulances dispatched increased slightly. However, a spokeswoman for North East Ambulance Service told the Health Service Journal that NHS 111 had effectively “capped” the number of ambulances sent out from rising further in the pilot area.

CATERING Finger food menu for dementia patients

New online tool to improve patient care in Norfolk

Mealtimes for patients with dementia at Barnsley Hospital NHS Foundation Trust are set to improve thanks to the introduction of a new finger foods menu.

All patients at the hospital suffering with dementia will be offered a choice of finger foods such as pork pies, cheese cubes, potato wedges, bread rolls and chicken and fish goujons, in place of more traditionally served hospital food.

Karen Sharp, matron for older people services at Barnsley Hospital, said: “The initiative will benefit patients in a number of ways helping to preserve their dignity, and ultimately it will be less stressful for them as the everyday foods are prepared in a way that makes them easy to pick up and eat with the hands.

“The food on the menu will meet all their nutritional requirements and will also help promote patients’ independence at mealtimes.”

Bernie Baxter, catering manager, said: “Potentially other patient groups at the hospital will also be able to benefit from a finger food menu option such as patients struggling with dexterity, or post operative patients.”

NHS Employers has launched its new online toolkit, Engaging your staff: the NHS staff engagement resource.

The innovative toolkit contains is a ‘click and go’ guide that provides you with all the information and tools you need to help increase staff engagement in your organisation.

Developed jointly between the NHS Employers organisation and the Department of Health, it contains a wide range of information including an introduction to staff engagement, practical working examples and evidence of the benefits that you can achieve from having an engaged workforce.

Nurses sought for drug testing at Olympics Nurses are to be recruited to play a key role in stamping out the use of performanceenhancing drugs during the 2012 Olympics. UK Anti-Doping, the organisation carrying out sports drug testing for the games, is looking to hire ten phlebotomists from around the country to take blood tests from sportsmen and women.

The recruits will cover Olympic events taking place outside of London, such as football, sailing and rowing.

Anyone interested in applying should visit www.ukad.org.uk

New dialysis unit open

A new, secure online system is being trialled in Norfolk to help GPs discuss patients’ care with hospital specialists.

NHS Norfolk is introducing the webbased communication tool, called ‘Confer’ for a three month trial. GPs will be able to “confer” with specialists and consultants in hospitals over a secure link to discuss an individual patient’s treatment options.

Ultimately, GPs will be able to find the most appropriate care for their patients, whether it is in the community setting or in hospital.

It should increase communication between GP practices and hospitals, improve patient outcomes and reduce unnecessary referrals.

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A brand new £1.5 million dialysis unit has opened at Huddersfield Royal Infirmary.

Former doctors’ quarters have been converted into a modern, purposedesigned facility with up to 14 treatment areas and with dedicated parking spaces for renal patients.

Dr Elizabeth Garthwaite, consultant nephrologist at Leeds Teaching Hospitals, commented: “Renal patients spend a long time on dialysis so providing a facility as close to people’s homes as possible is a key part of our strategy.

We are delighted to have worked with Calderdale and Huddersfield NHS Foundation Trust to create this state-of-the-art new facility on their Huddersfield Royal Infirmary site.”

The facility has been funded by and will be run by Leeds Teaching Hospitals NHS Trust, which provides specialist renal services to patients across West Yorkshire.

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NEWS IN BRIEF Broomfield Hopper bus to be made permanent The Broomfield Hopper free bus service has been given the green light to carry on after proving a great success with patients and visitors to Broomfield Hospital.

Malcolm Stamp, chief executive of mid Essex Hospital Services NHS Trust, said: “I am delighted that the Broomfield Hopper has made a difference to some patients and visitors who were finding it difficult to get around the site since we opened the new hospital wing.

“As a result of this feedback we have decided to make it a permanent service. The only change to the service will be that a new vehicle will be introduced that is able to accommodate wheelchair access.”

The Broomfield Hopper runs from 8.30am to 6.00pm five days a week around the Broomfield Hospital site, also stopping at the Linden and Crystal centres and Farleigh Hospice.

News

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PATIENT SERVICES

SECAmb introduces new 999 triage system South East Coast Ambulance Service NHS Foundation Trust has introduced a new 999 triage system helping patients access the best healthcare for their needs.

NHS Pathways, replacing the American-based AMPDS 999 priority call system, is a sophisticated triage system which prioritises calls based on the clinical symptoms of the patient.

Linked to this system is a

directory of services that provides real-time information about the availability of alternative healthcare services across the region.

Distribution manager Dan Garratt said: “NHS Pathways and the directory of services allow us to help patients reach the right service for their clinical need while freeing up our ambulance clinicians to respond to more serious emergencies that require urgent medical attention.”

Dignity spot checks for elderly in Wales Hospitals in Wales are to undergo dignity spot checks, ministers have said. The Welsh Government announced that it will be asking the watchdog Healthcare Inspectorate Wales to undertake “targeted spot checks to ensure dignity in care is at the top of health boards’ priorities”.

The move is in response to concerns raised by the Older People’s Commissioner for Wales earlier this year. It follows similarly critical reports in England from the health service ombudsman and the Care Quality Commission, which has already been carrying out hospital inspections targeted at the care of older patients.

The Care Quality Commission recently published its fourth batch of 15 reports on inspections at 100 hospitals, focusing on whether older people were treated with dignity and respect, and received proper nutrition.

Scottish health app proves popular A free medical app for smartphones and tablets designed by the Scottish NHS has become one of the most popular free available for download. The SIGN (Scottish Intercollegiate Guidelines Network) app was the idea of professor John Kinsella and outlines what kind of care patients should expect when they suffer from certain medical conditions, such as rheumatoid arthritis, eczema and diabetes.

Professor Kineslla, who works in intensive care at Glasgow’s Royal Infirmary and is also a member of an NHS organisation called Healthcare Improvement Scotland, designed the app after realising he needed a quicker way of accessing the latest NHS guidelines. Since its launch in April, it has been downloaded more than 8,000 times.

INFECTION CONTROL

NICE consults on new advice on preventing and controlling HCAIs NICE, in partnership with the Health Protection Agency (HPA), is currently developing advice on the prevention and control of healthcare associated infections (HCAIs) in secondary care settings as part of a pilot project.

Draft advice, which is aimed at commissioners, managers, clinicians and other professionals working in secondary care settings, and published recently for public consultation, identifies the organisational characteristics, arrangements and practices that indicate whether a secondary care trust is effectively preventing and controlling HCAIs. Drawing on recommendations from the best available evidence, the draft advice consists of 12 statements and indicators that provide specific, concise markers of high quality, costeffective practice and care in the prevention and control of health care associated infections in secondary care trusts. The quality measures accompanying the

advice aim to provide indicators, or ways to measure management and structural processes and associated interventions that improve outcomes in terms of reducing harm from infection in secondary care settings.

Professor Mike Kelly, director of the Centre for Public Health Excellence at NICE, said: “Good infection control practice can only be achieved with strong organisational support and commitment to implementing policies that are practicable and effective in preventing and controlling healthcare associated infections. This draft advice outlines how secondary care organisations can take a whole system approach to tackling the problem, based on the best available evidence, and focuses on organisational-level structures, activities and practices.”

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and care facilities) spreading directly from patient to patient or being acquired from the environment, contaminated equipment or via HCW hands.

Infection Control

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DEALING WITH AN OUTBREAK Following standard outbreak control measures in April to June 2009 – including ward closure, reviewing antimicrobial prescribing and decontamination – the outbreak was declared closed.

In December 2009 a rise in incidence was detected and ribotyping of strains proved that the trust was once again affected by the 027 strain and it had affected several wards.

An executive led outbreak committee was established and an action plan was produced. However, following a number of infection control measures and changes in practice the situation has improved dramatically with the number of cases of C. difficile within the trust reduced by 30 per cent, meaning that the trust attributed cases was 20 cases below its trajectory.

PATIENT SAFETY

C. DIFFICILE: THE SCARBOROUGH EXPERIENCE

Infection prevention at Scarborough and North East Yorkshire Healthcare NHS Trust is showing impressive results following a challenging three years. We take a look at the trust’s strategy Infection prevention and control (IP&C) at Scarborough and North East Yorkshire Healthcare NHS Trust is showing impressive results following a challenging three years.

The trust’s Clostridium difficile rate per 1,000 bed days had not decreased since 2007 and despite always being just below the set trajectory, most other trusts had halved their incidence.

In spring 2009 the trust experienced an outbreak of the 027 strain of Clostridium difficile with a cluster of cases in April, May and June affecting one ward.

WHAT IS C. DIFFICILE? Clostridium difficile is a spore forming bacteria that three per cent of healthy people and ten to 20 per cent of hospitalised people carry in their gut. It is normally kept in check by

the bowels friendly bacteria (flora). Infection ranges from mild to severe diarrhoea to, more unusually, severe inflammation of the bowel (known as pseudomembranous colitis).

The 027 ribotype is a virulent strain which produces more toxin and has a higher morbidity, relapse and mortality rate. It resists standard cleaning and has a greater environmental contamination rate than other strains.

People who have been treated with broad spectrum antibiotics (those that affect a wide range of bacteria), people with serious underlying illnesses and the elderly are at greatest risk – over 80 per cent of Clostridium difficile infections reported are in people aged over 65 years.

C. difficile infection may cause outbreaks in communal settings (for example hospital

ABOUT THE TRUST The trust which runs two hospitals – Scarborough General Hospital and Bridlington District Hospital – provides a range of acute hospital services for around 240,000 people living in and around Scarborough, Bridlington, Whitby and Ryedale.

The diverse area also covers communities in the market towns of Malton, Norton, Driffield, Pickering and Kirkbymoorside as well as the huge rural areas of the North York Moors and East Yorkshire Wolds. As a consequence, there are enormous fluctuations in population numbers, which increase considerably during the summer holidays.

Popularity as a retirement destination also leads to particular demands upon healthcare provision. More than 20 per cent of the population is over the age of 65, against a national average of 15 per cent.

CONTROL MEASURES The dramatic reduction in the number of cases of C. difficile at Scarborough and North East Yorkshire Healthcare NHS Trust came about through various changes in practice and the introduction of a number of control measures, these included: • Reducing visiting hours, which is still in operation today • Suspending all elective admissions for a period in January 2010 to reduce bed occupancy • An isolation unit was opened in March 2010 with admission and discharge criteria • A commitment from the trust board and an additional £500,000 released for improving cleanliness Measures also included the introduction of HPV environment and equipment decontamination initially via an external company to allow full ward decontamination to take place. This was followed by E

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Infection Control

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PATIENT SAFETY performing their entry was professionally produced and staff were invited to vote on who they thought was most deserving of the ‘Wash Factor’ title.

Maggie and the Mopheads were officially crowned the Wash Factor Winner at the Scarborough Hospital Ball.

Otherwise know as domestic supervisor Maggie Oxley and domestic assistants Janet Lockey, Julie Tayne and Shirley Major, the team scooped first place with their rendition of Three Steps to Hand Hygiene’ which was sung to Eddie Cochran’s 1960’s single ‘Three Steps to Heaven.’

To view the winning video of Maggie and the Mopheads visit http://vimeo.com/18500827

E investment in HPV decontamination equipment and staff training so that deep cleaning could take place internally.

Daily executive meetings (which are now fortnightly) and regular walkarounds were introduced, which features a member of the trust board making a series of checks on wards with an infection control nurse.

In addition, every commode in the hospital – a total of 130 – were replaced with a new state-of-the-art version, designed for easy cleaning.

The trust adopted the SIGHT principles and changed to the Five Moments for Hand Hygiene tool. Meanwhile more information about C. Difficile was made available to both staff and patients, through leaflets and staff briefings; coupled with a huge push on hand washing and the use of antibacterial gels.

A revision of a restricted antimicrobial prescribing policy also took place along with the launch of an innovative competition called the Wash Factor.

THE WASH FACTOR A competition was launched during International Infection Prevention and Control week in October 2010 to encourage wards and departments to come up with a song

12

HEALTH BUSINESS MAGAZINE Volume | 11.6

or dance to highlight good hand washing.

The competition was the idea of Donna Winter, infection control nurse, who was inspired to do something creative in order to really push the importance of good hand hygiene.

Donna explained: “Hands are the most common vehicle to transmit healthcare associated infection and it is the role of every single member of staff to ensure that we take hand hygiene seriously.

“With the X Factor and Strictly Come Dancing fever we thought that it would be a good time to hold our own singing and dancing competition, however the twist was that the song or dance had to be about hand washing and infection prevention.

“Staff could choose to either change the words of an existing song, or come up with an original number. Or they could take a popular dance routine and change the actions.”

Wards and departments were asked to send a short clip of their song or dance to the infection control team and were asked to perform their entry in a live final in December.

However, the caliber of the entries was so strong that the judges were unable to make a decision and instead chose four finalists.

A film clip of each of the four finalists

NEW ANTIMICROBIAL PRESCRIBING GUIDELINES New antimicrobial prescribing guidelines in conjunction with neighbouring York Teaching Hospital NHS Foundation Trust were also introduced. Antimicrobial pharmacist Pam Garnett explained: “Antibiotics don’t cause C. difficile but if someone ingests the infection and are on antibiotics, it can multiply.

“We’ve changed the guidelines to include narrow spectrum antibiotics, which are less likely to encourage growth of C. difficile.

“We’re also doing a fortnightly audit of antimicrobial prescribing and trying to encourage doctors to only prescribe antibiotics when they are absolutely needed.”

Following its success in dealing with the outbreak, the trust was invited to share its experience at a national healthcare conference in Birmingham last month by hosting a masterclass in managing infection outbreaks.

Sue Peckitt, deputy director of infection prevention and control said: “This was a real honour for the trust and was a great accolade for all the hard work and effort that our staff have given.”

THE SITUATION NOW Year end figures for 2010/11 showed that the organisation had processed 119 confirmed cases of C. difficile and of these 119 cases, 46 were attributed to the trust, placing it 20 cases below its trajectory for the year.

This is in stark contrast to 2009/10 when there were 170 confirmed cases, 77 of which were attributed to the trust.

Sue continued: “This is a phenomenal achievement, but we’ve not done it on our own. All members of staff have worked very hard to achieve this and they should be very proud of themselves.

“However, we are not complacent because we know that at any time it could reoccur. Patients can come to us from the community or other hospitals that already have Clostridium difficile, so we are trying to work more closely with community staff.

“Our trajectory for 2010/11 is 46 and our priority is to maintain control of the situation so that we can once again meet this target.” L

for all badges. Reports can be generated for each of these based on a sliding timescale.

For management purposes, the Ekahau Hand Hygiene Compliance Reporting tool provides a high level histogram that displays the hand hygiene compliance trending.

HAND HYGIENE

WASHING PAYS

Ekahau enabled monitoring and managing hand washing compliance can significantly reduce hospital-acquired infections Hospital-acquired infections (HAIs) pose a severe patient safety risk, can cost hospitals tens of thousands of pounds per incident to treat, yet can be significantly reduced through proper monitoring and enforcement of hand washing policies.

The World Health Organization (WHO) has identified the link between HAIs and hand washing to be a global problem that should be addressed on national and local levels.

The Joint Commission, CDC and WHO have a variety of information and guidelines on how to develop and manage hand washing policies for hospitals. This includes the use of sanitizer as well as the more traditional soap and water methods. Recommendations to assess hand hygiene compliance include monitoring compliance by direct observation, often in the form of having internal staff or third party “secret shoppers” to track the activities of staff members. Direct observation monitoring is not only costly, but also prone to errors and omissions. Electronic monitoring is a relatively new method for monitoring hand hygiene compliance that may offer significant advantages over direct observation by deploying an automated system to monitor workflow and hand hygiene activity.

THE EKAHAU SOLUTION Operating over the existing Wi-Fi network, Ekahau’s RTLS system can track and monitor staff activities tied to patient care. The system uses a series of patented algorithms and methodologies to “fingerprint” a hospital, its layout and wireless network.

In areas of insufficient coverage, Ekahau Location Beacons (small battery powered transmitters) can be used to supplement the wireless coverage. Through these two approaches, and using T301BD staff badges, the Ekahau system is able to track staff members’ activities within a room or down to the bed-level, giving administrators visibility into staff and patient interactions.

Because the Ekahau tags can communicate bi-directionally over the Wi-Fi network and have built-in text displays, a buzzer and multicolour LEDs, the wearer of the badge can be alerted to status e.g. “Clean”“Dirty” based on the last activity configurable timeout periods.

The Ekahau RTLS system combines staff location and hand hygiene events into a timed series of events, and through a proprietary algorithm, calculates the hand hygiene compliance percentage for each staff badge, specific groups of badges or

Infection Control

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THE BENEFIT By leveraging the hospital’s existing Wi-Fi network and integrating technologies with the GOJO SmartLink™ Series Dispensers, the Ekahau hand hygiene compliance monitoring solution can provide hospitals a unique and cost effective way to monitor hand hygiene compliance. The same Ekahau RTLS system and tags can be leveraged simultaneously for a variety of other applications such as staff safety, wireless nurse call, work order dispatch and management, staff paging and delivering other mission critical events or alarms to the displays on the T301BD tags. Once set up, the same RTLS system can be used for tracking and managing assets, patient flow, environmental monitoring and several other applications.

Since the Ekahau system is based on operating over Wi-Fi which is a globally standardised technology, the system is not only future-proof, but also compatible with virtually any Wi-Fi system available on the market ensuring continued “plug and play” support for the technology for years to come.

Finally, since the Ekahau system leverages your existing wireless network; there is no need to install wired chokepoints, readers, sensors or any other infrastructure.

The system can be rolled out hospitalwide without disrupting any operations, patient care or having to shut down departments for re-wiring. Due to the low deployment cost versus other alternatives and the benefits generate by the system, the total system payback can be generated in months, not years.

Ekahau Inc. is the worldwide leader in Wi-Fi-based RTLS solutions. These solutions include asset tracking, patient flow and safety, staff safety, infection control and wireless temperature and humidity monitoring.

Ekahau’s customers, including several Fortune 500 companies worldwide, are realising the benefits of Wi-Fi based location services and innovative Wi-Fi network planning and optimisation tools. Today, Ekahau’s solutions are used in more than 300 hospitals, as well as in manufacturing, retail and industrial companies, government agencies and the military. L FOR MORE INFORMATION Ekahau Hiilikatu 3 00180 Helsinki Finland Tel: +358 20 7435910 Fax: +358 30 7435919 annina.pierson@ekahau.com www.ekahau.com

Volume 11.6 | HEALTH BUSINESS MAGAZINE

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SUSTAINABILITY

AN OPPORTUNITY FOR CHANGE Shaun McCarthy, director, Action Sustainability, and chair of the Commission for a Sustainable London 2012, ponders the shift in focus from lowest price to consideration of wider impacts The world is warming up, the population is growing and we are using resources at unsustainable rates. If we are to face down this triple threat businesses and governments need to work together in a manner unprecedented since the second world war.

The era of self delivers is long gone. Most public and private organisations do things through their supply chains and have the potential to use their spending power to influence more sustainable behaviour but few maximise this opportunity. In order to really make progress organisations need a common set of standards to work from, they also need significant behaviour change to consider wider aspects of procurement, innovation and assurance.

NEW ERA – NEW STANDARD 2011 will see a new era for sustainable procurement; a subject that was virtually unknown five years ago is now one that is well known but not necessarily well defined or practised.

September 2010 saw the publication of the world’s first formal standard to describe overall sustainable procurement practice.

This is BS 8903, which I hope will enable the UK to lead the world in this discipline by adopting it as an ISO standard in a similar way that the quality assurance world adopted BS 5750 as ISO 9001, the global benchmark for good quality assurance.

This was quickly followed by a book on the subject from BSI publications and guidance for the construction industry from the Construction Industry Research Association (CIRIA) both published in early 2011.

All this means that sustainable procurement is coming of age. Five years have passed since the publication of the government’s sustainable development strategy ‘Securing the Future’, which contained the blindingly obvious conclusion that government may be able to influence markets with an annual spend in excess of £175bn. ‘Procuring the Future’, published a year later, gave us the Flexible Framework, devised to summarise advice from major businesses on how the public sector may set about this task. The Flexible Framework was designed as a strategic guide to the enablers necessary to deliver sustainable procurement, it does not tell you how to do it. BS 8903 and the CIRIA guidance help to fill that gap by

describing the fundamental business drivers, organisational enablers and how procurement practice needs to be done differently.

Over the past five years, many public bodies have adopted the Flexible Framework and this has made a difference. It is time to move on to a more formal guidance standard and then eventually to an ISO standard. Public bodies could do worse than to mandate the standard to their first tier suppliers and insist on an independent evaluation against the requirement.

CHANGING BEHAVIOUR Standards are an important aspect of behaviour change but it is not as simple as this. In order to do something different, an organisation needs to have a reason to do so.

Organisations may have a variety of reasons to be sustainable; they may be led by personal vision, such as the late Anita Roddick of Body shop, by market leadership like Marks & Spencer, by competition like the automotive sector, or by public duty, like utilities and public bodies. All organisations have a unique mix of these motivations and it is vital to understand them in order to make decisions about how you need your supply chain to behave.

An example of this would be Marks & Spencer’s brilliant Plan A. This concept is ubiquitous in their stores and their offices, the vast open plan office is awash with Plan A sceensavers, posters, mugs and suchlike. They are doing this because they genuinely believe they can create a market for more responsible retailers. As part of their work on carbon footprint, they discovered that a significant portion of this footprint is in the way in which their customers wash, dry and iron their clothes. This led them to demand products from their supply chain that can be washed at low temperatures, require less tumble drying or ironing. This is a great example of a core business direction, thoroughly thought through; leading to a substantial change in the expectations of a supply chain.

Businesses and cash-challenged public bodies need a strong reason to do anything, it is no longer acceptable to have sustainability as a bolt-on extra because “it is the right thing to do” or because it is “good PR”. If you don’t have a good reason (or reasons) to be sustainable, then don’t do it. However, businesses should be aware that if you don’t do it you may

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not have a business for much longer.

There is a clear correlation between health determinants and procurement. It is well known that poor air quality has negative health impacts so an emphasis on NOX and PM10 emissions from transport and other equipment such as generators needs to be a priority. The health impacts in manufacture, use and disposal of some materials such as PVC and some metals are well known so their use should be avoided. More general determinants of good health such as good jobs, housing, access to green space and reduced crime can all be tackled through social and economic measures through the supply chain.

The problem is that an infinite number of accountants with an infinite number of spreadsheets would never work out the cost benefit of such initiatives so a leap of faith is needed to address these issues. There are some good examples and I would pick out the Olympic Delivery Authority and Transport for London for particular praise. These are two organisations I work with closely, both have demonstrated the wit and courage to consider sustainable procurement beyond carbon emissions and take into account the important socio economic impacts, measure the results and follow up with suppliers to ensure good performance.

It is essential to prove the link between cost savings and sustainability. It should be obvious that buying things that have less waste, use less energy, require fewer materials and support the socio/economic objectives of the public body concerned will lead to better value. Case studies are hard to find. I am pleased to say I am donating some of the hard earned social enterprise budget from my business Action Sustainability, to make a small contribution to the evidence base by independently reviewing and publishing some key case studies from the London 2012 programme to help prove the case. We are not being paid for this, it is an independent evaluation of the evidence. It won’t be conclusive but it will be a contribution.

INNOVATION The idea of innovation to support sustainability (eco-innovation is the fashionable term) is as compelling as it is challenging. I recently had a fascinating discussion with a potential client who was very interested and passionate about eco-innovation and wanted some help to get more of it into her supply chain. We had a long conversation about how all this may work when she added “….but of course we would expect the product to have a threeyear track record of reliable service, that’s our minimum standard”. By definition it can’t be innovative can it? Needless to say we did not take the conversation much further and I had to put the time down to experience of dealing with yet another procurement professional that does not get it or does not have the wit, courage or authority to take a risk.

Innovation is all about risk; if you don’t E

Volume 11.6 | HEALTH BUSINESS MAGAZINE

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SUSTAINABILITY E have an appetite for risk then there is no point is pretending you are encouraging ecoinnovation or any other sort of innovation for that matter. It is about finding out what the market may be able to provide in the future rather than specifying things you have always had. To quote Henry Ford: “If I had asked my customers what they wanted they would have asked for more horses.”

Are you the sort of buyer who asks for more horses? Or will you take a chance on something new? For the public sector, there is a perceived clash between public duty and risk taking which will need to be managed carefully. There is a difference between careless risk taking and risk management.

It is not all bad news. I have been leading a project recently that we call Green Dragons.

The format is a bit like TV’s Dragon’s Den – CPO’s get to quiz small suppliers of innovative products and decide if they are interested in having the product in their supply chain.

This bit is all great fun but to be honest that is just the beginning – positioning the product at an appropriate point in the supply chain, dealing with sceptical technical people and others is a long haul but it is worth the effort when you help a small, truly innovative supplier break new ground, deliver cost savings, environmental benefits, new jobs and local prosperity.

ASSURE Until recently the application of sustainable procurement was limited to sending a standard questionnaire to all suppliers, performing some rudimentary evaluation to keep the environment people happy and making sure it is never used to make a procurement decision. The question “how do you know” was not often asked.

Times are changing though. I chair an organisation called the Commission for a Sustainable London 2012, an official but independent body responsible for assuring the sustainability of the London Olympics. My role reports directly to the Mayor and the Olympics Minister, and I have a free hand to tell the

public whether the Games are as sustainable as they were claimed to be in the bid.

Whatever your sector; the world of procurement is changing and a shift in focus from lowest price regardless of any other consequences to consideration of wider impacts.

UNITED UTILITIES United Utilities (UU), providing water and wastewater services, embarked on a comprehensive development of sustainable procurement in 2008. UU began by providing training to all supply chain staff in its organisational sustainability goals and how they could make a difference in terms of supply chain management. Staff received a combination of classroom style teaching, interactive workshops, one to one ’surgeries’, a 10-strong Knowledge Group and many informal meetings/coaching sessions.

Employee opinion surveys over the last three years show a significant improvement in staff perception around sustainability; specifically, UU asks their employees if they know how to take action to make the company more sustainable.

In 2008, survey results showed that less than 40 per cent scored favourably in the supply chain department; since the introduction of the sustainable supply chain strategy, this percentage has risen to over 90 per cent. This has also contributed to the retention of key talent in the department and sustainability is now a key driver for any new recruitment.

SKANSKA Skanska has created a comprehensive sustainability strategy aimed at supporting their corporate objective to be the “greenest construction company in the world”. A key element of this strategy is to support their suppliers on the journey “from vanilla to deep green” over a period of time and to achieve “five zreos” related to defects, accidents, environmental incidents, ethical breaches and losses. This is used to assess all projects, and helps Skanska measure

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and meet its sustainability objectives.

The organisation recognises that it cannot deliver its objectives without the support of its key supply chain partners and wants to engage with a supply chain that mirrors its commitment to undertake activities in a sustainable and responsible manner.

Skanska has created a supply chain strategy document that sets out its sustainable procurement policy, key targets and objectives.

The policy sets out very clear requirements and suppliers are being encouraged to join Skanska on the journey to deep green.

FMC TECHNOLOGIES FMC is part of a global organisation and makes subsea Christmas trees for the oil and gas sector. Their current sustainability achievement is remarkable: zero waste to landfill in 2010, 28 per cent reduction in carbon emissions by 2010 compared to 2005, and 25 per cent reduction in water consumption in the same period.

They now have planning consent to build a 1.5mW wind turbine on their site to generate electricity and they plan to make carbon part of their competitive evaluation in the near future as they strive for a zero carbon supply chain in the long term.

For the past two years they have been donating money related to the emissions of their flights (necessary to support their equipment in the field) to a fund called Greenshoots. This is used to fund carbon reduction projects in the community. For two years they have been inviting their clients to “pay” for the carbon embodied in their product by contributing to the fund, which has been met with indifference until recently.

In the past few months two very large clients have decided to get involved, which has led to the Greenshoots Fund being established as a charity and an application will shortly be submitted to the Scottish Charity Regulator. L FOR MORE INFORMATION www.actionsustainability.com www.cslondon.org

Computer Aided Facilities Management software (CAFM) from Tabs FM Tabs FM Ltd represents a mature, user focused approach to Computer Aided Facilities Management software (CAFM).

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Volume 11.6 | HEALTH BUSINESS MAGAZINE

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TRAINING

Karen Waterlow explains how skills development for facilities managers is key to surviving the challenging times ahead The current economic climate and the stringent cuts to the public services budgets are producing challenges to the facilities management and estates organisations in the health and social care sectors.

The organisations are under pressure to deliver more efficiencies and their service providers are being asked to provide more for less to support service delivery.

This is an on-going challenge and some have questioned whether it is even possible to produce more savings, claiming that with fewer resources, standards of service will inevitably drop. However, despite concerns

about service levels and the effects on services to clients, many FM and estates managers are also recognising that their organisation must have the right skills in its workforce to deliver the operational efficiencies and manage change.

INVESTING IN SKILLS There is growing evidence that both FM clients and FM suppliers in healthcare are looking at ways to use skills development to ensure effective operations and implement the process of change. Suppliers to the healthcare sector are being asked to show evidence of

Volume 11.6 | HEALTH BUSINESS MAGAZINE

Written by Karen Waterlow from Asset Skills, the Sector Skills Council for Facilities Management

INVESTING IN THE RIGHT FM SKILLS

investment in skills at all levels and in many public sector contracts, training requirements are becoming increasingly specific and geared towards accredited programmes such as apprenticeships. Investment in skills and particularly apprenticeships also helps support succession planning within the FM and estates teams, with directly employed or via service providers.

Despite the economic challenges, Asset Skills has seen increased skills activity and interest among employers during the first year of operating its new UK Academy for Business Services. In May 2010 the academy was set up

by Asset Skills as a pilot to support the delivery of FM qualifications and specifically the new Apprenticeship in Facilities Management.

It has gone from strength to strength in its first year. Essentially, the academy is a network organisation which provides a direct service to employers looking for support on skills development and training. Employers are able to join the academy to access account management services which enable them to locate the right programmes or qualification and access a selected network E

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Sit up to a smarter way of working

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‘Professor Ergo’ will not only offer you solutions to improve your workstation but will offer ergonomic product recommendations.

This allows businesses to make cost effective decisions, as the recommendations ensure you only purchase what you need and what will have the most impact.

Explore www.ergo.fellowes.com for tips and advice on how you should be sat at your computer as well as product recommendations from Fellowes, to ensure correct ergonomic posture is achieved. The site also offers a toolkit of materials to help promote correct posture whilst working at your computer and a useful video with Professor Ergo providing a virtual tour of and ideal desk layout.

Implementing ergonomics into the workplace is a golden opportunity for all employers no matter how large or small their company, and by engaging with free programmes such as ‘Professor Ergo’, applying the science of ergonomics is easier and more manageable than ever. Visit www. ergo.fellowes.com for more information.

You can also follow SmartAtWork on: * Fellowes commissioned Dynamik Markets Research 2010.

TRAINING

E of training providers and funding where this is available. The employer membership of the academy has continued to grow, initially with FM service supplier companies working in both private and public sectors but increasingly with a number of client FM organisations from a variety of backgrounds.

Initially one of the key roles of the academy was to establish a network of training providers willing and able to deliver the new FM Apprenticeship. One of the drivers behind setting it up was employer feedback about the challenges of finding accredited training providers willing and able to work with a demanding sector such as facilities management which requires flexibility and business focus.

The initial pilot groups put forward by the first employers who wanted candidates to undertake the new qualifications helped the network to develop and the apprenticeship to gain a track record of success.

There is now a network of training providers working under the UK Academy banner, including further education colleges and private training companies providing coverage throughout England.

THE FM APPRENTICESHIP The employers who have registered staff onto the Apprenticeship in Facilities Management programme have mostly used it as a way of developing the skills of existing employees. As apprenticeships are essentially a package of qualifications, they work well for this purpose

Facilities Management

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Despite concerns about service levels and the effects on services to clients, many FM and estates managers are also recognising that their organisation must have the right skills in its workforce to deliver the operational efficiencies and manage change. in any sector of the economy and are not just a tool to bring young people into an industry.

As the average age profile and entry age of the FM industry is more mature, the longer term value of the apprenticeship is primarily going as a vehicle for improving the skills profile of the current workforce. This makes it a particularly useful programme for an area such as healthcare where there is a real need to address issues of succession planning and ensure the next generation of senior managers is progressing.

The apprenticeship now has a valuable track record as a development tool for employers who want to improve their workforce’s management skills and FM knowledge in the context of their job roles.

It can also be extensively customised to an individual organisation’s culture. The programme can be adapted to the needs of the healthcare sector and units can be selected to reflect the requirements of either a property/estates based role or a

facilities/services role. Customising can even include selecting whether the term ‘apprenticeship’ is actually used. Where the organisation would prefer not to use it as a title, because it might be less attractive to older employees, the training provider can deliver the programme under an internal title.

FUNDING The Asset Skills UK Academy for Business Services handled more than 200 employer enquiries during its pilot year and has just produced its first annual report. Enquiries have resulted in more than 300 candidates being referred for a variety of accredited programmes including 150 apprenticeships.

Most of the training has been in facilities management but as the academy aims to provide a one-stop-service for employers, a wide range of programmes have been sourced including higher level programmes in FM (such as the British Institute of Facilities Management [BIFM] qualifications) E

Volume 11.6 | HEALTH BUSINESS MAGAZINE

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TRAINING E and accredited qualifications in related service sectors that support FM and estates management such as maintenance operations, cleaning and support services, administration, customer services and catering, including food hygiene.

It is estimated that the value of these qualifications in terms of funding accessed by the employers through the academy is circa £700,000 of apprenticeship funding and £137,000 for other accredited programmes. The academy will continue to respond to the wide range of requirements and is building network capacity in any service areas required by employers.

Other Asset Skills projects have been successful in expanding take up of the Apprenticeship in FM. In Wales, funding was secured to deliver the apprenticeship to pilot groups with one of the key objectives to develop a sustainable network of training providers for the future who will continue to develop a profile for FM qualifications in Wales. There have also been developments in Scotland where the approval of the Level 3 Modern Apprenticeship in Facilities Management (A-level equivalent) and a Level 2 Facilities Services Apprenticeship (GCSE equivalent) by the Scottish Qualifications Authority is giving potential candidates access to qualifications and encouraging

training providers in Scotland.

Asset Skills, through the UK Academy, has also been successful in attracting the first funding to support employers wishing to undertake higher development programmes in facilities management. This has resulted in additional pilot groups undertaking the Level 4 BIFM Certificates. Also, as a result of this investment by government, new centres have been accredited by the BIFM which has increased national coverage for their qualifications.

The academy sees activity and support for higher level skills as being one of the growth areas into 2011/12. Funding support for BIFM qualifications is likely to continue and there is renewed interest in the FM Foundation Degree programmes. We are also anticipating increased activity related to carbon reduction and sustainability, which will see a new raft of accredited qualifications emerging in energy advice for the commercial sector linked to the government’s new Green Deal policy. This will be of interest to many in the FM sector looking to formalise and develop their skills in this area.

A CHALLENGING AND UNCERTAIN FUTURE The financial and organisational challenges for the public sector and particularly healthcare will continue for the foreseeable future.

The facilities and estates management functions will have a significant role to play in supporting the drive towards greater efficiency. Some of this may come from a greater level of outsourcing where the burden will be placed on the service suppliers in the outsourcing industry. However, the common consensus is that the outsourcing industry will only experience minimal growth in 2011 – Treasury forecasts predict growth of just one per cent. In the longer term it is believed that the potential UK market for facilities management may increase over the next five years with the continued trend towards outsourcing potentially offering future growth opportunities for facilities management suppliers.

Whichever prediction prove correct there seems to be recognition that FM skills are one of the most valuable assets within the public sector, and investment in developing the skills base is essential to achieve efficiency and contribute to growth, for individual employers and for the public sector as a whole. L FOR MORE INFORMATION For further information on the UK Academy for Business Services, e-mail ukacademy@assetskills.org or call 0844 822 2525. Alternatively, visit www.assetskills.org/ukacademy

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Hospital, observed: “When we set up the unit, we installed Clos-o-Mats in all the sites. They give our patients with physical disabilities independence and dignity when toileting. We specified the Clos-o-Mat with arm supports, which enables patients with sitting balance to go to the toilet on their own. The Clos-o-Mats have been in about eight years now, are serviced annually, and continue to provide a useful service for our patients.”

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Volume 11.6 | HEALTH BUSINESS MAGAZINE

23

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.

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The Phoenix Spaceframe and Triple Stack Systems have been designed to meet all of these requirements. Any size and type of facility can be designed and manufactured to meet your specifications.

Both modular systems provide the facility for individual offices and open plan areas. The areas can be fitted out as conventional offices, training centres, toilet/staff amenity areas, changing rooms and catering facilities to all levels.

In addition, they provide an excellent long term investment for contractors and plant hire companies alike. Buildings are delivered to site with all internal finishes and services already fitted. The buildings are installed onto prepared foundations ready for connection to mains services, handover and occupation.

Portable Units / Jackleg Cabins The Phoenix extensive range of portable units are the answer to any instant prefabricated accommodation needs. Designed to a very high specification to meet the requirements of any public or private sector industry, Jackleg / Portable Cabin units are available in sizes from 9ft x 9ft’ all the way to 60ft x 12ft and delivered throughout the U.K. Contact Us - Phoenix Building Systems Unit 6, Brookbanks Industrial Estate - Tower House Lane Hedon Road, Hull - HU12 8EE Tel Number: 01482 317260 Fax Number: 01482 899252 Web: www.phoenixbuildingsystems.com Email: Michael@phoenixbuildingsystems.com

MODULAR BUILDINGS

OFF-SITE CONSTRUCTION BENEFITS HEALTH SECTOR

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Given the critical nature of healthcare, being able to add a modular building without the day-to-day disruption of onsite construction is a great benefit, writes Jackie Maginnis, chief executive of the Modular & Portable Building Association The modular & portable building industry, like other off-site businesses, faced new challenges from the 1 October last year.

With the requirements for Energy Performance Certificates (EPCs) for modular buildings in the new regulations there was a need to consider the impact this would have on companies that have existing buildings and the way forward for the future, in particular to what is known as a ‘distress purchase’ to serve the health and education sectors of the market.

Prefabricated buildings as they were known historically (and still so in many people’s eyes) have not always enjoyed good press in the past. More often than not they have attracted or been associated with controversy and it is fair to say that when used in the health sector they have had their share of criticism.

Considered by many to be a poor substitute for the real thing before they arrive – this has also been compounded by local authorities choosing the most basic models

solutions for clients as in the past. The industry has always been able to offer a fast track solution to providing equipment; the scheme enables this to still apply.

With the assistance of Local Authority Building Control (LABC) and the Association of Consultant Approved Inspectors (ACAI), a guidance document has been written by the MPBA and sent to all building control offices.

This incorporates flow charts to enable ease of understanding of the requirements.

MODULAR HOSPITALS As an industry modular buildings are now increasingly used in the health sector for a variety of reasons.

Healthcare modules used as a temporary measure can be added or removed (dependent on design) when a particular hospital new build is ready for occupation. This enables buildings to be removed and reused if required.

For many years now we have been providing temporary healthcare buildings, which today still remain as a permanent feature. anticipating a trouble free building for the rest of its life. But this is not the case today.

Nowadays, everyone is being asked to consider sustainability, reduction of carbon emissions, reduction of waste, and embodied energy. These are four major factors that play a major role in the products that our industry produces today.

PERMANENT SOLUTIONS Our industry has proven the sceptics wrong – for many years now we have been providing temporary healthcare buildings, which today still remain as a permanent feature.

The current trend of off-site construction is not new to the manufacturers and hirers of modular buildings. For some 20 years the industry has been filling the need for additional facilities throughout the UK. With the current government campaign to redevelop and rebuild, the benefits of modular buildings can be of great assistance.

To ensure that the industry can still respond, MPBA has put in place a compliance scheme for both members and non-members to continue to be able to provide quick

All buildings fully comply with the required building regulations, and are carefully planned by specialist personal that have many years’ experience in this type of facility.

Soundproofing was an issue for many years, but with the new modern materials used this has now been overcome. The same principle applies to heating and lighting.

With limited space available, which is often the case for existing hospitals, the advantage of modular buildings gives clients the opportunities of making use of every space available.

Consideration needs to be taken with regards to avoiding disruption to crucial day-to-day operations. It is always worth remembering that with modular buildings, ground works and production can take place at the same time.

The modular and portable building industry has many companies who will be able to meet the quality and needs of any project and will perform to a high standard of service and reliability.

Consider all the factors and you have an ideal solution to solving your problems E

Royal Surrey County Hospital

Royal Surrey County Hospital Sunderland Hospital

Sunderland Hospital

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OFF-SITE BUILDING SOLUTIONS TRUSTED PARTNER TO THE EDUCATION SECTOR

increased speed of construction design and build improved quality modern methods of construction waste reduction off-site manufacturing sustainable design

OFF-SITE BUILDING SOLUTIONS

OFF-SITE BUILDING SOLUTIONS

0800 085 8231 construction@elliottuk.com www.elliottuk.com/off-site

OFF-SITE BUILDING SOLUTIONS

OFF-SITE BUILDING SOLUTIONS

OFF-SITE BUILDING SOLUTIONS

OFF-SITE BUILDING SOLUTIONS

MODULAR BUILDINGS E of new or replacement buildings. If in doubt the industry is supported by its very own industry association and will answer any questions that you may have.

With the ever increasing demands for additional facilities in the health sector, once more members of the MPBA prove the benefits of using modular buildings for this purpose, as detailed in the case studies below.

CASE STUDY – RECYCLED MODULES A project to expand an existing recycled modular building at Royal Surrey County Hospital in Guildford to provide additional bed capacity for its surgical services has been recently completed.

An interim ward building for the Short Stay Surgery Unit, which was supplied by Foremans to Royal Surrey County Hospital

craned into position over a weekend.

Commenting on the project, Graham Maynard, head of capital and estates at Royal Surrey County Hospital NHS Foundation Trust, said: “We are very pleased with the building, the extension and the appearance. The company performed well on this project and were sufficiently flexible to allow us to purchase and extend our interim ward accommodation to convert it to permanent use. We have had a good relationship with their team and would recommend their recycled modular building approach to other NHS trusts.”

Philip Howell of the trust’s design consultants Drake & Kannemeyer, said: “The refurbished external appearance of the building provides a modern contemporary look and demonstrates what can be achieved when

“The external appearance of the building provides a modern contemporary look and demonstrates what can be achieved when you combine the recycled modular approach with strong architectural design” Philip Howell, Drake & Kannemeyer.

NHS Foundation Trust, has been extended to create a further two new purpose-designed five-bed wards for the Elective Surgery Unit.

The building has also been refurbished externally with a new covered entrance and walkway, a new roof, low-level brick planters, and overcladding to each elevation using aluminium-faced panels in silver, blue and white for a more contemporary appearance and to further improve thermal performance and insulation.

The 26-module building was completed to a tight programme of just 15 weeks from receipt of order to handover to allow the trust to increase surgical bed capacity as fast as possible. In order to minimise any disruption to patient care, the recycled building modules arrived on site and were

you combine the recycled modular approach with strong architectural design.”

As budgets become tighter in the current economic climate, healthcare providers need to look for alternatives to providing accommodation solutions that deliver best value and yet maintain quality – whether for interim or permanent applications.

With the Foremans approach, only the steel structure of the building is recycled – all fixtures and fittings, from doors and windows to wall linings and cladding, are new. However, the recycling of modular buildings is a more cost-effective alternative to both new manufacture and traditional site-based construction and is up to 70 per cent faster. It is also very sustainable, giving organisations an environmentally

Design & Build

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sound alternative to the disposal of surplus modular accommodation in landfill sites.

By re-using a modular building, less than ten per cent of the carbon emissions are generated compared to a newly manufactured building of equivalent size. This dramatically improves a building’s carbon footprint.

Case Study provided by Foremans.

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 9000sq-mtr project consisted of 106 steel frame modules, some of which are up to 19 metres in length and include 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 was a key procedure 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 a training room.

Case Study Provided by Britspace. L FOR MORE INFORMATION www.mpba.biz

Better solutions with Thurston Building Systems Thurston Building Systems specialises in providing inspiring off-site building solutions.

By choosing a modular building by Thurston, you are investing in an affordable, costeffective system that will meet all your needs from ward accommodation to training and administration areas or health centres.

We recently worked with University Hospital of South Manchester NHS Trust. At Wynethshaw Hospital, Thurston delivered a staged project providing three specialist ward facilities. By working in partnership with the trust we developed a detailed specification of the facility, which met with strict budget parameters for each stage of the development.

hospital the extra space they needed.

With over 40 years’ experience in the health sector, Thurston is a name that you can trust to deliver your project, on time and on budget. Our flexible approach to design, development and manufacturing means that you can be assured your project will meet the relevant building regulations and individual hygiene control standards whilst still delivering the building you need.

The final product is a two storey building with 74 bays, providing 105 extra bed spaces, various consultancy rooms and relevant auxiliary and support facilities, giving the

FOR MORE INFORMATION Tel: 01924 237214 sarah.rawsthorne@thurstongroup.co.uk www.thurstongroup.co.uk

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Design & Build

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EVENT PREVIEW

NHS REFORMS AND THE FUTURE BUILT ENVIRONMENT Andy Stuart, event project director at Future Health & Care Expo, looks at the challenges built environment professionals face in addressing the changes to the NHS For an essential public body as old and as large as the NHS, reform is inevitable. Whilst this doesn’t mean such reforms are ever uniformly palatable, they are a fact of life and crucial if the NHS is to prosper – especially given the present economic climate.

The UK Government’s Health and Social Care Bill stands to be just as divisive as any other preceding set of reforms, and the NHS Future Forum’s recommendations seem to have engendered even greater discord in the debate. However, it appears inevitable that the amended reforms, which will now incorporate more than 16 of Future Forum’s recommendations, will come into effect and change the face of the NHS for decades to come.

For anyone involved in building and maintaining health and care facilities, both in the private and public sector, these reforms are going to have far-reaching consequences.

In conjunction with this, the sector is faced with the constant need to respond to changing patient demands and social pressure. The Future Health & Care conference will provide built environment professional with the knowledge, skills and tools to they need to address these issues and implement cutting edge health and care environments. While the conference will address a range of issues, there are three key areas that many of the keynote speeches, panel debates and conference modules will focus on.

IMPACT OF POLICY REFORMS In a recent interview, health secretary Andrew Lansley claimed that the NHS could be facing a potential funding gap of £20 billion by 2015 with expenditure reaching £130 billion by this point1. This is despite the government providing an additional £11.5 billion in funding. There are many reasons why NHS costs are going to rise so dramatically over the next few years, including an aging population and the corresponding increase in chronic diseases, as well as better informed patients demanding new and more expensive treatments.

To curb spiralling costs, the NHS has to make tough choices as to how resources are allocated. With cuts to front line services, treatments and staff considered a last resort, the easier option is to cancel or postpone new facilities, and reduce the money spent on refurbishment and maintenance. However, the need for new sites remains, and it will

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HEALTH BUSINESS MAGAZINE Volume | 11.6

be up to those responsible for securing these construction projects to demonstrate the value they deliver. And while the NHS has always had to face up to the problems of demand being greater than the resources available, the situation isn’t getting any easier. This topic will make up one of the optional conference modules at Future Health & Care Expo, where the head of health at Brown Jacobson LLP, Mike Suggett, will assess the impact of policy reform on design and construction in the health sector.

COMPETING FOR CARE Increasing the level of competition between different facilities, both private and public was at the heart of the healthcare reforms originally proposed by the government. The idea was that it would result in a greater quality of care, since facilities would be forced to maintain high standards in order to attract patients. In the amendments to the reforms based on the Future Forum’s recommendations, however, the competition aspect of the bill is scaled back.

Monitor, the public body originally responsible for overseeing competition in

facilities they are visiting will also play an important part in their final decision.

On top of this, it is a simple matter of cost.

In order to compete effectively, both now and in the future, sites need to deliver value for money. At the Future Health & Care Expo conference, former health secretary Alan Milburn’s keynote speech will look at this issue in more depth, analysing the changes across the NHS and the implications for the way in which the built environment delivers services.

In addition to the government’s NHS reforms, the built environment sector needs to adapt to meet the challenges presented by growing social and economic trends. There are so many factors at work, it is virtually impossible to list them all. However, even by skimming the surface, it is clear that the way in which health and care facilities are built and managed is going to have to change.

For example, Private Finance Initiatives, the scheme through which health trusts can outsource the cost of building and maintaining care facilities, are a constant expense for many NHS trusts. Attempts to renegotiate monthly repayments will become more common as the NHS looks

For anyone involved in building and maintaining health and care facilities, both in the private and public sector, these reforms are going to have far-reaching consequences. the health and care sector, will now also be responsible for promoting collaboration and integration. Encouraging competition is still recognised as a “tool for supporting choice, promoting integration and improving quality”2, as Steve Fields, chairman of the Future Health Forum confirmed recently.

Although he argued that it should never be used “as an end in itself”.

Clearly, competition is becoming a bigger part of the NHS, and is something that the built environment is going to need to play a larger role in as free-market ideas gain more prominence across the health sector. This pressure is only going to grow as patients increasingly turn to providers of private care. While patients will be judging private and public providers on waiting times and available treatments, the quality of the

for ways to improve available resources. At the same time, there may be an increase in the number of PFI projects. New healthcare facilities are always going to be required, but given that the NHS won’t have the necessary resources for the foreseeable future, PFIs will offer the only viable alternative.

Contractors and architects will therefore need to reassess how the change in the NHS’ relationships with PFIs will be affected. In addition, the way in which facilities are built and maintained must adapt in response to changing health demands from the public.

For example, with hospital-borne diseases like MRSA constantly in the media, the need to update existing facilities and equipment to reduce the risk of infection is paramount. And with the standards of care that patients expect from their NHS trust always under scrutiny, E

E care providers must ensure that the facilities they provide are modern and efficient.

The built environment will therefore continue to be an integral part of the way in which care is delivered in the UK, and the health and care sector will be increasingly reliant on its ability to adapt and support it in ensuring that patient needs continue to be met.

In the second keynote presentation at the Future Health & Care Expo conference, representatives from the health teams at Balfour Beatty and Anshen + Allen will be looking at the global drivers and trends that will underpin healthcare facility and estates design over the next 30 years, providing delegates with a greater insight into the factors that will shape this aspect of the built environment.

readdress how they serve the needs of the NHS and private sector health and care providers. Together, they must ensure that the sector remains healthy and profitable, and be able to guarantee that patient care maintains a high standard.

The process of writing the amended Health and Social Care Bill into law will take some time. Even with additional amends being introduced, the built environment clearly needs to scrutinise the changes and make adequate provisions for adapting to the changing landscape.

The Future Health & Care Expo conference will provide the perfect forum for debating the changes set to sweep the health and care industry, and will help all of those involved in the built environment to understand exactly how the new reforms affect them. L

READDRESSING NEEDS The NHS reforms result in a state of flux Notes within the health and care sector. Although 1. The Daily Telegraph – http://www.telegraph. the NHS Future Forum has presented its co.uk/comment/personal-view/8551239/ findings, and confirmed how the reforms Why-the-health-service-needs-surgery.html are going to be delivered, there is still much confusion as to how they will affect 2. NHS Future Forum Summary Report: + silver/grey the way in which health and care facilities AJC dark blue http://www.dh.gov.uk/prod_consum_dh/ are built, managed and maintained. groups/dh_digitalassets/documents/ From architects and facility managers digitalasset/dh_127540.pdf to local authorities and contractors, everyone involved in the health and care FOR MORE INFORMATION built environment is going to have to www.futurehealthexpo.com

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About Future Health & Care Expo Organised by UBM Built Environment, Future Health & Care Expo is the mustattend free exhibition and conference for anyone involved in building and maintaining health and care facilities.

Spread over two days, the show will include over 100 of the leading companies in the health and care construction and maintenance sector, including Balfour Beatty Healthcare, BAM, Graham Construction and Facilities Management, Anshen + Allen and MedicX. The show will bring together stakeholders and industry leaders in this rapidly developing sector, providing a wealth of networking opportunities and allowing attendees to keep up-to-date with new industry innovation.

The parallel conference will feature keynote speeches delivered by senior industry figures, as well as a modular conference programme delivering indepth discussions on a range of topics.

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A WEALTH OF ACCESSIBILITY EXPERIENCE We excel in creating kitchens that provide maximum independence for wheelchair users and people with limited vision or mobility.

Our designers work closely with installers and residents to deliver flexible, cost-effective solutions tailored to residents’ precise needs.

Features include safe hobs and easy to use taps and controls, low level and wheelchair accessible work surfaces, eye-level side opening ovens, pull-out storage and easy-open doors.

Safety comes as standard and the results will be stylish, user-friendly and built to last.

Contact us today for a free, no obligation chat about your next project. contractkitchensadmin@magnet.co.uk Tel: 0845 671 5506 www.magnettrade.co.uk/contractkitchensolutions

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Ready for the climate change challenge?

Western Power 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 organisations 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.

Aquastat – legionella consultants and water treatment specialists Aquastat Environmental Services Ltd have over 25 years experience in water hygiene.

Our client base includes public and private nursing and residential homes, public and private schools, dental practices, county councils, and many others. Aquastat hold a ‘Class 1’ accreditation from the Legionella Control Association and various other working accreditations such as safe contractor and Skilled worker.

We are able to guide you through the complexities of the legislative requirements regarding Legionellosis.

All works carried out are in accordance with the Health & Safety Executives Approved Code of Practice ACOP L8.

Our services include: • Consultancy • Comprehensive legionella risk assessments • Cleaning and disinfection of water storage tanks • Monitoring of hot and cold water systems • Microbiological and chemical analysis • Chemical de-scaling of boilers and calorifiers • Water storage tank refurbishment • Renewable Energy Solutions All advice and quotations are provided free of charge.

FOR MORE INFORMATION Tel: 01934 811264 enquiries@aquastat.co.uk www.aquastat.co.uk

FOR MORE INFORMATION Tel: 08457 448900 smartmetering@ westernpower.co.uk www.wpdsmart metering.co.uk

Health and Safety Compliance from RPS: The Healthcare Sector’s Partner.

With Health and Safety legislation becoming increasingly more stringent, it is essential that organisations are fully compliant with their obligations. Working in partnership with RPS will ensure that these obligations are met and delivered with a clear understanding of the operational and financial constraints faced by the sector.

RPS is an international consultancy providing advice upon the Health and Safety of people and the properties they work in. With many years experience of working within Healthcare, supporting both the private and public sectors, we have the ability to deliver complex projects on time and within budget.

RPS can assist and advise on n Legionella Risk Assessments n Health and Safety Risk Assessments n Review and Development of Health and Safety Management Systems n Fire Risk Assessments n Asbestos Surveys and Management Plans n Training n Web – based risk management systems Did you know that a new British Standard has been introduced for undertaking legionella risk assessments?

To find out more on the range of services we provide, Free Phone 08000 85 84 83 for further information

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HEALTH BUSINESS MAGAZINE Volume | 11.6

rpsgroup.com

CARBON REDUCTION

Energy

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A HEALTHY SAVING BY OPTIMISING ENERGY USAGE

A growing number of NHS trusts across the country are turning to new innovative solutions like voltage optimisation to reduce their energy consumption, costs and carbon emissions With limited budgets and the impending launch of the Carbon Reduction Commitment (CRC), combined with new emerging healthcare policies, NHS executives are seeking reliable, proven energy saving technologies that can not only help reduce carbon emissions, but can also make significant savings on energy consumption.

As a result, a growing number of NHS trusts are turning to new innovative solutions like voltage optimisation, which can not only reduce energy consumption, but also improve life expectancy of on-site equipment and reduce carbon emissions.

MEETING TARGETS Due to the Climate Change Act, which has set legally binding targets to reduce carbon emissions by 34 per cent by 2020 and 80 per cent by 2050 – based on 1990 levels – the UK Government is keen to introduce schemes to encourage organisations to reduce carbon emissions.

The CRC is the Government’s flagship policy to help meet these challenging targets.

A mandatory scheme, the CRC features a range of reputational, behavioural and financial drivers that aim to encourage organisations to develop energy management strategies that promote a better understanding of energy usage.

The scheme was originally launched to encourage organisations across the UK to monitor carbon dioxide emissions and for every tonne emitted they would have to surrender an ‘allowance’, which would be bought at the start of the financial year. Allowances could, under the original scheme, be sold-on to other organisations at a price determined by the buyer, should they have too many.

However, following the chancellor’s spending review in October 2010 and the subsequent budget in March 2011, if an organisation doesn’t surrender enough allowances, they will now be taxed directly by central government for every tonne of carbon dioxide they don’t submit allowances for. It is therefore in the best interest of the organisation to lower energy usage, not only to save money on their electricity bills, but also to reduce their carbon emissions to ensure they are not taxed by central government.

Voltage optimisation is an electrical energy saving technique, in which a device is installed in series with the mains electricity supply to provide an optimum supply voltage for the site’s equipment. Interestingly, it is also proven to improve power quality by balancing phase voltages and filtering harmonics and transients from the electricity supply, leading to reduced maintenance costs as less demand is placed on electrical equipment.

The reason voltage optimisation can have such a significant impact on energy used is because the National Grid supplies a higher voltage than is usually required.

Although the nominal voltage in the UK is 230V, the average delivered is actually 242V. This ‘over-voltage’ means that energy consumption is not only higher, but as a result, the lifespan of equipment is shortened.

Voltage optimisation can therefore improve the life expectancy of equipment.

CASE STUDY Mersey Care NHS Trust recently had a voltage optimisation system installed across a number of sites.

Working with EMSc UK Ltd, facilities management company MITIE installed the company’s solution, Powerstar, at Ashworth, Mossley and Rathbone Hospitals as well as Scott Clinic, all in Merseyside.

Prior to making any recommendations the engineers for the facilities management company, together with EMS engineers, carried out full on site surveys at each of the locations to ascertain the electrical loading characteristics. The process involved calculating the savings that could be achieved, which is ascertained in part through data logging the on-site voltage. The surveys also identified any energy consumption where voltage optimisation could achieve zero or reduced savings (e.g. high-frequency lighting, inverter drives). By analysing the data logging information, the optimum voltage for the site was then determined.

It’s the site survey that determines how much of a total site’s electricity load (as a percentage) will benefit from the full reduced or zero percentage saving. When specifying the percentages it’s important to take into consideration the operating load and the operational period of the equipment.

By dividing the voltage drop into the original voltage figure it was possible to ascertain the voltage percentage saving. The figure was then doubled, because according to the Institute of Engineering and Technology (IET), on average a one per cent reduction in voltage will produce a 2.1 per cent reduction in electricity consumption. Site loads that would yield less than optimum savings were then taken into consideration and a guaranteed saving, as a percentage of kWh was calculated.

ENERGY SAVINGS Once all the initial on-site calculations and work was completed, MITIE then commissioned bespoke Powerstar units to be manufactured to meet the specific requirements for each of the sites, ensuring the maximum level of energy savings were guaranteed.

A draft Project Installation Plan (PIP) was initially presented to Mersey Care NHS Trust with all the parties reviewing and agreeing the proposed plan. The progress of the PIP was tracked throughout the installation process to ensure all the timescales were met with any deviations highlighted and communicated.

Engineers were on site at all the locations, to ensure a smooth operation. Once the installation was finished all the respective sites were issued with the appropriate manuals, certificates and fitted drawings.

The solution has enabled Mersey Care NHS to reduce energy usage, therefore lowering its carbon footprint. So far total savings across the sites have reached an average 18 per cent on annual energy consumption. At Rathbone Hospital annual kWh savings are 65,796, the equivalent of £6,974, whilst Scott Clinic has benefited from annual savings of 51,573 kWh, or £5,446.

As the UK faces worsening power quality issues with harmonic, transient, power factor and phase balancing issues, voltage optimisation is emerging as one of the most secure, cost effective technologies for organisations to adopt as part of not only reducing costs but also saving energy and reducing carbon emissions.

In today’s world of spiralling energy costs, introducing high-efficiency energy saving devices is becoming a must. They not only reduce energy and maintenance costs, they also safeguard the environment. L

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Fire Safety

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RISK MANAGEMENT

MAKING FIRE SAFETY A PRIORITY Fires happen to other people, right? Wrong, and as an employer you have the responsibilty to have a strategy and appropriate procedures in place to provide a safe environment In the May issue of Health Business, there were two interesting articles: ‘Improving levels of property protection’, by Graham Ellicott, CEO of the Fire Industry Association (FIA), and ‘Do you have a plan in place?’

by Ruth Spellman, chief executive of the Chartered Management Institute.

These articles reinforced the important points that the person or people responsible for each organisation that delivers healthcare in the UK should ensure that his or her organisation has plans in place to continuously monitor its fire safety policy and procedures to prevent fire.

Also, in the unfortunate event of a fire, they must be able to deal with the consequences so as to maintain the delivery of healthcare.

THE EMPLOYER’S RESPONSIBILITY Despite fire safety now being the responsibility of employers, the level of attention devoted to fire safety appears to be as low as it has ever been. The key word in this sentence is ‘employers’.

The Regulatory Reform (Fire Safety) Order 2005 (FSO) came into effect in October 2006 and applies to all non-domestic premises in England and Wales. It defines the person responsible for the FSO in a workplace as “the employer and any other person who may have control of any part of the premises, e.g. the occupier or owner. In all other premises the person or people in control of the premises will be responsible”.

This does not mean the Department of Health or an employee in the maintenance department. The authority for implementing a fire safety policy can be delegated, but the responsibility for the fire safety of the organisation and its employees rests solely with the employer – “the person or people in control of the premises”.

FIRES IN HEALTHCARE PREMISES Fires happen, that is an unpleasant fact of life. Whether they are started maliciously as in the case of an arson attack, or accidentally, for a variety of reasons, they do happen. As Graham Ellicott pointed out in his article, fires in healthcare premises are not uncommon.

According to the Association of British Insurers, 40 per cent of businesses do not recover following a fire, but going out of business is not an option for a community hospital. In the aftermath of a fire, the costs of maintaining these healthcare services for the

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community can be enormous when compared to the modest costs of implementing fire defence procedures in the first place.

If a hospital suffers from a fire, some or all of its facilities may be taken out of action. As part of the critical infrastructure of the local community, if the hospital cannot deliver all of the functions itself it has to seek to provide alternative arrangements elsewhere.

The level of difficulty in maintaining service continuity will be dependent upon which part of the hospital has been affected by fire, but there will be issues that arise regardless of which departments are affected.

Re-location of patients – the health service generally is operating at or near to maximum capacity so finding available beds for patients could be complicated and a thorny issue for relatives unable to travel far to visit their loved one.

Logistics – the transfer of equipment and resources will be necessary to enable the receiving hospital(s) to cope with the additional patients. Medical records will have to be moved securely.

Re-scheduling of staff rostas – the disruption to staff shift patterns is inevitable both at the damaged hospital and those receiving the re-located patients. Some staff will be reluctant or unable to travel and so temporary staff will need recruiting.

Disruption during renovation – the noise pollution and commotion that will happen during the restoration work may seriously inconvenience the departments unaffected by the fire, possibly delaying patient recovery or disrupting surgery schedules.

The toughest task will be if a key department is taken out of action. If, for example, the Pathology department is affected, then everything will slow down as samples have to be sent away off site for diagnostic or forensic purposes. The knock-on effect may put unbearable strain on the other departments.

IT’S NOT A COST ISSUE Despite the current economic climate and constant search for cost cutting, the costs of implementing the fire safety policy through rigorous procedures should be ring-fenced as part of an organisation’s health and safety, security, and business continuity programmes.

It is not a cost issue; the FSO has made it unambiguously clear that the responsibility for fire safety rests with the employers. Every

week we read about employers being fined huge amounts, even given custodial sentences, for breaches of the FSO, yet the perception remains that fire safety is not a high priority.

WHAT CAN BE DONE? So how can an employer ensure that, in the unthinkable circumstance where someone tragically dies as a result of a fire incident, he or she does not get dragged before the courts accused of breaching the FSO? The first base is the acceptance that an organisation’s defence against fire is a continuous process. Anyone can download a Fire Risk Assessment (FRA) template from the internet, but whether you choose this route or you instruct a specialist person who has been trained by an industry body such as the Fire Industry Association, Fire Protection Association or the Institution of Fire Engineers, to name but three, it is important to appreciate that the FRA is just a snapshot in time. It requires updating regularly and monitoring continuously. Similarly emergency evacuation procedures should be tested frequently to ensure that all members of staff know what their role is in the event of an emergency.

Then there are the products that can minimise the risks that fires present. These products fall into two categories; active fire products and passive fire products.

Active fire products are those that detect fires and/or act to extinguish them. Fire alarms, extinguishers and water sprinkler systems are typical examples of active fire E

Fire Safety

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About the authors John Maxfield is a director of AFG Flameguard, a company that provides the highest quality active and passive products that will contain a fire and extinguish it. Colin Newman, principal consultant, Healthfire Limited, providing expert fire safety advice and support to the healthcare operators in both the public and private sectors.

smoke, to an adjoining area on the same level. Once at this location, patients may remain if safe to do so, or be evacuated further away and ultimately to a place of safety outside the building. In order for this to happen, the integrity of each fire resisting barrier must be undiminished.

E products. They act immediately to create awareness of the emergency, so allowing an appropriate response and emergency escape, and may then attack the fire whilst the Fire & Rescue Service is on its way.

Passive fire products, on the other hand, are those that are designed to contain a fire and prevent the flames, heat, smoke and dangerous gases from spreading around the building. Fire doors, fire blocks for pipes and vents, fire resistant paints and coatings are examples of passive fire products and it is this area that is often overlooked in healthcare premises.

Healthcare premises are constantly

evolving, with regular improvement works or alterations. Every change requires a review of the fire risk that may now be present as a result of these changes. There may be new ventilation ducts in walls, floors or ceilings; escape routes may be compromised; the wall coverings and furnishings may not be sufficiently fire or heat resistant.

The process of progressive horizontal evacuation that is used in the evacuation of hospitals, care homes and some other premises is a process of moving patients from an area affected by a fire through a fire resisting barrier, designed to protect the occupants from the effects of the fire and

UNDERSTANDING THE ISSUE Unfortunately fires don’t only happen to other people. The importance of fire safety needs to be understood by all of the employers in the healthcare industry and through their leadership the mindset will cascade down through to all employees and stakeholders of their organisation.

For employers in the healthcare industry reading this article, can you answer this question: Do I have a fire strategy in place that complies with current legislation and guidance, provides a safe patient environment that can be managed by healthcare providers, incorporates appropriate means of escape and evacuation, active and passive fire protection and necessary provisions for firefighting?

If the answer is no, then you should act immediately to devise a strategy and implement appropriate fire safety procedures.

There is not a moment to lose and with plenty of assistance available through industry bodies such as those mentioned above, the Association of Specialist Fire Protection or private companies, there are no excuses if the unthinkable does happen. L

Complete fire safety with PHS Compliance The Fire Statistics Monitor reported that in the six months from April to September there were 140 fatalities in the UK from fires. Fire equipment testing is essential to safeguard lives and businesses. Under The Regulatory Reform (Fire Safety) Order 2005 the responsible person must provide general precautions, including the provision of means to fight fire.

Once provision is in place, the FSO makes it clear that systems, equipment and procedures must be “in an efficient state, in efficient working order and in good repair”. This means appropriate testing

business is fully compliant with all the relevant legislation. From initial risk assessment, to specification and implementation of fire detection, it is possible to call on one specialist, PHS Compliance. We can provide you with all the support you need to ensure your complete compliance. and maintenance of all fire equipment and systems. Our engineers are qualified to IOSH Health and Safety, NVQ Assessor D32 and D33, ensuring your complete compliance.

Using a certified compliance testing partner will give you peace of mind your

FOR MORE INFORMATION For complete compliance solutions for all your services in electrical, fire, gas and water services visit www.phscompliance.co.uk or contact 01942 290888.

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LONE WORKING

SAFETY FIRST Making lone workers’ health and safety less of a solo effort is the responsibility of the employer, says IOSH, and encourages employers to take simple yet effective measures to protect staff Lone working is simply part of the job for many frontline healthcare staff, but year upon year there are still tens of thousands of assaults on these UK employees.

Safeguarding a workforce that by its very nature puts its patients’ health at the top of the agenda is of course, deeply complex, but the Institution of Occupational Safety and Health (IOSH) encourages simple, effective and non-alarmist measures that make a difference to the safety of lone workers in this sector.

Figures suggest there are around 690,000 healthcare professionals employed nationwide, and according to official NHS statistics, 56,718 of its staff were violently attacked in 2009/10.

Although it is hard to pinpoint how many of

Generally though, it is employees who have close contact with the general public that are subject to the most risk. It can be the nature of their work that presents the most risk; for example, encountering drug or alcohol use, working at height, or alone in a workshop. Late nights and early mornings can also be a factor, as can working in high crime or isolated locations.

THE LAW Organisations must think about and deal with any health and safety risks that their line of work creates – that includes mitigating dangers of lone working. Employers have a duty to protect their lone workers. But where

Figures suggest there are around 690,000 healthcare professionals employed nationwide, and according to official NHS statistics, 56,718 of its staff were violently attacked in 2009/10. Although it is hard to pinpoint how many of these were lone worker-related incidents, it is common knowledge that these employees do face an increased risk. these were lone worker-related incidents, it is common knowledge that these employees do face an increased risk, owing to the fact that by their very definition, they work by themselves without close or direct supervision.

TYPES OF LONE WORK Lone workers cover a diverse cross section of healthcare employees; some work on their own within an organisation’s buildings, some at home alone, others on the road in a variety of locations. Their roles include community midwives, social and care workers, paramedics and emergency responders, security staff, counsellors, maintenance workers, and even nurses or doctors on shifts or home visits.

Community-based healthcare staff face perhaps the widest variety of risks; the biggest being a social one, of abuse or attack, owing to the fact many work with individuals with specialist and diverse needs.

In fact, the NHS employs an estimated 200,000 to 250,000 community-based staff, all of whom are guided under the healthcare system’s lone working policy.

good health and safety measures are in place and an organisation sticks to the line of the law, employees have a duty to protect themselves and heed the advice they’re given.

Under the 1974 Health and Safety at Work Act, employers are responsible for the health, safety and welfare of their entire workforce. Not only that, they must protect the health and safety of those affected by their work activities, such as the selfemployed and visitors including contractors.

In each lone working situation that a healthcare organisation places its employees in, the Management of Health and Safety at Work Regulations 1999 says they must investigate significant hazards and assess the risk of working within those circumstances.

They must put in place procedures – physical and mental – to control or completely avoid those risks. Where the risk is too great, lone working simply shouldn’t happen.

REDUCING THE RISKS It is important that the steps organisations put in place to safeguard their workforce

are kept under constant review. This will mean that they are changed and improved to reflect the experiences of those frontline healthcare workers that face potential incidents on a daily basis.

Lone workers need to be provided with extra support to mitigate the risks they face. They need to be empowered through training to make sure they are equipped with the know-how and responsibility for their own safety and security.

The best way for an employer to ensure there is organisation-wide consistency over lone working is to develop a policy that managers can integrate into their workforce. Both regular and occasional lone workers should be looked after, so that everyone is aware of the techniques they can employ to protect personal safety.

Group training is an ideal way to share and learn from experiences of this type of work, helping people pool suggestions on the measures that can help to overcome problems.

After all, good communication is the most important aspect of looking after lone workers.

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PREVENTION RATHER THAN CURE When the correct policies are in place and regular training is given on how these policies apply to people’s reallife experiences, this means incidents are much less likely to happen.

Learning from experience is one of the best ways of avoiding problems in the future, so organisations should not just report incidents and file them away – they should be used to improve lone working policy to avoid similar problems in the future. Encouraging a risk and incident reporting culture is important, and the perspective of other stakeholders who witnessed or dealt with incidents should provide key information for report and strategy in the future.

Prior to a lone worker stepping out in their job, a company needs to take a step back from their tasks and find out what areas of their work will need more finely tuned health and safety considerations and procedures.

Risk assessments perform that role.

In fact, dynamic risk assessments are the most important lesson companies have to learn in finding out how to best protect their lone workers. These should assess whether the conditions they’ll be working in are normal or abnormal, and whether they are hazardous – both in terms of the groups of people they face, and the physical conditions of the area such as hygiene and lighting. Lone workers in the healthcare sector might have to refuse appointments, give medication or give bad news – all of which can spark emotional reactions that they will need to be trained to diffuse. Those who work with alcohol or drug users, and patients with mental or personality disorders also face specific risks that need careful procedures and training in place to be able to deal with them.

Certain types of equipment will require E

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LONE WORKING E assessment, as well as the lone worker’s ability to prevent that equipment from being stolen or mishandled, such as medication.

They will also need to carry equipment to help them in unpredictable situations, such as a torch, map of the local area, telephone numbers for emergencies including local police, first aid kits, or mobile phone chargers.

Whether a lone worker is disabled, pregnant, or inexperienced will also need taking into consideration to find out their physical capability of dealing with abuse or attack.

PRACTICAL SOLUTIONS There is an array of solutions to the risks that lone working presents. Some of them are physical, such as providing employees with mobile phones, panic alarms, or even light body armour in accident and emergency departments, but others are psychological and learnt methods that both prevent and calm heated situations.

IOSH believes that communication plays a key role in protecting lone workers. If managers and colleagues are aware of where their fellow employee is, and they keep in regular contact and are able to make contact if an emergency arises, the risk of harm is dramatically reduced. As previously mentioned, robust risk assessments will also help to mitigate risks by providing systems that will cope with potential or actual attack or abuse.

IOSH recommends appointing a ‘personal safety’ champion to ensure lone working is managed proactively in an organisation.

‘Buddy’ systems are useful as they enable a lone worker to keep in regular touch with another employee based back at head office, or another location. This buddy will know the places, times and people that their colleague is coming into contact with and will be able to raise the alarm if an expected call is missed.

If none of these measures are in place, at the very least, others in the organisation should always be aware of a lone worker’s movements, with a full address of where they will be, the details of the person they are

visiting or working with, telephone numbers, and times they expect to be at that location.

For those employees who make visits to homes or other places alone, they should ideally make contact each side of the visit. Risk assessments should establish whether the visit presents a chance of harm to the lone worker, and if this is the case, the employer should try to arrange someone to accompany them, or pre-arrange a call during the appointment.

If there is a history of violence where the appointment is being held, or the patient or service is considered high risk, the lone worker should have a colleague, security officer, or in extreme cases, a police officer with them. Visits of this type are best in a neutral location or within a secure environment.

SAFETY DEVICES There are several safety systems that allow these lone workers to quickly alert colleagues if they need help, but their level of complexity and reactivity will depend on the risk that person is exposed to. IOSH does urge companies to adopt sensible control measures that don’t unnecessarily alarm – they must be practical and proportionate.

Technology shouldn’t be used on its own, or as a substitute for proper training and techniques. It’s an added layer of protection that adds value and can make the difference in a worst case scenario.

The simplest of safety devices come in the form of speed dial buttons on mobile phones, panic buttons that link to base or the police, as well as others that link a user’s whereabouts to their PC and shared e-mail calendar. The simple panic alarm, which sets off a loud noise, is also an effective method.

Other more technical applications might provide automated GPS tracking that can show a user’s movements. There are those that require people to regularly log in to show they are safe, starting a chain reaction of emergency procedures if they don’t.

It’s important that organisations understand that these devices are important, but they don’t make lone workers invincible, nor

do they mean they won’t be abused or attacked. What they achieve is enhanced protection, either as a deterrent, or to assist in investigations as evidence.

Lone work within the healthcare sector will more often than not involve driving a company or self-owned vehicle. Advice might seem intuitive for employees in this area, but so often, it is the simple things that get missed because they seem insignificant and easy to carry out at any point during or after working hours. IOSH urges people not to overlook the more obvious precautions.

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THE AFTERMATH If an incident does happen, staff and employers need to understand the importance of reporting. Not only will this help to improve their lone worker policies of the future, but on a national level it will inform RIDDOR statistics and other figure-based evidence of incident rates.

Organisations need to have a system in place that cares for those employees who have been a victim of an abusive or violent incident. This might include debriefing or counseling services, post-trauma support, peer support, psychological support and access to a trade union representative.

CONFIDENCE The key to prevention of abuse or attack of lone healthcare workers is instilling in them the confidence to refuse to go into a situation where they feel their safety or the safety of others could be compromised. Intuitively, they will know what risks are not worth taking, and a common sense approach is needed to safety in this context. Dynamic risk assessment skills should help individuals make informed decisions while they are doing their jobs and will help to protect them. This pragmatic approach will also balance with the standard of care that patients and service users do need in order to get better. L FOR MORE INFORMATION www.iosh.co.uk

Legionnaires’ Temperature Monitoring Kit from ETI If you are an employer or person in control of premises, you must organise a Legionella risk assessment, therefore a reliable thermometer kit is essential. ETI’s Legionnaires’ Temperature Monitoring Kit has been specifically designed to monitor the temperature of both standing water and the surface temperature of pipes and tanks that form part of the water system.

Each kit contains a Therma 1 thermometer, three probes - penetration, precision ribbon surface and PTFE exposed junction wire, a tub of Probe-Wipes and a waterproof countdown timer, all housed in an carrying case.

Legionella, like many bacteria, thrive at certain water temperatures and therefore,

universities, hospitals, nursing and care homes, schools, children’s nurseries, housing associations, charities and hostels. In fact, anywhere where water is stored and circulated around a building. Landlords, managing agents, hoteliers, and owners of guest houses, caravan and camping sites must also be aware of this.

ETI supplies the Legionnaires’ Temperature Monitoring Kit at £122.50 plus carriage and VAT. a wide range of workplaces are at risk where artificial water systems exist, e.g. local authorities, large businesses,

FOR MORE INFORMATION Tel: 01903 202151 www.etiltd.com

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West Country Private Ambulance Service continues to go from strength to strength Founder Gerry Pickard’s experience across a variety of patient care situations revealed a need for dedicated transport facilities.

He worked initially with a converted car and two members of staff. At that stage the main focus was on hospital to hospital and home to hospital transfers, with one hospital as the principal client.

The service grew quickly as its reputation spread. WPAS has continued to grow ever since Gerry started it and is about to relocate to larger premise’s to accommodate this rapid growth.

Highly trained staff are joining our team all the time to offer new specialisms.

Throughout our development, emphasis has been placed on thorough training and high quality vehicles. All drivers are regularly assessed by The Devon Drivers Centre in Exeter and we have a demonstrable commitment to on-going professional development. We recently achieved Investors in People accreditation and Care Quality Commission recognition.

Now more than 40 people form the WPAS team and our enviable track record rests on their commitment and dedication. Staff retention is high and we are well known for friendly and motivated people who establish excellent working relationships with patients.

Training and assessment have always

been and remain our top priorities. Every staff member begins with an induction period including a first aid course, basic manual handling and procedures.

Beyond the initial training period, further programmes deliver a range of additional skills.

All WPAS staff are required to take an in-depth first aid course dealing with situations such as blood loss and fractures. This training is reviewed annually and repeated every three years.

On-going assessments include basic life support, CPR and driving skills are also regularly re-assessed. Staff members wanting to expand their skills still further are encouraged to do

so and we have hosted externally delivered two-week technician courses, which are equivalent to NHS technician level and are retaken by the staff concerned every two years.

It is our intention to continue to keep improving our services and providing the best level of care possible for all our patients and service users.

FOR MORE INFORMATION Tel: 01884 841911 Fax: 01884 841544 derek.wpas@fsmail.net www.wpas.co.uk

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HEALTH BUSINESS MAGAZINE Volume | 11.6

VEHICLES & TECHNOLOGY

ADAPTING TO MODERN NEEDS

West Midlands Ambulance Service has adopted an innovative approach to providing emergency care which has led to them scooping two awards at this year’s Emergency Service Awards

West Midlands Ambulance Service won two Emergency Services Awards at a high profile ceremony at the Emirates Stadium in London on 7 April, presented

by Nicholas Owen of BBC News.

The awards for innovation and technology recognise the hard work done by the trust to develop an A&E bariatric ambulance which became the subject of national news coverage and the creation of a ‘performance cell’ to help operational managers effectively run the service.

The trust won the Emergency Services Ambulance Innovation Award for the development of its ARV bariatric vehicle. This vehicle met the award criteria of “recognising the ambulance service that can demonstrate innovation in providing a new service to the community or by delivering existing services in a new and effective way”.

AN ALTERNATIVE SERVICE In 2002 whilst undertaking an NHS management training course, a group of officers from Warwickshire Ambulance Service were tasked with a project to

establish an alternative response to category C calls within the ambulance service, with the intention of leaving paramedic crews available for more serious calls. This project highlighted a number of areas where a lower level trained crew could assist safely with various emergency, urgent and specialist jobs in support of the 999 service.

It was during this process that the ARV (Alternative Response Vehicle) was born.

Initially based on a PTS Stretcher-type vehicle, the new service would also carry a patient hoist and an air lifting cushion as well as a number of other handling aides to enable crews to deal with simple falls and patients who were on the floor but didn’t require the assistance of a paramedic.

These vehicles were an immediate success, but also came with some difficulties. With the equipment they carried they soon became regularly requested by paramedic crews who were faced with patients who could be lifted using the air cushion or by using the hoist. The difficulty came in trying to send out a vehicle that didn’t have blue lights to incidents across a wide area within an acceptable time frame.

WORKING PARTNERSHIPS In 2004 additional vehicles were built to meet the increased workload brought by Warwickshire Ambulance Service’s merger with Coventry Ambulance Service. This gave the opportunity to build the latest vehicles with blue light capability and also upgrade the original vehicles. There also came the opportunity to introduce the first bariatric stretchers to two of the new vehicles.

During these early developments, partnerships were also formed with community care groups to ensure similar equipment was made available by local councils to ensure their mobile wardens had access to them and were trained.

This was to avoid a number of 999 calls merely to assist with simple falls where the patients had not suffered injury. This work still bears the fruit of those partnerships.

Although the ARV project was a success a number of challenges continued to arise.

The regionalisation of ambulance trusts across the country in 2006 meant that the ARV project in Coventry and Warwickshire left an inequality of service across the new West Midlands region. Also, a new way needed to be found to deal with patients who were continuing to grow in physical size and that, on many of these occasions, the patients needed the assistance of a paramedic with all their associated equipment.

NEW CHALLENGE This was a new challenge. The trust now needed to build a full A/E spec bariatric vehicle. It would carry over all of the successful attributes of the old ARV vehicles, whilst having all of the requirements for the latest A/E vehicles as laid out in the national vehicle specifications and CEN regulations.

Whilst all national specification vehicles have to have a bariatric capability, this is far from the full bariatric specialist vehicle.

The project, headed by Graham Cann, regional head of fleet and Nigel Wells, A/E logistics manager, formed a partnership with ambulance builders O&H Facilities of Goole and Collet/Giffa in France to build a one-off design concept vehicle. The base vehicle chosen was a 4-tonne Citroën Relay, built with a 4.5-tonne upgrade to take the additional weight required to carry the additional kit and high patient weight.

More than nine months was spent undertaking testing and ensuring the vehicle would comply with all regulations.

The vehicle was also specified with the latest equipment for ensuring the best possible treatments for our patients.

The vehicle has to safely carry and store in its own cupboards the latest generation Mangar Elk lifting cushion, capable of lifting 50 stones (318kg); the latest Molift Hoist, capable of being assembled in the patient’s own home and will hoist 40 stones (255kg); and the latest electric version of the Ferno E

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Experienced provider of quality effective private ambulance services to both private, public and commercial clients throughout the United Kingdom Aero Medical Ambulance Service has been established for over 36 years.

We specialise in medical repatriations and being based in Hertfordshire, we are conveniently located within easy reach of the South East: London Stansted, London Luton, London Heathrow, London City, London Gatwick and various other smaller airfields that accept air ambulances. In addition to meeting patients and medical crews at airports, we also provide airside lift-offs from commercial flights and specialised air ambulances, as well as continental repatriations and long distance journeys.

We are also able to provide medical cars, fully equipped ambulances, through to high dependency ambulances with a full medical crew complete with specialist nurses and doctors, also coordinating full air ambulance evacuations. We can also offer a full range of medical facilities, health screening, travel vaccinations and many other options.

Experienced at providing medical support and cover at events and various occasions, we can provide first aid cover to specialist nurses and doctors for sports events. We have a fully kited emergency 4x4 ambulance,

which enables us to take a full medical crew to the patient no matter what the terrain. We have the unique ability to be able to take all the equipment with us to treat the patient no matter what the situation or conditions.

We are also able to offer medical cover for events where there is a large area and have a response car remotely patrolling to deal with issues, being backed by a full

emergency ambulance and crew.

This is particularly effective with walks, runs and large scale events.

We provide enhanced medical cover for any event no matter how large, providing effective medical cover and reassurance for those who attend.

Aero Medical Ambulance Service works in partnership to provide all kinds of medical transport from air ambulances to emergency ambulance response, patient transport, organ and blood transport and all various medical needs.

We operate 24 hours a day, 365 days a year. Working closely with private doctors we also provide a fast response day or night for patients wanting to be transported to their chosen care provider.

Any patient transported by Aero Medical Ambulance Service can be assured of receiving a very high level of care and treatment from the moment of first contact to ensure all their needs are met.

FOR MORE INFORMATION Tel: 07717 478 648 www.aeromedicalambulance.com

We Listen to you, We have Time for you, We treat you with Care.

Aero Medical Ambulance Service is based in the South East of England, located close to the main road routes to access areas quickly.

Aero Medical Ambulance Service is an independent provider of quality private ambulance services. We have a well known reputation for specialising in medical repatriations within the UK and Europe since 1974. Aero Medical Ambulance Service

24/7 365 Days

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HEALTH BUSINESS MAGAZINE Volume | 11.6

offer a friendly and professional service to meet your requirements. All our ambulances are kitted to deal with all needs of the patient. Patients receive a high level of care, from the moment of first contact to ensure all their needs are met.

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VEHICLES & TECHNOLOGY E Harrier XL, an all electric stretcher carrying up to 60 stones (400kg). The vehicle also had to meet the trust’s own specification for its A/E vehicles and would form the basis of its future fleet, meeting CEN regulations and testing.

The first vehicle was delivered in May 2009 to the Coventry and Warwickshire locality at a cost of £91,000 and was an immediate success. The vehicle design also allowed for it to be fitted with an incubator trolley or high dependency trolley, which was immediately found to be a benefit when a new service was required to transport seriously ill patients suffering with swine flu across the region during the winter of 2009.

ADDITIONAL VEHICLES During 2009/10 the design was further honed with the introduction of new A/E vehicle across the West Midlands Region. Three further ARV bariatric vehicles were built at the same time as the start of the build of 60 A/E vehicles. The intelligent design of the vehicles meant that more than 90 per cent of the build was identical for both types of vehicle, reducing the cost of build from the original ARV design cost of £91,000 to £86,000 and the full A/E spec vehicles at £81,000.

This has allowed the trust to strategically place the now four ARV bariatric vehicles across the region to ensure availability to all patients and crews. The trust now has 24-hour-a-day availability of fully equipped A/E specification vehicles with paramedic crews to be able to deliver the care, dignity and equality of service for the larger patient.

The generic design in line with its A/E fleet means the vehicles are an easily adapted workplace for the crew, with all the same features they are used to using. Those similarities mean that there is only the need for a short training course in the use of the additional equipment and management of bariatric patients in general. All of the new A/E vehicles being brought into the trust also benefit from a level of bariatric capability if required in line with national specifications.

Graham Cann, the fleet manager who

was involved in the vehicle’s design and development, said: “A considerable amount of work and effort has gone into bringing our vehicles to such a high standard and this is now proven in the ARV Bariatric vehicle.

West Midlands Ambulance Service is now the market leader in van-to-ambulance conversion. Other ambulance trusts, including Scotland, East Midlands and the North West are now following us.”

TECHNOLOGY West Midlands Ambulance Service also took home the Emergency Services Ambulance Technology Award for its ‘performance cell’.

This project lived up to the criteria of “most

was created a year ago, with the help of a number of external companies in analysing a wide range of information. These partners include Software Enterprises (roster information), Process Evolution (resource and activity planning), Lightfoot (reporting tools) and Cleric (response post planning).

The resultant information, which includes hospital data, resource status and narrative is displayed on easy-to-read, accurate and live dashboards. Accurate forecasts are produced for anticipated demand and early warnings are issued of pressures that can affect performance. All the information is easily understood and used by all parts of the organisation allowing for safe

Ambulance Services

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“A considerable amount of work and effort has gone into bringing our vehicles to such a high standard and this is now proven in the ARV Bariatric vehicle. West Midlands Ambulance Service is now the market leader in van-toambulance conversion. Other ambulance trusts (including Scotland, East Midlands and the North West) are now following us” – Graham Cann. innovative and successful application of a new or emerging technology to assist in ambulance service operations.”

West Midlands Ambulance Service (WMAS) serves a population of 5.36 million in an area of 12,998 square kilometres. The geographical make up of the region is diverse with densely populated urban areas as well as some of the remotest rural areas in England.

The aim of the performance cell is to combine skills and experience in data mining and analysis provided by the information team with the operational expertise of senior managers to stabilise performance and find innovations in service design. It

and effective decisions to be made, such as placing on duty the correct level of resource to match levels of activity.

Already there is evidence that the information given and forecasts produced have led to an efficient use of resource and a reduction in wastage. It has been vital in helping operational managers effectively run the ambulance service.

Daren Fradgley, regional head of performance improvement, said: “It’s a remarkable achievement for a new department that is only a year old to win such a prestigious award and have such an impact on service stability.” L

Poshchair – working closely with the NHS Poshchair Medical is proud to claim that it puts the patients welfare first above all else.

Our in-house manual handling advisor offers training and assessment to aid in making the correct choice. Our dedicated rental and sales division covers a comprehensive range of equipment delivered 24/7 direct to you.

At Poshchair Medical Ltd we are constantly striving to obtain new products and ideas to aid the NHS with their bariatric patients.

We offer an excellent range of quality beds, chairs, walking aids and commodes.

We also work closely with CJ Medical in promoting their hover tech system, which aids in the transfer of patients. Please see

our website for updates on new products.

Poshchair Medical also has a good relationship with the bariatric amublance service to ensure the smooth transition of transferring patients from hospitals to either their homes or care/nursing homes.

We hold regular study days and offer a training room on site for any meetings or conferences the hospitals require.

FOR MORE INFORMATION Tel: 0844 8000899 Fax: 023 80446895 Mob: 07827 779301 info@poshchair.co.uk

Volume 11.6 | HEALTH BUSINESS MAGAZINE

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Ambulance Services

THE BUSINESS MAGAZINE FOR HEALTH MANAGEMENT – www.healthbusinessuk.net

There is a new kind of ambulance on Britain’s streets, that can shift people who weigh up to 70 stone – the bariatric, or ‘supersize’, ambulance Over the past five years, the number of bariatric patients needing hospital treatment has more than trebled, and as Britons get bigger, moving this patient group to and from hospital has become a challenge as traumatic for patients as it is challenging for health staff.

Prior to the introduction of specialist equipment and vehicles we had witnessed bariatric patients being transported in all manners of undignified ways, examples including laying the patient on the floor of an ambulance with no mattress, in a builders skip, on the floor of a Luton style 7.5 ton box van, or on a flatbed trailer towed behind a car exposed to the elements.

The need for bariatric services was first identified around the year 2000 with acute hospitals requesting transfers of the larger patient in a dignified way. The USA had seen the market potential for bariatrics but there was little or no equipment available in the UK and therefore the search began in earnest.

Thames Ambulance Service, an independent ambulance service, designed an initial concept vehicle based on a Fiat Ducato, which went into service with a reinforced floor pan, ramp and winch with

a 1.5 ton capacity four months later.

Not only did the vehicle require designing but equipment required sourcing. This was one of the biggest challenges at the time.

The initial equipment selected for this vehicle consisted of a heavy duty winch, a Ferno Pro Flex Stretcher (70 Stone Capacity), Mediwrap Heavy Duty Rescue Bag (100 stone capacity), a BCW Advantage 34” wheelchair from 1st Call Mobility and an AAT star climber.

As the demand for such a service has grown, Thames has increased its service provision with

all new standard vehicles now being able to accommodate patients up to 50 stone.

As part of the initial design concept as well as with new vehicles it has been the intention of Thames not to single out through appearance vehicle specialist types and as such all vehicles within the Thames fleet carry the standard company livery. This adds the dignity and privacy of the patient as words such as “specialist unit” are not on the side of the vehicle, thus drawing attention to the user’s unique needs.

As a result of the work within this field Thames continues to work with manufacturers of bariatric equipment in order to redesign, test and trial new ways of transporting this patient group safely and with dignity and respect.

Further enhancements to the vehicles and equipment are constantly being explored.

Thames has been positively active within the media through participation in a number of documentaries highlighting the need for specialised equipment to undertake sometimes complex and challenging transfers.

This has lead to a number of approaches from other external organisations seeking both transportation and equipment advice.

Pro Medicus Limited Trading as Pro Medicus Ambulance & Paramedic Service

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42

Corporate members of AREMT-UK

Tel: 0844 357 8214 email: info@wantmedical.co.uk Web: www.wantmedical.co.uk

HEALTH BUSINESS MAGAZINE Volume | 11.6

Pro Medicus is an Independent Ambulance Service offering a wide range of essential services to both the Public and Private sectors. We are registered with the Care Quality Commission and all our staff are trained to a high standard and all staff are Police checked to enhanced level.

We are available 24 hours a day 365 days of the year. We cover all manner of professional and amateur sporting events and we also offer a wide selection of Training Courses.

Unit 2, Thrales End Business Centre, Thrales End Lane, Harpenden, Herts AL5 3NS Email pro.medicus@ntlworld.com Tel: 01582 969313 Web: www.promedicus-harpenden.co.uk Mobile: 07778 211771 Fax: 01582 645774 Companies House Registration Number: 06498390

THE BUSINESS MAGAZINE FOR HEALTH MANAGEMENT – www.healthbusinessuk.net

Professional healthcare specialists suitable for all your requirements

Sites Ambulance Service – working for the care of the patient

Emergency Care Group is operated by a team of professional security and healthcare specialists. Our team of professionals have experience in the management of all types of medical and security events, ambulance and security operations, training and the provision of world class emergency care, as well as personal protection solutions, training solutions, provision of first aid equipment and supplies, occupational health solutions and staff placement and contracting solutions.

Our management team have a combined total of 20 years’ experience, both nationally and internationally, in the emergency care, training and security industry, which in the end, gives you the best and most experienced service available. Internationally the management team have

Sites Ambulance Service is successful because all of our staff are dedicated, keen and enjoy their roles and responsibilities giving our clients the best service.

Our aims are to provide a safe and friendly environment that will ensure, so far as is reasonably practicable, the health and safety of our patients, staff and to comply with all statutory provisions for their health and safety.

Sites Ambulance Service can offer private patients, hospitals, doctors surgeries, NHS trusts, organisations and individuals, a reliable, high-quality, and cost-effective ambulance service for all medical purposes and event coverage.

Our services include first aid, wheelchair transportation, intensive care transportation, organ transportation, medical crew transportation, patient recovery, repatriation, patient transport service, blue light emergency work and medical coverage for all types of

experience from Afghanistan, West, East and Southern Africa.

The team is made up of professionals who excel in the medical and paramedical, security and training field, with specialist interest in pre-hospital care, close protection, and personal security detail, maritime security, remote medicine, occupational health and training. We have various levels of operational staff to ensure you always receive the best and most suitable coverage for your requirements.

FOR MORE INFORMATION Address: 74 Cantilupe Crescent, Aston, Sheffield, South Yorkshire S26 2AT Tel: 0844 800 5975 Mob: 0777 624357 Fax: 0114 2876233

Providing ambulances for almost 40 years B. N. Gibson Ltd is a private family orientated CQC accredited ambulance company that has been established almost 40 years.

We have over 70 vehicles and provide tail lifted accessible ambulances with full stretcher and capacity for a further two strap down wheelchairs, three sitting patients, driver and escort.

All staff will have enhanced CRB disclosure, they are professionally trained in all aspects of first aid and patient handling including High Dependency.

All vehicles provided will conform to legal requirements and are presented in a clean and tidy condition for the work. Spare vehicles including a bariatric ambulance, are always available in the event of breakdowns.

We have our own engineering workshops and the capability

to adapt seating arrangements to satisfy special requests. We provide services throughout the Midlands and on occasions as far as Cornwall and Scotland.

B.N. Gibson has the ability to offer a response from the point of initial contact with our control centre by the immediate dispatching of an ambulance, this 24/7 service ensures a special provision of transport for the needy.

As you can see from details above we are in a strong flexible position and offer a very competitive service to our valued customers.

FOR MORE INFORMATION Contact: Keith Townsend Tel: 01623 870312 Fax: 01623 871740 keith@bngibson.co.uk www.bngibson.co.uk

events including TV and film sets, sporting events, fetes and other occassions.

Our motto: Without the clients we wouldn’t have the staff, without the staff we wouldn’t have a company so lets look after them all to be a successful ambulance service.

We are a member of the British Ambulance Association and abide by its standards and have been inspected and approved.

FOR MORE INFORMATION Please see our website for full details of our services www.ambulancesites.co.uk or contact us on 0845 0171129.

Professional ambulance services from MBS Medical MBS Medical Ltd is a small company with the objective of providing medical cover and ambulance transport at events, such as moto cross, equestrian activities, athletics and fairs over a wide area of the south of England.

We also undertake patient transport, both privately and in support of the NHS, between UK locations. We will travel over a wide area, and carry out in-journey care, particularly needed for longer distances.

The company owns a small fleet of fully equipped ambulances and all terrain vehicles, and can respond to a variety of requests, often at limited notice, always endeavouring to meet the commitment. Our equipment include spinal care, defibrillators, and paramedic drugs.

We use staff with nationally recognised qualifications as emergency medical technicians and responders, and state

registered paramedics can be supplied if requested.

We are registered with the Care Quality Commission (CQC), and are subject to regular inspection and audit by their representatives. We also have membership of the the British Ambulance Association, and abide by their code of practice.

We welcome all enquiries, and will be pleased to supply no obligation quotes for our range of services. Our rates are competitive, and you can be assured of a professional response.

FOR MORE INFORMATION Contact: Barry Goodman Tel: 01483 486999 mbsmedical999@aol.com

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SMARTPHONES

THE CHANGING ROLE OF THE MOBILE PHONE

Mobile Technology

THE BUSINESS MAGAZINE FOR HEALTH MANAGEMENT – www.healthbusinessuk.net

Nick Hunn, vice chairman of the Mobile Data Association, looks at how the health service is embracing a variety of mobile technologies to transform service delivery and patient care It’s proving to be an interesting time for mobile technologies and healthcare. The health service has always had a somewhat inconsistent approach to the use of mobile technology. Whilst simple applications like fall alarms are well known and widely deployed, the acceptance of mobile phones in hospitals and healthcare has often been rejected, with many believing they are still banned. That’s in sharp contrast to almost every other workplace, where they have been accepted as an important tool.

It’s very difficult to uncover the rationale behind the reason for banning mobile phones within hospital environments. Most of the scientific claims regarding interference have about as much evidence behind them as the images of life enhancing benefits you see adorning the window of your local health food store. That argument might hold true for a few very sensitive pieces of electronics equipment, but nowadays these are designed to cope with interference from a wide range of radio sources.

MOBILE PHONE USE AT WORK The truth may well be a social and status one. Certain groups within the profession are somewhat technophobic and distrust new technology, particularly if they perceive that others around them appear to be more comfortable with it than they are.

Whatever the reason, there still is a strong culture against using mobile phones.

At the end of last year, Devices 4 – a nonprofit group attempting to increase the use of mobile technology by doctors, nurses and other care professionals – undertook a wideranging survey of attitudes to mobile phones.

Of those surveyed, only just over a quarter (26 per cent) reported that they were freely allowed to use their mobile devices at work. A larger percentage of respondents (31 per cent) replied that phones were not allowed, with the remainder in a grey area where they were tolerated. For a sector where communication is vital, that’s worrying – it suggests a more institutional misunderstanding of the benefits of mobile phones than anywhere else.

ONLINE BEHAVIOUR The conservatism of health services had led many commentators to suggest that this E

Whilst simple applications like fall alarms are well know and widely deployed, the acceptance of mobile phones in hospitals and healthcare has often been rejected, with many believing they are still banned.

Volume 11.6 | HEALTH BUSINESS MAGAZINE

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SMARTPHONES

E would result in patients taking monitoring into their own hands. In recent years we’ve seen an increasing range of economically priced monitors available in the high street, from blood pressure meters through to personal ECGs and glucose monitors.

What an individual can buy varies from country to country, but the internet has broken down most barriers, letting patients acquire whatever they feel they need.

On the back of this, many internet companies have been set up to allow patients to upload their medical data to their own electronic health records. The most well known of these was GoogleHealth.

However, despite a massive amount of media coverage, usage has been limited, and at the end of June, Google announced that they were retiring GoogleHealth. In their words: “It failed to move adoption beyond a small population of tech savvy patients.”

This announcement may signal a back-track in the way that the medical profession looks at mobile technology. Some are claiming that it signals the fact that most patients are not interested in taking healthcare into their own hands, but continue to rely on the medical profession to do the job

Mobile Technology

THE BUSINESS MAGAZINE FOR HEALTH MANAGEMENT – www.healthbusinessuk.net

Ever since Norman Lamont’s budget tax on mobile phone, which was seen to be based as much on status as anything else, the hierarchy of healthcare IT has reinforced the attitude that smarter phones are not seen as necessary tools, but as status symbols. for them. Equally, the initial experiment with consumer healthcare has made them more aware of what’s available, which raises their expectations for how they expect to see health professionals use it.

SMARTPHONES It’s not as if the medical profession does not embrace mobile phone. The Devices 4 survey indicated that 81 per cent of respondents use a smartphone, of which almost half use it for accessing information on the web. That’s in line with experience elsewhere. Two recent surveys in the US, by Aptilon and Manhattan research came up with smartphone ownership amongst physicians at 84 per cent and 82

per cent respectively. In a telling statement on the brand loyalty of US doctors, 61 per cent told the Aptilon researches that they would be using an iPhone by the end of the year. So it seems an apple a day still has relevance to doctors’ mobile aspirations.

However, it appears that some other factor is at play in stopping three quarters of UK doctors using their phone for work.

The UK does seem to be unique in the barriers it has created for using mobile phones in healthcare. Ever since Norman Lamont’s budget tax on mobile phone, which was seen to be based as much on status as anything else, the hierarchy of healthcare IT has reinforced the attitude that smarter phones E

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SMARTPHONES their mobile phones. The trust believes that the system paid for itself within the first year, as well as freeing up time equivalent to five midwives, giving them more time to care.

One key finding from the deployment was that engaging the midwives in the design of the system really helped to make it more engaging and more efficient. Many people in many tiers of the mobile industry forget that the end users often know more about how an application works. It’s very important to get them involved from the start.

E are not seen as necessary tools, but as status symbols. Which is doing an immense disservice to patients, many of whom use their mobile devices in a more competent way than their doctors. It’s a complaint heard often from health workers that “they do more useful things on their phone outside office hours”.

However, there are many excellent examples of how mobile devices are being used. Many of them are simple and have been deployed in small scale, local implementations. The most obvious is still not done nearly enough, which is to use mobile phones for messaging.

Health services seem to be one of the last to realise that all of its staff have mobile phones that can be used for messaging during working hours. It’s an area which raises the question of whether an employee should be expected to use their own phone, or have one provided by their employer for work use.

Most other areas of industry have realised the benefit of using the single phone. Very few of us like carrying multiple phones, so it’s more efficient, which means it’s more likely to work.

But doing that means that cost and intrusion needs to be managed. People will only accept this if their phone does not get called

when they’re off duty. Some hospitals have worked this out, but many are still stuck over deciding whether to provide a second phone.

The second simple use is text for appointment reminders. Patients use their phones every day, and text messages are very suitable for reminders, as well as providing personal information. Some STD clinics have been making good use of this.

The Terrence Higgins Trust’s Young and free website is an excellent example of how to do it, particularly their ‘Hide Me’ button.

A BETTER WAY OF WORKING That’s the very low hanging fruit, which needs only the most basic phone. Move to smartphones and limitless possibilities appear.

Portsmouth NHS Trust did more than just join the dots when they worked with BlackBerry to make it easier for their midwives to record data during post-natal visits. In the past they’d write their notes, which they then had to enter on the system when they got back to hospital. Their paper pads have been replaced with digital pens and electronic paper, which captures what they write and transmits it back to the system via a Bluetooth link to

Mobile Technology

THE BUSINESS MAGAZINE FOR HEALTH MANAGEMENT – www.healthbusinessuk.net

AN END TO TRADITIONAL PROCESSES Portsmouth isn’t the only successful example of the digital pen in healthcare.

Wolverhampton is so pleased with the trial they did with their anti-coagulation and district nursing service, that they’ve just rolled them out to 600 community care staff. They believe that as a result, information is getting back to the hospital records five days earlier.

These applications open up the ability to share patient records and information – particularly important for caring for patients in the community, where they are likely to come into contact with multiple carers. The major network operators – particularly O2, Vodafone and Orange – have all set up health divisions that are working closely on trials in this area with a range of NHS trusts.

Phones don’t need to look like phones.

A good example is the lone worker alarm that is being provided by Identicom. To all intents and purposes this look like a normal NHS identity badge, but the back of the badge holder contains a GPS tracking device and an embedded mobile phone. When the wearer presses a discreet button on the rear of the badge holder, it makes a phone call to a monitoring centre, who can listen to and react to the conversation taking place.

If the badge is ripped off, it immediately sends an alarm, along with its location.

The beauty of this design is that it is nonthreatening; because it looks like a normal badge it is unlikely to cause confrontation.

It’s already widely used within the NHS – you’ve probably seen one, but not realised.

Nor is it just people who need to communicate. It’s often claimed that the location of up to 25 per cent of wheelchairs and 30 per cent of endoscopes are unknown. Wi-Fi tracking devices are increasingly being fitted to these for asset management, reducing the time that is wasted in tracking down a wide range of equipment that isn’t where it ought to be.

In our everyday life we all recognise that mobile phones have transformed the way we interact with friends and run our lives. The health services have been slow to adopt that trend, hampered by internal issues. That tide is beginning to turn. As more of those involved in running our health services become aware of what is possible, often on their own phone, the future for mobile communications is looking decidedly brighter. L

Volume 11.6 | HEALTH BUSINESS MAGAZINE

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SECURITY

REDUCING THE RISK OF A BREACH

Responsible for plenty of sensitive patient information, the health sector is not immune to the consequences brought on by ineffective confidential waste disposal, writes Russell Harris, chairman of the BSIA’s Information Destruction Section Recently exposed data breaches such as the case of the NHS in Birmingham and the North Lanarkshire Council incident highlight how, despite the heightened press interest on data protection issues, the handling of sensitive information is still something that many organisations are failing to get right.

Responsible for plenty of sensitive patient information, from demographic data such as age, occupation and race to addresses and contact details, health condition and financial information, the health sector is not immune to the consequences brought on by ineffective confidential waste disposal.

With the health sector coming increasingly under scrutiny for the way in which patients data is handled, and the ICO acquiring more powers in 2010 to impose fines on organisations failing to comply with data regulation, effective information destruction strategies continue to play an essential role in the security of companies. The consequences for non-compliance are many, and can bring organisations to their knees, resulting in financial losses and negative impact on customer and stakeholder confidence.

THE CONSEQUENCES OF BREACHES Health care organisations face particular risks, as well as legal obligations. The sector necessarily holds vast amounts of sensitive personal information and nowadays, almost any kind of personal information is valuable to criminals, whether it is residents’ records, financial reports, payroll information or personnel data. The unlawful use of such information contributes to an explosion of identity theft crimes, which allows criminals to obtain goods, credit or services in someone else’s name and could put the institution, customers, or even suppliers, at risk.

In addition, data breaches carry with them hefty fines and bear great financial costs to organisations. In 2010 the Information Commissioner’s Office (ICO)’s powers were extended, allowing it to now issue penalty fines of up to £500,000 for breaches to the Data Protection Act. Moreover, a UK study sponsored by data protection firm PGP Corporation highlights how, in 2010, the overall costs of data breaches rose for the third time in consecutive years to reach on average £1.9m, with each individual record lost costing UK organisations an average

of £71, a 13 per cent year-on-year raise.

Finally, mishandling sensitive information can result in significant reductions in consumer confidence. This can be extremely damaging for all kinds of organisations, particularly for those where patients’ trust is an absolute requisite. Research recently commissioned by the ICO found that 94 per cent of respondents from the general public selected protecting personal information as one of their main social concerns, same as preventing crime (94 per cent) and more than the NHS (88 per cent) and national security (87 per cent).

Continuous reports of data breaches – such as in North Lanarkshire Council where paper documents containing sensitive information were stolen from an employee’s bag, and the NHS in Birmingham, which occurred due to reportedly lax IT security – prove how wellfounded these concerns are, and demonstrate that organisations need to do more to regain consumer confidence and credibility.

There are many ways in which these risks can be countered, however. In particular, it is essential to have clear waste management strategies in place, to be able to integrate these to the wider security strategy and be aware of the legislation surrounding the handling of patient data.

SETTING UP CLEAR STRATEGIES Only a small fraction of organisational waste paper and data processing products such as hard drives, CDs, memory sticks and DVDs are destroyed annually by professional firms. By far the majority of such material continues to be disposed of via municipal refuse collection or waste paper reprocessing.

Neither method generally involves any kind of secure handling, however it is not uncommon to find much confidential data included amongst general waste, becoming a significant cause of avoidable risk.

It is not surprising in these circumstances that the rubbish bin is a regular source of prosecutions under the Data Protection Act, just as it has long been a core element of the private detective’s trade.

Effective waste strategies clearly separate the handling and disposing of general waste to that of sensitive material held on documents, PCs and memory devices such as CDs and hard drives. Anyone responsible for the handling of the sensitive data should be

extensively briefed on the correct disposal of the material, and should be made aware of the consequences for non-compliance.

According to another report from the ICO the NHS topped the list of security breaches reported involving the loss of personal data since November 2007. The report highlighted how more than 100 breaches by the national health institution were due to stolen data or hardware, 87 due to lost data or hardware and 43 cases due to error.

Simple steps can be taken internally to reduce the risk of breaches, including ensuring all unwanted documents, CDs and DVDs are being properly shredded, wiping clean the information held on old computers before disposing of them and regularly changing network as well as PC passwords.

However, leaving document destruction to individuals can compromise security as items might not be thoroughly destroyed and therefore may be recovered. For this reason, employing a professional data destruction company will ensure law compliance and the highest standard of service, giving institutions the peace of mind that the interests of their patients are protected.

A reliable information destruction supplier should be able to provide sacks that cannot be tampered with and bins to match the office furniture, and that can only be accessed by key.

To provide further protection, each collection and sack should contain a unique code so that customers can access a full audit trail of their paper once it has left the building.

The law sets clear rules for the destruction of personal information. Information destruction suppliers should be able to guarantee under contract that their work is carried out securely and effectively, in accordance to data protection laws. The process consists of waste collection by secure transport, inspection, removal and destruction of rubbish, and the shredding, pulping and recycling or incineration of other material.

European Standard EN 15713:2009 describes the essential requirements and operating procedures for a professional information destruction company, including employment practices such as the security vetting of all staff members and details relating to the security of its premises by means of monitored intruder alarms and CCTV systems. Detailed rules are set out for the actual destruction of data, incorporating material-specific shred sizes, and requirements for the security of vehicles used both for the collection and on-site destruction of confidential waste.

Although many information destruction companies claim to work to these standards, security buyers are encouraged to employ the services of those service providers who have EN15713:2009 incorporated into their UKAS ISO9001 quality management system. This means that they will be independently audited to ensure they continue to comply with the requirements laid down within the standard.

All BSIA information destruction E

Volume 11.6 | HEALTH BUSINESS MAGAZINE

Information Destruction

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SECURITY E section members are inspected to the European standard, as part of the audit procedure for their obligatory ISO 9001:2008 quality accreditation.

Another significant development in the sector has been the publication of National Occupational Standards (NOS), which encompass all key activities undertaken within the sector. The BSIA worked closely with Skills for Security in developing the NOS, which all member companies incorporate into their training practices. In short, the risks of careless or ineffective data disposal are high but the solution is readily available.

Effective waste procedures that set out clear guidelines on the disposal of sensitive information can however prove worthless if the material is not kept securely whilst still in use. It is important for companies to ensure that only trusted and vetted staff have access to confidential or sensitive personal material, and that this is kept securely locked away from unauthorised personnel, patients and intruders.

With large amounts of people accessing the sites every day, health sector organisations need to ensure effective security measures are in place at all times to avoid data getting into the wrong hands. This could include installing access control systems and physical security systems such as locks on the doors of the offices where the information is held, ensuring

CCTV systems are adequately located to be able to monitor access in and out of the area and mark computer equipment held on site with company details or by using forensic technology to enable property to be traced.

EXPERT ADVICE The nature of work conducted onsite and the individual threats and risks that the premises may face, determines what security measures will be required for each individual premise. Making the most of technology and choosing methods that will do the job properly is important but this can be a daunting task, particularly for those who are not familiar with the technologies that are available on the market.

Security consultancies can guide whoever is in charge of procuring the security solutions for hospitals or care homes towards the best security measures that will be of most use.

A consultancy will conduct a thorough risk assessment, providing essential advice on security reviews and audits, development of security polices and strategy, guarding services, systems design, tender management and security awareness training. They will work with their client to identify threats and ensure that business continuity is addressed, therefore eliminating the chance for corners to be cut.

The consequences for the careless disposal

Dajon for leading edge document management solutions Established in 1998, Dajon Data Management has grown into one of the leading and most dynamic document management service providers in the UK. We now provide services to hundreds of organisations on a daily basis and have established a reputation as a provider of unrivalled personalised services.

As a philosophy, Dajon continues to search out new technologies and develop solutions to enhance business performance through efficient information processes.

Dajon’s cost effective and comprehensive range of solutions includes

• Document archiving & records management • Document scanning • Data capture from forms and business documents • Cloud based information and collaboration portal solutions • Electronic document management • Invoice processing and digital mailroom solutions Dajon is ISO 9001, 14001 and 27001 certified.

FOR MORE INFORMATION Tel: 020 7323223 info@dajon.co.uk www.dajon.co.uk

About the BSIA The British Security Industry Association (BSIA) is the professional trade association of the UK security industry.

Its members produce over 70 per cent of the country’s security products and services to strict quality standards. BSIA members meet strict quality criteria and as such, the Association’s website is a great place to start when considering your next security investment.

Information Destruction

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of sensitive waste are many and can often cause companies a series of problems. For this reason, it is important to ensure that only reliable security providers are given the responsibility to handle such data. Members of the BSIA Information Destruction section securely destroy a range of confidential information, including paper, DVDs and computer hard-drives. The section members also destroy items that could potentially cause problems if they fall into the wrong hands, such as branded products and uniforms, and already have extensive experience supplying solutions to a wide range of customers. L FOR MORE INFORMATION www.bsia.co.uk/shredding

At last – a real one stop shop FM solution Control Group UK is a leading business services provider.

We offer commercial relocations, document archiving, document destruction, interior design and refurbishment, as well as IT solutions.

Our clients include hospitals, doctors surguries, dentist practices and even the Health Protection Agency. CGUK has been described as a facility manager’s dream! Our services which at first seem diverse actually blend well together and offer an ideal one stop shop solution to FM, resulting in reducing the number of suppliers required and thus freeing up time and saving money.

Commercial relocation: Project management, dismantling/ reassembly of furniture, packing service, decomm and re-comm of IT, crate hire and insurance cover (£500,000 per vehicle load).

Document archiving: Storage by file or box, with a same day or next day collection and delivery service. CGUK works to BS5454 (Recommendations for the storage of archive records).

Document destruction: Safe, secure service for paper, magnetic media and WEEE. Our staff are CRB vetted and security checked to BS7858. All paper is shred to DIN level 4 and a certificate of destruction is issued.

Interior design & refurbishment: All aspects including space planning, partioning and dilapidation works.

IT systems: Hardware and software supply and ongoing system maintenance.

FOR MORE INFORMATION Tel: 01908 334410 john.daly@cguk.co.uk www.cgrelocations.co.uk

Volume 11.6 | HEALTH BUSINESS MAGAZINE

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Patient entertainment solutions.

If you really want to give your patients what they really want, look no further than the INIX TV. With additional bedside touchscreens, Freeview TVs and multiple mounting solutions, both hospitals and patients are spoilt for choice.

At Airwave we fully understand technology, and our flexible multi-system approach allows us to offer the best solutions for both hospital and patient.

For friendly professional advice, contact us at info@airwave.tv to offer patients the ultimate in entertainment and communication.

Visit us at www.hospitaltv.co.uk or call us on 0845 555 1212

IN-ROOM SERVICES

LET ME ENTERTAIN YOU

Hospital Entertainment

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With an array of services available, there is no reason not to provide a good patient entertainment solution whatever the budget, says Paul Chambers of Airwave Europe

Whatever the budget or objectives, setting out to provide the best possible patient entertainment solution is an exciting and over whelming task. One thing is clear – everything is changing and moving at an ever increasing pace with patients expecting a home-from-home experience.

The subsequent implementation of an upgrade, a replacement or brand new install must all be effective and efficient avoiding unnecessary and timely resource upon nursing and estate staff. Guaranteeing both a positive patient experience in parallel with a value for money robust system can be a challenge.

Every site has a different set of internal needs, objectives, inputs and initiatives.

The PES provider will need the ability to understand these from the outset and hopefully improve upon the expectations whilst remaining within the budget constraints and delivering on time.

INFRASTRUCTURE The last few years there has been much debate about which infrastructure is most future proof. Installing the correct hospitality TV or IP infrastructure is critical but even with this said, some projects fail to include either the right infrastructure or cabling of the correct quality. The most cost effective network remains coaxial cable, which delivers great bandwidth and content. A single double screened cable can in fact carry nearly 1,000 channels including all digital Freeview, FM Radio and DAB services plus all digital satellite channels. Included in this are high quality HD and 3DTV channels and foreign language services.

Recent times have seen project designers declaring the future would be CAT5 or CAT6 only and facilities have omitted to install coaxial. This drives any establishment down an IPTV route which, whilst very flexible, is normally a more costly path. Well run and well managed IPTV systems offer an incredible array of features and benefits but the reality is that you do need someone to run it as well as service cover to ensure quick recovery in any downtime or system failure.

An experienced supplier should always recommend if possible, the installation of both coaxial cabling and CAT5/6 and at least to the nearest connection hubs to ensure the best of both worlds and reassurance that the facility is not relying on a single technology.

FREEVIEW TV SOLUTIONS The advent of Freeview has allowed multichannel viewing, simplicity and choice.

By installing Freeview the hospital can

easily provide 50 crystal clear TV and 24 Radio digital channels with patient recognisable services and a good spread of content. An added advantage of Freeview is that it can typically be installed onto an existing RF coax network.

A major benefit of Freeview on a RF coaxial network is a robust and reliable solution in parallel with lower head-end infrastructure costs and it still gives some scope to customise to individual hospital and healthcare requirements. It’s also extremely easy to support and maintain. Implementing the correct head-end and TV means you can still control the channel selection.

IPTV SOLUTIONS Internet Protocol Television, or IPTV, refers to television that is distributed over an IP network – the same kind of network people use to surf the internet. With IPTV, you can easily distribute terrestrial and satellite television and radio, videos/DVDs, digital videos on-demand (VODs), digital signage, information boards, and web content throughout your facility. All of this multimedia content can be viewed on standard and high definition TVs and various kinds of AV display equipment including PCs on desktops.

By installing IPTV the hospital can easily distribute TV channels via a CTA5/6 network, manage content and channels from a single point source, allow for easy to use interactive information, offer video, movies and hospital controlled clinical data on demand, and integrate local hospital radio and TV services.

The benefits include consistent picture quality on every TV and is upgradeable to HD. IPTV is easy to scale up, easy to manage by existing hospital IT groups and can be customised for individual hospital and healthcare requirements. Further features include remote access ability for easy support and maintenance, and instant information control out to patients from a single source.

IPTV also delivers much more stringent access control – not just by channel, but by building, department, ward, or individual in-room user.

END USER SOLUTIONS Considering this is what the patient sees and interfaces with every day the choice here is a key factor. There are a multitude of styles to choose starting with your Freeview hospitality TV right the way through to the recently launched large screen ultra-thin medical LED TV with an in-built embedded computer and gesture remote control. A hospitality specific TV should also be selected to lock down menus and configurations to

prevent patient tampering with settings e.g. volume control and channel line-ups.

End user feedback has consistently indicated that any screen below 15” diagonal is too small to easily view and today a minimum screen size of 22” is recommended for TVs on ceiling mounted poles or 19” when on an arm.

The most popular solution remains a TV or touchscreen on an arm with the arm installed from the wall behind the bed or from the ceiling. Any good provider will work with the facility, estates or building departments to ensure walls and ceilings are of adequate construction.

When scoping the TV and touchscreen additional factors need to be considered such as the degree of available screen movement, arm distances (are beds with or without bed bumpers), and infection control considerations such as internal cable management, wipe down remote controls, keyboards and rear TV covers. The creation of new hospitals has seen a trend for single rooms, however, in existing and continued multi-bedded wards TVs should be specified that allow differing infra-red codes to prevent one patient changing channels on another patient’s TV. The trend for single rooms and larger TVs coupled with demands for greater interactivity is now serviced by large screen ultra-thin medical TVs with inbuilt embedded computers, IP rated waterproof infection control glass fronts and gesture remote controls.

ADDITIONAL SERVICES When looking for a PES provider there is also great value in considering additional services provided and these can be easily forgotten.

Such items include hospital information channels for better informed patients and these can be programmed as a start-up channel ensuring all patients have sight of the day’s real time site messaging or local news.

Hospital or healthcare TV channels and digital signage are fast becoming preferred methods of high impact communication with patients, visitors and staff. A PES provider should offer solutions and dedicated healthcare channels for standalone and networked locations.

Considering today’s stringent infection control regimes additional items should include a range of accessories that enhance both the hospital services and the patients’ wellbeing. These include wireless infection control keyboards, replaceable or recyclable headphone and headphone sponges, disposable remote controls and remote control covers. L

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Recruitment Agency l

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LAK LOCUMS MEDICAL RECRUITMENT AGENCY

Professional working relationships in a professional working environment LAK Locums was established in September 2008. We have over 10 years Medical Recruitment experience and specialise in providing Doctors and GPs into NHS Hospitals and GP Practices. We work very closely with all of our Doctors and Trusts throughout the UK ensuring that we can provide a first

class service at all times.

We pride ourselves on the quality relationships we have built over the years and are often complimented on this aspect of our work. We offer a 24 hours day service as hospitals are 24 hours and so are we!!!!!

Please contact Louise for any further information Tel – 0113 237 9690 Email – info@laklocums.co.uk Web – www.laklocums.co.uk

Recruitment

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TEMPORARY STAFF

RECRUITMENT IN THE AGE OF AUSTERITY

The NHS will need to embrace bold and innovative recruitment models to ensure that budget reductions do not mean cuts to patient service, urges Ed McRandal, policy and PR advisor at the Recruitment and Employment Confederation The public sector is changing. Confronted by radical reform and spending cuts, managers are trying to maintain standards of service in the face of radical reform and far tougher spending settlements. There is no clearer example of this than in the healthcare sector, where implementation of wide scale reforms has to be balanced against the requirement to make ÂŁ20 billion of efficiency savings. The NHS will need to be bold and innovative in its response to this problem, embracing different recruitment models to ensure that budget reductions do not mean cuts to service.

The current budget settlement for the

NHS suggests, for now at least, that the days of inflation-busting funding increases are over. When budgets are tight there is often a temptation to cut recruitment costs in order to save money. However this is often a false economy and puts the health service in a difficult position when it comes to resourcing, risking the effective supply of frontline staff. The NHS workforce stands at the cross roads, faced by the spectre of staffing cuts. It is important that they avoid arbitrarily slashing workforce budgets, treading the path towards flexible, innovative working practices.

When budgets are tight there is often a temptation to cut recruitment costs in order to save money. However this is often a false economy and puts the health service in a difficult position when it comes to resourcing, risking the effective supply of frontline staff.

FLEXIBLE STAFFING If the healthcare industry is to deal with the increasing pressure to cut costs, flexible staffing will become increasingly important.

Fortunately, managers are becoming more and more aware that full-time staff, such as doctors that work on standby, are not always the most cost effective option. In fact they can often prove more expensive, as trusts have to pay a fixed cost to retain staff, whereas locums are only paid as and when their work is required.

Temporary staffing plays a crucial role in the industry and is part of the cost and resourcing solution. The NHS regularly use locum doctors to help managers cover planned and unplanned absences or provide support during peaks in demand. In short, locums guard against a drop in staff numbers leading to a decline in standards.

However, it is wrong to assume that flexible staffing solutions should only be adopted in the context of declining budgets. Temporary workers help boost workplace productivity, channelling staff to deliver patient care, drive down waiting lists and fill important backroom E

Volume 11.6 | HEALTH BUSINESS MAGAZINE

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Recruitment

THE BUSINESS MAGAZINE FOR HEALTH MANAGEMENT – www.healthbusinessuk.net

TEMPORARY STAFF CIPD surveys indicate that 78 per cent of staff are sourced through employment agencies.

Why is this the case? What do recruitment agencies bring that in-house solutions do not?

Firstly, agencies take over the financial risks of the recruitment process, as they are only paid when a successful placement is made. That means that they are responsible for advertising, interviewing and finding candidates, ensuring that healthcare professionals can focus on the job they are paid to do. This is particularly pertinent in relation to the recruitment of management level staff, as surveys have found that 93 per cent of public sector workers believe a lack of effective leaders is the biggest challenge that they face. In the context of the abolition of PCTs and SHAs it is now critical that candidates with the required leadership and managerial qualities are identified in a quick, efficient and cost effective way.

E functions. This is a particular problem in the NHS as staff sickness rates are high and productivity levels have only increased at half the rate of spending. Now that the funding tap is being turned off, boosting productivity must become a greater concern.

MANAGING THE PROCESS Whilst it is encouraging that more and more managers are adopting flexible working practices, it is important to assess the most effective ways to manage this process.

The biggest risk in the recruitment process is not finding the right member of staff:

spending large sums on advertising, staff time on short listing and interviewing, only to discover that no suitable candidates were available. In fact, studies from Hansard Canada estimate that, on average, employers spend 134.5 hours on recruiting per (permanent) position. When the cost of staff hours, vetting, checking and training candidates is taken into account, the average cost is £8,160 per appointment. In the age of austerity the NHS cannot afford to take this risk.

Healthcare professionals must look to the private sector, where companies are turning to recruitment agencies to deliver this process.

INVOLVE THE PROFESSIONALS Working closely with an REC-approved healthcare recruitment agency will not only make recruitment more efficient and easier, helping boost productivity throughout the recruitment process, it can also help to increase or decrease staffing resources (and therefore cost) according to demand.

Employers can also benefit from long term workforce planning: if a healthcare agency is able to understand the sector’s resourcing needs, they can help manage the staffing process, helping employers navigate the peaks and troughs of demand.

In the age of austerity it is important that healthcare managers carefully analyse the implications of slashing workforce spending. Locum staff provide valuable support to guard against staff absence and demand, boosting workforce productivity.

Recruitment agencies must play a leading role in this process, applying their expertise so that the right staff are placed in the right position for the right price. L

Choose TLA Group for all your staffing solutions TLA Group is a provider of professional staff for clients in the health and commercial sectors. The company also offers a portfolio of personal and professional development.

TLA Group supplies specialist staff into the following sectors: Primary Care – GPs, nurses and allied health professionals; Secondary Care – hospital doctors, allied health and health science professionals; Vocational Rehabilitation – case managers, psychologists, occupational and physiotherapists; Organisational Health – physicians, nurses and health screening technicians; Clinical Negligence – legal nurses and physicians.

In addition, as organisations look to grow their businesses out of recession, we provide sales and marketing professionals.

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HEALTH BUSINESS MAGAZINE Volume | 11.6

The senior team at TLA Group have extensive experience in the health and commercial recruitment sectors, having worked for large multinational and smaller niche health recruiters. The team have hands-on experience delivering managed recruitment campaigns (national and international), master vendor recruitment solutions, as well as supporting our clients’

emergency and planned recruitment needs.

Our Personal and Professional Development portfolio includes: Professional Business Skills; Management & Leadership Development; Neuro Linguistic Programming (NLP); Motivational Interviewing (MI); Wide range of health professional specific study days; Mentoring & Consultancy services.

TLA Group actively promotes personal and professional development for all of our candidates.

FOR MORE INFORMATION Tel: 0800 321 3212 Fax: 0333 900 0998 info@tlagroup.co.uk www.tlagroup.co.uk

TechNET IT Recruitment Ltd has recently been approved as a Buying Solutions Supplier for non-medical temporary and permanent resource. We specialise in all aspects if IT recruitment and have a proven background recruiting into PCT’s and NHS Trusts. Please view our website www.technet-it.co.uk for further information regarding our services.

be prepared for the year ahead with the Randstad workpocket 2011/12 your essential HR guide we are delighted to launch the Randstad workpocket 2011/12 – our free annual guide to HR and employment issues The Randstad workpocket is: • the essential reference guide for anyone dealing with HR and employment issues • a comprehensive, all-in-one guide packed full of valuable insights into HR and employment best practice featuring real life case studies from leading organisations including PACE, Barclays Retail Bank and Unilever • written by HR and employment professionals to help organisations, of all sizes, deal with HR-related legislation in a complex and competitive marketplace and navigate the minefield of ever-changing employment law The ninth annual edition of the Randstad workpocket is now available so don’t miss out on this highly sought after HR guide.

Order your own free copy today online at www.randstadcare.co.uk/workpocket or by contacting your local Randstad Care branch.

There is no charge for the Randstad workpocket – we invest in and share this information as part of our commitment to shaping the world of work.

0844 8000 675 care@randstadcare.co.uk www.randstadcare.co.uk

R E S Ta U R a n T S H i P

HiSPanioLa

DINNER CRUISE UniQUE RivERSidE vEnUE

Riverside venues in London don’t come any better than the R.S. Hispaniola. l Private Hire & Events l Boardroom & Meeting Room Hire l Suitable for up to 250 seated or 400 standing l Restaurant, Bar & Sun Terraces l Perfect for Pimms Party’s, Private BBQ or dinning from our distinctive Mediterranean style menu

For information and reservations call 020 7839 3011 or e-mail: info@hispaniola.co.uk www.hispaniola.co.uk

d i n E a n d d a n c E T H E n i g H T a w ay a S yo U c R U i S E T H E R i v E R T H a M E S

Take a leisurely evening cruise through the heart of London, with its famous sights and breathtaking river views – in summertime you’ll also enjoy a stunning sunset.

3.5 hour river cruise l Welcome drink l 4-course dinner l

Half-bottle of wine l Entertainment l Dancing l

Available for group bookings and private hire call 020 77 400 400 for booking and prices citycruises.com

KENT

DISCOVER EXCITING ATTRACTIONS FOR ALL

Conferences & Events

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Kent, known as the Garden of England, has breathtaking countryside dotted with orchards, vineyards, hop gardens, oast houses and more famously the White Cliffs of Dover The county is steeped in history and heritage, stuning gardens and world famous buildings including Leeds Castle where Henry VIII visited frequently in Tudor Times, and Hever Castle, the childhood home of Anne Boleyn.

The South East region offers a selection of remarkable conference venues in both new and traditional settings including modern hotels, purpose built conference centres and historic houses and well as unusual venues.

Kent offers some of the most recognised chain hotels such as the Marriott, Hilton, Holiday Inn, Ramada and QHotels. Towns range from the seaside resorts of Herne Bay, Folkestone, Dover and Hythe, these are great locations for team away days. More urban areas include Ashford, Maidstone, Canterbury and Tunbridge Wells, all easily accessible from the UK motorway network.

event is a success from beginning to end.

The friendly team at Kent Conference Bureau are dedicated to making life simpler by offering free, impartial, practical advice, and a written personalised proposal detailing rates and availability within one working day. In addition show rounds of venues within Kent can be arranged to ensure the site of your choice meets your specific needs and requirements.

The Kent Conference Bureau also arranges familiarisation visits, covering each area of Kent. The day offers conference and event organisers the opportunity to speak to venue staff, collate information and meet other service users. If you would like to be added to our mailing list so you are notified when and where the next familiarisation visit is taking place please do not hesitate to contact the team.

HELP AT HAND Kent Conference Bureau is the official award winning organisation charged with promoting the county as a first class destination for conferences, incentives and events. It represents over 70 of the county’s top venues and suppliers and provides a variety of free services to help ensure each and every

SOMETHING DIFFERENT All Kent venues have something different to offer facilitators, speakers and delegates.

Your next meeting could really be the one your delegates remember.

If you are looking for something to freshen up your next meeting, why not enhance communication skills, improve

office relationships, boost moral or maybe just reward the workforce with some team building activities? Activities can vary from a quiet round of golf, a simple treasure hunt, a high wire forest adventure at Go Ape, to an adrenaline fuelled multi-activity day.

Catering for meetings and conferences is one area in which organisations can help to reduce their impact on the environment. Kent is keen to work towards a reduced carbon footprint and your contribution can help towards this.

Produced in Kent promotes local and seasonal produce and provides support and services to some of the Kent Conference Bureau venues.

GREEN ISSUES Sustainability and green issues are now very much mainstream, with governments, businesses and individuals all involved.

The Kent Conference Bureau operates under an environmental policy within Maidstone Borough Council, and recognises that the conference and events industry can impact on the local and global environment. In order to show continued commitment wherever possible, Kent Conference Bureau recommends local suppliers with good records E

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The ideal venue for your event At Brighton Centre we have been playing host to Medical conferences for over 30 years and have been proud to welcome and work with the following conferences recently: International Haematology, International Iymphoedema, British Medical Association, British Haematology society, British Medical Ultrasound, British Geriatric Society, British Orthodontic Society, College of Occupational Therapists, Royal College of General Practitioners. The combination of dedicated management, professional staff and flexible venue right in the heart of the vibrant City of Brighton, within easy walking distance of the City’s hotels shops and restaurants make our venue a favourite with delegates and conference organisers.

n 2,000m2 primary exhibition space n 4,450 plenary meeting capacity n 18 syndicate rooms n Experienced operational team with the ability to run high security and prestigious international events.

Brighton Centre, Kings Road, Brighton, East Sussex, BN1 2GR. 01273 292671 01273 779980 debbie.matthews@brighton-hove.gov.uk www.brightoncentre.co.uk/conference

Three superb venues for all your corporate needs

London

Training Meetings Conferences T: 020 7631 8306 E: conference@pccc.co.uk W: www.pccc.co.uk

Alexandra Suite St Mary’s Road, Swanley, Kent BR8 7BU

The Woodlands Hilda May Avenue, Swanley, Kent BR8 7BT

The Olympic Beechenlea Lane, Swanley, Kent BR8 8DR

• Min/Max capacity: 2/270 • Flexible meeting and banqueting rooms • Ideally located at junction 3 (M25) Junction 1 (M20) • Excellent transport links to London and the South East • Free car parking • Free internet access • Personal service tailored to meet your needs • Exceptional value • Hotel accommodation nearby • Corporate functions and Christmas events Telephone: 01322 613900 Email: swanleybanqueting@swanley.org.uk Website: www.swanley.org.uk

KENT E for using recyclable materials, sustainable products and environmental policies in place.

When placing your enquiry, feel free to ask for more information about the sustainable and greener venues in Kent.

With new high speed trains able to run at up to 140 mph through Kent, rail connections have significantly reduced journey times across the region. With a trip from London to Ashford taking on average 37 minutes (previously 80 minutes) and to Canterbury taking 60 minutes (previously 100 minutes), Kent can easily be reached for your next meeting or event.

NEW DEVELOPMENTS Best Western Dover Marina Hotel & Spa is a recently refurbished seaside gem on the waterfront, opened under new ownership this spring. Located on Marine Parade, and commanding stunning views across the Dover seafront, it is an ideal conference or meeting venue.

The hotel has three well appointed meeting rooms with up to date facilities. For meeting delegates seeking luxurious accommodation, fine dining and panoramic views, and a hotel with exceptional charm and character, one should look no further then the Best Western Dover Marina Hotel & Spa. Late autumn 2011, will see the opening of a 55,000 sq ft (5,200m2) events and exhibition venue at Bluewater. The Bluewater Events Venue will be the UK’s focal point for retail and leisure led events, shows and exhibitions. It will complement Bluewater’s retail offer whilst meeting the continued demand for specialist consumer events in a purpose-built environment.

The Clive Emson Conference Centre at the Kent Event Centre is a £1.2 million conversion of the old Stanley Cornwallis Building. The facilities opened mid-June 2011 and now include a clear span exhibition hall of over 1,700 sq metres and three conference rooms with offices and catering. The facilities can accommodate fine dining and cabaret style for up to 1,000 people and conferences with breakout rooms for 10 to 2,000 people.

New for 2011, the Maiden’s Tower is a wonderful hospitality venue at historic Leeds Castle. Set on the castle island, surrounded by a moat and 500 acres of tranquil parkland, the Maiden’s Tower provides peace, privacy and security for residential and day conferences, meetings and corporate hospitality.

The venue is entirely self-contained and separate from the areas used by castle visitors so delegates have exclusive use throughout the day. The estate also offers a wide range of team building and leisure pursuits to complement the business activities. The scenic nine-hole, par 33 golf course is a popular choice and there are also opportunities for Segway motorised tours, laser clay shooting, falconry, quad biking, hot air balloon flights and Go Ape – a forest adventure where teams can climb trees, cross rope bridges and zip wire to the ground. Additional team

building activity programmes can be tailored to meet guests’ specific requirements.

NEW VENUES TO JOIN KENT CONFERENCE BUREAU The British pub has always been at the heart of the community but local firms are recognising that it can also be at the heart of the business community, the perfect venue for lunches, meetings, seminars and conferences.

Pubs with restaurants and function rooms offer a variety of bespoke packages at competitive prices, including audio visual and conference equipment. Shepherd Neame, Britain’s oldest brewer, offers a selection of venues across Kent. Each has its own unique characteristics that can turn an average meeting into an inspiring and memorable experience.

The Dog & Bear in Lenham has a function suite with its own bar and patio garden.

A full bar and catering service is available, from sandwiches and finger buffets to three-course meals, and the room accommodates approximately 50 delegates.

The century-old Marine Hotel sits on a striking clifftop location on the Tankerton Slopes. The Galleon Suite accommodates up to 150 delegates, the Maunsell Suite is suitable for up to 80 people and the lounge up to 50.

The Parklands Suite at Conningbrook Hotel, Ashford, can accommodate 68 for a sit-down lunch and 120 for buffet-style events. The adaptable room can split into two separate, soundproofed rooms, transforming it into The Garden Room and The Orchard Room.

A second function room, Little Burton, provides a comfortable and hospitable conference venue which accommodates 60 in theatre mode and 30 in boardroom style.

Built in 1874, the Crown Inn in Chislehurst has a comfortable 36-seat restaurant, seven en-suite rooms and a ground floor function room suitable for business meetings and conferences, equipped with its own separate bar and can accommodate up to 70 people.

FLEXIBLE VENUES The picturesque early 18th century Royal Hotel, Deal, offers excellent hospitality, with 18 en-suite bedrooms, a stylish restaurant, function and meeting rooms and a pleasant bar and patio overlooking the English Channel.

Two rooms are available for functions: the Map Room, which accommodates 40 guests, and the Reading Room, with a capacity of 16. These rooms can also be combined.

Gillingham Football Club’s purpose-built Priestfield Conference & Banqueting venue is the largest of its kind in the South East and provides a unique setting for meetings and events. The Great Hall can cater for up to 700 delegates theatre style (500 for a banquet), and there are a variety of smaller suites and rooms with flexible layouts to meet clients’ needs. Particularly impressive are the Board Room and the Piano Bar. Rooms are fully airconditioned with wireless broadband access,

VENUES DIRECTORY

Conferences & Events

THE BUSINESS MAGAZINE FOR HEALTH MANAGEMENT – www.healthbusinessuk.net

Request a copy of the brand new A5 Conference Venues Directory, which contains all the contact information and venue capacities you need when searching for a conference venue in Kent.

You can get your free copy by e-mailing info@kentconferencebureau.co.uk or by logging onto www.kentconferencebureau.co.uk

audio-visual facilities and natural daylight.

London Golf Club prides itself on creating simple elegant solutions that enhance and elevate every event. From the moment you pass through the gates and wind your way down the one-mile drive you know you have arrived somewhere special. With the perfect balance between excellence and effortless comfort, you can relax and enjoy stylish surroundings in a world attended to by the courteous and professional team.

The club offers a wide range of meeting rooms, all flooded with natural light and equipped with the latest audio-visual technology. The clubhouse has complimentary wireless broadband and meeting rooms have access to outside space where up to 170 delegates can enjoy views over the fabulous Jack Nicklaus designed golf courses.

The Bexleyheath Marriott Hotel is located in north Kent and in close proximity to A2, M25 and M20. The hotel offers contemporary styling, great people, excellent service and is within 10 minutes of Bluewater and Ebbsfleet and 20 minutes to The O2 and Greenwich.

The venue has 142 air conditioned guest rooms, nine conference and banqueting rooms suitable for up to 250 delegates, all with natural daylight, Copper Restaurant, Planters Bar, swimming pool and gym.

NORTH KENT’S BEST KEPT SECRET The University of Kent in Canterbury is thrilled to have been awarded Group Travel Organiser’s ‘Best University Accommodation for Groups’ for the fourth year running. The award was presented to the University of Kent team by travel-writer and broadcaster Simon Calder at a prestigious ceremony at London’s Park Plaza Riverbank Hotel in June.

Set in 450 acres of beautifully landscaped grounds overlooking the historic city of Canterbury, the university offers some 3,750 rooms on campus. Groups can choose either self-catering flats (each sleeping five to six people) or single standard or en-suite rooms in halls of residence on a room-only or B&B basis.

The university has many conference rooms available for hire and can accommodate up to 1,200 delegates theatre style. L FOR MORE INFORMATION Tel: 01622 602485 info@kentconferencebureau.co.uk www.kentconferencebureau.co.uk

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Finance

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EQUIPMENT

FROZEN CAPITAL IN HEALTHCARE

David Martin of Siemens Financial Services Ltd discusses how healthcare organisations can unleash untapped liquidity potential with a sustainable equipment purchasing strategy Across most of the developed countries in the Western world, healthcare systems nowadays are experiencing various forms of financial pressure either due to restricted capital spending, national health deficit, or in most cases, a combination of both. At the same time, billions of pounds are being inefficiently deployed in outright equipment purchasing, resulting in those funds being “frozen” and therefore unavailable for frontline healthcare treatment. The seriousness of the issue of frozen capital is laid bare by a recent research conducted by the financial services division of Siemens. According to the study, the UK healthcare system alone sees over £2 billion of capital trapped in the healthcare sector, with over £600 million of capital frozen in diagnostic imaging equipment acquisition and £1.4 billion in other medical equipment categories.

The research results are echoed by a report issued in April by the National Audit Office (NAO) which questioned whether the NHS gets value for money for high-value capital purchases. It expresses a concern that if the NHS does not make major changes to its procurement systems, it could find itself unable to keep up with demand and see patient outcomes deteriorate. But the most immediate equipment challenge confronting NHS trusts lies elsewhere: over half of the MRI, CT and linac machines in use in hospitals across England will need replacing in the next three years at a cost of £460 million – at a time when capital spending is being curtailed.

TIGHTENING HEALTHCARE’S BELT Even though the UK healthcare system carries no operating deficit – unlike its European neighbours, for example Germany or France – its healthcare capital budgets are being put under grave financial restraint amid a revolutionary overhaul to increase efficiency in the sector. In the coalition government’s spending review, NHS spending as a whole has been ring-fenced, yet capital spending is to fall by 17 per cent in the next four years (from £5.1 billion in 2010/11 to £4.4 billion in 2014/15), with £1bn reallocated to social care, and over £20bn of efficiency savings to be achieved across this period.

Whether or not the target can be met will depend on the ability of the NHS to deliver huge increases in productivity: four per cent every year until 2015.

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Considering the historical records, it is hardly surprising that observers have raised concerns whether these goals can actually be achieved. According to the Office for National Statistics, NHS productivity fell by 0.3 per cent every year between 1995 and 2008. But the

unprecedented conjunction of clinical and financial pressures is not the only challenge facing the healthcare sector. With the UK’s population both growing and rapidly ageing, it is estimated that demographic change will cost the NHS an extra £1 billion every year into the foreseeable future. Against this backdrop, demands for diagnostic machines are set to increase. It is therefore particularly alarming that Britain has even fewer MRI machines per million populations in 2010 than the Slovak Republic, Turkey, Estonia and Ireland, as measured by the NAO. While Greece and the Czech Republic have around 30 and 15 CT scanners per million populations respectively, Britain is trailing behind with just 8.4.

The current savings efficiency challenge is meant to prompt the healthcare sector to deliver services through more intelligent E

With the UK’s population both growing and rapidly ageing, it is estimated that demographic change will cost the NHS an extra £1 billion every year into the foreseeable future. Against this backdrop, demands for diagnostic machines are set to increase.

E strategies. However, there is already growing evidence that NHS managers have to meet short-term requirements by cutting jobs and services, adding to further concerns about undermining service quality in a system that is known to have been overstretched in some areas for some years.

Therefore, the jury is out as to whether these austerity measures will lead to a desired increase in productivity or, in contrast, they may lead to falling service standards.

These financial pressures, with their uncertain outcomes, are leading NHS finance professionals to consider whether an extended use of financing tools already widely deployed in the private healthcare sector may help afford state-of-the-art and sophisticated medical equipment and technology, without tying up scarce capital or reducing the liquid budgets available for front line services. The urgency of this financing debate is heightened by the increasingly wide recognition of the disproportionately positive contribution to clinical and diagnostic accuracy, throughput and cost-per-treatment reduction made by the latest technology.

the most up-to-date healthcare technology often has a disproportionately large impact on the ability to deliver better health outcomes and operating efficiencies. For instance, MRI scan times have been reduced by up to 75 per cent with technological advances since the millennium, according to Siemens’ studies, not to mention the improvements in diagnostic imaging. The NAO has also pointed out that the number of diagnostic scans carried out on NHS patients using MRI and CT machines has increased three-fold in ten years. In parallel, the number of radiotherapy treatment sessions has increased two-anda-half times over the same period. A focus on reducing waiting times and an increasing clinical application of the technologies have largely contributed to their growing demand.

For many conditions, up-to-date healthcare technology enables faster, better diagnoses and treatments, with throughput rates that help reduce the cost per procedure, either through early intervention, or by avoiding costly and invasive exploratory surgery, or by improving recovery times so that the days spent in hospital are radically reduced.

INCREASING DIAGNOSTIC EFFICIENCIES Although capital equipment investment represents just five per cent of health spending in most countries’ health systems, access to

ENCOURAGING COMPETITION The current cultural shift to a patient focused NHS has also provided a systemic impetus to explore techniques and technologies

Finance

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that enable better, faster, more efficient health outcomes. Any discussion of trends in healthcare financing would be incomplete without a brief review of this current cultural trend in the NHS. The Health and Social Care Bill 2011 announced for the first time that there would be a defined legal duty for the NHS and the whole care system to improve continuously the quality of patient care in the areas of effectiveness, safety and patient experience. Patients will be more involved in decisions about their treatment and care and healthcare providers who deliver excellence will benefit from more patients choosing their services, thus helping drive competition and force up service standards.

In order to cultivate such a value-based competition environment, various schemes have already been introduced to give patients greater freedom in choosing their medical services. The Patient Choice scheme allows patients not only to choose where they are treated for certain procedures, but also to have specified minor operations in a private hospital (3,500/month opt to do so). Moreover, the Payment by Results policy forces hospitals to compete for patients, introducing an unprecedented level of risk for acute NHS trusts. The modernisation plan for the NHS has blown the starting whistle for a race to quality, excellence and efficiency, virtues which can only be realised with the help of advanced and up-to-date medical equipments.

SUSTAINABLE EQUIPMENT FINANCING The provision of superior patient care will require diligent asset management that embraces comprehensive evaluation and robust planning. Since technology tends to advance in sudden leaps, and in some examples can be obsolete within 12-18 months, healthcare infrastructure should be sustainable over time, or otherwise healthcare financial managers could be driven into a corner when equipment requires upgrades or replacements which they cannot afford. As the widespread roll-out of scanning equipment has been confined mainly to the past decade with improving applications and more affordable pricing, these devices are now approaching the end of their useful lives after a typical seven to ten year lifespan. NHS trusts will have to find £460 million in the next three years to replace these outdated machines – a tall order in light of the squeezed capital budgets.

In order to craft a sustainable medical equipment strategy, financing methods are required that allow financial managers to easily, accurately and transparently calculate cost-per-procedure. In this way, management can better evaluate the true cost of new equipment, whether the break-even cost matches expected demand, and what treatment or diagnosis volumes need to be to align the investment with that demand.

These financing schemes should also take account of technology upgrades without the need of major capital investment. E

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Finance

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EQUIPMENT payment per treatment. Ultimately, this allows financial managers in the healthcare sector to make much more acute judgements about the affordability and cost-benefits of each equipment acquisition or upgrade.

E Healthcare organisations that find themselves owning previous generation equipment will experience difficulties in attracting patients in a health system that fosters internal competition – a key trend in the overall reform of global healthcare.

Financing techniques that enable a health institution to upgrade to a superior technology at certain points are therefore gaining in popularity. For these financing techniques to be effective, and to offer good value, financiers need to understand technology development paths, and also have the channels through which to remarket the older equipment at a reliable and predictable residual value.

Without a clear understanding of utilisation across their equipment portfolio and a well articulated procurement strategy, healthcare institutions can easily overspend in outright purchasing of capital medical equipment.

Under the imminent spending restrictions, however, they can no longer afford to have a growing proportion of their annual capital budgets tied up in equipment. By exploiting alternative forms of finance, the inefficiently deployed or frozen capital of over £2 billion in UK healthcare can be

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replaced with an asset-financing plan that: • simply charges a fixed equipment lease/rental and maintenance cost against revenue budgets • reduces longer-term outlay because the financier retains title and can dispose of the technology on the secondary markets • introduces the possibility of the healthcare organisation being able to upgrade its technology in broad line with technology developments without having to write down the full capital cost of purchase • recognises the additional efficiency gains that can be offset against the cost of financing the equipment.

To summarise, the importance of improved working capital management in the financial supply chain is that it makes acquisition of the most up-to-date healthcare equipment and technology affordable. It also provides healthcare managers with a much more transparent and accurate visibility of the true cost of the asset over time. By correlating the asset finance costs with patient throughput volumes, a cost-per-use can be calculated, all of which more closely reflects the trend away from global needs funding, and towards

CONCLUSIONS Healthcare systems across the globe are under mounting pressure to understand and control cost-per-procedure. According to projections from SFS, over £13 trillion will be needed to fund developments in the global public services infrastructure to 2030. Of that, around £2 trillion will be needed for healthcare provision. These spending projections put into context how much the public services, and healthcare in particular, are under pressure to identify and use the most efficient and effective methods to finance these developments.

There are significant economies and efficiencies to be gained by refining the delivery structure and supply chain in UK healthcare – moving from an input focused management structure, to one driven by outputs. Underpinning this will be a radical reform of financial management and the financial supply chains within healthcare systems.

In the UK, where firm central pressure to stay within budget was enforced over the last couple of years, selected institutions were only able to meet those requirements by eating into their capital budgets and effectively putting a partial freeze on new technology and equipment acquisition.

This phenomenon is now spreading to other European countries and also the USA. Under this scenario, not only is capital spending under pressure, it is actually being suppressed, leading to diagnostic and treatment inefficiency through a negative spiral of under-investment. Most importantly, lack of appropriate technology may directly impact on standards of patient care.

Inefficient use of capital is now widely regarded as anathema by healthcare finance professionals. Asset finance techniques are increasingly recognised and utilised as a powerful means of releasing cash savings.

As a matter of fact, NHS Supply Chain, which promotes leasing to trusts and offers guidance on the subject, also acknowledges the existence of frozen capital and agrees that leasing can often be the most sensible choice to finance medical equipment.

Most world healthcare systems, even in the United States where leasing penetration is relatively high, hold huge potential for freeing up currently frozen capital to improve their financial efficiency. Numerous private healthcare providers in the UK already recognise the value of alternative methods of financing and consequently employ them much more widely than the public sector not just to their own financial benefits, but more crucially, also to the health benefits of their patients. L

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A world of choice from The Voucher Shop We are your one stop shop for corporate gift vouchers, benefits and employee rewards. When it comes to choosing a reward it’s hard to please everybody.

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Professional collection services from Lasker Debt is a very real part of running a business; not necessarily debt that you owe a creditor, but certainly debt that is owed to you by various debtors to whom you have offered credit. In many businesses, it is an unavoidable aspect of daily running. For this reason, it is a good idea to invest in the services of qualified and professional debt collectors.

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Architecture, space planning and strategic space management The practice has over 13 years experience working in-house for large public and private sector institutions across London and the South East.

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affilliations include RIBA Chartered Practice Federation of Small Businesses Approved Contractor – Chelmer Housing Partnership and Chelmsford Approved Contractor – St Georges Community Housing, Basildon.

FOR MORE INFORMATION Glynn Williams Tel: 01245 222692 Fax: 01245 222692 Mobile: 07973 835067 glynn.williams@tesco.net www.glynnwilliams architects.com

Wave goodbye to latex with Cromwell Polythene Cromwell Polythene, the leading independent supplier of sacks, bags and speciality products for the storage and collection of waste and recyclables, has launched a range of latex-free, disposable examination gloves for professional use. Manufactured under the ‘Wave’ brand, the gloves will be sold through Cromwell’s distributor network.

The Wave range includes a blue nitrile, non-sterile examination glove – finger textured and with all the barrier properties of latex, at significantly lower cost – and two low-budget vinyl products – a clear vinyl glove, which has a smooth internal finish and is suitable for a wide range of lowrisk applications and a synthetic vinyl glove for those who prefer a softer, more flexible fit.

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FOR MORE INFORMATION Tel: 01977 686868 Fax: 01977 686869 info@cromwellpolythene.co.uk www.cromwellpolythene.co.uk

Volume 11.6 | HEALTH BUSINESS MAGAZINE

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Customer Contact

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PATIENT COMMUNICATION

CONTACT CENTRES: THE HEART OF HEALTHCARE? Paul Smedley, executive director of the Professional Planning Forum, uncovers the secrets behind five recent success stories in public sector customer contact It’s clear that all public sector services are going to need further and deeper plans to drive efficiency, delivering more with less. In this new world, technology appears again and again in transformation plans and budgets, but technology alone doesn’t drive down costs.

As David McElhinney, acting chief executive of Liverpool Council, said at our Public Sector seminar in Liverpool last year, just buying new laptops never saved a penny, but getting people to work differently transforms service. Transformation requires putting the customer at the heart of how things work.

The experience of our members – especially in the public sector – is that a contact centre which channels and manages customer enquiries can be a real catalyst for genuinely doing more with less in the organisation.

PIONEERING PROJECTS Sometimes this starts with changes to everyday working practices. NHS Business Authority were finalists in our 2011 Customer Contact Innovation Awards – for inspiring work in organising telephone contact. In just three months MyTime – a self-scheduling workforce management system – introduced flexibility, following full union consultation, saving £150,00 in just one year in a small workforce – and helping cut cost per call by ten per cent.

What’s significant, is that a small officebased unit has demonstrated how to achieve radical changes in working practices, with the full engagement of the unions, because it is customer focused. As Paul Fitzsimons, UNISON branch chair explains: “There was a clear business need, what we needed to do was to communicate that to staff in a very clear way and together phase in the new way of working.”

Equally vital was the work behind the scenes that created alternative working practices that offered genuine advantages to staff who gave up traditional flexitime arrangements.

“Knowing our audience has been key to getting them on board,” explains Richard Abdy, forecasting planning and MI manager.

We used a lot of the things people liked about flexi time and built that into the new system.”

The new approach was also designed

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to support the flexibility needed for the business to move forward – for example the more multi-skilled you are, the more opportunities there will be for you to get the shifts you want. What Richard found is that success depended on piecing together the scheduling jigsaw – there was a far better way of doing it if you could take a fresh look that started with the customer’s needs.

SHARING BEST PRACTICE Like other public sector managers, healthcare managers need to get clever about how to work differently and perhaps the key to this lies in looking for success elsewhere. With this in mind, I want to share four further success stories from local government, which demonstrate the scale of impact that can be achieved when there is a vision and commitment, together with the skills and resources to make change happen.

All of them are putting the customer at the heart of the decision – with a focus on simplicity and process re-design.

One service at Liverpool that’s made a dramatic difference is the ground breaking Careline service, which uniquely offers full 24/7 social care support by telephone for vulnerable children, adults and families throughout Liverpool. Highly skilled call-handlers now assess all new cases in this extremely sensitive area of work, supported 24-hours by trained social workers within the team. Costs are down 23 per cent, with 20 per cent more calls answered and fewer cases passed to area social work teams – and employee survey scores for communication are up 26 per cent.

Social care is a brave area for innovation in the public sector; with high risks and huge consequences if the wrong judgements are made. Louise Gray, director of public access services, explains that although they are handling calls, Careline is not a typical call centre: “We define ourselves as a social care centre. We have been praised for the sensitivity of our advisors.” Experienced social workers sit alongside highly trained advisors as part of a single operation; they jointly mange the risk and referrals.

Dave Spender is one of the social work team leaders. “Culturally, it’s like a different

social work office,” he says. While social workers bring their experience and peoplefocus, Careline was also able to build on the wider infrastructure for handling calls and process improvement that already existed in Liverpool Direct Ltd. Furthermore, now the concept has been proven successfully, the service is being offered to other authorities looking to achieve a similar transformation.

At Wokingham Borough Council, Suzan Law, chief executive, has set out a different kind of approach: “We invested in prevention and greater depth of service; the building block in our transformation programme.”

Smart working was introduced, using flexible hours and home-based agents, with the aim of making council-wide savings of £1 million. Breaking down silos has delivered budget savings of £100k, cut e-mail response time from ten days to one day, and reduced abandonment rates from 40 per cent to under five per cent.

Sarah Barrow manages Wokingham Direct – the council’s contact centre service – and has invested significantly in technology E

feedback and help design new solutions.

The Catapult team – a group of frontline advisors – gather ideas from council staff or customers and meet monthly to discuss how to implement them.

Thanks to a holistic channel strategy and setting up a web service team within the contact centre, problems are identified as soon as they occur and cost per contact has been reduced by 28 per cent.

Getting people to change the way they work plainly delivers more with less – if it’s focused on what the customer needs, employees are fully engaged and good planning creates a framework for improvement.

E such as cloud computing, webchat and SMS to make contact quick, cheap and easy for customers. “Integrated service technology has got to a state where we are confident it will give customers a better experience.” Furthermore, both website and the communications team now come under the same management as the contact centre, making it a way to move fast and develop an integrated communications plan.

A MODEL CONTACT CENTRE Another authority famous for transforming customer service is Surrey County Council, commended at the European Call Centre

Awards. They developed a new model contact centre which has become a diagnostic tool for the whole council – to successfully streamline process, halve complaints, and raise colleague satisfaction to 72 per cent – all while saving £400,000 for the tax payer.

As Simon Pollock, head of customer service explains: “The contact centre has become a barometer of the council’s performance.”

Working with customers, frontline staff and other departments, the council drove improvement projects that have reduced the number of calls coming in by 11.5 per cent.

The Customer Service Investigation (CSI) team dig behind passive as well as active customer

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A DIFFERENT APPROACH The housing department at Portsmouth City Council provides a valuable example of a different kind of approach which is even less reliant on technology. Here we can discover what happens when an organisation changes the thinking that drives service design and delivery. Portsmouth transformed the housing service and halved the cost of repair, by applying Vanguard’s Systems Thinking methods and uncovering what creates true customer satisfaction. As Owen Buckwell, head of housing, explains: “It’s not about economies of scale, it’s about economies of flow.” Managers need to start looking at different metrics – and gearing their working polices and practices towards a different, customer focused, purpose.

Now, repairs are provided at the specific time/day requested by tenants – 75 per cent within 48 hours – and completed to a high standard on the first visit. Most managers would argue that it couldn’t be done or would be massively expensive. In fact, focus on people and value, rather than cost and process, has cost less – with £2m annual savings, fewer properties left empty and double the grounds maintenance at no cost.

“The real change is that I don’t get any letters about housing,” comments councillor Steve Wylie, whose city centre ward includes many council tenants. “Residents now have the attitude that the work will get done.”

MAKING THINGS SIMPLER Getting people to change the way they work plainly delivers more with less – if it’s focused on what the customer needs, employees are fully engaged and good planning creates a framework for improvement. Many of these success stories have indeed involved technology, but contact centres are often at the heart of it. It starts with the customer, to make their lives simpler.

The case studies referenced in this article are all published in the Planning Forum’s Best Practice Guide for 2010 or 2011. E-mail for your copy or download individual case studies from the public sector pages at www.planningforum.co.uk L

Copyright Professional Planning Forum 2011 FOR MORE INFORMATION Tel: 020 89931129 info@planningforum.co.uk

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Advertisers Index

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8

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ProMedicus Ambulance & Paramedic Service

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44

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60

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40

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59

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54

IT Asset Disposal

50

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30

AJC Trailers

29

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Sheffield University

Apollo Fire Detectors

4

Love2reward

14

Shokk

16

Aquastat Environmental Services

30

Magnet Trade

29

Siemens

64

B.N. Gibson

43

MBS Medical

43

Sites Ambulances services

43

Control Group

53

MDC

46

Swanley Banqueting & Conference Centre

62

Cooleasy

22

Modular Portable Buildings Hire

26

Tabs FM

17

Cromwell Polythene

67

Nursing Hygiene

The Future of Clinical Commissioning Conference

16

Dajon Data Management

53

OKI Printing Solutions

The Locum Agency

58

DED

22

Olympus

The New Mayfair Hotel

34

Direct Battery Solutions

16

Park Crescent Conference Centre

62

Thurston Building Systems

27

Document & Data Shred

50

Philips

48

Total Gym Software

22

Dyson

10

Phoenix Building Systems

24

Voucher Shop

67

Ekahau

13

PHS Group

33

WANT Medical Services

42

Elliott Offsite Building Solutions

26

PK Care

56

West Country Private Ambulance Service

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Emergency Care Group

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Poshchair Medical

41

Western Power Distribution

30

ETI

37

Premier Life Skills

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