VOLUME 11.5
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CONFERENCES & EVENTS
INCENTIVES & REWARDS
PATIENT HANDLING
INFECTION CONTROL A top priority in Liverpool
ENERGY – Taking efficiency seriously to achieve a sustainable low carbon future
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’s full matrix high resolution dual colour range of signs, known as Pegasus, offer the health authorities, individual hospitals etc a flexible solution in three different character heights and in either landscape or portrait mode. 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.
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HEALTH BUSINESS MAGAZINE VOlumE 11.5
www.healthbusinessuk.net
CONFERENCES & EVENTS
INCENTIVES & REWARDS
PATIENT HANDlING
INFECTION CONTROl A top priority in Liverpool
ENERGY – Taking efficiency seriously to achieve a sustainable low carbon future
Comment
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DEAR READER The listening period has come to an end and the government has agreed to make changes to its controversial reforms as recommended by the NHS Future Forum. The Prime Minister announced that the revised plans will relax the 2013 deadline for the new GP commissioning arrangements to be introduced, and boost the role of other professionals such as hospital doctors and nurses alongside GPs. So the NHS will still change, which is needed in order to be able to cope with shifting demographics and lifestyles. For example, with the UK having the highest rates of obesity in Europe, and future cost of diseases related to overweight projected at £22.9 billion by 2050, obesity management must certainly be addressed. In order to treat obesity we need to not only identify its characteristics, we also need to understand the costs so that we can plan appropriately, discussed on page 39. The NHS also needs to make sure it receives value for money. However, the National Audit Office has said it has no grounds for confidence that the National programme for IT represents money well spent. We find out why on page 55. Enjoy the issue.
Sofie Lidefjard, Editor editorial@psigroupltd.co.uk
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226 High Rd, Loughton, Essex IG10 1ET. Tel: 020 8532 0055 Fax: 020 8532 0066 Web: www.psi-media.co.uk EDITOR Sofie Lidefjard ASSISTANT EDITOR Angela Pisanu PRODUCTION EDITOR Karl O’Sullivan PRODUCTION DESIGN Jacqueline Grist PRODUCTION CONTROL Julie White ADVERTISEMENT SALES Jasmina Zaveri, Lucy Rowland, Beverley Sennett, Kim Fouracre, Amanda Frodsham SALES ADMINISTRATION Jackie Carnochan, Martine Carnochan ADMINISTRATION Victoria Leftwich, Joanne Mackerness SALES SUPERVISOR Marina Grant PUBLISHER Karen Hopps GROUP PUBLISHER Barry Doyle REPRODUCTION & PRINT Argent Media
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Volume 11.5 | HEALTH BUSINESS MAGAZINE
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CONTENTS 07 NEWS 11 INFECTION CONTROL The Infection Prevention and Control team at Liverpool Community Health NHS Trust explains how it works to protect patients and staff from the spread of infection
15 LEGIONELLA PREVENTION The Water Management Society reports on the latest industrial and legislative developments in legionella control
18 PATIENT HANDLING Specially trained paramedics at South East Coast Ambulance Trust save lives and do so at lower cost than the alternatives
21 ENERGY In order to become a sustainable, low carbon society in the very near future, energy efficiency is the place to start, says the Energy Services and Technology Association
27 FACILITIES MANAGEMENT
37 CATERING
55 HEALTHCARE IT
The kitchens, wards and restaurant at Musgrove Park Hospital in Taunton have been recognised by the Food Standards Agency for their health, safety and hygiene standards
A National Audit Office report has said the National programme for IT is not achieving value for money. Why is this?
39 OBESITY MANAGEMENT In order to treat obesity we need to not only identify its characteristics, we also need to understand the costs so that we can plan appropriately
Balancing the needs of patients and visitors, staff and healthcare professionals to ensure access to fair and cost-effective facilities requires courage and determination, says the British Parking Association
41 INCENTIVES & REWARDS
60 FLEET MANAGEMENT
Gift cards and vouchers can play a valuable role in the success of motivation schemes, says the UK Gift Card & Voucher Association
The Royal Society for the Prevention of Accidents highlights the importance of managing occupational road risk
45 CONFERENCES & EVENTS With a warm welcome, fine food and drink, and venues to suit all budgets and tastes, Scotland is a great place to do healthcare business
59 PARKING
63 ASBESTOS MANAGEMENT Asbestos is the single greatest cause of work-related deaths in the UK. How do you protect your staff against it?
64 LANDSCAPING & GROUNDSCARE
50 TRAINING
We get an insight into a day in the life of a supplier trying to tender for an NHS contract
Why is it essential in the current economic climate to invest in the wellbeing of staff working within the NHS?
33 FIRE SAFETY
53 RECRUITMENT
The Association for Specialist Fire Protection highlights the many factors that need to be considered in undertaking a fire risk assessment in healthcare buildings
Contents
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Charity Learning through Landscapes looks at ways in which hospitals could transform their outdoor environments as spaces for children to enjoy and develop within
Despite media reports it’s not all doom and gloom when it comes to the state of jobs and recruitment in the healthcare sector
Health Business Magazine
www.healthbusinessuk.net Volume 11.5 | HEALTH BUSINESS MAGAZINE
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TRAINING
New clinical skills centre trains Yorkshire’s future healthcare staff
News
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NEWS IN BRIEF Airedale launches video consultation service Patients living in Grassington can now see a hospital consultant in their local community centre thanks to the wonders of video technology. Airedale NHS Foundation Trust has placed telemedicine equipment in a private room within the village’s newly opened community hub to carry out follow up consultations. TO READ MORE PLEASE VISIT...
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Telehealth technology empowers heart failure patients in Liverpool Practice educator for theatres, Andy Sykes and consultant anaesthetist, Dr Jill Horn, preparing for training in the new simulation centre.
A Technical Skills Laboratory and Simulation Centre, which will train Yorkshire’s future doctors, nurses and dentists, has been officially opened at the Bradford Royal Infirmary by Professor Sir Christopher Edwards, chairman of NHS Medical Education England. The Technical Skills Laboratory, which cost £485,000, provides high-tech facilities for the teaching of advanced surgical techniques across a range of medical specialties and the unit is dedicated to the advancement of medical training. A smaller seminar room equipped with six dental head simulators will train dentists and related staff. The Simulation Centre, built at a cost of more than £245,000, consists of several simulated
ORTHOPAEDIC TREATMENT £21.5m to speed up orthopaedic treatment Funding worth up to £21.5m will be made available for the NHS to cut orthopaedic waiting times this year, Welsh Health Minister Lesley Griffiths has announced. Lesley Griffiths said: “This is not a quick fix – the funding will be used to bring about a sustainable service model over the next three years but in the short term we need to increase orthopaedic capacity and reduce the backlog that has built up. “As of last March, 4,361 orthopaedic patients were waiting longer than 36 weeks but we anticipate that by the end of March next year the vast majority of these patients will have been removed from the list.” Where there is agreement between clinicians and patients, some orthopaedic patients will also be transferred to a neighbouring Health Board for faster treatment if the waiting time in their Health Board area is in excess of targets. It means that long orthopaedic waits will be all but eliminated by the end of March 2012. TO READ MORE... www.healthbusinessuk.net/n/009
clinical environments including a four-bedded ward complete with hoist; a multi-purpose room which can replicate a patient’s home; a clinician’s consulting room; a discussion room, and a modern operating theatre plus resuscitation area where students and teachers can recreate real-life medical scenarios. Training performances in the theatre can be viewed from an adjacent seminar room via one-way viewing glass. General manager for education, Maria Neary, said: “Team-working and clinical skills can all be assessed within the safety of the centre and the potential for this facility continues to grow with fire safety, domestic and other forms of non-clinical training already being explored.”
Changes to mealtimes for patients at NNUH The Norfolk and Norwich University Hospital is trialling new menus for hospital in-patients using local suppliers. The introduction of an afternoon tea and snack is being used to encourage patients to eat regularly throughout the day. Freshly baked scones, pastries and sandwiches are being provided by Norfolk bakery Linzers for the lunch and afternoon tea. Fresh fruit is also available at all meal times. Following discussions with patients and their representatives, lunchtime and evening meals have been switched. A lighter meal is served at lunchtime, followed by an afternoon tea and snack between 2-3pm and then more substantial evening meal at 5-7pm. Director of nursing Nick Coveney says: “The menu changes have been very positively received and it is part of a wider plan to encourage patients to eat well. Early evening is a more relaxed time in the hospital when patients can take their time to eat and family members can be involved in the meal time routine if they wish.”
Heart failure patients in Liverpool are some of the first to test drive a new scheme where their health is monitored via a set top box. The new technology sits on top of the television and patients make their own checks, such as blood pressure and weight. Results are sent via broadband to the team at Liverpool Community Health NHS Trust.
New group to provide extra support for dementia patients in Shrewsbury The Shrewsbury and Telford Hospital NHS Trust has set up a new group to help improve the care provided to patients with dementia and other patients with extra support needs. The group includes a carer representative, representatives from the Alzheimer’s Society and other patient groups, trust staff and staff from local NHS organisations and local authorities.
Government urged to publish information strategy BCS Health, part of BCS, The Chartered Institute for IT, is urging the Department of Health to publish its information strategy as soon as possible. Concerned that the information strategy has been caught up in the listening period, Matthew Swindells, chair of BCS Health, said: “The NHS cannot deliver 20 per cent productivity improvements whilst maintaining quality and access without the use of information technology.” TO READ MORE PLEASE VISIT...
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Volume 11.5 | HEALTH BUSINESS MAGAZINE
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PROCUREMENT
New standardised bar codes will make millions in efficiency savings A new system to tackle variation in how much NHS hospitals pay for products has been announced by Health Minister Simon Burns. Currently some hospitals are paying nearly three times as much as others for the same products like surgical gloves and stents. Introducing a fairer and more transparent bar code system will lead to significant savings for the NHS in a market which currently costs it up to £6 billion annually. The minister said: “The NHS cannot afford to continue paying different prices for the same products. By simply using bar codes, NHS procurement will become more efficient as organisations can see how much they are paying for products compared to others. It’s a simple idea that could
save the NHS millions. “Most importantly this is a vital opportunity to save money for reinvestment in front-line care at a time when the NHS needs to make efficiency savings.” Currently there are a multitude of systems and approaches for procurement resulting in a lack of consistent information. For the first time standard ‘GS-1’ bar codes on products will be used across the NHS making it easier to track and compare purchases. It also has potential to improve patient safety. Bar coding systems have been shown to reduce medication errors, the risk of wrong-site surgery and the effective tracking and tracing of surgical instruments, equipment and other devices to improve record keeping and reduce error, malfunction and contamination.
PARKING
Car parking concessions extended in Hertfordshire Concessionary car parking for patients and visitors has been extended on all three of West Hertfordshire Hospitals NHS Trust’s hospitals sites, Watford General Hospital, St Albans City Hospital and Hemel Hempstead Hospital. From 1 July 2011, there will be a reduced parking rate for patients and visitors who are attending any ward or department on a frequent or long term basis and to relatives who are actively participating in the care of a patient who is staying on a hospital ward.
Chief executive Jan Filochowski said: “Our patients and their relatives have told us that they felt that the reduced parking charges offered by the trust were not broad enough. We have therefore reviewed the concessions and introduced a system that covers a wider range of patients, their carers and their visitors” “As well as the concessionary parking rates, there is free parking for disabled users and free 30 minute parking bays on each of it hospital sites.”
News
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NEWS IN BRIEF Call for greater continuity of care in general practice Keeping general practice familiar and local improves continuity of care and can tackle health inequalities more effectively, says a new Policy Paper from the Royal College of General Practitioners (RCGP). Written by dr Alison Hill and professor George Freeman, ‘Promoting Continuity of Care in General Practice’ outlines the evidence of the cost-effectiveness of general practice, citing the fact that one day’s GP care is equivalent in cost to one tenth of a day in hospital. RCGP chair dr Clare Gerada said: “High-quality general practice care is the best of most cost-effective way of delivering health services to patients. I welcome this new policy paper, and urge policy-makers, practices, managers and commissioners to take its recommendations on board for the good of our patients and for the advancement of the excellent care that general practitioners provide.”
Fall in healthcare associated infections in Cumbria Clinical staff at north Cumbria’s two hospitals are continuing to win the battle against infection, with no cases of MRSA for over a year, latest figures show. Hard work by clinical teams to minimise infections means there have been no post-48 hour MRSA bacteraemia for 12 months at West Cumberland Hospital in Whitehaven, and at the Cumberland Infirmary in Carlisle. The trust is also performing very well on C.diff, with only 57 cases of the infection in the last financial year against a target of 160.
Celebrity chef gets behind supplier event for local food producers Celebrity chef James Martin is encouraging local food businesses from across the Scarborough, Whitby, Bridlington and Ryedale region to attend an informal event, where they can find out more about how to bid for the future provision of food products to Scarborough and North East Yorkshire Healthcare NHS Trust. The Saturday Kitchen presenter is currently working alongside chefs at Scarborough Hospital to change the way hospital food is created, in a week long special series for BBC One Daytime, to be broadcast in the autumn.
Booklet designed to improve communications for London’s ambulance staff The London Ambulance Service has helped produce a booklet to improve the way frontline staff interact with patients who have difficulties communicating. “A hospital communication guide had already been produced, but there was nothing on the market for the pre-hospital setting,” said practice learning manager Alan Taylor, who helped develop the book. “The guide has pictures and words to help the patient explain what has happened to them and the ambulance staff to explain how they are going to treat the patient.” The book, which was produced with The Clear Communication People, also contains guidance for staff on supporting patients with hearing and visual impairments, deafblind, guiding people and assistance dogs. It also enables patients who have communication difficulties to give or TO READ MORE PLEASE VISIT... withhold their consent www.healthbusinessuk.net/n/012 to be treated.
Volume 11.5 | HEALTH BUSINESS MAGAZINE
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Infection Control
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BEST PRACTICE
SPREADING THE WORD, NOT THE INFECTION Emma Goodier, Infection Prevention and Control nurse at Liverpool Community Health NHS Trust, shares her team’s experience in the area of infection prevention and control Infection Prevention and Control (IP&C) is a priority for anyone working in the healthcare service. Whether a hospital or a community health organisation, all are striving to ensure they follow best practice and protect patients and staff from the spread of infection. Guidelines from the Health and Social care act 2008 (2010), from the National Institute of Clinical Excellence (NICE), and national targets on reducing Methicillin Resistant Staphcoccous Aureus (MRSA) and Clostridium Difficile only drive the importance of IP&C more. Organisations are keen to meet these targets and avoid any cases of infection spread, which can be detrimental for individual patient care
in quickly assessing compliance with IP&C guidance along with issues that require further actions to remedy problems. In 2010 all care homes within the LCH footprint were audited using an audit tool utilising the criterion specified in the Health and Social care act 2008 (DOH 2010). This audit plan proved successful in forging links between care home staff and the IP&C team, which later proved useful when investigating outbreaks of infection of the seasonal bug Norovirus, which affected some of the care homes along with the wider community this year. More recently the team completed a
IP&C in a community health setting presents its own challenges, with the focus very much on preventing the spread of infection in shared care settings of care homes, patients’ own homes, GP surgeries and health centres. and trust or organisation reputation alike. Not surprisingly at Liverpool Community Health NHS Trust (LCH) IP&C is one of our top priorities and we have invested in a dedicated team of nurses whose job it is to advise community staff and the general public on how to prevent infection. The team includes a lead nurse, four IP&C nurses, a dental IP&C nurse, a surveillance nurse and an administrator. IP&C in a community health setting presents its own challenges, with the focus very much on reducing risk and preventing the spread of infection in shared care settings of care homes, patients’ own homes, GP surgeries and health centres. INFECTION CONTROL AUDITS Infection control audits carried out by the team at LCH find out what the issues are and how we can correct them to minimise the spread of infection. We carry out these audits for all LCH premises where patient care is delivered: care homes, GP surgeries and dental practices. The aim of the audits is to assess compliance with IP&C policies and guidelines, determine the state of the environment and review clinical practice in relation to IP&C. We’ve used the audit system throughout the organisation and it has proved beneficial
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detailed audit of Liverpool’s 60 independent NHS contracted dental practices and 10 community based practices. These practices have had to comply with new dental guidance the HTM 01-05. This is a document that has been released by the Department of Health to offer guidance in relation to decontamination in dental health. All practices were visited by the dental infection control nurse and using the Infection Prevention Society (IPS) audit tool, were left with an action plan and a score indicating compliance with the tool. This audit revealed some interesting findings; it became apparent from the baseline audits that training was a big issue within dental practices. Many dental professionals had not received IP&C training since qualifying and this was something that needed to be addressed quickly. TRAINING The training of staff is key to IP&C. Often it is only simple standards that need to be maintained in order to prevent infection spreading. Hand hygiene has been highlighted as the single most important measure in preventing the spread of infection. As a team we promote the Ayliffe hand hygiene technique, which was also highlighted within the cleanyourhands campaign. This
is basically the simple principle of ensuring staff wash all parts of their hands and that they wash them at the correct time when delivering care. This is monitored through a peer to peer audit programme, where work colleagues in a team ensure they are each following the correct procedures. Following on from the audit cycle undertaken in the care homes we developed an IP&C training programme, which has been delivered to care home staff, both qualified and unqualified. This was well received by those who attended and again it was particularly helpful in managing outbreaks of infection of the winter vomiting virus (Norovirus). The principles taught on the training session were put into practice by the care home staff. Our recent work with the dental practices showed the value of training. All dental practices were initially offered two places on a three-day training programme, which covered standard precautions such as hand washing, basic microbiology, clinical governance and decontamination. The original training was reduced to two days as more practices implemented change within their workplace. Following on from the original audit a re-visit took place; the improvements made following the training were dramatic, with most dental clinics exhibiting best practice in infection control, scoring more than 90 per cent for their compliance levels within the HTM 01-05 guidance. SURVEILLANCE As part of our best practice in IP&C we have been carefully monitoring the number and type of infections occurring in the community and investigating any potential causes of infection. Infection issues such as MRSA blood stream infection (bacteraemia) and C.diff are a key focus for this year. Any cases that do occur are investigated to see what can be learned to ensure it doesn’t happen again. The trust has a target that must not be exceeded this year for these two serious infections set by the Strategic Health Authority. The challenges we have faced as a team are typical of the issues many IP&C teams have to address when working in a community health setting. One of the key problems of the organisation is to update our current building to ensure it is fit for purpose from an IP&C perspective. There has been a change in healthcare in recent years with a move towards only acutely E
E ill patients being hospitalised, reducing the number of hospital beds with other services being available to the public within the community health setting. Services provided by the trust now include intravenous therapy, minor surgery, X-ray and wound care. These procedures require environments that are clean, safe and fit for purpose. Some buildings used by the organisation were out-dated and not designed for the services we offer now. In recent years the team have been auditing all the buildings where care by LCH staff is given to assess risk and recommend required refurbishing to provide the right environments for clinical procedures carried out within the community. As a result of these audits, IP&C buildings guidance and work with developers has ensured many of our buildings now include newlydesigned rooms which can provide a safe setting for more high risk clinical work. The IP&C team are now more involved in new property developments by the trust and we are an active part of the consultation process, working with architects and healthcare managers to ensure new buildings constructed are fit for 21st century community health services. Another key challenge is the provision of domiciliary care. We have many patients who are housebound or in care homes, unable
to attend treatment centres for clinical care. Domiciliary teams such as district nurses, podiatry and dental, provide care in patient homes. In these environments it is much more difficult to manage the environment in which staff are working and to put infection control procedures in place. Education and training is vital, making sure staff are up to date with the latest in IP&C best practice. TARGETS/PERFORMANCE INDICATORS In 2010/11 as a community trust, we met our target relating to Clostridium Difficile infection of fewer than 310 cases. The 2011/12 target is 204 cases – a 34.2 per cent reduction from the previous year. This target is a challenge for the team. The 2010/11 target for MRSA bacteraemia infection was narrowly missed by just one case. The 2011/12 target is to decrease this incidence by 18.8 per cent, which equates to 13 cases. These targets are set by the Strategic Health Authority to all trusts on a yearly basis. The 2011/12 work specification for the IP&C team has been devised to target these areas of infection with the aim of reducing the incidence and meeting targets being set. The teams plan to introduce a decolonisation regime within care homes for patients returning home from inpatient settings found
to be MRSA positive. These are at increased risk due to the presence of indwelling devices, such as urinary catheters, entral feeding tubes or the presence of a wound. We are launching IP&C practice audits to defined groups of healthcare staff, to provided assurance that IP&C practices are to be undertaken and cleanliness audits at all healthcare sites using criteria will be carried out by individual buildings managers to ensure standards of cleanliness are maintained. The team will also implement a detailed ‘Root Cause Analysis’ (RCA) investigation of Clostridium Difficile, MRSA, MSSA (Methicillin Sensitive Staphcoccous Aureus) and E-Coli bacteraemia infections. This will establish cause and produce action plans and lessons learnt. These will then be circulated to the wider health economy. We are also auditing all independent GP practices in the LCH footprint to ensure environments are fit for the delivery of healthcare. Our clinical mandatory training has also been changed to every two years instead of three, in line with an agreed north west training schedule. Staff will therefore receive training more regularly, ensuring standards of infection control are at their highest. L
Infection Control
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FOR MORE INFORMATION www.liverpoolcommunityhealth.nhs.uk
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CLEAnER HEALTHCARE nOw
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Infection Control
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Innovative low concentration hydrogen peroxide dry-mist vapour technology has helped Royal Liverpool and Broadgreen University Hospital NHS Trust become one of the best performing trusts in the country for infection prevention Royal Liverpool and Broadgreen University Hospitals NHS Trust has embraced low concentration hydrogen peroxide drymist vapour technology solution from Advanced Sterilization Products (ASP) as part of its rapid response initiative to C.diff and as a managed service element of a major ward deep clean programme. Hotel services manager Jacqui Pennington explained: “As part of our national deep clean programme commencing in December 2007 we chose to utilise part of the funding to purchase five GLOSAIR™ hydrogen peroxide vapour machines and operate them as part of the facilities contract. We looked at the options available at the time and chose the dry-mist hydrogen peroxide vapour solution.” SIMPLE & EFFECTIVE The trust has four HPV machines at Royal Liverpool and one at Broadgreen, all operated by facilities services provider ISS Facility Services - Healthcare. Jacqui added: “ISS has embraced the use of HPV – it’s a simple, effective solution. The trust sat in on the training and it was very clear that having programmed the machines ourselves based on cubic meterage information provided by estates it only then required a two-button manoeuvre to operate.” In addition to the national deep clean programme and as a further infection prevention and control measure the trust developed and funded a rapid response 24/7 cleaning team, again through ISS Facility Services - Healthcare. Working under the direction of the patient flow team, its sole purpose is to terminally clean after a patient with infection, including the use of HPV technology in cases of C.diff. It’s now part of the day-to-day operational routine. Where appropriate and following thorough cleaning, the ISS team employs the low concentration hydrogen peroxide drymist vapour technology, which consists of a vapourising cycle dependent on room size and two-hour contact time. The room is then available as the safest possible environment for the next patient. DEEP CLEAN In a recent initiative, 12 wards at Royal Liverpool and three at Broadgreen underwent a programme of deep cleaning, which includes estates work, cleaning and HPV. The three-week, rolling schedule of work for each ward, comprised a two-week
phase for estates work and one week for deep clean and the HPV phase. A managed service operated by ASP deployed multiple HPV machines to complete the final part of the programme delivering its GLOSAIR™ low concentration hydrogen peroxide dry-mist vapour technology, using the same make of machine that’s operated by the rapid response team. Jacqui said: “Our deep cleans have always included HPVing, but with the size of the recent programme we acknowledged that we would not be able to undertake this ourselves. We went for a managed service because of the number of machines and manpower required, and the time frames within which to complete. “We contacted current operators of HPV managed services and chose ASP. Cost was a factor and the confidence in the company, the equipment and the people. ASP is part of the Johnson & Johnson Family of companies, a large established and renowned organisation.” Jacqui added: “We’ve got a deep clean programme and certain parts can overrun – due to estates work for example. We keep ASP up to date and they’ve been very accommodating, very helpful in working around this. They’re part of the team.” The advantage of the process is that you can leave furniture, curtains and medical equipment in place to be decontaminated due to the low level of
hydrogen peroxide in the dry-mist. The GLOSAIR™ 400 area decontamination system uses a combination of hydrogen peroxide and silver cations to rapidly disinfect surfaces requiring a reduced bioburden, without leaving any toxic residues. The machines ensure there’s an even spread of the disinfectant throughout the ward and there’s full traceability of the process. IMPROVED INFECTION CONTROL Commenting on the trust’s infection control initiatives, Diane Wake, director of infection prevention and control, said: “Patients can be reassured that we are continuing to see significant falls in the number of C.diff and MRSA cases. We have halved our C.diff rates in the last year. With a greater emphasis on cleaning and cleaning standards, and the use of innovative solutions as provided by ASP, we have made tackling hospital infections our top priority and our current performance clearly show that our efforts are making a huge difference; we have gone from being one of the poorest to one of the best performing trusts in the country for infection control.” L FOR MORE INFORMATION For further information on GLOSAIR™ call ASP 01344 871081 or e-mail glosairukie@its.jnj.com or visit our website at www.aspjj.com/emea
Volume 11.5 | HEALTH BUSINESS MAGAZINE
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Legionella Specialist in CQC, HTM 01-05 Compliance and Training.
For more details, call Julie or Shafik on 01704 834 477 or send e-mail to julie@brodexuk.com or shafik@brodexuk.com
knock-on effects are part of everyday life and must be accommodated. At risk of sounding like the outsider “who knows exactly what is wrong with healthcare in this country” or a junior manager fresh from a motivate-yourstaff course, they can be an opportunity, or at least a powerful motive for re-examining and rationalising activities that may no longer be as appropriate as when they were established. For example, countless hours and doubtless millions of pounds are spent each month on flushing cold and hot taps at sentinel points for two minutes and one minute respectively to ensure the temperature falls below 20°C or increases to more than 50°C, then more time is spent recording this information and some more in reviewing and auditing it because L8 and HTM 04-01 say so. What HTM 04-01 also says is that the computerised building management system (BMS) should continuously monitor the temperature of the cold water entering the building and of the hot water leaving the calorifiers, and that this schedule is recommended; what L8 says is that the frequency and extent of routine monitoring will depend on the operating characteristics of the system, but should be at least weekly. So these two guides, whose authority is often regarded as bordering on being compulsory, provide real scope for options based on the individual characteristics of the systems and their performance and also a clue as to how it might be achieved at least as well as, if not better than, in the conventional way by means of automatic monitoring and recording.
RISK MANAGEMENT
FLUSHING OUT IRRATIONAL JUDGEMENT Giles Green, chairman of the Water Management Society’s technical committee, reports on the latest industrial and legislative developments in the area of legionella control The Water Management Society first addressed the issue of legionella control in Health Business some months ago and explained that this wholly preventable disease is not going away. The article also considered some of the special difficulties in healthcare premises, in particular the difference between design concept and operational reality, the high incidence of susceptibility of those exposed and the conflict inherent in scaldsafe and legionella-safe water temperatures. What has happened in the meantime is that always-stretched budgets have
come under greater pressure and a successful prosecution has been brought under the Corporate Manslaughter and Corporate Homicide Act 2007. What has not happened (despite assurances from on high that the beast would be tamed) is there has not been any substantive reduction in duties and responsibilities under health and safety law. COMMON SENSE APPROACH Over-stretched or reduced budgets, demands for efficiency savings and managing the
Legionella Prevention
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SMARTER APPROACH BMSs have been in routine use for decades. The writer can recall an early one in the estates manager’s office in a large general hospital in 1985 and that was quite smart enough to sound an alarm when a theatre temperature or humidity was out of range and to make adjustments by tapping a few keys. In the succeeding quarter of a century, computing has progressed more than somewhat and today much more powerful systems are not only available, but commonplace, so would it be possible, practicable and economic to use the BMS to perform much of the routine monitoring? If the answer to that is not known, perhaps it should be and whilst considering the matter, could the BMS also be used to examine the results and raise an alarm if any are outside their control limits? This simple change in approach could convert a labour-intensive and intrusive monthly routine into a much less frequent one of checking the calibration of sensors. No doubt there is a set up cost, both in hardware and software, but there are suppliers who will provide for free and recoup their costs over a contract of a few years, quite possibly saving the estates manager money at the same time as making a profit for themselves. So would such an approach be acceptable in light of the HTM and L8? E
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RISK MANAGEMENT E The simple answer to that is maybe. It is self-evident that very high risk areas should not brook any compromise, whilst many lower risk areas might be able to afford a little less scrutiny, but how many very high risk areas are in fact correctly operated to minimise risk in practice? For example, ITU patients do not get out of bed to use the toilet or get a drink or to sit down to a hearty meal, so why are there so often washbasins throughout the wards? Surely removing those would eliminate completely the water that could carry legionella and put them at risk, but this is seldom done, the washbasins remain and either show up on an underused installation list to be flushed (generating an aerosol of stale water where there are highly susceptible individuals), or missed. At the opposite extreme, there are places where the risk is so low that any monitoring might be considered to be a waste of resources – consider a self-contained small building such as a gatehouse or satellite office with mains water and an under sink water heater serving a single WC and tea station. These, however, are invariably included in the monitoring regime “to be on the safe side” or perhaps because “you might as well, while you’re doing it everywhere else”. In between these two extremes there are many systems and areas that are subject to the model regime of checks set out in L8 and the HTM, not because the risk assessment indicates the need, rather because it is the custom. Indeed many risk assessments do not address the question of monitoring frequency and when they do, they seldom advocate less than L8 recommends, whilst some make a great deal of fuss over a few rust spots or a sprinkling of sediment in a cold water tank or cold water at a washbasin that is a fraction of a degree warmer than the target. This is not to say that the guidance should be disregarded, it most certainly should not, but it is important to apply reason and common sense to differentiate between the areas where a standard regime is sensible, where it is too little and where it is too much. This last situation is the most difficult, because it places a substantial responsibility on the individual. However, that is surely part of the purpose of the risk assessment and surely it is part of the responsibility which gives the responsible person that title. CASE FOR PROSECUTION Then there is the matter of corporate manslaughter. When the act entered the public domain, concerns were expressed in some quarters that it seemed to enable the courts to punish a business so severely that it would be destroyed. No doubt others viewed the same facility and concluded that it was exactly what was required to prevent negligence, which common sense dictated should be criminal, from going unpunished for want of a clear mechanism to pin the blame somewhere. It is not for the Water Management Society to proffer a view on that debate.
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The message is that the time for unthinking adherence to generic regimes, not using the risk assessment to assess the risk and inform rational judgment has passed and that seriously unprofessional behaviour which leads to tragedy will be seen for what it is and punished accordingly. However, it can report that prior to the act there were several attempts to prosecute a manslaughter charge for deaths from legionnaires’ disease, all of which failed. Again, it is not appropriate to comment here on whether or not justice was done in these cases, but clearly it was believed to be in the public interest to pursue these cases. The technical difficulties with manslaughter when there is a business involved, stem from it being a charge against an individual, when the actions or omissions that led to the death were by more than one individual or by an individual with little or no understanding of the consequences and little or no discretion; the Corporate Manslaughter Act changes that by placing responsibility on directors and managers and not only senior managers. The first successful prosecution was nothing to do with legionella or even water, it involved the collapse of an unsupported trench onto a worker, but the penalty and the judge’s comments suggest the court quite deliberately set out to destroy the business. The fine was £385,000 payable
over ten years by a company that reportedly employs four people and is only marginally profitable. The judge, Mr Justice Field, is quoted as saying: “It may well be that the fine in the terms of its payment will put this company into liquidation. If that is the case it’s unfortunate but unavoidable… it’s the consequence of the serious breach.” So what is the message in all this? Go out on a limb on legionella control, take liberties with the regime advocated by the Health and Safety Executive and Department of Health, but look out because if you get it wrong, the courts might take a very dim view indeed? No, the message is that the time for unthinking adherence to generic regimes, not using the risk assessment to assess the risk and inform rational judgment has passed and that seriously unprofessional behaviour which leads to tragedy will be seen for what it is and punished accordingly. L FOR MORE INFORMATION Tel: 01827 289558 www.wmsoc.org.uk
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Patient Handling
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TRAUMA CARE
PARAMEDIC ROLE MORE VALUABLE THAN EVER A study of specially-trained critical care paramedics (CCPs) at South East Coast Ambulance Trust reveals that they not only save lives, but they do so at a lower cost than the alternatives New advanced paramedics will save more lives and cut costs according to a study from the NHS Confederation. The study looked at the use of paramedics at the South East Coast Ambulance Trust called critical care paramedics (CCPs). These advanced paramedics have been given extra training to deal with the most acute cases such as serious car crashes and strokes. COST BENEFIT ANALYSIS A cost benefit analysis in the study shows that the introduction of CCPs helps reduce avoidable deaths and saves lives. It also shows that they offer much better value for money. The study’s analysis sets out the value of life saved using CCPs is just over £34,000 – more than £200,000 less than an equivalent doctor-led team. CCPs would also easily pass the National Institute for
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HEALTH BUSINESS MAGAZINE Volume | 11.5
Health and Clinical Excellence’s (NICE) cost effectiveness standards for a new treatment. The trust trained 25 CCPs with the skills needed to use a wider range of drugs and advanced airway management. They focus on the most urgent of cases in teams that allow for better coordination with local acute hospital services. The CCP initiative is based on a model of care developed in Melbourne, Australia
that saw paramedics with advanced clinical skills being used on ambulances. Such paramedic-led systems have higher survival rates for trauma patients – up to 20 per cent higher in North America, for example. HIGH QUALITY CARE The CCP model is just one example of ambulance services using the advanced clinical skills of their staff to give patients E
Critical care paramedics are part of the future of the ambulance service where patients get high quality clinical care rather than stabilised and taken to the nearest A&E department. As a result, lives are being saved that otherwise would not be.
We have reached an important point in the development of the CCP and have a much clearer insight into the all-important health economic aspects of the initiative thanks to this work. We must now develop our CCPs to their full patient care potential in order to continuously improve outcomes for this key group of patients. E high quality care. The NHS Confederation believes this study will make important reading for new GP-based commissioners. Jo Webber, director of the Ambulance Service Network, said: “Critical care paramedics are part of the future of the ambulance service where patients get high quality clinical care rather than stabilised and taken to the nearest A&E department. As a result of this work, lives are being saved that otherwise would not be. Increasingly, ambulance trusts up and down the country are looking to use specially-skilled clinicians to provide high quality care to patients, coordinated with the rest of the NHS. “Our report highlights not only that lives are being saved but also that this is an extremely cost-effective way of
providing care. The clinical capabilities of a modern ambulance service are constantly growing and this report offers an insight into what ambulance trusts are doing to improve the quality of care for patients. “As the NHS sets about an extremely ambitious set of reforms, it is vital for policy makers and commissioners to realise that good care for the most acute services requires integration between hospital, ambulance and other related services.” IMPROVING OUTCOMES Professor Andy Newton, consultant paramedic and South East Coast Ambulance Trust’s director of Clinical Operations, said: “We know as the NHS we must
improve the care we provide to critically ill and injured patients. Research suggests that, nationally, between 450 and 770 trauma-related deaths are avoidable. This in our view is simply unacceptable. “We therefore wanted to develop an initiative to improve the care we provide to these patients, thus improving their outcomes, and so the CCP role was born. We are therefore delighted that the Confederation’s report recognises the benefits of this key paramedic role in improving outcomes for the critically ill and injured. DEVELOPMENT “We have reached an important point in the development of the CCP and have a much clearer insight into the all-important health economic aspects of the initiative thanks to this work. We must now develop our CCPs to their full patient care potential in order to continuously improve outcomes for this key group of patients, while also undertaking further research and evaluation to better understand the contribution and advantages such innovations in patient care can bring to the communities we serve, and the NHS.” L
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FOR MORE INFORMATION www.nhsconfed.org/networks/ ambulanceservice
Sites Ambulance Service – working for the care of the patient Sites Ambulance Service is successful because all of our staff are dedicated, keen and enjoy their roles and responsibilities giving our clients the best service. Our aims are to provide a safe and friendly environment that will ensure, so far as is reasonably practicable, the health and safety of our patients, staff and to comply with all statutory provisions for their health and safety. Sites Ambulance Service can offer private patients, hospitals, doctors surgeries, NHS Trusts, organisations and individuals, a reliable, high-quality, and cost-effective ambulance service for all medical purposes and event coverage. Our services include first aid, wheel chair transportation, intensive care transportation,
organ transportation, medical crew transportation, patient recovery, repatriation, patient transport service, blue light emergency work and medical coverage for all types of events including TV and film sets, sporting events, fetes and other occassions. Our motto: Without the clients we wouldn’t have the staff, without the staff we wouldn’t have a company so lets look after them all to be a successful ambulance service. We are a member of the British Ambulance Association and abide by its standards and have been inspected and approved. FOR MORE INFORMATION Please see our website for full details of our services www.ambulancesites.co.uk or contact us on 0845 0171129
Who Cares? We Care! Southern Country Ambulance Service is a family run CQC registered private ambulance provider serving the south of England from our base in Micheldever, Hampshire. We provide uniformed qualified crews on equipped stretcher and wheelchair accessible ambulances. Our focus is on providing our clients / patients with a friendly, professional and personal service, attending to each individual’s requirements throughout their transfer.
An example of what we offer: NHS and private hospitals and clinics Non-emergency patient transport services (PTS) Outpatient appointments, Patient discharges, hospital to hospital transfers and admissions n Local and long distance n HDU/ICU/ITU Transfers, Mental health Transfers/ admissions n Private patients, solicitors, social services and insurance companies n Special requests, Organ transfers, Air Ambulance support And more.... n n
Fax: 01962 774260, E-mail: scas999@yahoo.co.uk Highways House, Micheldever, Winchester, Hampshire, SO21 3DW
CQC Registered. Cert No.1-261222958 & British Ambulance Association. Member No.12
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EFFICIENCY
Energy
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DRIVING HOME THE ENERGY EFFICIENCY MESSAGE In the wake of a flurry of announcements from government, Alan Aldridge, executive director of ESTA, asks what impact they may have on energy management in the health sector In mid-May, the government announced that it would accept the recommendation of the Committee on Climate Change (CCC) and commit the country to reducing its carbon emissions by 50 per cent (from 1990 levels) by 2025. This is a significant ramping up of the action against climate change. After all, the 2020 target is 34 per cent and if that is met then a great deal of the much-talked-about ‘low hanging fruit’ will already have been picked. The CCC suggested where many of these savings could be made. One of the main areas of focus is the built environment. In the report it compiled on how to continue to reduce emissions in the coming years, the committee devoted one chapter to ‘Reducing emissions from buildings and industry through the 2020s’. Emissions from buildings currently account for 36 per cent of the UK total. Their previous analysis identified scope for a 35 per cent reduction in building emissions by 2020, primarily through energy efficiency improvement and increased deployment of renewable heat. INTO THE FUTURE Looking beyond this, the committee identifies a further 74 per cent reduction in building emissions (relative to 2007) by the year 2030. Insulation will still play a major part (though mainly external and internal wall insulation as most roofs and cavity walls will have been treated by then) but so will technology. In particular, it highlights the potential for reducing indirect (i.e. electricity-related) emissions through the use of energy efficient appliances and lighting. This assumes that options like energy management have already been deployed by 2020 in appropriate buildings – and not just those included in the CRC. The Energy Services and Technology Association (ESTA) has been stressing the need to look at these areas. They are costeffective and – even before the Green Deal kicks in – there are a number of third party financing options to help organisations implement energy efficiency programmes. And the health sector is an attractive area for these organisations as it is relatively low risk. GOVERNMENT FOCUS ESTA is concerned that, despite such opportunities, the emphasis from government remains resolutely on decarbonising energy
Giles Chichester, president of the European Energy Forum, and Lord Teverson (right) at the recent ESTA Energy Summit in London
Emissions from buildings currently account for 36 per cent of the UK total. Their previous analysis identified scope for a 35 per cent reduction in building emissions by 2020, primarily through energy efficiency improvement and increased deployment of renewable heat. generation rather than on resource-efficiency. Speaking at the ESTA Energy Summit in London in May, the Liberal Democrat spokesman on climate change in the House of Lords, Lord Teverson, argued that we need to take energy efficiency much more seriously if we are ever to achieve a sustainable energy future for the UK. He added that by really embracing energy efficiency and cutting consumption, it will be much less expensive to construct the low-carbon energy supply system we need for the future. Add to this the cost savings to consumers as well as the employment opportunities for
low carbon industry and it looks distinctly odd that the emphasis remains on the supply side. There are, though, one or two signs that the message may be finally getting through. The government has just announced the establishment of an Office of National Energy Efficiency, although details are still awaited. It is to be part of the Department of Energy and Climate Change (DECC) to provide a “wider energy efficiency strategy, strong programme management, and a cohesive view of DECC’s customer facing policies”. Meanwhile, the Carbon Trust and Energy Saving Trust have had their core grant funding E
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EFFICIENCY
“Energy efficiency is the low hanging fruit of European energy and climate change policy yet we have failed to grasp it” – Giles Chichester, president of the European Energy Forum. E removed from 2012/13, and the government has said that it expects them to compete for services put out to tender while also developing new commercial opportunities. These will include services provided under the umbrella of the Green Deal, which will be the main vehicle for delivering energy efficiency programmes over the coming years. The government has said that it wants the services that underpin the scheme to be the subject of competitive tendering. In a recent speech at a conference organised by Climate Change Capital, Deputy Prime Minister Nick Clegg also suggested The Green Investment Bank may have a role to play in delivering energy efficiency, particularly in the non-domestic sector. However, given the range of policy streams and programmes, it can be difficult for organisations to work out practically what is the best, most cost-effective, way forward. The way the energy markets are organised in this country is currently being
revised by Parliament, while the powers of the regulator, Ofgem, are also being reviewed and upgraded. At the same time as the government pushes forward with its climate agenda, heavy industry is pushing back against further carbon taxation – with some success given Chris Huhne’s promise to introduce measures to protect it against foreign competition. Energy can often seem to be a maze of conflicting policies. THE EUROPEAN PICTURE It is not just the UK where action seems unfocused. Giles Chichester is president of the European Energy Forum, conservative member of the European Parliament (MEP) and conservative spokesman on the European Parliament’s Energy Committee. Speaking at the ESTA Energy Summit, he remarked on the lack of attention to energy efficiency in the overall mix of policy aiming at a low carbon economy. “Energy efficiency is the low hanging fruit of
Energy
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European energy and climate change policy yet we have failed to grasp it,” he said. Ultimately, though, the essentials remain the same. Only using what you absolutely need – i.e. being efficient – is good for the organisation’s balance sheet and also the environment. It reduces vulnerability to price volatility and there is plenty of that at the moment given the political realities in the Middle East. As Robin Teverson says, a sustainable energy supply is one that is resource-efficient. TAKING ACTION The urgency to move forward on carbon savings remains, so we need to take action now. Indeed, the CCC believes that the buildings sector will have to be zero carbon in total by 2050 if the UK is to meet its commitment to an 80 per cet cut in emissions by then. So if we are aiming to become a sustainable, low carbon society in the very near future, energy efficiency is the place to start! The Energy Services and Technology Association (ESTA) represents over 100 major providers of energy management equipment and services across the UK. L FOR MORE INFORMATION www.esta.org.uk
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smart metering, you have the confidence of working with a company with many years’ experience of helping UK organisations manage energy more efficiently. As an independent company, WPD Smart Metering works with your supplier on behalf of your business to deliver a firstclass service – from low cost installation of the latest smart meter technologies through to full maintenance and support. FOR MORE INFORMATION Tel: 0870 448900 smartmetering@ westernpower.co.uk www.wpdsmart metering.co.uk
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POWER CONDITIONING
Energy
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POWER CONDITIONING IN THE HEALTH SECTOR Rob Morris, UK country manager at POWERVAR, gives the business case for power conditioning in healthcare Most healthcare organisations today recognise that power quality is a serious issue when it comes to the detrimental effect of power disturbances on sensitive and expensive equipment and systems, such as clinical and diagnostic equipment, patient monitoring and imaging systems and analytical instrumentation. The problem, however, is in accurately calculating figures that demonstrate the financial downside of dealing with bad power. For many hospitals, clinics and healthcare businesses power quality problems tend to be out of sight, out of mind. While the frequency of spikes, surges and other phenomena in power distribution is generally understood and accepted, many fail to make the connection between these irregularities and the impact to the bottom line. Over the last two years, we have worked closely with customers to identify a technique to help quantify and educate the industry about calculating real return on investment (ROI). A major focus has been about understanding the so-called ‘service burden rate’ – this is the proportion of the price of a product allocated to cover ongoing maintenance and repairs during the warranty period. Our extensive research found that the typical service burden rate ranged somewhere between four and eight per cent of the price of the equipment or solution. But results gathered from more than a thousand pieces of power conditioning equipment installed by POWERVAR customers showed a reduction of between 43 and 88 per cent in warranty service costs. Even taking into account the cost of buying the power protection equipment, the ROI in these applications varied between 154 per cent and a staggering 1,148 per cent. Benefits were not just financial either. There is a ‘softer ROI’ to consider, such as a reduction in the number of service calls, as
well as competitive advantage – important in any businesses largely driven by price. POWER SUPPLY PROBLEMS Whether power comes from a public utility or produced onsite by a generator, the quality is always a challenge for modern electronic equipment. The power from utility companies, even in developed countries, still largely meets standards set in the very earliest days of electricity. This was fine for many years until the advent of hi-tech medical equipment incorporating sensitive components like integrated circuits.
The power supply in the US and other developed nations experiences an average of 8.8 hours of outages a year. Less visible is the annual average of 79 hours in which the quality of power is not satisfactory. Over the course of a year, these incidents frequently cause costly damage or failures. Such power irregularities are usually not immediately fatal to equipment, but can produce cumulative damage that will eventually cause sudden system failure or lock up without warning, which can be critical in the case of lifesaving equipment. As soon as one component is replaced, the cycle begins again and it is only a matter of time before the failure is repeated. UNBURDENING THE SERVICE RATE The key to ensuring a higher ROI is a direct and fast reduction in the service burden.
At POWERVAR, we focus on increasing equipment reliability and uptime on the one hand and reducing operational and service costs on the other. A notable proportion of service problems result in ‘no trouble found’ service calls, most likely caused by power quality problems. The ability to reduce these calls has a positive impact on warranty costs and customer satisfaction. By reducing service costs by up to 88 per cent, or even 43 per cent, as reported in our study, customers are saving several millions in some cases. In addition, the average number of help desk calls dropped by 60 per cent. These are savings that every organisation wants to achieve. Harder to measure is the impact on reputation and competitiveness, although these are very real benefits too. Clearly, power quality is not the only factor impacting the service burden rate. There are all sorts of software, training, hardware and personnel issues that can also play a role, but addressing and eliminating the ‘hidden’ and often hard-to-trace problems caused by power fluctuations frees up time and resources to sort out these other important areas. THE FINANCIAL CASE IS CLEAR Over the years, the power quality market and associated UPS business, which is highly competitive and largely driven by price, has been unable to demonstrate to healthcare customers how much power disturbances are costing them and how power conditioning technology can deliver cost savings. The market is now entering a new era, where investment is made on the grounds of measurable ROI and demonstrable cost savings. Our industry must work harder to show healthcare organisations the kind of savings achievable by working in partnership and information sharing. L
POWERVAR’s ‘The Business Case for Power Conditioning: An ROI Study of Unburdening Service Costs from the Bottom Line’ is available to download from www.powervar.com/technical-articles.cfm FOR MORE INFORMATION www.powervar.com
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Are your fire exit signs compliant with the new EN 7010?
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MAKING SENSE OF IT ALL
Facilities Management
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We get an insight into a day in the life of Bernard Mills, of Asckey Data Services, a supplier trying to make sense of the jungle that is tendering for an NHS contract Today we have received notice that there is now a tender available from Rinsted NHS Foundation Trust. But before we can read it, we have to go through the rigmarole of registering on yet another Tendering Portal. That makes 19 different portal sites we have registered for in the last year at an average of 45 minutes each (two days doing nothing but enter the “same but different” data into web pages). NEW SYSTEM As anticipated, this is for the new system we have spent much time discussing, and which the last we heard was in the pipeline having met all requirements and with a cost well under any mandatory tender limits. It seems that our contact there has been over-ruled by the finance department, which has arrived at a much higher estimated cost for the project by looking at a much longer lifespan. While the new cost estimate does not reach the mandatory level, it has still triggered a formal tender process. The costs of creating that Tender PQQ must be a significant proportion of the costs of delivery of the system! I wonder if their finance team have properly recognised how much it has cost them to produce this. They can’t have costed the staff time needed etc. otherwise they would have realised that the cost of the exercise has been completely out of proportion to the overall project, even with their new lifetime costs calculation. MANDATE TENDERING As for it still being way under the mandatory limit, this presumably fits in with the apparent intention of government to mandate tendering for all sums above £10,000. But looking at the tender, with all the cut and paste material from what looks like their standard (probably bought in template) tender documents for multi million pound building projects relating to environmental issues, health and safety, etc., this is going to cost us as a lot of time and effort to complete. Particularly discouraging as E
It seems that our contact there has been overruled by the finance department, which has arrived at a much higher estimated cost for the project by looking at a much longer lifespan. Volume 11.5 | HEALTH BUSINESS MAGAZINE
27
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NHS TENDERS E we have already been through an extensive evaluation process. And, what they didn’t cut and paste from irrelevant material they seem to have taken from our discussions. COSTING A PROPOSAL Looking at the tender itself, the scope seems to have ballooned beyond control. As an example, data integration with the trust accounts is now mandatory, but there is absolutely no specification of what integration means. Their earlier realisation that they need to accept that this can be done, but will need lot more detail from them has obviously been over-ruled. Luckily we have some idea of what their intentions are, but there is nothing like enough detail available even for us to create a properly costed proposal. We can expect to see a lot of detailed questions appearing on the tender portal.
Facilities Management
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DISCARDED PROPOSALS There are many more additions that had been looked at and discarded in the interests of arriving at a system that was manageable from both a cost and a usage point of view. “Finance” is going to have at least doubled the cost of this system. This is worrying, as it may eliminate us if subject to the usual initial “tick the boxes” filtering of responses, as we may find ourselves E
Architecture, space planning and strategic space management The practice has over 13 years experience working in-house for large public and private sector institutions across London and the South East. We are equally at home preparing briefs, feasibilities and detailed proposals for any size of project, however large or small, and have the capability to manage complex, multi-sited property portfolios between 500 and 500,000 sq. ft. We pride ourselves in a professional and timely delivery of high quality information in a variety of formats to suit individual organisational technology platforms and communication methods. Benefits to an organisation of this working model can be summarised across rapid response and refinement of proposals, on-call service delivery and economic, high quality delivery.
Professional and trade body affilliations include RIBA Chartered Practice Federation of Small Businesses Approved Contractor – Chelmer Housing Partnership and Chelmsford Approved Contractor – St Georges Community Housing, Basildon. FOR MORE INFORMATION Glynn Williams Tel: 01245 222692 Fax: 01245 222692 Mobile: 07973 835067 glynn.williams@tesco.net www.glynnwilliams architects.com
Eclipse-fm® – simplifying facilities management Eclipse-fm® v6 is the latest version of the facilities management system developed by Asckey Data Services Ltd for the Healthcare Facilities Consortium (HFC). Operations are further streamlined by the flexibility of the new PPM scheduling facility, mobile Stock management viaPDA/ Smartphones) and a revamped web helpdesk module. Phil Wright, Asckey’s NHS account manager, explains: “Eclipse-fm® V6 simplifies the definition of maintenance tasks, combining a ‘one size fits all’ basic definition with ad hoc changes that handle specific circumstances that can arise. It is designed to provide increased flexibility when managing the library of PPM definitions.” Meanwhile, the mobile device provisions included in Eclipse-fm® V6 allow stock issues and stock checks to be carried out ‘on the fly’ with full synchronisation to the trust
stores database thus eliminating the need to constantly update paper-based systems. Further improvements to Web Eclipse are delivering reductions in help desk calls, lower print/ paper bills and improved management overview. Parminder Singh Bilkhu, EBME manager of Dudley Primary Care Trust, says: “The new Web Eclipse module is user-friendly and easy to use, especially when imputing new jobs. It is making our life easier.” FOR MORE INFORMATION Asckey Data Services Ltd Tel: 0845 2707747 Web: www.asckey.com and/or www.hfc.org.uk
Volume 11.5 | HEALTH BUSINESS MAGAZINE
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Facilities Management
THE BUSINESS MAGAZINE FOR HEALTH MANAGEMENT – www.healthbusinessuk.net
NHS TENDERS
Whatever happened to the process of face to face discussions between qualified suppliers and the trust, aimed at identifying their exact current needs and subsequent use of competitive quotations? E eliminated on turnover grounds, even though we can still meet all the technical requirements. And how will they assess environmental impact questions/answers on a business that essentially has none? No reference to NHS SID, the official NHS repository of supplier information. Does any NHS Trust know that they have an extensive resource available to them that comprehensively answers all business, environmental and quality issues in the NHS SID system? As usual we have to re-format this standard material into “same but different” answers and it will take a significant amount of time. MISSED DOCUMENTATION Of course, they have missed many elements. No reference to externally validated quality processes such as ISO 9001 or TickIT. Instead there are many questions with an obvious quality concern, none of which quite hit the target while requiring extracts from our quality, health and safety, and employment
Shhh!
policies documentation, accounts, all of which are covered in NHS SID and/or implied by our ISO 9001/TickIT qualification. In all, we now have three to four man days ahead of us to assemble and check the material, and enter via PQQ Portal web pages. There are at least five areas that we will need to raise questions on. And the time limit, though on the surface better than some we have seen, takes no account of the public holidays between now and the deadline. TENDER SEARCH Meantime it is tender search day. 21 websites to look through, some will be multi-page, some at a glance. The only valuable one is the OJ “TED” one, the UK Govt sites, particularly www.supply2.gov.uk and the new www. supplytender.co.uk site are useless, either in terms of relevant results, or sensible searching capabilities. Most that do appear relevant will not give enough detail to assess our likely capability to respond without applying for
the PQQ, which will involve registering with yet another Tendering Portal, and we are signed up to 24 already. Every organisation with a tender appears to use a different one, or require a new account to be created on an existing one, which takes nearly as long. So, back to that Rinsted tender. Scenario 1: It went to the cheapest bidder, known to have no development quality control, with a history of multiple business failures, and vastly inflated second/subsequent years costs. Scenario 2: After what was obviously a lengthy process, judging from the number of questions that appeared on the portal, and the delay in arriving at and circulating a conclusion, the tender was withdrawn. Apparently the responses were so complex and varied that they could not arrive at a sensible comparison. We may have to go through the whole process for a third time. Scenario 3: The tender was withdrawn, the trust having run out of money, probably having spent too much on the tendering process. So much for formal tendering. Whatever happened to the process of face to face discussions between qualified suppliers and the trust, aimed at identifying their exact current needs and subsequent use of competitive quotations? L
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HEALTH BUSINESS MAGAZINE Volume | 11.5
THE BUSINESS MAGAZINE FOR HEALTH MANAGEMENT – www.healthbusinessuk.net
Edison Nurse Call – innovating IP controlled call systems Edison Nurse Call is being installed in many NHS and private hospitals on existing wiring saving cost and disruption. The Nurse Call is HTM compliant and can include bed light switching and TV control, and can be fitted into trunking. Edison is in step with the requirements of the UK NHS and private hospitals, with over 30 million events recorded and other functions through an IP gateway. Edison embraces technology by recognising that future need, for the next few years at least, will be to re-vamp existing wards. Edison can re-use the existing wiring and, where appropriate, can install without having to decant the ward. This has been demonstrated both in the NHS and private sector. This saving in hospital disruption is complemented by favourable pricing from Edison, where we know that our competitive pricing is 10 to 15 per cent less in equipment and vastly
less in installation charges. The cost saving is also there for new systems and their installation. Edison provides two levels of call as standard and a third level of call can be easily achieved. Most systems include an infra-red window, which allows even more levels of call, such as ‘Attack’ in A&E.
Marley Eternit’s new healthcare portfolio Marley Eternit’s fibre cement rainscreen cladding is the material of choice for a range of healthcare developments, where its aesthetic appeal and practical benefits are proving a winning combination. In response to increasing demand from the healthcare sector, Marley Eternit has produced a new ‘Healthcare’ portfolio. Showcasing a selection of projects, including both new and refurbishment, the portfolio includes contributions from architects and specifiers highlighting how Marley Eternit’s fibre cement cladding,
as part of a rainscreen cladding system, has met each projects challenging requirements. Marley Eternit’s extensive fibre cement rainscreen cladding range offers specifiers a sustainable and low maintenance facade that combines excellent aesthetics with durability and impact resistance: qualities that will enhance any build project. FOR MORE INFORMATION To order your free copy of the ‘Healthcare’ portfolio call 01283 722588 or e-mail your request to info@marleyeternit.co.uk
FOR MORE INFORMATION Tel: 01252 330220 info@edisontelecom.co.uk www.edisontelecom.co.uk
UNLOCK THE SAVINGS IN YOUR MEDICAL EQUIPMENT BUDGET Reduce your costs, not your service levels When times are difficult, savings should be about getting more for your money, not cutting quality. At Asteral we understand the pressures on hospital budgets. Our equipment management programmes are designed to unlock the significant savings in your maintenance arrangements while retaining your existing OEM maintenance people, so continuity and service levels are guaranteed.
Find out how you can improve efficiency and unlock budget savings. Go to www.asteral.com or call Jason Long on 0118 900 8100
Asteral_Health_Business_125x178_0611_2.indd 1
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Fire Safety
THE BUSINESS MAGAZINE FOR HEALTH MANAGEMENT – www.healthbusinessuk.net
Can your healthcare establishment get more for less? With costs rising and budgets squeezed, this daily dilemma can detract from the real purpose of healthcare, so any organisation offering a sensible solution deserves to be carefully considered. PEL Services Ltd has worked hard for more than 35 years to supply cost effective systems and services to healthcare establishments that are worthy of such consideration. We believe that now, perhaps more than ever, efficient service is essential to gain genuine economy of scale. Imagine the benefits of obtaining your sound, fire, security and communications systems maintenance from a single quality assured organisation – a team of professionals that make sure from the outset that your particular requirements are understood by all concerned and that communicates effectively with you, a team with over 35 years of experience and a track record that is highly regarded. Because PEL is so well established it shouldn’t be surprising that every system and service offered by the company is handled in-house rather than sub-contracted. PEL engineers are trained to support fire alarm, nurse call, assistance call, intruder alarm, escape lighting, access control, CCTV and audio visual systems, thus optimising routine service programmes. It isn’t difficult to imagine how much admin time, workplace disruption, duplicated effort and staff involvement, not to mention
unnecessary cost, that is caused by numerous visits from individual services providers. Add to this the environmental impact of repetitive journeys and the picture is clear – there is so much to be gained by employing one organisation to do the work previously undertaken by many others. PEL offers a range of service agreements, including routine maintenance and fully comprehensive cover, on third party as well as PEL systems. Both single site
and group customers benefit from high quality response from our experienced engineers throughout the UK and Eire. Think of the savings in time and money and the saving of effort and administration that this genuine economy of scale provides – then please contact us for a quotation. FOR MORE INFORMATION Tel: 020 8839 2100 www.pel.co.uk
PEL Services Ltd have supplied and maintained
Fire & Security
Maintenance & Service
Sound & Communications
Audio / Visual
Sound, Fire, Security & Communication Systems throughout the UK for over 35 years. Our multi-discipline engineers ensure genuine economy of scale... • combined site visits • simpler administration • reduced carbon footprint Call 020 8839 2100 to discover how to get ‘more for less!’
www.pel.co.uk 32
HEALTH BUSINESS MAGAZINE Volume | 11.5
RISK ASSESSMENT
Fire Safety
THE BUSINESS MAGAZINE FOR HEALTH MANAGEMENT – www.healthbusinessuk.net
NOT FOR THE FAINTHEARTED
The subject of risk management in hospitals, clinics, nursing homes and the like is probably beyond the competence of the average fire risk assessor The above is possibly a rather controversial statement to make, especially at the start of an article on risk management in health related buildings. But when so many problems with fire risk assessments arise and get widely reported in the press, it is increasingly becoming an accepted opinion. It is well known that under the Regulatory Reform (Fire Safety) Order, there are currently no qualification, knowledge or experience requirements for fire risk assessors. Anybody can do it and as a result there are a number of substandard risk assessments in circulation. The more infamous ones have been well documented, but what about more complex structures such as fire engineered buildings, or those in the healthcare sector where there are a number of factors that make the undertaking of a fire risk assessment unsuitable for the fainthearted? What special requirements do they have that make them beyond the competence of the average fire risk assessor? Fire engineered hospitals and similar healthcare buildings are complex and pose a number of problems for the responsible person, the owner, the occupier and the developer/contractor, such as: • innovative complex design • limited mobility of occupants • extended escape distances high reliance on fire safety management procedures • requirements for 24-hour operation • inclusion of hazardous materials and processes • increased compartment sizes removal of stairs resulting in an increase in the useable floor plate • flexibility in the use of space for the end user • reduced construction costs. FIRE ENGINEERING TECHNIQUES To cope with these, buildings in the healthcare sector may rely upon a number of fire engineering techniques such as hot smoke extraction systems, smoke venting, smoke curtains, extensive automatic fire detection, fire suppression systems, compartmentation of high risk areas and well defined operational procedures. Such an approach demands a very high standard of fire safety management covering the day-to-day operational arrangements for the building. It also requires a robust, planned preventative maintenance regime in respect of fire safety systems. Whilst this is feasible, is it realistic in the day-to-day running of medical buildings? What happens over time when, bit by bit, small changes are made to the building, that compromise or invalidate the fire
It is well known that under the Regulatory Reform (Fire Safety) Order, there are currently no qualification, knowledge or experience requirements for fire risk assessors. Anybody can do it and as a result there are a number of substandard risk assessments in circulation. safety measures, which are essential to such a building working correctly? RESPONSIBLE PERSONS The fire risk assessor evaluating a healthcare building will need to review any Fire Safety Strategy (FSS) in order to be able to undertake a suitable and sufficient assessment. Whilst
fundamentally accepting its validity, since it will have been signed off by the regulator, the assessor will need to review the FSS for deviations present in the building which will need addressing; either by requiring compliance or developing an alternative strategy. It should be noted that the FSS will often be justified by detailed models and E
Volume 11.5 | HEALTH BUSINESS MAGAZINE
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RISK ASSESSMENT E calculations that are outside the scope of a fire risk assessment. They are also likely to be outside the competence of any fire risk assessor who is not a fire engineer. In order to undertake the fire risk assessment, the assessor will also need extensive support from the so called responsible person because he/she must hold all the information on all the fire safety systems that make the building safe. This will include the passive fire protection (structural or built-in) measures, all the active fire protection (detection, alarm, suppression) measures and for such buildings, the Fire Safety Strategy including the assumptions made in producing it. FIRE RISK FOCUS For buildings constructed since 2006, the requirement to maintain such information is enshrined in Regulation 16b of the Building Regulations (now superseded by Regulation 38). This requires that information be given to the responsible person so that any fire risk assessor can obtain the information from them and undertake their fire risk assessment. Unfortunately, Regulation 38 information is rarely available, which makes it more difficult for the responsible person and the fire risk assessor to come up with a credible assessment. There are four areas that the fire risk assessor will need to concentrate on in conducting a fire risk assessment on a complex building, such as a hospital, based on a review of the Fire Safety Strategy. Firstly, there should be a review of the building geometry/layout. Has the building layout or geometry been changed from that specified in the Fire Safety Strategy? In particular, has the building been modified? Does the compartmentation and use of the building reflect what is stated in the strategy? Secondly, in the same way that all the passive fire protection measures need reviewing, so do the active fire protection measures. Consider the following fire safety systems and ask yourself if the average
responsible person or fire risk assessor can answer the questions related to each: • fire alarm including automatic fire detection smoke and heat extract ventilation systems (SHEVS) • smoke control pressurisation systems fire suppression systems eg sprinklers, water mist and gas suppression systems • evacuation lifts/fire-fighters’ lifts. Thirdly, operational arrangements covering the management and operation of the building will need to be reviewed as part of any fire risk assessment, specifically to ensure it is in alignment with the Fire Safety Strategy. In doing this the fire risk assessor will have to use his skills and experience to address the following areas: • procedures for evacuating (or defending in place) of occupants who may have very limited mobility • means of escape • control of fire load • displays and temporary furnishings. Lastly, planned preventative maintenance and the testing of fire safety equipment essential to the Fire Safety Strategy is crucially important in a complex building because the operation of the systems is critical in affording the required level of safety to the occupants. SUPPORTING THE ASSESSORS This article highlights the many special factors that need to be considered in undertaking a fire risk assessment in a complex or fire engineered healthcare building. There are a myriad of specialist questions in each of the four areas – passive fire protection, active fire protection, operational requirements and planned preventative maintenance – that need detailed answers. Undertaking such a risk assessment is not for the fainthearted and can probably only be undertaken by a qualified fire safety engineer. Simpler buildings also need qualified and experienced people (although to a lower level) to undertake fire risk assessments. Consequently, the Association for Specialist
Fire Safety
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About ASFP The Association for Specialist Fire Protection (ASFP) always recommends the use of specialist contractors and requires all its contracting members to hold third party installer certification. Many Responsible Persons and many fire risk assessors simply do not have the skills to undertake much more than a cursory inspection of installed passive fire protection. Whilst it may not be reasonable to insist upon a third party inspection at every fire risk assessment (usually annually), if the passive fire protection has not been properly inspected for a few years, it would be prudent to employ a specialist inspector who can verify that that the passive fire protection is satisfactory and if there are any shortfalls, how they can be remedied.
Fire Protection (ASFP) fully supports efforts being made by the fire risk assessor industry to develop a set of agreed competencies, experience and qualifications in preparation for a national register of fire risk assessors. THIRD PARTY CERTIFICATION The ASFP, in line with its policy promoting third party certification for the manufacture and installation of passive fire protection products, supports those schemes which require full third party certification – either for individual assessors under a personnel certification scheme, or for companies that employ assessors under a company scheme. Any such schemes will need to be accredited by UKAS – the UK body responsible for accrediting certification bodies – to ensure credibility. It is only in this way will we see the status of the profession of fire risk assessor rise to the level that it deserves. L FOR MORE INFORMATION www.asfp.org.uk
Complete fire safety with PHS Compliance The Fire Statistics Monitor reported that in the six months from April to September there were 140 fatalities in the UK from fires. Fire equipment testing is essential to safeguard lives and businesses. Under The Regulatory Reform (Fire Safety) Order 2005 the responsible person must provide general precautions, including the provision of means to fight fire. Once provision is in place, the FSO makes it clear that systems, equipment and procedures must be “in an efficient state, in efficient working order and in good repair”. This means appropriate testing
business is fully compliant with all the relevant legislation. From initial risk assessment, to specification and implementation of fire detection, it is possible to call on one specialist, PHS Compliance. We can provide you with all the support you need to ensure your complete compliance. and maintenance of all fire equipment and systems. Our engineers are qualified to IOSH Health and Safety, NVQ Assessor D32 and D33, ensuring your complete compliance. Using a certified compliance testing partner will give you peace of mind your
FOR MORE INFORMATION For complete compliance solutions for all your services in electrical, fire, gas and water services visit www.phscompliance.co.uk or contact 01942 290888.
Volume 11.5 | HEALTH BUSINESS MAGAZINE
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helping your patients recover, helping you save time and money At apetito we deliver more than tasty, nutritious meals for your patients. We provide a personalised service for you too. We’re dedicated to offering individual training, useful advice and a range of systems and products to meet your patients’ needs. It’s our way of helping you run an efficient and cost effective service, day in, day out. Over 200 ways to aid patient recovery
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HEALTH, SAFETY & HYGIENE
SERVING UP FIVE STAR FACILITIES AND EQUIPMENT The kitchens, wards and retail outlets at Musgrove Park Hospital in Taunton have been recognised by the Food Standards Agency for their impeccable health, safety and hygiene standards The five-star award was given by the Food Standards Agency (FSA) after a full day’s unannounced inspection visit by a food hygiene expert. This new scheme, replacing the old ‘stars’ system, is no longer run by local authorities, but is a national programme, ensuring that, wherever you go across the country, the same rigorous standards apply. Inspectors look not just at the main kitchens at the hospital, but ward kitchens, personal hygiene of all those involved in the serving of food and all appropriate records – for example looking at buildings, food temperatures, cleaning rotas and delivery. The records are also checked against the actual practice to ensure that they match up. SPECIAL ASSURANCE This is all designed to provide the highest assurance to patients, visitors and carers that the best possible food hygiene is being practiced by the hospital. Anyone can now go on the Food Standards Agency website and see what their local hospital is like for food hygiene. This is a big step forward in both guaranteeing standards and ensuring transparency. For all of these reasons, Jon Smith, catering
manager at Musgrove Park Hospital, was absolutely thrilled when the facility attained the highest possible score from the expert inspectors. “It has been a long journey for us all, trying to provide a high quality retail and ward-based food service for our patients, visitors and staff. The new system is very strict and testing, and so it was particularly pleasing to get the highest score possible,” he said. WHAT’S CHANGED? But what have Jon and his team changed in order to secure this achievement? He highlights four elements that have made a difference: monitoring, personal responsibility, training and involvement. “We monitor rigorously. Check sheets are looked at and double-checked against the staff member signing to say they have carried out the work. If they sign for a job, they know they will be asked to prove that they’ve done it. “Everyone takes a personal responsibility. You can’t simply insist on standards being imposed and acted upon. People need to understand that it is down to them. My staff take a great pride in their work and know that they can make a genuine difference to the patient experience – and that’s what motivates them. They are dedicated to providing the
Catering
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best that they can and this has created a real can-do culture among all the team.” Jon continues: “Training helps with this. Every member of staff has a basic food hygiene certificate, and this includes all of the ward staff who are involved in food preparation and serving. We work closely with local colleges to provide the on the job training and theory that people need. “And we work hard to involve people. We have a quarterly food safety group with representatives form the main kitchen, cleaning teams, dieticians, housekeepers and ward assistants as well as the main kitchen and restaurant staff. This group keeps a close eye on the statistics and looks to make sure that we keep moving in the right direction. We also have a Musgrove Partner on the group – a non staff member who has been a patient or a carer at the hospital who gives us an independent view on what we are doing.” TWO WAY COMMUNICATION Linked to this, feedback is important and we encourage it from every source. Jon comments: “Every patient is given a ‘How Did We Do?’ card when they leave and they are encouraged to tell us what we got right and what we need to work on. And staff are always given every opportunity to tell us what they think about the work and what they have seen that we need to do more of. I lead the team brief in the kitchen every month and try to respond and act on suggestions wherever I can. “We are very pleased but not complacent. The challenges of working in a building that has some parts dating back 60 years make sure of that. As we modernise the estate and see inevitable changes to how we provide healthcare, my team are determined to move with the times and improve hygiene practice and customer satisfaction. Watch this space!” L FOR MORE INFORMATION www.tsft.nhs.uk
Providing hospitals with refreshment solutions for more than 40 years We have been providing refreshment solutions for over 40 years and have become a leading provider of drink, food and snack refreshments, generating sales in excess of £8m. An independent business owned by the second generation of the Balmforth family, we have established a reputation for quality, timely and trusted service. Our high standards and dedicated workforce have contributed enormously to our success. We can serve all our customers’ needs whether they require a fully operated service or specialised coffee equipment. Supplying a wide range of machines, we also offer a wide range of branded ingredients, such as Kenco, PG tips and Cadburys. Building on our success, we have continued to explore other opportunities. With consumers
looking for high street quality drinks at low cost, we launched Café Amore – a coffee shop concept that includes a vending machine which serves perfectly prepared drinks into a 9/12oz cup just like you would find on the high street. At the latest HEFMA exhibition we showcased how our products and services can fit in healthcare environments, keeping costs down whilst generating a profit. More recently we
were awarded as the supplier of hot beverages at the Whittington Hospital, London. FOR MORE INFORMATION Address: 31 Bolling Road Bradford BD4 7HN Tel: 0800 9153046 info@refreshmentsystems.co.uk www.refreshmentsystems.co.uk
Volume 11.5 | HEALTH BUSINESS MAGAZINE
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THE BUSINESS MAGAZINE FOR HEALTH MANAGEMENT – www.healthbusinessuk.net
New high capacity scales for UK doctors
High quality, specialist bariatric equipment
With obesity becoming a major concern in the UK doctors are looking to change their medical equipment to prepare for heavier patients. Welch Allyn – the leading manufacturer of diagnostic equipment has partnered with American company Pelstar LLC, makers of Health o meter® Professional Scales, to co-brand and introduce to the UK a range of scales with a greater capacity for larger patients. Hopsitals and practices can now invest in the range of Class III Professional Scales, which includes wheelchair, bariatric, column and floor – ensuring that they will benefit from a lower lifetime cost as the scale is fit for purpose for many years to come. With the latest Heatlh
Poshchair Medical Ltd, established in 2002, has quickly become one of the leading UK suppliers of high quality specialist bariatric equipment, bariatric seating and patient seating. Poshchair Medical is pleased to assume the role of a well respected and trusted company that puts patients and staff above all else. Our company moving and handling advisor is available to discuss any complex bariatric patient handling needs to ensure you obtain the appropriate package for your patient’s needs. Thus reducing unnecessary high charges. Poshchair Medical is an active
Survey for England showing nearly one in four adults are obese, this trend will inevitably affect spending within the NHS on associated treatments and equipment such as medical scales. Jon Soderberg, vice president of international business development at Welch Allyn said: “The innovation, ease of use and versatility of the Welch Allyn Health o meter line of medical scales will undoubtedly provide practitioners with the accuracy and reliability they’ll need to provide a higher level of care to their patients.” FOR MORE INFORMATION Welch Allyn Tel: 020 7365 6780 www.welchallyn.co.uk
member of the BHTA and operates under the terms and conditions of the BHTA code of practice. We have recently expanded to include a decontamination center and training room. We hold many open days where we not only demonstrate our products but those of other companies. Poshchair Medical has good working relationships with many companies so that we all work together to provide the best service. FOR MORE INFORMATION Tel: 0844 8000899 Mob: 07827 779301 Fax: 02380 446895 info@poshchair.co.uk www.poshchair.co.uk
Passenger Transport
We appreciate that clients need flexibility and booking transport to get to hospital 2 days in advance is not always possible. To that end, our crews can be contacted using state of the art equipment and all our vehicles are tracked. Operating 24/7 we provide a fleet of Ambulances and wheelchair vehicles which will cater for all your transport requirements.
Private Ambulances
Our fleet of ambulances are used for both private clients and contracted clients. We come highly recommended from many of the Primary Care Trusts.
Bariatric Transport & Care
AM Medical have invested heavily in state of the art Bariatric equipment. If you have a Bariatric patient that needs transporting, then please give us a call. Professionally trained crews helping to improve Bariatric care at highly competitive prices.
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38
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HEALTH BUSINESS MAGAZINE Volume | 11.5
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FINANCE
UNDERSTANDING THE COST OF OBESITY TO THE NHS
Obesity Management
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Charlotte Lawson and Amy Burrell of health research specialist Perpetuity consider some of the recent evidence and reveal the true cost of obesity as well as the associated challenges it creates Measures to prevent and treat obesity have received considerable interest in recent years as the prevalence of obesity has increased and clear commitments have been made by the government to curb its rise. However, in order to treat obesity we need to not only identify its characteristics, we also need to understand the costs so that we can plan appropriately. Obesity is a growing problem in the UK, with data from the NHS Information Centre suggesting that nearly a quarter of adults in England in 2009 were classified as obese. Furthermore, 16 per cent of boys and 15 per cent of girls aged 2 to 15 were classified as obese. Also in 2009, 1.45 million prescription items were dispensed for the treatment of obesity. The issue is of particular concern when viewed from a European perspective – the Organisation of Economic Co-operation and Development (OECD) has reported that the UK has the highest rates of obesity in Europe. Also, in England rates have increased faster than in most OECD countries. ADAPTING TO CHANGE As society changes and obesity becomes more commonplace, the health service has to adapt to meet the needs of these individuals. One interesting example, featuring in a BBC1 documentary, is the launch of the so-called supersize ambulance equipped with apparatus capable of manoeuvring patients of up to 70 stone between home and hospital. Granted, the Thames Ambulance Service, which operates the service, is a private company and therefore likely to secure contracts from a variety of clients, including NHS Trusts. Whatever the funding sources, it is clear that there must be a demand for bariatric services if a private company (whose priorities are likely to include the need to be profitable) is operating in this area. Furthermore, this trend to provide specialist transport services to accommodate obese patients is seemingly growing as reports are emerging suggesting that every ambulance service in the country is obligated to purchase bariatric equipment. The costs of obesity extend much further than specialist transport services to and from hospital. It is well documented that obesity increases the risk of individuals suffering from a range of health problems, including high blood pressure, heart attacks, and respiratory problems, at least compared to people with average BMIs. Further, as obesity can make surgery more complicated and dangerous, the
potential solutions to health problems can be limited and/or more risky for the patient. There are also considerable costs associated with weight management surgery, such as gastric bands. Obese patients are able to secure funding for weight loss surgery through the NHS, which places pressure on the NHS budget. FUTURE COST PREDICTIONS So, what is the actual cost of services for obese patients to the NHS? The Foresight Review contains perhaps the most commonlyquoted estimate of costs and projected future costs. This suggests that the 2007 costs to the NHS attributable to overweight and obese individuals were £4.2 billion, with the total annual costs of all obesity-related diseases reaching an estimated £17.4bn. Future costs were also projected within the report predicting that by 2050 the cost to the NHS of overweight and obese patients may have more than doubled to £9.7bn, and with the total annual cost for all related diseases potentially rising to £22.9bn. The report highlights that costs include: • obesity surgery (including maintenance) • obesity treatment • treating obesity related conditions such as stroke, coronary heart disease and diabetes Since then the National Obesity Observatory has produced a briefing paper to identify any updated figures that can be used to estimate the costs of obesity. It identifies a number of other studies that have considered alternative calculations and reached differing estimates. The report does, however, highlight a number of further considerations. Firstly, the publication of the NICE obesity guidelines in 2006 estimated that implementing the guidance would cost £63.3 million nationally in the first year and £35.5m in year ten, with identified savings of £55.6m. Secondly, that there may also be an average spend of £60,000 on specialist hospital equipment that has a larger weight capacity (a finding from a survey of 150 hospital trusts in England in 2008). Projecting this figure to all trusts in England and Wales was reported to equate to a spend of £10 million per annum on larger capacity hospital equipment. Funding is also directed towards weight management programmes and prevention programmes – often targeted at schoolchildren to try to stop or reduce the need for subsequent medical treatment for
About Perpetuity Perpetuity provides research in the areas of health, community safety, transport, security and education. It provides bespoke services to international companies, central and local government, public service providers, and private businesses as well as charities and voluntary organisations. The company combines a scholarly approach with a broad range of practical experience.
overweight and obesity related illnesses. These initiatives hold promise as a more sustainable approach and one that is more likely to curb the rise in obesity, especially when programmes target the attitudes and behaviours of both children and their parents, and focus on the benefits of having a healthy diet and exercising regularly. What is not yet clear is the sum of the impact of non-clinical measures to prevent and tackle obesity and overweight in individuals. A review of the long term effectiveness of weight management schemes for adults found that while weight management programmes generally promote weight loss, changes are small and weight regain is common. It also found that interventions were likely to be cost-effective. However, no UK based programmes (with randomised control trials) were included in the review highlighting the need for research to evaluate the impacts of these interventions in a UK setting. This article has briefly considered some of the challenges that the NHS faces in terms of meeting the needs of obese patients and ensuring they receive the best care possible. Obesity is placing increasing pressure on an already stretched NHS budget. As spending on obesity related diseases and surgery is predicted to rise considerably, it is clear that current reactive approaches to obesity and related health problems are not sustainable in the long term. The proposed re-structuring of the NHS by the coalition government, which in today’s economic climate is likely to bring with it considerable budget cuts, will only add to the challenge. L FOR MORE INFORMATION prci@perpetuitygroup.com www.perpetuityresearch.com
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STAFF MOTIVATION
MAKING WORK A MORE REWARDING EXPERIENCE In a tough economy like the one we’re experiencing right now, there are many reasons why vouchers and pre-paid solutions are the smart choice for incentivising the people in your organisation In every industry, motivating employees is essential to ensure optimum productivity. With the public health sector undergoing efficiency savings amounting to billions of pounds, the result is likely to be redundancies and increased absenteeism, extended working hours, pay freezes and fewer career opportunities; all potentially detrimental to staff performance. So how can the NHS motivate staff? What rewards should it offer? For many years gift cards and vouchers have been the popular choice for staff incentive schemes as they are
flexible and not only fit within any budget, but also allow the recipient to select their own gift. REDUCING SICK DAYS With employees facing increased workrelated stress, absenteeism is also likely to increase; in fact recent statistics from PricewaterhouseCoopers reveal that UK public sector workers take the highest number of sick days annually. David Butler, general manager, National Garden Gift Vouchers, observes: “Many organisations are so concerned about
Written by Andrew Johnson, director-general of the UK Gift Card & Voucher Association
employee wellbeing they consider it one of the main issues of the working environment and are investing in ways to support and encourage better health and lifestyles. A mix of individual incentive or motivation programmes, with a high satisfaction level and wellbeing appeal, can result in enhanced engagement and productivity.“ He adds: “We know that rewards and incentives that allow choice, but at the same time encourage physical and holistic activities that could be family inclusive, are increasing in popularity with staff and employers alike.” Denise Porter, on behalf of Maxchoice International, reports that the company has successfully used gift vouchers in motivation schemes to address issues such as high levels of absenteeism, low productivity, and high staff turnover. The overall wellbeing of employees should certainly not be overlooked, since a healthy and happy employee is more likely to be a productive employee. Kevin Harrington, managing director of the Global Prepaid Exchange, reveals: “The health sector doesn’t typically boast the biggest salary packages, so prepaid incentives such as gift cards are a great way of incentivising staff as an additional benefit. For example, if you want your employees to eat more healthily you could offer them a card that is restricted to healthy food retailers.”
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COUNTING THE BENEFITS At a time when the cost of living is rising faster than pay, added benefits from prepaid cards are particularly appealing. Gilles Coccoli, managing director of PrePay Solutions, comments: “Receiving a reward or incentive, for example a prepaid card with added value features such as discounts, is not only motivating, but also acts as reassurance that work is valued and appreciated.” Cassandra Cavanah, executive director, SpaFinder Europe, also sees the benefits of discount incentives: “Another way of rewarding employees is through exclusive discounts – it’s an alternative way to recognise employees by giving them something exclusive at a minimal cost. The rise of instant eVouchers, which can be personalised and sent to the recipient directly, makes coordinating employee rewards much simpler.” Rewarding loyalty and service is still important as a form of motivation for the future. The Voucher Shop’s head of business development, Kuljit Kaur, explains: “In the workplace of today it is all about recognising staff after shorter periods of employment, offering maximum choice of reward and being cost-effective.” Prepaid cards and vouchers also suit employers well. John Dove, manager of House of Fraser Business Incentives, pointed out: “Prepaid cards and vouchers have a proven track record when it comes to staff rewards. With discounts available on bulk purchases they’re a great way of getting the E
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mkanig sesne in the wolrd of inecintevs and raewrds
Reward & Recognition l Incentives & Motivation l Sales Promotion l Employee Benefits
www.love2reward.co.uk/sense4
STAFF MOTIVATION
Incentives & Rewards
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Andrew Johnson
About UKGCVA UK Gift Card & Voucher Association was established as a trade body in 1991 to represent the key players in the £4 billion gift vouchers, cards and stored value solutions market. It provides an information and reference point for both voucher and gift card suppliers and customers, and is at the forefront of the issues affecting the industry. Its main objective is to raise the profile and use of vouchers and gift cards within the UK, promoting the industry to consumers, businesses, government and other interested parties.
“The public healthcare sector’s diverse workforce means it would naturally struggle with a one size fits all reward policy. Giving a voucher means that the recipient can choose how and when to use it” – Cassandra Cavanah, SpaFinder. E best return on your staff reward investment, and are extremely simple to administer.” Monitoring progress is vital. “Once implemented, ongoing tracking of a programme will help to demonstrate the return on investment of such a scheme. It will also ensure transparency so incentive activity is seen as inclusive, fair and accessible by all – this is of particular importance to a sector which is publicly accountable,” observes Gilles Coccoli. THE VALUE OF CHOICE Convenience and choice are key ingredients when it comes to offering appealing incentive rewards. It is easy to understand why vouchers and gift cards are such a popular solution for employees, with the B2B voucher and gift card market, largely incorporating employee incentive rewards, representing around 45 per cent of the UK’s total £4 billion market. Martin Cooper, head of national accounts and marketing at Love2reward, says:
“Multi-option vouchers and gift cards can be deemed best-suited to the health sector because of the diverse demographic of the intended recipient base, where it may be impossible to reward everyone with a single brand or product alone.” Agreeing that choice is essential, Cassandra Cavanah states: “The public healthcare sector’s diverse workforce means it would naturally struggle with a one size fits all reward policy. Giving a voucher means that the recipient can choose how and when to use it.” IMPORTANT RECOGNITION A personal reward leaves a positive impression upon an employee and is more beneficial than a cash incentive. The Gift Voucher Shop’s managing director UK, Declan Byrne states: “Research and experience clearly indicates that non-cash incentives, such as nationwide multi-store gift cards offering the recipient endless choice, are far more successful than cash as an incentive reward. The trophy
value that a non-cash reward offers also reinforces the gift as a symbol of achievement and encourages other employees.” Kuljit Kaur also confirms the importance and value in public recognition and the creation of ceremony and excitement in a reward scheme. With a declining budget for holidays, experiences can create lasting memories as a holiday does but at a lower cost. Darren Ziff, head of business development for experience expert Acorne PLC concurs: “Experiences have soared in popularity in recent years as tougher economic times have led to an upturn in numbers choosing to spend leisure time in the UK and the advent of the ‘staycation’.” Stuart Murray, account manager, Signet Corporate Services, explores the memorable appeal of rewards: “Choosing a memorable gift for a valued employee to mark a significant event can be difficult. An attractive and well presented gift card or voucher can be just as significant to the recipient whilst allowing the individual to choose something that they truly want and which they will treasure in years to come.” It is clear from these observations that motivation schemes can address a wide range of issues facing NHS managers and that gift cards and vouchers can play a valuable role in their success. L FOR MORE INFORMATION www.ukgcva.co.uk
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Only in Scotland will your conference be truly inspiring. Scotland provides a stimulating environment to give new perspective to your own ideas and spur you on to greater heights. Some of the world’s oldest universities and modern research institutes nurture fresh talent to follow in the famous footsteps of alumni, who have changed the world as we know it. Given Scotland’s reputation as a leading light in the fields of science, medicine, finance, energy and technology, it’s no surprise we have conference facilities to match. And it’s never been easier to get here. So to find out more about hosting an event in Scotland, log onto conventionscotland.com Or perhaps that should be unconventional Scotland.
Only in Scotland
Hi-tech conference centres in stimulating surroundings. You can’t help but be inventive.
SCOTLAND
A HEALTHY DESTINATION
Conferences & Events
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With a warm welcome, fine food and drink, and venues to suit all budgets and tastes, Scotland is the perfect place for your conference, meeting, incentive and event management needs A resurgence in Americans returning to Europe, more indigenous companies choosing to stay closer to home, and the strength of the euro against the pound and the dollar are all factors combining to inspire a renewed sense of optimism around the business tourism sector in Scotland. In addition, 2011 is a year which will see an unprecedented number of large-scale projects – both new-build and redevelopments – opening their doors to provide yet more choice for meeting planners and event organisers. All of which is good news for a sector that, between leisure and business travellers, is a huge contributor to the Scottish economy and one of the country’s biggest employers. With almost three million business trips to Scotland in 2010, up 13 per cent on 2009, VisitScotland’s Business Tourism Unit (BTU) continues to fly the Scottish flag at home and
abroad with a robust marketing programme aimed at existing and new markets. FOREIGN INTEREST In Europe the pace of economic recovery varies from country to country, with France leading the charge and Spain yet to get off the ground. In terms of inbound business travellers to Scotland, interest from France has been gaining momentum over the past 18 months, while the BTU is noting a sudden upswing from Germany late 2010 onwards. Enquiries continue to increase from lucrative North American markets too. Canadian visitor numbers are up 20 per cent on last year and more and more American companies are bringing incentive-based trips to Scotland to take advantage of the range of luxury venues on offer at competitive rates. Amanda Henderson, BTU marketing
manager, Europe, comments: “The wish list for European visitors is increasingly shorthaul, but still with the appeal of the exotic, and obviously Scotland fits that bill in spades. France in particular is eschewing previously popular destinations in West Africa because of growing political unrest and is seeing Scotland as an undiscovered Celtic region. “The net benefit to us is huge with French visitor numbers doubling to 44,000 from 2007 to 2009; and the value of enquiries rising from £1 milllion in business year 2009/10 to £3.6 million in 2010/11. Given results like these, our tourism providers are increasingly encouraged to partner with us and support our activities in Europe as they can see the value in the opportunity.” In total, business tourism contributes over £800 million to the Scottish economy, with almost a quarter of all association E
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SCOTLAND
In total, business tourism contributes over £800 million to the Scottish economy, with almost a quarter of all association conferences and events held in the UK being hosted by Scotland. E conferences and events held in the UK being hosted by Scotland. Glasgow and Edinburgh are second only to London as the location of choice for government and other professional associations looking for something a bit different. And 2011 is certainly the year to find it! CULTURAL HERITAGE ON THE AGENDA Tourism in all its many forms is the biggest employer in Scotland and the country is justly proud of its competitive advantage in providing one of the warmest welcomes in the world, a reputation for fine food and drink, a range of activities to challenge even the most adventurous and accommodation to suit every budget. Headlining in investment are the culture and heritage facilities in Glasgow and Edinburgh, giving Scotland plenty to shout about this year. First off the blocks will be the brand new £74m Riverside Museum beside the
River Clyde which is opening this summer. Designed by internationally acclaimed architect, Zaha Hadid, this futuristic structure will house Glasgow’s existing transport collection and new exhibits, with the Clydebuilt Glenlee Tall Ship berthed alongside. The museum can be hired in whole or in part for themed events and meetings, with capacity for up to 900 guests for receptions. Edinburgh boasts two highly prestigious developments, both opening in 2011. This summer, the £46.4 million redevelopment of the National Museum of Scotland will transform this magnificent example of Victorian architecture into a world class 21st century experience. The museum will open for corporate events from October, offering a range of different event spaces ideal for meetings and receptions. With the stunning Grand Gallery’s soaring atrium and 16 new galleries, there can be few more inspiring backdrops for
Conferences & Events
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gala dinners for up to 850 people. The city’s other major project is the threeyear refurbishment of the Scottish National Portrait Gallery, which will be completed this year. Previously hidden galleries and arcades have been uncovered that have both extended the space and returned this iconic building to its 19th century grandeur. Breathing new life into one of Scotland’s best-loved buildings, the transformation will be revealed in November when the Portrait Gallery opens its doors to exciting new exhibitions and welcomes corporate events into what will be a unique setting in the heart of the capital city. A STEP BACK IN TIME In Stirling, always a popular choice for association conferences with both the University and Stirling Management Centre offering first-class facilities, the restoration of the Castle’s 16th century Royal Palace has just completed. Traditional craftsmen and women have been brought on board to restore the palace to how it was in the heyday of the royal court. With costumed characters and sumptuous surroundings, the Royal Palace will be the perfect backdrop for drinks receptions, offering the chance to step back in time to see life as it was and adding a different dimension. Kerry Watson, marketing manager, Associations for VisitScotland’s Business E
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London Training Conferences Meetings
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SCOTLAND E Tourism Unit, is buoyant about the impact of the level of investment coming on stream and says: “The wealth of major new developments topping the bill in Scotland this year is unprecedented in recent years, with three projects alone accounting for over £150 million in terms of investment. “With the 2014 Commonwealth Games looming, and so many high-profile projects launching, there is undoubtedly a renewed optimism in the sector, giving Scotland a greater competitive advantage.” DOING BUSINESS OUTSIDE THE CITIES Fabulous venues are not just to be found in Scotland’s major cities. Around the country, there are a wealth of reasons to head to less well-known areas for greater choice, a wider flavour of what Scotland has to offer, and often cost benefits on top. Close to Edinburgh, Fife’s Carnegie Conference Centre is a purpose-built meetings and events facility situated on private grounds adjacent to Carnegie College in Dunfermline. The centre has recently completed a refurbishment to provide conferencing facilities for up to 250 delegates, with 25 meeting and break-out rooms, and a video conference suite. Food is very much on the agenda with two restaurant areas offering first-class dining overseen by a head chef who has worked in some of
the most prestigious hotels in Scotland. North Fife also boasts the superb New School of Medicine at St Andrew’s University. Following a £45 million investment, this cutting-edge new building is available for conferences and major exhibitions and, with the range of accommodation facilities within St Andrews, there is great scope for large events to be held in an historic seat of learning. Only 15 minutes from Glasgow, one of the jewels in Scotland’s crown for healthcare and medical conferences is the multiple awardwinning Beardmore in Clydebank. With 168 bedrooms, the Beardmore is the national public sector conference centre, and also hosts events for internationally renowned companies such as BAE Systems and 02. The new Beardmore Centre for Health Science provides a range of facilities equipped with innovative medical services for training doctors, surgeons, nurses and other clinicians and healthcare workers. Working in partnership with the adjoining Golden Jubilee National Hospital, the Beardmore has the ability to stream live surgical procedures and afford delegates the opportunity to interact with the medical team. Also close to Glasgow is Lanarkshire, home to two World Heritage Sites – the Antonine Wall and New Lanark, a beautifully restored 18th century cotton mill village
close to the dramatic Falls of Clyde. The New Lanark Hotel, Shawlands Park Hotel and Westerwood Hotel and Golf Resort each offer state of the art facilities for inspiring events all within easy reach of Edinburgh and Glasgow. In particular, Westerwood’s central location and capacity to host conferences up to 400, has hosted events on behalf of NHS 24hr, NHS National Services Scotland, Scottish Centre for Healthy Working Lives, Bowel Cancer UK, and Breast Cancer Care.
Conferences & Events
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HELP AT HAND VisitScotland’s Business Tourism Unit is on hand to provide support, suggest the perfect venue for perfect events, plus offer advice and guidance on an unrivalled range of support facilities – from team building to fine dining. Kerry Watson goes on to say: “With robust Ambassador Programmes in all of the major cities, combined with our own programmes in Stirling, St Andrews and the Highlands, we are in the enviable position of having a network of specialists who can match Scotland’s indigenous expertise with almost any area of healthcare. All of that makes Scotland a great place to do healthcare business!” In short, Scotland has the prescription for memorable, inspiring and successful events – find out more in a few clicks by visiting www.conventionscotland.com L
Imperial College London – the brighter venue choice Consistently rated among the world’s best universities, Imperial College London is a science-based institution with a reputation for excellence in teaching and research. The College is also one of the UK’s largest academic conference venues with three out of nine campuses in and around London offering conference facilities. Imperial offers over 200 event spaces such as meeting rooms, lecture theatres, concourse areas, exhibition spaces, and unique historical town houses, located at its main campus in South Kensington in central London, and at its Hammersmith and Charing Cross campuses in West London. Our South Kensington campus is located just minutes from the Royal Albert Hall, Hyde Park and London’s famous museums, and benefits from a vibrant neighbourhood and excellent transport links. Many of our unique spaces are located on this campus, from the Great Hall, our largest permanent venue which seats up to 740 delegates theatre-style, to the Queen’s Tower Rooms, a modern glass-fronted banqueting and exhibition space which overlooks the Queen’s Lawn, and Imperial’s famous Queen’s Tower,
offering guests a unique space balancing history, quality and the contemporary. At certain times of the year, the Queen’s Lawn, a 1,600 square metre space located in the centre of the campus, houses a marquee suitable for exhibitions, dinners, conferences and much more. It can be used as a standalone venue or as an extension to the Queen’s Tower Rooms a few metres away. Our two historic executive venues, 170 Queen’s Gate and 58 Prince’s Gate, are available all year and are perfect for private dining and more intimate events for up
to 120 guests. These two selfcontained venues are ideal for really impressing your guests and creating that wow-factor. With its unique design and room layout flexibility, the College has venues to accommodate a wide variety of corporate and private events from high profile conferences to intimate dinners and receptions. Imperial offers more than just space to hire – additional services have been developed to make the organisation of your event smoother and to make you and your guests feel special. Our award-winning in house catering, dedicated events team and excellent on-site technical support mean your event is handled with expert care and attention. During the summer months, accommodation at the South Kensington campus is transformed into 3- to 4-star hotel-style bed and breakfast facilities, and year-round we can help you find the best hotel accommodation at carefully selected local hotels. FOR MORE INFORMATION Tel: +44 (0)20 75949494 conferenceandevents@imperial.ac.uk www.imperial.ac.uk/conferenceandevents
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Training
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STAFF WELLBEING
BUILDING A RESILIENT TEAM Stress and wellbeing expert Jane Thomas, director of Premier Life Skills, explains why it is essential in the current economic climate to invest in the wellbeing of staff working within the NHS Dame Carol Black, the national director for Health and Work, says: “Improving the health of the UK’s workforce will have a critical impact not only on individuals, but on businesses and the UK economy as a whole. There are simple steps that all organisations can take to ensure the wellbeing of employees. Focusing on specific health issues is obviously important; however employers should not underestimate the role that better management and engagement of employees can have on the wellbeing and, ultimately, the productivity, of their workforce.” Black’s report, entitled ‘Working For a Healthier Tomorrow’ called for the government to develop a model of measuring the benefits to employers of investment in health and wellbeing. “Employers should use this to report on health and wellbeing in the boardroom and company accounts,” said Black. RISK OF BURN OUT Since Black’s report the economy has crashed and the NHS is looking at huge redundancies and effective financial management. The NHS is going through considerable upheaval at the moment: “We are concerned at the NHS’s ability to cope,” said The Royal College of Nursing’s Peter Carter in April. Dr Carter said the situation meant nurses were at risk of ‘burn out’ which would harm patient care and undermine attempts to reform the health service as nurses were the ‘oil in the engine’ of the NHS. “The NHS is going through considerable upheaval at the moment,” Carter said. “Coupled with increasing demands on the health service, including a rise in people with long-term conditions, we are concerned at the NHS’s ability to cope. Trusts need to make sure they have the right numbers and balance of staff to deal with this.” However, a Department of Health spokesman said: “We have 2,677 more nurses now than we did in 2009, and have committed to employing an extra 4,200 health visitors to support children and families in the crucial early weeks and years. “The government is getting rid of bureaucracy and clinically unjustified targets so that nurses are freed up to do what they do best – taking care of patients. We are also protecting the NHS – ploughing in an extra
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£11.5 billion of funding. Any efficiency savings must not impact adversely on patient care.” The question that needs to be asked is how much of this £11.5bn will be invested in staff wellbeing? On 2 February, the government published its most recent mental health strategy. This sets out six objectives for mental health, which feed into the overall outcomes that are being set for the NHS, public health and social care in the new outcomes approach that the coalition government is introducing. Two of these objectives address the benefits and reward of investment, and building resilient teams in the ever-changing workplace On the face of it this is fantastic news, with an estimated £400m of funding over the next four years to meet the six objectives. However, there has also been criticism as to how this will be achieved and monitored. The current picture seems very different, especially to those who are working in the NHS. The reality is that staff are at breaking point, with low morale, high absence levels, poor work/life balance, higher expectations from patients and their relatives or carers, and expectations for workload levels to remain the same, but with fewer staff. A focus for the new funding needs to be the mental wellbeing of staff in NHS organisations; in particular the building of resilient workplace teams. To understand the rewards of investment we firstly need to look at the psychosocial risks to employees’ wellbeing. This is about prevention and keeping staff healthy and at work. MANAGEMENT STANDARDS In 2005 The Health and Safety Executive (HSE) published The Management Standards which define the characteristics, or culture, of an organisation within which the risks from work-related stress are being effectively managed and controlled. The Management Standards cover six key areas of work design that, if not properly managed, are associated with poor health and wellbeing, lower productivity and increased sickness absence. In other words, the six areas cover the primary sources of stress at work. These are: • Demands – this includes issues such as workload, work patterns and the work environment. • Control – how much say the person
has in the way they do their work. • Support – this includes the encouragement, sponsorship and resources provided by the organisation, line management and colleagues. • Relationships – this includes promoting positive working to avoid conflict and dealing with unacceptable behaviour. • Role – whether people understand their role within the organisation and whether the organisation ensures that they do not have conflicting roles. • Change – how organisational change (large or small) is managed and communicated in the organisation. The Management Standards represent a set of conditions that, if present, reflect a high level of personal wellbeing and organisational performance. COMPLEX CHANGES Change is a fact of life. It’s a natural organisational response to competition and to shifts in the socio-economic environment, as well as a route to gaining advantage and building business performance proactively. However, organisational changes are complex and the NHS has never experienced such fast and quick changes that also have a huge impact on patient care. Each stakeholder group has its own part to play and the employees are critical to the process, as without employees there would be no organisation. For change to be successful, managers need to ensure that employees both understand and support the change. It is therefore not surprising that for many managers, communicating change is perhaps the most demanding aspect of their work. The wellbeing of staff need not be compromised even if organisations have to make significant changes to their workplace environment and teams. A healthy and positive work culture that is essential for wellbeing and performance at work can be achieved for both the manager and their staff with the patient benefiting from excellent care. Promoting psychological wellbeing and performance at work relies on the creation of effective cultural foundations that encourage behaviours that lead to trust, commitment and engagement between individuals, and their manager. It is no soft option since it deals with hidden areas of fear and gets to the root cause of any unproductive behaviour. However, it is very rewarding when relationships improve with their team thus creating a positive work culture. The following personal characteristics of managers need to be developed and applied in interactions with staff: • the demonstration of genuine attentiveness to others • trustworthiness • Emotional Intelligence • a sense of humour • the demonstration of passion for the work of the organisation and the work of staff • the demonstration of meeting E
E individual needs as they arise, nurturing staff to realise their potential • the demonstration of skills to resolve conflicts. Over a period of time the team will start to build on these characteristics and the resilience of the team will be seen when the next change has to be implemented with a solutions based approach rather than a negative response. It will eventually become learnt behaviour by the whole team or effectively managed by the manager should individuals wish to not comply. BENEFITS OF TRAINING People are the key to success in today’s workplace, managers need to be allowed to lead their teams, however, they need to be supported in developing skills to enable successful change processes to happen in an extremely demanding economic climate. As the business world is continuously changing, organisations will need to provide their employees with training throughout their careers. If they choose not to provide continuous training they will find it difficult to stay ahead of the competition. Regular training and learning opportunities are an investment that help employees to prosper and develop their careers while giving the organisation a highly skilled workforce
and a competitive advantage in the market. The other benefit of training is that it will keep your employees motivated. New skills and knowledge can help to reduce boredom. It also demonstrates to the employee that they are valuable enough for the employer to invest in them and their development. Training can be used to create positive attitudes through clarifying the behaviours and attitudes that are expected from the employee. Training can be cost effective, as it is cheaper to train existing employees compared to recruiting new employee with the skills you need. Also important, training can save the organisation money if the training helps the employee to become more efficient. Organisations that invest in training their staff can expect certain benefits.These include helping new employees to learn their jobs quickly and effectively and to perform to the required level in a shorter time, and at the same time helping existing employees to improve their work performance. Second, you will see a reduction in the number of mistakes made, thereby reducing the amount of management time required to sort these out, and a saving in the cost of re-doing them. Third, reduction in staff turnover is likely because employees who have received training are less likely to become frustrated
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at the lack of training opportunities and will have a higher degree of job satisfaction, and from their point of view, job security. Furthermore, if the company has a reputation as one where good training is available, this can attract high quality applicants. Training in health and safety can also reduce accidents and the consequent loss of productive activity. Finally, you can expect to see a more flexible workforce because training can increase staff versatility by widening the number of jobs they are able to undertake. People enjoy learning when the material is relevant to their interests and many will be eager to apply their new skills and knowledge in practical situations. Staff who possess diverse skills are generally more satisfied and positive in their jobs. This decreases the occurrence of work-related stress and improves the overall work environment. By investing in their training, staff often feel that their employer has confidence in them to do the job, and that the organisation values them and is giving something back over and above wages. As a result, employees will become selfstarters and develop further competencies such as leadership and teambuilding and be more willing to undertake further training. L
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LOCUMS
IN GOOD SHAPE Despite media reports it’s not all doom and gloom when it comes to the state of jobs and recruitment in the healthcare sector, says to Andrei Shelton, managing director, British Medical Jobs
You would be forgiven for thinking that there will be little remaining of the NHS by the time the next general election comes around in 2014. However, despite analysts suggesting that between now and then some 53,000¹ jobs will be lost in the drive to achieve £20bn efficiency savings in the health service, there is a danger of getting carried away with the ‘bloodbath’ rhetoric dominating the headlines. The NHS is undergoing arguably the single greatest cultural shift since Aneurin Bevan’s vision of a state-funded health service became a reality back in 1948 – cultural in the sense that the job for life ethos now appears moribund having been replaced by the new buzzword “flexibility”. USING LOCUMS Liz Eddy, head of skills and employment at health trust representative body NHS Employers, recently commented that if you were to take a job in the NHS today, it might not look the same in 18 months’ time. She said: “It’s really about your ability to work with the organisation and adapt and develop your skills as things change.” And she appears to be right.
Indeed, the shift in the nature of demand for healthcare professionals over the last 12 months has been significant. Locums, for instance, are increasingly being used by the NHS to bolster existing staffing levels on either a short or long term basis without the on-going costs of employing permanent staff. While this approach may have its critics, the increased dependence on locums is not only providing a cost effective solution to employers who may have lost highly skilled medical professionals due to the cuts, but also ensures the continued provision of quality patient care. Admittedly, many people have suggested that employing locum staff to cover full time NHS posts is both detrimental to patient care and diminishes the skill set of an otherwise permanently employed doctor. But this would be a poor assumption to make. The reality is that agency staff employed through the Buying Solutions Framework of approved companies are often vetted more thoroughly than permanent staff. Locums are required to be licensed to practice and invariably have a broader range of skills, often having worked at different hospitals and in
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roles that may not have been available had they remained in one location. As such, the increased dependency on employing locums need not be at the detriment to either patient care or those working within the NHS itself. ACHIEVING CUTS Cast your mind back to when David Cameron’s election pledge was to “cut the deficit, not the NHS”. The then Health Secretary of the incumbent Labour government warned that should the Tories come into power, they “will cut the number of nurses, the number of doctors and the number of hospital beds. It does not get more frontline than that”. But whilst the scale of job losses originally forecast has proven to have been grossly underestimated from initial predictions of 27,000², it is not all doom and gloom. Far from it. Most of the cuts are likely to be achieved through natural wastage rather than compulsory redundancies. And as an employer of 1.4 million people, the NHS remains the single largest employer in Europe. So even if the number of jobs lost reaches the number anticipated over the next few years, more than 30,000³ people retire from the health service every year where posts will need to be filled. Yes the purse strings may be tightening and the job for life culture within the public sector in general has already seemingly consigned to the history books, but there are jobs within the NHS – and plenty of them. VACANCIES At the time of writing, the number of live vacancies on the NHS jobs website stood at over 6,3004 – almost 80 per cent of which were for non-clinical posts, ranging from administrative to IT positions. BritishMedicalJobs.com alone has seen a 118 per cent increase in the number of vacancies being recruited for the year-on-year period April 2010 v April 2011, combined with a 55 per cent increase in demand for locum vacancies and a comparative 55 per cent boost in the number of online applications. While it was expected that the loss of many permanent jobs would cause an increase in new candidate registrations and applications for locum positions in particular, no one could have quite anticipated the speed at which these changes would start to take effect. And should the government succeed in shedding the 53,000 jobs it currently predicts, employment within the health service will still be 1.34 million – some 341,000 more than when Tony Blair took office in 19975. L Notes 1. Health & Social Care Bill 2. November 2010: Royal College of Nursing estimated the number of jobs cut would be 27,000. 3. Health Business 4. NHS Jobs 5. NHS Information Centre
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NATIONAL PROGRAMME FOR IT
A lot of time, effort and money has gone into the National Programme for IT, however, a new report from the National Audit Office says it’s failing. Why is this, and what can be done? After several years and many billion pounds, users, patients, IT suppliers and the government remain mired in a healthcare IT programme that has not made anyone appreciably better off. A recent National Audit Office (NAO) report says as much and so makes for depressing – albeit not surprising – reading. By creating the foundation for developing a solution to long-standing problems, the NAO report has a good deal to recommend. Considering the report, the history of the programme and the self-interest of the protagonists together leads to the conclusion that more positive and effective underlying conditions have the ability to turn a failure into a success. The value of IT in the more
efficient delivery of better healthcare should not be underestimated, so moving rapidly to a solution would benefit everyone. CREATING A SOLUTION Now is the time to create an environment that will foster more progress and less conflict, and to move beyond the recriminations. Ask people involved in the birth of the current programme and they will almost uniformly agree that it
Written by John Enstone, partner with Faegre & Benson LLP
IMPROVING THE DELIVERY OF HEALTHCARE
was painful. Some would go as far as to say that being in at the birth was indistinguishable from being in at the kill. Substituting politics and expediency for pragmatism was never the way to deliver IT systems. The first step in forging a solution to the IT challenges in the healthcare sector is to examine what the NAO report actually says and, at least as importantly, what it does not say. The second is to see what experience tells us about the mindset of the protagonists. And the last is to develop a strategy that gives users, patients, suppliers and the government a safe and satisfactory way forward. One illusion that no one can afford is that major IT systems are straightforward to deliver, regardless of how well they are managed. In fact, transformational IT systems are brutally difficult to design and deliver. In other words, using IT to provide better healthcare across an entire country was always going to take the best minds the users and suppliers have to offer, together with a great deal of dedication, patience and hard work. It is rare indeed to find a major IT implementation in which the responsibilities of the users/ government and the suppliers are not so E
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Now is the time to create an environment that will foster more progress and less conflict, and to move beyond the recriminations.
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3M Health Information Systems
Driving Health Informatics Improving Patient Care 3M is the trusted UK market leader in clinical coding software, with strong capability in data analysis and document management. We combine the expertise and security of an innovative global leader in health informatics software solutions, with local and responsive development capability and strong customer service support. With a long history of supplying to the NHS and more installations than any other supplier of clinical coding software, 3M is helping health care organisations to manage revenue, and improve the quality of patient care. Ensure that your current and future needs are met by partnering with 3M. For more information or a demonstration Call: Freephone 0800 626578 E-mail: help.his.uk@3m.com Web: www.3m.co.uk/HIS
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Citadel Events launches in4matics – an integrated healthcare IT event in4matics 2012 Healthcare Informatics Expo is a two-day integrated event for companies and individuals involved in creating, delivering and operating the healthcare IT systems of the future, to be held at ICC, Birmingham 9-10 May 2012. in4matics is a different kind of healthcare event that is responding positively to the challenges of today’s business climate, shows an ability to react to the market place and demonstrates a clear understanding of what stakeholders in healthcare informatics want to achieve. The event will focus on how information will be managed within the evolving health service and will be attended by those working in health and social care informatics; commissioning and using systems, consulting information, and managing and delivering information and IT services. Free to attend for NHS
delegates with a conference that embraces both intellectual and commercial content. Floor space rates are very competitive and there are more opportunities for the supplier community to grow their exposure at the event, via sponsorship and demonstrations, in order to reach key decision makers in the NHS. Citadel Events has notable credentials in healthcare events and has organised BCS HC Health Informatics Congress (formerly Healthcare Computing) over the last three years. FOR MORE INFORMATION Tel: 01423 526971 www.in4matics.co.uk
ITIL foundation training from £325 per person HELIX offers fully accredited ITIL® training at an economical cost. Combining an informal, friendly approach, with rigorous attention to examination performance, we emphasise exam preparation, with mock-exams and detailed feedback. We believe that training and education are major factors in the successful introduction of best practise to business environments and enjoy delivering bespoke training designed to meet specific customer needs. For an even more economical approach, we also offer e-learning options. Consultancy – our consultants have worked with a number of NHS trusts, establishing service desks and implementing service management processes that adhere to ITIL best practice principles, whilst meeting
the particular challenges of working within the NHS Helix also offers a unique “remote consultancy” option, at a fraction of the cost of onsite consultants. Our Best Practice Building Blocks option offers expert advice available when you need it, with a tailored roadmap, action plan and other guidance addressing your specific issues. It includes an extensive library of practical resources and templates. Building Blocks provides an innovative consultancy approach to IT Service Management blending online and onsite advice, planning, resources, mentoring, facilitation and training. FOR MORE INFORMATION Tel: 0845 2997522 enquiry@helix-services.com www.helix-services.com
NATIONAL PROGRAMME FOR IT E heavily interdependent that working out who is ultimately to blame for the failure of a programme is a productive endeavour. Against the backdrop of this brave, new world of cuts and proposed changes in the provision of health services, one thing that should most certainly change is the way we deal with the rollout of useful technology. One preliminary but vital point is that the NAO does not seem to say that a new care records system along the lines of what has been contemplated cannot be delivered – at least not from a technical point of view. This gives us reason to believe that fixing the current problems can lead to improvements in healthcare delivery by the intelligent use of IT, hopefully for less effort and expenditure than starting again would require. A MOVING TARGET For those of us immersed in this and other IT programmes, two recurrent themes predominate in the NAO report. The first is that after so many years the deliverable is still a moving target. The other is that the protagonists have assumed the stances of budding litigants, each blaming the other for the difficulties. If we are to achieve a positive result we must correct both of these major shortcomings. One of the challenges, of course, is that the ability to agree on and stick to the deliverable is intertwined with the willingness of the protagonists to sit down and do so in a spirit of cooperation. This spirit is understandably weak, given the traumatic birth and early life of NPfIT. IT professionals look at flux in a deliverable and immediately worry about its ultimate quality and integrity, delays in handing over a working system and cost over-runs. Even if the contract can accommodate changes in the specification of the deliverable through a workable change order process, the delays and cost over-runs will remain. It is far better to agree on and stick with a specification that is close to what is needed than to add precision later or make changes as improvements and refinements come to mind. How many would consider setting a sat-nav to travel from Bristol to Edinburgh (or, worse still, somewhere as yet undetermined in the North) and, as Newcastle recedes from sight, reset the sat-nav for Brighton, all the while thinking that doing so will be without significant time and cost implications? THE USERS’ VIEWS The users of the system, seemingly excluded even from the early planning, understandably have their own grievances and have been articulate in expressing them. Lawyers – one can be absolutely sure that they have been extensively consulted – regard the protagonists’ stances as consistent with standard legal advice: reduce or eliminate downside risk by blaming the other side. Even their usual language, namely the expression
“the other side”, makes it sound like a war. We are certainly not seeing those halcyon days to which users and suppliers refer – usually when contract negotiations have reached a particularly painful stage – which involve living happily ever after by putting the signed contract in a drawer and never looking at it again. There is nothing wrong with putting one’s best legal foot forward and establishing a trail of evidence that shows one in the best light possible and the other side in the worst. It is even better sometimes if that trail of evidence is subtly established so that the other side does not realise what is happening until it is too late for them to defend. The test of good contract management and legal advice, however, is to balance these legal strategies with the overarching need to achieve the objective, specifically the successful delivery of a system that provides useful services to the users and benefits to the patients at a reasonable cost. A rapid adjustment is required if we are to reap the rewards that IT investment can provide. Get the priorities wrong and everyone ultimately loses. GOING FORWARD So, what will drive the protagonists toward success and away from collective failure? Commercial experience suggests that the motivation of sensible people to act in the way described by the NAO results from the absence of underlying conditions that offer a safe course toward the successful delivery of a system. Human nature, reinforced by competent legal advice, will usually lead to conduct that includes covering one’s own back. Only when there is little apparent chance of success will rational business people and, in this instance, healthcare providers begin to ignore the need to deliver a working system in favour of self preservation. The objective is to create a new deal that represents a workable solution for all the protagonists. They may not come to like each other, but if we can get them to cooperate toward a well-defined deliverable and the collective good we will have achieved a significant result. Creating the underlying conditions that will allow the protagonists to work together instead of against each other is essential. Appointing a knowledgeable, practical person to get the protagonists speaking constructively would be a good start. That person should quickly set some ground rules for this conversation. A key element of these rules would be that the conversation be free of legal ramifications, specifically that what people say cannot be used against them later. To be clear, existing rights and remedies should remain available until a new deal has been agreed. In addition to creating a “without prejudice” footing, there needs to be an acceptance that learning from the past and using what has been learned to solve problems are productive, but debating the past is not. We all accept that
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About the author John Enstone, a lawyer and former IT project director, has spent 30 years fixing IT projects that have gone off track. He is a partner with Faegre & Benson LLP in London.
the protagonists (past and present) have had a difficult time, but these conversations are not an acceptable forum for placing blame. The foregoing leads to the third, key ground rule: not only should blame not play a role in solving current difficulties, but the protagonists should be encouraged not to seek extensive compensation for past wrongs. That is not to say that effective remedies for future defaults should be eliminated. On the contrary, the approach should be to take a realistic view of what each of the protagonists can and should be required to deliver and the price at which a system will be provided. Realism on these points is important to moving forward and to establishing the credibility of remedies that make sense given the size, importance and cost of the programme. The Draconian remedies of earlier NPfIT contracts should be avoided – more effective incentives to perform well are generally available through bonuses. FINALISING THE DEAL Time is of the essence with regard to finalising the new deal. For all of the criticism of the way NPfIT was born, the time from release of the RFP to contract signing was short for a programme of its magnitude and complexity. As one of the participants in that marathon, I am convinced that taking more time would not have made for a better result. So an abbreviated schedule for the protagonists to agree a new deal is appropriate and workable. All the protagonists have had the opportunity to refine and express their own views and to understand those of others. There is, therefore, no need for a lengthy period for them to formulate and present their positions. A short paper from each setting out the five or six key points that each wishes to achieve would be helpful. To some, the approach outlined above will doubtless appear naive. There are certainly challenges in bringing protagonists with entrenched views together in this way with the objective of agreeing a new deal. Experience suggests, however, that when an IT programme is failing there is often an attitude of “better the devil you know than the devil you don’t”. Disengaging and disentangling can be much more challenging, and no more likely to produce a working and useful improvement to the delivery of healthcare. It would also be wrong to ignore the various legal requirements that apply to the public sector. Constructive criticism is valuable, cynicism is not. The benefits of the programme are worth the effort of implementing a solution. L
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CAR PARK MANAGEMENT
HOSPITAL PARKING IN THE SPOTLIGHT With initiatives like its Hospital Parking Charter and special interest groups, the British Parking Association strives to raise parking standards in the healthcare environment Parking at hospitals and healthcare services is always going to be a soft target for the media to tell a good story about how not to do it. Healthcare is very personal, second only, it seems to finding somewhere to park. In combination it’s always an opportunity for an emotional headline. Free parking at hospitals is the norm in Wales and Scotland as governments pander to the popular demand. Increasingly there is a demand for England to follow suit. None of this is without consequences and it is only too apparent in Scotland and Wales that there is no such thing as a free parking space as there is always someone who is paying for it. Is it right then that dwindling healthcare budgets should be used to provide parking facilities for those who choose to drive to hospital and yet those who arrive by public transport continue to pay? Shouldn’t healthcare budgets be used to provide healthcare? DEMAND & SUPPLY The big difference between parking at hospitals and other healthcare facilities, and parking for business and leisure is that often there is little choice. Few people choose to go to hospital and even fewer have a choice of which hospital. These are facilities used most when we are unwell or seeking medical advice or obtaining treatment for long-term conditions. At best we are visiting someone who is unwell. Like so many other places, the demand for parking spaces at hospitals exceeds the supply and therefore it needs to be rationed and managed. How best then do we manage it? How do you prioritise allocation of spaces and use? How is it paid for? What is the impact on the community served by the hospital? Is it a good neighbour? These are all topics for debate and resolution. Just over a year ago the BPA launched its Hospital Parking Charter, which sets out the importance of offering a high standard of management and customer service, reflecting the needs of all car park users, including patients, visitors and staff, car parks with proper and adequate access controls, and fair and reasonable enforcement where this is required. There is of course, much more to the Charter and it’s now time to give it a ‘Health Check’.
We want to ensure that it’s fit for purpose and encourage more to sign up and to abide by its principles. We also want to make the Charter easier to understand, simple to promote and above all, make sure that its intentions are delivered. This work continues through 2011 and if you would like to help you can do so by contacting Dave Smith at dave.s@britishparking.co.uk PARKING SPECIAL INTEREST GROUP In support of this work, the BPA has initiated a Healthcare Parking Special Interest Group, which brings together people in NHS facilities, with parking operators and service providers to share knowledge and experience. It became very clear at a recent meeting of this group that there are some serious challenges and yet also some simple solutions. If only people knew about them. Working together through the BPA Healthcare Parking Special Interest Group we can collectively share knowledge and best practice, as well as campaign for better recognition of the services provided and the need for them to be properly funded. The BPA’s Healthcare Parking SIG’s second meeting in April was kindly hosted by Mid Staffordshire NHS Trust. The meeting opened with a session on the Hospital Parking Charter, launched last year as a joint collaboration between the NHS Confederation, the Healthcare Facilities Consortium (HFC) and the BPA. This was an opportunity to review the Charter and discuss potential for additional development to bring it in line with the Healthcare Parking Good Practice Guide, which was launched by the HFC in March. Keith Sammonds, MD of HFC, presented the guide, which sits alongside a suite of facilities guides available to NHS practitioners. It aims to give NHS Trusts practical support to ensure their parking and traffic management operations are in line with what is considered to be best practice. The group also had the opportunity to look in detail at enforcement on healthcare sites by listening to case studies, views from the private sector and a presentation by the BPA on the Approved Operator Scheme and implications of the Freedom Bill, which is currently making its journey through parliament. The Protection of Freedoms Bill, to give it its full title, covers a wide range of issues relating to civil
Parking
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liberties – the most significant sections of the bill for parking practitioners relate to a proposal for a complete ban of clamping and towing away on private land in England and Wales, and the move towards keeper liability in the instance of issue of penalties. ROUGE CLAMPINNG The first of these issues has been strongly opposed by the BPA who has been lobbying government at senior level, including presenting its case to the Bill Committee recently. The BPA considers that an outright ban is not the way forward to help prevent rogue clamping, which only represents a minority of current operators in the sector. The BPA is also concerned that this proposal gives the landowner no option of last resort to deal with problem vehicles dangerously parked/causing obstruction or persistent evaders. The case has been presented that government should consider regulating parking enforcement in the private sector in line with the highly regulated public sector regime. The second issue has been presented by the BPA to government to enable private operators who ticket and use DVLA records to pursue penalties to have the same rights as local authorities to hold the keeper of the vehicle liable. At present driver liability presents the motorist with an easy route of appeal by claiming they weren’t driving the vehicle at the time which, without evidence to the contrary makes pursuing such penalties extremely difficult. The group will continue to develop and start looking at forging links with relevant stakeholders and other sectors within parking from whom the members can learn and develop cooperative working relationships. A small working group has been formed which will meet shortly to discuss the resources they would like BPA to develop for them and to plan future agendas and identify key stakeholder working opportunities. If you are interested in getting involved in this working group please contact Alison Tooze alison.t@britishparking.co.uk The next meeting of the group will be held in conjunction with the BPA’s Higher Education Parking SIG. Already on the agenda is a session looking at the provision of disabled parking including a view from the motorist, which will be presented by Disabled Motoring UK. In addition the group will look at methods for hitting carbon reduction targets and managing parking and parking policy at combined hospital/university sites. The meeting will take place 28 June at the RHS Conference Centre in central London. Places are limited – if you wish to attend please contact the BPA. L FOR MORE INFORMATION Tel: 01444 447300 Fax: 01444 454105 info@britishparking.co.uk www.britishparking.co.uk
Volume 11.5 | HEALTH BUSINESS MAGAZINE
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Fleet Management
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ROAD SAFETY
MANAGE OCCUPATIONAL ROAD RISK AND KEEP YOUR DRIVERS SAFE With an estimated third of accidents involving people at work, it’s vital that employers get their policy in order and make staff aware of the risks, says Kevin Clinton, head of road safety, RoSPA
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15 years ago, the Royal Society for the Prevention of Accidents (RoSPA) embarked on a pioneering campaign that was the first to reveal occupational road risk as a hidden killer on Britain’s roads. Through our Managing Occupational Road Risk (MORR) campaign, we became the first organisation to try to quantify the devastating impact of at-work road accidents – considering not only professional drivers like lorry and bus drivers, but also people who drive company cars, vans or their own vehicles on work-related journeys. Subsequent research has since confirmed, and even increased, our early casualty estimates.
work-related road accidents in Britain. This continuing level of suffering, and the fact we have an increasingly road-mobile workforce, means that – 15 years on – we cannot put a tick in the work-related road safety box and declare that it has been ‘achieved’. While there have been tremendous steps forward and some really positive examples of employers acknowledging the importance of this issue, driving still remains the most dangerous thing that most of us do for work and too many organisations are still failing to act on MORR. Therefore, to mark the 15th anniversary of our campaign, we are urging employers
THE CAMPAIGN The MORR campaign was launched when our occupational safety adviser published a groundbreaking discussion paper in 1996. In the absence of official statistics, he estimated that up to 25 per cent of road deaths each year involved vehicles being driven in the course of work activities. This amounted to more than 875 deaths, of which more than 300 were associated with accidents involving company cars and more than 300 with accidents involving vans. The paper said that “those who cover significant mileages as part of their job in company cars and vans may be at higher risk of occupational fatality than workers in acknowledged high risk sectors such as construction or underground mining”. In the years since, we have campaigned for MORR to be taken seriously by employers and regulators, and have developed and provided practical help for employers to enable them to address the issue. We have also sought to gain the support of other key players in encouraging employers to adopt a proactive approach, promoting not only the clear moral, legal and business imperatives, but also the contribution that MORR would make to meeting national road casualty reduction targets. Since the 1996 discussion paper, subsequent research has estimated that up to a third of road accidents involve someone who is at work. Applying this to the most recent casualty figures means that in 2009, an estimated 740 people lost their lives – more than two people a day – and a further 8,230 were seriously injured in
Despite employers acknowledging the importance of the issue, driving still remains the most dangerous thing that most of us do for work.
HEALTH BUSINESS MAGAZINE Volume | 11.5
– including those in the health sector – to make 2011 the year in which they commit to regularly reviewing and improving their road safety arrangements. WHY ACT ON MORR? As we have written in the pages of Health Business previously, there are significant prompts for managing occupational road risk. From an ethical perspective, employers can reduce the pain and suffering caused by at-work road accidents, which can have effects for the employee as well as his or her family and friends. Helping drivers to be safer on work-related journeys – for example, by arranging driver training – can also help them to be safer when they’re driving on other journeys, meaning employers can play an important part in reducing the overall accident toll on Britain’s roads. Turning to the environmental perspective, the good news is that there are clear overlaps between safer and fuel-efficient driving, both of which focus on smooth vehicle control and planning ahead. Indeed, many training providers now offer eco driving courses, which explicitly highlight these overlaps. From a business perspective, it’s not just about saving money on fuel bills.
Research by the Health and Safety Executive (HSE) into workplace accidents suggests that for every £1 recovered through insurance, between £8 and £36 may be lost through uninsured costs. Occupational road accidents are likely to cost organisations in terms of lost business, administrative and legal fees and rising insurance premiums. Particularly when they involve liveried vehicles, they can also adversely affect organisational reputation, bringing further financial implications. It is understandable that when budgets are tight and organisations are looking for cost-savings, safety may not be at the forefront of everyone’s mind. But, it is in
these times that cutting the avoidable losses associated with accidents becomes all the more important. It is crucial that employers understand this business case for action on road safety and know that it is actually stronger when times are tough. Looking briefly at the legal perspective, we can see that guidance issued by the HSE and Department for Transport (Driving at Work: Managing Occupational Road Safety, INDG382) clearly states that health and safety law applies to on-the-road work activities as to all work activities. Employers must therefore manage risks on the road within the framework they should already have in place for dealing with other aspects of health and safety. The general duties laid out by the Health and Safety at Work Act mean they must assess the risks involved in the use of the road for work and put in place all ‘reasonably practicable’ measures to ensure that: workrelated journeys are safe; staff are fit and competent to drive safely; and vehicles used are fit-for-purpose and in a safe condition. The police also look at work-related factors when road crashes are investigated and action has been taken against employers. Once the prompts for action on MORR E
E are understood and accepted, it’s time to look at how to act. Throughout our 15year campaign, one of our key messages has been that managing occupational road risk needs to be addressed using the same policies and procedures that organisations should already have in place for managing other aspects of health and safety. Like managing any kind of workrelated risk, safety on the road while at work cannot be achieved by a variety of disjointed, perhaps one-off, interventions. Instead, you need an overarching system, and there needs to be a commitment to a cycle of continuous improvement. A good starting place is to establish how well your organisation is doing on work-related road safety at the moment. Questions to ask include: what elements of a management system do you have in place already? What is your current accident rate? What are the main causes of accidents? How much are accidents actually costing your organisation? Your answers to questions like these will give you a sound reason for action on work-related road risk that is unique to your organisation – crucial if you are going to achieve buy-in from senior management, as well as employees – and they will identify any gaps in your MORR system that need filling. An important part of a robust MORR
system is risk assessment, because it helps you focus attention on where problems are or where they are likely to arise. In this way you can ensure your resources are used to their best effect. Doing risk assessment on a driver-by-driver basis, as well as for the organisation as a whole, would be preferable because no two drivers are the same. Any number of practical and cost-effective control measures could be flagged up by a good and sensible risk assessment, including: exploring safer alternatives to road travel (e.g. taking the train or videoconferencing); specifying safest routes; insisting on compliance with speed limits; setting standards for safe schedules, journey times and distance limits; specifying the use of vehicles with additional safety features; ensuring safe maintenance; and ensuring drivers are fit to do the task, which includes driver selection procedures, assessment, training and continual development. When it comes to driver development, the value of treating drivers as individuals comes to the fore. An organisational risk assessment might flag up training needs, but the needs of each driver, and the interventions that might help them, are likely to be different. For example, some drivers might benefit from e-learning (interactive online training), a classroom theory session
or perhaps something as simple as receiving a copy of the revised Highway Code and being encouraged to read it. For others, a risk assessment might point to the need for in-car training. The proper investigation of accidents and learning from them is also an important part of a MORR system.
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SEEKING HELP At RoSPA, we would be more than happy to help organisations looking to improve their MORR arrangements. On our website, we have a wide variety of free resources for employers, including guides about issues you could include in your MORR policies, such as vehicle technology, the use of employees’ own vehicles, drink and drug driving, and the use of mobile phones, plus a free-toview film. In addition, we have a range of paid-for training and consultancy services. There are also many organisations that are already well advanced in addressing workrelated road risk, so business-to-business learning can also be useful. For more details see the website of the Occupational Road Safety Alliance (www.orsa.org.uk) or, if you are based in Scotland, the Scottish Occupational Road Safety Alliance (www.scorsa.org.uk). L FOR MORE INFORMATION www.rospa.com
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RISK MANAGEMENT
DOING YOUR DUTY The Institution of Occupational Safety and Health helps you understand your responsibilities and how to protect yourself and others from the single greatest cause of work-related deaths Pre-2000 buildings may contain asbestos and asbestos containing materials. Asbestos has been used for insulation around boilers and pipework, partition walls, wall panels, lift shaft linings, fire doors and air conditioning and ventilation systems. Asbestos composites can even be found in toilet cisterns, seats and bath panels. The most dangerous types, crocidolite (blue asbestos) and amosite (brown asbestos) have been banned since 1985, while chrysotile (white asbestos) has been banned since 1999. There is also a ban on the second-hand use of asbestos products. However, it’s estimated that around half a million non-domestic buildings still contain asbestos, although some asbestos containing materials such as floor tiles, asbestos cement roofing, guttering and textured coatings are considered a lower risk. If asbestos is not disturbed and remains in good condition, then it does not present a risk. But problems can arise if asbestos deteriorates, or is damaged or interfered with, allowing fibres to be released into the air and people to be exposed. Past exposure to asbestos causes around 4,000 deaths a year in Great Britain and we have the world’s highest death rate from the asbestos-related cancer mesothelioma (2,156 in 2007). The figure for male deaths from this disease is predicted to peak around the year 2016. WHAT THE LAW REQUIRES The Control of Asbestos Regulations 2006 (CAR) bans the importation, supply and use of all forms of asbestos. CAR regulation 4 requires those who own, occupy or manage a building or are responsible for managing its maintenance and repair, to manage any asbestos within it. So, if you have responsibly for maintenance or repair of premises, you need to know whether they contain any asbestos, where it is, what condition it’s in, what the risk is and ensure that it’s managed properly – including telling anyone who may disturb it that it’s there. If you find asbestos in good condition where it’s unlikely to be disturbed or damaged, then it can be left in place and monitored regularly to make sure it’s still OK. MANAGING THE RISK If you’re the person responsible for maintenance or repair, your first task is to decide if you (or one of your staff) is able to carry out your own asbestos assessment inspection. If not, you should engage
someone competent to assist you. If doing it yourself, you need to find out which parts of your building were constructed or refurbished before 2000 and whether your building is on a brownfield site – land previously used for industrial or commercial purposes that may have asbestos buried on it. Also, whether there is any old equipment in use such as ovens, insulating mats, fire blankets, oven gloves, ironing surfaces, which can be assumed to contain asbestos. Get together information you already have, such as building plans and previous asbestos surveys (though beware, these may have missed the asbestos). It can be also be useful to contact tenants or the builder or building’s architect to see if they have any relevant information. The next task is to inspect the building and create an asbestos register to record where asbestos may be present (presuming that asbestos is present in the absence of evidence that it’s not). You need to
showing who will do what and the time frame • a schedule for monitoring the materials’ condition • a communication plan to tell people who may be working near the asbestos • a plan for emergencies where asbestos contamination might occur. Getting competent help is important. The HSE publishes a list of companies licensed to work with asbestos, which is updated every fortnight. Depending on the materials and type of work being done, you may need to use an HSE-licensed asbestos contractor. If this is not needed, you must use a contractor who is competent to deal with asbestos.
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RECORDS AND INSPECTIONS It’s essential that you keep your records up to date. Make sure you update your asbestos register every time you have work done on asbestos materials or carry out an inspection. Asbestos materials should be inspected at least yearly to check they haven’t deteriorated and any changes should be noted. Include these inspections in your action plan and say who is responsible and when they are going to make the checks. Ensure they have the necessary training to help them do this. Tell your employees and contractors about your asbestos register and where you have found asbestos and display warning signs if appropriate. Help workers to recognise what
Problems can arise if asbestos deteriorates, or is damaged or interfered with, allowing fibres to be released into the air and people to be exposed. determine your priorities for dealing with any asbestos you find and decide how to manage it depending on its type (if known), form, condition and location. For example, are you dealing with old pipe lagging or asbestos cement? The HSE has developed an online tool to help you assess the risk of the asbestos you have found and also a tool to help you decide how to manage it. If you decide you need help with this, it is important to find a competent surveyor to carry out an asbestos survey. Surveyors need to be appropriately trained, have relevant experience and follow good practice. Look for accreditation by the United Kingdom Accreditation Service, UKAS, or personnel certification by the Asbestos Building Inspection Certification Scheme, ABICS. MAKE A PLAN Once your asbestos register is complete, you can devise a plan for managing asbestos. Your plan should include: • a site plan showing where asbestos has been found • the register which you prepared earlier • an action plan for dealing with the asbestos,
asbestos may look like; where they need to take care; and what to do if they come across asbestos materials unexpectedly. When planning maintenance work, carry out a risk assessment to ensure that any contact with asbestos is identified and the risk of exposure to workers and or others is properly managed. If more extensive maintenance or repair is needed, then a localised ‘refurbishment survey’ is required, where the ‘management survey’ hasn’t been intrusive. If you have several contractors involved in maintenance work, appoint someone to ensure they are communicating effectively with each other. So the key message is, don’t ignore asbestos or be tempted to take a chance – people’s future health is at stake here. Make sure you are complying with the law and have good procedures in place. If in doubt get expert help. Effective management of asbestos in your building will ensure that today’s healthcare staff, contractors and building users, don’t become tomorrow’s asbestos victims. L FOR MORE INFORMATION www.iosh.co.uk
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Landscaping & Groundscare
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NATURAL PLAY SPACES
THE POTENTIAL OF NATURAL PLAY IN HOSPITAL GROUNDS Learning through Landscapes, the charity that specialises in outdoor learning and play, offers suggestions on ways in which hospitals could transform their outdoor environments as spaces for children to enjoy and develop within Children thrive and their minds and bodies develop best when they have access to a natural, inclusive outdoor play space. Engaging with such an environment builds confidence, improves wellbeing and aids the development of motor skills, balance and coordination. Although many hospitals have outdoor areas surrounding the building these are often underused and undervalued – rarely are these spaces used to their full potential. So, what could be done to improve these areas to offer children the benefits of access to natural play environments? To reach the full potential of an outdoor environment there are many design features
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that can be incorporated into hospital grounds without requiring a redesign of the entire space. Such developments would have a huge impact on the health and wellbeing of the children in (and visiting) the hospital – and making such changes need not cost the earth. ACTIVE PLAY SPACES Active play enhances proprioceptive and vestibular development and also encourages the use of fine and gross motor skills. A well-designed active play area will promote suitable challenges such as climbing, balance, coordination, swinging, bouncing and spinning. This activity can be encouraged by
providing balance beams (that can be set on the ground, or at low level with fixed rails) and by adding natural logs at a higher level with grab posts. These can be accompanied by a complex range of balance opportunities with no supports at all. Such structures can then be used for physiotherapy as well as play. NATURAL PLAY SPACES Various natural resources and plants can be used to create leafy dens and hiding areas. Shady outdoor play tunnels can also be made from willow or hazel trees which provide suitable areas for children that cannot be exposed to the sun for too long. Planting E
Although many hospitals have outdoor areas surrounding the building these are often underused and undervalued – rarely are these spaces used to their full potential. E trees, shrubs and flowers will bring seasonal play objects such as leaves, petals, conkers and acorns which offer a range of activities that are often underprovided in play spaces. Open areas of grass can be developed by transforming them into wildlife meadows. By adding long grass with a mown pathway children can walk through these areas, which should be fully accessible so that children in wheelchairs can join, if they choose to, their friends at ground level to explore flowers and mini-beasts. SENSORY ENVIRONMENTS Sensory environments can help to provide children with a wonderful opportunity to engage with natural stimulation or escape to calmer places. These spaces can also offer nurses and play practitioners an alternative space to calm or stimulate children. Careful design can help to provide for children who are hypo and hyper sensitive and good microclimate amelioration can help to make the outdoor environment comfortable for all. Consider a variety of plants that simulate all five of the senses. Adding a surface with the right texture and topography will
enhance the play and physiotherapy potential of an environment. It is, of course, essential to comply with the Disability Discrimination Act (DDA), but by going beyond compliance it is possible to explore additional routes to provide different textures and topographies and deliver a wider range of play scenarios. Walking up slopes, crawling through planted areas, climbing steps, stepping from log to log or balancing on wobbly bridges are both fun and key in rehabilitation. Ideally these areas would be created as close to the physiotherapy department as possible for easy access. With a little imagination and attention to detail, seating can serve various purposes and offer children, visitors and staff a better, more comfortable place to rest. Details such as back rests, arms (to push up from) and choice of location can have a huge effect. Incidental seating such a boulders, logs or walls also provide impromptu seating and can offer different textures and alternative play surfaces. Whilst most children use their imagination in play scenarios some find it harder to improvise or pretend. Creativity and imagination can be supported through the provision of a wide range of materials. Leaves, twigs, branches, flowers, sand, water, logs and stones all offer a wide range of opportunities to help children of all abilities to share, interact and play together.
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RESEARCH Learning through Landscapes’ publication ‘Naturally Inclusive’ is the result of two years of extensive research into natural and inclusive play in partnership with the London Borough of Camden. The new book comes with a training guide and DVD and offers more examples of how inclusivity can be designed into various play environments. ‘Naturally Inclusive’ can be purchased from the Learning through Landscapes website. L FOR MORE INFORMATION www.ltl.org.uk
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Advertisers Index
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ADVERTISERS INDEX
The publishers accept no responsibility for errors or omissions in this free service 3M
56
Haigh
11
PHS Group
35
Advanced Sterilization Products
12
Helix SMS
56
PK Care
52
Airwave
54
Imperial College London
49
Poshchair Medical
38
AM Medical Services South
38
Lavazza Apollo Fire Detectors
in4matics
56
Powervar
25
6
Induced Energy
23
Primary Care Training Centre
51
IBC
ING Car Leasing
61
Refreshment Systems
Apetito
36
Kyocera
28
Rentokil Specialist Hygiene
Asckey Data Services
29
Leas Cliff Hall Theatre
48
RoSPA
62
Asteral
31
LeoSignage
26
SCCI Energy
22
BIFM
30
Love2reward
42
Sites Ambulance Service
19
Brodex
14
Mariposa Holidays
48
Southern Country Ambulance Service
19
Phillips
54
Marley Eternit
31
Systematic Energy
24
Carrier Rental Systems
16
Maxchoice International
40
Timotay Landscapes
65
Cordtape Environmental Services
8
Müller Dairy
37 OBC
4
TM Electronics
14
Direct Enforcement
58
Nortech Control Systems
58
Total Car Parks
58
Edison Telecom
31
Nottingham Trent University
48
Variable Message Signs
EMSc
20
OKI Printing Solutions
34
Village Hotels
46
Excel Parking Services
58
Park Crescent Conference Centre
48
VisitScotland
44
Expert Messaging
51
Pel Services
32
Welch Alley
38
Glyn Williams Architects
29
Perfect Portion Control
38
Western Power Distribution
23
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