Health Business Magazine issue 11.2 by Public Sector Publishing

VOLUME 11.2

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FIRE SAFETY

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With the number of Consortia Pathfinders now 177 it seems GPs are eager to be part of the government’s plans to modernise the NHS. However, delegates at a recent emergency meeting of the British Medical Association voted in favour of calling for ministers to withdraw the health bill, saying the proposals go too far too fast. Should Andrew Lansley back down?

FIRE SAFETY

Dealing with false alarms

While there is still time until surgeries have to comply with new cleaning standards – 1 April next year – practice managers should be obtaining information now so that they know what changes will have to be made and budget for these well in advance. Find out more on page 27. The Care Quality Commission recently criticised a hospital in Cambridgeshire for not doing enough to ensure patients are safe from abuse, saying the trust must improve or face enforcement action. NHS Trusts must also provide a safe working environment for staff, something that we take a closer look at on page 70.

SECURITY Ensure the safety of patients, staff, visitors and assets with access control

OBESITY CATERInG MAnAGEMEnT FInAnCE

HEALTHCARE IT – Are medical smartphone apps the next big thing? PLUS MORE InSIdE

Enjoy the issue.

Sofie Lidefjard, Editor editorial@psigroupltd.co.uk

HEALTH BUSINESS MAGAZINE ONLINE If you would like to receive six issues of Health Business magazine for £45 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: P NEWS P FEATURES P PROFILES P CASE STUDIES P EVENTS P AND MORE

www.healthbusinessuk.com PUBLISHED BY PUBLIC SECTOR INFORMATION LIMITED 226 High Rd, Loughton, Essex IG10 1ET. Tel: 020 8532 0055 Fax: 020 8532 0066 EDITOR Sofie Lidefjard ASSISTANT EDITOR Angela Pisanu PRODUCTION EDITOR Karl O’Sullivan PRODUCTION DESIGN Jacqueline Grist PRODUCTION CONTROL Julie White

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Health Business | Volume 11.2

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CONTENTS HEALTH BUSINESS VOLUME 11.2

07 NEWS 13 FINANCE Now the dust has settled, the Institute of Payroll Professionals looks at the key aspects of the chancellor’s spending review and their likely impact on payroll departments

17 FLEET MANAGEMENT John Webb from the Institute of Car Fleet Management explains the best way to introduce low emission vehicles into a fleet

21 INFECTION CONTROL Hull and East Yorkshire Hospitals NHS Trust discusses the trust’s infection control strategies

27 CLEANING GP surgeries and medical centres will soon need the latest, most effective cleaning methods to meet new CQC standards

31 FACILITIES MANAGEMENT The Healthcare Facilities Consortium’s Keith Sammonds looks at how statutory returns information can be used to drive efficiency savings

35 ENERGY We visit St. Peter’s Primary Health Care Centre in Burnley, which has greatly reduced its energy use

39 AIR CONDITIONING & REFRIGERATION

43 FIRE SAFETY Graham Elliot, chief executive of the Fire Industry Association, advises on how to avoid false alarms The understanding of the meaning of fire safety signs is a fundamental requirement of the Health and Safety Regulations

49 SECURITY Access control can play an important role when it comes to ensuring the safety of patients, staff, visitors and assets, says the British Security Industry Association A round-up of the various levels of security a hospital should have in place

55 HEALTHCARE IT Are medical smartphone apps the next big thing in healthcare, asks the Mobile Data Association’s Nick Hunn

58 INFORMATION DESTRUCTION The British Security Industry Association explains the issues surrounding data protection in the health sector

60 STRESS MANAGEMENT Ann McCracken, chair of the International Stress Management Association UK, gives advice on how to deal with today’s pressures

63 TRAINING The Skills Passport for Health is a portable, online record of an individual’s career history, current skills and training

67 RECRUITMENT Ruth Warden, deputy head of employment services at the NHS Employers, talks about the current recruitment challenges the health service faces

70 CONFLICT MANGEMENT Providing a safe working environment and safe working practices for employees is a complex but necessary task, says personal safety charity the Suzy Lamplugh Trust

73 CATERING Keith Hinchcliffe, food trading manager at NHS Supply Chain, discusses the importance of responsible food purchasing

77 OBESITY MANAGEMENT What are the day-to-day problems of dealing with obese patients? Liz Leigh from Southend University Hospital NHS Foundation Trust, investigates

81 CONFERENCES & EVENTS We explore the North West of England to see what the area has to offer conference and event organisers

84 LANDSCAPING & GROUNDSCARE The Institute of Groundsmanship explains why training is the key to successful groundscare

By 4 July 2011, all personnel working on refrigeration, air conditioning and heat pump systems must obtain a full qualification, warns F-Gas Support

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Health Business | Volume 11.2

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New primary care centres gets go-ahead wo brand new primary care centres have been given the go-ahead for Westcliff-on-Sea. Each centre will include a range of services including GPs, a pharmacy, blood taking and community nursing services. It is also hoped that the centres will become a community hub that can be used by local groups and residents. Margaret Hathaway, associate director New centre on Valkyrie Road of Commercial Services for NHS South East Essex, said: “I am delighted that this final hurdle has been achieved. We decision, but the PCT Board recognised can now continue with our plans, as it is that this area remained its highest priority vital that healthcare buildings continue and the development of new health to improve to be able to ensure that a care facilities was essential to tackle the range of high quality, modern services are health inequalities and deprivation.” delivered in the community. The tough Construction of the two new primary care financial situation and the uncertainty about centres will start in the summer of 2011 the future of the NHS made this a difficult with a planned opening date of early 2013.

Free parking trial for Good Hope Hospital visitors isitors to Good Hope Hospital are benefitting from a free parking trial. Main visitor car parks are free of charge between 6pm and 9pm, Monday to Friday. The trial is expected to last for a three-month period, ending 13 May. The aim of the scheme is to both encourage people to visit their relatives and friends more regularly and to ease some of the congestion experienced at peak times at the hospital. The trial will help determine whether providing free parking in the evening will help ease car park congestion during the day, when the

hospital and its parking is at its busiest. Paul Quinsey, head of Technical Services for the Heart of England NHS Foundation Trust, said: “This trial is a positive step forward in working to tackle the long standing parking capacity issues. It is our hope that people visiting their inpatient relatives and friends during the daytime, find they can park more swiftly and efficiently with this scheme in place. Depending on the results of the trial, it may be something we roll out on a permanent basis, or it may simply provide us with more information about what we can do next.”

NEWSINBRIEF Hospital food is recipe for health Plymouth Hospitals NHS Trust will be hosting a display and demonstration of hospital food in the main entrance of Derriford Hospital, 22 March. The display will highlight how the nutritional needs of patients are met during inpatient stays at the hospital. Members of the public are invited to sample a wide variety of the dishes available on our patient menu and to provide feedback directly to the trust. Dieticians will also be on hand to showcase some of the projects currently being undertaken to improve patient menus and enhance nutritional intake. Matron Jill Swales will be present to talk about high impact actions such as protected mealtimes, red trays and lids, which are being used to ensure patients are supported in eating and drinking.

Pennine Acute Hospitals Trust bans smoking on grounds Hospitals at the Pennine Acute Hospitals NHS Trust are creating no smoking zones immediately outside their main entrances and A&E departments. To coincide with national no smoking day 9 March, Fairfield General Hospital in Bury was the first to see the red hatched areas bearing the words ‘Smoking is strictly prohibited in this red zone’, painted onto the ground outside its front doors. Dr Sally Bradley, deputy medical director at the Pennine Acute Trust, said: “Smoking at hospital entrances is not only unsightly and unpleasant for people who have to walk through a cloud of smoke to gain access to our hospitals, but it is causing increased litter and is a serious fire risk and health hazard.”

New uniforms for senior nurses Senior nurses at Queen Alexandra Hospital are now wearing new red uniforms – a simple yet effective way to help patients and their families identify who is the most senior nurse in charge of clinical and corporate services. This will enable them to direct comments and raise awareness of issues to the highest nursing level. The uniforms also promote leadership within the clinical environment. The red uniforms are worn by the head of nursing for each Clinical Service Centre (CSC) and corporate services within Portsmouth Hospitals NHS Trust, as well as the deputy chief nurse and the director of nursing. It consists of either a dress or tunic and black trousers.

©Portsmouth Hospitals NHS Trust

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Health Business | Volume 11.2

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Campaign to reduce £2.1 million medicine wastage Ps and pharmacists across Mid Essex have joined together in a bid to educate patients about their treatment and to help patients understand more about their medicines and the options they have. One of the main concerns is medicines on repeat prescriptions that are ordered and collected by patients but not used. It is estimated that £90 million worth of unused prescription medicines are retained in individuals’ homes, across the UK, at any one time. Paula Wilkinson, chief pharmacist, NHS Mid Essex says: “Everyone involved in prescribing, dispensing or reviewing medicines needs to make sure that patients are involved in making decisions about their treatment and that more medicines are taken as recommended.” The campaign, aimed at reducing an

estimated £2.1 million wasted on medicines, will consist of bus advertising together with posters and leaflets that will be displayed in pharmacies and GP practices to raise awareness of medicine waste among both patients and carers. It will encourage patients to have regular reviews of their medicines with their pharmacist or prescribing doctor to discuss any issues they may have with taking their medication.

Salon small talk to save lives in west London ith take-up rates among the lowest in the country, the NHS in Hammersmith and Fulham is teaming up with ten health and beauty salons in Shepherds Bush to encourage women to attend cancer screenings. Kemi Asomuyide, from NHS Hammersmith and Fulham’s Public Health team, said: “We know most women feel at ease in salons and enjoy a chat with the stylists and beauticians. So we’re putting written information into salons and have

trained staff so they know all about the screening programmes, and how to work what can be a taboo topic into their conversations with customers.” Dr Clare Graley, a local GP, says: “Women take time to make sure they look good on the outside but it is what they can’t see on the inside that can be more devastating, and screening is a way of checking this. Cancer screening is very important and saves lives. I always encourage my patients to take up the offer of screening.”

Derby’s innovative tabard is first of its kind erby Hospitals staff have devised a unique tabard for nurses to wear while carrying out medication rounds on the ward. The aim of the new tabards, produced by Boyd Cooper, is to improve patient safety by reducing the number of potential errors that can occur if a nurse is disturbed with a non-urgent enquiry while measuring out a patient’s medication. Senior nurse Ian Davidson and matron Lorraine Hourd came up with idea of the tabards, which say “Drug round, do not disturb”. They are made of a material that can be wiped down to help with infection prevention and control as they can be cleaned in the same way as other surfaces on a ward. Nurses will still interact with the patients they are administering the medication to but non-urgent enquiries from patients and visitors will be dealt with by other staff on the wards.

Nurse Kevin Martin-Sadler

NEWSINBRIEF Trust awarded carbon reduction accreditation The North West London Hospitals NHS Trust has been awarded the Carbon Trust Standard for managing and reducing its carbon footprint by nearly 4 per cent. Chief executive of the trust, Fiona Wise, said: “We have achieved these targets by improving heating controls and increasing lighting and heating efficiency. This initial reduction is part of an ongoing plan and we are committed to making further reductions in the future.” The Carbon Trust Standard recognises organisations for real carbon reduction. Based on a rigorous and independent assessment, it certifies that organisations have measured, managed and reduced their carbon emissions across their operations, and are committed to reducing them year on year.

New parking scheme for chemotherapy patients in Stafford Mid Staffordshire NHS Foundation Trust is working with Stafford Borough Council and Cannock Chase District Council, to offer eligible patients free parking in any of the council car parks in either town centre. Patients who don’t qualify for a blue badge, but suffer from fatigue as a result of their treatment, will be able to apply for the scheme. The trust, which runs Stafford and Cannock Chase Hospitals, is the first in the country to set up such a scheme.

Keep up to date with NHS news from London NHS London has launched My NHS Alerts, a new way of keeping NHS staff, patients and other interested parties informed of health news across the capital. The website brings together news from London’s NHS in one easy to use portal, and offers users information tailored to their individual needs. It will replace the current system of ad hoc communications, lighten inboxes, and make it quicker and easier for organisations to distribute updates and news. Users are invited to choose information by topic and geographical area, and to select how and when they want to receive it. Subscribers will receive regular e-mails or RSS feeds as information is published which matches the choices they made when registering. Ruth Carnall, chief executive of NHS London, said: “Effective communication is more important than ever at this time of change. My NHS Alerts will help us to save our valuable resources by replacing costly newsletters, and will mean that people only receive information they actually want.” News updates are provided by NHS London and other pan-London organisations, as well as London’s six NHS sectors.

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Health Business | Volume 11.2

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Increased staff confidence

NEWSINBRIEF

he recent NHS Staff Survey reveals staff feel more confident reporting adverse incidents, have better support from their managers and improved appraisals. Dean Royles, director NHS Employers, says: “Employers are clearly working hard in partnership with their health unions and staff to continue improving the NHS in these challenging times and this year’s NHS Staff Survey shows that these efforts are paying off. “Employers have worked to create a climate where staff feel confident reporting concerns and it is encouraging that staff find procedures for reporting concerns fairer and more effective. “We are pleased with the survey’s finding that over three-quarters of staff now receive appraisals and this is the highest

Summary Care Records roll-out begins in Northampton

ever. Existing research has confirmed the strong relationship between appraisals and a good standard of patient care. “Year on year the NHS Staff Survey has reported overall improvements and it is important to understand existing areas of concern, such as the one per cent increase in work-related stress, within this context.”

Hospital trust outlines process for finding a partner he health trust that runs Trafford’s hospitals has outlined the process by which it will find a larger partner to join. It has also announced how hospital staff, patients, GPs, the public and other key groups will be involved in helping it choose a partner. Trafford Healthcare NHS Trust has agreed to work with its three neighbouring foundation hospital trusts – Central Manchester University Hospitals, University Hospital of South Manchester, and Salford Royal – to see if one of them will make a suitable partner. Ron Calvert, chief executive of the trust, said: “Our top priority in looking for a

partner is ensuring that people in Trafford can continue to access excellent and appropriate health services, even though we are too small to remain viable in our own right. It is important that we hear the views of patients, hospital staff, GPs and other organisations in Trafford so we are grateful to everyone helping us with this by sitting on the reference groups.” Trafford Healthcare NHS Trust announced in December that it was seeking to become part of a larger organisation because it was too small to become a foundation trust by 1 April 2014, as required by the government.

New management structure to improve patient care new operational management structure has been implemented at North Middlesex University Hospital NHS Trust, which will help doctors, matrons and key operational leads deliver high quality care to patients from the front line. How services are managed on a day to day basis have changed so that each service is managed by a clinical director in partnership with a general manager and matron. Instead of having three separate divisions, the trust has created five clinical business units accountable to an acting director of operations. Lee McPhail, director of operations (acting), said: “We have developed the Clinical Business Units so that we can support the drive for a clinicallyled NHS. We believe that this new structure will translate into better patient care as changes can be made to services immediately by those that

Patients of three GP surgeries in Northampton will be the first in the county to have the opportunity to ensure that healthcare staff have quicker, easier access to important information about them in the event they need emergency care. Summary Care Records will give doctors and nurses access to information about patients’ allergies, medications and any bad reactions patients may have had to medication in the past. John Parkes, chief executive of NHS Northamptonshire, said: “NHS Northamptonshire believes it’s really important that we provide services which make it as easy as possible for health professionals to understand the patient’s condition, as well as ensuring we provide top quality service to those we serve in the local community.”

Major initiative to reduce pressure ulcers Staff at George Eliot Hospital have been making the pledge to cut incidents of pressure ulcers amongst patients. The hospital’s PUPs (Pressure Ulcer Prevention) initiative aims to raise awareness of the pain and harm pressure ulcers cause to patients, and the billions of pounds it costs to treat. The initiative follows a recent public commitment by the trust’s board of directors to adopt a zero tolerance approach to pressure ulcers and introduce a new way of tackling and recording such incidents. Incidents of pressure ulcers will be reported as ‘harm events’ in a similar way that serious healthcare associated infections such as C. diff and MRSA are. The hospital has seen a significant drop in cases of these infections over recent years and it hopes that by introducing the same level of prominence for pressure ulcers, a similar reduction will be seen.

Portsmouth GPs offer extended opening hours All 27 of Portsmouth’s GP practices are now offering extended opening hours to their patients. For the first time, every single practice in the city offers routine GP appointments outside of their core hours from 8am to 6.30 pm, Monday through to Fridays. Carol Giles, head of General Practice for NHS Portsmouth, said: “We have been working with GPs to find solutions to make life easier for many patients. We are delighted to have achieved 100 per cent uptake of extended hours opening from all the practices.”

are best placed to know of the current health needs of our patients.”

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Capital Planning

Securing the future with capital planning

Managing capital equipment expenditure is an ongoing challenge that every trust faces and in the current economic climate, the future looks particularly unpredictable. NHS Supply Chain offers you the opportunity to become part of a bigger picture in which you share in the savings derived from consolidating and aggregating capital equipment purchases across a number of trusts. By sharing capital plans, many trusts have already benefited from tens of thousands of pounds on individual pieces of medical equipment, and economies of this scale can only increase as more trusts come on board. By doing so, you could also benefit from the following: Key benefits: • additional savings made over and above the framework price • influence over the equipment which is purchased via commitment deals and bulk buys • our visibility of trust wide plans drives savings across a range of capital spend • national aggregated purchasing power for your local trust • help with maximising your annual spend • continuous review and monitoring of plans • access to the quarterly planning report Let us work with you to provide even greater savings through planning your capital medical equipment requirements.

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Edward Grainger Senior Planning Manager Tel: 07850 931942 Email: capital.planning@supplychain.nhs.uk

Planning • Procurement • Leasing • Management • Maintenance • Disposal

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Contact your Regional Capital Account Manager or get in touch with the capital planning team:

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FINANCE

PAYROLL – NEGOTIATING THE LEGISLATIVE LANDSCAPE Elaine Gibson, senior policy officer at the Chartered Institute of Payroll Professionals examines the key aspects of the Chancellor’s spending review and how they may impact payroll departments WHEN CHANCELLOR GEORGE OSBORNE delivered his spending review on October 20, 2010 it contained a mixed bag of pending changes. In keeping with its commitment to providing up-to-date news for employers’ payroll departments, the IPP Policy team has extracted the key points from the review that will likely affect those working in this sector. The review identified that 490,000 jobs in the public sector will go over the next four years. In the June Budget, the government announced a two year pay freeze from 2011-12 for public sector workers earning over £21,000, with those earning less than this receiving at least £250 in each year. PAY SCALE DISPARITY In addition, the government asked Will Hutton to lead a Review of Fair Pay in the public sector, making recommendations on tackling

disparities between the lowest and highest paid in public sector organisations. The Review published its interim findings earlier this year. The Independent Public Service Pensions Commission (IPSPC) led by John Hutton published an interim report on October 7. The report highlights the importance of providing good quality pensions to public servants and concludes that there is a clear rationale for public servants to make a greater contribution if their pensions are to remain fair to taxpayers

and employees, and affordable for the country. In response to the Commission’s interim recommendations, the government will: • Commit to continue with a form of defined benefit pension • Await Lord Hutton’s final recommendation before determining the nature of that benefit and the precise level of progressive contribution required • Carry out a public consultation on the discount rate used to set contribution rates

In the June Budget, the government announced a two year pay freeze from 2011-12 for public sector workers earning over £21,000, with those earning less than this receiving at least £250 in each year

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FINANCE

in the public service pension schemes • Implement progressive changes to the level of employee contributions that lead to anadditional saving of £1.8bn a year by 2014-15, equivalent to three percentage points on average, to be phased in from April 2012 • Exempt the armed forces from this increase in employee contributions • Seek engagement with all stakeholders including trade unions.

HMRC will modernise tax administration and will improve and tailor services for taxpayers. £100 million has been budgeted to improve the operation of Pay As You Earn (PAYE) for both employers and individuals. All businesses will be filing their tax returns online by 2012 with at least 80 per cent of self assessments to be filed online by 2014-15. The Department will also modernise PAYE, moving towards more real time information so that people can be reassured that they have paid the right amount of tax throughout the year.

STATE PENSION Increasing longevity and demographic change pose challenges over the longer term. In response, the government will speed up the pace of State Pension Age equalisation for women from April 2016 so that Women’s State Pension Age reaches 65 in November 2018. The State Pension Age will then increase to 66 for both men and women from December 2018 to April 2020, six years earlier than planned. Following the faster increase to 66, the government is also considering future increases to the State Pension Age and will bring forward proposals in due course. The Basic State Pension will be uprated by a triple guarantee of earnings, prices or 2.5 per cent, whichever is highest. Bringing forward the date at which the State Pension Age will start to rise to 66 to 2018 will ensure this is fiscally sustainable.

OTHER POINTS OF INTEREST The government is committed to the implementation of the devolution of Scottish income tax as laid out in the Calman Commission Report, and will introduce a Scotland Bill in the current Parliamentary session. HMRC has published new guidance and a Q&A for employers (and also one for employees) on the forthcoming changes to Employer Supported Childcare. It includes details of the basic earnings assessment which employers will need to carry out on any employee who joins a childcare voucher scheme on or after April 6, 2011. HMRC has also published further guidance for employers on Additional Statutory Paternity Pay. It explains who is eligible, how much you must pay and how to calculate before April 2011. Full details of the qualifying conditions for Additional Statutory Paternity Leave and Pay can be found on the Business Link website. Business Link has also published new guidance leaflets for employers and employees on maternity and paternity rights which includes new guidance on Additional Statutory Paternity Leave and Pay.

WELFARE REFORMS Over the next two parliaments the current complex system of means-tested working age benefits and tax credits will gradually be replaced with the Universal Credit – an integrated payment that will ensure work always pays, with less scope for fraud and error. £2 billion has been set aside in DWP’s DEL settlement over the next four years to fund the implementation of the Universal Credit. Further details will be set out in DWP’s forthcoming White Paper. To provide a fair and affordable platform for the introduction of the Universal Credit the Spending Review also announced a package of reforms to the existing welfare system which will deliver net AME savings of £7 billion a year by 2014-15. Changes include capping household benefit payments from 2013 at around £500 per week for couple and lone parent households and around £350 per week for single adult households, so that no family can receive more in welfare than median after tax earnings for working households. All disability living allowance claimants, war widows, and working families claiming the working tax credits will be exempt from the cap. Changes also include withdrawing child benefit from families with a higher rate taxpayer from January 2013 so that people on lower incomes are not subsidising those who are better off, saving £2.5 billion a year by 2014-15. The costs of tax credits will be controlled by reducing the percentage of childcare costs that parents can claim through the childcare element of the Working Tax Credit (WTC) from 80 per cent to its previous 70 per cent level in April 2011, saving £385 million a year by 2014-15. Eligibility rules will be changed so that couples with children must work 24 hours a week between them, with one partner working at least 16 hours a week in order to qualify for the WTC, saving £390 million a year by 2014-15. The basic and 30 hour elements of the WTC will be freezed for three years from 2011-12, saving £625 million a year by 2014-15. Lastly changes include increasing the child element above indexation by a further £30 in 2011-12 and £50 in 2012-13, in addition to the £150 and £60 increases provided at the June Budget. This will ensure that the overall outcome of the Spending Review will have no measurable impact on child poverty in the next two years.

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HMRC In order to focus resources on frontline tax collection, HMRC will invest in new technology to improve risk assessment capability, better join up taxpayer information and streamline internal processes. Savings will be maximised from IT and other procurement contracts, and administration costs will be reduced by a third with reductions in the size of corporate services and back office support functions.

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Fiat, the car brand with the lowest average CO2 emissions in Europe†. Fiat 500 TwinAir, the lowest CO2 emission petrol car engine in the world*. Fuel consumption for Fiat 500 TwinAir: mpg (l/100km) and CO2 emissions: Urban 57.6 (4.9) Extra Urban 76.3 (3.7) Combined 68.9 (4.1). CO2 emissions 95 g/km. Source: JATO Dynamics. Based on Volume-weighted average CO emissions (g/km) of the best selling †

brands in Europe, year 2010. *According to NEDC standard. tThe 10% company car tax band currently applies to cars with CO2 emissions of less than 120 g/km.

Health Business | Volume 11.2

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FLEET MANAGEMENT

CREATING A LEANER, GREENER NHS FLEET How should the health sector approach introducing low emission vehicles into its huge and complex fleet, asks John Webb, council member of the Institute of Car Fleet Management THE HEALTH SECTOR has not been left out of government carbon reduction targets. As such they have much to gain through greening their fleets, not just because of the CO2 savings they will achieve but also the financial savings. RETURN ON INVESTMENT The importance of stakeholder buy-in to the business case for a greener fleet cannot be under-estimated. This is the reference point against which all fleet investment decisions must be made. Fleet is usually one of the highest costs of an organisation alongside salaries, estates and IT. Vehicles are costly assets that must support core complex NHS activities and objectives. Consideration needs to be given to if the vehicle fleet supports operational targets and if company cars are perceived as a valued

recruitment and retention tool. An overly restrictive car policy that reduces choice can also push company car drivers into a cash option, which can prove to be more expensive, less safe and less environmentally friendly, as older, higher emitting cars are often chosen by employees. In the public sector, the Office of

Government Commerce (OGC) estimates that nearly 57 per cent of â&#x20AC;&#x2DC;at workâ&#x20AC;&#x2122; mileage is covered by employees in privately-owned vehicles. That equates to around 1.4 billion miles a year covered by vehicles that do not necessarily comply with current law or are fit for the purpose. And, in the public sector, the average age of a privately-owned

An overly restrictive car policy that reduces choice can also push company car drivers into a cash option which can prove to be more expensive, less safe and less environmentally friendly, as older, higher emitting cars are often chosen by employees

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FLEET MANAGEMENT

vehicle used on public sector business is 6.7 years old, compared to the average age of a company car of around two years. Considerable savings can therefore be achieved through reduction of grey fleet numbers and usage alone. Since 2007/08, organisations engaged with OGC have reduced their grey fleet mileage by 22m miles generating over £8m of savings and reducing carbon emissions by over 5,300 tonnes. In the 2009/10 financial year, the OGC forecast was for grey fleet mileage to be reduced by over 40m miles, generating over £15m of savings. VEHICLE TECHNOLOGY There is no ‘one size fits all’ green solution for fleet operators within the NHS. Starting the process with a fixed view of the technology

including A&E ambulances, doctors’ cars and other complex fast response vehicles (FRV), together with converted vans and patient minibuses. The larger fleets also may have the added complexity of managing HGV vehicles with the additional regulation that this entails. Before purchase, it is good practice to set clear technical and qualitative evaluation criteria including cost and performance at the outset. Give the manufacturers and the vehicle conversion specialists feedback. They need this to develop the product – and hopefully enable them to make a sale next time round. One area where innovative vehicle technology can provide challenges is the service, maintenance and repair infrastructure to support the new vehicles. So any decisions about new vehicle models must include adequate provision for keeping

The key to successful green fleet management within the NHS is to identify the needs of the organisation and ensure the fleet matches those needs efficiently and effectively to be chosen is often the source of problems further down the line. While a bold step change to introduce the latest low emission vehicles can offer the potential for a significant drop in emissions, this may be at the cost of driver dissatisfaction, reduced operational performance and increased costs. Therefore, the needs of the complex range of business stakeholders needs to be taken on board if the end users are to buy in to the change. The key to successful green fleet management within the NHS is to identify the needs of the organisation and ensure the fleet matches those needs efficiently and effectively. The best approach is therefore to adopt a technologically neutral approach which aims to provide the lowest CO2 emitting vehicle which is right for the job – fit for purpose. This means that a mix of petrol, diesel, dual-fuel, hybrid and electric may exist successfully within the same fleet. Selecting the right low CO2 emitting vehicles in this way will result in significant cost savings and will not require policy to be revisited every time new vehicle technologies arrive on the market. Effective green fleet management should focus on the careful management of all the key elements of business travel and optimising these to minimise non-productive mileage, inefficient vehicles and inefficient driving practices. VEHICLE EVALUATION In the NHS, the role of the fleet manager or fleet director is a well established function. The NHS operates a huge and complex range of vehicles that present considerable challenges to those responsible for managing them. Front line activities depend on the availability, reliability and safety of a wide range of specialist vehicles

them on the road and reducing downtime. Enlisting the support of drivers is also a critical element of selection and evaluation, particularly for job need vehicles. NHS vehicles often operate on a shift basis and multiple driver operating styles bring further management challenges including ensuring every driver is familiar with the correct procedure for adjusting the vehicle for their use. While on the road trials are an invaluable opportunity to put vehicles to the test they must be done by employees who understand the evaluation criteria and can make an objective assessment. It should also be remembered that badly driven green vehicles can be more polluting than well driven conventional ones. A critical factor in successful green fleet management is securing drivers’ buy-in to the new vehicles. Even when given the most efficient and clean vehicle available in the market today, an employee who resents having the vehicle will manage to make even a clean, efficient vehicle perform inefficiently. Therefore get the drivers’ early buy-in to environmental policy and then the objectives will be much more achievable. Ensure that employees are made aware of any financial savings available to them – low CO2 emitting cars will reduce company car tax and private fuel costs. Employees need to be shown the key features of vehicles to understand any special driving characteristics. For example, hybrids require a different driving style to optimise their dual-power systems. SAFETY FIRST Any successful vehicle selection policies must have safety at the core. Therefore

any vehicle evaluation must include factors such as Euro NCAP (European New Car Assessment Programme) rating. In terms of choosing safety, start by deciding on the size and kind of vehicle needed, then look for the best performers in that group. Some buyers may be interested in a particular aspect of a car’s performance and, under the rating scheme, a car’s score is given for each part of the assessment, as well as the overall star rating. Most fleet selection policies will include front and side airbags and, of course seatbelts which are a legal requirement. However, most manufacturers are developing innovative safety features which also need to be considered if available. Anti-lock Braking System (ABS) helps maintain steering control under emergency braking. Electronic Brake Assist senses how firmly the brake pedal is depressed and keeps applying the brake to help the ABS work. Electronic Stability Control (ESC) detects when a driver is about to lose control and automatically and selectively applies the brakes to individual wheels. ESC has been shown to reduce fatalities by 25 per cent. Within the NHS fleet, special consideration has to be given to the impact of the fitment of specialist equipment on vehicle handling and the safe distribution of loads. The over-riding message is that safety must not be compromised for CO2 reduction. COST COMPARISONS At a ICFM Conference workshop, the majority of members advised they managed fleet on the basis of Whole Life Costs (WLC). The total cost of ownership over the life of a vehicle is a proven, robust method of cost comparison that works on many levels as WLC modelling involves calculations on lease rate, blocked VAT, National Insurance Class 1, fuel and taxation based on a vehicle’s CO2 emissions. This will ‘future proof’ policies and ensure that the effects of the tax changes are reflected in the formation of policy and therefore the choices which drivers make. WLC is also a proven method of influencing the vehicle choice of ‘perk’ company car drivers where the imposition of a CO2 cap restricting choice below say 160 g/km may go against rewards and benefits objectives. The final element of the process is monitoring costs throughout the life of the vehicle and ensuring that the objectives of the original business case have been met. In conclusion, following a structured planned approach to green fleet acquisition within the complex NHS fleet may require additional effort but the benefits will be enjoyed for many years to come.

FOR MORE INFORMATION Web: www.icfm.com

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Here’s how you could singlehandedly reduce surgical site infections by

41%

A landmark study published in The New England Journal of Medicine proves that ChloraPrep provides greater protection against SSIs than povidone iodine1 According to the study, ChloraPrep (2% Chlorhexidine Gluconate & 70% Isopropyl Alcohol): reduced overall infections compared with a traditional povidone iodine scrub and paint method by 41% reduced superficial infections by 52% and deep incisional infections by 67% The 2% chlorhexidine concentration is now proven in 39 outcome studies and recommended in 11 evidence-based guidelines

ChloraPrep. Prep the skin. Protect the patient. Please telephone: 0800 043 7546 or visit: www.chloraprep.co.uk Prescribing Information ChloraPrep® (PL31760/0002) & ChloraPrep with Tint (PL31760-0001) 2% chlorhexidine gluconate w/v / 70% isopropyl alcohol v/v cutaneous solution. Indication: Disinfection of skin prior to invasive medical procedures. Dosage & administration: ChloraPrep – 0.67ml, 1.5ml, 3ml, 10.5ml, 26ml ; ChloraPrep with Tint – 3ml, 10.5ml, 26ml. Volume dependent on invasive procedure being undertaken. Applicator squeezed to break ampoule and release antiseptic solution onto sponge. Solution applied by gently pressing sponge against skin and moving back and forth for 30 seconds. The area

covered should be allowed to air dry. Side effects, precautions & contra-indications: Very rarely allergic or skin reactions reported with chlorhexidine, isopropyl alcohol and Sunset Yellow. Contraindicated for patients with known hypersensitivity to these constituents. For external use only on intact skin. Avoid contact with eyes, mucous membranes, middle ear and neural tissue. Should not be used in children under 2 months of age. Solution is flammable. Do not use with ignition sources until dry, do not allow to pool, and remove soaked materials before use. Over-vigorous use on fragile or sensitive skin or repeated use may lead to local skin

reactions. At the first sign of local skin reaction, application should be stopped. Per applicator costs (ex VAT) ChloraPrep: 0.67ml (SEPP) - 30p; 1.5ml (FREPP) - 55p; 1.5ml – 78p; 3ml – 85p; 10.5ml - £2.92; 26ml - £6.50 ChloraPrep with Tint: 3ml – 89p; 10.5ml £3.07; 26ml £6.83. Legal category: GSL. Marketing Authorisation Holder: CareFusion UK 244 Ltd, 43 London Road, Reigate, Surrey RH2 9PW, UK. Date of preparation: Oct 2010 Reference: 1. Darouiche RO et al. N Engl J Med 2010; 362: 18-26. CHL102d July 2010

Health Business | Volume 11.2

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INFECTION CONTROL

GIVE SOAP A CHANCE Eileen Henderson, assistant to medical director, Hull and East Yorkshire Hospitals NHS Trust, discusses how working in partnerships can help achieve a reduction in infection rates MANY OF THE NATIONAL INITIATIVES to reduce infection have focused on healthcare staff and the significant contribution of hand hygiene, i.e. the cleanyourhands campaign and now the WHO 5 moments for hand hygiene. The evidence base is primarily in relation to healthcare staff from Nightingale and Semilweiss in the 19th century, to more recently published evidence in the EPIC 2 guidelines (2007). Fung and Cairncross (2007) highlighted that community hand washing increased during the 2003 SARS outbreak. They also noted a significant gender difference in hand washing compliance and indeed the importance of family support and “significant female others” with the promotion of hand hygiene. Most recently a Cochrane review, Jefferson et al (2010) has established that hand hygiene can reduce the spread of respiratory virus. The review emphasised this was particularly important around children and that frequent

handwashing reduced the transmission from children to other members of the household. INITIAL PARTNERSHIPS Hull and East Yorkshire Hospitals NHS Trust has adopted a multi-faceted approach to reduce its infection rates and sustain improvement. One of the key pieces of work was the development of a leadership programme in partnership with Hull University Business School (HUBS) for our link practitioners in infection prevention. An initial cohort of ten colleagues participated in a unique action learning approach to improvement during a six-month period. As part of the first cohort, work was undertaken during 2007/08 with the trust, HUBS, a media company and our link infection prevention practitioners to improve the awareness of infection. As a result an information leaflet targeted at both patients and visitors to inform them of infection

prevention was designed and launched. These were then distributed throughout the hospital, all GP surgeries in the area and local pharmacies. The work received national acclaim at the Department of Health and was featured as good practice on the www.clean-safe-care.nhs.uk website. Our second cohort of infection prevention link practitioners highlighted again that patients and relatives required further education about their role within infection – this identified a further need to look differently at our approach to raise awareness. Our first approach had been developed in isolation without an input from other health partners and the wider community. THE VISION We had a vision to raise the importance of social hand washing to the general public, within schools, employment, the home environment and health and social care establishments,

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Antibac Display Boards Eliminates 99.9% of bacteria including MRSA Antibac display board for maximum defence against bacteria: Long lasting mechanical method for eliminating bacteria and does not require any further application or treatment. Antibac display boards are fabric based with new anti-bacterial fabric X-Static which has silver yarns woven into the fabric base. This naturally works through ionisation as the electron release of the silver smothers any micro-organism that lands on the fabric. Fabric tested in accordance with the following antibacterial standards. AATCC100, AARCC147, JISL1902, EN ISO 20645 and ENO ISO 20743 Will not support bacterial growth including: MRSA, E Coli, Aspergillus Niger, Altinata, Salmonella, Pennicillium, Staphylococcus Aureus, Cladosporium Herbarism. Antibac Display boards assists with the compliance of the Heath Act 2006 Code of Practice for the Prevention and Control of Health Care Association Infections.

Health Business | Volume 11.2

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INFECTION CONTROL

Hand hygiene and reducing infection has often been perceived as a “health” problem but through the engagement of our local partners the campaign has been able to reach a wider audience which enabled us to engage with lots of different communities. Hand hygiene and reducing infection has often been perceived as a “health” problem but through the engagement of our local partners the campaign has been able to reach a wider audience. North Yorkshire and the Humber Health Protection Unit, were able to identify some initial key players within other organisations i.e. Hull and Goole Port Authority and both local authorities. The health partners, the trust, NHS Hull, the HPU, NHS Yorkshire and Humber and NHS East Riding of Yorkshire contributed financially to the campaign. CHOOSING THE APPROACH Our media partners, Bluestorm designed a variety of campaign posters and a brand which was then market tested. Meetings were held with the partner agencies including Hull and

Goole Port Authority, East Riding of Yorkshire Council Health Schools and the Public Health Department. Focus groups were held in an infant school within Hull and a sixth form college. Local shops and businesses were visited in the area to canvass their views on the campaign approach as well as visitors, staff and patients within healthcare. Give Soap a Chance was launched at our local Service Improvement Day in March 2009, which resulted in more contacts being established. Following our brief, Bluestorm designed a simple yet effective message and an approach to the campaign which allowed for maximum impact within the local community. Using key dates such as Global Hand Hygiene day and local events ranging from agricultural shows, farmers markets to just being in out and about, has continued to raise our profile. The use of print media, the radio, the

development of the www.wash-hands.com website and simple marketing strategies has enabled the campaign to move forward as well providing other opportunities. Our local partners have opened doors to free media opportunities, for example our posters and hand wash stickers are in every council building within the City of Hull and our hand washing video runs in all their customer care centres. Joining the NHS Choices Road shows during the summer with both primary care trusts enabled the campaign to reach all areas of the Hull and East Yorkshire community. ENGAGING WITH BUSINESS The campaign also launched a business pack at the start of summer 2009 with the emphasis of highlighting this issue to both employers – in terms of reducing potential sick days – and to employees – in terms of loss of pay. To date more than 100 businesses have signed up. Comet has rolled out our posters and leaflets nationally, and we have recently signed up Smith & Nephew. The campaign has travelled to other parts of the world with requests coming from the USA, Canada, Kenya, Russia and Australia. Our Environmental Health colleagues within both local authorities have been

Improve toilet hygiene with the Clos-o-Mat

Get a grip on healthcare acquired infections

ORWARDTHINKING hospitals have discovered an efficient way of simultaneously improving patient and staff hygiene control: installation of a Clos-o-Mat bidet WC. The automatic toilet, which combines conventional toileting with a douche and drier, eliminates handto-body contact by the individual using the toilet and/or carer – and thus the potential of contact with and transfer of germs via urine and faeces. It also disposes of the need for toilet paper, so giving an environmental benefit too. Clos-o-Mats have already been installed in, among others, Sir Robert Peel Hospital in Tamworth, St Albans City Hospital and Upton Hospital in Slough, specificially on wards providing elderly or rehabilitation care, and in specialist departments such as neurological rehabilitation and endoscopy. The neurological rehabilitation units throughout Hertfordshire which includes St Albans City

LLGOOD PLC is the UK’s leading architectural ironmonger in the supply of products to the construction industry. The company specialises in unique fine design and high performance products. In every aspect of the business we strive to provide the best quality and exemplary service, representing real value for money. Allgood has built a reputation for supplying products of the highest aesthetic standard, matched with guaranteed performance and excellent service. Always looking to innovate, Allgood has developed a range of products for the healthcare market including: • anti-microbial ironmongery • anti-microbial door sets • anti-microbial washroom accessories • anti ligature furniture • finger guards As ironmongery is one of the most touched items in a building, it is extremely important to

Hospital, observed: “When we set up the unit, we installed Closo-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.” The Clos-o-Mat Palma is WRAS approved, enabling it to be connected to the UK water supply – the only complete, automatic shower toilet to have this certification. Total Hygiene provides a comprehensive sales, installation and after sales package, and offers a range of options to enable tailoring of each unit to individual requirements.

FOR MORE INFORMATION Full information is detailed at wwww.clos-o-mat.com

protect these areas from crosscontamination of bacteria and all forms of Healthcare Acquired Infections (HAIs). At Allgood we use anti-microbial technology in a range of products to prevent the growth of bacteria between cleans. All of our products are minimalist, architectural, highly coordinated and robust. They also meet the highest levels of product performance standards.

FOR MORE INFORMATION Address: 297 Euston Road, London NW1 3AQ Tel: 020 73879951 Fax: 020 73801232 E-mail: info@allgood.co.uk Web: www.allgood.co.uk

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Bugban

FU LL Y BY SU HA PP IG ORT H E D

ACTIVE ANTIMICROBIAL BUILT IN

Bacteria-ridden remote controls are the likely place for patients to get a cold or flu. ZAPLEX disposable remote control protectors are injected with an antibacterial compound proven to help hospitals avoid the all-too-common hand-to-remote transferring of a cold, flu or MRSA

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

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

3 Easy for housekeeping staff to apply; 3 Disposable: Change in seconds with each new guest; 3 Antibacterial-injected compound provides added sanitary protection; 3 High perceived impact at a low-cost-per-stay ratio; 3 Saves on lost batteries and remote control battery compartment covers; 3 Protect remote controls from spills and grime; and 3 One size fits virtually all remote controls. Global Entertainment Management (UK) Limited Contact us today on 0845 260 2180 or via email: sales@globalentertainment.co.uk

Health Business | Volume 11.2

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INFECTION CONTROL

instrumental in connecting the campaign with food business throughout the area. A discovery about the involvement of businesses in the promotion of hand hygiene has in itself seen new partnerships develop in particular soap retailers LUSH who regularly promote effective hand hygiene to their customer base groups as well as doing ad hoc teaching sessions with in schools. Such a partnership has enabled the campaign to undertake hand hygiene challenges within town centres reaching a mixed audience of people wishing to be shown how to wash their hands effectively. SCHOOLS The launch of Sammy Soap and the Clean Team (Sally Splash, Sammy Soap, Rosie Rinse and Mr Dry) at the start of the new academic year with a key stage 1 teaching pack was the result of an amazing piece of work during the summer months by the health school advisors, primary school consultants, health colleagues and Bluestorm. A large Sammy Soap is now able to visit schools with a mixture of colleagues ranging from environmental health officers, school nurses, infection prevention and control nurses as well as being available to accompany teachers in their promotion of hand hygiene. The teaching packs have provided different

partners with a tool to use in schools. The campaign has enabled some school nurses to refocus on hand hygiene in their local areas as well as strengthen the partnerships between health and education. The campaign has highlighted that different agencies were doing different activities in school but not connected – the Clean Team and the campaign has provided an overall umbrella. Continual work with our partners sees over 4,000 children being educated locally in using the Clean Team packs and an evaluation of the pack is about to be undertaken to assess the effectiveness of the pack as a teaching tool. The profile of Give Soap a Chance – encouraged by an accolade received by the World Health Organisation – continues to grow. Our website has on average 1,200 hits a month and we receive over 40 requests for business packs every month. The simple message got us noticed by Action MRSA UK and it has been wonderful to work closely with the chair Derek and his members. The trust continues to work actively with the business school, a 3rd cohort of link practitioners has just successfully completed the programme and we are now planning our next cohort. Our level of infection continues to decrease contributing to a safer patient environment and

Audio visual and digital signage solutions HARM PROVIDES fully tailored and off-the-shelf audio visual, digital signage and content solutions to hospitals, surgeries, schools and businesses throughout the UK. From sophisticated conference hall and training rooms to complex signage network facilities or stand alone information screens, we’re here to help. Digital signage is quickly replacing static signs, notice boards, banners and posters as the most effective method of communicating key information. Used correctly it can help convey detailed messages to almost any audience, anywhere, anytime. Unlike traditional printed signs, digital signage can be updated instantaneously, allowing you to capture current events and suit the demands of the moment. It also eliminates the high ongoing cost of creating and distributing printed ad campaigns. Whether you intend to build a brand,

FOR MORE INFORMATION Tel: 0854 4502012 E-mail: rod@charmoffice.co.uk Web: www.charmoffice.co.uk

Eileen Henderson Dip COT BSc(Hons) MBA assistant to medical director at Hull and East Yorkshire Hospitals NHS Trust References: Pratt et al (2007) epic2:National Evidence-Based Guidelines for Preventing Healthcare-Associated infections in NHS Hospitals in England Fung !C, Carincross S (2007) How often do you wash your hands? A review of studies of hand-washing practices in the community during and after the SARS outbreak in 2003 Int J Environmental Res. 2007 Jun:17(3):161-83 Jefferson T, Del Mar C, Dooley L, Ferroni E, Al-Ansary LA, Bawazeer GA, van Driel ML, Nair S, Foxlee R, Rivetti A. Physical interventions to interrupt or reduce the spread of respiratory viruses. Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No.: CD006207. DOI: 10.1002/14651858.CD006207.pub3

Mersey Care NHS makes 18 per cent energy savings with Powerstar NERGY SAVING, voltage optimisation solutions provider EMSc Powerstar is pleased to announce that Mersey Care NHS Trust is amongst the latest care trusts to have installed Powerstar, with installations including Ashworth, Mossley and Rathbone Hospitals along with Scott Clinic. 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 benefitted from annual kWh savings of 51,573 kWh, or £5,446. As a result of increasing pressure to reduce carbon emissions, a growing number of NHS Trusts are turning to Powerstar, an entirely British made, market leading voltage optimisation system, not only for its ability to reduce energy

influence behaviour or simply provide useful information to visitors, staff or patients, the dynamic visual experience created by digital signage helps get your message across. Our Signage Servers are based on established and extremely stable technologies designed to be active 24/7. They require little or no maintenance once installed – a true “fix and forget” service. To learn more about how Charm can help please get in touch.

in the local community. The simple message of Give Soap a Chance has indeed raised the profile of effective hand hygiene and provided the opportunities for collaborative working. The relationships developed with businesses offers a further real potential.

consumption, but also to improve the life expectancy of on-site equipment as well as reduce maintenance costs. Powerstar cuts energy use by controlling the incoming voltage so that it accurately meets the specifications of equipment on site. Terry Shemwell, Powerstar consultant to local authorities and the NHS commented: “The NHS has highlighted its commitment to cutting carbon emissions and meeting the government’s targets to cutting emissions by 80 per cent, by 2050. Solutions such as Powerstar are allowing trusts to not only achieve these targets but plough back money saved into improved patient care and services.”

FOR MORE INFORMATION Tel: +44 (0)1709 836200 E-mail: info@ems-uk.org Web: www.powerstar.co.uk

THE BUSINESS MAGAZINE FOR HEALTH MANAGEMENT

Health Business | Volume 11.2

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CLEANING

SAFE AND SPOTLESS Next year, GP surgeries and medical centres will need the latest, most effective cleaning methods to meet the new CQC standards, writes Ceris Burns IT’S NOT THAT LONG SINCE cleaning a doctor’s surgery was essentially the same as cleaning his or her home, but with added disinfectant. Times change. As individual surgeries group together as medical centres, as medical centres grow in technical and therapeutic versatility and as more and more new and devastating infective organisms become potential adversaries at the primary care level, cleaning has to be more comprehensive, planned in detail and costed to the last detail. DEMONSTRATING COMPLIANCE But even that is far from the whole story. From 1 April 2012, all 8,500 GP practices in England will be required to register with the Care Quality Commission, and practices will be required to demonstrate compliance with sixteen key standards, including the safety and suitability of premises, in order to maintain their registration. Practices will have to demonstrate that they have processes and systems in place to ensure that they meet the standards, and could be deemed to be operating illegally if they continue to provide GP services while not meeting the standards, and will potentially face prosecution and penalties if they fall out with the new watchdog1. Those systems covered by the CQC standards include cleaning. The Care Quality Commission is providing information on the standards required in all areas of GP practice maintenance, including cleaning, and information is available from www.cqc.org.uk. Clearly, all GP Practice Managers should be obtaining full information now so that they know what changes will have to be made and budgeted for well in advance of April 2012. SUSTAINABILITY TOO If that were not enough, loud voices from various environmental lobby groups insist that cleaning in all medical premises must achieve sustainability. So how does a cleaner in a GP medical centre work more sustainably? Sustainability can be applied to machines, materials and techniques. Cleaning chemicals should be considered. Regularly review the list of cleaning chemicals that the practice’s cleaners use and check whether safer and greener alternatives have become available. According to SafeWorkers reference organisation2, there are around 100,000 different harmful substances recognised across Europe as being used in workplaces, and at the top of their list of places where potentially dangerous substances are found you will find cleaning chemicals. You really do not want to exacerbate existing asthma or dermatitis with cleaning chemical residues

As individual surgeries group together as medical centres, as medical centres grow in technical and therapeutic versatility and as more and more new and devastating infective organisms become potential adversaries at the primary care level, cleaning has to be more comprehensive, planned in detail and costed to the last detail in the waiting room or consulting rooms. In the case of floor cleaning machines, look for machines that have been made greener by reducing their energy consumption and cutting down on the need for replacement wheels, brushes, squeegees and consumables, without also reducing their operating efficiency. In areas close to where patients are being

treated – perhaps minor surgical procedures – noise from cleaning machines can also be a big issue, since noise pollution has a direct bearing on health and speed of recovery. Cleaning machine manufacturers such as Truvox International are actively reducing noise from machines, whether by using smaller motors, replacing metal with

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Health Business | Volume 11.2

www.healthbusinessuk.com

CLEANING

ready to walk on in minutes. The Multiwash is good at ‘difficult’ floors like non-slip safety floors, low pile carpets and entrance matting. It offers a medical centre cleaner the ability to achieve greater speed, improved cleaning efficiency and dryer floors immediately after cleaning to reduce the risk of accidents. Then there is the issue of tiled floors, which have a tendency to retain dirt, and potentially infection, in the recesses where the floor has been grouted. Cleaners in medical centres and clinics need machines that scrub deeply into the recesses, so should always ask the supplier the depth to which a scrubber scrubs. Deep scrubbing uses less water and a smaller quantity of chemicals than shallow scrubbing to remove grit and soil. Machines with cylindrical brushes, like the Multiwash, exert greater pressure on floors and can dig more deeply into tile and grout areas. Less use of chemicals means lower costs; deeper scrubbing means cleaner results and better asepsis. engineering plastics in the gear trains, or designing vacuum cleaners differently, and it has been shown to be entirely practical to reduce noise emissions from cleaning in health centres. The pressure to achieve sustainability is causing manufacturers to design machines differently, so why not design them to run more quietly at the same time? STANDARDS AND TRAINING As standards of asepsis are pushed ever higher, cleaning has to be more efficient – to achieve greater safety and a better hygiene standard for less effort, less expense or both. This is true both of emergency cleaning and of routine cleaning, which is nowadays usually by specialised medical cleaning contractors. In the case of emergency cleaning, safety for all concerned can be achieved only by surgery staff knowing the correct procedures for dealing with, for example, spillages of body fluids, such as blood or vomit, which are far more rigorous than they once were. Training of surgery staff in such emergency cleaning is essential, as is the provision of protective clothing and equipment to modern standards. For example, when dealing with blood spillages3. • Move patients and anybody else in the vicinity as far as possible away from the spillage. • The person dealing with the spillage must wear a face visor, gloves and disposable overalls, use disposable cloths and have a yellow clinical waste sack available. • Open windows and make sure the room is well ventilated before starting. • Cover the spillage with dichloroisocyanurate granules in solution (read the instructions to get the strength of the solution correct). Leave this in place for seven minutes and stay clear of the spillage while the solution is acting. • Mop up the spillage with disposable cloths until the area is clean. • Dispose of cloths, gloves and protective

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overalls in the yellow sack, seal the sack and send it for incineration. • Wash and dry hands. • Spot clean the area with detergent and hot water. For routine cleaning, check carefully that the cleaning contractor that you are using is fully conversant with the standards that the Care Quality Commission will be enforcing from April 2012 (insofar as the detail is available) and is keeping up to date with the latest developments in machines and/or materials that are fully efficient at removing soil and materials that harbour pathogens. VARIOUS SURFACES Most GP medical centres have areas of hard floor, such as tiles or cushioned vinyl. The majority also have areas of carpet – usually consulting rooms and corridors. Keeping both clean is labour and energy intensive. The practice manager and his or her management team therefore need to know about all developments that can help their budgets and objectives, while saving some cash – and maybe also helping their sustainability. An important recent development where there is a lot of carpet is encapsulation technology. This encapsulates soil from among carpet fibres so that, instead of trying to vacuum unmodified oily grime or tar residues from carpet, the cleaners vacuum hard brittle encapsulated dirt which is easy to pick up. PRACTICAL SAFETY FIRST It is essential to eliminate the risks of wet or damp hard floors, which can cause accidents and claims for compensation. Here again cleaning machine manufacturers have a key role to play. For example, the Truvox Multiwash washes, mops, scrubs and dries on both hard and soft floor coverings in a single pass and leaves floors

SUMMING UP It is vital that every surgery and medical centre fully understands what the Care Quality Commission will be requiring of them from April 2012 and takes steps to meet the new standards as soon as possible. The CQC changes will be happening at the same time as the massive changes to General Practice announced by the coalition government and the consequent establishment of the new NHS Commissioning Board and GP Consortia to manage NHS financing. GP practices are likely to have so many changes happening at one time that a degree of confusion could result, and anything that can be tackled sooner rather than later should be organised before the funding changes take effect. As part of the GP practice review to ensure that it meets next year’s CQC criteria (which include security, for example, as well as cleaning and asepsis) it is also essential that necessary additional training for surgery staff is organised and carried out. A full review of the practice’s contract cleaning arrangements should be carried out as soon as possible to ensure that the business carrying out the cleaning is fully conversant with CQC requirements. The contractor should be asked to produce a written plan showing changes that will be necessary to conform to CQC standards.

Ceris Burns is marketing consultant to Truvox International References 1. www.gpsurveyors.co.uk/cqc.htm 2. www.safeworkers.co.uk/ WorkingDangerousSubstances.html 3. www.master-cleaners.co.uk/surgery-cleaning

FOR MORE INFORMATION Web: www.truvox.com

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CLEANING

TO BE SAFE, COMPLIANCE MUST BE 100 PER CENT Richard Norman, managing director of Indepth Hygiene Services, explains why it is important to give extract ventilation systems the priority attention they require if building occupants are to be kept safe IN RECENT MONTHS, Fire & Rescue Services across the country have reported a spate of fires in catering establishments which have been linked to uncleaned or, inadequately cleaned, grease extract systems. An example of what can happen when extract ducting has not been thoroughly cleaned of grease of deposits was a major fire at the Burger King restaurant at London’s Liverpool Street station. The London Fire Brigade reported that grease in the extract ducting caught fire resulting in widespread and destructive damage. Fortunately, the building was quickly evacuated and nobody was injured. Such a fire in a hospital kitchen would have posed serious evacuation problems. It showed once again what can happen when a spark or flame from the cooking units finds flammable grease deposits in the extract ducting. The Fire Authorities are well aware of the potential dangers in these systems. A spokesman has stated “uncleaned grease extract ventilation systems present probably the greatest potential risk to occupants in buildings with catering facilities.” LEGALLY REQUIRED COMPLIANCE The Fire Safety Order (Regulatory Reform (Fire Safety) Order 2005) makes compliance requirements quite clear. Any potential fire hazard which might put building occupants at risk must be included in the fire risk assessments and action taken to eliminate, or at the very least, to minimise the risk. Cleaning the kitchen canopies, filters and the extract ducting as far as can be reached from the filter housings, which is so often the extent of cleaning in so many hospitals, is not the same as minimising the risk. There have been numerous instances where a spark or flame ignited combustible grease deposits in the ducting many feet away from the canopy. To eliminate the fire risk requires the extract system to be cleaned in its entirety.” There are other factors which might account for the poor levels of compliance. Extract ducting often runs from the kitchen canopy out of sight behind ceilings and walls. To be made safe, access to the internal ducting surfaces for thorough cleaning by way of access panels is essential. There are unscrupulous contractors who will claim to have cleaned the system without the need to install access panels. No access panels installed invariably means inadequate cleaning being carried out. Grease extract ducting cannot be cleaned unless access to the ducting has been effected to allow thorough removal of all grease

Reproduced by kind permission of Nicholas Adams of www.guerillaphotography.co.uk

deposits. Any assurance from a contractor that he will not need to install access panels as he will be using motorised or other mechanical devices to provide cleaning is not acceptable. These might be appropriate for cleaning air conditioning systems but grease deposits in extract ducting can only be fully eliminated by the application of old fashioned elbow grease aided by cleaning chemicals, brushes, scrapers and cloths. MAKING SURE CLEANED MEANS CLEAN Poor inspection post clean may also account for poor compliance. In the event of a fire it is not a defence to claim “I thought it was being cleaned.” The responsible person, who is required to be appointed under the Fire Safety Order, must be sure he is getting what is being paid for – a cleaned and therefore safe extract system. Anything less could result in a highly destructive fire and, if death or injury was to result, the responsible person could face criminal prosecutions. It is now over four years since the Fire Safety Order became law. There is therefore no excuse for its compliance requirements not to have been put in place. The Fire & Rescue services that are responsible for checking on compliance with the legislation are obviously not able to check all premises. That further underlines the need for those

responsible for building occupants’ safety to take the required action and not wait for the fire inspector to point out deficiencies. For the cleaning of extract ductwork systems it is essential to select a contractor who will undertake to carry out the work in accordance with the industry standard of excellence – HVCA TR19. This document entitled ‘A Guide to Good Practice for the Internal Cleanliness of Ventilation Systems’ and published by the Heating & Ventilating Contractors Association sets out very clearly the standards of cleaning which must be achieved to ensure systems are made safe. As an HVCA approved contractor, Indepth Hygiene Services will first carry out a survey of the extract system and provide a detailed assessment of its fire risk condition, quite free of charge. The survey report will invariably be accompanied by a schematic of the system with costings for providing a fully compliant service. Following completion of the work a certificate is provided to be shown to fire inspectors as evidence that compliance requirements for the extract system have been fulfilled.

FOR MORE INFORMATION Tel: 020 86617888 E-mail: ductclean@indepthhygiene.co.uk

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FACILITIES MANAGEMENT

ENHANCING ESTATES AND FACILITIES INFORMATION Keith Sammonds, managing director of the Healthcare Facilities Consortium, looks at how statutory returns information can be used to drive efficiency savings when mixed with other national or locally held information IT WAS INTERESTING to receive feedback after the article in the last edition that looked at the English Functional Suitability figures. This was written after the BBC approached us to comment on the figures released from the Department of Health that are extracted from the ERIC returns. Interest ranged from plain old general curiosity to specific queries about how we use and interpret information to help health providers understand their estates and facilities issues. As with any such conversations it is inevitable that people get round to asking why: • Why does the government require this information? • Why do they keep changing the data set? • Why isn’t there any trend information? • Why doesn’t anyone link the estate costs to actual use? • Why can’t we get a UK set of figures? • Why isn’t this of any real use? I cannot answer all these questions definitively but have a view on them all, as you would expect. Government requires the information so that they can monitor the effectiveness of the NHS estate and have some overview of the cost and value for money of the service provision. They keep changing the dataset as the political drivers keep changing and so the Civil Service has to answer the parliamentary questions. This obviously impacts on the trend information available but through the HFC Benchmarking Club we have been producing trend information for our subscribers for over 20 years and continue to do so year on year with at least ten years information in our annual report. SUCCESSFUL INITIATIVES It has been very encouraging to see more and more NHS bodies looking at their Estates and Facilities information alongside other key information and producing meaningful business based informatics. This then allows and supports more business based decision making at board level. One of the more obvious moves from this has been the recognition that hospital space is relatively expensive and so it makes sense to move services that do not have to be in the hospital away to cheaper and probably more appropriate accommodation. My local PCT has set their facilities management team up in offices in the community rather than on a hospital site and their home care delivery service is run from an industrial unit rather than a hospital base. At the University College London Hospitals NHS Trust they have established a delivery

At the University College London Hospitals NHS Trust they have established a delivery pathway that sees all deliveries made to one of three hubs out by the M25 and then dedicated mixed deliveries in eco vehicles to the relevant hospitals. This has reduced problems with large lorries accessing central London sites to make part load deliveries and contributes to the greening of the Trust through its long term carbon commitments

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FACILITIES MANAGEMENT

pathway that sees all deliveries made to one of three hubs out by the M25 and then dedicated mixed deliveries in eco vehicles to the relevant hospitals. This has reduced problems with large lorries accessing central London sites to make part load deliveries and contributes to the greening of the Trust through its long term carbon commitments. Such initiatives are often seen as innovative within the NHS, and indeed they are, but in reality this is only picking up on what industry has been doing for some time. However, the impact of such change can only be seen and proven if the business cases are supported by accurate and relevant estates and facilities information used alongside an understanding of the business processes involved. There are many other areas where the health service can become more efficient and the recent NAO report of the procurement processes for consumables highlighted some classic examples that make for good media but appeared to be thin on the actual savings that can realistically be achieved. DRIVING EFFICIENCY 17 types of A4 sounds extreme but even in our little office we have 4 different weights and finishes of A4 paper in use, each for a specific purpose. Our fliers and information sheets would be useless on the 90gsm paper we use for letters and invoicing and similarly it would be very wasteful to print routine correspondence on a 160 gsm glossy paper. Any organisation like a large Acute NHS service provider that produces its own publicity material, temporary internal notices, and disease or treatment sheets as folders will of course need to carry a reasonable range of different papers relevant to their needs. Of course this then leads to the question of the relevance of an NHS service provider running its own internal printing department when there are plenty of good, reliable and cost effective commercial providers of this service. The same applies to car parking – why are we using NHS employed staff to manage car parks? The answer is simple – the decision was made that this is a cost effective and efficient way to handle this side of the management of our premises. The proof of the decision is in the effectiveness of the service provided and this requires ongoing monitoring. THE BIG PICTURE The thorny issue of getting a UK wide set of figures is a very difficult one to answer. When I first joined the NHS it was NHS UK and although different District and Area Health Authorities worked in different ways the whole was provided under a single set of guidance and standards. Since devolution we now have four governing bodies each with their own view and political need to express their independence. As an Englishman it would be remise of me not to point out that England is the only one of the four countries in the UK that does not

have its own government; but that is an issue for a completely different forum. At present English figures are published through an open access web site but as far as I am aware no one in the UK Government offices compiles a UK data set relating to the performance of the whole of the NHS throughout the UK. Some of us compile what we can from the open access information and our own data sets and that really leads us on to the last of the questions – why isn’t this of any real use? WHAT’S THE USE? As an ex NHS Trust Information Manager it greatly upsets me when I hear this question voiced. National statistics are of real use; they help define and drive the national level decisions that form the framework for the delivery of healthcare to the nation. Sometimes it might feel like the politicians make decisions

Benchmarking has a variety of functions and one of the problems, which Roy highlights in his article, is that it is often used only to produce league tables; you know where you are in the table and put lots of effort into improving the position. Sight of the service provision is actually lost in the light of the number in the list. Where benchmarking is just used in this way it really is a waste of time but once the information is used to inform the current position and provide trend analysis you have a solid understanding of how your organisation is performing now and in which direction it is facing. Returning to the driving analogy, you cannot plan a journey unless you know where you are. As change is then made using the benchmarking information, or management information as it should perhaps more correctly be known, you can actively monitor

Enhancing estates and facilities information is not about adding to it, or making it more complicated; it is about using it to inform and drive business decision making that aren’t based on the figures but at least with the figures there a level of accountability is provided. One of the problems is that if locally people don’t believe that the statutory returns are important and have value then the reliability of the figures comes into question. The bottom line is the statutory figures are only a high level summary of the information that should be being used for day to day management and strategic decision making at the local level. The recent QIPP exercise has shown how the SHAs in England use the figures and several of the squeals heard around the West Midlands really proved that the Trusts had not been taking care with the accuracy of the information they provided. BENCHMARKING Roy Lilley has recently written a very challenging article about QIPP and within this he noted that: “Benchmarking is another waste of time,” and likened it to “driving looking in the rear view mirror.” Whilst I have a great deal of respect for Roy and his, often, outspoken views I do feel that he is taking a very lopsided view here. Yes – of course we have to look forward as we plan the business of healthcare for the future but when driving it is actually very important to know what is going on all around you. My one daughter failed her driving test on one occasion for “failing to be aware of the surrounding environment.” In other words she didn’t use her mirrors and side view enough so her awareness was limited. Likewise at work we need to have a wide view and not a blinkered one.

progress and the impact of the changes made and see if the movement is in the right direction. Yes it is useful to know what your performance is like relative to others but not in a league table; use the information to tease out who does what better, or more effectively, and then see if this better practice can be applied to your own set up. BETTER DECISION MAKING Enhancing estates and facilities information is not about adding to it, or making it more complicated; it is about using it to inform and drive business decision making. After all, the estate and the facilities are there to enable the healthcare provision that is the primary objective of our organisations, so it is pointless just looking at this in isolation. A little thought to end on: If the government wants to see a ten per cent increase in front line services then surely we have to accept that there is going to be a commensurate increase in the wear and tear and utilities costs on the premises these services are provided in. I am still trying to get my mind round how that can be achieved, whilst maintaining current standards to ensure a clean and safe environment, with a 45 per cent decrease in what has been called “back office costs.” This is the reality of the challenge facing the estates and facilities teams and their management boards around the country.

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

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ENERGY

LEADING THE WAY IN REDUCING ENERGY USE The St. Peter’s Primary Health Care Centre, located in the centre of Burnley, Lancashire, is a great example of how a healthcare provider can make significant CO2 and cost savings THE UK’S HEALTHCARE SECTOR spends £400 million on energy and accounts for 8 tonnes of CO2 per year or 3 per cent of the UK’s carbon emissions. According to LessEn partner the Carbon Trust, a huge proportion of this could be saved with the implementation of behaviour change and by investing in building energy efficiency technology. Unfortunately, this also means that a significant proportion of healthcare funding is wasted, indicating that energy saving has largely been overlooked. In 2010, the LessEn initiative launched the world’s first energy map showcasing building energy efficiency across the UK. The LessEn Energy Map is based on Display Energy Certificates (DEC) and supported through a free smartphone application that displays building energy ratings through augmented reality. As a result of the energy map, a healthcare service in Burnley, Lancashire has proven that not all of the UK’s healthcare services have been blind to potential savings. The St Peter’s Health Centre is a combined state-of-the-art leisure and primary health

care facility, located in the centre of Burnley, Lancashire and a shining example of how a healthcare service can make significant energy savings. A joint project between Burnley Borough Council and East Lancashire NHS Trust was designed and constructed by Preston based developer The Eric Wright Group. Annual energy saving measures have resulted in a 27 per cent reduction in its DEC rating. A UK FIRST The mix of health and leisure facilities is thought to be the first of its kind in the UK and was procured under the LIFT model (Local Improvement Finance Trust). The total cost of the building refurbishment was £29m. The Eric Wright Group will deliver facilities management services to the health centre for the remaining 23 years of the lease period while the borough council maintains the leisure centre. The leisure centre includes two swimming pools, a fitness suite, a health suite, a café and sports halls. The primary healthcare centre houses a wide range of services

over nine floors, including an out-of-hours GP service, clinics ranging from orthoptics, occupational therapy, physiotherapy and musculoskeletal through to dentistry, speech and language therapy, sexual health, retinal screening and audiology. District and school nurses, community matrons and visitors for the area are also housed within the centre. Energy efficiency was a key consideration when the centre was built. The project was designed and constructed within a very short timescale to meet the requirements of external grants and, as a result, the project team were faced with some financial and programme restrictions. Construction commenced in January 2005, with the leisure element completed by March 2006 and the health element by September of that year. In 2009, the health centre received a Display Energy Certificate (DEC) rating of 112, which put it in the E category. CHANGING ENERGY BEHAVIOUR Key to achieving a high level of energy efficiency at St Peter’s Health Centre has been the team’s dedication to reviewing possible energy efficiency opportunities. As a result it was clear that, although highly efficient lighting and plant had been installed, one of the biggest challenges would be to change the mindset of the people using the building every day. The Eric Wright team, led by Blair Fotheringham and his assistant Paul Truby, set up a user group within the health centre involving employees from all departments.

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ENERGY

Regular meetings to discuss operational issues were organised and a campaign to reduce energy across the healthcare facility was started with further support from the Carbon Trust in terms of providing ‘please switch off’ stickers and posters. The stickers and posters provided an engaging action for all staff and were very effective. Many of the 500 staff at the health centre use a computer, and by reminding them to switch it off at the end of the day, the team were already starting to make an impact. They also installed additional PIR motion sensors to minimise lighting usage and once again the response was very positive, which suggested that placing responsibility with staff increased their commitment to the initiative. To increase the support for the facilities management group, Blair Fotheringham’s team further enhanced the building management software allowing them to fine-tune the controls for heating, ventilation and lighting. These measures have allowed the FM team to gain a greater control of the building’s core temperatures, improve indoor air quality and the ability to optimise room settings according to changing weather conditions. One finding has been that judging the optimum set points for heating and ventilation levels in any building takes a lot of time and effort and it is important to keep reviewing the settings as operational changes take place on a weekly basis. The team had to be particularly careful due to the building’s health centre function in which people are under regular clinical assessment. The key is to find the right balance between internal and external air temperature so as to maximise natural temperature conditions. THE RESULTS St Peter’s Health Centre started with an initial DEC rating of E (112), however, this has been improved to a DEC rating of 88, putting it firmly in category D, and well above the

average rating for a building of this size. Blair Fotheringham’s team used the DEC rating as a showcase to the user group and gave them a like-for-like comparison over the previous assessment. Working collectively across the healthcare centre towards an achievable energy efficiency goal had captured people’s attention and continues to lead energy efficiency for the centre. Interestingly, during the time since the last DEC rating, the operating hours of the centre have significantly increased. This has slightly distorted the rating but it is still an accurate assessment of the building’s energy performance. Throughout 2010, Blair Fotheringham’s team, in conjunction with the East Lancashire NHS management team and building users, continued to make improvements, resulting in an energy savings of over £36,000 with 154,047Kwh of electricity and 12,862 Kwh of gas saved versus 2009. Gas savings achieved for the first three quarters of 2010 were 13.17 per cent for St Peter’s Health Centre, however, severe temperatures heavily impacted their excellent energy saving results. With temperatures regularly dipping below -5 degrees C during the day, much of their year’s gas savings were unfortunately lost. WHAT IS NEXT? The aim is to continue to improve the energy efficiency of the building with the objective of improving the DEC rating still further. Moving up a DEC level has been a great achievement and it will be interesting to see how far St Peter’s Health Centre can go in achieving higher energy certificates. Technical energy saving measures being considered at the centre include the installation of LED lights in specific areas, voltage optimisation and solar panels to make the most of the current feed-in tariffs. An additional benefit that saving energy

ABOUT LESSEN The name LessEn emphasises the focus on lessening the confusion that surrounds the issue of energy efficiency, lessening energy consumption and lessening energy costs. LessEn is a global resource initiated by The Urban Land Institute (ULI), the global not-for-profit research and education organisation for the real estate industry. LessEn is supported by the investment and resources of Arup, Chelsfield, Hines, Philips, ECE, Union Investment, Lutron and Gensler. LessEn represents the successful development of an 18-month beta pilot project on European energy efficiency, called the ULI Energy Efficiency Exchange. This was initially funded by ULI life trustee Sir Stuart Lipton, who donated the $100,000 prize that was awarded to him as winner of the J.C. Nichols prize for Visionaries in Urban Development given by the Urban Land Institute. has brought to St Peter’s Health Centre is that it will be better placed to take the lead in the Carbon Reduction Commitment Energy Efficiency Scheme (CRC) as it enters its first reporting year at the start of April this year. The CRC will result in a huge shift in the UK healthcare service to improve its energy efficiency, and organisations that fail will be taxed and shamed through the public league tables produced on an annual basis after each reporting period. Blair Fotheringham’s initiatives at St Peter’s Healthcare are a shining example that energy savings can be realised and working with organisation-wide strategies can make significant savings.

FOR MORE INFORMATION Web: www.less-en.org

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Hose Solutions

for H&V and Plumbing applications

Hydraquip offer a choice of hose assemblies with cores in a variety of materials, such as PEX,

stainless and rubber, meeting current requirements and standards (including DH(2010) 03) to suit various applications. Vast stocks of off-the-shelf standard assemblies meet most needs with bespoke hoses manufactured quickly to meet the demands of specific project requirements.

TAP FLEXIBLES Standard and non standard combinations are available with stainless over braided WRAS approved PEX liner or EPDM rubber with a wide range of end fittings to suit. Convoluted stainless assemblies with 15mm and 22mm copper pipe ends in 300mm and 450mm lengths are suitable for applications up to 14bar (15mm) and 11bar (22mm) where a semi permanent flexible is required. FAN COIL and CEILING HOSES BSRIA approved assemblies meeting the needs of today’s heating circuits. DN08 to DN50 stainless over braided epdm rubber with male, female, tube/standpipe, compression and push fit ends. CATERQUIP hoses meet BS669/Part 2 for use on commercial gas applications. Available in 1/2”, 3/4” and 1” bores in a choice of lengths. The ELEGANT range of deep chromed fittings from HYDRAQUIP are perfect for installations where connections are on show.

LARGE BORE HOSES For applications such as oil and steam that require a flexible connector, these can be manufactured in bore sizes up to DN200 (8”) from stock, with larger bore sizes available within a few days.

Hydraquip Braided Hose Division tel 0845 260 4334 fax 0845 260 4335 email hq@hydraquip.co.uk

www.hydraquip.co.uk

HYDRAQUIP HOSES ARE AVAILABLE FROM YOUR LOCAL PLUMBING SUPPLIER

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AIR CONDITIONING & REFRIGERATION

THE NEED FOR FULL CERTIFICATION By 4 July 2011, all personnel working on refrigeration, air conditioning and heat pump systems containing HFC refrigerants must obtain a full qualification, warns F-Gas Support WE ARE HOPEFULLY waving goodbye to a long cold winter and looking forward to a hot summer; great for sun lovers and for keeping the air conditioning working. But if you work with refrigeration and air conditioning equipment there is one extra thing to be concerned with this summer. By 4 July 2011, all personnel working on refrigeration, air conditioning and heat pump systems containing HFC refrigerants, must obtain a full qualification that meets the minimum requirements specified in the EC F gas Regulation. In addition, all organisations employing personnel with these skills will need a Full Company Certificate. COMPLIANCE Under the GB F gas Regulations (SI 261/2009) it will be an offence to carry out installation, servicing and maintenance on refrigeration and air conditioning systems using HFCs without a Full Company Certificate after July 4 2011. This means there is a lot of work to do, since as of January only 15 per cent of refrigeration companies have obtained a full certificate. Of course the level of uptake at the moment doesn’t tell the full story as much training may be required before an organisation is in a position to gain a full certificate. Despite this low level of uptake we are still seeing some major organisations demanding a full certificate in advance of the deadline. You need to make sure you and your contractors are up-to-speed with the requirements and you have a full Company Certificate and copies of your contractors full Company Certificates by July 2011. WHAT YOU NEED TO DO First you need to ensure that your engineers are all fully qualified. The relevant qualifications for equipment containing 3kg or more HFC refrigerant are: • City and Guilds Level 2079-11 • Construction Skills, CITB J11 If you have not already done so, now is the time to book your employees on the relevant courseplaces are filling fast as the deadline looms. If you are struggling to find a training provider, or require further information from the training providers, you should contact City & Guilds (020 7294 2800, www.cityandguilds.com) who has a course finder facility where you enter your postcode to find courses available near to you. You can also contact Construction Skills CITB (0844 844 0046, www.citb.co.uk).

By 4 July 2011, all personnel working on refrigeration, air conditioning and heat pump systems containing HFC refrigerants, must obtain a full qualification that meets the minimum requirements specified in the EC F gas Regulation. In addition, all organisations employing personnel with these skills will need a Full Company Certificate

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AIR CONDITIONING & REFRIGERATION

It may be worth talking to your chosen certification body in advance as they will be able to give advice on timescales or pre-registration procedures. If you are struggling to meet the deadline, for example if some of your engineers fail their training, you might be able to use the temporary training exemption COMPANY CERTIFICATION Once you have your engineers fully qualified you still need to obtain a full Company Certificate. These can be obtained from any of the following providers: Refcom, Bureau Veritas, Quidos and Stroma (available from Mid March onwards). It may be worth talking to your chosen certification body in advance as they will be able to give advice on timescales or preregistration procedures. If you are struggling

to meet the deadline, for example if some of your engineers fail their training, you might be able to use the temporary training exemption. TEMPORARY TRAINING EXEMPTION Personnel who do not hold a full stationary equipment qualification by 4 July 2011 might be able to make use of the temporary training exemption in Regulation 20(3) of the GB F gas Regulation (SI 261/2009). The exemption allows someone who is enrolled on a course

to gain one of the required qualifications, to continue to work under the supervision of someone that holds a valid qualification. Finally, if you are still not sure of what you need to do, or how to do it, F-Gas Support is here to help. F-Gas Support is a government funded team that can provide help and guidance with the EC F gas and Ozone Regulations. F Gas Support has a website where information sheets can be downloaded and receives many questions from engineers who have concerns about qualifications and Company Certification. They also get many queries about the recast EC Ozone Regulation or interpretation of the EC F gas Regulation. Queries tend to be answered in writing usually within 24 to 48 hours.

FOR MORE INFORMATION Helpline: 0161 8743663 E-mail: fgas-support@enviros.com Web: www.defra.gov.uk/fgas

Why bother with an air condition inspection?

Specialist ventilation products for healthcare

AVENDISH ENGINEERS, the low carbon consultancy and engineering firm, provides air conditioning inspections along with its sister company DX Electrica. Air conditioning inspection legislation changed in January this year, which has meant that any air conditioning unit over 12kw requires an inspection. Building owners failing to meet deadlines face fines from £300 every six weeks (post caution notice). There are many advantages to the customer in having the inspection carried out; and in many cases it highlights and recommends ways that the system can be set up efficiently as well as great energy savings. Many owners are either not aware of the legislation or are worried about

OSPITALS are important institutions providing medical and surgical treatment, as well as nursing care for sick or injured people. Ventilation is used extensively in healthcare premises for primary patient treatment in operating departments, intensive treatment areas and isolation units. It is also installed to ensure compliance with quality assurance of manufactured items in pharmacy and sterile supply departments and to protect staff from harmful organisms and toxic substances, for example, in laboratories. Protective ventilation measures are required in a variety of hospital room applications, from operating theatres, emergency treatment, nursery, critical and intensive care rooms to recovery, radiology, laboratories, X-ray and darkrooms, where patients are susceptible to contamination and infection. Elta Fans provides a wide range of ventilation products for hospitals and health care buildings, from air handling systems to extract

the cost implications following the report. People may not realise that they don’t have to act upon the advice given by the inspection report, but in most cases there are benefits in doing so. When you consider that inspections start from just £435, it can prove very cost effective to have one done. DX Electrica has set up a website on this specific service including advice and information.

FOR MORE INFORMATION Please visit www.airconditioning inspectionlondon.co.uk and mention this publication to receive 10 per cent discount. Address: DX Electrica/ Cavendish Engineers 36 Spital Square, London E1 6DY Tel: 020 73757145

fans, all designed to provide the precise specifications to meet the necessary ventilation requirements for greater comfort in the hospital patient care environment. Elta’s products are available worldwide, either through appointed distributors or companies manufacturing under licence, several of which are also part of the Elta Group.

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

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FIRE SAFETY

STOP WASTING TIME AND RESOURCES When it comes to false alarms, you had better get your house in order, says Graham Ellicott, CEO Fire Industry Association IF YOU HAVE A HIGH INCIDENCE of false alarms in your healthcare premises then it could finally be time to put your house in order to avoid having to pay out lots of hard-earned cash in the way of charges – but more on that later. My daughter is a vegetarian and spends a lot of her time hunting down food that is suitable to eat. Living in student accommodation it isn’t always easy for her to spear a spring roll or to bring down some falafel that is full flight across the veldt of the Junior Common Room. I’m mixing my international culinary terms, my geography, and metaphors but I think you’ll get my drift. THE TOASTER In order to keep up her calorie intake, she often resorts to that tried and trusted friend of student kind – the toaster. Now having been bored to tears and near to losing the will to live because of me banging on about the fire industry, she knows better than to insert a slice

of her favourite loaf into the toaster if it’s near a smoke detector. However, she’s unusual in this regard, as most students don’t understand the possible consequences of this type of action – the younger generation what are they coming to? Remember, they will be funding our old age via their taxes and...off on another tangent here so better return to the subject at hand! So, the less well-informed student burns the toast, setting off the smoke detector, the Fire and Rescue guys come running, and a lot of time and money is wasted. One thing to point out here is that the smoke detector has done its job. I mention this

as many people attribute false alarms to equipment malfunctions when in reality a lot of them are about premises management. NOT JUST STUDENTS It’s not only students that burn the toast, cooking in general in the NHS is a major cause of false alarms, and a lot of these are actually down to toasters. Indeed, for the financial year 2009/10 there were nearly 22,000 false alarms in NHS premises. Help is at hand via the revised CFOA/ FIA False Alarms Policy. This policy attempts to clarify the relationship between those responsible for the protected premises: the fire alarm service provider, the Alarm Receiving Centres (ARC), and the Fire and Rescue Services (FRS). It ties in the responsibilities of all those involved to their duties under the Regulatory Reform (Fire Safety) Order. The policy sets out a distinction between what happens at the premises, the point at which the alarm signal is considered a ‘false

It’s not only students that burn the toast, cooking in general in the NHS is a major cause of false alarms, and a lot of these are actually down to toasters

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have confidence in your security and fire solutions NSI believes every customer, whether a householder or large commercial organisation, is entitled to receive a first class service from security and fire detection companies. As a specialist certification and approvals body, we ensure our approved companies comply with industry Standards and our own Codes of Practice. Our inspection services are said to be the toughest in the industry and by specifying NSI approved companies you are protecting your interests, your property, your assets and your personnel.

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FIRE SAFETY

alarm’ if there is no fire; and at the fire brigade, where the signal becomes an ‘unwanted fire signal’. Unwanted because the FRS want to respond to real fires, not false alarms. The policy goes on to look at how this fire signal can be dealt with at the various stages before it reaches the FRS. Coming back to our less well educated student; they burn the toast and then what happens? Well, the smoke alarm goes off but under the new policy, the FRS will attend the first time there is a signal from the premises. However, if they arrive and it turns out to be a false alarm, the premises will receive a letter from the FRS requiring the premises be registered to the policy. Part of the registration will involve the FRS, the premises and the maintenance provider discussing the best way of managing the problem, which can involve system changes, if appropriate, or in most cases, a change in the management of the system. Therefore, if there is a fire signal from the system in the future, there should be a management system in place to investigate the signal before it is transmitted to the ARC or FRS. INTEGRATED RISK MANAGEMENT PLAN If it’s a confirmed fire then the signal is passed to the FRS and they arrive with the appropriate level of response, as dictated in their Integrated Risk Management Plan. It is not envisaged that the responsible person is expected to do a full search of the premises – the fire panel should give them the location of the signal and they should be able to check safely if there is a fire or a false alarm. If no management plan is in place at a later date and a false alarm reaches the FRS as an unwanted fire signal, then the FRS can instigate the changes in the response level given in the plan, but they will still work with the premises to improve the system. If nothing is done and false alarm signals from the premises continue to reach the FRS they will look to take action against the premises under the Regulatory Reform (Fire Safety) Order. The policy recognises that in many cases an alarm at protected premises never reaches the FRS as it is handled by the management systems, either it was proved to be a false alarm and the call was cancelled, or it was a fire but was dealt with by the first aid firefighting equipment. ONSITE CHECKS Regarding signals from an ARC, the policy presupposes that the onsite checks already have been carried out as part of the contract between the premises and the ARC, so the FRS will go to the premises assuming that there is a fire. If it turns out not to be a fire then the same action mentioned above begins. The policy also treats social alarm providers (Telecare) separately but they still have to confirm that there is a fire, either by call back or their management plan. It also deals with the 999 call to the brigade. All of the above scenarios are covered in flow charts which form part of the policy. The policy is clear that competent persons have a big role to play and that third party certification is the best method of providing proof of competence, with regard to fire alarms. The policy currently only recognises BAFE SP203 and LPS 1014 as suitable schemes to prove competence in fire alarm systems. But why is it time to put your house in order with regard to false alarms and what are those charges? In the Localism Bill, which is making its way through Parliament, the Fire and Rescue Authorities – after local consultation – will have the right, if they so choose, to start sending out bills for false alarm attendance to persistent offenders. So, if you’re one of those persistent false alarm offenders, look out for a bill landing on your desk; the FIA estimates that these invoices will be £350 or more per attendance depending upon where you are and how many fire engines arrive at your door. You have been warned...

FOR MORE INFORMATION Tel: 020 31665002 Fax: 020 89410972 E-mail: info@fia.uk.com Web: www.fia.uk.com

Lifeline Fire & Security – always on hand HERE’S EVERY reason to be alarmed – but no reason to be concerned Lifeline Fire & Security is a specialist electronic security installation and breakdown company. We can design, install, commission and maintain electronic systems to suit your building and needs. Our services include: • Fire alarm systems • Staff attack systems • CCTV systems • Access control systems • Alarm systems • Nurse call systems The key to our service is ensuring the systems meet the demands of the clients. We are on call 24 hours a day 365 days a year to make sure you are confident with

the electronic systems you have. Even if you already have systems in place, we can advise and maintain existing systems through a planned preventative scheme which can be reviewed yearly. This can save you time and money.

FOR MORE INFORMATION To find out how you can benefit from our service call today 01634 373522 or check our website on www.lifelinegroup.co.uk

Award winning fire consultancy services IRE-STAT International Ltd is an award winning international fire and safety consultancy which has been trading now for the past 21 years. The company is a member of the Association of Fire Consultants (AFC), the Institution of Fire Engineers (IFE) and the Fire Protection Association (FPA). The company also holds a Certificate of Quality & Service from the Guild of Mastercraftsmen (GMC). FireStat International’s fire consultants are all ex-fire and rescue service specialists and are fully accredited as fire risk assessors. Fire-Stat International Ltd are experts in the following areas: • Providing professional fire risk assessments complying with current legislation (including both evacuation plans and fire action plans). • Providing expert fire safety training (fire wardens and fire marshals) including the practical use of extinguishers and basic fire awareness training. • Undertaking fire investigations

(following a fire) to assist senior managers deal with Insurance problems and the securing of proper compensation. • Providing helpful fire advice in relation to building conversions, alterations and everyday general fire safety problems. The company is fully insured for both professional indemnity, public liability and employers liability. The managing director of Fire-Stat International is the former chief fire officer of the Kent Fire & Rescue Service, a former government fire safety advisor, past president of the Institute of Fire Safety Managers and former SE president of the British Fire Services Association.

FOR MORE INFORMATION Address: Oak Trees, 2 Stocks Close, Horley, Surrey RH6 9GU Tel: +44 (0)1293 823921 Fax: +44 (0)1293 823044 Mobile: 07949 638071 E-mail: gary@fire-stat.co.uk Web: www.fire-stat.co.uk

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Wireless fire detection – the coming-of-age for robust, reliable and future-proof fire systems HEN IT COMES TO USING wireless in fire detection, technology has improved dramatically over the past few years and a new European Standard, EN54 Part 25, will become mandatory in March 2011. Thus, from January 2011 onwards, any new wireless fire detection systems and components specified and installed should already comply with the new legislation. Eurotech Fire Systems Ltd supplies the leading EN54-25 compliant systems – the product itself was the first to gain full LPCB approval to the new standard – offering a complete approved range using wireless intelligent optical, heat or multisensor detectors as well as sounders, beacons, call points and even voice speakers. A key advantage of wireless fire detection is flexibility. Systems can be installed in practically any type of building construction and allow rapid installation without creating structural disruption, dust or other environmental pollution caused when installing new cable runs. Where a traditional hard-wired fire detection system already exists, a hybrid solution is available, integrating wireless with hard-wired systems; ideal, for example,

for property extensions in a GP practice or where a new building is added to a hospital site. Wireless units can be installed and the devices added to an existing system simply by including the appropriate module in the panel, thus avoiding additional cabling. According to Eurotech design manager, Alan Capaldi-Tallon, system programming is also a major benefit: “Because of the wireless element, fire detectors and translator modules can be programmed off-site, meaning on-site installation takes a matter

of hours for a full system, keeping downtime for a ward, consultation area or laboratory to a minimum.” For any fire system, reliable and robust interaction between fire detectors and control panels is critical; even more so where wireless interface and healthcare environments are involved. With the latest EN54-25 compliant technology, bi-directional communication provides the highest level of transmission security and reliability. The encrypted signal operates across seven independent channels and the multidirectional antennae ensure that signal corruption and fade are virtually eliminated. All devices have a notional range of 150m in free air. However, expander modules allow further range or enhanced transmission strength in areas of difficulty due to structural architecture. Wireless fire detection is another weapon in Eurotech’s armoury of combatting fire and saving lives.

FOR MORE INFORMATION Tel: 020 31410999 E-mail: enquiry@eurotechfire.com Web: www.eurotechfire.com

Wireless Detection! Wireless fire detection technology offers robust, reliable, future-proof systems with no wires attached; designed to save lives, time and money. Eurotech Fire Systems Ltd, supplies the leading EN54-25 compliant wireless fire detection products backed up by customer support and service from one of the fire industry’s most experienced teams.

Benefits of wireless fire detection...

Installation in practically any type of building Rapid installation with minimal disruption No cable runs required No interference or signal crossover Can be linked to traditional hard-wired systems Ideal for listed or specialist building designs

Benefits of Eurotech...

All wireless components EN54-25 compatible Contact Eurotech Fire Systems Ltd for help Single brand approved system with all of your fire detection specifications One contact, one telephone call Dedicated to customer service W www.eurotechfire.com T +44 (0) 203 141 0999 F +44 (0) 239 225 2554 Address 19/20 Stratfield Park, Elettra Avenue, Waterlooville, Hampshire PO7 7XN Personal service and support

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Health Business | Volume 11.2

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FIRE SAFETY

FIRE SAFETY SIGN DESIGN The most important thing about the introduction of graphical symbols to convey safety messages, is that the staff intuitively understand them THE ADOPTION OF ISO7010 as a European norm has finally drawn the end game for fire safety signs that were introduced as a consequence of an EC Directive published in 1977. It is satisfying to know that NHS Estates realised the most important thing about the introduction of graphical symbols to convey safety messages, is that the staff intuitively understand them. The research carried out 20 years ago by NHS Estates gave clear indication that there were risks involved with the introduction of abstract symbols to indicate escape routes. NEW STANDARDS Research and the development of the Health Technical Memorandum 65 Part 2 – Fire Safety Signs, which has been superseded by NHS Wayfinding Document, has stood as a bed rock for the subsequent development by both British Standards and International Standards of comprehension testing and inclusion of all graphical symbols for safety application. The development of ISO 9816-1: 2007 Graphical Symbols – Test Methods – Part 1: Methods for Testing Comprehensibility, is a testimony to the need to ensure not only the extent of comprehension but also indicates of the need for supplementary text, training and instruction. The graphical symbol chosen by the NHS enhances the British and International Standard symbol with the use of flames as a determinant, presenting a clear and unequivocal message. Research and tests proved that the NHS symbol increased comprehension and understanding of signs by an amazing 300 per cent. The legislative framework derived from EC Directive 92/58 requires that responsible persons ensure that all building occupants, not only comprehend the meaning of safety signs, but also understand the action to be taken in conjunction with the signs. CLEARING THE CONFUSION The changes in fire safety legislation, moving from a very prescriptive regime to a risk based engineered solution, has highlighted the dangers when using escape route signs that may cause confusion. It has taken 20 years for the rest of the industry to question the validity of using a graphical symbol that is not clearly understood. Using signage that is not clear may have an impact on egress speed and efficient evacuation, which could be fatal. The use of HTM 65 (NHS Wayfinding Document) for escape route signs ensured that a known convention was implemented for safety way guidance.

Image courtesy of the Fire Industry Association

It has taken 20 years for the rest of the industry to question the validity of using a graphical symbol that is not clearly understood. Using signage that is not clear may have an impact on egress speed and efficient evacuation, which could be fatal This simple convention was a foundation to BS5499 Part 4 2000 and carried its provenance through to the development internationally of ISO I6069: 2004 – Graphical Symbols – Safety Signs – Safety Way Guidance Systems (SWGS). The understanding of the meaning and actions to be taken in conjunction with safety signs is a fundamental requirement of the Health and Safety (Safety Signs and Signals) Regulations. NHS Estates have to be congratulated for their insight 20 years ago.

The NHS Estates will now wait for the rest of the world to catch up and stop playing ‘Pictionary’ with people’s lives. A Means of Escape Publication, on behalf of the Health and Safety Sign Association (HSSA). Jim Creak is chairman of the HSSA.

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

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In an ever more demanding world, Variable Message Signs Limited combines innovation, experience and technology in strategic and urban driver information. Our road traffic product range covers applications in the strategic , urban, and traffic management equipment sectors. We offer a full range of services to suit individual client requirements from design, manufacture, supply, installation and commissioning of LED driver information systems, including fully UTMC compliant systems and all for clients, which include the Highways Agency, Transport for London, Local Authorities, Local Health Authorities, Hospitals and others. We have supplied and installed a number of hospital sites which use our Safewatch range of vehicle activated signs for road & patients safety, by advising and reinforcing the speed limits and other hazards, such as pedestrian crossings, side roads and car park entrances and exits, etc;

Our range of car park guidance and information signs advise drivers where the car parks are on site and the number of spaces left within each, providing information and choice for drivers entering the site, and via our TRAMS car park management software package, the hospital / customer has control over all the listed car parks, the number of displayed / available spaces as well as providing various management reports and helps reduce emissions by keeping traffic moving and avoiding queuing. Variable Message Signs Limited now introduce for the very first time, Pegasus our new range of urban dual colour full matrix signs. The sign’s attractive and slim design is especially suited to today’s urban streetscape, where it will deliver driver and pedestrian information. The sign is offered in three sizes, with high resolution matrix areas suitable for the display of four lines of text with character heights of 160mm, 100mm, and 50mm. All variants are capable of displaying combined text and pictogram information and employ a dual-coloured, amber and red, matrix. A special feature of the new sign system is the ability to mount it in a landscape or portrait format, with five mounting options for landscape fixing and three for portrait fixing.

VMSL The sign of the times; There’s no substitute for quality:

Variable Message Signs Limited Unit 1, Monkton Business Park North, Mill Lane, Hebburn, Tyne & Wear NE31 2JZ T 0191 423 7070 F 0191 423 7071 E ghutton@vmslimited.co.uk W www.vmslimited.co.uk

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SECURITY

HEALTHY SECURITY FOR HOSPITALS AND CARE HOMES Access control plays a key role in helping to protect healthcare premises against criminals, says Mike Sussman, chairman of the British Security Industry Association’s Access Control Section read range. Other methods include a smart card and reader, a swipe card and reader, PIN pads or biometric equipment such as fingerprint and iris scanning. This equipment can be used throughout a hospital’s site, which will only grant access to staff and patients thereby reducing the risk of intruders. The door controller and software is the third important tool in an access control system. This is used to decide who can gain access through which access point at what time of day, and can vary depending on the size of the system and how many readers or sites are being controlled. There are several options when it comes to installing this technology including: a standalone door controller linked to a single door with no software; a number of door controllers all linked together to a single PC to control one site; a number of sites all interlinked together over a wide network area. All three systems are effective and depend on the premises’ requirements.

WITH LARGE PREMISES, expensive equipment held on site and a large number of visitors accessing the premises every day, hospitals and residential care homes face a number of security threats. While ensuring the safety of patients, staff, visitors and assets is always a top priority, it is also a challenge. Access control plays a key role in tackling this challenge. Hospitals and care homes have high volumes of valuable goods located on site such as computers and IT equipment, while sensitive patient data is also often held on site, as well as the personal possessions of staff, visitors and patients. Both equipment and possessions are extremely attractive to thieves so it is no surprise that these sites are increasingly becoming targeted by criminals. For these reasons, a growing number of premises are now turning to access control systems for extra protection. WHAT IS ACCESS CONTROL? Access control provides the ability to control, monitor and restrict the movement of people or assets in, out and around a building or site. Depending on the location and sensitivity of the area involved, access control measures can range from paper-based logging systems for temporary contractors’ permits through to access control cards using radio frequency identification (RFID) chips for more convenient

proximity reading of card details and activation of gates, turnstiles and vehicle barriers. The system has a wide range of applications from controlling a single entrance door to a large integrated security network solution, and can prove invaluable when protecting areas holding sensitive information or valuable equipment. Access control can be used to ensure that only authorised persons, such as staff, can access specific areas of the sites, or that the whole site is inaccessible to intruders outside of opening hours. In hospitals, the system can also be used to restrict access to areas that need to be kept separate from the rest of the premise for the safety of other patients, such as isolation rooms. THREE COMPONENTS The systems consist of three components. Firstly, there is the physical barrier, which restricts access into a building. This is achieved through methods such as doors being secured by a magnetic or strike lock and turnstiles or speedgates, which are designed to limit access to one person for one card presented. Secondly, there is the identification device, which identifies users of an access control system before granting access. There are a variety of different devices including a proximity card and reader which uses Radio Frequency Identification (RFID), at both a short or long

OTHER FEATURES There are many more features of access control that can be of further benefit to hospitals and residential care homes. The first is visitor monitoring, which proves very useful in these types of premises, as visitors can often be difficult to spot as they can blend in with staff and patients very easily. Therefore the use of PC and computer networks should be considered as these systems can print photographic ID of staff and allow access to be restricted to certain areas. This is an easy and inexpensive solution for visitor management that is frequently used. In addition, systems such as Automatic Number Plate Recognition (ANPR) and fire roll-call software can prove valuable as well. ANPR is particularly useful on the larger sites where a high volume of staff, patients and visitors are driving in and out of the premises. ANPR will monitor the entry of vehicles on-site using CCTV-style cameras and computer software, which identify number plates. Some systems will also store photographs of the driver and vehicle for subsequent analysis. This sophisticated software will draw attention to on-site (or off-site) security staff and will enable them to identify any returning cars that are considered suspicious. Furthermore, it allows critical information to be passed to the police to assist in the pursuit, identification and capture of offenders. Fire roll-call software, on the other hand, automatically generates a report containing

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Secure, onsite shredding for the public sector LLSHRED is the leading regional on-site secure destruction company based in Oxfordshire and serving the surrounding counties within a 50 mile radius of Oxford. Allshred is a founder member of the National Association for Information Destruction – Europe, the international trade association. In 2008 Allshred Limited was the first English secure destruction company to achieve NAID AAA Certification, the international gold standard for security and operations. The criteria for NAID AAA Certification exceed the requirements of BS 8470 and BS 7858 and as well as the initial rigorous audit we are subject to unannounced audits. This is your guarantee that we take the security of your information and records very seriously so that you can meet your obligations

If something matters, it’s worth protecting. That’s why our digitally printed, full colour, access control cards are so popular. • RFID (Contactless) Cards • Swipe & Barcoded Cards • Photo ID Cards

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under the Data Protection Act. Our high speed shredder means that our visits take less time to reduce your documents to random shaped fragments that are recycled under strict security. For customers who require a regular shredding service, we offer secure containers for storage of documents between visits. The visit frequency is tailored to your needs. Allshred helps those customers who make an annual clearout or are moving offices to minimise the work you do in preparation. We provide flexible economical solutions to ensure your records and data are secure at destruction.

FOR MORE INFORMATION Contact: Ian MacKay Tel: 0800 3895155 or 01993 830629 E-mail: sales@allshred.co.uk Web: www.allshred.co.uk

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SECURITY

vital information as to the whereabouts of individuals inside a building in the event of a fire. This software operates via the access control smart card or fob that an employee uses to gain access or to exit a building. In the event of an emergency the fire roll-call software alerts occupants while simultaneously activating the report at a safe pre-determined remote point. INTEGRATING THE SYSTEM Due to the nature of the work carried out in hospitals and residential care homes, security is of paramount importance. Access control can greatly assist these premises and ensures that staff, patients and visitors are safe while on-site and any unauthorised personnel cannot access areas that they should not be entering. However, a truly effective security strategy is one that combines a number of different measures, to ensure all aspects of protecting a premise are covered. The ease of integrating access control with other security measures is another reason why the system is so appealing, and it enables hospitals and care homes to provide even tougher protection for their site. The systems are often effectively linked to the likes of CCTV, property marking, perimeter protection or intruder alarms. In particular, CCTV and access control are a great security combination. CCTV systems greatly assist the site because if any unauthorised personnel attempts to access a specific area they should not enter, this action can be recorded and the footage analysed. Cameras strategically placed around a site can provide a thorough coverage of large areas, and if the system is outsourced to a private security company, can be monitored 24/7. Providing an in house security solution could also be effective, with security on site to protect the site and its contents. The systems act also as deterrent to intruders and criminals.

Reputable suppliers will be happy to dispense advice on the correct installation and set-up of CCTV systems, and how this can be integrated effectively with access control measures. SECURITY IN DERBYSHIRE One BSIA member was called upon by Derbyshire Mental Health Services NHS Trust after they experienced difficulties with repeat offences of theft, robbery and motor vehicle theft at its sites and who wanted an access control and CCTV solution. The BSIA member installed CCTV across a network of 11 Derbyshire NHS sites, which linked back to a monitoring centre. Across the 11 sites, a variety of 37 CCTV units, infrared detectors and tannoy solutions were installed. The BSIA member also introduced a total of 17 access control installations as well as 24 proximity readers, break glass and infrared detectors. This integrated system provided operators with a quicker and more effective solution and a thorough overview of the entire site’s security. Each member of Derbyshire NHS staff was then issued with an access key. On using the key, the action is bookmarked along with the footage from the nearest CCTV unit. If an access card is stolen and access is granted fraudulently, CCTV footage of when and where it was used can be brought up on the integrated recording timeline. This is done almost instantaneously thus allowing for quick evidential footage retrieval. Furthermore, if one of the break-glass detectors or an infrared alarm is activated, this is also logged into the CCTV footage, which operators can examine straightaway. Since installing the system, crime rates across Derbyshire Mental Health Services NHS Trust have reduced to zero. This integration of access control could also be combined with intruder alarm technology. If unauthorised personnel attempt to access a protected area, an alarm could be

triggered drawing attention to that individual in the hope that it will deter them from continuing to break through the barrier. It will also enable security staff to respond to the incident and send someone out to deal with the person(s) as appropriate. INVALUABLE PROTECTION Access control systems are invaluable to hospitals and residential care homes, and the flexibility of the systems available on the market means that they can respond to different requirements. To ensure even greater protection of the premises it is, however, important to combine the system with other security measures such as CCTV and alarms. If you are new to sourcing access control and other security products, you can receive expert advice by employing a security consultancy. The consultancy will be able to take into consideration the individual requirements of your premises and advise as to what the best security solutions in the market are. They will also be able to put you in contact with reputable suppliers, making sure that your money is well spent. 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. To locate a supplier in your area, or to find out more about the solutions mentioned in this article, visit the website. 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.

FOR MORE INFORMATION Tel: 0845 3893889 Web: www.bsia.co.uk

Security solutions tailored to your needs EST LONDON SECURITY LTD (WLS) was established in 1983, and holds the industry’s highest quality standard, NACOSS Gold. We are approved for design, installation and maintenance of electronic security systems and have over 25 years experience specialising in access control, door entry and CCTV systems in and around central London. Our services also include fire systems, intruder alarms and gate automation & barriers. We install and maintain access control and CCTV systems at numerous prestige sites, including some major London private hospitals and banks. Access control installations can range from a single door to a system controlling hundreds of doors, lifts and turnstiles, and

systems are tailored to match your requirements and can include fixed or moving cameras, number plate recognition and remote interactive monitoring through our central monitoring station. We have access to the latest technology and innovations including video analytics (unusual movements/face in a crowd) software. Our dedicated sales team are available to provide a no obligation quotation.

can incorporate CCTV cameras at the point of access. Different sites can also be controlled from a central location over the internet. Our CCTV systems can be conventional or IP based and have the capability to monitor premises using a network of cameras connected to a central viewing and recording station. The

FOR MORE INFORMATION Address: 22-36 Paxton Place, London SE27 9SS Tel: 020 86764300 Fax: 020 86764301 E-mail: info@westlondonsecurity.com Web: www.westlondonsecurity.com

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Visit the website to view the categorised product finder

Nortech – simplifying security through smarter access control ORTECH SPECIALISES in the design, manufacture and distribution of innovative personnel and vehicle access control solutions, and has been providing solutions to the security industry for over 20 years. Installations include hospitals, colleges, ports, airports and government buildings. Nortech’s success has been largely achieved through its collaborative relationship with its customers and industry partners. Nortech’s product range is suited to health sector applications and has provided customer specific parking management and access control solutions to a number of NHS trusts and private clinics. Parking management solutions deliver cost-effective methods of collecting parking revenue and/or preventing the abuse of parking facilities.

The security of patients, valuables and confidential information requires a versatile access control solution that can deal with a transient population of patients and visitors as well as the staff. The system must offer several levels of protection with minimal disruption to the day-to-day activities of the hospital or care home. Nortech offers simple, economical door controllers as well as fully networked systems with multiple security levels to accommodate differing requirements around the premises, alongside a choice of management and reporting features to serve dedicated safety and security applications.

FOR MORE INFORMATION Tel: 01633 485533 E-mail: info@nortechcontrol.com Web: www.nortechcontrol.com

VGI Security Solutions – the security specialists GI SECURITY SOLUTIONS is a Surrey based company that provides consultancy, design, installation and commissioning of a variety of security solutions for all types of premises. Whether you have a system already in place that needs some maintenance/ updating or you want to install a new security system, VGI can provide a customised solution that matches your budget. With over 20 years of experience in the security industry working for customers in the commercial, public and private sectors in London and the South East, we offer a range of products including: CCTV Systems, Intruder and Fire Alarms, Access Control, Gate and Perimeter Security, Video and Door Entry, and Assisted Living Technology providing a complete tailored solution according to your needs. We are NSI and ECA certified, which ensures our engineers have been thoroughly security vetted, and the work is done according

to the highest quality standards. Our vast experience installing and commissioning security systems includes the involvement in large projects such as: Heathrow Terminal 5, University College Hospital London, Westfield Shopping Centre, as well as installing security solutions for schools, SMEs and residential customers. No matter the size of your request VGI offers a free no-obligation survey to provide the solution you need.

FOR MORE INFORMATION Tel: 01932 402888 E-mail: enquires@vgisecurity.co.uk Web: www.vgisecurity.co.uk

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Ward – not all security companies are the same AVID AND KEVIN WARD lead an award winning team of over 300 staff providing security provisions ranging from guarding, key holding and mobile patrols, to dog teams, building inspections and CCTV surveillance. With such a variety of skills at their disposal Ward Security can offer truly bespoke solutions. Whether public or private sector organisations throughout London, the South East or Midlands, Ward Security treats each client and their requirements individually and endeavours to tailor each service to their specific needs. Potential clients can have real peace of mind knowing its ISO 9001 quality accreditation encompasses working to various BS codes of practice, and that all officers are SIA licensed, CRB checked and trained to British Safety Council standards for health and safety. As a member of the SIA’s Approved Contractor scheme Ward Security is committed to raising performance standards

across the security industry. Its recent annual ACS audit scored the company within the top 5 per cent of all audited security companies nationally qualifying it to be a member of the Security Watchdog’s prestigious Pacesetters Hall of Fame. This underpins Ward Security’s ongoing commitment to achieving the highest possible quality allowing its clients to concentrate on their own core expertise.

FOR MORE INFORMATION Tel: 0845 847 6180 Fax: 01634 225101 E-mail: info@ward-security.co.uk Web: www.ward-security.co.uk

Investing in training the next GP generation MAJOR BREAKTHROUGH in skills training video technology is helping GP registrars to pass the new style Clinical Skills Assessment examination. The ideal way to develop skills is through videoing of consultations, regularly reviewed throughout the year. But many practices struggle with difficult to use video equipment, and patients are uncomfortable with intrusive camera equipment. Now GB Security Group has developed a unique GP skills training video production solution, which harnesses remote CCTV monitoring technology that is more usually found in surveillance situations. It provides a discreet solution for patients, including sound only recording, whilst optimising review and editing capability to ensure trainees get the most from the exercise; all at the flick of a simple wall switch. One user is Dr Nick Foster, programme director on the Nottingham GP Specialty Training Programme and MRCGP examiner, who says: “This new system is

far easier to operate, far less intrusive and has overcome problems we used to have with poor sound recording. “As soon as I saw it in action I could see it would be fantastic. It has been a good investment as it enables us to offer training to the Deanery.”

FOR MORE INFORMATION If you would like to visit a medical practice to see the unique video training system in action, call GB Security Group now. Tel: 01775 821100 E-mail: enquiries@gbsg.co.uk Web: www.gbsg.co.uk

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SECURITY

HEALTHCARE NEEDS SECURITY AT ALL LEVELS Security in a healthcare environment has many facets, from personal safety to general safety, from localised security to site-wide security DEPENDING ON WHERE one looks for evidence, it seems clear that protecting personal safety is not a trivial matter in the NHS. In January this year, The NHS Security Management Service suggested that almost 57,000 violent assaults were made on NHS staff in the previous 12 months (a three per cent rise from the year before). Acute care was particularly badly affected. DANGER FROM STRESS Many hospitals and healthcare establishments have equipped nursing staff with personal attack alarms and pagers specifically as a remedy to this problem. Keeping staff safe is more difficult in situations under pressure and when people feel stressed. Dr Peter Carter, chief executive and general secretary of the service, said: “We are concerned, for example, that staff shortages could mean a return to the days of long waits in A&E where tempers could flare on a regular basis. We would urge trusts to do everything in their power to avoid this situation.” LONE WORKERS How does a hospital keep its staff safe, particularly when they are working on their own? A relatively low-cost solution in use in many healthcare environments is a wireless alarm carried by members of staff. If encountering a crisis, a nurse or other worker simply press a single button that transmits an alarm that alerts management and security staff. These and similar panic buttons can be worn discreetly on a belt clip, wrist band or necklace; additional buttons can be permanently mounted in locations where risks commonly exist. Such alarms include accurate location and a simple, single button for easy use in emergencies. PATIENT AND VISITOR SECURITY In another initiative, Whittington Hospital, in North London, and other hospitals give their waiting room patients the freedom of the hospital and an easy recall to the department by equipping them with anti-viral, antibacterial pagers at registration. Patients can then choose to avoid the potentially lengthy wait in queues and full waiting rooms, which can be distressing circumstances and that may cause angry confrontations. Staff members feel more relaxed, as tempers remain calmer, and the invisible queue is managed in an orderly fashion with the ‘MediCall’ Paging System and TouchClean-treated pagers.

A hospital also needs to consider the welfare and safety of its visitors and patients. Fire and emergency evacuations needs to be well managed, if needed. Immediate, reliable communication between medical staff and security is another requirement. Protecting all hospital workers and visitors from harm and deterring unwelcome intruders are third and fourth. Communications systems, perhaps surprisingly, play a role in all these areas. Staff carrying pagers can quickly be alerted to opening fire doors, unexpected entries to restricted areas, emergencies and urgent calls for assistance. An integrated, wireless communications system can monitor all the building alarms and fire panel signals, automatically alerting the appropriate staff, or fire service, when needed. KEEPING THE WRONG PEOPLE OUT At a greater level of sophistication when high security and protection is needed, Radio Frequency ID (RFID) systems can manage individuals’ access rights, and prevent exits or ingress as appropriate. By wearing an RFID tag (ID card or wristband), patients at risk of absconding or whose mental capacity makes them incapable of caring for their personal safety, can be given appropriate but curtailed freedom in the establishment. For example, they may be able to visit the day room and cloakroom facilities but not to exit by any door. Sophisticated versions of this system enable their access rights to be dependent on the proximity of their carer. So, for example, when the patient approaches a door on his/ her own, it remains closed, when approaching with an authorised staff member, it opens. Similarly, access control systems prevent entry by unauthorised personnel to specific areas. Fingerprint readers are the technology at the forefront but have greatly advanced in the past year. By using multi spectral imaging (MSI), many of the problems of older systems are overcome and these systems are also vandal-resistant. SITE-WIDE CONCERNS Hospitals also have a wider remit and need to manage their premises as well as the people using them. Sometimes they operate on complex sites and from multiple buildings. Remaining open to authorised users, while deterring entry by unauthorised people, is a constant requirement that modern, advanced technology can assist and greatly improve.

Access control and entry systems, video surveillance and perimeter management are the key technologies in this. Current IP technology allows wireless IP CCTV systems to be deployed in lower security areas. Wired systems will be necessary where greater reliability and continuous operation is essential. Coupled with advanced intelligent video analytics, CCTV plays an important role in securing the premises itself as well as the perimeter; analytics software analyses live CCTV footage to look for certain pre-defined behaviours within each scene such as crowd formation, loitering, unattended baggage, missing objects and can alert security personnel as the event is happening. PERIMETER PROTECTION In many circumstances, double knock perimeter protection is the wisest choice. Challenges generally operate on the onion skin principle, using physical obstacles, buried sensors and CCTV surveillance, accompanied by scene analysis, combining to frustrate intruders and alert facility managers, security personnel and/or police. Video analytics can prevent perimeter intrusion and create sterile zones that automatically alert security operatives to unauthorised incursions across boundaries or into controlled areas. Other approaches, such as vibration and volumetric detection, play a role in securing large perimeters but false alarms can result, notably with buried sensor cables, since large animals can trigger the system and calibration for weight becomes a delicate issue. Controlling access to the buildings can then be managed using access control systems of varying complexity. Some more advanced systems communicate with CCTV so that a snapshot can be taken of staff members or visitors when they touch a reader. A ‘triggers and actions’ function allows SMS messages, or e-mails, to be sent when a specified trigger happens. When a named individual presents a fob to certain doors, a manager or supervisor receives a message. Similarly, when a door is forced, a facilities manager might receive a message. Call Systems Technology and its sister company, Security Systems Technology, have the accreditation and the expertise to assist healthcare users in all these areas discussed.

FOR MORE INFORMATION Web: www.call-systems.com

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You choose the direction CLOUD ITSM ON PREMISE ITSM

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HEALTHCARE IT

WHO WILL PRESCRIBE MOBILE-HEALTH APPS? Talk around mobile health applications has gained momentum over recent months. The Mobile Data Association’s Nick Hunn explores pressing issues of how mHealth applications will be applied either much healthier or spending their time doing something else. These figures don’t merely reflect the hopes of developers. Pyramid research has been looking at key players in the mobile healthcare chain and report that 70 per cent of users would like to have a mobile application on their phone. Before getting too carried away by the analysts, we need to bear in mind that only 20 per cent of phones currently being bought are classed as smartphones. That means there’s a mismatch here: the bulk of research participants don’t understand the question or are a narrowly selected portion of the population. That skew isn’t unusual. However, these projections are only ever going to come true if people can make money out of writing apps. It’s possible that they will be produced altruistically (and the NHS could be a good source for that), but it’s unlikely to result in a massive shift in the industry.

IF YOU’VE BEEN READING the mHealth blogs and analyst reports over Christmas and the New Year, you’ll have realised that medical smartphone applications (apps) are being promoted as being the next big thing. In fact you could even be forgiven for thinking that by 2015 we’ll have given up on conventional medicine and GPs themselves will have become the primary source of these apps. This may be fanciful, but there are a number of reasons why the health application market is very different to the consumer application market: complexities of medical regulation, issues of connectivity to worn medical sensors and attitudes in the medical profession itself. THE BUZZ AROUND APPS The bulk of doctors are only just discovering apps for themselves – is it really likely that they will be able to move from that position to

one of informed provider in just a few years, particularly given the number of other pressures they face with current health reorganisations? The headline figure that got everyone excited was a report from Kalorama estimating that the medical mobile apps market had grown from £25 million in 2009 to £52 million in 2010. The inference is that 2011 will be the start of a massive growth, with untold riches in the years to come. There is no doubt that the growth of apps stores has seen a surge in health applications, even if a definition of ‘health’ often stretches seamlessly into lifestyle, sports and fitness. Another analyst, Distimo, released a report covering all phone apps that were released in 2010. This indicated that health and wellness is attracting plenty of interest. It’s the second fastest growing area for applications for the iPhone, and the fifth fastest for both BlackBerry and Android. Windows and Symbian users are

WHO IS WRITING THE APPS? Hence the question: who will make money from mobile health apps? The heady days of boys in their bedroom writing apps that make them a million has gone. Already developers are increasingly relying on advertising revenues, in-app purchases, or just being paid to write apps for larger companies. And even that last option is getting less profitable as more apps developers come online and development tools make it easier to write them. So mHealth apps are unlikely to produce a golden path to riches. Various reports on the size of the market look shaky because they don’t ask the questions of who will be writing health applications, and why. One of the early sectors, perhaps not surprisingly, has been pharmaceutical companies, particularly in the US where they can promote their products to the public. As they are using apps to hook users onto drugs (in a responsible way), these are invariably free. But even paid-for health apps are generally cheap, according to another analyst, vFluence, the average price for a health app is under $2. Apps sold to doctors average $15 but includes textbooks and medical references. The $2 figure sets a price-point for consumer health apps which the market will find difficult to increase. So anyone entering this market needs to work out a business model built around the provision of free apps. Of course there may be ways to get people to pay. There has to be

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Compelling Healthcare Solutions at the 2011 NEC Solutions Showcase NEC invites you to attend the NEC Solutions Showcase, Wednesday 6th April at Battersea Power Station. Focusing on application rather than product the Showcase represents a compelling opportunity for anyone buying, installing or specifying within the healthcare environment. Get hands-on with NEC’s wide range of healthcare solutions from diagnostic displays for PACS, large format LCD digital signage solutions, interactive touch displays for bed management and wayfinding and the latest VC and remote training solutions for MDMs. Register now by emailing Samantha.Jefferies@eu.nec.com to reserve your place at the most unique display solutions event of the year. All attendees earn a chance to win an iPad!

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HEALTHCARE IT

I suspect that things will move much more slowly than the analysts predict and most GPs won’t have patients coming to them for phone apps in their lifetime a market for celebrity health apps. Next time Britney has a sore throat or Heston has a health problem, you could expect to see a premium-priced celebrity heath app on a phone near you. But how many GPs would want to be associated with that? CONSUMER INTEREST What has been interesting to observe is the range of views about where users will purchase health applications. Analyst firm, Research4Guidance, has been surveying customers about this in Berlin. Although consumers use apps stores today, the research participants expect this to change. By 2015, 65 per cent expected to get apps from their doctors, 68 per cent from clinicians and 56 per cent are from specific health websites. Their survey is clearly about “traditional” health, as the main therapeutic areas that were mentioned by respondents were the classic long term chronic conditions – diabetes, obesity, hypertension, asthma and COPD, with a strong showing for chronic heart disease as well. Of course, the big question is how doctors will make the transition from dispensing pills to dispensing apps? The survey highlights a dichotomy facing the GP – first of choosing apps for their own work, to help them to manage better, and then choosing apps to ‘sell’ to their patients as part of their treatment. Analysts like Pyramid see a role for the network providers here. UTILISING THE MOBILE PHONE I was much more impressed by a company I met while chairing the Mobile Healthcare Industry Review at the King’s Fund before Christmas. It was a new company called Devices 4 Ltd. Structured as a non-profit organisation, it has been working closely with the healthcare industry so is very aware of both parts of the problem. They ran a survey of health professionals in the UK and found that only 18 per cent run a medical or health application. They were told that figure would double if the phone was provided to them with work related apps. Over half of respondents, believed that they “would be more productive if they had a mobile phone for use at work”. The survey also highlighted that within the UK, using a mobile phone in a medical environment is still not allowed, or is frowned upon for over a third of those surveyed. The survey went on to reveal that over a third of health managers still see no benefit to medical staff using mobile phones. Even where they are allowed or tolerated, there’s no coordination about which phone or network to use, or which applications might be relevant to which job. Individual health workers are left to make that decision themselves. Devices 4 is aiming to be the glue that brings that together, allowing information and best practice to be shared and to act as a group purchasing organisation for UK healthcare professionals. I suspect that things will move much more slowly than the analysts predict and most GPs won’t have patients coming to them for phone apps in their lifetime. But you never know; they may be right. If you’re one of that sizeable percentage of GPs without a smartphone, take note of the smartphone deals on offer at the moment. It could be time to upgrade your contract.

FOR MORE INFORMATION Web: www.themda.org

Recognise staff with voucher rewards HE VOUCHER SHOP offers a one stop shop for corporate gift vouchers, flexible benefits and employee rewards. When it comes to choosing a reward, benefit or gift it’s hard to please everybody. After all, how do you appeal to all tastes, ages and types? With vouchers, that’s how! Our solutions include: • Bulk Voucher Orders • Flexible Benefits Schemes – Online banking & prepaid cards • Voucher Cheques • Long Service Awards • Experiences • Promotions • Gift Cards At The Voucher Shop we have something for everyone, our

portfolio of over 40 big retail names should give you and your employees plenty to choose from. Retailers include: Love2Shop, M&S, Boots, Sainsbury’s, HMV, Argos, Next, B&Q, John Lewis, Homebase, Debenhams, Comet and many more.

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Virtual healthcare from Zebra Technologies EBRA PRINTERS and supplies are reliable tools to help improve patient safety, manage records securely and efficiently, and track samples and supplies accurately. Medication administration errors cause an estimated 7,000 deaths in the U.S. each year. Bar code identification systems are a proven way of preventing these errors. Zebra wristbands help healthcare professionals identify the right patient every time, and they are a cornerstone of multiple bar code applications that can improve safety, accuracy, and efficiency throughout a hospital. • Accurately and automatically identify patients and staff with accurate, legible, and tamper-proof patient identification wristbands. • Ensure greater security by identifying employees with employee ID cards. • Use lightweight, mobile printers to accurately label specimens at bedside or wherever they are collected, and to provide other documentation at the point of care.

• Track medical records, charts, files, and test results with bar code labels. • Zebra’s extensive range of tag and label supplies includes sterile materials for identifying bandages, kits, instruments, and supplies used in sterile, cleanroom, and laboratory environments, including labels that withstand moisture, frozen storage, heat treatment, and other challenging conditions. • Create RSS or other bar code labels for unit-of-use packaging so medications can be used in automated dispensing machines or scanned as part of a medication administration system. • Improve inventory management by using bar code or Radio Frequency Identification (RFID) smart labels to track medical supplies and equipment.

FOR MORE INFORMATION For more information on how Zebra can help improve patient safety and reduce costs, visit www.virtualzebra. com/healthcare

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Health Business | Volume 11.2

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INFORMATION DESTRUCTION

SHREDDING THE THREAT TO PIECES Russell Harris, chairman of the British Security Industry Association’s Information Destruction Section, investigates the issues surrounding data protection in the health sector, and how these can be overcome by implementing tight waste management strategies WITH CONTINUOUS LEGISLATIVE changes impacting the way sensitive information is handled, and the negative financial and reputational repercussions institutions face as a result of data breaches, effective information destruction strategies continue to be an essential requirement for all types of organisations. In the health sector in particular, organisations have a duty of care towards their patients and staff, and this includes the way they handle the highly sensitive information they hold on site. IDENTITY FRAUD With identity fraud continuing to threaten our society, institutions of all sizes should take extra precaution when destroying information, regardless of the material – whether it is paper documents, computer hard drives or even staff uniforms. The careless disposal of data can enable criminals to steal identities or conduct fraudulent transactions without anyone noticing. In addition, data breaches carry with them hefty fines and result in significant reductions in consumer confidence. This can be extremely damaging for all kinds of organisations, in particular within the health sector, where patients’ trust is an absolute requisite. Research recently commissioned by the Information Commissioner’s Office (ICO) found that 92 per cent of individuals surveyed are concerned that organisations do not keep their details secure. Continuous reports of data breaches prove how wellfounded these concerns are, and demonstrate that organisations need to do more to regain consumer confidence and credibility. 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. The health sector in particular is 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 details. For this reason, ensuring sturdy processes are in place for the disposal of both paper documents and information held on computers as well as storage devices – where simply deleting files is not an adequate solution – should be a primary concern. According to another report published by the ICO in the summer of 2010, the NHS topped

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The careless disposal of data can enable criminals to steal identities or conduct fraudulent transactions without anyone noticing. In addition, data breaches carry with them hefty fines and result in significant reductions in consumer confidence the list of security breaches reported involving the loss of personal data since November 2007. The publicly funded healthcare system reported more than 100 breaches due to stolen data or hardware, 87 due to lost data or hardware and 43 cases due to error. Since then, the ICO has called for tightened data disposal procedures to invert the process, however, with the public sector facing considerable budget

cuts in the coming years, the risk that waste management strategies may be overlooked in an effort to save money is a very real one. VALUE OF INFORMATION DESTRUCTION Generally speaking, institutions can take simple steps internally to reduce the risk of data breaches, including ensuring all unwanted documents, CDs and DVDs are being properly

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INFORMATION DESTRUCTION

Professional information destruction companies should be employed in order to ensure that personal information or company data is better protected and destroyed efficiently shredded, wiping clean the information held on old computers before disposing of them and regularly changing network as well as PC passwords. However, leaving shredding to individuals can compromise security as the document is not always thoroughly destroyed and can often be pieced together. Therefore, 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. An information destruction supplier should be able to provide sacks that cannot be tampered with and bins to match the office furniture 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. It should be carried out by a company that guarantees under contract that destruction is done securely and effectively. 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 down 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. As well as helping to ensure the highest standards, EN 15713:2009 therefore provides a valuable new benchmark to assist users in choosing a provider. All BSIA information destruction 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 there is a solution. 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. THE INCONVENIENCE OF A BREACH It‘s important to remember that if confidential information does fall into the wrong hands, it not only causes problems for certain individuals

or businesses but there is also the time and inconvenience involved in contacting the authorities and sorting out paperwork once a security breach has occurred. Moreover, data breaches often occur from inside an organisation, meaning it is extremely important that staff are adequately vetted before gaining access to sensitive information. Professional information destruction companies should be employed in order to ensure that personal information or company data is better protected and destroyed efficiently. Reliable suppliers will in fact be able to advise as to what information destruction solutions available on the market will be suitable to each specific organisation. Not only this, but companies will be able to make use of their knowledge and expertise to devise a strategy that integrates with other security measures – for example access control, physical security equipment such as locks and cabinets, and CCTV – to further protect an organisation against the threat of security breaches. 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. For more information about any of the solutions and standards discussed above, visit the BSIA’s Information Destruction website. 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.

FOR MORE INFORMATION Web: www.bsia.co.uk/shredding

Secure shredding and recycling from ShredPro HREDPRO LTD is a family run paper shredding company, providing a secure, efficient, simple and cost effective plan for destroying your company’s confidential data. ShredPro provides a complete on-site shredding service, ensuring maximum protection against the potential misuse of company information. Our shredding services comply with the Data Protection Act (1998). An ever increasing amount of material is considered confidential and has to be disposed of in a secure and environmentally friendly way. ShredPro’s friendly staff will arrive on-site and place all material to be destroyed into a secure truck. Upon completion of shredding

ShredPro issues the appropriate Certificate of Destruction for your company. We provide secure document destruction and paper shredding services for a wide range of industries, our client base include: accountants, solicitors, web design agencies, facilities managers, call

centres, hospitals, doctors, general offices, financial advisors and many more. The data which we securely recycle on a daily basis includes, personnel files, payroll records, financial records, medical records, legal documents, invoices, customer lists, price lists, quotations, etc. Contact ShredPro today to help manage your confidential waste and ensure you comply with the Data Protection Act.

FOR MORE INFORMATION Contact: Darren Brown Tel: 0800 1214680 E-mail sales@shredpro-uk.com. Web: www.sales@shredpro-uk.com

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Health Business | Volume 11.2

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STRESS MANAGEMENT

RISE ABOVE IT In this article, Ann McCracken, chair of the International Stress Management Association UK, gives advice on how to deal with today’s stresses and pressures OUR SOCIETY IS IN TURMOIL as we see many of our hard earned achievements under threat – job, status, home, holidays, education, pensions, health care, and so on. Looking wider, the world is in turmoil with people wanting to free themselves from corruption and oppression and some are giving their lives to achieve this freedom. A step change of significance is happing right now throughout the world. Here in the UK we have encouraged, even demanded, our government to overspend on health, education, services, equality, diversity and much more and this may now be the time to review personal values, needs and expectations. WHAT IS STRESS? When an individual feels under pressure for a significant period of time the result is ill health – this is the definition of stress. The problem here is that what is pressure to one person is challenge and excitement to another. This suggests that personality and attitude to life also play important parts in coping with the pressures/challenges that life throws at us. We are constantly bombarded with negative headlines and doom-mongering in both the papers and broadcast media, and this has an insidious effect on our psyche. Some of us start to believe it and tell it to others as truth rather than someone’s opinion. It becomes a national rumour. So much disinformation is spread for political point scoring that sometimes it is difficult to find the reality unless you are prepared to wade through long speeches or informed expert presentations. Statistics are used as proof, yet the same statistics can be interpreted differently by someone else. This level of confusion I believe is creating an anxious nation. Even people with a ‘can do’ positive attitude can find the constant drip feed of negativity demoralising. FIGHT OR FLIGHT When the human body experiences a challenge (be it fear or excitement) it responds immediately, activating the response to fight or run away. This is the stone age fight or flight response and it affects every part of the mind and body. We share this behaviour with all mammals, birds and reptiles. It is a primal survival mechanism and is to keep us safe from a perceived danger. However danger today in the 21st century is not only about life and death, it is about our fear over our pension pot, our fear that

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we will not be cared for in old age, our fear that we may not have a job soon, our fear that our children will be harmed by unknown strangers, vehicles or foodstuffs, fear of unknown, threatened work changes, and so on. Many people are weighed down by all these fears over which they have little control. SYMPTOMS This means that over a period of time much of the population begins to feel stressed. They come to work experiencing some of the following sign and symptoms of stress, shown on the next page. Staff dealing with these symptoms are not as effective and this state is known as ‘presenteeism’. The outcome is that every day challenges in work and at home can be seen in a very different light. In the health service visitors and colleagues can be difficult, sometimes aggressive. New procedures are a pain, even unworkable; staff shortages increase pressure; management expectations seem unreasonable; communication fails. In the state of anxious nation, patients, visitors, situations and every day procedures seem more complex and irritating. Not only does this cost money in a hidden, insidious way (reputation, sabotage, mediation, tribunals, managers’ time), it also costs staff self respect at all levels of the organisation. WHAT IS THE ANSWER? To reduce anxiety in a nation requires individuals to take responsibility for the quality and standards they want upheld. This is a larger, strategic topic than this article so I will focus on how individuals can turn their back on national anxiety and regain composure, confidence and creativity to support them through change, challenges and conflict. Firstly, understand what is important to you and value it – make a list and plan your life to honour your values. Secondly, understand your thinking style – are you a positive or negative thinker? Positive thinkers are solution focused, ‘can do’ people, negative thinkers always expect the worst and usually get it. If you want to explore this more, start at the ISMA’s top ten stress busting tips at www.isma.org.uk Also, know your energy drains – spend as little time as possible with people and situations that drain your energy and make you feel low. Likewise know your energy gains – spend time with people and in situations that

energise you and make you feel good. In addition, eat healthy, fresh balanced meals, stop smoking and exercise regularly. Get the right amount of sleep so when you awaken you feel rested and ready for the day. Lastly, relax a little each day – take five to twenty minutes to meditate, visualise, do yoga, tai chi and deep breathing. OUR OWN ANXIETIES Starting with our own anxieties will help individuals to feel stronger, healthier and more able to cope with life’s challenges at this time of insecurity and change, as well as reduce this phenomenon of national anxiety.

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

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STRESS MANAGEMENT

PHYSICAL SIGNS OF STRESS • • • • • • • • • • • •

headaches tension rashes frequent colds tiredness skin problems increased/lost weight over eating panic attacks irritable bowel high blood pressure heart problems

PSYCHOLOGICAL SIGNS OF STRESS • • • • • • • • • •

can’t make decisions memory lapses easily distracted less intuitive worrying poor concentration negative thinking feeling a victim depressed/sad anxious

BEHAVIOURAL SIGNS OF STRESS • withdrawn • restless • reckless • aggressive • increased/renewed drinking and smoking • legal/illegal drug taking • lying • accident prone • nervous • bored

EMOTIONAL SIGNS OF STRESS • • • • • • • • •

tearful irritable moody sensitive to criticism lack of motivation angry frustrated guilty lonely

Stress Torque™ from WellMind Limited N THESE DAYS of recession and cuts we need everyone to perform to the best of their abilities. The pressure is on. But too much pressure on individuals can result in excess stress; lower efficiency and mistakes may result. Excess stress also brings an increased risk of absenteeism and staff turnover placing further pressure on those at work. OASIS, the On-Line Audit of Stress IndicatorS, has been developed by Stress Torque™ to confidentially and cost effectively measure whether the pressure your staff are under is likely to be reducing their workplace

performance. For less than £5 per employee, an OASIS report will highlight the problem areas and recommend the follow-up action required. OASIS works in real time so basic survey results can be available within hours. Analysis and recommendations are normally available within a few days of survey completion. Stress Torque™ can also provide a range

of additional services as required from focus group facilitation and random interviewing, which will further identify the sources of stress, to workshops, seminars and employee support facilities to manage the effects. With over ten years experience, we really can help.

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TRAINING

AN EDUCATION AND EXPERTISE PASSPORT FOR HEALTH A Skills Passport for Health is a portable, online record of an individual’s career history, current skills and training, designed to reduce duplication of training and pre-employment checks A ‘SKILLS PASSPORT’ for all staff across the entire health sector is moving a step nearer as Care UK prepares to be the first independent provider of health and social care piloting the scheme within the UK. The company has been chosen by Skills for Health, the sector skills council for health services across the UK, to explore the potential of testing the passport among its workforce, before a possible nationwide roll-out. Supported by the Department of Health, the Skills Passport for Health is a portable, online record of an individual’s career history, current skills and training. The information it contains can be independently verified and includes an individual’s education, qualifications, competencies, employment history, training record and objectives. It is accessible securely via the internet at anytime, from anywhere, and can be viewed by prospective or existing employers. The Skills Passport is intended to cover the NHS and independent sectors, permanent, contract temporary and volunteer workers, clinical and non-clinical staff across England, Scotland, Wales and Northern Ireland. Care UK employs over 2,000 staff working in primary and secondary healthcare, caring for approximately half a million people over the course of a year. It is a leading independent sector provider of services to NHS patients, operating over 40 primary care sites (including GP and walk-in services, out of hours, diagnostics centres, clinical assessment & treatment services and prison health services) and eight hospital treatment centres that specialise in elective surgery. The six-month long Skills Passport pilot, which is due to start this summer, will involve Care UK staff from three different service schemes providing healthcare for NHS patients in north west England – an independent treatment centre, walk-in centre and GP practice – as well as other sites across the organisation. BACKGROUND Skills Passports are already issued by employers to their employees across a number of industry sectors of the UK economy, in both public and private sectors, and similar schemes are being developed around the world, including Australia, Canada and the EU. The idea of a national competence passport in health emerged from a series of national stakeholder events and was included as an action in Modernising

Nursing Careers (DH2006). To support these demands from all stakeholders, the Skills Passport for Health was born. Since March 2009, Skills for Health has been working to develop and pilot a Skills Passport for Health under the guidance of a Strategy Group, chaired by David Foster, deputy chief nursing officer for England. The group’s membership includes representatives from the Departments of Health of England, Wales, Scotland and Northern Ireland, Nursing and Midwifery Council, Unison, Royal College of Nursing (RCN), and health services for the military, prison service and education. An initial pilot during 2009 focused on nursing, with around 300 nurses from 12 NHS organisations actively piloting the system. The scheme was independently evaluated at the end of March 2010 and the Strategy Group agreed to extend the number of pilot sites, broaden them beyond nursing and roll out to an entire region. David Foster said: “The nursing workforce has repeatedly called for some form of competency passport to support the modernisation of nursing careers. I am delighted that this project has not only confirmed the case for a Skills Passport but also highlighted a range of potential additional benefits for employers, health workers throughout the UK, universities and, most importantly, those who use health services.” OBJECTIVES An immediate objective is to reduce costly and unnecessary duplication of statutory and mandatory training – and pre-employment checks each time a worker moves between employers. Another is to provide a tool to encourage workers to take control of their skill and career development, in exchange for providing employers and policy makers with visibility of the skills, capabilities and compliance of the workforce. The longer-term objective is to increase the flexibility, mobility and skills of health sector workers and in doing so increase productivity and quality of patient care. The Skills Passport is not intended to replace ESR (Employee Staff Record), which is the HR and payroll system for the NHS across England and Wales, but will compliment ESR and other HR systems. It can be used to populate these systems with high quality, verified information and an individual can be connected to more than one organisation at any one time.

This makes it particularly valuable for flexible workers, bank staff, specialists that work for numerous employers, and those that offer their spare time to voluntary groups or other organisations. As Care UK’s clinical education manager Adele Veldsman points out: “Interest and momentum for the Skills Passport is increasing at a rapid rate and we are delighted to come on board as a new pilot site that is independent but works in close partnership with NHS organisations.” Skills for Health is confident that, as a progressive care service provider continually striving for innovation, Care UK is the right organisation to pilot passports within the independent sector. Care UK has already signed the Skills Pledge, which publicly demonstrates its commitment to supporting all healthcare employees to develop and gain valuable qualifications. The Skills Passport can support Care UK in delivering this pledge by providing individuals within its organisation with the ability to record and evidence training, skills, qualifications and professional development. It is crucial to the success of the pilot that key organisational stakeholders have been involved in the early planning stages, including representatives from Care UK’s training and development team, human resources and information technology department. For example, it has been shown that preloading data into individual Skills Passports is the quickest and preferred method in implementing them within an organisation. This allows individual passports holders to have verified data at the beginning of the pilot, but required an IT readiness assessment to be conducted by Care UK to identify any issues at an early stage with regards to access and data transfer. All the pilot sites will be given a project plan for six months to guide them during this period. Core training material will be provided for by Skills for Health to individuals, trainers and verifier organisations involved in the pilot. Training sessions and drop-in sessions will be provided to participants on how to learn to use the tool; and they will be encouraged to bring in paper-based certificates and training records for uploading to computers as they populate their passport online. THE CARE UK COMMITMENT Across its clinical teams, Care UK employs a whole range of healthcare

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TRAINING

professionals including healthcare assistants, nurses, RMOs, GPs, physiotherapists, radiographers, technicians, anaesthetists, surgeons and consultants. Whatever the background or level of experience of an employee, Care UK has a systematic approach to learning and development across the entire healthcare workforce. Everyone working in the healthcare division, at whatever level, is required to maintain and develop knowledge and skills appropriate to their role, in addition to completing a full range of mandatory training. An annual programme of courses is delivered by the in-house training team, by external consultants, through links with universities and medical schools, and through a range of e-learning. These are accredited for Continuing Professional Development by an external independent training organisation, the CPD Certification Service, and are open to both full and part-time employees, as well as locums and seconded staff. Care UK‘s commitment to training and development not only extends to its own healthcare professionals but also to a variety of medical, nursing and dental students, who gain experience through clinical practice placements in treatment centres and minor injury units. Care UK works with education provider representatives to ensure that all accreditation requirements for these placements are met. There are also more informal opportunities for shadowing and mentoring. PILOT SITES Adele explains how these elements will link within the pilot scheme: “The sites we have chosen include a surgery & GP led walk-in service in Liverpool and Manchester Clinical

Assessment & Treatment Services. These were ideal for the ramp–up of the pilot project as Cheshire and Merseyside were part of the NHS pilot and we (both Care UK and Skills for Health) are interested in seeing the integration benefits for staff and employers if staff move between the NHS and Care UK in these areas. “Edgehill University is also in this area and we will be able to integrate data from staff that complete any of their courses, either mandatory or CPD, onto our systems with immediate verification. “There are so many potential advantages for our own staff, and for students and secondees, which will truly test the transferability of the Skills Passport. More and more, we are seeing a trend for people to move between public and private sector employment during their career. Or like many of our specialists, they may have a mixed employment pattern, spending part of their working week with a NHS trust and part at Care UK.” She contrives: “Effective skills development is vital for the health sector workforce and it will become increasingly important to evidence this, as employers seek to implement new and more productive ways of working in response to a more challenging financial climate. Independent organisations such as ours contribute a great deal to the future development of effective, skilled workers for all areas of healthcare. At some point, staff may well move from the independent sector to the NHS, or vice versa. “The Skills Passport captures and updates all the training and development that people gain with us, whether they pursue their career with Care UK, move to another employer, take a career break or return to education. Evidence of their transferrable knowledge and skills stays with them.”

BENEFITS The Skills Passport for Health pilot aims to demonstrate a range of benefits for individuals and organisations. For employers they include: • Reduces duplication of training • Simplifies statutory and mandatory training, so that more time can be spent on up-skilling rather than compliance • Reduces the time to hire employees, cost of staff cover and pre-employment administration • Provides visibility over the skills and abilities of the entire workforce, meaning that training can be precisely targeted and enabling better planning for national skills shortages and emergencies • More flexible workforce • Promotes a culture encouraging individuals to take ownership of their own career progression, reducing staff turnover and increasing productivity EMPLOYEE BENEFITS For employees benefits include: • A single verified and portable career record from education to retirement, • Reduce time to hire, speed up career progression and increase earnings • Ability to move both within the health sector and beyond • Provides a list of training that needs to be completed and by when • Personal development planner to define and track objectives • An online store of all evidence of skills, learning, training, employment, work placements and volunteering, ready whenever needed e.g. demonstrating suitability for new role or revalidation • Faster career progression and less administration

Management Futures – outstanding track record in the health sector ANAGEMENT FUTURES has been helping an array of leaders and their teams to excel in the health sector since 1997. In that time we have provided executive coaching to scores of chief executives and directors, building our business primarily through word of mouth recommendation. We have also coached and developed numerous senior teams, helping them to succeed in the many changes and challenges they have been called upon to lead. We have additional expertise and track record in the training of coaching skills within the health sector – hundreds of senior staff have taken our courses in coaching skills for managers. Many of these have gone on to achieve professional coaching qualifications

we hold a prestigious quality award. All of our team are highly experienced and qualified and have significant management experience of their own. We bring a wealth of experience from the health sector and add to this our strong track record working with senior leaders and teams in government, the media, commerce and the not-for-profit sector.

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RECRUITMENT

RECRUITMENT CHALLENGES: THE NHS PERSPECTIVE A vigorous and adaptable approach to recruitment is needed to ensure the health service has the right staff to deliver the highest quality care THE NHS HAS REGULARLY FACED recruitment difficulties. However, the essential challenge remains â&#x20AC;&#x201C; getting the right people with the right skills in the right place at the right time to meet service and patient needs. Getting all of these things correct at the same time is the holy grail of workforce planners, with effective workforce planning an essential pre-requisite to successful recruiting. THE RIGHT SKILLS? This question is central to the recruitment challenge and the answer should be based on an identification of the expectations and needs of our patients and service users. Patient expectations are changing and we need to ensure that the NHS workforce is flexible enough to meet these needs. For example, can the NHS change its emphasis towards a more preventative service which promotes wellness and health rather than addressing illness? This is a fundamental shift which will require different types of staff with different skills. The recent Department of Health consultation on education and training, Liberating the NHS: Developing the healthcare workforce, proposes a major change to the link between workforce planning and the commissioning of education and training for the next generation of healthcare workers. Local decisions made by a network of local providers will form the basis for education commissioning. This presents opportunities for NHS providers to address some of the local skills shortages that underpin recruitment difficulties by giving them control to commission education and skills training based on local need. Advances in technology and medicine will require more staff who are able to take part in research and facilitate the utilisation of new technology into service delivery. The changes to the training and recruitment of healthcare scientists are an example of this; scientists will be given an initial broader training base before specialising in one area. Ultimately this will enable greater flexibility in skills and therefore in service delivery. A pilot of this approach to training in the genetics area proved very successful. THE RIGHT PEOPLE? A national perspective on the type of staff required in the NHS is being developed by the Centre for Workforce Intelligence (CfWI). Established in 2010, the CfWI will help health and social care organisations plan their workforce more effectively round

The temporary workforce is a vital element in enabling the NHS to respond to short term skills shortages and fluctuations in service demand. The costs of this sort of staff have increased over the past few years and there is pressure to reduce these costs even further. Managers will need to think carefully about the most efficient and effective use of this type of staff

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The ideal staff and customer rewards – vouchers and gift cards versus secure codes

IFT VOUCHERS and cards make ideal staff and customer rewards, offering flexibility, a vast range of stores and ease of use for customers. As technology has advanced solutions are now available that make operating a reward program both easier and quicker, with in many cases dramatic cost savings. The two major constraints of operating a voucher or gift card programme are firstly that you are not always sure as to which voucher would appeal more to staff or customers, and secondly that there is often a time delay between achieving the reward and actually receiving it, which creates disinterest and prevents full adoption of the scheme. Many organisations outsource the fulfilment of their reward programme which adds, in these times of economic restraint, further costs. Even operating the service in-house has added costs in purchasing, securing and distributing the gift cards and vouchers, and often involves posting to customers and or staff home addresses. Rewards and promotions are an even more important aspect in times of shrinking markets and participants need to feel the excitement of achieving their reward. By offering the participant the choice of which retail gift voucher or card and being able to

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redemption codes. Instead of purchasing gift vouchers or cards, a purchase is made of secure codes with a defined value and method of delivery. These codes are issued to the participants who are requested to visit a secure website and select the gift vouchers for the retailer or activity they require, to the value of the secure code that has been issued to them. The secure code can be for a mix of different retailers’ gift vouchers and cards, and is shipped direct to the participant by the delivery method selected by the programme operator. This scheme gives ease of use, reduced costs, delivers the reward of the participant’s choice and can be delivered next day, only 24 hours after achieving the award, thereby encouraging further participation or purchase by the customer.

FOR MORE INFORMATION

deliver the reward within 24 hours of the achievement can only encourage participation. A solution to meet the current constraints is now available using secure codes, or

Address: Charity Gift Vouchers Marketing Ltd Chicheley, Hempstead Lane, Hailsham, East Sussex BN27 3PR Contact: Terry Harvey, Select Rewards Tel: 01323 841253 Fax: 01323 848807 E-mail: sales@vouchers4charity.org.uk Web: www.vouchers4charity.org.uk

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RECRUITMENT

delivering more people focused care, with an emphasis on shifting the delivery of care away from hospitals and moving the balance of staff towards the front line. The NHS has a disproportionate number of older staff of which 30,000 retire each year. This ageing workforce means that we need to attract younger staff and build their skills now so that we retain a high quality workforce for the future. Current unemployment rates in the young population (National Statistics Online – Employment), coupled with the financial incentives available for the support of apprenticeships, make this group a potential source for the future NHS workforce. Similarly, social responsibility challenges the NHS to look at the mix of its workforce in terms of age, gender and ethnicity. The NHS is seeking to increase productivity and combined with the drive for efficiency savings there is an opportunity to reshape the workforce to meet patient needs using skill mix and extended roles. This can be seen in the development of roles of staff earning up to around £22,000, particularly assistant/associate practitioner roles. These roles also begin to develop career pathways which enable staff to join at a more junior level and progress through a series of clearly defined roles with the potential to enter professional training if they wish. Changes to the skill mix include the development of new advanced practitioner roles where qualified staff, such as nurses, occupational therapists or physiotherapists, take on specific roles which have previously been undertaken by consultants. These developments present a challenge to managers recruiting to a role and they will have to carefully assess what sort of a person they need. THE RIGHT TIME? It is vital that the skilled NHS workforce is used effectively in line with service demands. The productivity agenda in the NHS expects

considerable savings to be achieved by examining and changing the way we deliver services. Alongside this are the requirements to adhere to European working time directives (EWTD) and balance individual requirements for flexible working and work life balance with meeting the needs of the service. Increasingly organisations are using e-rostering facilities to help them address this balance. The temporary workforce is a vital element in enabling the NHS to respond to short term skills shortages and fluctuations in service demand. The costs of this sort of staff have increased over the past few years and there is pressure to reduce these costs even further. Managers will need to think carefully about the most efficient and effective use of this type of staff. THE RIGHT PLACE? Increasingly there are moves to shift the emphasis of healthcare delivery away from

the acute sector into people’s homes and the community. Online facilities and technology advancements mean that consultations do not necessarily have to take place in service settings. Again this provides a challenge to the recruiting manager when considering what sort of staff are required to deliver the service. Managers in the health sector need to consider these different factors when considering how they recruit. It will require greater flexibility and creativity to challenge existing professional and service norms. But with the need to drive efficiencies and the workforce consultation providing the opportunity to reshape and simplify the system, the time is right to make these changes. Patients expect to receive the highest quality care available and it is through a vigorous and adaptable approach to recruitment that we will ensure we have the right staff in the right place to deliver this for them.

Apex health and social care staffing solutions PEX HEALTH + SOCIAL CARE was established in 1992 and has grown into one of the UK’s leading independent providers of health and social care. Operating from our extensive branch network throughout the North West and Midlands, we provide registered nurses, specialist nurses, social workers, support workers and healthcare assistants to the NHS, private hospitals, primary care trusts, local authorities and private clients. All of our staff are recruited to the strict guidelines laid down by the Care Quality Commission and the NHS National Framework Agreement, and are trained and inducted by our own in house training teams.

We only employ conscientious staff that believe in our insistence on excellence. Operating a genuine 24 hour contact centre, Apex supports all client groups and staff seven days a week, 365 days of the year. Whatever your health or social care staffing needs, Apex is here to offer the solution. Our policy is to exceed your expectations by listening to your needs and tailoring our service to suit.

FOR MORE INFORMATION Tel: 0845 6003041 E-mail: info@apexhsc.co.uk Web: www.apexhsc.co.uk

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CONFLICT MANAGEMENT

SAFETY FOR ALL Catherine Skinner, director of personal safety charity Suzy Lamplugh Trust, looks at the security issues healthcare staff face and makes the case for conflict resolution training PROVIDING A SAFE working environment and safe working practices for employees is a relatively complex task for any large organisation. For an organisation as enormous, diverse and geographically widespread as the NHS, this is a huge undertaking and the complexity of it should never be underestimated. It is a massive job but essential for both the organisation and its employees that it is done – and done well. Intervention strategies to manage challenging situations have to be relevant and commensurate with the risks faced. RISK ASSESSMENTS In order to ensure the safety of staff, there are basic steps managers need to undertake. The first of these is to carry out risk assessments. This means assessing the risks involved with the individual tasks members of staff undertake. These assessments have to be thorough and they have to be targeted. There is no point carrying out risk assessments for some staff and then producing policies and procedures for the whole organisation based on this. Each hospital, clinic or surgery has a different layout, location and patient profile. Therefore the safety risks will vary, and the safety policies and procedures for each location and the staff based there must be tailor-made to deal with their specific risks. It is also crucial to consider clinicians and other professionals who may work alone in the community. It is important that those who carry out the risk assessments have an understanding, knowledge and skill in the specialised area they are assessing. For risk assessments to be effective, the assessor must communicate directly with the frontline staff, in order to find out how the jobs are really carried out. Consulting with staff – whether via focus groups, questionnaires or reporting amnesties – will enable employers to find out what the real issues are. POLICIES & PROCEDURES Once the risks have been identified, this consultation with staff should continue through to the development of relevant policies and procedures. If safety procedures are to work, their input is invaluable. The frontline employees – whether that’s GPs receptionists, ambulance drivers or doctors in the A&E – know what really happens on a day-to-day basis, what procedures would be practical for them and, importantly, which procedures they would actually follow. As with risk assessments, generic policies and procedures are not always helpful. They must be tailored to suit the specific needs of the various roles at each individual location.

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Hospital porters have totally different safety issues from a GP when making home visits. No matter how thorough the risk assessments have been, and how robust and tailored the policies and procedures are, it is rarely possible to eliminate all risk. Therefore staff must be given the knowledge and skills that will enable them to deal with the residual risk. It is important that training is only introduced at this stage and not before. Training should only ever be used as part of an overall personal safety strategy and never in place of one. If the correct risk assessments have not been carried out previously or thorough enough policies and procedures have not been put in place, if an incident were to occur, the organisation could be at risk of litigation for not accepting that its work systems were inherently unsafe. TRAINING FOR FRONTLINE STAFF Good personal safety/conflict resolution training for frontline staff should include how to make dynamic risk assessments of the person they are dealing with, the environment in which the situation is taking place and the task that is involved. Is the person they are dealing with under the influence of drugs/alcohol, are they frightened/in pain/angry? Are there colleagues/security nearby who could come to their assistance if any problems occurred? Do they have to tell the person something that might upset them? Could any of these factors compromise their safety and what should they do about it? Could a possible misconception of their duty of care to an aggressive individual potentially inhibit effective safe responses? Frontline training should also give staff the knowledge and skills to recognise early warning signs of anger/aggression. The earlier they can spot these signs, the easier it will be for them to take action to defuse or de-escalate the situation if possible, or to exit it and call for assistance if necessary. How to manage our own behaviour is a vital part of any personal safety training. A crucial element when dealing with others is the awareness of our own feelings – such as anger, disgust, fear or resentment – that could cause aggression in the other person. Good personal safety training should enable staff to act appropriately when dealing with aggression, rather than reacting in a way that could make the situation worse. Employees should be trained in how to judge whether it is safe to stay and attempt to deal with any given situation – and how to defuse that situation if they do decide to stay. Likewise, they need to learn about strategies for exiting a difficult situation safely

Catherine Skinner

if they decide that is the safest option. As with risk assessments and policies and procedures, the challenge with training is that it needs to be relevant to the individual and service area. The greater the diversity of jobs within an organisation, the more important it is for the training to be bespoke. The training needs for a nurse who makes home visits may be very different to those of a paramedic who may treat people under the influence of drugs or alcohol on a regular basis. If training is to be cascaded down to other teams, then it is vital that the trainees are also taught how to transpose the generic advice to the specifics of their own department. Training the trainers sufficiently is essential if all frontline employees are to be given the necessary targeted knowledge and skills to keep themselves safe in their particular role. ADDITIONAL ELEMENTS Hospitals and other healthcare facilities are using security staff more and more and they play a vital role. However, if clinicians have not received sufficient personal safety/conflict management training themselves, it can be tempting for them to hand over the management of aggressive situations to security staff. This can cause problems if security staff are asked to manage aggression caused by a patient’s clinical condition or treatment, e.g. dementia/certain medications/pain/fear etc. Although security staff can play a part in containing or defusing this type of situation, the situation should always be managed by the clinicians in charge of the patient. They are the

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CONFLICT MANAGEMENT

employer is to keep risk assessments and procedures up-to-date. Employees should always be encouraged to report incidents and near misses. They will only do so if the system is simple, not time consuming and they can see a clear result/benefit of reporting.

Those responsible for staff safety need to ensure that thorough risk assessments are carried out and that safety policies and procedures are designed and fully implemented ones who fully understand how the condition or treatment is affecting the patient’s behaviour and therefore how it should be addressed. Training needs to complement other control measures in reducing and managing work related violence; therefore technology can be very useful if its use is clearly defined. Alarms and tracing systems can be extremely

effective in summoning help and in alerting to possible problems. However, they cannot prevent a violent or aggressive incident from happening nor can they help an employee to deal with such an incident until help reaches them. Technology should never be used to replace good safety procedures and training. Good reporting systems are essential if an

EMPLOYER RESPONSIBILITIES Those responsible for staff safety need to ensure that thorough risk assessments are carried out and that safety policies and procedures are designed and fully implemented. They need to ensure that employees know about, contribute to the creation of and buy into these safety policies and procedures. They should also ensure that frontline employees receive relevant and targeted training and that personal safety is kept on the agenda and integrated into existing structures across the organisation. Finally, they need to create and implement a structured reporting and aftercare process to ensure that victims are supported. There are numerous factors that can adversely affect the personal safety of healthcare employees – from dealing with people who are frightened/in pain/mentally ill or under the influence of drugs or alcohol, to making home visits, getting home after finishing late night shifts or transporting drugs. The diversity of the roles in the health service, the locations where interactions with the public take place and the risk factors involved, make it extremely hard to provide effective personal safety solutions for all those in the health sector. Following 25 years experience of safety training in the workplace, Suzy Lamplugh Trust believes that the only way this can be done is for the training – of both frontline staff and managers – to become less generic and more bespoke in the future.

FOR MORE INFORMATION Web: www.suzylamplugh.org

Prevent and manage challenging behaviour ECURICARE has been at the forefront of training in the prevention and management of challenging, aggressive and violent behaviours since the early 1990s. The training is accredited and can be externally certificated. SecuriCare is an Institute of Conflict Management Quality Award Centre ICMQAC. The training covers the following core learning objectives and meets the requirements of the NHS National Conflict Resolution Training Programme: Describe the common causes of conflict; Describe different forms of communication; Give examples of

communication breakdown; Explain three examples of communication models that can assist in conflict resolution; Describe patterns of behaviour they may encounter during different interactions; Explain the different warning and danger signs; Give examples of impact factors;

Describe the use of distance when dealing with conflict; Explain the use of “reasonable force” as it applies to conflict resolution; Describe different methods of dealing with possible conflict situations.The training also includes; disengagement skills; and physical intervention/ restraint skills where necessary, and is part of the organisations policy and staff guidelines. Train the Trainer Packages are available for in-house training personnel and can including NVQ Level 3 Direct Training & Support (QTLS).

FOR MORE INFORMATION Please visit our website at: www.securicare.com

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Hagesud-BosseUKLtd Unit 10a Ashburton Industrial Estate Ross-on-Wye Herefordshire HR9 7BW Phone: 01989 565971 Fax: 01989 767684 www.hagesud-bosse.co.uk | info@hagesud-bosse.co.uk

Instant quality, flavour, convenience What patients want Great taste and appearance. Our instant products offer both. And the benefit of instant meals low in salt and sugar, zero gluten and high in protein.

Instant simmer and cold water soups, sauces, gravies, desserts and custards. Caterers enjoy the ease-of-use and convenience of our instant products at ward level. And our cold water mixes for CPU applications.

Fulfilling the needs of caterers for • Qaulity natural ingedients • Top flavour • Great visual appeal • Low salt and sugar • Ease of use and convenience • Gluten free • Low salt and sugar • High protein • Excellent portion control • Cost effective format. • Re-sealable packaging

Serving caterers, cooks and food manufacturers We supply convenience and food service products to health and public sector catering professionals. Private and public sectors catering. Boullions, glazes, marinades, glazes, coaters and breaders,decorating sauces, salad dressings and desserts.

Quality services We deliver excellent application advice, dependable order processing and despatch, on-time delivery and great after-sales service.

Food manufacturing industry We supply high quality food flavouringsseasonings, herbs and spices.

The proof of the pudding ... It’s in the tasting. So, to arrange tasting samples phone Craig Creed on 01989 565971 (Mob: 0780 3024874) or email addressed to craig@hagesud-bosse.co.uk.

There’s no substitute for great taste www.hagesud-bosse.co.uk

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CATERING

RESPONSIBLE FOOD PURCHASING The impacts associated with what we grow, how we transport it and how we dispose of it need to be taken into account when making a purchasing decision, writes Keith Hinchcliffe, food trading manager at NHS Supply Chain We also need to work closely with the Hospital Catering Association (HCA) and catering managers across the NHS to make sure we are able to supply what items they need and in a manageable format. In simple terms, you would expect that all our eggs meet minimum European standards, but we need to make sure they are locally sourced where possible, use minimum packaging that protects them during transportation and have shelf lives that are marked to ensure they can be used while they are fresh. This is just one example where we take the role of the shopper as we would expect the same standards and quality as discerning people make when they are shopping for their own food.

AS THE LARGEST SUPPLIER of hospital food in England and operated by DHL, NHS Supply Chain is always on a mission to improve choice and reduce the costs of produce. But now, in the tougher economic climate, there is a renewed effort to ensure that suppliers’ sustainable practices can also demonstrate the highest ethical standards. Whilst we welcome the ideals of this, the delivery route is far more complicated than most people imagine. As a responsible supplier of around 60 per cent of hospital food, NHS Supply Chain is a strong supporter of sustainable practices. People who want to supply food to the NHS need to do more than talk a good story. They need to demonstrate that whether they are individuals, small or medium sized enterprises or multi corporations they meet our principles. RESPONSIBLE PURCHASING Sustainable food considers the impact that our food choices have on the environment, the seasonal nature of fresh produce, the methods used by farmers to grow food and how they sell to public services impact upon both local and global economies. The impacts associated with what we grow, how we transport it and how we dispose of it need to be taken into account when making a purchasing decision. Sustainable food also considers the impact of what we eat – looking at whether the food is healthy, fresh and nutritious and contributing to the government’s overall objective of achieving a better quality of life. Last year we had a major drive to underpin all our food contracts with the Ethical Trading

Initiative (ETI) to ensure ethical and safe farming practices, and that suppliers are continually developing its practices to encompass sustainability. ETI is a ground-breaking alliance of companies, trade unions and voluntary organisations working in partnership to improve the working lives of people across the globe that make or grow consumer goods. This means that our suppliers need to show a commitment to reduce food miles, carbon reduction and unnecessary packaging; ensure safer farming practices – including pesticide use – animal welfare and fish sourcing; and provide fresh seasonal produce, where possible, with an optimum shelf life. TENDERING PROCESS Although hospitals can chose their own products, it is very important that we can reassure those who do use NHS Supply Chain that we can offer them a complete and reliable service in meeting their varying needs. That is why in 2010, NHS Supply Chain introduced a new tendering process. These stringent updated measures also scored potential suppliers on their sustainable credentials – with greener companies getting higher marks. We naturally need to ensure our work is cutting edge and meets the government’s latest standards. Our process reflects the Department of Health (DH) Healthier Food Mark Scheme, but the Department for Environment, Food and Rural Affairs (Defra) Public Sector Food Procurement Initiative (PSFPI), also independently shows that we are supporting British business as they supply around 70 per cent of food products.

FAIR OPPORTUNITIES All NHS Supply Chain food contracts are tendered following an open procedure which gives all operators a fair and equal chance of gaining work. Our feedback has been very encouraging with small and medium sized firms positively displaying good management standards across their business and winning more work. To ensure the order process is as smooth as possible, NHS Supply Chain has set up a dedicated area on their website for catering, www.supplychain.nhs.uk/catering. Catering managers can browse the full product range and search by postcode for local suppliers that deliver to their trust and find useful information such as seasonal availability of fresh produce, along with how to run mini competitions. NEW CONTRACTS In November we launched a new meat and poultry contract that will have a strong local supplier base; milk, cream, bread and morning goods was launched in September; and fresh and prepared fruit, vegetables and eggs commenced in August. All have an increased supplier base offering a wider local choice – milk and bread alone by 158 per cent. But that is not the end of the matter. NHS Supply Chain works with the contractors for continuous improvement across technical, food safety and due diligence areas and the shared support has reaped good rewards. To supplement these vital aspects of any trust’s food purchasing requirements, NHS Supply Chain uses independent auditors STS to check that all food products supplied via our framework agreements are delivered by accredited suppliers. This provides peace of mind to trust supplies and catering managers alike, especially when they are ordering high risk products such as meat and poultry.

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CATERING

For all the suppliers for the meat and poultry contract, there is an additionally early unannounced audit. This covers production and processing of the meat – from receipt as a carcass through to consumption – with final visits undertaken to check the final product received at hospital sites as agreed by the selected catering department. Sustainability matters to all of us and by implementing strong ethical standards across all food contracts and encouraging local suppliers and SMEs to bid for contracts, our pioneering approach is leading the way within the public sector. AMBIENT GOODS Unprecedented global price increases of up to 70 per cent on key commodities like wheat, orange juice and coffee have put additional strains on already limited budgets. And with rapid price changes there can be an almost endless circle of having to re-tender and receiving bigger bills than expected. NHS Supply Chain’s senior ambient food buyer, Jill Massey, is very clear about the importance of this business: “Sustainable and ethical sourcing of ambient goods brings with it a different set of challenges to the fresh produce sector. Much of the

raw ingredients such as coffee, tea and juices are not available locally and therefore require a different approach to sourcing. “Recognised accreditation such as Fairtrade and Rainforest Alliance offer assurance that goods and services have been produced to ensure sustainable benefits socially, economically and environmentally. That said, with the ever growing demand for accredited goods, manufacturers are beginning to feel the limitations with regard to consistent availability of sufficient raw materials. Working with key suppliers to provide forecasts and potential range developments, will help NHS Supply Chain keep goods available and at the same time encourage developing and new products in the pipeline. “In addition, NHS Supply Chain works with suppliers to ensure products which are not accredited are sourced with the same high standard and corporate responsibility. “Where products is sourced and provided from the UK, NHSSC are working with a number of small to medium enterprises to develop ranges and specifications to meet the requirements of NHS caterers. It is these relationships which will provide the opportunity for NHS Supply Chain to develop the Choice for Catering range which is due to be launched to the market towards the end of 2011. This will involve an end to end

Holmes Catering Equipment food and retail concepts HE HOLMES GROUP is a leading design, manufacture and fit out specialist for foodservice and food retail areas. Holmes Group utilises in house design skills to convert initial conceptual ideas through to a completed project. Throughout the process, highly skilled and knowledgeable designers provide advice and recommendations to the client team, working up the initial design ideas to a fully functional, practical and high quality facility. As a leading UK based manufacturer, with a highly skilled R&D team, Holmes Group has many of products that are unique to the industry, including the patented Aplate™ energy saving foodservice display hotplates, independently tested by a leading UK retailer and proven to save 75 per cent of the electrical running cost compared to standard

products. Alongside the Aplate™, Holmes Group has developed a number of other products, such as heated cupboards and chilled displays to reaffirm our commitment to developing energy saving products. In addition, Holmes Group offers a full design and build construction service and also supplies, installs and maintains equipment from all leading foodservice equipment manufacturers. Holmes Group works with clients ranging from leading retailers, blue chip companies, hospital groups and the Royal Household through to local independent foodservice operators and retailers.

FOR MORE INFORMATION Tel: 01759 375500 Fax: 01759 375509 E-mail: sales@hce.co.uk Web: www.holmesgroup.co.uk

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NHS SUPPLY CHAIN UNDERTAKES THE FOLLOWING: • Liaises directly with the customer base via customer groups to ensure our frameworks meet their needs • Professionally tenders framework agreements through the OJEU process which incorporate sustainability requirements and targets and optimum consumption of local seasonal produce • Constantly reviews frameworks to investigate cost reduction opportunities • Ensures audits are undertaken to provide a due diligence defence • Maximises savings for the customer base. sourcing strategy working with key suppliers to ensure not only quality representing value for money but also long term opportunities for local and global ethical sourcing.”

FOR MORE INFORMATION E-mail: keith.hinchcliffe@supplychain.nhs.uk Web: www.supplychain.nhs.uk

TM Electronics (UK) Limited Accurate, quality thermometers and sensors for hospitals, care homes and assisted living.

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Dishwasher-safe probes Temperature kits for legionella prevention Room temperature monitoring Calibration and repair

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CATERING

MÜLLER® EXPANDS MINI POTS RANGE Müller Dairy offers a comprehensive and cost-effective range of yogurts for healthcare to help meet the challenge of providing both patients and front of house catering with healthy yogurt and dessert options IN CREATING ITS PORTFOLIO for the healthcare sector Müller Dairy focused on meeting two key requirements: firstly, specifically developing for hospital caterers an affordable, nutritious yogurt ideally suited to patient feeding, and secondly, to offer a wide range of products that are perfect for restaurants and for staff and visitor alike in case formats that consider the needs of the caterer by offering optimum choice, and also help manage waste and space constraints. Developed specifically to provide hospital caterers with an affordable, tasty, smooth and nutritious yogurt in a portion size and pack format ideally suited to patient feeding, the Müller Thick & Creamy brand is available in three flavours – Strawberry, Peach and Toffee flavour in a 12 x 110g mixed case format. QUALITY & TASTE Müller Thick & Creamy was launched in April 2009 and has enjoyed incredible success, with volume and distribution gains across the NHS and private sector healthcare due to it’s quality, taste and competitive price point. Key attributes of the Thick & Creamy range include: • the completely smooth texture which makes the yogurt easy for patients to eat • a smaller 110g pot size which is perfect for patients with smaller appetites, and also reduces food waste and cost per pot for the caterer • each pot contains 130 calories and provides a source of protein as well as 23 per cent of calcium RDA • the product is non-probiotic and is suitable for a variety of patient diets including both vegetarian and coeliac • it contains no artificial colours or preservatives • the range offers a choice of two fruit flavours and one confectionery flavour, with a selection of each (6 x strawberry, 3 x peach and 3 x toffee flavour) being included in a 12 x 110g mixed case. Müller knows hospital food is an essential part of patient care. Good quality, well-balanced, wholesome meals can encourage patients to eat well and give them the nutrients they need to recover from surgery or illness. At a time when appetite is often lacking, it’s really important for the food to be tasty, easy to eat

and presented in manageable portion sizes that the patient doesn’t find daunting. All these considerations were at the heart of the development of our Thick & Creamy yogurts. DAIRY GOODNESS From a hospital caterer’s perspective Müller Thick & Creamy yogurts provide whole milk dairy goodness and are a natural source of dairy calcium, while the portion size and mixed case format offers optimum choice and convenience at a competitive and affordable price. The Thick & Creamy additions complements

probiotic to help maintain a healthy digestive system. Healthy Balance is supplied in cases of 12 x 100g in a choice of three flavours – strawberry, peach or raspberry. MINI MÜLLER RICE POTS A new addition to the Müller range in 2010, the 95g Mini Müller Rice pots were introduced as an extension to the popular standard 190g pots. Made with no artificial colours or preservatives, Mini Müller Rice is also low in fat and just as tasty as regular size Müller Rice – only smaller for smaller appetites. Müller Dairy offers a special mixed-flavours case comprising 12 x 95g pots (4 x Strawberry/4 x Apple/4 x Original) and would offer a great alternative on patient menus as well as front of house catering. All of the Müller lines available in the healthcare sector have no artificial colours or preservatives, and can make an invaluable contribution towards a healthy, balanced diet, or simply to help provide patients with the nutrients to help them to recover. The range of Müller products, including mixed case options, are available through Foodservice chilled Wholesalers including Brakes, 3663, DBC and regional foodservice wholesalers. 1. Source: Nielsen Scantrack MAT w/e 30.10.10 2. Source: Nielsen Scantrack GB Penetration 52 w/e 30.10.10

FOR MORE INFORMATION the existing range of Müller yogurts sold in the healthcare sector to meet different patient feeding requirements. These include: Müllerlight – the leading fat free reduced calorie yogurt1 offered in selection of mixed case options; Müller Vitality – a low fat yogurt with pro-biotic, and Müller Little Stars – a fromage frais made with 100 per cent naturally sourced ingredients which are suitable for children’s menus. HEALTHY BALANCE The Müller range also includes 100g pots of Healthy Balance – completely smooth yogurts made with 100 per cent natural ingredients. The Healthy Balance range is also low in fat and the yogurt is

Further details, including nutritional information, are available on the Müller Dairy website www.mullerdairy. co.uk. For specific education related queries, please contact Müller Dairy on poskits@muller.co.uk

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Adjust this wheelchair

to fit the size required The Vario wheelchair makes it easy to have a wheelchair available for a wide variety of users. Vario boasts an adjustable width from 39-50cm, combining 8 wheelchair models into 1 and covering 80% of user requirements. And its lightweight, rugged construction makes it good for years of reliable service. Available exclusively from Nursing Hygiene, Vario makes quality provision straightforward and cost-effective. If a user’s size is changing over time, Vario can change with them. Whatever the requirement, with Vario you’ll probably have it covered.

• Adjustable seat width from 39-50cm • Adjustable seat height from 42-53cm • 8 standard wheelchair sizes in 1 • Lightweight durable aluminium frame • Complies with EN12182:1999, EN12183:1999 and European Medical Devices Directive 93/42/EEC

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One quality solution for bariatric users Many more from Nursing Hygiene’s bariatric department For over 20 years, Nursing Hygiene has met the detailed needs of care homes and those in care. Our experience and product range extends to specialisation in bariatric requirements. We have a wide range of Bariatric equipment and furniture for purchase or rental under our Medi-Rental scheme:

• Lounge/bedroom seating • Profiling beds • Specialist seating • Mobility • Hoisting Nursing Hygiene Charwood House, Oakhurst Business Park Southwater, West Sussex. RH13 9RT.

T: 01403 825825 F: 01403 825826 E: sales@nursinghygiene.com

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OBESITY MANAGEMENT

HOW OBESITY AFFECTS PATIENT HANDLING Liz Leigh, manual handling adviser & clinical ergonomist, Southend University Hospital NHS Foundation Trust, explains the day-to-day problems of dealing with obese patients IN THE UNITED KINGDOM the national audit office reported (2001) the prevalence of obesity in England had tripled over the last 20 years and continues to rise. Most adults in England are overweight, and one in five is obese. It was estimated that obesity accounted for 18 million days of sickness absence and 30,000 premature deaths in 1998. Treating obesity costs the NHS at least half a billion pounds per year. PATIENT HANDLING Managing bariatric patients safely is a growing problem and is well documented by researchers; Rush (2005) said that the number of obese patients had more than doubled in the last decade, and Palmer (2004) suggests that handling patients can be more complex when the person is obese. It is a known fact that the population is getting heavier and this has caused a number of difficulties for many hospitals and the staff managing the situation. One area of difficulty is managing a very obese deceased patient. This can not only be problematic in a hospital but causes all kinds of problems to other agencies. Transporting a very obese patient (occasionally deceased) into hospital with dignity has been difficult when there were no reinforced vehicles or appropriate equipment to deal with them. The mortuary is thought of as a place of sadness, grief or repulsion and no-one really wants to have to visit it if at all possible. The families that have lost a loved one may have to visit and this can be a traumatic experience. Mortuary staff attempt to make the experience as pleasant, calm and dignified as possible. In some hospitals the mortuary may have existed for as long as the hospital which for some can be over a century and can be very small. The refrigerated mortuary shelving system used in most hospitals are of a floor to ceiling design. This requires mortuary staff to use equipment to assist them when handling the deceased person to reduce injuries to staff and maintain dignity for the deceased. There is evidence that handling bariatric patients is high risk and this has been confirmed in a study by Randall et al (2009).

This research showed that when bariatric patients with a body mass index (BMI>35kg/ m2) were <10 per cent of the workload, handling accidents had accounted for almost 30 per cent of the recorded staff injuries. An article in an Australian newspaper (Pepper 2010) informed the public that the director of Forensic Science SA, Dr Ross Vining, had said that racks used to store bodies need to be widened

and reinforced, and heavy duty lifting gear needs to be installed to cope with bodies heavier than 300kg. The report went on to say that in 2007 a post mortem had to be performed on the floor of a mortuary in Adelaide because the deceased weighed 315 kilograms and was too heavy to lift. Dr Vining said an upgrade of the morgue would take place in

the coming years, although no date has been set and costs have not been determined. A SENSITIVE ISSUE In the United Kingdom there have been a number of articles in the press about obesity contributing to an early demise. In reality obesity has created real problems for many hospital workers whose role is to look after this group of people. The most sensitive area is the mortuary and the staff working in this area have the task of looking after the deceased until the body is released for burial. In some instances a post mortem is necessary and staff are required to move a body from the fridges to a mortuary table and return to the fridge on completion. Some trusts have carried out extensive changes to the mortuary and invested where possible in lifting equipment that is fixed to the ceiling which reduces the risks of injuries to staff involved in performing these tasks. The type and quantity of equipment in a mortuary varies, in some cases this can be due to the age of the building. In an old building there are limitations to the installation of some equipment as the building is just too small to accommodate it. Ceiling tracking is not an option in some old buildings because the ceiling will not support the extra weight. Free standing gantry hoisting is available but once erected reduces the space the technician has to work in because of the area the equipment requires. SPECIAL EQUIPMENT Some of the more recent ergonomic changes that have taken place at the hospital as a result of working with a manufacturer have been to help a hoist company develop lifting equipment which is suitable for the small

In reality obesity has created real problems for many hospital workers whose role is to look after this group of people. The most sensitive area is the mortuary and the staff working in this area has the task of looking after the deceased until the body is released for burial

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OBESITY MANAGEMENT

mortuary as well as those fortunate enough to have been purpose built for the obese person. The work has taken approximately two years to complete but the finished product has received interest from mortuaries all over the UK. The hoist was originally manufactured for moving a patient in a seated position. It moves with a motorised base which allows the operator to manoeuvrer it with a remote control and it can be taken very close to an object. Unlike conventional hoists that require the operator to push and pull the machine to operate it and usually requires staff to manoeuvre the hoist legs under furniture, this hoist can be manoeuvred in a very small space which is also advantageous. As the population gets heavier, there is a need for hospitals and emergency services to establish plans to work together to cope with obese patients, while maintaining their dignity and privacy. There is a need to establish a safe solution to the difficulties arising from the moving and handling of bariatric individuals from community to acute care in the event of a hospital appointment or emergency admission, and back to community care on discharge. In some cases, patients have to be brought into the hospital on the floor of an ambulance because they were over the safe working load

In some cases, patients have to be brought into the hospital on the floor of an ambulance because they were over the safe working load for the equipment the ambulance service had on board. This was very distressing for the patient who was already in crisis and was now being subjected to an undignified transfer for the equipment the ambulance service had on board. This is very distressing for the patient who was already in crisis and was now being subjected to an undignified transfer. Discharging patients is also problematic when attempting to send them home with dignity and ensuring they have an adequate package of care. ADDRESSING THE PROBLEM To address these issues a bariatric working party was set up with representatives from acute care, fire, police, ambulance (this included the private sector) and community care services in an attempt to work in partnership with outside agencies. The ultimate aim of the

group was to work in partnership, sharing experience, skills, knowledge and equipment through effective communication. The group began by establishing a core group of multidisciplinary representatives. Invitations were extended to other disciplines to attend meetings on an ad hoc basis. A care pathway was drawn up and dependant on the section to be discussed the appropriate person was invited to attend. This has worked very well and a good working relationship has been established throughout. It has improved patient privacy, dignity and safety as well as establishing the sharing of information and ultimately equipment.

Alison Kyle, independent registered dietian, looks at how the NHS can meet nutritonal needs for all

UTRITION is becoming the word on everyoneâ&#x20AC;&#x2122;s lips, regardless of the patients we are looking after. There are very real health problems with obesity and the associated future problems of cardiovascular disease, diabetes and often psychological issues in both adults and children. Also, an increasingly aging population comes with different nutritional concerns of swallowing difficulties, poor appetite, lack of help to eat and consequently the development of malnutrition1. Treatment of malnutrition costs the NHS ÂŁ13bn a year and represents an area where significant savings could be made. Recognition of clinical need through screening for malnutrition, improvement in food provision in hospital, nursing and residential care, practical feeding assistance and appropriate nutritional support from dietitians is needed. The Care Quality Commission highlights nutrition as fundamental in patient care2. Treatment options for obesity are diverse within the NHS and the private sector. Traditionally patients have been referred to a dietitian for one to one dietary advice. However, the rapid increase in overweight and obesity within the last generation has not matched an increase in qualified dietitians. We have had to look at more innovative ways of treating overweight and obesity, while still acknowledging that a one size

may have. This degree of weight loss would have been difficult to achieve form conventional weight loss strategies. It must be stressed that this is a lifelong change in diet and lifestyle to enable maintenance of this weight loss. If we are to ensure that the population achieve better nutritional status in years to come we need to ensure that there are enough experts in the field. Dietitians are key professionals qualified in food and nutrition and should be involved in the strategic development of nutrition policies and programmes for health improvement in your health trust. fits all solution is not the answer. There are now many health trusts within England that work closely with commercial slimming clubs referring patients for an agreed number of sessions to help them to lose weight3. These may also include exercise which can have a significant effect on improved self esteem and overall clinical benefit. For children specific groups such as MEND4 run sessions to address eating behaviour, improved food and nutrition knowledge to give children and their parents better skills around food choice. We realise, however, that for some patients bariatric surgery may be the most realistic option for treatment. When managed carefully with expert dietetic and medical intervention these patients can achieve clinically beneficial weight loss and reduce other co-morbid conditions they

References 1. BAPEN (2010) Malnutrition Matters Meeting Quality Standards in Nutritional Care. A Toolkit for Commissioners and Providers in England 2. Care Quality Commission. Guidance about Compliance, essential standards of quality and safety, 2009 3. www.slimmingworld.com/health professionals 4. www.mendprogramme.org

FOR MORE INFORMATION Contact: Alison Kyle, Nutrition 2Day, independent registered dietitan Tel: 01823 491105 Mobile: 07973 877000 E-mail: alidiet10@googlemail.com

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CONFERENCES & EVENTS

THE NORTH WEST: A DESTINATION WITH MUCH TO BOAST ABOUT Whether you are looking for urban or rural scenery, a relaxed or an energetic atmosphere, the North West of England can offer whatever you need for your next conference or event THE NORTH WEST is a region of contrast, from the cosmopolitan style and contemporary built environment of Manchester to the cultural credentials and architectural grandeur of Liverpool, the Roman and medieval heritage of Chester to the rolling hills of Lancashire and the stunning scenery around the Lake District. ART, CULTURE AND SPORT The region is celebrated for the range and wealth of its cultural assets with art collections, museums, theatres and music of international repute. Sport also plays a huge role, from international events and world-class venues to globally recognised clubs and renowned sporting personalities. In addition the region boasts some of the UK’s most beautiful and inspiring natural landscapes, with three official areas of outstanding natural beauty and 32 nature reserves. The region is currently home to the UK’s largest manufacturing sector with major strengths in aerospace and chemicals, it will also soon be Europe’s second largest media hub. It also boasts an internationally-recognised biomedical community and is a major player in the global nuclear energy market. The North West includes five dedicated regional conference bureaus which exist to support conference and event organisers in planning events. The conference bureaus each offer a free venue finding service and help with securing hotel accommodation, as well as advising and providing guidance on partner programmes and teambuilding activities. The individual regions are Manchester City Region, Liverpool City Region, Chester and Cheshire, Lancashire and Blackpool, and Cumbria. LANCASHIRE AND BLACKPOOL History and sport are set to make 2012 a record year as Lancashire and Blackpool Conferences & Meetings (LBCM) cement the region’s position as the UK’s most unusual and diverse business tourism destination. A combination of events are raising the area’s national profile. These include the unique Preston Guild celebrations, Preston becoming a European City of Sport and the region also hosting the 19th UK Corporate Games. One-off projects planned for the year include turning Preston’s Moor Park into a ‘Future City’, with a 5,000-seat temporary arena which will be available for conferences and exhibitions. Preston Guild 2012 will mark 833 years since King Henry initially granted a ‘Guild Merchant’

to Preston, allowing citizens with special rights the ability to control trade within the town. As a European City of Sport, Preston has ambitions to hold an international sporting conference and will also host Olympic teams in 2012 from countries including Thailand and Fiji. The 19th UK Corporate Games is Europe’s largest corporate multisport festival. It has been estimated that the games will boost the Lancashire and Blackpool economy by at least £3 million. The county is home to some of the most unusual, diverse and intriguing conference settings anywhere in the UK. These range from the world famous Pleasure Beach Blackpool Theme Park to the incredible Tree House Conference Suite at Ribby Hall Village conference venue, between Preston and Blackpool. The UK’s first floating conference centre is due to open in the heart of the brand new Brockholes nature reserve, just off the motorway on the outskirts of Preston in April. The area also provides the opportunity to combine a conference or meeting with golf, with venues such as Mytton Fold Hotel and Golf Complex having their own 18-hole course. CUMBRIA Whether you are holding a meeting for five or an annual conference for 500 delegates, then you may just wish to consider Carlisle and Cumbria as an ideal destination with an inspirational backdrop. Conference venues include luxurious hotels on tranquil lakesides, contemporary urban hotels, purpose built centres, country house retreats, state of the art visitor attractions, a spectacular racecourse and even a majestic castle. In addition to the wide variety of venues, bookers can also be confident in the quality on offer. All of the venues promoted by myplacecumbria are ‘AIM-Cumbria’ accredited, so you can be confident in your venue selection from your initial enquiry and check-in, right through to departure. myplacecumbria teamed up with the Meetings Industry Association (MIA) to launch the AIM (Accredited In Meetings) venue accreditation scheme in the county and it was the first such scheme of its kind in the UK. When it comes to teambuilding, it is the space, beauty and diversity of this region that lends itself perfectly to a wide variety of team-based events and activities. Enjoy unusual activities such as cooking lunch for your colleagues using nothing more than a NATO ration pack. Consider a ‘meeting with a mission’ or a ‘conference with a conscience.’

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CONFERENCES & EVENTS

Talk to the team and take your pick of teambuilding challenges that reflect elements of your corporate social responsibility. Dry stone walling, re-building fellside footpaths, hedge laying, bracken bashing or woodland management are just a few of the options available depending on your time, budget, numbers and of course, the season. Alternatively, for a fun filled adrenaline rush, consider ‘Go Ape!’ and zip-wire 120ft through trees, get wet with kayak orienteering on a spectacular lake, abseil into a redundant quarry, get muddy in the mountains with a mountain bike or go off-road in a 4x4. For the foodies out there why not enjoy the quality of Cumbria’s cuisine with a personal ‘Cumbria on a Plate’ food safari. Or arrange for a local chef to host your event and try the art of making Cumberland Sausage by hand from scratch, or have a go at ‘taste testing’ – could you identify a celery seed in a jar of marmalade? Superb venues and inspirational settings all combined with quality food and drink – surely, the perfect partners for a successful event. CHESTER Business tourism is one of Cheshire and Warrington’s key markets, with venues showing distinctiveness and choice. Recently there has been the creation of more than 966 new bedrooms, including the 85-bed ABode Chester. Cottons Hotel & Spa refurbished the Verandah Suite at a cost of £1 million whilst a £1.5 million development at Peckforton Castle included 11 additional bedrooms and spa treatment rooms. Arley Hall opened its Olympia conference facilities and Doubletree by Hilton Chester is also making a name for itself in the sector. Developments in the pipeline include Mere Golf & Country Club’s 83-bedroom development with spa and gym, opening in 2011 whilst Thornton Manor is building two permanent marquees for large events. During 2009/10, Chester and Cheshire Conference Bureau placed 78 events in Cheshire which contributed to over 8,000 delegates visiting the area with a delegate economic benefit of over £2.3 million.

The bureau expands its conferences through existing networks and universities under the Ambassadors Programme, and is in the process of supporting an ambassador to secure the International Conference of Equine Physiology; the 2010 event was held in South Africa. Maintaining cross-border relationships is essential; working with key partner destinations to ensure conferences they can’t accommodate are referred and vice versa. Chester and Cheshire Conference Bureau has the support of strategic partners including Virgin Trains, where the creation of new services. has resulted in greater access to Cheshire with train journeys of two hours to and from London. Working with partners such as Tatton Park and Chester Zoo provides added value packages for delegates in our bespoke Welcome Packs. We work hard to ensure local businesses are aware of, and make use of facilities that are on their own doorstep. MANCHESTER The city is enjoying a renaissance where innovation has found new uses for old buildings, where creativity is flourishing and where people and businesses want to be seen. There is a saying: “What Manchester does today, the world does tomorrow” and with just cause. Manchester makes history yet it still retains the intimacy and variety that makes old cities so successful, and ensures people feel welcome and valued. There is more to Manchester than meets the eye; it’s a city waiting to be discovered. From superb shopping areas, a hot-bed of cultural activity and exciting nightlife to stunning countryside, award-winning architecture and a vibrant history, Manchester really has everything. It is a city of great variety, showcasing both the historic and modern. Thanks to continued effort from the city’s venues – such as Manchester Central, the Point, University Place, and ongoing investment in hotel accommodation – Manchester continues to demonstrate its profile as a leading business tourism destination. Indeed, 2010 saw Manchester named as

the Best UK Destination by a panel of industry experts at International Confex and earlier the city was named third best conference destination in the world by the readers of Conference & Incentive Travel Europe magazine. Manchester is capable of accommodating all events from the most simple to the most demanding. The city offers an abundance of quality venues and accommodation for up to 19,000 delegates. Modern, purpose-built meeting and exhibition facilities contrasted with elegant refurbished Victorian buildings and dramatic out of the ordinary venues; whatever your requirements Manchester will provide the ideal back-drop for your event. Details of these venues can be found on the new Manchester website, www.visitmanchester. com/conference, which has been re-launched to bring the city’s business tourism online presence in sync with that of its leisure tourism site. Steven Small, head of business tourism added: “The new website is easy to use and doesn’t rely on gimmicks. It allows time-poor event organisers to gain an understanding of what Manchester has to offer. This includes an event planners tool-kit and general information about what there is to see and do in the city – which we know to be important when choosing a location for a conference or event.” In addition, the 2011 Manchester Conference Guide has been launched – the city’s long-standing reference for event organisers looking to hold an event in the city. Manchester is the first city in the UK to ensure that all of the venues in its guide have been assessed by Accredited in Meetings – the industry quality assurance scheme. To order your own copy of the new conference guide please log onto www.visitmanchester.com/conference

FOR MORE INFORMATION Lancashire & Blackpool: www.lancashireandblackpoolconference.com Cumbria: www.myplacecumbria.co.uk Chester and Cheshire: www.meetinchesterandcheshire.com Manchester: www.visitmanchester. com/conference

Everyone deserves a little lakeland luxury ET IN THE HEART of the fabulous English Lake District, The Ambleside Salutation Hotel is ideal for walking, sight seeing or simply relaxing. Offering richly appointed en-suite bedrooms, stylish lounge bar, and award winning breakfast, bistro area and restaurant offering fine local cuisine. Fantastic on site leisure facilities include Techno Gym, indoor pool, sauna, steam room, Canadian hot tub and an Oxley’s Blue Fish Spa for that ultimate pamper experience. Dine with us and enjoy our three course menu for just £23 including a bottle of

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LANDSCAPING & GROUNDSCARE

SKILLS FOR GROUNDSCARE The Institute of Groundsmanship explains why training is the key to successful groundscare THE INSTITUTE of Groundsmanship (IOG) has been recognised as a National Accredited Apprenticeship Provider, an accolade that is the latest piece in a comprehensive jigsaw of education and training services that are unmatched for their efficacy and costeffectiveness for all its clients – including those involved in more general groundscare such as maintaining the open areas within and around hospital grounds. With more than 10,000 grounds professionals benefiting during the past ten years alone from IOG training and education services (the institute has been offering training courses for 50 years), the IOG is already a City & Guilds/NPTC approved delivery body and a provider of qualifications and courses accredited in line with National Occupational Standards (Levels 1, 2, 3 and 4). FOR ALL SECTORS In addition to being attended by grounds professionals from across the sports spectrum, IOG training and education is increasingly being taken up by a swathe of public and

FROM BASIC TO ADVANCED He continues: “The training could start with the basics of operating hand-held and ride-on machinery, pesticide and fertiliser application then extend to a range of specialist maintenance procedures that will vary according to the type of ground you work at. “And as you progress in your career and become responsible for managing budgets, personnel and the purchase of machinery and products, as well as advising on and implementing annual maintenance programmes and renovations, the IOG continues to offer the appropriate training so that you are armed with skills to handle these tasks. “Today, we offer training and education that covers the complete gambit, starting with basic lawn care, and we are now also developing, for example, a Foundation Degree for Groundsmanship. “The result is that the IOG provides a onestop, end-to-end training and education service that will suit every need. And because not every course is work-based, with our Moodle virtual learning platform, students

Whether it is a local authority team or a specialist contractor providing a range of services for the NHS, for example, the rules remain the same for each individual: the better qualified you are then the better the chance of employment – and as your skills/career progresses, so the financial rewards should also increase proportionally – Ian Lacy, head of professional services, IOG private organisations covering all sports and amenity services, and embracing both the professional and volunteer sector. Ian Lacy, the IOG’s head of professional services, explains this is all for good reasons: “Whether it is a local authority team or a specialist contractor providing a range of services for the NHS, for example, the rules remain the same for each individual: the better qualified you are then the better the chance of employment – and as your skills/ career progresses, so the financial rewards should also increase proportionally. “There is, of course, a similar benefit for employers and their clients; a more highly trained and qualified workforce will generally lead to a greater amount of business opportunities while also providing clients with a very professional service.”

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can, in a number of cases, study at their own pace and in their own time.” Training (initially one-day courses) extends, for instance, from health and safety to the use of strimmers and mowers (pedestrian and ride-on) plus tractor driving and pesticide application. Also included here are short courses in weeds, pests, diseases and disorders, grass identification, drainage and synthetic surfaces. QUALIFICATIONS In terms of education, the IOG offers a variety of courses, including Key Skills (City & Guilds) and IOG National Practical Certificate. Also on offer are apprenticeships (including the IOG Young Apprentice Scheme), Level 2 and 3 horticulture sport turf qualifications – workbased or online – and an ongoing Continuing Professional Development programme.

Ian Lacy

Level 1 courses are suitable for anyone involved in practical grounds maintenance and are ideal as an introductory course for those new to the profession or as a refresher course for those who want to keep abreast of the latest techniques. Level 2 will be of particular benefit to those who have completed Level 1 or as a precursor for Level 3. Level 3 explains the management techniques and principles required by today’s experienced grounds staff to produce a safe and consistent surface. It will also build on technical knowledge in line with current processes and techniques. Level 3 will be of most benefit to those in senior positions and responsible for making assessments and decisions about the management of resources and the surface. OPEN TO EVERYONE “So, as can be seen,” concludes Ian Lacy, “the IOG offers a wide range of easily-accessible, affordable – and meaningful – options that are open to everyone wishing to take up a career in groundscare and to those already in the industry who are looking to progress.” Visit the website for comprehensive details, including training and education options, timescales and costs, as well as help and advice on career paths.

FOR MORE INFORMATION Web: www.iog.org

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LANDSCAPING & GROUNDSCARE

Commercial landscape maintenance and enhancement work VON LANDSCAPES LTD, established in 1985, undertakes commercial landscape maintenance and enhancement work on numerous sites throughout the south west. Clients currently include both Somerset and Wiltshire Primary Care Trusts. Avon Landscapes Ltd is experienced in all aspects of domestic and commercial landscaping. We also coordinate tree surgery and removal of large trees using qualified tree surgeons for this work. Plant material is sourced from reputable wholesalers, and we are able to implement schemes of any size, using the smallest shrub to large semi-mature trees imported from the continent when

organisations with whom we work. We are very proud of our excellent health and safety record.References are always available. Our membership of the British Association of Landscape Industries www.bali.org is your assurance that our work is consistently of a high standard. Please do not hesitate to contact us if you wish Avon Landscapes Ltd to provide a quotation for any of your projects, or maintenance contracts. Contact Phil Hargrave who will always be pleased to help.

necessary. There is no minimum contract value. We are a proactive company working to maintain both a high standard of workmanship as well as a considerate and cooperative approach to all individuals and

FOR MORE INFORMATION Tel: 01373 830789 Fax: 01373 830902 E-mail: avonlandscapes@btconnect.com

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