Health service procurement review 17

Issue 17

Health Service Procurement Review

Promoting best practice in the NHS

ICT • Infection Control • Risk Management • Nutrition & Catering • HR • Estates • Sustainability • Security

Foreword Jim Easton, NHS N ational Director for I mprovement and Efficiency

Production Manager Charly Paige Designer Trefor Morgan-Hayes

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Sales John Lobb Paul Marshall Anthony Snagg Sarah Wilson Patrick Whitfield

he NHS is facing one of the most significant challenges in its sixty year history as it seeks to drive up

the quality of care it delivers in a tighter financial climate.

Making quality the organising principle

Publisher Ben Dorney

of the NHS during a period of economic uncertainty is an urgent issue for the whole NHS system. It is not something we can address through a single national programme or a set of top-down

Health Service Procurement Review is published by Media Storm Ltd. The

initiatives. The real changes, that will make the biggest differences, will be designed and

Authors alone are responsible for the

delivered locally with the centre playing an enabling role.

contents of their relevant articles and the views expressed are not necessarily

We know that frontline staff have the talent and the will to make the changes we are

those of the publishers.

looking for. During Lord Darzi’s Next Stage Review of the NHS each region of the country

Whilst Media Storm acknowledges the appearance of advertisers, it does not

set out ambitious ten year plans to deliver clinically-led high quality care. These plans are now more important than ever and we will be building our response to the tighter

necessarily endorse the products or

economic climate on the work done to develop these plans and the structures already

services advertised.

in place.

Š 2015 Media Storm

We should take an evidence-based approach to this issue. I know there are many powerful examples of ways to improve quality in the NHS while encouraging better productivity, and of how we can use innovation to drive and embed change. Together we need to identify these examples of excellence, understand why this kind of approach is successful and actively diffuse this good practice across the whole health service.

MediastorM C O M M U N I C AT I O N S

I want to be sure that we are working effectively with key partners, including industry and the independent sector on these issues. I want to see joint working and an exploration of every opportunity we have to find innovative solutions.

This is the defining challenge facing the NHS over the coming years. In the sphere of effective procurement, as in many others, we need to drive for both high quality and better efficiency together, to secure an improving and sustainable NHS.

Media Storm Communications Ltd. 145-157 St. John Street London, EC1V 4PW Tel: 0845 617 1034 E-mail: info@mediastorm.uk.com www.mediastorm.uk.com

HEALTH SERVICE PROCUREMENT REVIEW I

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O verview 4. DH: Quality at the heart of the NHS

16. DH: Putting patients at the heart of services

Sir Bruce Keogh is clear that innovation is essential to the drive for quality.

Joan Saddler, Director of Patient and Public Affairs at the Department for Health explains why recording and acting on patient experience is important.

John Warrington, Deputy Director, Procurement, Investment & Commercial Division at the DH, introduces the Commercial Operating Model.

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6. DH: A new Commercial Operating Model

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ICT

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18. Case study: Software speeds up survey responses Vivienne Payne, Senior Engagement Manager at NHS Bedfordshire, explains how implementing Speedwell’s software solution to analyse public feedback has made consultations easier and more effective.

Scalable Communications Plc explains how integrating communications in a large Foundation Trust directly improved the quality of patient care.

Will Moss, Programme Head, NHSmail, NHS Connecting for Health, discusses the benefits of implementing NHSmail.

12. Case study: Fast, secure communications Cable and Wireless explains why increasing numbers of healthcare organisations are switching off their local email services in favour of NHSmail.

R isk M anagement

38. Case study: A leading light in energy creation and savings

Alison Bartholomew, Risk Management Director, NHS Litigation Authority provides an overview of the Authority’s risk management programme for NHS healthcare organisations.

Ocip energy combines the potential for creation of renewable energy with use of the latest technology in lighting, driving the adoption of commercial LED lighting as well as Vertical Axis Wind Turbines (VAWTs).

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S ecurity

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I nfection C ontrol 40. Case study: Setting the standard for disinfection Synergy Health outlines the role their new, clinically proven product, AzoMaxActive, may play in the battle to control Healthcare Associated Infection (HCAI).

24. BSIA: Planning access control in the health service

42. DH: The HCAI Technology Innovation Programme

Mike Sussman, Chairman of the British Security Industry Association (BSIA)’s Access Control Section, describes the various options available for enhancing security in the health service environment.

The HCAI Technology Innovation Programme explains how it can add value at the NHS frontline, impacting on infection as well as quality, safety and satisfaction.

26. Case study: Intelligent access control Conquest Hospital, Hastings, describes how and why it installed the Net2 networked access control system from Paxton Access.

28. BSIA: National Occupational Standards in data destruction

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MBE KTN explains why innovative design, products, systems and processes are required if we are to achieve a sustainable healthcare estate for tomorrow and deliver benefits for all healthcare stakeholders.

20. NHSLA: A framework for managing risks

Stephen Roberts, Head of Strategic Risk at Marsh Risk Consulting, outlines the challenges of implementing risk management across an NHS organisation.

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34. NHS SDU: Doing ordinary things extraordinarily well

36. MBE KTN: Innovation in healthcare buildings

22. Case study. The role of risk management in healthcare

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S ustainability The NHS’s Sustainable Development Unit (SDU) advises on how the NHS can become a leading sustainable organisation with a reduced carbon footprint.

8. Case study: Integrated communication

10. Connecting for Health NHSmail – a secure solution

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P atient E ngagement

44. Upholsteries and draperies join the battle against HCAI Panaz introduces Panvelle, a waterproof contract upholstery fabric developed specifically for the healthcare environment.

48. NPSA: Clean hands save lives

Russell Harris, BSIA Information Destruction Section Chairman, outlines this year’s developments in data destruction practices.

Dr Kevin Cleary, Medical Director at the National Patient Safety Agency outlines the key messages of the cleanyourhands campaign and its impact on hand hygiene.

30. Case study: Flying the banner for secure data disposal

50. Case study: The optimum in safety and infection control

Anne Toone, Category Lead at HMRC and chair of Buying Solutions’ collaborative procurement strategy board, outline’s the department’s new solution for the destruction of data, supplied by Banner.

Horne Engineering explains how the company applied its thermostatic design expertise to the creation of the Optitherm, an award-winning tap designed for use in hospitals to reduce infection spread.

H uman R esources 52. DH: The Commercial Resource Framework Melanie Kay, Deputy Director, Procurement, Investment and Commercial Division highlights the benefits of the Commercial Resource Framework.

54. Interims – deliver today and develop skills for tomorrow Alium outlines how using interims wisely will enable the NHS to deliver today while building inhouse capabilities for the future.

56. Cabinet Office: Leaders to face the challenge of reform Paula McDonald, Deputy Director of the Public Services Reform Group at the Cabinet Office, outlines the investment being made in public sector leadership in order to face new challenges thrown up by the recession.

70. Personal support in uncertain times – achieving ROI Clayton Glen, Director at HDA, discusses how healthcare organisations can best support their staff through the difficult times ahead.

80. IOSH: A strategy for well-being Dr Kathryn Bellamy, senior policy and technical adviser, IOSH, outlines ways in which organisations can ensure that employees feel valued and have access to resources that will improve their wellbeing.

82. Creating an all-encompassing rewards package Helen Dickinson, Head of Simplyhealth People, shows that rewarding employees can often shape the way in which they interact with customers.

H ealth & W ell - being 84. IAPT: New talking therapies have a wider impact The £173 million Improving Access to Psychological Therapies (IAPT) programme is helping PCTs deliver evidence-based, effective and cost-efficient treatments.

86. Return to wellbeing: delivering on IAPT Dr Mark Winwood, Director of Psychological Services at AXA ICAS, explains how the company is applying its experience in employee wellness programmes to NHS settings.

58. Flexible training solutions for today’s health service LSN outlines how managers can get the most out of a limited training budget by using it creatively.

62. Developing management and leadership skills The Chartered Management Institute explains how it guides and supports Department, NHS and Skills for Health agendas in achieving objectives integral to the ‘Inspirational Leadership’ programme.

64. DWP: Real jobs for people with learning disabilities Jonathan Shaw MP outlines the impact the cross-government Learning Disability Employment Strategy, Valuing Employment Now, is likely to have on the NHS.

66. Case study: Remploy and the NHS –transforming lives Remploy explains how it helps organisations develop employee retention solutions which meet business requirements and help corporate social responsibility and diversity policies become a reality.

68. Unite: The recession, staff and procurement policies Gail Cartmail, Unite Assistant General Secretary for the Public Sector, outlines how organisations should ensure budgets are used in the most effective way.

88. Dr Steve Boorman: The Boorman Review Dr Steve Boorman discusses the messages of his Interim Report into staff health and well-being.

90. A new path of provision – integration of mental health Sue Harris, Director of Strategic Business at Turning Point, looks at the development of a new service and its pioneering attempt to truly integrate an individual’s care.

92. Infertility Network UK: Regulated fertility services

N utrition & C atering

Clare Lewis-Jones MBE, Chief Executive of the Infertility Network UK, discusses NHS fertility service provision.

98. HCA: Increase your revenue through hospital catering

94. Case study: Preserving the fertility of cancer sufferers Dr Gillian Lockwood, medical director of Midland Fertility Services, considers the potential of ‘egg freezing’ to preserve the possibility of future genetic motherhood for young women diagnosed with cancer.

Kevan Wallace, National Chairman of the Hospital Caterers Association, explains how hospitals can gain the most from their catering budgets.

102. NPSA: Dysphagia, nutrition and patient safety Caroline Lecko, Nutrition Lead at the National Patient Safety Agency (NPSA), discusses the work being done to ensure that patients with dysphagia receive appropriate care and nutrition.

104. Findus Care Cuisine: bringing back the joy of food Findus Care Cuisine outlines its range of food and meals for patients with eating difficulties (dysphagia).

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OVERVIEW

Q uality at the heart of our NHS – S ir B ruce K eogh The NHS is facing the biggest challenge in its 60 year history as it continues improving the quality of care while making efficiency gains in a tighter economic environment. Much of the success of the Quality and Productivity challenge will rest with clinical leaders, such as medical directors, working with frontline staff to deliver the ambitious local visions for high quality care set out in Lord Darzi’s report High Quality Care for All.

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ord Darzi defined high quality care as care that is safe, effective and gives the patient a positive experience. NHS Medical Director Sir Bruce Keogh is using his network of medical directors across the country to bring this message home, drive up the quality of care and increase productivity.

He has plenty of experience – both as a consultant cardiothoracic surgeon but also as a consumer of healthcare.

Professor Sir Bruce Keogh is telling the story of how a major West Midlands teaching hospital ‘lost’ his wife when she was a patient there.

‘She was being treated in a ward downstairs from where I worked as a cardiac surgeon, but when I visited one lunch hour, I found her bed empty, and none of the ward staff could tell me where she was.’

It was only thanks to the patient in the next bed that Sir Bruce discovered his wife had been transferred to another hospital. ‘I was a medical director in that hospital, so I knew how the system worked. But what if I had been an 80-year-old man who had travelled by bus from the Black Country, who was in the big city, frightened – and there are lots of people like that. It would be a terrifying experience.’

As the first medical director of the NHS, Sir Bruce’s job is to drive the quality transformation of the NHS and help it weather tough financial conditions which many predict are just around the corner.

He sees the story as emblematic of the improvements the NHS must make to become a service fit for the 21st century.

‘That sort of thing, for me, gets to the heart of where we could make huge changes in the way people feel about the NHS, for not much effort.

‘If you take the pure medical side of it, on the whole most people get high quality care. But it’s all the ancillary stuff that has a major impact on quality.’

Sir Bruce says it was the first great wave of reform in the NHS, dramatically improving access to care and treatment, which has got us to the point where both patients and professionals can focus on improving quality and efficiency. High quality care is also the most cost effective care resulting in fewer hospitalisations and shorter stays.

The challenge Sir Bruce now sets the health service is to meet these changing public expectations by building services around the three dimensions of quality care set out by Lord Darzi in the Next Stage Review.

‘We have got a national definition of quality, which is that a good service is effective, it is safe and it offers a good experience,’ says Sir Bruce.

He describes a culture change among patients and clinicians as ‘the two big starting blocks’ the NHS now needs. And he is clear this means moving away from a paternalistic ‘doctor knows best’ attitude to a more equal conversation between patients and professionals.

‘The NHS was founded at a time of great deprivation after the war, but we cannot continue to rely on that sense of gratitude patients have.

‘We need to start recognising that patients are customers of the NHS and that they are right. They don’t always know about their condition or the treatments, and that is what they are coming to us for, but they know whether somebody has taken the care to explain something to them properly and they know whether that has been delivered with compassion.

‘It’s quite easy when you have done a complex operation, to say that was a

are starting to focus more “onPeople the quality and the safety of

the care that they receive.

High quality care is also cost effective care and getting this right is crucial to the future of the NHS

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In his own specialism, cardiology, Sir Bruce has witnessed the transformative effect of the National Service Framework, from ‘a third world service to a worldleading service.’

‘Ten years ago what patients regarded as quality was just getting to see someone and then getting the treatment. But that’s changed. People are starting to focus more on the quality and the safety of the care that they receive. And they are starting to focus more on the relationship with the people delivering that care.’

OVERVIEW

The Quality and Productivity Challenge

great operation, and it might be a great technical success. But if the patient doesn’t feel better, then from their perspective it hasn’t been a successful encounter with the health service.

‘As professionals, we need to recognise that the final judge of whether somebody has had good treatment or not is the person who has had the treatment.’

The levers of change in this quality transformation are just beginning to emerge. They include the publication of Indicators for Quality Improvement, and quality accounts now being piloted by some NHS providers ahead of their introduction in 2010.

Within weeks of the Next Stage Review final report last June, Sir Bruce had published the first set of outcome measures – a set of mortality rates that allowed patients to compare trusts on several procedures.

And he is convinced that a culture of openness is one of the keys to the quality

Sir Bruce Keogh (second from left) at the first meeting of the National Quality Board

drive. ‘We must invite the public to be a bit more challenging about the service they have received. And in order to do that, we have got to provide them with the information.’

He welcomes the internet revolution that means patients are better informed than ever before.

‘Patients now come in, they know more about their condition, treatment options, they have been on all sorts of sites. I reckon most patients have looked me up, they know my results.

‘Now you can have a much better, informed conversation, you are talking to people on a far more even playing field.

I think it is fantastic. That’s how you start to give the patients empowerment to challenge the NHS.’ The NHS Medical Director has also signalled his intention to use clinicians’ annual assessments and doctors’ five-year re-validations to drive quality.

‘We need to develop ways of measuring effectiveness, safety and experience and we need to make that really relevant to the clinicians who are providing the treatment and to patients.

‘We should use the annual staff appraisals to take form around those

NHS Chief Executive David Nicholson has challenged the NHS to make £15-20 billion efficiency savings from 2011-14 with the focus firmly on improving quality and efficiency together.

Locally, Strategic Health Authorities are refreshing the ten-year plans written during the NHS Next Stage Review.

Nationally, the DH is looking at transforming pathways of care, reducing commissioner spend and improving provider efficiency.

Innovation will be used to diffuse examples of good practice across the NHS to ensure wholesale adoption.

There will be a new focus on efforts to prevent ill health and improve lifestyle choices.

domains; to ask: “Are you offering your patients an effective service, a safe service and a decent service?”’

For more information please visit www.dh.gov.uk/highqualitycareforall

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OVERVIEW

A new C ommercial O perating M odel The challenge faced by the NHS to continue to improve the quality, accessibility and range of services for patients while driving efficiency hard and securing better value for money for the taxpayer has been well documented in recent months.

John Warrington, Deputy Director, Policy & Research, Procurement, Investment & Commercial Division at the Department of Health, outlines how the NHS will be meeting the challenge and improving the quality of patient care.

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n June the NHS Chief Executive expressed the stark reality that the NHS will have to make efficiency savings of £15 billion-£20 billion from 2011-14 at a time when we are pressing ahead with reform to deliver higher quality care for patients.

This represents a huge challenge for NHS procurement. In difficult times procurement is often asked to bear a heavy burden to deliver savings quickly and it is tempting to indiscriminately slash purchasing and push all suppliers for across-the-board, large reductions in pricing. This approach, however, is dangerous because it neither incorporates the full picture of an organisation’s needs nor the realities faced by suppliers today.

A more complete picture of the impact of economic change on procurement is necessary and an alignment of procurement strategy with organisational strategic goals is needed. The key to weathering the economic storm is solid coordination and cooperation within and across NHS organisations and now, more than ever, a better and more business-tobusiness like relationship between the NHS and its key suppliers is necessary to ensure we can collectively meet the difficult times ahead.

This is one of the reasons we are pressing ahead with the delivery of a new Commercial Operating Model in the NHS. Commercial and procurement skills are now integral to the NHS at all levels and the way we organise and apply them at different levels across the NHS is critical to delivering maximum impact.

Four challenges for procurement The NHS spends some £20 billion on goods and services from suppliers but the opportunity to deliver efficiencies are not limited to this sum alone. The way we spend this £20 billion can have a direct bearing on how healthcare is delivered.

For example, the purchase of new medical technologies that shorten the time patients spend in hospital can have a major impact on the efficiency of the NHS and potentially deliver better outcomes for patients. It can also have positive effect on the economy for those suppliers who are prepared to innovate to meet these challenges. This is the first challenge for procurement. How can we ensure critical and innovative technologies are embraced by the NHS quickly and efficiently? This is procurement’s transformational role.

HMT treasury’s recent Operational Efficiency Programme (OEP) found that £6.1 billion of savings a year are possible through harnessing the public sector’s collective buying power by buying

NHS through organisations such as PASA, NHS Supply Chain and Collaborative Procurement hubs, we know there are still opportunities to deliver more. This is the second challenge for procurement, its collaboration role.

The NHS relies heavily on its supply chains to ensure goods and services are in the right place at the right time and at the right cost and that streamlined and effective supporting ‘transaction systems’ are in place to enable this. Poor and inefficient logistics and transaction systems can have costly and potentially catastrophic consequences. While the NHS already has some good systems in place we know there is more to be done.

This is procurement’s third challenge, its transactional role.

As money becomes tighter “ the NHS will look critically at what it

does and how it does it and this will inevitably lead to Trusts considering alternative ways of delivering back-office or non-critical services

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more goods in a collaborative way and driving more procurement spending through collaborative channels. While we have done a lot to encourage more collaborative procurement across the

OVERVIEW

As money becomes tighter the NHS will look critically at what it does and how it does it and this will inevitably lead to Trusts considering alternative ways of delivering back-office or non-critical services. This could lead to an increase in the outsourcing of some services. Indeed the Treasury’s Operational Efficiency Programme pushes areas such as the use of shared services to the point of being almost mandatory. Procurement has a significant role to play here and this is the fourth challenge, its commercial role.

The overarching challenge is to ensure we have an efficient and capable procurement system that can deliver these four challenges.

A new Commercial Operating Model To ensure we are well-placed to deliver we have been pressing ahead with the

delivery of a new Commercial Operating Model. We are: • Continuing to support SHAs in the development and implementation of the new regional Commercial Support Units (CSUs). CSUs will become the local owners of the procurement challenge • Continuing to work closely with NHS Supply Chain to optimise this channel as an efficient and cost-effective supply route to the NHS • Moving the respective parts of NHS PASA to new owners in the commercial landscape where they will have an even greater opportunity to deliver value for the NHS, for example, energy purchasing to OGC’s Buying Solutions where there is greater potential to use the NHS’ demand

to drive better deals with energy suppliers • Building a new Procurement, Investment & Commercial Division in the Department of Health to provide the leadership for the new landscape Implementation of the new model is not without its challenges. The consensus already forged is that the prize – improved commercial capability supporting measurable improvements in healthcare and value for money – is well worth it.

For more information please visit www.dh.gov.uk

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CASE STUDY

I ntegrating

communications to improve patient care

Denny Meijer, Technical Director at Scalable Communications Plc, explains how the company successfully completed the installation of integrated communications in a new cardiothoracic centre at a large Foundation Trust and, as a result, changed the way the Trust communicates and directly improved the quality of patient care.

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n 2006 Scalable Communications became involved with a new build project, a Cardiothoracic Centre (CTC) at a large NHS Foundation Trust, where it had previously developed a resilient network across the entire campus.

The CTC is one of the most modern centres of its kind in the country, with the latest equipment and technology throughout, including state-of-the-art operating theatres and cardiac catheter laboratories. Delivering specialist treatment for people with serious heart and lung conditions, the CTC has facilities for 100 patients and the capacity to perform 1,400 surgical procedures and 2,500 cardiology procedures each year.

The CTC was a new building, which had to be completed by summer 2007. Scalable was given less than 24 weeks access until the go live date to install and test all of the systems.

to reams of information being gathered from all of the different applications and machinery in the theatre.

There was a real opportunity to start improving patient recovery post surgery and in order to do this he needed to collect and store as much information as possible, which could be analysed when the patient had been moved onto the wards. In addition, he wanted to be able to have statistical proof to confirm anecdotal evidence of patients’ reactions while they were in surgery.

The challenge The CTC posed a challenge in many ways. It incorporated multiple bespoke medical systems and applications, from a variety of vendors; including patient monitoring, surgery observation and perfusion. Because the Lead Perfusionist was given the opportunity to create the theatre exactly how he wanted to ensure the best patient care, this layout had never been tested in the UK as a fully integrated and working system.

He felt that technology should be used to improve patient care, and was instrumental in detailing what he wanted in theatre, from simple requests such as no wires in the path of the team, through

In order to get all of this information, multiple healthcare machines needed to link together and send data to a central area where it could be analysed post surgery. This would enable staff to learn from what had happened in one operation and apply this learning the next time they operated.

All of these applications and systems had to run over a wired and wireless network. Scalable was asked to integrate all the new systems and design, build and support the network.

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Network (LAN) for the CTC integrating with the existing LAN at the main campus.

This enables the Trust to share applications and create a resilient infrastructure capable of meeting the immediate and future demands of the organisation.

Also included is a high performance dual core chassis based solution with 20 Gbps connectivity to the existing dual core Extreme Networks Black Diamond 10K chassis at the main campus. Each core switch is capable of delivering 40Gbps per blade and 1Gbps to the desktop with no over subscription. The solution also consists of a modular operating system to allow the Trust and Scalable to make changes without bringing the network down. This modular approach simplifies management and support of the system and also allows scalability and capacity for future expansion and applications.

The system uses a combination of 802.1x and an Intrusion Detection System (IDS) for security. The Trust is able to monitor ports and protect against day zero attacks by combing the IDS device with key features available on the core switches.

Scalable monitors the system constantly and any network issues are responded to within four hours – at any time of the day or night.

The most challenging element to the project was the integration of all the different medical applications such as Draeger, Sorin and Medcon. All of their individual agendas and technical requirements had to be met by the Trust and Scalable Communications. We worked very closely with all parties and

The CTC incorporated multiple bespoke medical systems and applications from a variety of vendors, including patient monitoring, surgery observation and perfusion

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Our solution Working to the Trust’s requirements, we deployed a resilient Local Area

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CASE STUDY

Scalable

Communications Plc… … is a leading provider of secure, converged business communications.

We enable organisations to increase productivity and reduce costs by exploiting the latest technologies and consolidating suppliers and bills.

ran a number of workshop sessions with the engineers from the Trust and other suppliers. Implementation was achieved in stages, ensuring that each supplier’s criteria were met and fully tested before being signed off by the individual supplier and the Trust.

The technologies used are leading edge, and so the suppliers’ requirements changed regularly as solutions were tweaked to meet the needs of the Trust.

Extreme Networks and Scalable were tasked to develop specific codes to allow certain vendors to deliver unique services to the Trust.

In addition, Scalable integrated bespoke Siemens systems with Draeger and Extreme to deliver quality of service and security across the wireless network.

Ultimately after many testing sessions Scalable Communications successfully deployed a network that met all the needs of the suppliers and the Trust.

The result – improved patient care Scalable’s solution supports all of the Lead Perfusionist’s requirements. It

allows Patient Monitoring Systems to seamlessly move from wired to wireless, by undocking heart monitoring equipment and moving it with the patients, without losing data, as well as allowing the transfer of the data from the equipment.

It is capable of handling large amounts of bandwidth, to carry Cardiology PACS (Picture Archiving Communication System) and video across the LAN live from theatre during operations, for training purposes.

Lastly, information from all of the machinery is exported from theatre to wherever the surgeons require to access it post operation – removing the need for them to visit a central process records department.

As a result, surgeons can spend more time on patient management and records handling has been improved, which has had a direct, positive impact on the quality of patient care.

Scalable’s solution has been designed to support the existing applications, but also to support future developments, such as RFID tagging for patient tracking and monitoring of assets, and IP telephony.

Scalable brings a consultative and holistic approach to your organisation, understanding where you are today, your long-term goals and your challenges. We undertake an audit of your IT infrastructure, applications and communications, then provide a solution that will improve communications, bring cost savings and allow you to increase productivity and patient care.

Scalable has over twelve years strong performance and consistent growth with medium and large-sized customers from the private and public sectors, and understands the issues faced by the healthcare sector.

For more information, or to talk to one of our healthcare solution specialists about your requirements, please contact us Tel: 01628 852500 Email: marketing@splc.co.uk www.splc.co.uk/health

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ICT

NHS mail –

the secure communication solution Will Moss, Programme Head, NHSmail, NHS Connecting for Health, discusses the benefits of implementing NHSmail, a free national email and directory service that will save your organisation money, allow faster communication between clinicians and, ultimately, enable better patient care.

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ising costs of treatment and an ageing population coupled with the worst recession for over 60 years is putting pressure on NHS organisations to find additional and innovative ways of reducing costs.

An effective and efficient email system is an essential part of any modern organisation. Trusts looking at upgrading their local service could make substantial savings by choosing to switch to NHSmail, the national email and directory service available to all NHS staff in England and Scotland.

The NHSmail service is available for use, without charge to organisations.

It is actively used in around 1,380 organisations improving communications for hundreds of thousands of health professionals and, ultimately, leading to better patient care.

Endorsed by the British Medical Association (BMA), the Royal College of Nursing (RCN) and the Chartered Society of Physiotherapy (CSP), the service is a

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secure means for exchanging patient identifiable information with other users.

As it can be accessed from anywhere via any internet connected computer and on over 200 different types of emailenabled mobile devices, it is particularly beneficial for peripatetic and communitybased staff.

Launched in October 2004 the NHSmail service now has over 350,000 NHS staff registered for a user account with numbers growing daily. In April this year NHSmail users were successfully migrated to a new platform based on Microsoft Exchange 2007, the largest migration of its kind in the world.

The recent upgrade to Microsoft Exchange gives users access to a more feature rich and user friendly service, allowing faster communication between clinicians and better patient care, as patient information is obtainable much more speedily and securely.

What does NHSmail offer?

NHSmail provides a secure, enterprise standard email account. It offers a full electronic calendar, folders that can be shared with NHS colleagues and the ability to send free SMS and fax messages.

For NHS staff, accessibility, collaborative working and the reassurance that sensitive information is secure and confidential are top priorities when it comes to communications. NHSmail encourages joint working through cross-organisation shared mailboxes and folders and a powerful and data rich NHS Directory containing the professional contact details of over one million staff across the NHS.

Secure communication is essential for NHS staff to share sensitive information confidently and NHSmail allows organisations to provide their staff with the tools to carry out their jobs more effectively. It is the only NHS email service that is secure enough for exchanging patient data.

The NHS traditionally communicates by letters and phone calls, so patient care, referrals and follow-ups take time.

With NHSmail, processes are e-enabled, speeding up communications and improving patient care.

As a centrally funded and managed service, organisations benefit from access to a nationally shared platform.

This reduces local costs and frees up local IT staff to work on other areas.

Crucially, organisations stay in control of their accounts with locally appointed administrators having access to a bespoke management portal. Tools are provided allowing them to perform administrative tasks such as resetting passwords and managing mailbox quotas.

What are the main benefits?

• Secure. Staff benefit from access to a service that is accredited to Government Restricted level, allowing them to safely share sensitive information with NHS colleagues as well as local authorities and government. It is the only NHS email service with this level of security, which is why it’s approved by the Department of Health and endorsed by the BMA, RCN and CSP. NHSmail reduces the risk of data loss and consequential organisational liability.

ICT

• Resilient. NHSmail is centrally provided and run from two data centres, so availability is guaranteed along with full disaster recovery.

ISO270001 accredited and protected by over 100 service level agreements ranging from message delivery times to service availability, organisations can be confident in the service provided for their staff. In addition, all email traffic is monitored 24x7 and accounts are protected by cutting edge anti-spam and anti-virus protection.

• Fully accessible. For NHS staff that work across multiple organisations or in the community, NHSmail, which can be accessed via the web as well as email clients such as Outlook, allows them access to stay connected wherever they are. With full push email on over 200 mobile devices including the Blackberry, staff equipped with a mobile device can avoid trips to base, maximising productivity, enabling a better work/ life balance and allowing more time for patients.

• Saves money. In moving over to NHSmail, organisations can decommission their existing email services, free up resources and allocate

the savings elsewhere. In these challenging economic times, NHS staff are under pressure to deliver more for less – with NHSmail, the monthly cost of running a local email service is almost completely eliminated.

• Increased efficiency. The free text messaging service enables personalised patient communication such as appointment reminders, a key tool in reducing Do Not Attend (DNA) rates. Recent reports have highlighted that between 2007 and 2008, 6.5 million appointments were missed in the UK, with hospitals losing around £100 per patient in revenue.

Future developments The recent upgrade to Microsoft Exchange has been essential in meeting the evolving requirements of the service and allows for potential future developments such as incoming SMS and instant messaging.

Use of the service is accelerating at a great pace with an average of 12,000 new users a month. By 2011 it is estimated that NHSmail will be used by half a million NHS staff and currently, on a typical day, over 100,000 users log in and send and receive an average of 1.2 million messages.

By using NHSmail as a collaborative

tool clinicians can seek the expertise of others regardless of where they are in the country. And this is helping to create virtual communities where knowledge, expertise and different working practices are shared among those in similar areas of medicine and administration leading to better patient care.

The fastest growing element is use of the SMS feature showing how changes to working practices are being implemented at local levels. On average 25,000 SMS messages are sent via NHSmail every day to reduce DNAs, as well as for other communication such as flu jab reminders and relaying weather warnings to patients who suffer from diseases such as chronic bronchitis and emphysema.

Innovations such as these are saving the NHS time and money and benefitting both staff and patients. Feedback from users is that NHSmail is a must-have tool that improves communications between health professionals, in turn providing better care for patients. This explains why increasing numbers of organisations are switching off their local services in favour of NHSmail.

For more information please visit www.connectingforhealth.nhs.uk

HEALTH SERVICE PROCUREMENT REVIEW I 11

CASE STUDY

S peeding

up secure communication to improve patient care

For NHS staff, accessibility, collaborative working and the reassurance that sensitive information is secure are top priorities for communications. That’s why increasing numbers of organisations are switching off their local email services in favour of NHSmail, the national email and directory service for the NHS in England and Scotland.

O

up and costs reduced – with NHSmail, monthly email management costs could fall by up to 80 per cent.

Availability is guaranteed with full disaster recovery, and ISO2000 accreditation gives organisations confidence in the service provided for their staff. In addition all email traffic is monitored 24x7 and accounts are protected by cutting edge anti-spam and anti-virus protection.

Representing the gold standard in functionality, NHSmail offers a range of features that enable staff to send a mix of email, fax Reason for change and SMS text messages.

Since 2004, Cable&Wireless It incorporates a full electronic has worked closely with NHS Will Moss, Programme Head, NHS Connecting for Health calendar and folders that can be Connecting for Health to provide shared with colleagues across a fully managed enterprise email organisation boundaries. service to the NHS. Take control The first generation NHSmail platform NHSmail is accredited to Government Drive value successfully supported 350,000 users, Restricted level, allowing users to safely The NHS traditionally communicates however requirements had changed with share sensitive information with NHS by letters and phone calls, so patient an increasing need for collaboration and colleagues as well as local authorities care, referrals and follow-ups take time. mobility features. It was time to consider and government. NHSmail is the only With NHSmail, processes are e-enabled, moving to a more feature rich platform NHS email service with this level of speeding up communications and security, which is why it’s approved by improving patient care. the Department of Health and endorsed NHSmail allows organisations to by the British Medical Association, Royal provide their staff with the tools to carry College of Nursing and the Chartered out their jobs more effectively.

Society of Physiotherapy.

Staff also benefit from access to Crucially, organisations stay in control the national directory containing the of their accounts – locally appointed professional contact details of over administrators have access to a bespoke a million staff across the NHS. As a management portal developed by collaborative tool, clinicians can seek the Cable&Wireless, allowing them to perform expertise of others regardless of where tasks such as resetting passwords and they are in the country. This is helping managing mailbox quotas. to create virtual communities where Existing email services can be knowledge and expertise can be shared. decommissioned, IT resources freed ur vision was to build a single shared service platform, which could be scaled to support the whole NHS user base. This would encourage organisations to switch off locally supported services in favour of NHSmail. Building on the success of the first generation platform, the new service would have the potential to benefit nearly one million healthcare professionals across the NHS either still using locally supported, unsecured platforms or with no access at all to communications tools.

and it became clear that Microsoft® had made great strides in the provision of a large-scale public sector email service.

In 2007 the decision was taken to migrate users to a new platform based on Microsoft Exchange 2007 to meet the evolving requirements of the service and allow for developments such as incoming SMS and collaboration tools.

“

The feedback from users is that NHSmail is a must-have tool that improves communications between health professionals and, in turn, provides better care for patients

”

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I HEALTH SERVICE PROCUREMENT REVIEW

CASE STUDY

For staff that work across multiple organisations or in the community, NHSmail allows them access to stay connected wherever they are. With push email on over 200 mobile devices including BlackBerry®, a Community Nurse with a mobile device can avoid trips to base, maximising productivity and allowing more time for patients.

SMS is one of the fastest growing features showing how changes to working practices in the NHS are being implemented at local levels. On average 35,000 SMS messages are sent via NHSmail every day to reduce appointment no shows, as well as for other communication such as flu jab reminders and relaying weather warnings to patients who suffer from diseases such as chronic bronchitis and emphysema.

C&W service delivery Migrations began in January 2009 and over 11 weekends more than 350,000 accounts were moved to the new platform, reaching a peak when a massive

47,000 accounts were migrated in just 48 hours. With an unprecedented success rate, Cable&Wireless achieved the biggest and fastest enterprise email migration of its kind ever. And with the capability of serving one million users, the service is the largest Exchange 2007 implementation of its type in the world.

Use of the service is accelerating at a great pace with an average of 12,000 new users joining the service per month.

By 2011 it’s estimated that NHSmail will be used by half a million NHS staff and on a typical day over 100,000 users log in and send and receive an average of 1.6 million messages.

Feedback ‘NHSmail is a fantastic application that provides NHS staff with the communications tools to carry out their jobs more effectively, the improvements to NHSmail mean that staff have access to a vastly improved communications tool.

This new email service will mean faster communication between clinicians and

better patient care, as patient information will be obtainable much more speedily and securely.

‘The feedback from users is that NHSmail is a must-have tool that improves communications between health professionals and, in turn, provides better care for patients.’

Will Moss, Programme Head, NHS Connecting for Health.

For more information please contact Ian Fowler – ian.fowler@cw.com or publicsector@cw.com

HEALTH SERVICE PROCUREMENT REVIEW I 13

ICT

I mprove

patient care with integrated video - conferencing Investing in technology can directly impact on the standard of patient care. Computacenter explains how a project to provide video-conferencing solutions to East Kent Hospitals University NHS Foundation Trust has resulted in the hospital reducing costs, increasing efficiency and training, and improving the quality of care.

E

ast Kent Hospitals University NHS Foundation Trust serves a wide geographical area. With its main hospital sites some miles apart, the Trust’s clinicians frequently had to travel to attend meetings and conduct training sessions. The Trust recognised travelling was not an efficient use of clinicians’ time.

In addition to the impact on productivity, the Trust was also keen to reduce travel expenditure and its impact on the environment.

Computacenter solution The Trust partnered with Computacenter to design, implement and support a sophisticated videoconferencing solution. The solution installed at the Trust’s three acute hospitals includes high-definition displays to enable clinicians to share images from the hospital’s PACS (Picture Archiving and Communications System) such as x-rays and scans.

Technology solution overview Computacenter services: • • • • •

Project management Product supply Configuration Installation Maintenance

Technology: • Tandberg high-definition video conferencing units • AMX control panels

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I HEALTH SERVICE PROCUREMENT REVIEW

Results By enabling its healthcare professionals to hold virtual meetings and share medical information, East Kent University NHS Foundation Trust has reduced travel costs and its impact on the environment. More importantly, the solution enables faster diagnosis and treatment of patients, and improves

patients’ homes via a number of smaller community-based hospitals and walk-in centres.

Business challenge: Reducing the need for travel East Kent Hospitals University NHS Foundation Trust covers a wide geographical area, including the entire south east coast. The Trust’s three acute sites – Kent Canterbury Hospital, Queen Elizabeth the Queen Mother Hospital and William Harvey Hospital – are some miles apart.

The Trust’s clinicians frequently had to travel between these sites for departmental meetings and Tracey Miles, Head of Supplies & Procurement, training purposes. As Tracey Miles, East Kent Hospitals University NHS Foundation Trust Head of Supplies & Procurement at East Kent Hospitals University NHS Foundation Trust, explains: ‘Due mentoring and training for medical staff. to our teaching activities, our medical These factors all contribute to improving professionals need to be able to mentor the standard of patient care delivered to and share knowledge with more junior the population of East Kent. staff. This often involved travelling between sites.’

Customer profile: The Trust recognised that this travel Providing healthcare services to the was not an efficient use of clinicians’ time. people of East Kent In addition to the impact on productivity, East Kent Hospitals University NHS the hospital was keen to reduce travel Foundation Trust is one of the largest expenditure and its impact on the hospital trusts in England, formed in environment. With onsite parking also an 1999 when three hospital trusts merged. issue for the Trust, it needed to reduce the The Trust provides comprehensive health need for travel wherever possible. care provision for the people of East Kent, serving a population of 720,500 Computacenter solution: and having 1,118 beds (as of July 2008) Integrated video-conferencing across the three main hospitals in Ashford, The Trust identified that a videoCanterbury and Margate. The Trust is also conferencing solution could help address focused on delivering treatment nearer to

project “ Thehasvideo-conferencing demonstrated how

investment in technology can help reduce costs, increase efficiency and improve patient care

”

ICT

Computacenter…

these issues. To find a suitable partner to assist with the project, it carried out a formal benchmarking exercise via the Office of Government Commerce (OGC).

Computacenter proved to be the most appropriate match in terms of technical capabilities, experience and best value for money.

Following an extensive scoping exercise, Computacenter worked closely with the Trust’s project team to fine-tune its requirements and design a solution that met its needs. Tracey comments: ‘In order to support meetings and training, we wanted the video-conferencing solution to integrate with the hospital’s Picture Archiving and Communications System (PACS). This would enable medical staff to share x-rays and scans during virtual meetings.’

The quality of such images is crucial for accurate diagnosis. It was therefore important to provide a solution that would be able to display such images in high definition.

Results: Improved patient care ‘The video-conferencing project has demonstrated how investment in technology can help reduce costs, increase efficiency and improve patient care,’ comments Tracey. ‘This was a groundbreaking project for us, which has proved to be a great success thanks to the collaboration and hard work of all involved.’

By enabling its healthcare professionals to hold virtual meetings and share medical information, East Kent Hospitals University NHS Foundation Trust has reduced travel costs and its impact on the environment. More importantly, the solution enables faster diagnosis and treatment of patients, and improves mentoring and training for medical staff.

These factors all contribute to improving the standard of patient care delivered to the population of East Kent.

… is Europe’s leading independent provider of IT infrastructure services.

We advise customers on their IT strategy, implement the most appropriate technology from a wide range of leading vendors and manage their technology infrastructures on their behalf. At every stage we make our customers’ businesses sharper by removing cost, complexity and barriers to change across their IT infrastructures.

Our corporate and government clients are served by offices across the UK, Germany, France, the Benelux countries, Spain and South Africa. We also serve our customers’ global requirements through our extensive partner network.

For more information please contact Tel: 0845 604 5151 www.computacenter.com/ government

HEALTH SERVICE PROCUREMENT REVIEW I 15

PATIENT ENGAGEMENT

P utting

patients at the heart of services The needs of the patient have always been at the heart of the NHS. When it was founded, the public wanted an NHS available to everyone, free at the point of delivery and this is what they got. Today, this principle remains true but effectively understanding and acting on what really matters to patients has never been more important. Joan Saddler, Director of Patient and Public Affairs at the Department for Health, explains.

putting pressure on resources, while the economic conditions facing the world make increases in NHS funding unlikely.

Increased quality and greater personalisation have both been driving NHS reform in the last few years.

However, with UK plc facing a future of financial constraint, the government is now also asking services to make more of existing resources by focusing on innovation and productivity.

A

s consumers, we demand high quality services that understand and respond to our individual needs. In the public’s mind, the NHS is no different. They pay their taxes and in return they want an NHS that gets the basics right, that fits services around their lives, that treats them as individuals and not just a set of symptoms, and that works with them as partners.

As well as having to meet these higher expectations, the NHS is facing other challenges. The cost of keeping pace with modern technology and medicine is

Growing importance of patient engagement and experience Even before the recession, engaging patients about their experiences and acting upon this information was part of NHS reform. In the years to come, if we are to meet public expectations and make the best use of resources, this approach will be crucial.

We know what good looks like For years, the private and public sectors have demonstrated that effective engagement of customers can result in innovative new ideas, as well as improved quality, productivity and customer satisfaction. Put simply, the better you

understand your customer, the more responsive you can be to their needs.

However, to do this you have to put in place the right systems to engage people and then gather, interpret and use what they tell you.

Up and down the country, there are examples of NHS managers and commissioners using this approach to improve day-to-day care, as well as to design and commission services.

To help improve front-line care, the Homerton University Hospital in London uses electronic surveys on wards so that patients can give instant feedback. The results – on subjects like privacy and staff attitude – are displayed along with any agreed actions for improvement.

NHS Bradford and Airedale have developed a database to capture what people say about their services. The system then analyses each story, tags it as positive, negative or neutral and files it under one of five quality indicators. The results are used with other data to identify where improvements can be made.

When it comes to commissioning, Dudley Primary Care Trust has developed a central repository to collate all of the

Engagement and experience – fundamental to reform The importance of patient engagement and experience is a key part of policies to reform the NHS • World Class Commissioning calls upon commissioners to engage communities and to use the feedback they get to shape their decisions.

• Under High Quality of Care for All, the experience of service users is now one of the major measures of service

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quality. Something that is being taken forward by provider quality accounts and Commissioning for Quality and Innovation payments • The government has committed to getting all NHS hospitals to use realtime patient experience information

to drive design and delivery of care • The NHS Constitution will help to make the public more aware of how they can influence their own care and local services – from their legal right to complain to initiatives such as Local Involvement Networks

PATIENT ENGAGEMENT

Top tips on using feedback • • • • • • • • • • •

Do Remember, improving experience involves changing minds – positive attitudes make the difference Ensure senior clinical commitment Select the method of measuring feedback that matches your purpose and the needs of your patients Pilot your chosen method before using it on a large scale Use technology but remember it is an aid not a solution Ensure that the resources you need are factored in Collate feedback with other data to gain a full insight Avoid paralysis by analysis – resist the temptation to gather ever more information before taking action Identify what is working well – reward good practice Avoid providing data alone, without interpretation Explain the results and demonstrate the action taken

feedback it gets. Feedback comes from a range of sources including national, local and regional surveys, workshops, PALS data, complaints, incidents and LINks. The repository is managed by a dedicated analyst who supports PCT colleagues using the information. The PCT is looking closely at how the repository could be extended. It would include local providers’ feedback so the PCT gets a comprehensive overview, to drive improvements more effectively.

NHS Hampshire asked patients to identify the aspects of hospital care that they were most concerned about. Seven themes emerged, which were developed by the PCT into improvement targets and included in the contracts with hospital providers. As a result the PCT knows it is improving services in line with local expectations and can track its progress.

Don’t • Expect a ‘quick fix’ – changing minds takes time and creating a structured approach enables you to monitor success • Ignore the need to invest in capability and capacity • Measure progress too narrowly • Decide upon an approach without understanding the ongoing costs • Collect feedback before knowing who will use the insight • Forget to feed back to staff and patients • Focus only on the negative – celebrate successes.

Making engagement and experience part of our DNA These are just a few examples of how the NHS using patent experience information to drive improvements. The NHS is also making greater use of social marketing techniques to motivate people to lead healthier lives – and also to feed into their engagement processes.

However, if we are to make this sort of approach the norm in the NHS, then we need to spread the word about successes and encourage others to follow suit. We also need to encourage the NHS to take a comprehensive approach to ensuring that the people who use services drive the design and delivery of care. Patient engagement should not be done in a vacuum, it should work across organisations, as well as pathways of health and social care.

To help achieve this ambitious agenda, the Department has produced a range of resources and more tools are in the pipeline. For example, the ‘Engagement cycle’ highlights who needs to do what to engage people at each stage of the commissioning cycle. The Department has also published ‘Understanding what matters: A guide to using patient feedback to transform care’, which provides advice to commissioners and providers on how to use experience information to transform services.

However, we all need to play our part.

From Chief Executive to nurse, we need to put what really matters to patients at the heart of everything we do.

For more information please visit www.dh.gov.uk/ppe

HEALTH SERVICE PROCUREMENT REVIEW I 17

CASE STUDY

Bedfordshire

S oftware

speeds up survey responses Patient engagement – and understanding the information generated – is key to driving forward services. Vivienne Payne, Senior Engagement Manager at NHS Bedfordshire, explains how implementing a new software solution to analyse public feedback has made the process easier and more effective.

W

hen I joined NHS Bedfordshire a year ago it was clear that securing public and patient feedback was rising up the agenda nationwide – patient engagement is a key part of policies to reform the NHS, and used to drive forward the design and delivery of services.

NHS Bedfordshire is constantly generating and collating a vast amount of information. The PCT runs consultations constantly and, traditionally, these would be paper based surveys. At any one time we have two large consultations in progress, plus smaller projects for different services, which are conducted using other techniques such as workshops and focus groups. A full consultation takes about

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I HEALTH SERVICE PROCUREMENT REVIEW

12 weeks, plus two months of preparation (to determine the questions and design) and two months to collate and analyse the results. All in all the whole process can take around six months. Alongside the main consultations we also run public meetings and drop-in sessions so that everyone gets to have their say.

“

KeyPoint allows us to gain a real insight into how our services can best work for the community

”

I knew that using public feedback information in its purest form would enable the PCT to make the greatest effect on services, but to do this effectively I realised that we would need some help in the collection and analysis of

data. A software solution would enable us to collate and use information quickly.

We identified what the PCT would want from a software package and researched what was available.

It was important that the software was easy to use, as occasionally a consultation requires us to send data to an external source for interpretation – for example, when we are dealing with sensitive issues and must prove that an independent party has verified the results. For this reason, among others, the software also needed to be very secure, as any data we gather is protected under the data protection act.

We found that KeyPoint, an off-theshelf solution from Speedwell, offers a flexible solution that meets all our criteria.

KeyPoint is similar to Microsoft products, in that it is easy to learn, with comprehensive instructions. It is also very secure and can be password protected to the level required by the client.

In addition, the package is future proof. Any developments in our surveying and information gathering are likely to be matched to developments in the software.

We were able to gain results very early on using the software.

A recent eight-week consultation provides a good example of our experiences of using KeyPoint. The consultation involved issuing summary leaflets to 9,500 patients outlining proposals to establish a new health centre in their village. All the information was designed before we implemented the software – the paper survey had a tear off section that the patients could send back to us, and by this time KeyPoint

CASE STUDY

was in place to help collate and analyse the results. Importantly, KeyPoint is able to capture people’s opinions from a qualitative view, therefore we are able to monitor respondents’ key priorities, perceptions, strong feelings and reasoning for them. We were able to access this information to generate a range of reports for key areas within the PCT. It’s more efficient and captures more information than other feedback methods.

KeyPoint also allows us to feed back information to the community simply and effectively, by helping us to transform the data into emails, newsletters and media releases as comprehensively as possible.

Importantly, KeyPoint allows us to learn as we proceed through a consultation. Whereas before, we would have to wait until we had closed each consultation to input results and responses, now we do it constantly as we go along. This allows us to pick up on any trends in responses and react accordingly – for example, if the majority

of responses are from females then we would review and develop our methods to enable an equal number of men to respond. Our learning and understanding of communities and communication techniques can evolve as each consultation develops, rather than waiting until the next consultation, which makes the results more effective and responsive.

The software gives us a flexible approach to the future. Innovation is key to conducting consultations, to keep people’s interest we must develop new ways of getting people involved. KeyPoint will allow us to do this.

We are now looking at using KeyPoint to collect real time data from staff using handheld devices for surveys in the community. This data can be available for analysis almost immediately. Taking handheld devices and standing outside a local supermarket is easy and effective, something we wouldn’t necessarily be able to do so easily using traditional methods. And the immediacy of the collation will allow us to learn and adapt our methods far more quickly.

Speedwell has been very responsive and has proved to be very accessible and on call whenever we need help. The IT

assistance is very efficient, training is offered in segments, which allows us to pick the sections we need. As the training is onsite it is very informal, which suits us very well. The PCT is getting used to KeyPoint and I envisage the package helping us to expand our operations as the software evolves. The NHS is answerable to the public and needs to show that it is listening to them – KeyPoint will support the ways in which we work with communities to gain a real insight into how our services can best work for them.

For more information please contact Tel: 01223 815210 ext. 693 Email: nhs@speedwell.co.uk www.speedwell.co.uk/freetrial

HEALTH SERVICE PROCUREMENT REVIEW I 19

RISK MANAGEMENT

An

effective framework for managing risks Alison Bartholomew, Risk Management Director, NHS Litigation Authority provides an overview of the Authority’s risk management programme for NHS healthcare organisations

T

he NHS Litigation Authority (NHSLA) manages clinical and non clinical negligence claims made against NHS organisations in England and promotes good risk management within those organisations. By reducing the number and severity of incidents, good risk management can improve patient and staff safety and also save resources.

Claims The number of claims reported to and total payments made by the NHSLA under the Clinical Negligence Scheme for Trusts (CNST) and non clinical Liabilities to Third Parties Scheme (LTPS) in each of the last five financial years are shown in Figures A and B. The number of clinical claims reported in 2008/09 rose by more than 11 per cent compared to the previous financial year and the number of non clinical claims by over 10 per cent but the NHSLA has been unable to identify any single factor that might have precipitated these increases. The growth in claims payments over the whole period is in large part a reflection of the growing maturity of the schemes, fuelled by claims inflation

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of circa 10 per cent per annum, and the use of conditional fee arrangements to pursue claims.

The cost of claims is funded by scheme members – all NHS organisations – on a pay-as-you-go basis. Actuaries analyse the available data and predict the total amount expected to be paid on behalf of members by the NHSLA in respect of damages, legal costs and other expenses in the ensuing financial year.

This amount is then apportioned between members on a risk basis and collected via contributions (premiums). The average total gross CNST and LTPS contributions for an acute organisation providing maternity services in 2009/10 is £4.7 million but the average figure for other types of NHS healthcare organisations is much less at slightly over £250,000.

Standards The NHSLA risk management programme includes standards against which most NHS organisations are required to be assessed. The standards are based on factors which give rise to claims, and the systems which organisations need to have in place both to prevent patient and staff safety incidents and to enable such incidents to be dealt with appropriately when they occur.

The specific requirements within the standards are based on guidance and recommendations issued by relevant professional and other bodies.

The standards are designed to: • Provide a structured framework within which to focus effective risk management activities in order to

•

•

•

•

•

• •

deliver quality improvements in organisational governance, patient care and the safety of patients, staff and others Increase awareness and encourage implementation of the national agenda for the NHS Encourage and support organisations in taking a proactive approach to improvement Reflect risk exposure and allow organisations to determine how to manage their own risks Contribute to embedding risk management in the culture of an organisation Reduce the level of claims by reducing the number of adverse incidents and the likelihood of recurrence Assist in the management of adverse incidents and claims Facilitate learning and the sharing of lessons to be learned from adverse incidents

There are separate NHSLA risk management standards incorporating organisational, clinical and health & safety risks for NHS acute, mental health & learning disability, ambulance and primary care trusts. Each set of standards contains five individual standard areas: • Governance • Competent & Capable Workforce • Safe Environment • Clinical Care • Learning from Experience Within each standard area there are ten equally weighted criteria or risk areas.

In addition, because of the high cost

RISK MANAGEMENT

of maternity claims, there are separate clinical standards for organisations providing labour ward services.

,

Assessments The management of each risk area

by NHS organisations is assessed at three distinct, progressive levels via an ongoing and regular programme of assessment: • Level 1 – Policy. The processes for managing risk have been described and documented.

• Level 2 – Practice. The processes for managing risk, as described in the approved documentation at Level 1, are in use and have been implemented throughout the organisation.

• Level 3 – Performance. Monitoring whether or not the processes for managing risk, as described in the approved documentation at Level 1, are working across the entire organisation. Where failings have been identified, action plans must have been drawn up and changes made to reduce risk.

All assessments take place on site over two days and are carried out on behalf of the NHSLA by a dedicated team employed

by Det Norske Veritas (DNV), a specialist risk management services contractor.

Compliance with the standards provides the board, stakeholders (including

patients and staff) and other inspecting bodies with assurance about the risk management processes in place within an organisation.

Organisations which demonstrate compliance with the standards at assessment receive increasing discounts, ranging from 10 per cent – 30 per cent, on their contributions to the NHSLA schemes as they progress from Level 1 to Level 3. Details of the assessment levels and assessment reports are published on the NHSLA website.

Education In addition to the standards manuals, a range of tools are available to help organisations achieve the NHSLA risk management standards: • Handbook containing guidance and reference sources in support of the standards • Template documents to help organisations draft local policies to manage risks • Frequently Asked Questions and answers on the standards and assessments • Evidence Template to assist organisations in conducting a self assessment Organisations are also offered an informal support visit by their assessor

each year and learning events, eg workshops, are provided too.

Value of the NHSLA Risk Management Programme It is not possible to show a direct relationship between the NHSLA risk management activities and improvements in patient and staff safety because this would require their impact to be measured in isolation. Evidence that the programme has prevented the number of claims from rising still further would require proof of a negative, ie an incident that would have given rise to a claim did not happen and thus no claim was made. However, some research, anecdotal evidence from those assessed against the standards, and the views of other stakeholders, indicate that the NHSLA risk management standards provide an effective framework within which to manage risk and that demonstrating compliance at the higher levels at assessment may act as an indicator that an organisation is implementing effective processes to manage their risks.

More information about the NHSLA and its risk management activities can be found at www.nhsla.com

HEALTH SERVICE PROCUREMENT REVIEW I 21

RISK MANAGEMENT

T he

role of risk management in the healthcare sector Stephen Roberts, Head of Strategic Risk at Marsh Risk Consulting, outlines the challenges of implementing risk management across a healthcare organisation and suggests ways of embedding it to add value.

in organisational decisions, in order to demonstrate to stakeholders that the organisation is robust.

R

isk management has always been prevalent in both the public and private healthcare sector, particularly from an operational/clinical perspective.

However, as the healthcare sector evolves, so does its risk profile. Many healthcare organisations are now looking to go beyond simply achieving compliance through their risk management, to ensuring that it is a key management tool which provides a clear line of sight to the organisation for management, and also enables decisions to be made in an informed and demonstrable manner.

In the current climate, it is even more important to consider the issue of how good an organisation’s risk management is. Put simply, risk management must go beyond compliance if it is to offer the greatest added value to the organisation.

In Marsh’s experience, many healthcare organisations in the UK are suffering from not moving their risk management past being a compliance issue, although there are a few exemplars.

While most organisations have risk management in place, we have found that this does not necessarily mean that it is embedded and adding value to the organisation.

There is, however, now a shift towards ensuring that risk management is used 22

I HEALTH SERVICE PROCUREMENT REVIEW

The compliance driver The independent regulator of NHS foundation trusts, Monitor, makes its stance on risk management quite clear: ‘The approach of Monitor to regulation is one of risk management’.

The regulator’s Compliance Framework and guidelines to foundation trust hospitals (and aspiring foundation trust hospitals) clearly set out risk management expectations. Find more information by visiting: www.monitor-nhsft.gov.uk

Best practice risk management in the healthcare sector Risk management may be in place in your organisation, but does it work?

From Marsh’s experience we have compiled a list of best practice tips that will add value to an organisation’s risk management: 1. Sponsorship and positioning 2. Managing the risk management process 3. Risk identification 4. Risk prioritisation 5. Risk treatment / control 6. Reporting 7. Monitoring 8. Risk awareness culture 9. Communication 10. Working with other organisations

The value driver Risk management provides the management information for healthcare boards to understand where they need to allocate focus, capital and resource, to effectively execute and ensure success of their strategic objectives.

How are healthcare organisations using risk management in a pro-active way?

From Marsh’s experience, risk management really proves its worth when it relates to the day-to-day issues of the organisation, and is used proactively to help with tactical and strategic decisions.

Organisations gain the most through deploying risk management around the following: Strategic plans and objectives.

Most healthcare organisations must submit a three- to five-year plan and strategic objectives to either the regulator, central government department or internal stakeholders, which enables the success of the organisation to be measured. However, very few organisations separately risk profile each strategic objective and its key performance indicators. Using risk management proactively can capture the unique risk profile of each objective and consider risk mitigation strategies.

Counterparties. For any organisation to operate successfully it must rely on a number of third party providers, such as IT, cleaners, equipment maintenance and so on. If a relationship with one of these suppliers breaks down it can damage the operations of the organisation, particularly its reputation. Risk management can capture the risk to each party, thereby

RISK MANAGEMENT

enabling the risks to the success of the relationship to be effectively identified and apportioned between the parties.

CAPEX projects. Larger healthcare organisations have various levels of development underway, from new wings to entire new sites. These are often high profile projects. While most construction projects are very effective at managing the operational aspects of the project, often the wider risk profile of the project is not formally captured, particularly strategic risks. With this in mind, often investors and financial backers are looking to see inclusion of a project wide risk management framework to ensure the project is delivered on time, on budget and to the best quality.

Performance targets. Healthcare organisations are set performance targets. To ensure that all of the risks to successfully achieving these targets are known and managed, some organisations are using risk management to gain clarity of sight in understanding where they must focus to manage these risks. In addition, the management information that a formalised risk management provides, gives confidence that these targets can and will be met.

Additional services. A common consideration for the healthcare sector is the potential to offer additional services.

Risk management can be used to support

the decision making process in this regard.

When organisations look to add additional services, risk management gives an insight into which service would – or already does – add the most to the organisation.

Effectively risk management provides a formalised and demonstrable thought process to the opportunities and threats that one service may offer over another.

In so doing senior management can then effectively weigh up each option armed with quality management information and make the most appropriate decision.

Emerging risk issues Where risk management can offer the most value is when it is deployed to capture emerging risks, thereby enabling the organisation to deal with the risks proactively. Reacting to an issue after the event often costs more money and time than pro-actively addressing it and limiting its impact.

Key emerging risks include: • Pandemic • Partnership risks • Commercial ventures • National service frameworks and delivering their key targets • Staff and skill shortages • Compliance with key areas around how to deal with children and young people

• Emergency care services in the longer term • Contract security and guaranteeing income security The benefits of using risk management in this way Through compliance alone the healthcare sector has to establish risk management. With this being a compulsory activity, healthcare organisations are now seeing the value in further developing their risk management in order to maximise the return of this compulsory activity. In doing so, risk management will begin to become a defaulted and valued management tool which can be deployed across challenges and opportunities across the sector.

For more information please contact Stephen Roberts – Head of Strategic Risk Marsh Risk Consulting Email: Stephen.Roberts@marsh.com www.marsh.co.uk/service/ riskconsulting

HEALTH SERVICE PROCUREMENT REVIEW I 23

security

P lanning

access control in the health service

Modern access control systems offer versatile options for ensuring the effective security of people, property and sensitive data by denying unrestricted access to sensitive areas, while enabling the convenient movement of authorised persons or vehicles. In this article, Mike Sussman, Chairman of the British Security Industry Association (BSIA)’s Access Control Section, describes the various options available for enhancing security in the health service environment.

W

hile it is often necessary to allow high levels of public access to hospitals and other health service facilities, including the routes linking different departments, entry to many internal areas needs to be restricted for the protection of patients, property and sensitive information.

Crime prevention and personal safety are obviously key issues but the managers of public buildings are also required to address the legal implications of effective security. Legislation such as the Health and Safety at Work Act, the Occupiers Liability Act and the Management of Health and Safety at Work Regulations impose a wideranging duty of care upon the owners and managers of buildings, while data protection laws have introduced new security implications for safeguarding personal information, a factor with clear relevance to the health service.

Precisely how these obligations are discharged depends on factors such as the level of security required in specific areas and the numbers of people likely to need access in the course of their work. Access control systems can differ considerably in detail, but their common aim is to restrict entry to people with the necessary authority. They do so by means of a terminal fitted on the outside of the protected area, linked to a lock release which opens a door, barrier or turnstile when certain pre-programmed information is entered. Systems can be ‘stand-alone,’ that is, designed to control

entry to a single door, or they can be linked electronically to an unlimited number of entrances, often with a computer interface to enable central programming and record details of usage.

Such networked systems are capable of being pre-programmed to allow different levels of access to different people at different times, according to the user’s needs or security clearance.

circulation routes. Some devices can be programmed to activate an alarm – or to cease to function for a pre-set period – if a series of incorrect codes are entered in a short space of time.

Card-based systems perform the same security function, while offering advantages such as integration with employee badging and the ability to invalidate individual lost cards. Increased security can be obtained from dual technology products that combine a card reader with a digital keypad. Some systems employ proximity tokens or fobs of different types, rather than conventional cards, which enable hands-free access, such as by wearing the fob like a badge, another facility with clear relevance to many hospital departments. Their ease and speed of operation also makes such proximity systems suitable for high-volume entrances.

Networked systems add to these various advantages by delivering real-time management capabilities, including the ability to add, delete, or amend levels of authority. They enable a range of reports to be generated, providing details of current or historical events. This allows access control systems to fulfil additional needs, such as using transaction recording for payroll purposes, determining current occupancy if it becomes necessary to evacuate an area in an emergency, or discovering who went where, at what time and for how long for investigation purposes. It is normal for multiple

In cases where very high levels “ of security are desired, biometric systems

may be employed to regulate access by comparing unique human characteristics.

Various types are available, which store the geometric patterns of the user’s retina, hand or fingerprint in an electronic memory

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I HEALTH SERVICE PROCUREMENT REVIEW

”

One of the most common types of technology is the digital keypad system, pre-set with a personal identification number (PIN), which allows the door release to operate when the same number is keyed into the terminal. The PIN can usually be changed at any time, either as a routine security measure, or if it is thought to have been compromised, such as when a formerly authorised person leaves or ceases to be authorised for one reason or another. They offer a simple yet effective means of restricting the number of internal areas accessible by visitors, such as private areas leading from public

security

operator positions to be available via standard LAN or WAN networks, generating full audit trails through password controls and hierarchical levels of operator authority.

In cases where very high levels of security are desired, biometric systems may be employed to regulate access by comparing unique human characteristics.

Various types are available, which store the geometric patterns of the user’s retina, hand or fingerprint in an electronic memory. It is likely that biometrics will become much more widely relevant in access control, driven by advances in technology, speed of operation and affordability. Developments such as e-passports and the proposed national identity register may in future provide significant new opportunities for integration across large organisations, making this type of high security more widely available and cheaper to implement at local level.

All current forms of access control technology have the added benefit of integrating well with other security measures, such as closed-circuit television surveillance. Integration also introduces the concept of total security management, linking such facilities as time and

attendance, CCTV, fire and intruder alarm systems and building management, as well as other services such as cashless vending and car parking. The exact type of system or combination of systems most appropriate to particular users will obviously differ from place to place. Some key questions to consider when planning for access include: what level of security is needed and how might the requirement change, what volume of use is expected, what scope for expansion is likely to be needed, how many entrances need to be controlled, what additional features are required and how will all these factors influence circulation?

A good starting point is to identify existing and possible future needs and discuss the options with equipment suppliers who belong to the BSIA. All member companies are required to achieve the internationally recognised quality management standard BS EN ISO 9000. They observe strict technical standards, including the application of British Standard specifications for the design and installation of access control systems. The BSIA also publishes advice and user’s guides on access control, which are available to download free of charge at www.bsia.co.uk/publications.

The British Security Industry Association is the trade association covering all aspects of the professional security industry in the UK. Its members provide over 70 per cent of UK security products and services and adhere to strict quality standards.

For more information please contact Email: info@bsia.co.uk Tel: 0845 389 3889 www.bsia.co.uk

HEALTH SERVICE PROCUREMENT REVIEW I 25

CASE STUDY

I ntelligent

access control

Based on a gently sloping site in Hastings, the Conquest Hospital is a modern District General Hospital. Built over four levels, the hospital opened 16 years ago and in 2002 merged with Eastbourne Hospital to form East Sussex Hospitals NHS Trust, serving the population of East Sussex. The Trust employs over 5,000 staff and is extremely busy. In the last year the Trust’s maternity teams delivered 3,835 babies; 95,393 people were treated as inpatients and day cases and a total of 115,147 patients were treated in their two emergency departments. The Trust also carried out nearly five million pathology tests.

I

n 2007, the access control system at the Conquest Hospital failed and could not be recovered. Installation of a new system by the current provider was not a realistic option because of the cost that had been quoted to them. John Kirk the Security Manager for both The Conquest and the DGH in Eastbourne explains: ‘Security is very important in this sort of environment. Hundreds of people come through the hospital every day and we need to ensure that the general public cannot wander into some areas of the hospital, whether by accident or design.’

John decided to investigate installing a Net2 networked access control system from Paxton Access: ‘The Eastbourne Hospital is already secured using the Net2 system. In addition, one of our satellite buildings on the Hastings site had four doors already controlled by Net2. Our Security Team Leader, Steve Edwards, had been managing the satellite system at Hastings and found it very easy and effective to use.

‘Our site in Eastbourne was also very happy with Net2. We were aware of Paxton Access as the market leader and that their systems set the industry standard, it also made more sense for the hospital to have a consistent access control system across different buildings.’

Vistec Systems of Crawley were approached to tender for the installation and won the project. The Net2 system is now working across all of their sites. This includes the main hospital in Hastings, Bexhill Hospital, the Irvine Unit, St Anne’s and the Woodlands Unit. Net2 connects to the remote buildings and between

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floors using the hospital’s existing network.

A total of 6,500 user cards have been issued and 83 doors are controlled by a Net2 System. John comments: ‘The ability to define who has access to which site is essential and Net2 provides us with this.’

Using 11 TCP/IP Ethernet interfaces, the remote sites are controlled via the hospital’s IT network. Dean Hawkins of Vistec says: ‘Instead of hardwiring between floors we decided to use the TCP/IP interfaces as they were so much more convenient and cost effective.’

Conquest Hospital has also found that some of the more specific characteristics of Net2 fit their needs perfectly. Steve says: ‘We are subject to opportunist theft, but using the Net2 events screen we can refine who was in the area at the time

of the theft. Not only does this mean we can narrow down the culprits but it also deters thieves from stealing in the first place. It is a very, very useful tool and is easy to monitor constantly if needed. The emergency lock down of different areas is also really appealing. It means that in the case of any eventuality, such as a chemical spill or the need to create a temporary mortuary, we can prevent access to chosen parts of the building.’

The hospital also houses an essential blood bank for the local area. However, there are strict EU guidelines that must be adhered to when handling blood. Each time the blood bank is opened someone must be accountable for the action and blood can only be signed in or out by a qualified member of staff. Access to the

CASE STUDY

blood bank is obviously restricted to those members of staff.

John explains: ‘Having access control on our blood banks is extremely important. Without it, the process would be more time consuming and less accurate, we can quickly access reports on who has opened the doors and when; we have total confidence in our system.’

Other highly controlled areas include the baby unit and the mental health wing.

Steve says: ‘We have a real mixture of doors that have to be controlled at many different levels. Not only can we achieve this with Net2, we can achieve it easily.’

After the turmoil caused by the previous access control system, how do the staff feel about the Net2 option?

Steve says: ‘Our staff are very happy to have the system in place, they grasp the swipe cards immediately and because the swipe cards have their picture and details on they can also use it as visual ID. ‘Having an access control system that actually works makes staff feel more secure than just having CCTV. Although

the CCTV complements Net2, our staff realise that while CCTV records, it does not prevent unauthorised people gaining access to the building or parts of it.

‘The transition was also really smooth because we were able to use all of our existing HiCode cards. This saved both time and money.’

John and Steve have been so impressed with Net2 that it will be integrated with their fire alarm and extended across their remaining remote sites. They are also in the process of adding another ten doors around the Conquest site.

John says: ‘At some stage we will also combine the system at the Eastbourne DGH with the one at the Conquest; this will give us greater flexibility over the management of both systems.

‘We would certainly recommend the system; we are more than happy with it. Compared with our earlier access control system it is far superior. This is the best period of security stability we have enjoyed in a long time.’

For more information please contact Tel: 01273 811011 Email: sales@paxton.co.uk www.paxton.co.uk

HEALTH SERVICE PROCUREMENT REVIEW I 27

security

N ational O ccupational S tandards in data destruction Ensuring that data is correctly handled, stored and disposed of is paramount to public sector organisations. In order to assure the highest quality in the secure destruction of confidential information, standards and practices are constantly updated and this past year has seen some important developments, says Russell Harris, British Security Industry Association (BSIA) Information Destruction Section Chairman.

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ith organisations such as the NHS holding a huge amount of confidential information ranging from staff personnel data and departmental budgets to patient records, one of the biggest threats is identity fraud. This involves an individual assuming another person’s identity and obtaining goods, credits or services in a false name and can also give them access to their ‘victim’s’ health services. If an individual is seeking healthcare under someone else’s name they could also potentially have access to medical records and prescribed medication, which may lead to receiving benefits on medial grounds.

To try and prevent this from happening the Data Protection Act was created under which organisations have legal obligations in the processing of personal information whether it is about employees, clients or members of the public.

Preventative measures need to be taken and organisations are urged to store information securely using lockable equipment and adopt strict procedures to protect access to computer records. Correctly disposing of data is of utmost importance and organisations are encouraged to use a professional information destruction company, which is inspected to the British Standard BS 8470:2006. All members of the BSIA information destruction section adhere to this standard.

While organisations comply with guidelines it is essential that there are frequent developments in standards, which help organisations preserve the

privacy of their confidential information and fulfil their obligations under the Data Protection Act. The secure disposal of data is a central element of the law and many infringements of the act relate to the way in which it is destroyed. The true scale of the problem is unknown as many examples of the improper disposal of confidential waste go undetected however, it is known that only a fraction of corporate waste paper and data processing products such as disks are destroyed annually by professional firms.

A majority of this confidential information is disposed of via municipal refuse collection, waste paper reprocessing or general waste, which poses a clear risk.

originally a BSIA code of practice for its members but was developed into a British and then a European standard.

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

As well as helping to ensure the highest standards, EN 15713:2009 provides a valuable new benchmark to assist users in choosing a provider.

All BSIA information destruction section members will be inspected to the new standard as part of the audit procedure for their obligatory ISO 9001:2008 accreditation.

Another significant development in the sector has been the publication of new National Occupational Standards (NOS), which define the level of competence needed to work in information destruction and increase professionalism. The BSIA worked closely with Skills for Security in developing the new standards, which all member companies are being urged to incorporate into their training practices. It is anticipated that in future the NOS could lead to a formal industry recognised qualification in the field. The publication

The secure disposal of data “ is a central element of the law and many

infringements of the act relate to the way in which it is destroyed

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”

The solution is to ensure a professional information destruction service is used to destroy personal and sensitive data and the BSIA incorporates a dedicated information destruction section so public and private sector organisations can rest assured that they are employing a properly accredited operator. The latest additions to standards and operating practices will further enhance customer confidence.

They include the publication of a new European standard for the sector, which is known as the EN 15713:2009. This was

security

encompasses all key activities undertaken within the sector, as well as situations employees are likely to encounter in their day-to-day work. It covers a comprehensive range of topics, from customer service, to risk assessment, the use of IT, vehicle load security, vehicle and equipment safety, and even good driving techniques. As such, it is seen as an indispensable tool for creating and maintaining a highly skilled workforce and providing benchmarks for good practice across the UK. The NOS specify standards of occupational competence for the sector.

It deals with all aspects of the operation, including collecting consignments of confidential material, complying with proof of collection requirements and maintaining security during the loading and transportation process.

The use of documentation to meet audit trail requirements and comply with relevant legislation is covered in detail, encompassing the use of waste transfer, pre-treatment, collection and delivery notes, vehicle check sheets and certificates of destruction. It goes on to

describe performance criteria and essential knowledge for the destruction of data, incorporating the use and maintenance of mobile and on-site equipment. A separate section is devoted to providing a quality service when carrying out information destruction operations, including communicating effectively with customers and colleagues, and identifying ways to improve performance.

The BSIA has encouraged all companies operating in secure waste disposal to embrace the NOS, which carries clear benefits in terms of creating a highly qualified workforce and raising standards across the industry.

For more information about the new NOS, visit www.ukstandards.org.uk and to find out more about the BSIA’s work in information destruction, visit our website, www.bsia.co.uk/shredding.

These important developments in standards will help organisations such as the NHS provide assurance to the public that they are disposing of confidential information in the best way possible to help prevent unlawful disclosure of the data.

The British Security Industry Association is the trade association covering all aspects of the professional security industry in the UK. Its members provide over 70 per cent of UK security products and services and adhere to strict quality standards.

For more information please contact Email: info@bsia.co.uk Tel: 0845 389 3889 www.bsia.co.uk

HEALTH SERVICE PROCUREMENT REVIEW I 29

CASE STUDY

F lying

the banner for secure data disposal

HM Revenue & Customs have recently implemented a new solution for the destruction of confidential waste. This service is now also available to the NHS via NHS Supply Chain. We asked Anne Toone, Category Lead at HMRC and chair of Buying Solutions’ collaborative procurement strategy board, to tell us more.

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he new secure document destruction solution is vital to HMRC. It means that all HMRC confidential waste is destroyed securely and then recycled. That helps us to ensure that our confidential information is protected and plays a big part in meeting our environmental objectives.

How much waste has been destroyed so far?

We began a pilot scheme with Banner Business Services in 2008 for the secure destruction of confidential waste.

Since that time, Banner has destroyed over 4,700 tonnes of our confidential waste, saving over 80,000 trees. All of this waste has been recycled into paper-based products.

personnel – if we are ever unsure of a new staff member we can just call Banner to check the staff identification. Our own staff oversee the whole process which gives added peace of mind that everything is securely disposed of.

There are a number of locations that create less waste, so they shred everything onsite and then Banner arranges to pick up the full bags of waste. This arrangement is just for our paper waste; we also have a separate agreement with Banner for CDs and electronic media.

sending our own waste to be recycled into the paper that we would then use again. In 2003, this was a bit too forward thinking and so this idea was not raised again until we amalgamated with Inland Revenue in 2006.

A project that began as an environmental one quickly changed its focus when, in November 2007, the loss of child benefit data became a high profile issue. We began to scrutinise data processes across all of the HMRC locations. At that time there was around 800 sites (it’s now down to 480) and we found that we had various waste disposal arrangements in place.

Confidential waste was being bagged up and taken away without knowing the exact destination, which was obviously a problem.

For example, in my building, on one floor alone, there were 13 waste receptacles, labelled for various degrees of security (such as restricted waste, confidential waste and secret waste).

Although all secret waste was destroyed onsite, it was up to the user to decide which category their waste fell into and then dispose of it into the correct receptacle. We ran mandatory courses and monitored staff decisions, but the system was flawed and complicated.

Now, in line with the Cabinet Office’s guidance, all confidential waste is shred onsite and we are issued certificates of destruction for all our confidential data. It’s a high profile project. As chair of Buying Solutions’ collaborative procurement strategy board I spoke at

All office waste goes into locked “ receptacles supplied by Banner. We have a tailored collection schedule, and waste is collected and shred onsite

How does the service work?

All office waste goes into locked receptacles supplied by Banner. We have a tailored collection schedule, and waste is collected and shred onsite. All the vehicles are fitted with powerful high-capacity shredding machines, which completely destroy our confidential material before the vehicle leaves the premises.

All the shred waste now goes to one depot and we receive certificates of destruction after each visit. We’ve gained security and greater control over our data disposal. Before the new solution was implemented, we didn’t know exactly where our waste was going – now we can trace everything.

All of the Banner staff are security checked and they provide us with named 30

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”

What prompted the move towards secure data destruction?

In 2003, prior to the merger with Inland Revenue, Customs and Excise began a framework contract for the supply of office products with Banner.

We were concerned about the impact our offices were having on the environment – at this time, Customs and Excise was using virgin copier paper, which accounted for the majority of our spend on office goods. At the start of the contract with Banner we imposed a rule of 100 per cent recycled paper.

At the same time, I started to explore with Banner where our paper waste was going to, again from an environmental viewpoint. I looked at the possibility of

CASE STUDY

Supporting the NHS via NHS SupplyChain Banner Business Services is an established provider of stationery, office technology equipment and waste disposal bags to the NHS via NHS Supply Chain.

The company is a key supplier on the Stationery, Consumables and Miscellaneous Office Products Framework Agreement recently re-awarded in April 2009.

Procurement Solutions 2008 to outline what we are doing and received a lot of interest from the market place and the public sector.

implement a mutual gainshare. The NHS needs the B Grade waste and we need A Grade – under this gainshare their waste could come to us and vice versa.

Environmental issues are clearly a priority for HMRC. Are there are other initiatives you’d like to implement?

Grade A paper waste (with little ink on it) goes back to the mill to be recycled into copier paper. It is our hope that we will eventually be able to track this back and ensure that HMRC waste is recycled back into copier paper for our use, in a sustainable way. This would have huge benefits for us and the wider public sector, in terms of greater control over price, quality of paper and benefits to the environment.

Grade B waste, i.e. waste that has been contaminated with ink or plastic, gets recycled into tissue and cardboard. The plan is for this waste to be amalgamated into the waste being collected from within the NHS by Banner via NHS Supply Chain. This will then be made into items such as cardboard hospital bowls for use within the NHS. I am currently in dialogue with NHS Supply Chain, through Banner, to

How has your relationship with Banner developed?

Our framework contract with Banner for the supply of stationery, paper, listing paper and IT consumables began in 2003.

This framework was for five years with the potential to extend it for two. More than 140 government departments and public sector bodies use the framework, which in 2008 was re-issued as the HMRC Collaborative Framework.

Banner has been disposing of data securely for us since 2008. We now benefit from a gainshare with Banner.

HMRC receives an agreed percentage of the profits Banner makes on the waste, and this amount is deducted from the cost of new recycled copier paper.

In the time we have been working with the company, Banner has reinvented itself into a very progressive company – there’s been a change from just a supplier to a services based operation, which they pride themselves on. We have really benefited from that.

Under the new Framework Agreement Banner now provides a secure waste destruction service. Waste can be collected and destroyed either on or off site. This service is available for all NHS and public sector bodies to ensure that their confidential waste is disposed of securely.

‘Banner is an excellent, trusted, long-term supplier to NHS Supply Chain.’

Senior Buyer, Office Services, NHS Supply Chain

For more information please contact Lisa Bailey – General Manager – NHS Tel: 07736 365594 Email: lisa.bailey@bbslimited.co.uk

HEALTH SERVICE PROCUREMENT REVIEW I 31

ESTATES

at

P ro C ure 21 delivers NHS F oundation T rust

Kettering General Hospital is dedicated to improving efficiency while providing better and more diverse services. A Cardiac Catheter Laboratory was key to this. A ProCure21 partnership with Medicinq helped the hospital to develop an estates strategy to deliver this and future developments.

K

ettering General Hospital wants to become first choice for local patients and a credible alternative for those further afield. To succeed it needed to deliver its capital programme on time, to budget and to high standards; it needed confidence in its Principal Supply Chain Partner.

‘We want to be an ‘excellent’ District General Hospital.

Upgrading the environment in which patients are treated is integral to that,’ said James Hayward, Director of Estates. ‘We knew it would help us to retain local patients, attract external referrals, reduce operating costs, lower infection risks and secure improved ratings in patient satisfaction surveys.

‘I was confident of ProCure21, but I had to convince my Trust Board. Having completed a Full Business Case, we invited

“

partner could deliver the Cardiac Catheter Procedure Unit (CCPU) on time and under budget. We appointed Medicinq after a thorough selection process.’

‘Our approach is total transparency, trust and openness,’ said Andy Dixon, Operations Director for Medicinq. ‘To promote confidence in the Trust we took stakeholders to other CCPUs we had completed. They could see what we had done, what could work for them, what wouldn’t, and they could ask pertinent questions.’

‘It convinced us there was a real sense of partnership and openness,’ said Mr Hayward.

I was keen to look at alternative procurement that would yield the maximum benefit to the Trust and deliver this capital project, on time, on budget and to high standards.

I felt ProCure21 would complement our business objectives

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”

James Hayward, Director of Estates

the PSCPs to execute a cost validation exercise to ensure that the selected

Achievements and benefits ProCure21 allowed the Trust to conduct an in-depth analysis of project risk. Risks were identified and apportioned to the most appropriate partner. Based on the Trust’s appetite for risk, it retained some that Medicinq would traditionally have undertaken. The Guaranteed Maximum Price (GMP) was, therefore, more accurately calculated and almost certainly lower than if all risks had been apportioned to the PSCP. Design innovation was critical. Internal layout maximised use of natural light in wards, improved patient privacy and dignity, offered extra storage and provided dedicated staff changing and rest areas.

The CCPU was designed so that an additional C-arm diagnostic scanner can be added in future, if needed.

An access road built for construction vehicles was retained by the hospital for emergency vehicles without adding to the

ESTATES

GMP. The Trust used Medicinq on the selection and procurement of medical equipment to ensure co-ordinated provision, delivery and installation of the unit.

The scheme was delivered on time and £10,000 under budget. Kettering General Hospital has exceeded its year six target in attracting additional clinical referrals. It is confident about future capital projects through ProCure21.

Challenges Challenging access issues were overcome by constructing a new route at the back of the hospital diverting traffic from patient care areas.

The ward was closed to guarantee the project came in on time while minimising patient disruption.

Key innovations • Open book approach was supported by the Trust and Medicinq with cost reporting against the overall Trust budget and not solely the PSCP GMP. • Complex M & E Supply Services were incorporated at design after an extensive site investigation and consultation with Trust Estates

Department. This prevented potential problems and possible delays during construction.

• The CCPU was built above an existing ward, enveloping it so that it could be redeveloped with minimum disruption.

• The building envelope was rationalised and simplified while maintaining its aesthetic appearance.

• The building envelope has been extended, creating additional floor space without increasing the original budget.

For ProCure21 queries please contact p21helpdesk@dh.gsi.gov.uk

HEALTH SERVICE PROCUREMENT REVIEW I 33

SUSTAINABILITY

It’s

not about doing .... extraordinary things … … it’s more about doing ordinary things extraordinarily well. That is the message from the NHS’s Sustainable Development Unit (SDU). The Unit was set up last year to advise, create and lead on policy which will enable the NHS to become a leading sustainable organisation with a reduced carbon footprint.

T

his is a big task since the NHS produces 18 MILLION tonnes of CO2 a year. That makes it one of the largest public sector polluters in the world and NHS procurement makes up 60 percent of that emissions total. It’s not an accolade the health service should be proud of believes National Director of the SDU, David Pencheon. He says: ‘It’s imperative that the NHS adapts, invests and is innovative in the way it deals with climate change. Due to its size it will have a real impact in protecting the environment and therefore improving the health of the population. The NHS has a duty of care to take this issue seriously and visibly seriously at that.’

It is a tough message but it is certainly not a despairing one since there are also clear opportunities to save money. If procurement teams build sustainability and low carbon into their contracts and into everything they do they will help build a more resilient NHS, resilient not only to financial change but also to climate change. Admittedly David Pencheon says there may be a slightly higher initial cost but the rewards and financial returns are far greater. It is estimated that on average over a 50

year life span of a building for every pound spent on constructing it, around 75 pounds is spent on running it. So investing in a low carbon building upfront which is cheap to run is a win for staff, a win for patients, a win for health and a win because it saves money.

And saving money is going to become even more important. Building, creating and investing in a low carbon NHS will turn out to be essential as carbon taxes come into force. The carbon reduction commitment (CRC) will begin to bite next year for large NHS energy users and for some it will be a drain on finances.

But as the government moves to a low carbon economy it will only be a matter of time before the CRC looks at the entire healthcare system.

“

which leads to better physical and mental health. This leads to less traffic, fewer accidents and improved air quality.

Understanding the links between low carbon, health and financial savings is a vital key and procurement is the key way of making the NHS more sustainable. Contract writers are well placed to insert a sentence on sustainability and low carbon into all their contracts whether they are for food, for pharmaceuticals for building materials or for services.

Procurement teams should not think that reducing carbon is solely about purchasing energy efficient light bulbs or buying insulation to retro-fit buildings. Yes that is important but that is not going to make us reach our first target – reducing the NHS’s carbon footprint by 10 per cent from 2007 to 2015 – as we are still emitting more carbon than ever.

So the world of NHS procurement has to think outside of the box. It has to be innovative, efficient, looking at long term rather than short term gains and it definitely has to look at services.

Building, creating and investing in a low carbon NHS will turn out to be essential as carbon taxes come into force

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”

So how does the NHS reduce its footprint?

By transformational change. A transformation of culture so that staff across the entire organisation understand the importance of climate change and why the NHS needs to be involved. There are good reasons for this. Not only does it make good business sense but reducing our carbon footprint also improves health.

For example, it encourages different travel arrangements such as walking and cycling

SUSTAINABILITY

One Trust told the SDU that it built sustainability into a taxi firm contract.

The contract was so valuable for the taxi company that it produced a strategic plan to reduce emissions in its fleet year on year. This simple example shows that any NHS organisation can look at any part of its procurement and service plan and do something towards reducing its own carbon footprint and that of its suppliers.

The NHS is considered a beacon of excellence and is held in high regard by the majority of the people that use it.

It has survived its first 60 years due to its supreme flexibility and its ability to turn threats into new opportunities. Climate change is one threat it can not choose to ignore.

For more information please visit www.sdu.nhs.uk

HEALTH SERVICE PROCUREMENT REVIEW I 35

SUSTAINABILITY

I nnovation

in healthcare buildings The UK’s healthcare buildings have a huge impact on how we deliver healthcare services. Innovative design, products, systems and processes are required if we are to achieve a sustainable healthcare estate for tomorrow and deliver benefits for all healthcare stakeholders.

T

he healthcare estate is vast, consisting of some 160,000 buildings spread over 793 sites and 26km2, and the NHS is one of the UK construction industry’s largest clients. The construction of new facilities and the need to modernise and maintain the existing stock makes the healthcare estate a key area for built environment innovation.

Patient-centred approach to innovation Healthcare in the UK is primarily driven by clinical excellence, patient care, patient comfort and patient services. The NHS needs to have the best buildings to enable the delivery of these services.

Given the very sensitive nature of healthcare delivery any decisions taken to change or modify NHS buildings need to be made with the needs of the patient in mind.

Buildings need to be designed with patient outcomes in mind. A good example is the Cardio-Thoracic Centre at Basildon & Thurrock University Hospital Trust, where clinicians were involved at every stage of the design process. This approach has resulted in a building that works for the specific needs of that department and is flexible enough to respond to changing needs over time.

Energy use in buildings represents 22 per cent of current NHS England CO2 emissions. The fragmented nature of the NHS estate makes it difficult to control energy usage in NHS buildings – this is one of the reasons why its carbon footprint has increased by 40 per cent since 1990. If the UK is to reach its targets under the 2008 Climate Change Act, of an 80 per cent reduction in emissions on 1990 levels by 2050, this trend needs to be stabilised and reversed.

Saving Carbon, Improving Health, the recently launched NHS Carbon Reduction Strategy for England sets out a blue print for the NHS to stabilise emissions by 2010 and to achieve a 10 per cent reduction against 2007 levels by 2015. This strategy identifies buildings as one of the key areas where emissions can be readily reduced.

The 2015 target can be achieved through effective management at trust level, good housekeeping, staff awareness and spend-to-save investment in energy

(MBE KTN) has identified a number of key areas where innovation can lead to deep cuts in carbon emissions: • Lighting is responsible for just over 20 per cent of NHS electricity consumption. Fortunately, lighting technology is advancing towards greater efficiency; unfortunately, many lighting installations in hospitals have been changed without reference to current lighting design guidance. Trusts should therefore check their existing installed lighting capacity, from which it is possible to make a costed business case for relamping. For new buildings, Trusts should assure themselves that the lowest energy lighting option has been specified.

The MBE KTN is working with UK Displays and Lighting KTN and PASA

The fragmented nature of the NHS “ estate makes it difficult to control energy usage in NHS buildings – this is one of the reasons why its carbon footprint has increased by 40 per cent since 1990

Environmental sustainability – the big challenge With an energy bill of £700 million per annum and carbon dioxide emissions of 18 million tonnes per year, the NHS is one of the UK’s largest energy consumers.

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efficiency must become the norm across the NHS. However, in order to achieve the 2050 target, more radical, innovative solutions are necessary.

Working with key industry stakeholders the Modern Built Environment Knowledge Transfer Network

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SUSTAINABILITY

About the MBE KTN… The Modern Built Environment Knowledge Transfer Network (MBE KTN) is a single, national, over-arching knowledge transfer network for the built environment.

It aims to stimulate increased innovation and support its effective implementation in the modern built environment.

MBE KTN works with its members to identify industry challenges, showcase potential innovations, broker new collaborations, facilitate access to funding opportunities and help members connect with each other. It is currently concentrating on themes that have implications for all sectors of the built environment: to identify innovations in low-energy lighting technologies that can be successfully applied in the UK healthcare building stock.

• Building Controls & Air Tightness – Electric motors which drive cooling and ventilation account for just under 20 per cent of building emissions.

Reducing ventilation and cooling involves a range of solutions, including the need to lower unwanted gains from lighting, IT equipment and the sun; greater air tightness with higher ceilings and exposed thermal mass; and predominantly natural ventilation, with some mixed mode, in all noncritical areas. To achieve this, there needs to be debate within the NHS about thermal comfort, ventilation rates and a greater understanding between building professionals about

how these outcomes can be achieved.

The MBE KTN is working with a group of key stakeholders to identify how the clinical requirements of clean air and the drive for energy efficiency can be balanced for the benefit of both parties.

The MBE KTN is also working with the Building Controls Industry Association to identify how advances in building controls can be used to deliver a more efficient NHS Estate.

Innovation is needed to deliver the correct balance between carbon emissions reduction, patient care and clinical excellence, in order to deliver a truly sustainable healthcare estate. The MBE KTN is working with key players in the built environment industry and the NHS to ensure that innovation is effectively communicated to NHS decision-makers.

Energy & Carbon Efficiency Process Efficiency Climate Change Adaptatopn Life Extension & Retrofit

For more information about the KTN’s healthcare activities please contact Chris Hall Email: information@mbektn.co.uk www.mbektn.co.uk

HEALTH SERVICE PROCUREMENT REVIEW I 37

SUSTAINABILITY

A

leading light in sustainable energy creation and savings

The concept is simple, combine the potential for creation of renewable energy with use of the latest technology in lighting.

This is at the heart of ocip energy’s philosophy. The company is one of a new breed of alternative energy champions, but one that is successfully driving forward the adoption of commercial LED lighting as well as the acceptance of Vertical Axis Wind Turbines (VAWTs).

W

hy wind turbines? Our roots were in the mobile telecommunications industry and this background provided us with the essential skills to respond to the challenges of the alternative energy market. The urban environment, in which we had operated for many years, was a perfect platform for the new generation of VAWTs. The VAWTs have major advantages over traditional horizontal axis turbines in an urban environment. Many of the main factors that tend to be cited against wind turbine developments do not apply to the VAWTs. Among their major advantages is that they are virtually silent, as well as a consensus that the designs are more aesthetically pleasing.

The VAWTs offer a demonstrable statement of a business’s green credentials, as well as being an asset and an investment. It is for that reason that we are now distributors of the widest range of VAWTs in the UK. With wind being the

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fastest growing energy source worldwide, we will continue to add to our product range. The VAWT products are constantly evolving and we are working closely with our suppliers in this area – furthermore our turbines are sourced from UK, US and European manufacturers. The main advantages of the VAWT are: • Virtually silent • Suitable for urban and rural sites • Collects wind from all directions • Low visual impact, noise and vibration • Low maintenance • Sell surplus energy to grid • Aesthetically appealing What triggered the move into LEDs? In the energy conservation sector, the use of LED lighting is compelling.

Technology now permits the LED’s mechanical robustness, long lifetime and low power qualities to deliver significant cost savings to businesses. LEDs can offer immediate savings in electricity consumption, where between 50-75 per cent savings can be achieved. The range is for indoor and outdoor lighting, from small down-lighters to very large floodlights, spotlights, streetlights and high bay lights.

One of the key advantages of LEDbased lighting is its high efficiency, as measured by its light output per unit power input. This makes them suitable in both outdoor and indoor scenarios.LED lights are the perfect solution to reduce energy consumption without deterioration in the quality and brightness of the lighting. Indeed, the white light from LED bulbs even enhances CCTV images making it ideal for streetlighting.

With the cost of electricity set to rise dramatically over the coming years, investment in LED lighting will be one of the best investments a business can make.

Any building with high electricity consumption, such as academic institutions, hospitals, government buildings, car parks, distribution depots, factories, underground transport hubs and museums to name but a few, could see enormous savings being made through the direct replacement of the existing incandescent or halogen lighting.

Where now for the business?

The company has been investing for over a year now, with new offices, staff and a storage unit. In July 2009, Ed Miliband MP announced the government’s Transition Plan for a Low Carbon Britain.

The Government White Paper outlines a comprehensive plan for how the UK to become a low carbon country and we firmly believe that ocip energy is in a perfect position to help to deliver the targets for reducing emissions.

For more information please contact ocip energy ltd Freephone: 0800 917 9360 Email: info@ocipenergy.com www.ocipenergy.com

INFECTION CONTROL

I nfection

prevention : challenges and developments Tracey Cooper, Vice-President of the Infection Prevention Society, talks about recent developments in infection prevention and emerging issues discussed during Infection Prevention ‘09, the recent IPS national conference held in Harrogate.

O

ver the past decade there have been a staggering number of challenges and developments in relation to infection prevention across the UK and globally. These developments cover a spectrum that includes the global HIV epidemic, extremely drug-resistant tuberculosis, the first influenza pandemic of the century, and unprecedented focus on hospital-acquired infection. In the UK the focus has now moved from hospitalacquired infection, to the more accurately titled issue of healthcare-associated infection. In England concern over rates of MRSA was so significant that the Department of Health set a three-year target to achieve a 50 per cent reduction in rates of MRSA bloodstream infection. This target was achieved by March 2008 as a result of sustained effort by staff across the NHS, and heralds a new era in the way we think about infection.

The process of change and improvement over a period of three years, combined with achieving such a substantial reduction in infection has, for many, resulted in a re-evaluation of what was previously considered unavoidable or inevitable infection, and a real culture of ownership of infection prevention and ‘zero-tolerance’ to infection.

There is now a real momentum across the NHS, and the independent sector as well, to drive down all infections in order to improve patient safety. In order to do this, it is essential for organisations to understand where infections occur, especially in which areas of care and patient groups. The process of infection surveillance is commonly

used to monitor infections. Speakers at Infection Prevention ‘09 emphasised that with increasingly short lengths of stay post-operatively, it is essential that organisations include follow-up after discharge. Evidence demonstrates the mean time for infection to develop postoperatively is approximately 6-8 days after operation, yet discharge home often takes place at days 4-6. Therefore, many infections are missed if follow-up ceases at hospital discharge.

intravenous devices using a solution of 2 per cent chlorhexidine in 70 per cent isopropyl alcohol led to a significant reduction in infections. However, solutions containing these concentrations were not commercially available in the UK, meaning that most healthcare providers were unable to implement best practice.

Happily, products are now available, and many organisations have implemented commercially available products as part of a bundle of evidence-based measures and have seen reductions in infection associated with IV devices as a result.

Demand is rising for products that assist us to keep patients safe, and for products to be re-designed to make them easier to clean and less able to harbour micro-organisms that can cause infection. Recent work by the Design Council with the Department of Health has resulted in radical new designs for a number of common items which will help to reduce infection risk. The challenge now is to get these into care environments in order to benefit patients.

We face an exciting but challenging future in relation to infection prevention.

Our own expectation and that of our patients has never been greater, but we know now that major reductions in infection rates are possible and can be continued. The Infection Prevention Society motto is ‘inform, promote, sustain’ and together we must sustain the drive for improvement – our patients deserve no less than this.

There is now a real momentum “ across the NHS, and the independent sector as well, to drive down all infections

”

This area of focus will grow over the next few years as healthcare providers increasingly want to confirm low rates of infection via surveillance programmes.

This will bring requirements for IT systems, software and devices capable of collecting and collating surveillance data and converting this into information that can be used to identify and target infection problems and improve patient safety.

Recent years have also seen a drive for new technologies and innovation to support infection reduction, and many companies have responded to this emerging need by developing products that can directly impact on infection rates.

This signals improvement in collaborative working between manufacturers and practitioners. For example, for a number of years evidence has existed that skin preparation prior to insertion of

For more information please visit www.ips.uk.net

HEALTH SERVICE PROCUREMENT REVIEW I 39

INFECTION CONTROL

A zo M ax A ctive

tm

sets the standard for disinfection A recent clinical trial comparing a new cleaning product, AzoMaxActive, from Synergy Health to the current top cleaning products used in healthcare showed a marked reduction in levels of pathogens in the environment.

Here, Synergy Health outlines the processes used to trial the products, the benefits that were found and the role the new product may play in the battle to control Healthcare Associated Infection (HCAI).

T

he Department of Health (DH) recognise the importance of a clean healthcare environment, as clearly outlined in the following two paragraphs taken from page 22 of the DH publication Clean Safe Care: 5.1 Attention to cleanliness plays an important part in creating a culture that allows everyone in a healthcare facility to focus on infection control. Without the backdrop of a very clean environment, measures such as consistent hand cleaning and thorough cleaning of beds between patients can feel futile, and the confidence of both patients and staff is undermined.1

(bleach). The AzoMaxActive product range combines a detergent with a disinfectant and is suitable for cleaning all surfaces in the clinical setting.

Chlorine based disinfectants at a concentration of 1,000 ppm available chlorine are recognised as the most effective disinfectants used in the clinical setting; using hypochlorite as the ‘control’ treatment ensured the AzoMaxActive

hypochlorite (with neutral detergent used to clean floors). After seven months the cleaning regimes were swapped over and the study continued for a further four months.

The wards cleaned with the AzoMaxActive wipes, sprays and floor cleaning concentrate reported a clear, consistent and significant reduction in the total viable count, i.e. the numbers of bacteria that were found at the various swab sites every week.

This finding demonstrates that AzoMaxActive products create and maintain an appreciably cleaner healthcare environment than that achieved when using chlorine based disinfectants.

Dr Andrew Dodgson, the microbiologist who led the MRI trial said: ‘The results we have seen from the trial are very impressive. Cutting the levels of pathogens in the environment reduces the risk to patients of picking up an infection.

‘Our study has shown a reduction of one third in levels of MRSA in the environment when AzoMaxActive was compared with the gold standard bleachbased NHS cleaning agent.

‘AzoMaxActive has a potential role to play in helping all hospitals in the battle to control HCAIs and the demonstration of a residual antibacterial effect is a major new discovery that will be an additional weapon for the NHS in the battle against superbugs.’

These results represent a potential breakthrough in the battle against HCAI and the AzoMaxActive product range now offers a true, chlorine free

has shown a reduction “ ofOuronestudy third in levels of MRSA

in the environment when AzoMaxActive was compared with the ‘gold standard’ bleach-based NHS cleaning agent

5.2 Maintaining high standards of hygiene is key in preventing the spread of infection. C. difficile spores and, to a lesser extent, MRSA both survive well in the environment, meaning that enhanced environmental cleaning and decontamination are vital components in reducing rates of infection.1 Maintaining the cleanest possible environment in which to deliver care is a key element in reducing the risk of Healthcare Associated Infection (HCAI).

Microbiologists at Central Manchester University Hospitals NHS Foundation Trust (CMFT) recently completed a major eleven month clinical trial comparing the effectiveness of the AzoMaxActive disinfectant product range from Synergy Health against the current ‘gold standard’ chlorine based disinfectant, hypochlorite 40

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products were given the toughest possible challenge against which their performance was measured. The results of the trial demonstrate that AzoMaxActive products significantly outperform hypochlorite.

The study was undertaken across four hospital wards within the Manchester Royal Infirmary (MRI). Study outcomes were measured weekly and examined the total number of bacteria (total viable count) that were present at forty predetermined, frequently touched locations (such as bed rails, taps, door handles, nurse call buttons etc) within the clinical environment of each ward. In addition the presence of environmental MRSA and C. difficile found at these locations was also identified and reported.

Two of the wards in the study were cleaned using AzoMaxActive products and the other two were cleaned with

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INFECTION CONTROL

alternative to hypochlorite based cleaning agents. Chlorine releasing agents such as hypochlorite have numerous problems associated with use in hospitals and in addition to their tendency to corrode and damage many surfaces to which they are applied, they can also cause respiratory problems for staff and patients.

By contrast, AzoMaxActive technology is safe, easy to use, can be applied to delicate surfaces including fabrics and does not cause corrosion to surfaces.

Equally important is the fact that AzoMaxActive wipes and sprays do not require any special equipment or precautions during use making it a practical technology for everyday cleaning.

Central to the success of AzoMaxActive technology is its residual effectiveness which means it keeps killing micro-organisms for days after it has been applied to a surface. Conventional disinfectants, including hypochlorite, are only effective for one to two minutes after application. It is this aspect of the AzoMaxActive products which scientists believe could offer a wider breakthrough in the battle to reduce the incidence of healthcare associated infections as it has the potential to help drive down levels of harmful micro-organisms on an ongoing

basis and thereby reduce the risk of HCAI. AzoMaxActive products are now clinically proven to produce a cleaner healthcare environment with fewer bacteria which in turn reduces the risk of patients picking up a healthcare associated infection.

While the study used hypochlorite as the comparator it is the opportunity to use AzoMaxActive technology in place of neutral detergent that offers the real opportunity to reduce the risk of HCAI at both a local and a national level.

The majority of hospital cleaning uses ‘soap and water’ or neutral detergent.

Hypochlorite produces a cleaner environment than soap and water but due to its numerous shortcomings and corrosive nature its use is reserved for clinical areas at high risk of infection.

AzoMaxActive products are clinically proven to produce a cleaner environment than hypochlorite so they will certainly outperform soap and water in terms of environmental cleanliness. This marked improvement in cleanliness within the healthcare environment will correspond to a risk reduction for HCAI. In addition they are as gentle and non-hazardous as soap and water. Replacing the soap and water or neutral detergent currently used

References Department of Health. Clean, safe care: Reducing infections and saving lives. 2008; Available from: www.dh.gov.uk/publications

1.

in healthcare cleaning with AzoMaxActive products offers an instant risk reduction for HCAI by reducing the environmental bioburden to its lowest possible levels.

AzoMaxActive forms part of a range of products containing ByotrolTM technology and offers a true revolution in hygiene for managing environmental cleanliness in the clinical setting.

AzoMaxActive is a trademark of Synergy Health plc. Byotrol is a registered trademark of Byotrol plc.

Contact Synergy Health Email: contact@azomaxactive.com Tel: 01772 299900 www.azomaxactive.com

HEALTH SERVICE PROCUREMENT REVIEW I 41

INFECTION CONTROL

T he HCAI T echnology I nnovation P rogramme Part of the HCAI and Cleanliness Division of the Department of Health (DH); the HCAI Technology Innovation Programme is proving it can add value at the NHS frontline, impacting on infection as well as quality, safety and patient satisfaction.

T

his Programme aims to speed up the development and adoption of new technologies to help combat healthcare associated infections, especially MRSA and Clostridium difficile.

Launched in January 2008 in the Department of Health publication Clean, Safe Care – Reducing Infection and Saving Lives, the Programme has been widely acclaimed by the NHS and industry.

The Programme is designed to: • Help the NHS know what works and get more value for money it invests in infection prevention and control • Help industry better target their efforts and costs because it knows what the NHS wants and when it’s needed

the HCAI Technology and Innovation Programme has shown that it also has an important part to play in helping to combat HCAIs – especially MRSA and Clostridium difficile.

‘Tackling these is a key priority, and we have already achieved much through the hard work of NHS staff. The target to halve MRSA bloodstream infection has been met and exceeded, and we are on course to maintain this reduction. These encouraging results have been helped by a raft of support including more funding, expert help for those hospitals that need it and mandatory screening for MRSA.’

“

or competitor products. We have also encouraged front line infection prevention NHS staff to visit their local Showcase Hospital to see the technologies first hand and in action.

Evaluation reports on each of the technologies are being published to help support local NHS staff to make the case locally to adopt one or more of these technologies. These reports are published on www.clean-safe-care.nhs.uk The Smart Ideas Programme recognises that NHS front line staff, both clinical and non-clinical, are often best placed to spot solutions to the challenges raised by HCAIs. In autumn 2007 the team asked around 600 NHS staff what they needed in the form of technology to help combat infection. They came up with more than 150 ideas, which were then short listed down to ten.

These are now in development.

The NHS National Innovation Centre was commissioned to work with leading industrial designers to turn the ideas into working prototypes as quickly as possible. These prototypes together make up a complete mobile isolation facility or temporary side room including a portable hand washing station, infection resistant commode, double sided pod locker, and air door and screens facilitating privacy and avoiding patient contact. Alternative air curtain systems are also under development and are at the laboratory test stage.

Following satisfactory clinical trials and evaluations we hope to be working with possible commercial partners to

The Smart Ideas Programme recognises that NHS front line staff, both clinical and non-clinical, are often best placed to spot solutions Work so far has shown that new and innovative technologies can help to the challenges raised by HCAIs save lives and make it easier for NHS staff to fight infection.

The Programme celebrated its first anniversary in February 2009 with an International HCAI Technology Innovation Summit at Chelsea Football Club with 300 delegates from the NHS and industry.

The summit was followed by a dinner and presentation of the first HCAI Technology Innovation Awards created to highlight and celebrate innovation and success within the field of HCAI related technologies.

During her speech at the Summit, Health Minister Ann Keen, MP said: ‘We know that there are few real substitutes for hand hygiene and aseptic techniques along with prudent prescribing. However,

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An exhibition at the Summit showcased the latest high tech products designed to beat infections and featured displays from all four of the main strands of the Programme – Showcase Hospitals, Design Bugs Out, Smart Ideas and Smart Solutions.

Showcase Hospitals across England have tested six new infection beating technologies for periods of up to six months. We know that the technologies work from a scientific perspective but putting these technologies into the Showcase Hospitals means we can see how they perform on a day-to-day basis and how they compare to similar

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INFECTION CONTROL

encourage them to make these products available to the NHS as quickly as possible.

The Programme has been working with the Design Council on the Design Bugs Out Programme. This has involved getting top commercial designers to redesign existing hospital equipment and furniture, making them easier to use and clean. The Royal College of Art, one of the world’s leading postgraduate design schools, has been working on five design briefs, led by two Research Associates experienced in healthcare design.

Each team has produced a full size, working prototype of their proposed design and showcasing of the final prototypes began at the end April 2009.

Smart Solutions for HCAI is a national Programme run by Trustech, the North West of England NHS Innovation Hub, on behalf of DH and supported by the NHS National Innovation Centre.

As part of the Smart Solutions Programme, nine products have been selected as having the potential to reduce HCAIs. They include a liquid glass coating that protects surfaces, a portable ultraviolet air sterilisation device which kills airborne microorganisms and an antimicrobial needle-free IV connector.

The products are currently being trialled and evaluated in hospital settings.

There has been a significant change in NHS culture with regard to infection.

Infections have dramatically reduced and patient confidence has improved. Widely believed to be impossible to achieve, the national PSA target to reduce MRSA bacteraemias by 50 per cent in 2008 has been delivered, exceeded and sustained.

This has prevented 5000 patients from acquiring this infection and saved at least 1500 lives. The three year 30 per cent target to reduce Clostridium difficile has been delivered in 12 months and is now at 47 per cent reduction. Next year the Programme has plans for a number of exciting projects which include: • Ensuring nurses know where patients with infections are located so they can improve isolation

• New methods and technologies to drive improvements in hand hygiene compliance • Rapid point of care testing for MRSA in under 30 minutes • New ways of using more automation in hospital cleaning • Being able to ‘see’ if things are more scientifically clean by detecting MRSA and Clostridium difficile more easily • The possibility of an effective alternative to chlorine.

By acknowledging the needs and insights of healthcare professionals within the NHS, and supporting creativity among innovators, the programme continues to enable the development of truly creative solutions to the problem of HCAI, ultimately leading to improved quality, safety and patient satisfaction.

For more information about the HCAI Technology Innovation Programme visit www.clean-safe-care.nhs.uk

HEALTH SERVICE PROCUREMENT REVIEW I 43

INFECTION CONTROL

U pholsteries

and draperies join the battle against HCAI It is a disturbing statistic that approximately 5,000 people die annually from HCAI but encouragingly, quarterly targets for the reduction of HCAI are now being met and the hard work is set to continue as more and more effort and resource is targeted towards a reduction of these figures.

R

esearch into the spread of HCAIs is often inconclusive, as it usually focuses on only one mode of infection transfer. The outbreak of infection in hospital settings is more complex. Routes to infection are multiple and diverse and it is difficult to quantify the role of the environment in the transfer of infection. Nonetheless, some report that as much as 19 per cent of contamination may be attributable to the environment, including the furniture.

However, as focus remains on infection control, it is also important to note that these efforts need not be to the detriment of patient comfort.

A compromise is not inevitable.

Fabrics impact on our perception and appreciation of our surroundings, helping to create environments which aid recovery and foster a sense of wellbeing for patients, visitors and staff alike. This is something Panaz, a specialist healthcare textile company, is acutely aware of. The Panaz range of healthcare specific upholsteries combines attention to design and colour with the highest technical specification to create durable fabrics which will assist healthcare professionals in creating an environment which is cleaner, safer, and even more resilient to the daily wear and tear experienced in such extreme environments. Panaz upholsteries include 11 healthcare ranges, in vinyl and fabric.

Featured among these is Panvelle™, which is the market leader in waterproof contract upholstery fabrics and recognised by the Queen’s Award for Innovation.

Technically endorsed by laboratory certification, it provides the following: • Flame-retardancy to national and international contract standards.

• High durability and resistance to abrasion • Completely waterproof but breathable for real comfort

Panvelle has established a benchmark in comfortable seating fabrics, which are at once good looking, luxuriously comfortable and hard working.

Traditionally vinyls have been the upholstery of choice within hospitals, selected for their apparent wipeability and ease of cleaning. Soft upholsteries were not perceived as appropriate within such severe environments. They were considered difficult to clean and to keep looking good. Panvelle, however, has reversed this preconception as it consistently meets the challenges presented.

Paramount in any hospital setting is ease of cleaning.

Panvelle has surface soil release properties which promote easy cleaning and repel stains and oil based fluids (see image, right) such as body fluids and the usual suspects, tea, coffee and orange juice. Cleaning protocols throughout the healthcare sector are rigorous and Panvelle has been tested for resilience to most, if not all, of these

Routes to infection are multiple “ and diverse and it is difficult to quantify

the role of the environment in the transfer of infection. Nonetheless, some report that as much as 19 per cent of contamination may be attributable to the environment, including the furniture

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”

• Anti-microbial and anti-fungal: Panvelle™ technical excellence ensures that cross infection is reduced • Easy to clean with soil repellent treatments • Excellent colour fastness

Designs from Panaz Pure range

INFECTION CONTROL

Liquid resistance

including steam cleaning, alcohol wipes and sodium hypochlorite bleach solution.

None of these compromise the integrity of the product. Panvelle continues to look good and, more importantly, perform as expected.

Panvelle has an anti-fungal and antimicrobial surface protection that prohibits growth of bacteria and associated odours,

infection and cross-contamination.

Couple all these properties with a waterproof membrane creating a barrier for liquids and protecting the chair infrastructure and you have an upholstery product which healthcare professionals can specify with confidence.

Shield Plus…

Shield Plus drapery fabric for cubicle and window curtains is launched this autumn.

It is the latest addition to the Panaz specialist antimicrobial offer and is developed for the most extreme hospital environments to play a useful role in contributing to the reduction of routes to infection.

Shield Plus is protected by mædicalTM, a unique, non-leaching and non-silver antimicrobial which has been proved effective against the broadest spectrum of bacteria and is resilient to the harshest cleaning protocols whilst remaining bonded and durable for the life of the fabric. Exclusive to Panaz, mædicalTM has been tested for effectiveness by the Pasteur Institute under a EU-funded programme; FLEXIFUNBAR contract n° 505864 IP-SME-FP6.

Readers who consider a presentation detailing the development and studies undertaken on Shield Plus would be of interest are invited to contact Panaz Healthcare Division at the number featured in this article.

For more information please contact Healthcare Division Tel: 01282 696969 Email: admin@panaz.com www.panaz.com

HEALTH SERVICE PROCUREMENT REVIEW I 45

CASE STUDY

D etection ,

surveillance and faster action

Fiona Livesey, Lead Infection Control Nurse at the The Hillingdon Hospital NHS Trust, explains how implementing Healthcare Associated Infection (HCAI) case management and surveillance software from ICNet enabled the Trust to step up infection control efforts while allowing frontline staff to spend more time on the ward with patients.

A

s the Lead Infection Control Nurse, I have a key strategic and operational role in supporting the patient safety, governance and quality agenda. I am responsible for the development, implementation and ongoing compliance monitoring of clinical standards of care related directly to the prevention and control of infection. This includes leading policy making, driving audit programmes and sharing findings to further improve practices.

Reporting progress both internally and externally is a key function of my role. Prior to the introduction of ICNet, the Infection Control Team (ICT) reporting was paper based. Printed results were collected daily from the lab, which were then taken out onto the ward. Relying on the lab to print results meant that there was the potential to miss results, and the vast amounts of printed and paper data created other difficulties. Each patient’s progress was documented in a book, which threw up a challenge if specific information needed to be found quickly in the patient’s history. We were also unable to analyse trends or data without using other databases.

We wanted to know when MRSA patients were admitted to the Trust, but did not have a robust system in place.

In 2004, we researched the market and found ICNet. It’s a software package that allows real time collaboration of patient and laboratory data to enable proactive infection control case management. ICNet also allows the surveillance of HCAIs and can analyse and

manipulate the data so that reports can be generated quickly. To my knowledge no other system provides the same data analysis and infection control case management. We visited another trust to see the software in action,then put forward our business case. Installation commenced in 2008.

The ICNet team worked closely with our project management team to ensure that the software interfaced with our current systems effectively. Prior to the system’s launch, all designated administrators in the Trust were given training on what the system can do and how to give other members of the team access. Training was also given on how to manage the laboratory interface, PAS interface, labsift feature and the use of PDAs to capture data.

to spend more time on the ward treating patients, rather than sifting through reams of paperwork.

ICNet software captures all the results from the lab and allows us to create alerts that trigger when previous MRSA, CDT or ESBL patients are re-admitted.

We have used the system to manage D&V outbreaks, entering all symptomatic patients in order to track the progress of the infection and use the data to provide reports.

In recent months we have also used ICNet to enter suspected swine flu patients, producing admission reports, which contribute to accurate surveillance.

We are able to set tasks on the system which can be set for a number of activities, one of which is a set reminder when re-screening is required, alerting the team to contact a specific ward.

We use ICNet for enhanced surveillance on a number of organisms, which allows us to produce reports on, for example, antibiotic trends and patient history for C. diff patients. We can also manage conditions, such as chicken pox and measles, recording all patients with specific conditions and producing accurate statistics from the data collected.

On top of this, ICNet can produce letters for GPs, which is very helpful for discharged patients. Details from the PAS system are inputted onto a template (designed by us to include all the necessary fields). This feature enables us to share information clearly across the health economy.

The report generating function is

ICNet software captures “ all the results from the lab and allows

us to create alerts that trigger when previous MRSA, CDT or ESBL patients are re-admitted

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”

ICNet has visited the Trust a number of times since to aid us with case management, advanced case management and report generating.

Support has been excellent.

The system has cut the need for paper notes and decreased the time spent searching for information, allowing easy navigation of a patient’s notes to view any previous actions or treatments they have received. This allows the Trust’s ICT

CASE STUDY

ICNet… … is an innovative software package that allows real time collaboration of patient and laboratory data to enable proactive infection control case management and surveillance of HCAI. ICNet also provides a powerful tool for the manipulation and analysis required for mandatory reporting of these infections.

exceptional. It can look at resistance trends (which can even be mapped to postcode areas), it can look at wards and reveal potential incidents when cross-infection could have occurred – for example, x amount of CDT patients on a ward reported within x number of days.

The ICNet team has been very supportive in helping us to make the most of the software. They recognise that there is an incredible amount of information for us to process, and so provide the training in stages.

I have found the company very knowledgeable about the infection control agenda and the management of HCAI. Their expertise has enabled us to implement and use the system confidently and without any problems.

We continue to work with ICNet to identify new ways to extract information and advanced management, and are happy to share our experience with other NHS organisations.

Through interfacing with 3rd party databases such as the Laboratory system, Patient Administration / Hospital Information system, and Surgical systems, ICNet has been designed to automate the collection of data as required by the Infection Control Team (ICT), thus providing real time alerts, reports and analytical tools which saves considerable ICT time and helps to target action more effectively.

For more information please contact Tel: (+44)1452 814090 Email: sales@icnetplc.com Twitter: www.twitter.com/icnetplc www.icnetplc.com

HEALTH SERVICE PROCUREMENT REVIEW I 47

INFECTION CONTROL

C lean

hands save lives

Dr Kevin Cleary, Medical Director at the National Patient Safety Agency, outlines the key messages of the cleanyourhands campaign, its impact on hand hygiene and its wider effects on the spread of HCAIs.

I

n September 2008, the National Patient Safety Agency (NPSA) issued a revised Alert on hand hygiene to give greater emphasis to hand hygiene at the point of patient care and to remind healthcare staff that good hand hygiene makes a significant contribution to the war on healthcare associated infections (HCAI).

The emotional and financial cost of HCAI to patients and the NHS is considerable. In 2004, healthcare associated infection (HCAI) was estimated to contribute to the deaths of 5000 patients a year in England. The 2006 prevalence survey showed that at up to eight per cent of inpatients in England and six per cent in Wales have an infection any one time. On average, an HCAI adds three to ten days onto a patient’s length of stay in hospital, and for Clostridium difficile (C.diff) that stay will be even longer. Financially the overall cost to the NHS is estimated to be in excess of £1 billion a year.

One of the most effective ways of preventing the spread of HCAI is through good hand hygiene practice by healthcare staff. The NPSA identified HCAI as a patient safety issue in 2002. A project then began to assess barriers to hand

hygiene compliance and to learn from good practice and innovation in this field – both within the UK and internationally – with the aim of developing a solution that could be implemented on a national basis.

The resulting cleanyourhands campaign was developed by the National Patient Safety Agency (NPSA) to improve the hand hygiene of staff and help the NHS tackle HCAI. Using a multimodal approach, the cleanyourhands campaign supports NHS trusts to improve hand hygiene compliance through an organisationalwide approach to improvement by targeting the reasons behind poor compliance with hand hygiene by staff.

Since its launch in 2004, it has been implemented in over 97 per cent of all NHS trusts in England and Wales.

and has now become the norm as an effective method of hand hygiene at the point of care for routine patient contact.

However, soap and water should always be used when: • Hands are visibly soiled • Hands have come in contact with body fluids • Caring for someone with diarrhoea and/or vomiting • Working where there is an outbreak of diarrhoeal disease, eg Norovirus or C.diff Prior to the campaign launch, the NPSA worked with the NHS procurement organisations to ensure national contracts were in place for the supply of alcohol handrub; giving the NHS access to independently tested high quality products at competitive prices.

At the same time NHS Estates issued a parallel Alert providing advice for trusts advice on how to manage the risks of storage and fire.

Since the campaign started, there has been a greater awareness of serious infections like MRSA and C. diff not only within the health sector but among the public generally. The cleanyourhands campaign has continued to inform and educate healthcare staff with a yearly review and update of all its materials based on discussions with infection control leads in the NHS. Patient involvement has been part of the campaign since it was launched, with the message It’s OK to Ask featuring on some materials. In his 2006 Annual

One of the most effective ways “of preventing the spread of HCAI

is through good hand hygiene practice by healthcare staff

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”

The key message of the campaign is hand hygiene at the point of care, which can be achieved through the use of either alcohol handrub or soap and water. However the realities of delivering healthcare mean that soap and water is often not available where and when needed, which is why alcohol handrub comes in. Alcohol handrub enables staff to quickly and effectively clean their hands at the point of care. Alcohol handrub is acceptable for use in most care situations

INFECTION CONTROL

Report, Sir Liam Donaldson, the Chief Medical Officer (CMO) for England recommended that the campaign be further strengthened in this area with patients empowered to ask staff about hand hygiene.

A reference group chaired by Professor Didier Pittet was established and a feasibility study undertaken (January – March 2008) which showed that being given permission to ask increased the likelihood of asking but that, in order to empower patients, staff need to be empowered first.

The project has continued, with further market research indicating that there is the greatest opportunity for patient empowerment at the preadmission and pre-elective stages of the patient journey. However, staff involvement remains critical for converting intention into action and increasing patient empowerment generally.

The next step for the campaign is to develop a suite of tools and resources that will help provide a practical platform for long-term sustainability. The focus on hand hygiene is as strong as ever.

This gives the impetus to the NPSA to concentrate its energies on the point of care message, producing tools that advise staff on how to clean their hands, when to clean their hands and why it is important. The message is relatively simple, and yet it remains complicated and complex in its implementation.

When the NPSA reissued the hand hygiene Alert in September 2008, clearer instruction was given on when to use alcohol-based handrub and when to use soap and water and an even stronger emphasis was placed on risk management, particularly ingestion, skin irritation and storage. The NPSA worked with an expert advisory group including the Department of Health in England and the Welsh Assembly Government to ensure all priority issues were addressed.

The revised Alert was launched at a hand hygiene summit in September 2008, attended by over 200 infection control leads from the NHS attending, showing that staff continue to want to know more and to find new and better ways of getting the message out to their fellow NHS staff.

The cleanyourhands campaign is the driver that encourages, guides and motivates all types of NHS trusts regardless of their location or size, to continue to improve hand hygiene compliance.

For more information please contact Tel: 020 7927 9531 Email: handhygiene@npsa.nhs.uk. www.npsa.nhs.uk/cleanyourhands

HEALTH SERVICE PROCUREMENT REVIEW I 49

CASE STUDY

T he

optimum in safety and infection control

Hannah Berry, Marketing Manager at Horne Engineering, explains how the company applied its thermostatic design expertise to the creation of the Optitherm, an award-winning tap designed for use in hospitals, to reduce the spread of infection.

H

orne Engineering Ltd celebrates its centenary this year. The company has been designing and developing thermostatic mixing valves and showers for commercial and institutional markets since 1909, and has been supplying the healthcare sector for 100 years.

We specialise in regulating the temperature of domestic water services.

Horne developed the very first water blending valves in the 1920s, with feedback from healthcare customers, and since then many of our products have been developed specifically for use in the healthcare environment where reliability, ease of operation and robustness are particularly important.

Until recently, hospital hand basins were required to have hot water supplied from a thermostatic mixing valve (TMV) that was within two metres of the outlet.

Generally, the TMV was either underneath the basin (which was not very accessible) or behind a wall panel (where access required the wall panel to be removed).

Recent changes to the healthcare regulations regarding Legionnella (HTM 04-01: The Control of Legionnella, hygiene, ‘safe’ hot water, cold water and drinking systems, Department of Health 2007) now state that: ‘It is preferable that thermostatic mixing devices are fitted directly to the mixed temperature outlet, or be integral with it, and be the method of temperature and flow control.’ It was clear that the regulations were telling us to design a thermostatic tap.

So, we developed the Optitherm.

Rather than shoe-horning one of our existing thermostatic mechanisms into a tap, we started from scratch, building 50

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the new product to satisfy safe hot water regulations, medical staff users, the installers and the maintainers – and importantly, focusing on the aim to reduce infection spread. The new tap should: • Comply with regulations (HTM 04-01, HTM 64, Safe Hot Water and Surface Temperatures) • Combine with a variety of basin sizes • The surface temperature must never exceed that of the mixed water • Provide both warm and cold water • Be reliable to operate • Provide precise temperature control • Be highly accessible for ease of maintenance • Be easy to clean without angles or parts that can fall off to leave recesses where bacteria/pathogens can flourish • Function with minimal touch for infection prevention We deliberately steered clear of infra-red sensor technology as the mode of operation, as we didn’t believe this technology to be stable enough for the healthcare environment – a belief that has since been confirmed to us by growing numbers of Optitherm customers who have tried infra-red taps and found the technology, as well as the component set up, to be unreliable. As well as sensors being temperamental, maintenance requires wall panels to be removed, and flushing through (to flush out Legionella bacteria) takes longer than conventional lever operated systems. This not only increases the risk of infection spread, but means that basins can be out of action for a significant length of time.

A mechanical device is inherently more stable than sensor operated outlets and so maintenance is reduced. Optitherm’s thermostatic mechanism, the strainers and check valves are all accessible without removing wall panels. The hot and cold water supplies can be isolated from within the room and the tap can be worked on in situ, or replaced. Importantly, a tap can be replaced in under two minutes, eliminating the downtime of the outlet.

The Optitherm should be used handsfree or low touch to reduce infection spread. Contrary to other healthcare taps on the market, the lever rotates around the horizontal axis – perfect for operating with an elbow. It’s a dual lever – the shorter lever turns the tap on (operated by the thumb or finger), and the longer lever turns the tap off (operated by the elbow or forearm). This means that once the user’s hands are clean they do not have to touch the tap with their hands again.

The surface of the Optitherm is completely accessible and therefore very easy to clean. It is also thickly plated with chromium, so that cleaning chemicals will not cause any damage.

Having a dedicated cold water supply from the Optitherm is important for several reasons. It makes the supply more versatile, with uses ranging from surgical scrub up to drinking water and teeth cleaning. This versatility also reduces cost – only one tap per basin need be installed

CASE STUDY

Our centenary…

Horne Engineering has been supplying thermostatic control valves to the healthcare sector for 100 years. We developed the very first water blending valves in the early 1920s, in response to feedback from healthcare customers.

– and means that if the hot water supply should fail, the basin can still be used. The increased turn over of water through the one tap also decreases the likelihood of stagnation and the risk of Legionella.

The design of the Optitherm is highly innovative and specialised for healthcare, a product that achieves more than our competitors can offer with their

products. We believe that it can make a real difference to hand hygiene – and we are not alone in this belief: in 2008, the Optitherm won the award for Best Interiors Product at the Building Better Healthcare Awards.

An animated tour of the Optitherm is available to view at cgi.www.horne.co.uk/ optitherm/700Kbps/index.html.

Case Study: The Optitherm The Maintenance Manager at a large NHS teaching trust was impressed with the Optitherm’s design and performance: ‘Before installing the Optitherm, the hospital employed standard tap arrangements – lever operated taps with the thermostatic mixing valve (TMV) under the basin or behind wall panels.

‘Although the taps we were using eliminated a whole crochet of pipe work, we quickly discovered that the hot surfaces got very hot and so failed the Health Guidance Note, Safe Hot Water and Surface Temperatures. The supplier promised a solution, but didn’t deliver. We then discovered the Optitherm thermostatic tap, which, as well as meeting all the regulations has operational features that boost infection prevention efforts – to operate the tap correctly, you touch it once, then don’t touch the same part again with clean hands.

‘The price of the total job (the tap, plus installation) was a far cheaper option than Horne’s competitors could offer. This was our second attempt to install thermostatic taps, so it was important to keep the price down.

‘After consultation with our infection prevention team, we decided to refit an entire ward – six hand basins – with the Optitherm.

‘Horne provided us with instructions on correct operation of the Optitherm, including laminated images to place in the nurses stations – and on our suggestion will be supplying us with similar instructions with adhesive pads that can be stuck to the wall next to the basins.

‘Installation has gone very smoothly and we have been so pleased with the performance of the taps that we are now installing a further 13 Optitherm taps in the hospital’s endoscopy unit.’

To commemorate our centenary we have commissioned a specialist whisky bottling and will be distributing bottles among our supporters.

Horne will be re-launching its range of surface mounted shower panels with integral thermostatic controls at the IHEEM exhibition at the end of October.

For more information please contact Tel: 01505 321455 Email: sales@horne.co.uk www.horne.co.uk

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the commercial resource framework Melanie Kay, Deputy Director in the Department of Health’s Procurement, Investment and Commercial Division highlights the Commercial Resource Framework and describes the many benefits it offers to the NHS and other government organisations.

can help PCTs raise their scores in the forthcoming assurance exercise.

T

he Commercial Resource Framework (CRF) was set up on 1 June 2009 to provide the Department of Health and NHS organisations with easy access to a list of pre-qualified suppliers to assist them with the recruitment of commercial support on a short-term basis. The framework is also available to other parts of the public sector.

The timing of this initiative was no coincidence – against the backdrop of a tough economic climate and unprecedented levels of investment by the Government, all NHS organisations are under scrutiny to further improve their quality, range of services and value for money for the taxpayer. The role and importance of commercial skills has a major part to play in driving forward this agenda and in meeting the challenges of the financial constraints ahead.

The CRF supports the delivery of World Class Commissioning (WCC), Choice and Competition, and the recently launched Commercial Operating Model for the Department of Health and the NHS. It specifically supports the WCC competencies of stimulating the market, securing procurement skills, managing the local health system and making sound financial investments. Improving their performance against these competencies 52

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The journey The appetite for a CRF from across the NHS was clear and compelling, with a large volume of requests from the service for help in finding short-term commercial expertise. In a six month period during 2008, the Department sourced 30 candidates with commercial skills to support discrete pieces of work in the NHS. Taking forward that brief, the CRF was successfully developed by the Department’s newly formed Procurement, Investment and Commercial Division and colleagues from NHS Purchasing & Supply Agency (NHS PASA).

One of the attributes of the CRF was to ensure that any commercial knowledge being delivered through short-term external help would then be shared and embedded as commercial acumen within NHS organisations. The CRF would deliver both short-term benefits and put in place a legacy for the future.

When the CRF was launched in the summer, it was initially managed by NHS PASA and then transferred to Buying Solutions on 1 October 2009.

The CRF offering The CRF provides organisations with: • Potential value for money savings – both on day rates and agency fees • Compliance with procurement tendering processes • Quality assurance of suppliers, who have all signed robust terms and conditions

The type of commercial roles that are available from the CRF include, but are not confined to, the following: • Commercial directors • Commercial managers • Commercial relationships managers • Financial analysts (including financial modellers) • Contract managers • Commissioning managers • Project managers/directors • Programme managers/directors • Project coordinators • Business analysts • Procurement specialists In addition, subject matter expert roles to support commercial activities include: • Legal advisors • Commercial/clinical advisors • Workforce/human resources advisors • IM&T advisors • Communications specialists and researchers • Finance advisors Generic descriptions for each of these roles have been developed in conjunction with the NHS and these can be tailored to meet local specifications.

Fit for purpose Located on a simple and intuitive website, the CRF provides a raft of supporting information, templates and guidance. Too often, poor specification of roles has resulted in inappropriate appointments and disappointing delivery.

CRF is set up to avoid these pitfalls.

Flexible online templates allow commissioners and providers to specify:

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• What the individual will have to do (the key deliverables) • The areas in which they are expected to be competent (the key competencies) and the level of competence • The experience and qualifications required (identifying these as essential or desirable).

The benefits of the CRF The CRF is distinct from other consultancy services frameworks as it provides real individuals, as opposed to a paper solution, for a defined piece of work or support in fast-tracking a critical project. With easy access to a list of prequalified suppliers for non-permanent workers who meet a predefined standard of service, quality candidates can be provided at short notice to deliver high performance.

In addition, the CRF provides assurance that its suppliers have carried out the necessary pre-placement checks

and that the standard requirements for managing ongoing processes, such as timesheets and invoices, are met.

The CRF also adds value by providing: • A comprehensive set of clearly defined role scopes and competencies to facilitate the specification of a requirement • Simple standardised presentation of CVs with a template to highlight suitability • One point of contact with each supplier to simplify communication • Suppliers who understand the healthcare environment and are up to date with current policies to meet NHS needs • Commercial capability and capacity at the lowest whole life cost • Detailed and accurate management information available to customers and suppliers • Commercial acumen embedded into organisations, which is the vision of the Department’s commercial strategy.

Current position As at August 2009, the CRF comprised 62 suppliers providing national coverage. Forty NHS organisations have used the services of 20 suppliers, demonstrating cost savings of between 7 per cent and 10 per cent.

The NHS will continue to require specialist flexible and short-term support to delevop its WCC competencies and drive greater value from its transactions if it is to deliver the many challenges ahead.

The CRF is a key enabler to make this happen.

For more information on the Commercial Resource Framework please contact: Email: info@buyingsolutions.gsi.gov.uk Tel: 0845 410 2222

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human resources

The challenges facing the NHS are significant and will only increase in complexity in the coming years. Overlay the financial challenges ahead and executive teams will be fully stretched to deliver against these demanding targets.

H

ow to address the capability gap? Any executive team should look to their internal resources in the first instance to fill a capability gap as individuals from their own Talent Programme may prove to be a good potential source of candidates.

However, the practice of ‘double-hatting’ individuals is not the solution as this can lead to dilution of effort.

A good alternative is to look for a secondment but most organisations are keen to retain their own talent to enable them to deliver and secondments are not a common occurrence.

A really good alternative is to look to draw upon the resources offered by IMAS. I have a huge personal regard for IMAS and the capabilities they bring to the NHS and it may surprise the reader to learn that I encourage potential clients to look to IMAS in the first instance. It is far better to reduce the potential cost of an external resource by utilising the capabilities that IMAS has to offer – if they are readily available.

When to consider the external solution Those occasions where IMAS does not have the capacity to assist are when I believe the use of external assistance is fully justified. I recognise that this is not an easy decision given that to look externally for assistance presents a dilemma, particularly with the need to reduce the overall spend on interims across the NHS as a whole.

However, when the internal executives recognise the lack of a wider in-house capability to deliver against stretch targets, the use of an external interim executive offers the ideal solution – and certainly better value for money than consultants. An accountable interim who delivers results justifies the investment.

Why choose Alium?

We pride ourselves on offering the right interim to deliver the required outcome and outputs. It is imperative to understand the rationale of a potential client as to why an interim is needed. Interims are there to deliver specifics and not simply to provide manpower.

My approach is to understand from a prospective client four key factors:

One of the key advantages “ of using an interim is that you acquire

an individual who is accountable for delivery, not someone who will just provide advice

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Compliant procurement At Alium Partners we understand the importance of being compliant when procuring with any NHS organisation and our recent award to the Commercial Resource Framework (CRF), managed by the NHS Purchasing and Supply Agency, provides the necessary assurance. As the Director of the Public Sector Practice at Alium I have a clear mandate to add real value to the NHS and will only initiate any procurement via the CRF.

”

• What are the desired outcomes from the use of the interim?

• What are the required outputs?

• What deliverables are required?

• What timelines have been set?

Once the client has provided the necessary information, the assignment will be undertaken and work begins to identify the right interim that has the relevant set of competences, skill sets,

human resources

I nterims –

enabling the NHS to deliver today while building in house capabilities for the future

experience and most important, the right cultural fit to make the required difference. You cannot achieve the above by searching a database for keywords. At Alium Partners my team knows each and every interim in our practice and we are continually adding quality interims that we know can make a difference to the NHS. Our Public Sector Team has invested hundreds of hours interviewing interims to ensure that our 23 capability pools have the breadth and depth required to meet our clients’ needs.

The use of interims is not about the cost of the interim, rather the value being added to the organisation. We look to work with our clients to determine the return on investment that is being achieved and the legacy that is desired to ensure that skills transference actually occurs. One of the key advantages of using an interim is that you acquire an individual who is accountable for delivery, not someone who will just provide advice.

We are currently working with many NHS clients to enable them to make a real difference. We have the capabilities at our disposal to handle the largest of assignments, including the provision of teams. For instance, Alium is currently providing a Turnaround Team to assist a Foundation Trust. Our Commercial pool is providing deep expertise to SHAs to enable them to establish Commercial Support Units. We are providing Commissioning experience to PCTs and Programme and Project expertise to a range of NHS organisations – to name just a few examples of initiatives we are working on. We only work with the best of the interim community and only with those clients who need an interim to make a significant impact.

Interims can add tremendous value when used selectively by enabling the NHS to deliver today, while allowing the NHS to build the in-house capabilities for the future.

Should you wish to know more about Alium and how we can assist you in delivering and making a real difference then please feel free to contact me directly.

Mike Hollin Director of Public Sector Practice Email: mike.hollin@aliumpartners.com Tel: 020 7398 7520

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L eaders

equipped to face the challenge of reform Paula McDonald, CBE, Deputy Director (Public Services Workforce Reform) of the Public Services Reform Group at the Cabinet Office, outlines the work being done to ensure that the public sector invests in leadership in order to face the new challenges thrown up by the recession.

I

t is often said that the challenges currently facing the government are more intense than at any other time in the recent past. The reasons for this are many. The impact of the recession on our economy and on economies the world over means that difficult decisions have to be made about the balance of public spending. At the same time, the impact of the recession on individuals means that public services, particularly in some areas, are under pressure to deliver more and more.

Public service leaders are increasingly dealing with issues that span a wide range of sectors and agencies: balancing the need to protect vulnerable children with the need to protect civil liberties; dealing with the rise in obesity, particularly among younger people; supporting socially excluded adults into accommodation and work; tackling knife crime… Regardless of the level of investment, a single-sector

solution to these issues is unlikely to be the answer.

If we expect our senior public service leaders to address these issues in an inter-organisational way, they need to be equipped for the task. Leadership development is high on the agenda for government and for decision-makers in all areas of public services: the question is whether our current offerings are developing our leaders in a way that equips them to tackle these new challenges.

“

public service reforms at a new level of devolution to the front line.

A number of leadership development organisations – often referred to as ‘leadership academies’ – were established to help the public sector meet these ambitions. Despite their label, leadership development is sometimes only a small part of academies’ overall functions, which also include interventions aimed at developing the operational capacity of staff (for example the NHS Institute for Innovation and Improvement runs patient safety programmes) or wider work on behalf of government (the Improvement and Development Agency runs the national Beacons scheme for local government, and the National Policing Improvement Agency runs the national DNA database). However, the provision of leadership development interventions is an important part of their work, and 11 of the academies have joined together in an alliance called ‘Public Service Leadership’3.

For a long time these academies have provided sector-specific development and training that has produced worldclass public servants, such as teachers, fire and rescue teams, police and local government officers. The nature of public services now and in the future, however, means that leaders in these areas also

The nature of public services now and in the future, however, means that leaders in these areas also need to be leaders across a whole system and across a whole community

”

Leadership development has always been a key part of the government’s approach to public service reform1, recognising that workforce capacity and capability are key to meeting public service challenges. This is a vital strand in further work on public service reform: Excellence and Fairness2 developed the idea of a ‘new professionalism’, requiring excellent leaders to drive forward

1. PMSU, The UK Government’s Approach to Public Service Reform, 2006. 2. Cabinet Office, Excellence and Fairness: Achieving world class public services, 2008. 3. Public Service Leadership was previously known as the Public Service Leadership Alliance (PSLA). Its members are: National School of Government (NSG), NHS Institute for Innovation and Improvement (NHSIII), National Policing Improvement Agency (NPIA), the Defence Academy, Fire and Rescue College, Improvement and Development Agency (IDeA), Leadership Centre for Local Government, National College for School Leadership (NCSL), Leadership Foundation for Higher Education, and the Learning and Skills Improvement Service (LSIS), Public Service Leadership Wales.

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need to be leaders across a whole system and across a whole community. Benington and Hartley, in their 2009 report Whole Systems Go!, call for ‘new patterns of “adaptive leadership” to tackle tough complex, cross-cutting problems, where there may be no clear consensus about either the causes or the solutions to the problem.’4 This calls for a much deeper understanding of the interventions offered by the academies to ensure that the leadership development available to each sector is fit for purpose in supporting their leaders to achieve these goals.

The Cabinet Office’s 2009 review of the leadership academies that make up Public Service Leadership looked at this issue from three angles.

First, the review considered the effectiveness of the leadership development on offer from academies.

‘Effective’ has a number of meanings.

Is the leadership development provision aligned to government’s strategic objectives? Is it fit for purpose in creating leaders equipped to deal with crosscutting issues and the need for ‘leadership of place’? Are the interventions on offer innovative, and are their outcomes properly evaluated?

The findings from this part of the review led to a number of recommendations. While the leadership development objectives of many of the academies were laudable, it was not always clear to see a close alignment to the current objectives of the sponsoring

government department or to the public service agreements that affect that sector. Each academy had its own leadership principles although there were commonalities between them.

This suggested a framework of national leadership principles – building on the academies’ existing frameworks – could ensure closer alignment with the changing context of public service leadership. Academies were found to focus their content on individual or team-based interventions at the expense of the growing emphasis on inter-agency working and collaboration.

Continued on page 60

4. Benington and Hartley, Whole Systems Go! Improving leadership across the whole public service system, 2009.

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F lexible

training solutions for today ’ s health service

At LSN we know times are tough in the NHS. Managers have grown used to working within a limited budget, managing it closely to ensure they get the best value for money. Now however, they are facing up to the likelihood of cuts in government spending by 2011, and the managers we speak to are looking for creative ways to make their budgets work harder.

A

s NHS managers respond to reductions in funding, they are likely to be under pressure to reduce staffing costs. Many organisations will be looking for ways to help staff work more efficiently, improve productivity and develop the skills they need to adapt to the demands of the future.

One answer is to improve the skills of your staff. This is why, at LSN, we’ve developed cost effective, sustainable and flexible training solutions for the health service. Our training and development packages are underpinned by 25 years of experience in delivering major programmes that make learning work in the public services.

We’re a not-for-profit organisation so are committed to reinvesting in the sector. Through our thinktank, The Centre for Innovation in Learning, we are developing new ideas and approaches to ensure that learning responds to the needs of the future.

Strategic Health Authorities, Primary Care Trusts and over 20 NHS Trusts have already benefitted from our management and leadership programmes. Many of these clients tell us that as the health service is changing it is harder for people to undertake training. However, our programmes are flexible, tailored to your specific needs and use innovative delivery methods to enable people to fit training into their busy working lives.

One of our strengths at LSN is our innovative use of technology. We are the only training provider to offer the health service Institute of Leadership

and Management (ILM) accredited online learning programmes. We also pioneer the use of mobile technologies in learning. In practice, this means our programmes can use technology such as mobile phones, personal digital assistants (PDAs), and even gaming devices to enable your people to learn at a time and in a place convenient to them.

At LSN we’re renowned for coaching, offering flexible and solution focused packages. Our coaching specialists can work with your people to help find fast

“

more positive organisational culture.

We can work with you to develop flexible programmes and help you realise the benefits of good leadership training.

Our leadership and management development programmes have many advantages. In the words of Christine Abbott, an LSN Associate and a Director of the ILM: ‘Blended leadership and management programmes that carry an ILM accreditation offer a cost effective way for the NHS to improve skill levels and customer service while at the same time delivering a nationally recognised qualification to their staff, thereby improving skills while improving morale.’

For our clients, our blended learning model means that our training and development programmes are extremely flexible and fit the timescales that they need. We work with you to develop programmes that use the right mix of online, mobile, and classroom learning for your organisation. If it’s important for your people to share their experiences and learn from each other, we can find innovative ways to facilitate that.

We’ll even adapt any existing materials so they can be used in the programme.

Comments made by a recent delegate after taking part in a blended learning programme demonstrate the difference that our approach makes. Ken Scott, IT Training Manager at Northumberland Care Trust, said: ‘Flexibility of the online section of the course allowed me to work at my own pace, and at times that were suitable for me. Without that flexibility I wouldn’t

We can even develop programmes that help your staff develop their own coaching skills, enabling them to pass on their new skills to their colleagues, providing a cost effective and sustainable solution

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solutions to challenging issues, and help increase their understanding and improve their skills, leading to more efficient ways of working. We can even develop programmes that help your staff develop their own coaching skills, enabling them to pass on their new skills to their colleagues, providing a cost effective and sustainable solution.

Leadership development programmes are another area of LSN expertise. We understand that good leadership has measurable benefits such as lower staff turnover, higher staff morale, reduced sick leave, better patient care and a

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have been able to enrol on the course.’

Jonathan Evans, South West Regional Director for Skills for Health is another supporter of LSN’s Blended Learning Model. He commented: ‘The Blended Learning Model appears to deliver against so many NHS agendas, around new training processes that reflect our working and professional practice requirements.

We are very enthusiastic about its potential for improving capacity and employee engagement within NHS bodies and regions.’

In recent years, people working in the NHS have increasingly asked for training and development programmes that are accredited. By working with major awarding bodies, such as the Institute of Leadership and Management and the Chartered Management Institute, we offer programmes that result in formal awards or qualifications.

However, some people find conventional qualification bearing programmes time consuming and lacking in flexibility. We can also work with you to

develop flexible Self Certified leadership and management programmes. This solution is flexible enough to enable us to build a bespoke programme that fits the needs of your people. It is also rigorous enough to give your staff a qualification that can be recognised externally.

There are also times when a qualification or award is less important, for example if a training or development programme addresses a specific organisational need, so we also offer programmes that are non-accredited.

At LSN we have a 1,200 strong team of experts who are at the heart of all our training and development programmes.

Our programmes are always delivered by an associate with significant experience in the health service and a specific area of expertise.

LSN offers the health service training and professional development programmes that are flexible and adaptable. By using innovative delivery models, and with the creative application of technology, we ensure that our

programmes enable your people to develop their skills at a pace that suits them and allows them to fit training into their busy working lives. We understand the NHS is facing change, but with our proven success we are confident that we can offer you a solution that will help you to successfully respond to the challenges ahead.

John Baxter, Assistant Director, Public Services, LSN Tel: 0207 492 5000 Email: publicservices@lsnlearning.org.uk www.lsnlearning.org.uk

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Continued from page 57

This pointed to the need for an increased focus on cross-sector interventions and ‘systems-wide’ leadership that could better support leaders to deal with current and future public service challenges.

Secondly, the review considered how leadership development is provided by academies (their ‘models of provision’) and if these models help or hinder value for money and better strategic alignment.

Depending on how they are funded – and a number of different funding mechanisms are in place – the academies’ models of provision work in slightly different ways. Some operate as commissioners of programmes and outsource nearly all of their leadership provision while some act as the sole or main provider and act on a cost-recovery basis. Some operate a mixture of these two models.

There are benefits and drawbacks to each model and a mixed provision can offer both choice and healthy competition. But the review found a lack of a ‘level playing field’ across all the academies could create barriers to effective working and created perverse

incentives that encouraged unhelpful competition rather than helpful collaboration. The review recommended that – over a period of time – all academies should explore adopting more elements of the ‘intelligent commissioner model’, enabling them to both act as a broker for commissioning better-value leadership interventions from other providers to get

continue to explore greater collaboration through their joint body, Public Sector Leadership. Departments can use their financial relationship with the academies to lever the kind of systems-wide working that they need, and use their collective purchasing power to commission new and innovative interventions for public service leaders.

Thirdly, the review considered whether the academies offered value for money. This was not easy to objectively determine, for a number of reasons. The management information held by the academies is complex; it is also captured and interpreted differently, making accurate judgements about the scale of expenditure and the scope for efficiency very difficult. Improving and standardising the management information held by these organisations is a key recommendation of the review.

A further difficulty was that the value added by the academies is hard to determine in purely fiscal terms and it is more helpful to think about this in terms of public value5. The Centre for Excellence in Leadership’s6 helpful document on

The review found a lack of a “ ‘level playing field’ across all the academies could create barriers to effective working and created perverse incentives that encouraged unhelpful competition rather than helpful collaboration the best deal for their customers and – where it makes sense to do so – building their own capacity and expertise as direct providers.

In the short term there are a number of actions that the review recommended government departments and academies take to improve the effectiveness of leadership provision. Academies can

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5. Creating Public Value by Mark H Moore, 1995, Harvard University Press 6. Public Value and Leadership, 2007. The Centre for Excellence in Leadership is now part of the Learning and Skills Improvement Service (LSIS), the leadership academy for the Further Education sector

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this issue sets out the implications for leadership of taking a public value approach, highlighting the public leader’s role in educating and shaping public opinion, maintaining accountability to the centre while building credibility with citizens, and creating a strong community focus to build more effective public services in a local area7.

The review did find that there was scope for efficiencies in back office functions and potential for savings through shared procurement of services used by a number of academies. A more far reaching finding, however, was that the public sector’s overall spending on leadership development is far greater than that which is spent each year on leadership, training and OD interventions through the ten main public service academies.

This raises a number of questions about the types of leadership development being brought by public service employers from private and third sector organisations and the relationship of public service academies with these other providers. The review suggests that there is a role for public service academies to adopt a strategic role in the wider

leadership development market, joining up in procuring leadership interventions from and brokering better deals on behalf of customers. It also suggests that leadership academies cannot be complacent – clients will go elsewhere if they are not convinced that they are getting the best quality and value for their money. It is certainly clear that developing a portfolio of innovative, cross-sector, multi-agency interventions will ensure that the academies continue to be important players in the leadership community and demonstrate their added value.

As Benington and Hartley suggest, the time is now right for promoting and cultivating leadership capabilities for working across the public sector system8. Public Service Leadership and its member academies are already grasping the opportunities afforded by the review, and their conference is planned for this November in which they will set out their vision for the future and the work already in hand to implement the review’s recommendations. Similarly, the government is now taking steps to ensure that its departments support this direction of travel and that there are people at the most senior levels of government with

7. Centre for Excellence in Leadership, Public value and leadership: Exploring the implications, 2007 8. Benington and Hartley, 2009.

responsibility for seeing that this work is done. As we move ahead with the challenging agenda of public service reform, we look forward to seeing the outcomes of the review emerging in the new cadre of public sector system leaders.

For more information please visit www.cabinetoffice.gov.uk/ workforcematters.aspx

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development of management and leadership skills in the NHS The Chartered Management Institute provides a one stop shop, account manager led support service that can guide and support Department, NHS and Skills for Health agendas in achieving their management and leadership objectives, including those integral to the ‘Inspirational Leadership’ programme.

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he Chartered Management Institute (CMI) supports the NHS Leadership Council’s focus on standards; The CMI is home to the Management Standards Centre, which sets the national standards for management and leadership. These are governmentrecognised standards which describe the level of performance expected across a wide range of management and leadership activities.

The CMI is therefore uniquely placed to work with you and Skills for Health to map and benchmark the Leadership Quality Framework and any other NHS competency frameworks against the national standards. This will ensure that there is consistency in the competencies required by managers and leaders at all levels, across different trusts and structures. A key benefit would be to achieve parity across clinical and administrative leadership development.

As well as supporting the NHS to develop competency frameworks, the CMI can map job roles to qualification frameworks supporting your talent management and giving clear career progression routes. Thus, it becomes much clearer to identify the training and development needs of individuals and teams and makes the roll-out of development more consistent and more cost-effective.

qualifications from team leader level to strategic leadership. As such, we are able to rapidly provide the UK-wide accreditation service for this Certificate that ensures its quality, consistency and integrity across the UK. We accredit internal training departments/Centres of Excellence and external providers, as required, and have a track record of doing this successfully in the health sector. Examples include the Great Western, North West and East Midlands Ambulance Services; and the Royal Free and Hampstead NHS Trust.

Currently seeking CMI approval are 2Gether; the Gloucestershire Mental NHS Trust, and the Heart of England NHS Trust.

These organisations have found that accreditation of their awards by the CMI adds credibility and has significantly increased uptake.

For example, our e-courseware comprehensively underpins management qualifications at first line manager (level 3), middle (level 5) and senior/strategic (level 7) levels. This generic content was designed with the flexibility to customise and so for a relatively small investment can be contextualised for the NHS. We also offer ManagementDirect, our online management and leadership toolkit. Resources include leader videos (case studies); podcasts on best practices; summaries of key management models; action checklists for over 300 management tasks; and a comprehensive database of business journals and reports.

Collectively, they set the benchmark in the e-learning and online support arenas and offer flexible and engaging support to both programme deliverers and programme participants, while meeting the NHS goal to adopt modern learning techniques. The General Medical Council already subscribes to ManagementDirect, and has grown its user base since December 2008.

CMI is an awarding body with “ over 550 approved centres (universities, colleges, training providers and large employers) across the country

Accrediting the Leadership for Quality Certificate CMI is an awarding body with over 550 approved centres (universities, colleges, training providers and large employers) across the country, delivering 62

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Providing learning support, tools and materials CMI has available an unrivalled range and quality of learning resources and content. In recent years we have made a significant investment in developing our range of e-learning tools and materials.

These materials are derived from the qualifications and credit framework and have been specifically designed to provide a rich and engaging learning experience.

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Professionalising NHS management In the way that clinicians in the NHS are required to be members of their relevant professional or Chartered body, we believe that CEOs and managers should also be professionally qualified and supported. The CMI is the only chartered professional body for general management in the UK. We have grades of membership reflecting junior, middle and senior levels of management, and Chartered Manager status is evidence

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of the professional manager. Individuals studying for qualifications and awards accredited by the CMI gain free CMI membership at the appropriate grade.

Support for members includes: • Information services – instant online access to the latest news, research and learning resources contained in ManagementDirect • Branches and networks – CMI has 85 branches across the UK hosting over 300 events per year • Continuing Professional Development (CPD) – CMI provides an online CPD system to help members plan and monitor their own learning • The opportunity for professional recognition as a Chartered Manager • Plus a range of personal services including a free legal helpline and subscription to our magazines Our CPD resources can offer practical help to the NHS as it seeks to support and encourage lifelong learning. Our online CPD system enables individuals to test their management and leadership skills, set personal goals, be signposted to relevant learning and log achievements.

Altogether, membership of the CMI is a rapid route to professionalising management in the NHS.

Developing political awareness skills in NHS senior leaders CMI has recently developed an online 360-degree tool to help assess the political awareness skills of senior managers, with the NHS Institute for Innovation and Improvement as a development partner.

The tool has been developed as a result of a research programme led by CMI in conjunction with Warwick University Business School, which set out to measure and reposition the perceived value of political skills within leading organisations.

In this context, ‘political’ relates to partnership working, stakeholder management, having judgement and emotional intelligence. This project aimed to build on the growing recognition of the vital contribution that effective political leadership can make to delivering business results and to improving public services.

The tool supports the development of the skills we believe senior managers need in order to effectively lead and manage in the increasingly complex and media-visible world in which they operate. Feedback on its value from the NHS pilot candidates, which included 12 CEOs from NHS Trusts, has been excellent. With ‘political astuteness’ being a key LQF competency, we believe that this is an essential tool for the NHS.

Summary The Chartered Management Institute offers the NHS immediate, practical and effective support in meeting its management and leadership development goals. We are committed to supporting the development of high quality management and leadership skills and capability at both an individual and organisational level. We would welcome the opportunity to discuss how we might offer our expertise, resources and capability to partner with the NHS as it addresses its development challenges.

For more information, please contact Marianne Harris-Bridge Director, Employer Engagement & Business Development Email: marianne.harris-bridge@ managers.org.uk Tel: 01536 207380 www.managers.org.uk

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real jobs for people with learning disabilities

B y Jonathan Shaw MP – Minister for Disabled People and M inister for the S outh E ast Jonathan Shaw MP outlines the impact the cross-government Learning Disability Employment Strategy, Valuing Employment Now, is likely to have on the NHS.

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hrough my work in the Department for Work and Pensions, I have been closely involved in developing strategies to offer disabled people the support they need to find and stay in work. People with learning disabilities want real jobs – their talents have been understood by some but ignored by most.

It is our duty to ensure they have all the support they need to get real jobs and stay in work.

Our cross-government Learning Disability Employment Strategy, Valuing Employment Now, will help thousands more people with learning disabilities get into work. The strategy sets out a vision to increase the number of real jobs for people with learning disabilities and providing the most appropriate support.

It is important for us all to realise that people with learning disabilities can work and have careers. We are encouraging widespread culture change to transform, from an early age, expectations about work. We want to make sure that everyone gets the help and support they

need to overcome barriers to work.

We want people to fulfil their potential and build a better life for themselves and their families.

The aim of Valuing Employment Now is to close the employment rate gap between people with learning disabilities and disabled people generally. We will do this by providing as many real jobs, of at least 16 hours a week, as possible.

with learning disabilities to retain paid employment.

All government departments will have guidance to target people with learning disabilities in recruitment campaigns. There will also be good career and skills preparation in schools and colleges.

Valuing Employment Now is likely to have a major impact on the NHS. The Department of Health will continue to work with Strategic Health Authorities, the NHS Confederation and NHS Employers to increase the number of people with learning disabilities employed in the NHS. The NHS is the country’s biggest employer and has committed to ensure that people with learning disabilities are represented within its workforce. The NHS Workforce Directorate is working to

The NHS Workforce Directorate is “working to make sure that more people with learning disabilities and severe mental illness are employed within NHS organisations

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We will create 400 employment opportunities across the Department for Work and Pensions, including in Jobcentre Plus and Ministerial Private Offices.

Jobcentre Plus staff will continue to be trained to support disabled people into work. Job coaches will support people

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make sure that more people with learning disabilities and severe mental illness are employed within NHS organisations.

The NHS also has a key role to play in the way that our society forms expectations of people with learning disabilities, from the moment of their birth and beyond. Parents have told us of the pressure they feel when they are told their child has a learning disability.

Support is being given to frontline NHS staff, such as midwives and health visitors, to ensure they can give a positive message to parents.

The NHS has the ability to influence the employment of people with learning disabilities through its procurement policies. Healthcare and social care commissioners should build an expectation of work for adults with learning disabilities into contracts for

support providers. This will develop their key role in encouraging people to think about work and get the advice they need, and ultimately help people with learning disabilities move nearer the labour market.

Project Search is a model developed in Cincinnati Children’s Hospital to support people with moderate to severe learning disabilities into work. And the model has been successful – 78 per cent of students secured real jobs between 2003 and 2005. Project Search provides a series of internships for people with learning disabilities with a host employer.

The Office for Disability Issues is inviting interested organisations to submit proposals to become Project Search sites, from September 2010 and take part in an evaluation of the programme.

Proposals are still coming in, but we expect a significant proportion of Project

Search sites to be based in NHS hospitals.

Project Search is currently operating in Norfolk and Norwich University Hospital and the Royal United Hospital in Bath will be a Project Search host employer from this September.

We will ensure we work together – across government and beyond – to provide help and support for disabled people, including those with learning disabilities, to find real jobs and develop their career.

For more information please visit www.dwp.gov.uk

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CASE STUDY

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and the NHS – working together to transform lives

Remploy is the UK’s leading provider of employment opportunities for disabled people and people with a health condition.

We have forged successful partnerships with many of the UK’s leading public and private sector organisations, developing recruitment and employee retention solutions which meet employers’ business requirements and help corporate social responsibility and diversity policies become a reality.

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he key to our success in supporting people into employment is a personalised range of support – where there is greater need there will be greater support. Last year this approach, coupled with the strength of our relationships with employers, helped us to support over 7,000 people into meaningful employment. By 2012, we aim to support 20,000 people with complex barriers to work into sustainable employment each year.

development opportunities to people with moderate to severe learning disabilities we can help people who face complex barriers to find sustainable employment.

The project is based on the highly successful Project Search developed by Cincinnati Children’s Hospital in the US. In the UK, with the support of organisations like the NHS, education providers and private sector organisations, we aim to

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Remploy and the NHS As public sector organisations operating in competitive environments, and with people firmly at the heart of what we do, Remploy and the NHS are perfectly placed to work in a successful and mutually rewarding partnership.

This synergy has already proved successful with Trusts around the UK, and together we have supported 237 people into employment with the NHS in the last year alone.

These companies also find that the attendance record of Remploy candidates Case studies Good business sense is better than their non-disabled Nick Cowan, 41, from Clifton It makes good business sense Nick is a team leader at the to employ disabled people, a fact colleagues, and that Remploy candidates NHS Direct call centre in Bedford, that is recognised by some of the stay in post longer which offers 24 hour health advice and UK’s biggest employers, such as ASDA, BT and Royal Mail. By working in partnership with Remploy these organisations benefit from a recruitment partner that provides the right people with the right skills for their vacancies, and expert advice on the employment and retention of disabled people and people with a health condition. These companies also find that the attendance record of Remploy candidates is better than their nondisabled colleagues, and that Remploy candidates stay in post longer.

Working together In our determination to support disabled people into work we also pioneer new projects which promote joined up partnership working between public and private sector organisations. One such initiative, Project Search UK, demonstrates that by working together to provide structured work experience, training and 66

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replicate this success and make a real difference to the lives of people who face a huge disadvantage in the labour market.

Remploy also works with a number of NHS Trusts to deliver Individual Placement Support (IPS), which helps people experiencing mental health issues to find or keep employment. Working alongside clinical and community health teams in true collaboration, tailored packages of support are developed to help individuals make a smooth transition into work or stay in an existing role. This includes action plans, skills assessments, one to one development plans and in-work support. The initiative offers individuals the benefit of a seamless, holistic approach delivered by healthcare and employment professionals, and supports the government’s strategy to improve the life chances of socially excluded adults.

information. After 23 years as a soldier on active duty, Nick’s army career came to an end when he injured his lower

spine. Now he is advising up to 20 nurses and advisors in the call centre as well as doing personnel checks and career follow ups. ‘Just getting back to work has been brilliant,’ he said.

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Roger Smith, 49, from Cardiff After becoming a full time carer for his wife, Roger Smith from Cardiff decided to get back to work and was referred to Remploy by his local Jobcentre Plus.

Roger, who has a hearing impairment, explains the help he received from Remploy: ‘Remploy assessed my skills and confidence levels and suggested that I attend an NHS training programme.

‘On the course I learnt about the different jobs available within the NHS, underwent health and safety training and also attended a confidence building workshop. This job offers me security and a new start in life.’

If you would like to find out more about working in partnership to support socially excluded adults, or recruiting and retaining a diverse workforce, contact Stephen Dunn Strategic Partnerships Manager Tel: 07946 442774

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recession , staff and procurement policies With signs mounting that the NHS is bracing itself to make staffing cuts, Gail Cartmail, Unite Assistant General Secretary for the Public Sector, outlines how organisations should be using every opportunity to ensure budgets are used in the most effective way.

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n economic hard times, the government needs to use every lever at its disposal to ensure not just economic recovery but to promote its agenda of social justice. Using procurement policies in an innovative way can help to achieve some of the governments’ major policy objectives, not least those concerning local employment, skills, apprenticeships, equality and the environment.

The economic recession and the attendant government deficit of £175 billion have focused minds on cutting public expenditure – this is a theme underpinning most discussions about the future of public services, including the NHS. Such cuts will deepen the recession and impact on staff, service users and on the procurement policies of the NHS and other public sector organisations.

Some sections of the media, lobbyists and political parties are playing a game of which public services can be slashed and by how much. The CBI, for example, has published plans for cutting £136 billion over the next five years. As one of the largest budgets, sights will clearly be

trained on the NHS. The labour intensive nature of the NHS and the services it delivers means that staff costs comprise a large proportion of the budget – significant reductions in this budget will therefore lead to the axe falling on NHS staff numbers and therefore to the detriment of care.

Public sector users and employees should not be penalised for events they neither created nor had any control over.

The political narrative for public sector cuts is propped up by a shaky and deeply flawed economic analysis. A government cannot run a deficit of this scale permanently, but the current government is not proposing to. Despite the headlines about the scale of the deficit, this needs

Rather the deficit, one should remember, is a symptom not the cause of the economic difficulties. The main reason for the deficit is the contraction in the size of the economy; the solution is therefore economic growth. If economic growth is the solution, it is maintaining and increasing investment – not massive cuts – that will help get us there. The respected economist Professor David Blanchflower has stated that cutting investment too soon will hinder economic recovery. The argument for Keynesian pump priming in the public arena has never been stronger.

There are danger signs that NHS organisations are already bracing themselves to make staff cuts, for example, not replacing employees that leave. One in five workers is employed by the public sector and the NHS itself is the biggest employer in Europe.

The scale of expenditure cuts being talked about by the CBI can only realistically be accomplished by making deep staffing cuts. As well as placing intolerable workloads on remaining NHS staff and reducing service quality such cuts would add to the growing unemployment figures – currently at 2.47 million.

It is an obvious statement, but one that is rarely made – increasing unemployment will feed the recession by adding to the banks’ bad debts and further squeezing spending power.

Therefore the question, rather than how much and what should be chopped off from the public budget and the services it funds, is how to use public

Under former Mayor of London, “ Ken Livingstone, the Greater London

Authority introduced a responsible procurement policy which included ethical sourcing, workforce welfare and fair employment practices, such as the London Living Wage

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to be placed in context. The current debt ratio is not particularly high by historical standards, and it is lower than other advanced economies. There has been a tremendous shift in the political battleground away from addressing the cause of failing banks, our financial system being brought to the brink and the global economy collapsing towards attacking public services.

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investment in most effective way? And here we turn to the importance of public sector procurement as a mechanism to achieve wider social goals and economic growth – research from the Association of Public Service Excellence (APSE) has shown that for every £1 spent by a council in a local area, £1.62 is generated.

A clear and important distinction must be drawn between privatisation and outsourcing, and using a socially responsible procurement model for items the NHS needs to buy in. It has been argued that a more extensive use of the private and the third sectors to deliver NHS services will result in efficiency savings through competition and effective commissioning. But where privatisation and outsourcing may have reduced service operating costs, this has been routinely done through cutting pay and conditions and service quality. Yet other costs involved in managing a large scale NHS competitive commissioning market are high.

Professor Allyson Pollock of University of Edinburgh has written that: ‘Billions of pounds, probably approaching 20 per cent of annual NHS funds – estimated to be £20 billion in England in a year – are being squandered on what are called the transaction costs of the market’.

There are lots of goods and services that the NHS simply cannot manufacture or deliver directly. The public sector as a

whole has an annual expenditure of £176 billion on goods and services. It should use this expenditure in a creative and socially responsible way.

There is a great deal of uncertainty around what is and isn’t permitted under European Union procurement rules, and on this there needs to be stronger leadership from central government. EU objectives have been to open up public procurement to competition and achieving better value for money, although it includes principles on equal treatment, transparency and non-discrimination. The government’s guidance on procurement ‘Buy and make a difference’ was a welcome wind of change encouraging positive procurement.

The UK government’s overarching policy has been achieving value for money, but value for money does not necessarily have to mean lowest price. The Office of Government Commerce’s (OGC) policy and standards framework includes other policy goals such as social issues or sustainability that can be delivered through procurement. Procurement can also be used to promote economic regeneration.

Using procurement positively is a matter of political leadership and imagination. Under former Mayor of London, Ken Livingstone, the Greater London Authority introduced a responsible procurement policy which included

ethical sourcing, workforce welfare and fair employment practices, such as the London Living Wage. Transport for London replaces buses after eight years, which maintains high standards for passengers and contributes to reduced carbon emissions – the buses are also manufactured and sourced in the UK. Embedding equality as part of procurement in this way will ensure high quality services, and allow all businesses to compete on an equal footing. The Women and Work Commission argued that: ’Procurement in both public and private sectors should be used to encourage diversity and equal pay practice’. The Equality Bill currently going through Parliament is an important opportunity to clarify to tendering public authorities that they can include the promotion of equality as a social clause in their procurement process.

Trade unions can play a key role in building a socially responsible procurement model at a local level but that requires proper and meaningful involvement in the design, implementation and evaluation of social clauses.

For more information please visit www.unitetheunion.com

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personal support in uncertain times – achieving ROI The government’s ‘prioritise and economise’ message of September this year suggests that a significant number of NHS jobs are likely to come under scrutiny in the near future. Clayton Glen, Director at HDA, a UK-based career and talent management consultancy, discusses what the future is likely to bring to NHS workers and how healthcare organisations can best support their staff through the difficult times ahead.

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iagnosis. The NHS offers over 300 different careers all ultimately dedicated to patient care and treatment. That translates to an incredibly complex task addressing personal career aspirations at an organisational level. The task is complex enough during times of rapid growth (which the NHS has done over recent years), but becomes more complex during times of uncertainty; particularly as the 300 careers catered for by the NHS include skills and knowledge that are highly transferrable at one level, vs other skills and knowledge that are specific but not highly transferrable.

One in five Britons now already work for the state; with one in nineteen with the NHS, so, when in his April 2009 budget, the Chancellor conceded that the projected underperformance of the economy is so great that public spending will soon account for just under 50 per cent of national income, with public sector debt close to reaching £1,000billion; this provides a clear indicator that an increasing and significant number of NHS assets and jobs are likely to come under scrutiny over the coming months and years, with potential for large-scale job loss. The government’s ‘prioritise and economise’ message at the TUC on 15 September provides a clear picture of what is likely to follow.

The career continuity diagnosis is not great for many categories of skilled and experienced staff across the NHS. Prognosis. The implication for a cross section of UK healthcare workers is that the coming period is very likely to be characterised by the following:

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1. Increased uncertainty about the future in general, as well as increased uncertainty about personal career growth opportunities as staff development and recruitment budgets are revised.

trusts (PCTs), and strategic health trusts (SHAs) will be required to deliver the following ‘treatments’ to ensure that the organisation which emerges is one that emerges with its capability and reputation (employer brand) intact:

2. Increased fears, justified or not, about job security, and for many, the unfortunate loss of their jobs, requiring personal efforts towards:

• Actively support/empower managers to deliver tough messages, to manage change, and to take care of themselves during a difficult period, while seeking to maintain morale and dedication • Actively support/empower staff directly impacted by any redeployment or job cuts with realistic but creative career transition and outplacement support, (which may in future be in the context of reductions to redundancy pay conditions) • Actively support/empower (ie. inform and motivate) the ‘survivors’ of restructuring, with a view to assuring an engaged workforce committed to the restructured organisation that emerges from the change process.

• F inding new roles, in some cases suboptimal opportunities given a tight employment market with 2.5 million unemployed at the time of writing, and for others, involving potential international shifts, eg. the large cadre of foreign NHS workers who may need to return home; • Entering self-employment, as consultants, interims, etc; • Starting up a business; • Re-skilling and re-training themselves to improve their marketability; • Keeping busy and doing something meaningful during a career hiatus.

3. Others will suffer the discomfort of ‘surviving’ the redundancies of colleagues and friends, and the ongoing uncertainty related to change 4. Managers will face the prospect of having to keep skilled teams engaged and dedicated.

Treatment. Over the coming months and years, many leaders from across the various NHS hospital, mental health, ambulance and primary care

The treatments are not simple ones, and these obligations will in part be delivered using internal NHS resources, and in part via the engagement of professional change, career transition/ outplacement and talent consultancies.

One treatment without the others will lead to an incomplete output and sub-optimal return on investment (ROI).

As a world-class organisation, NHS leaders should expect that any external providers that they engage should demonstrate their ability to achieve all of the above, to maximise ROI.

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To maximise ROI it is recommended that you ask your prospective supplier the following questions before you commission them:

communicate the support on in such a way that it enhances the experience for those directly impacted, and the ease with which changes are implemented and accepted for those who stay with the organisation?

Do they follow up their work with transparent end of programme/project measures of individual satisfaction and settlement rates?

Do they take a realistic view of opportunities for re-settlement in a difficult market, vs creating unrealistic resettlement expectations?

Do they provide access to vocational training within their outplacement programmes; acknowledging that more and more people are recognising the need to develop their skills and knowledge during periods of career transition?

Do they offer to empower and train the organisation’s HR team to become effective career advisors as part of the value add that they deliver?

Manager support by external providers: • Do they demonstrate a measurable outcomes-focused approach?

• Is their approach aimed at imparting confidence and competence for managers to deliver tough messages under circumstances which may be personally distressing?

• Is their approach aimed at empowering managers to become effective change agents?

• Is their approach aimed at empowering managers to take care of themselves, including their health, their career development and their motivation during difficult times?

•

Redeployment/outplacement support by external providers: • Do they demonstrate a clear, measurable outcomes-focused approach?

• Do they offer comprehensive individualised support to impacted staff at all levels and with broad needs vs taking a one-size-fits-all sausagemachine approach?

• Do they have the means to effectively

Survivor support by external providers: • Do they demonstrate a clear, measurable outcomes-focused approach?

• Do they help staff put change in context, and stress the point to indirectly impacted staff that

•

•

•

redundancy is not a new thing, it affects an increasing number of people at some point, and it is often a valuable career development step?

• Do they recognise that much is to be gained from engaging the survivors of change in honest career leverage conversations and to develop conscious personal career ownership, by providing in-house careers centres?

Return on investment (ROI) and ‘value for money’ are key considerations in selecting an external provider, measured in terms of the ease with which changes are implemented and accepted, and how the provision of this support for managers, directly impacted staff and the survivors of restructuring, enhances the organisation’s reputation in the wider community.

For more information please contact Clayton Glen at HDA: Email: cxg@hda.co.uk Tel: 0207 484 5484 / 07949 109 773 www.hda.co.uk

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key to the public sector ’ s development Nicole Barber, Head of Employer Training Solutions at Westminster Kingsway College, explains how the college can work with the NHS to provide a more holistic approach to training through apprenticeships.

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ork-based apprenticeships are one way to ensure that your organisation receives the most up to date training for your staff.

Westminster Kingsway College in London has an excellent track record in working with the NHS and central government, providing apprenticeships, NVQ training, and tailor-made leadership and management programmes. The college is also working with the Sector Skills Council, Government Skills to provide apprenticeship programmes across the public sector.

An apprenticeship is a 12 month programme of work based training and qualifications that current and future employees complete while doing their job. Apprenticeships have been developed with the public sector for the public sector, to provide motivated and skilled staff. An apprenticeship focuses on the whole job and not just on individual skills, as tuition will take place in the workplace and through college based training.

An Apprenticeship Framework is a programme specified by the Sector Skills Council to incorporate the qualifications and skills needed to achieve a particular apprenticeship. Typically, an apprenticeship will include an NVQ qualification, key skills and a technical certificate depending on the type of apprenticeship undertaken.

It is a common misconception that apprenticeships are only for people aged 16-18. While a large number of apprenticeships are offered to this age group, there are also a substantial number of adult learners undertaking apprenticeship programmes. Westminster

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Kingsway College has over 250 adult learners on apprenticeship programmes, working within the public sector.

An apprenticeship programme using a more holistic approach concentrates on all facets of the individual by focusing on the practical, language and numeracy skills as well as building their knowledge and understanding within the workplace.

Within the Apprenticeship Framework, the NVQ element, either Level 2 or 3, assesses occupational competence within the skills people use at work.

A certificate in key skills addresses personal development and covers these areas; Application of Number and Communication. This training is also sector specific, meaning that your apprentice will develop key skills relevant to your organisation.

Finally, the Technical Certificate helps to develop knowledge and understanding related to the job role. The certificate is normally completed at a Further Education College, and offers structured skills teaching, including external assessment.

Together these elements provide apprentices with skills that are essential to progress in today’s economy.

To develop your customised apprenticeship programme, we first, through a series of visits, shadow your staff and research your organisation’s needs. We then build resources that will deliver the specific training you require. We will also develop programme objectives with your team to help measure the impact that training has made to your organisation. Westminster Kingsway College is one of the first colleges in London to be accredited with the

unconditional Training Quality Standard, in recognition of the quality of our training and the extra mile that we will go to provide relevant training programmes.

We use various delivery models to suit the requirements of our clients. Some of our successful models involve group workshops on a fortnightly or monthly basis; blended learning using our Virtual Learning Environment (VLE) on a one to one basis or in small groups; or distance learning using an e-portfolio with regular one to one visits. During our initial consultation we will design a personalised delivery model. It is important that our training will fit in with your work schedules and staff requirements. Training can be delivered either on the employer’s premises or at one of our centres.

We provide a number of apprenticeships programmes to the public sector and the NHS. These include Team Leading; Management; Health & Social Care; Support Services for Health Care; Cleaning & Support Services; Business Administration; Customer Service; Accounting; IT Users (ITQ).

For details of Westminster Kingsway College’s training programmes contact Nicole Barber Email: nicole.barber@westking.ac.uk www.employertrainingsolutions.co.uk

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NHS

apprenticeships – building the workforce of tomorrow To deliver the highest quality patient care the health sector needs a skilled and flexible workforce. With an ageing workforce and growing competition in health service provision this presents an increasing challenge. Bridget Herniman, Project Manager Apprenticeships, Skills for Health, explains.

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pprenticeships offer employers an effective means to attract and develop staff with the right skills and knowledge, while equipping apprentices with everything they need to start and progress their careers in the health sector.

What are apprenticeships?

Apprenticeships offer work based development programmes, to anyone over 16, that lead to nationally accredited qualifications. Within each framework apprentices undertake three components:

• A competence based qualification such as a National Vocational Qualification (NVQ) • An accredited programme of learning which underpins the NVQ known as a Technical Certificate • Key skills qualifications such as application of communication or information technology skills.

What are the benefits?

For employers, apprenticeships can: • Help address skill gaps • Support service and workforce redesign • Secure succession planning • Contribute to a multiskilled workforce • Improve retention

• Enable them to meet the Skills Pledge • Ensure employees achievements are transparently recognised within a nationally accredited framework, thereby supporting career progression • Support the development of a learning culture within the organisation • Support the corporate social responsibility agenda • Support the NHS Constitution commitment to ‘provide all staff with personal development, access to appropriate training for their jobs and line management support to succeed’.

For individuals, apprenticeships offer: • Confirmation and accreditation of skills and knowledge against national standards • Meaningful work based learning • Transparent progression pathways • acquisition of the skills required of a modern workforce • Opportunities to earn while learning • Development of confidence and competence.

Bringing the benefits to the NHS Maximising the potential offered by apprenticeships requires senior staff to build on their current provision and ensure future sustainability.

Skills for Health has recently launched the Health Sector Apprenticeship Toolkit, which contains all the information needed to initiate, manage and evaluate an apprenticeship scheme including business cases and how to access funding and support. A new signposting tool

integrates with the Toolkit by matching NHS job roles with the range of over 197 available apprenticeships, including: • Support services • Accountancy • Purchasing and supply (also available at level 4) • Payroll • Contact centres • IT users • IT telecoms and professionals • Management • Marketing and communications • Driving goods vehicles • Warehousing and storage • Traffic office • Vehicle maintenance and repair • Logistic operations manager • Carry and delivery goods

Continued on page 78

Apprentices from across the North West met the Secretary of State for Health, Andy Burnham, at University Hospital Aintree at the announcement of £25 million funding for NHS apprenticeships

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On 27 July Health Secretary Andy Burnham announced that NHS organisations will receive £25 million to accelerate the delivery of 5,000 more apprenticeships and create a sustainable infrastructure for providing future apprenticeships.

The Health Secretary said: ‘Apprenticeships are an excellent way of giving young people the chance to learn life changing skills and offer a genuine opportunity to train clinical staff.

‘In these tough economic times, we must do all we can to provide high quality routes into jobs so that we can ensure we have a highly skilled, highly motivated and loyal NHS workforce for future generations’.

What are people saying about apprenticeships?

‘Any organisation that is looking long term… to be able to survive in a competitive environment, the only way is to have a skilled labour force coming to take your business forward; the best way of doing it is through apprenticeships.’

Stanley East, Director of Operations, Prosthetics Department, Queen Mary’s Hospital.

‘The NHS is a stimulating and worthwhile environment and the apprenticeships will provide excellent training opportunities.’ Dave Prentis, General Secretary, UNISON. ‘Opportunity is the key to development and I am convinced that the apprenticeship agenda will see a raft of talent coming through into the NHS.’ Ron Kerr, Chief Executive, Guys’ and St Thomas’ NHS Foundation Trust.

For more information please contact Sue.Grattan@skillsforhealth.org.uk The Health Sector Toolkit and the list of apprenticeships against job roles are available on the website: www.skillsforhealth.org.uk or www.apprenticeships.org.uk

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‘Apprenticeships are an excellent way to recruit and develop staff while benefiting the service and ultimately the patient.’ Charlotte Ellis, Staff Development Lead, Kettering General Hospital NHS Foundation Trust.

‘Due to large scale retirements much needed skills will be lost. In order to replace these skills ahead of time apprenticeships were identified as the best way forward.’ Dave Bennett, Estates Maintenance Manager, Kettering General Hospital NHS Foundation Trust.

‘I thought a business administration apprenticeship with the NHS would give me the experience I need to go as far as I possibly can in my career. I am enjoying working on a variety of things and the team here make me really feel valued.’

Scott Turner, Nottinghamshire Health and Social Care Community Workforce Team.

‘At school it was just assumed that everyone would go to university, but once I’d looked into the apprenticeship I felt it offered more in terms of practical experience and vocational qualifications.’

Vicki Hardwell, Business Administration Apprentice, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust

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simple and effective approach to apprenticeship in the NHS

The Department of Health has thrown down a challenge to NHS Trusts to dramatically increase the number of apprentices they work with by March 2010. Health Secretary Andy Burnham has targeted Strategic Health Authorities with a total of over 5,000 new apprenticeships spread over ten SHAs. This represents a substantial jump from the current 1,500 and a relatively short time scale in which to get them into post.

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he announcement is clear that NHS organisations will receive a total of £25 million to create these jobs.

What is less clear is how the figures will add up and who in the NHS trusts will have the time to be able to source the apprentices and training providers. In London alone there are 73 Trusts with a target between them of 600 new apprenticeships. Although this represents less than 10 apprentices per Trust, some organisations will be starting with a limited understanding of what is involved in an apprenticeship.

During the last two months I have been calling many London NHS Trusts to explore ideas around apprenticeships.

I have found that some common themes have been running through the conversations. Firstly, it is not always clear who is responsible for making decisions about where an apprentice could fill a role; sometimes it’s Human Resources, other times the Training Department.

Secondly, nearly everyone I have spoken to feels under pressure and is working to meet targets in other equally important areas.

Finally, there still seems to be some confusion about the existing targets with some organisations seemingly unaware of them, or of the need to consider how taking on apprentices may meet the needs of the organisations.

There would seem to be substantial barriers that have not been addressed by this announcement. The question then is how can Trusts be helped to rise to these challenges?

A simple and new option already

available in London is a group apprenticeship scheme similar to those which have been operating in Australia for over twenty years, with 20,000 apprentices at any time under it. The London Apprenticeship Company is the first of a number of these new group apprenticeship organisations which should within six months be operating around England and Wales. The LSC has committed to financially supporting the creation of 10-15 new group apprenticeship organisations across the country by the end of 2009 with the target of delivering up to 15,000 apprenticeships places by 2014/2015.

The London Apprenticeship Company went live in April and is offering healthcare apprenticeships – as well as apprenticeships within many other sectors.

The attraction of the model to employers is that the group apprentice organisation itself employs the apprentice and ‘loans’ them out to an employer for the period of the apprenticeship. Recruitment, screening, training set-up, payroll and support are all undertaken by the apprenticeship organisation in partnership with the employer, (Host Organisation, as the London Apprenticeship Company calls them). The quality of the recruitment and support of the apprentice by the London Apprenticeship model is enhanced by the existence of a ‘hand back’ option by the Host Organisation at any time during the year if they are unhappy with the apprentice.

As a result, this Australian group apprenticeship model has a much higher rate of completion compared to the

traditional UK approach and because it is employer-friendly, it also has a much higher number of employers engaged proportionally.

This new model of apprenticeship will hopefully be a major contributor in the future within the NHS and in other sectors to increasing the attraction of apprenticeships for employers such as NHS Trusts. In this way, to quote Andy Burnham, ‘we can ensure we have a highly skilled, highly motivated loyal NHS workforce for future generations’.

Annette Helliwell leads on Healthcare at the London Apprenticeship Company and has a background in nursing and managing healthcare training in further education.

For further details please contact Email: annette.helliwell@ londonapprenticeship.co.uk www.londonapprenticeship.co.uk

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E- rostering to improve health , well - being and efficiency Efficiency and effectiveness of resources is a key message throughout the NHS, with trusts being urged to invest now to support the future. With staff costs accounting for 75 per cent of NHS running costs, trusts should explore all options which may help increase effectiveness – not just in expenditure, but also in the health, well-being and commitment of staff.

Karen Charman, Head of Employment Services at NHS Employers, discusses.

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ow staff are rostered, and how their time is managed, can have a significant impact on trust expenditure. As well as providing the means for you to optimise the use of permanent staff, electronic rostering systems also allow you to control demand for temporary staff and reduce overhead costs through integration with payroll systems. It is also known that increased control over work patterns is a key determinant of reduced stress levels and so contributes to staff overall well-being.

Dr Steve Boorman in his interim report on NHS Health and Well Being included the following within his definition of what well-being should look like: ‘Ensuring that services are available to staff when and where required, including on different trust sites and at times that are convenient for all workers, including those working on night shifts.’ Electronic rostering (or e-rostering) is simply an electronic way of efficiently managing when staff are needed to work.

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They enable managers to quickly build rosters and define the number of employees, by skill-mix, needed to meet the demands of the service. Employees can self roster, enabling them to work at times that are convenient to them, giving them a better work-life balance.

The NHS is a complex organisation which employs over 1.3 million staff in a variety of different roles. This, combined with the delivery of healthcare in a rapidly changing market, requires managers to make the best use of the resources they have available. Many trusts have implemented e-rostering systems and are seeing improvements in productivity and significant savings through better management of both substantive and temporary staff. Over the next 20 years the configuration of the workforce will need to be responsive to drivers for change from many sources, including: • The post-war baby boom will mean that the healthcare population aged over 65 and over will have increased by around 22 per cent, while, those over 85 will have increased by 26 per cent over the next 20 years • Advances in technology are producing new treatments that are turning fatal diseases into treatable conditions • Rising levels of obesity will increase pressures on the health system • The current birth rate is up 10 per cent to a new 25 year high • Part-time working and other flexible working patterns are going to be increasingly popular to fit in with modern family life

• New health and social care partnerships and new types of commissioning will require more effective people management When considering implementing an e-rostering system an assessment of the key benefits that the new system will bring often helps secure support from the trust board. It is likely that boards will feel able to support the following key benefits: • • • • • • • •

Easy access to workforce information Flexible working Improved absence management Improved clinical leadership Improved payroll accuracy More productive use of staff Reducing staff turnover Reduction in time spent on administration • Rostering staff to meet the needs of patients Before proceeding with the procurement of an e-rostering system a clear business case should be developed that details the justification and a full-cost benefit analysis. Depending on the scale and likely costs of the project, there may be a need to follow a formal procurement process for the selection and purchasing of the e-rostering system.

For the procurement and implementation process to be successful it is recommended that a structured project management approach is adopted with involvement of all stakeholders. This should include HR, workforce planning and organisational development, finance

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and payroll, IT, senior clinical staff and trade union representation. Trusts should also review the existing or develop a new rostering policy, which should contain the following features: Period of notice – the number of weeks before the off-duty is completed.

Safe minimum staffing levels – the skill mix and number of staff needed to cover a 24 hour period for each ward or work area.

Review period – to ensure that regular reviews are carried out as part of normal business and also when any reconfiguration of services take place.

Managing leave and absence management – specific rules in respect of managing leave.

Self-rostering – state how this will operate.

Workload variation – state how variation in workload will be managed.

Implementing an e-rostering system is a major piece of organisational development that is designed to deliver significant workforce productivity and service benefits to patients. The investment should therefore be managed carefully by applying clear and workable

governance arrangements. The following are some of the tips for effective implementing an e-rostering system: • Ensure support from the trust board through a trust board director sponsor • Establish a project board involvement all the key stakeholders including trade union representation • Assign an experienced human resources manager to project manage the process to ensure that any issues that may hinder the successful implementation can be managed at an early stage • Appoint a rostering manager to have overall responsibility for trustwide rostering. This will help ensure rostering effectiveness is sustained • Involve staff in the project team • Check and confirm that the funded establishments are correct • Review the existing or develop a new rostering policy • Review available e-rostering systems and select the system that will best deliver most productivity gains as defined in your business case • Review end-to-end payroll processes

There are a number of e-rostering systems now available to the NHS that are likely to meet the needs of the majority of trusts. An analysis of these systems was carried out by NHS Employers in 2007 and more details can be found in the guide to implementing electronic rostering in the workplace that was published in September 2007.

E-rostering can be of huge benefit to trusts, not only saving considerably on staffing costs and enabling organisations to meet the changing needs of delivering healthcare in the future but also allowing staff to have a better work life balance.

For more information please visit www.nhsemployers.org

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CASE STUDY

D eveloping e - rostering

for the unique needs of doctors

John Slade, Medical Staffing Manager for The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, outlines the benefits the trust is gaining from working with Zircadian on the development of an e-rostering system specifically for junior doctors.

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he implementation of an effective e-rostering system can yield immense benefits for trusts and their employees. However, in the case of junior doctors, that level of effectiveness depends on whether a system can handle their idiosyncratic working arrangements, and the complex rules and regulations which govern these. A generic e-rostering solution, which may be fit for purpose across all other staff groups, may actually increase costs or put patient safety at risk if unsuitably adapted to roster doctors. With this in mind, The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust has been assisting Zircadian in the development of e-rostering software that solves the unique challenges of managing junior doctors.

Creating and managing junior doctor rosters is a complex task, involving many

more considerations than for other worker groups. A junior doctor roster must link to the doctors’ underlying, contracted working arrangement (the rota), comply with the Working Time Regulations and New Deal, and help the trust manage doctors’ pay. Junior doctors have training requirements specified by the Deanery which must also be met. Yet while all these constraints must be applied, the roster must still allow doctors as much flexibility as possible when organising leave and swaps, and balance this with the trust’s need to provide a constant daytime and on-call service.

Zircadian has an in-depth understanding of what is required to satisfy these criteria, as it has long been a specialist in junior doctor rota management. Our trust has been using the company’s MRM-Live software to successfully manage our junior doctors’ rotas for the past five years. Now,

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Unique to junior doctors is the requirement to comply with the New Deal. The New Deal specifies hours limits and rest requirements, and stipulates that every junior must be assigned to a compliant, template working arrangement. This template forms the basis of the duty roster and determines pay. Unless a rostering system links to these underlying rota templates and assesses the roster against New Deal rules, it is very difficult for those who manage the rosters to build and maintain them compliantly. Any breaches on the roster, resulting from badly managed swaps or changes, can result in doctors being awarded expensive penalty bands.

Unexpected Band 3 payments would be financially crippling for any trust, but with a system tailored for junior doctors, our roster managers can automatically generate a roster based on the compliant rota template.

The Working Time Regulations (WTR), apply differently to junior doctors than to other worker groups.

Junior doctor’s hours of work are assessed over a greater number of weeks on the duty roster, and the 48-hour limit on working time may be removed through the opt-out or the 52-hour derogation. In certain instances, such as non-resident on-call duties, doctors can forego their rest entitlements.

This derogation is subject to the doctor getting compensatory rest and requires that the trust and doctors closely monitor these situations on the roster. These differences mean that the application of the WTR to doctors is far more

The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust has been assisting Zircadian in the development of e-rostering software that solves the unique challenges of managing junior doctors

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”

working with Zircadian on e-rostering for juniors means our experience is feeding development of a solution that is truly responsive to our needs, as well as to the needs of the wider NHS.

CASE STUDY

complex than to other staff groups, and necessitates continuous monitoring of the duty roster to ensure all doctors comply.

An e-rostering system designed especially for doctors can accommodate these complexities, and can maximise both the time a doctors spends working safely and his or her training opportunities.

Junior doctors’ on-going training needs must also be factored in. As with all trusts, a substantial number of our junior doctors are funded by the deanery to work with us. These deanery funded training posts often have specific training requirements and doctors must work across a number of specialties. In the past we have found that orchestrating these movements can be very complicated, but our new electronic system will automatically map the posts and placements to the rosters and populate them with the correct doctors.

Furthermore, the doctors’ ongoing WTR compliance can also be accurately assessed as they move between different specialties and work different placements.

Possibly our most pressured moments are when doctors report sick a few hours before the start of an on-call duty. It is crucially important for us to be able to identify which duties on the roster have on-call responsibilities, and who,

if anyone, they can be swapped with.

Because the new system is accessible through the web, up-to-date information about who is on call will always be accessible to the right people. The system will alert us to any gap in our minimum service levels or our on-call cover. Then, in response it will locate available doctors fast. The departmental roster manager and the out-of-hours clinical site manager will be provided with a list of appropriate doctors that have spare capacity and are available to work that duty. They can then be contacted quickly by email and SMS. This rapid response is exactly what is needed in these critically important situations. It also means that all internal solutions will have been exhausted before we try to source a doctor from an external agency, and this will preserve a high level of clinical care yet minimise costs.

When it comes to doctors, we have found that generic e-rostering systems are insufficient to cope with the many special conditions and controls on their working arrangements. By helping to design a solution with those specific rules and requirements in mind, I feel assured that we will have the best protection against financial penalties and utilise our doctors as effectively as we can; also that our doctors’ training needs are catered for

and patient care is safeguarded. The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust will continue to contribute to the ongoing development of Zircadian’s e-rostering system for junior doctors, ensuring that the software remains reactive to the evolving demands of the NHS.

For more information please contact Dee Enright at Zircadian Ltd Email: dee.enright@zircadian.com Tel: 020 8946 8199 or visit: www.zircadian.com

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strategy for well - being An organisation that invests in its employees is more likely to find that staff perform well and are more motivated. Dr Kathryn Bellamy, senior policy and technical adviser, IOSH, outlines ways in which organisations can ensure that employees feel valued and have access to resources that will improve their wellbeing.

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ellbeing is firmly on the agenda in the NHS following the Boorman1 review, which acknowledges that: ‘poor workforce health has a high cost’ and recommends the use of health and wellbeing targets and the provision of services, including early intervention programmes. The NHS loses over 10 million working days each year to sickness absence and the review has uncovered links between workforce wellbeing and key measures of patient satisfaction and Trust performance.

But what do we mean by ‘wellbeing’?

Definitions of wellbeing generally relate to people’s experience of their quality of life. For instance, Waddell & Burton2 define it as: ‘The subjective state of being healthy, happy contented, comfortable and satisfied with one’s quality of life. It includes physical, material, social, emotional (“happiness”), and development and activity dimensions’.

It is well known that being in work can be one of the best things for health and wellbeing, as long as the work is ‘good’. Health Service employers should help keep workers well and healthy by making sure work is not carried out in conditions that lead to injury, stress, MSDs, or other illness; supporting those 80

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with health problems; and providing health improvement opportunities.3,4 Employers who invest in employees demonstrate that they care for and value their staff. Encouraging employees to plan and take part in health related activities at work encourages social interaction and the development of a community. This will affect the other aspects of wellbeing and help the employer achieve a happy, motivated workforce that is more likely to stay and perform well.

mental and physical) to all employees.

Key elements of any successful initiative are that the programme should be designed to meet the needs and values of the employees; aligned to the overall business needs; supported by the senior management through active and visible participation; and communicated to employees, ie by informing and consulting on their needs and views on current and future programmes. There should also be a means of measuring the outcomes and business benefits.

However, if resources are limited then it would be sensible and probably more cost-effective to begin with issues that are causing the main problems to staff, such as stress or musculoskeletal disorders (MSDs). There may be distinctions between workrelated physical health issues and simply improving health awareness, but there will also be some cross-over which will reinforce the programmes. For example, respiratory conditions, covering awareness and control of work-related causes and also smoking cessation programmes; skin safety, covering awareness and control of work-related risks and advice on hand care or sun safety; and infection control, covering hand hygiene and vaccination policies. The most obvious areas for inclusion in health awareness promotion are healthy eating and obesity, physical activity, smoking, alcohol and drugs.

Healthy eating is not simply about maintaining a healthy weight. A balanced diet can help prevent digestive disorders, bone conditions such as osteoporosis, iron deficiency (which

major aspect of wellbeing is the “ Apromotion of positive health (both mental and physical) to all employees

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What’s the best way of delivering a wellbeing strategy? Leadership from a senior manager is crucial but HR, occupational health and health and safety practitioners have a key role in delivering the wellbeing strategy. In general, it’s better to implement wellbeingrelated initiatives as a series of discrete, sustainable projects, communicating and building on the success of each project. Each project should have clear, measurable outcomes and be part of an overall programme. To assess the impact of a wellbeing programme on costs, and cost of ill health to your organisation, the Health, Work and Wellbeing business health check evaluation tool5 or the Health and Safety Executive’s ill health costs calculator6 can be used.

A major aspect of wellbeing is the promotion of positive health (both

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can make people feel tired, irritable and less able to concentrate), cancers of the gastrointestinal tract and many other problems. Simple changes to the food offered in hospital dining rooms, alongside information on healthy eating, can change people’s eating habits for the better and improve health and wellbeing.

Alcohol is the cause of many hospital admissions for physical illness and accidents. Alcohol leads to both short and long term health problems. It’s responsible for up to 17 million lost working days annually and has been estimated to cost the economy £1.5 billion. Therefore giving employees information on where they can obtain advice on sensible drinking, alcohol and drug issues could be beneficial.

Another important aspect of wellbeing is supporting employees with health conditions to remain in work or to return to work following an absence.

There is a common belief that people who have problems with their health should not return to work until they are fully fit.

However, evidence shows that provided the correct modifications are made, managing an ill health condition at work is often better for the individual than prolonged absence.

Work-based activities that promote wellbeing and help employees develop positive coping behaviours are important in overcoming some of the psychosocial issues that may affect health. There are several ways in which recovery and

References 1. Boorman S. NHS Health and Well-being Review – Interim report 2009 www.nhshealthandwellbeing.org/InterimReport.html 2. Waddell G and Burton K. Is work good for your health and wellbeing. London: The Stationery Office, 2006 3. IOSH, A Healthy Return – Good practice guide to rehabilitating people at work. Wigston: IOSH, 2008 www.iosh.co.uk/files/technical/A%20HEALTHY%20RETURN121208.pdf 4. IOSH, Working well – Guidance on promoting health and wellbeing at work. Wigston: IOSH, 2009 www.iosh.co.uk/files/technical/Working_well_FINAL.pdf 5. Health, Work and Well Being, PricewaterhouseCoopers and Business in the Community. The business healthcheck. www.workingforhealth.gov.uk/Initiatives/business-healthcheck-tool/Default. aspx.

6. Health and Safety Executive. Ill-health costs introduction. www.hse.gov.uk/costs/ill_health_costs/ ill_health_costs_intro.asp

long-term management of their health condition at work can be assisted: • Education programmes for managers that address misconceptions about conditions such as mental illness • Providing employees with information about self-managing common health conditions, as well as details of support groups • Encouraging employees to set up their own in-house support groups • Providing flexible working arrangements that allow employees to take time off for treatment or frequent rest breaks • Providing employees with access to appropriate interventions – psychological (eg counselling or cognitive behavioural therapy or physical (eg physiotherapy) Looking at the potential benefits to workers, employers and patients, Boorman’s interim report1 concluded that there is a ‘…compelling argument to systematically support NHS workforce health and well-being for the benefit of all concerned.’

For more information, please visit www.iosh.co.uk

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S implyhealth –

creating an all encompassing rewards package Helen Dickinson, Head of Simplyhealth People, takes a look at Simplyhealth’s approach to rewards and benefits, and shows that rewarding employees can often shape the way in which they interact with customers.

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or Simplyhealth, helping others is our lifeblood. We let our values guide our business practices and not the other way round. When we look at new ways of supporting our people with their reward programme, we do it because it’s the right thing to do, and it’s important to us and our people.

As a business based on mutual values, we have been helping people with their health for nearly 140 years. We have one of the widest ranges of health products and services on the market – from cash plans and medical insurance to healthcare trusts and mobility aids.

As part of this ethos, it is important to us that we seek innovative employee rewards to complement life stages. We believe that this not only strengthens our employer brand, but also helps our people become more engaged and committed to helping customers.

Uniqueness and innovation continue to be very important to us; and we continue to create new rewards which meet the needs of our people and strengthen our employer brand. We have taken the lead in creating new and pioneering rewards in the following ways:

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• When house prices were increasing, we recognised that some employees may find it hard getting onto the property ladder, and that saving for retirement could be a low priority for the young members of our team.

So we developed our ‘Save to Buy Scheme’ where Simplyhealth matches employee contributions to help save a deposit for their first home. This isn’t designed to replace the pension scheme, but instead respond to our people’s different life stages.

• Many graduates leave university with a legacy of debt. By introducing our ‘Simplyhealth Student Loan Repayment Matching Scheme’ we help graduates pay off their loans twice as quickly, as Simplyhealth matches the employee’s monthly payment (through PAYE) to the Student Loans Company.

• It is also important that we support our people who are nearing retirement. We therefore decided to provide a ‘Prepare for your Retirement Scheme’ which encourages those nearing retirement to consider working reduced hours in the six months leading up to their retirement, on normal pay.

• We also develop rewards to help our people on a day to day basis. That’s why we introduced our ‘lifestyle leave’. This automatically gives an employee a day off work to spend moving house, or on their child’s first day at nursery or school.

• With disparities across all locations of the business, we unified our healthcare benefits across the workforce to give everybody the same access to everyday healthcare and additional cover for unforeseeable medical conditions. We took a consultative approach by gathering feedback from the local staff consultative committees and acting upon it. A full communications plan including face-to-face sessions was rolled out to ensure that all employees fully understood the benefits.

Communications To help support the introduction of our rewards programme, our team of people development and human resources professionals have proactively found new ways to communicate with everyone who works at Simplyhealth. This includes introducing new people pages on our internal intranet. Our people have also

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Simplyhealth employees who had made a difference in or outside of work were rewarded with a trip to Brazil to build a Health Centre for the local community

Staff giving out free apples to commuters to launch the new Simplyhealth brand

gone on the road, visiting every break out area and canteen in our various geographical locations in order to talk to our people individually and confidentially.

Diversity Instead of developing a one size fits all reward package, we have made a conscious decision to support all groups of employees. Despite cost implications, we continue to provide our reward

programme, because we know that our people value the way it helps them lead different lives and support their lifestyles.

We believe that this has had a positive impact on our customers and the service they receive because our people feel good about working for Simplyhealth.

We evidence this every day by providing our 1.3 million customers and 11,000 corporate clients with an excellent service. We pay over 16,000 claims, generally within a few days of receiving them, calls are answered by a person in the UK generally within 20 seconds and we send out correspondence within five working days. Our service levels mean that 94 per cent of our customers are delighted or completely satisfied with the service they receive from us.

The reason we exist is to make people feel healthier – an attitude that we have cherished for nearly 140 years.

We believe that, through our holistic and all encompassing approach to employee

rewards, we get the best out of our people. Which is why, whatever their role or position, the people at Simplyhealth all live up to our ethos of doing the right thing, not just the easy thing.

For more information about Simplyhealth, why not bother us at Email: forbusiness@simplyhealth.co.uk Tel: 0845 075 0063 www.simplyhealth.co.uk

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N ew

talking therapies have a wider impact

Mental ill health is Britain’s biggest social problem. The £173 million Improving Access to Psychological Therapies (IAPT) programme is helping PCTs deliver evidence-based, effective and cost-efficient treatments.

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ommissioning psychological therapies can improve health and well-being – and make savings for the wider health economy by improving people’s ability to manage their longterm physical conditions, such as diabetes and heart disease, through the positive management of their mental health.

The Improving Access to Psychological Therapies (IAPT) programme is helping PCTs train a new workforce and establish NICE-compliant psychological services for people with mild to moderate depression and anxiety disorders.

The programme began in 2006 with two demonstration sites – Newham and Doncaster – focusing on adults of working age. Around half the people who completed treatment made a measurable recovery, in line with the evidence from clinical trials, and the number in work rose by up to 10 per cent.

In 2007/8, 11 Pathfinder PCTs enabled commissioning for the whole community by exploring the psychological therapy needs of vulnerable groups in the population, including black and minority ethnic communities, older people, people with medically unexplained symptoms, people with long-term conditions, perinatal mental health issues, offenders, armed forces veterans, people with learning disabilities, children and young people.

Now, around 110 PCTs are delivering IAPT services and every PCT in the country is expected to do so next year.

A number have collaborated in their tendering processes, with support from a

regional procurement hub. Among them, Nottingham County PCT has learned some useful lessons.

A wide range of tools and guides have been published and best practice examples are shared through the website www.nhs.uk/iapt Routine collection of outcomes data is fundamental to delivering IAPT services effectively. Health and social outcomes must be recorded accurately, regularly and frequently so the therapist can see their patients’ progress.

all parts of the community – including probation and offender services – to make access for all as easy as possible.

Achieving sustained recovery Local need for psychological therapies can be determined in the Joint Strategic Needs Assessment that local authorities and PCTs do together. It is important to involve service users in all aspects of service design. They can also help in tailoring the information provided to people who enter the service.

An IAPT service offers a stepped model of care and provides two levels of treatment, using the minimum level necessary to achieve sustained recovery, stepping up as required.

Psychological Wellbeing Practitioners give low intensity interventions to people with mild to moderate depression. This may take the form of watchful waiting, guided self-help (which can be delivered over the telephone) or up to seven sessions of face-to-face psychological intervention. It can also include group work and guided use of computerised cognitive behavioural therapy.

A person who is severely depressed or does not respond to low-intensity intervention will receive high-intensity treatment involving up to 20 therapy sessions, normally on a face-to-face basis.

NICE recommends considering concurrent use of medication in cases of moderate to severe depression.

For some anxiety conditions, such as post-traumatic stress disorder, social

An IAPT service offers a “ stepped model of care and provides

two levels of treatment, using the minimum level necessary to achieve sustained recovery, stepping up as required

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Patients say that discussing their progress with their therapist helps them even more. The data also allows service managers and commissioners to monitor the workload and effectiveness of each worker and see if, overall, the service is delivering its commissioned outcomes.

IAPT’s normal process of referral is through primary care – but some people do not want to tell their GP or practice staff about their mental health problems so self-referral should be accepted, as the evidence shows that those who come forward are at least as ill as those referred

by GPs. Jobcentres and employers should also encourage those who need help to get referred. The service needs close links to

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Factfile Depression and anxiety disorders affect 6 million people in the UK, Psychological therapies are as effective as medication in the shortterm and in the long term are better at preventing relapse.

A recent World Health Organization study concluded that depression impacts on a person’s functioning 50 per cent more seriously than angina, asthma, diabetes and arthritis.

phobia or obsessive-compulsive disorder, patients normally go straight to highintensity treatment (usually 7 to 14 sessions) unless the problem is very mild or recent.

The team needs support from administrative staff, employment advisors, access to other relevant social supports, such as housing, a GP advisor and other local services.

Most services are likely to find a ratio of about six to four for high-intensity to low-intensity therapists to be suitable.

Competencies for qualified staff have been published and appropriately trained and experienced therapists give proper supervision to the trainees.

Understanding the market Commissioners are inviting interest from the broadest possible range of providers in order to secure the highest quality for the best value.

Nationally, an extensive range of third, independent and statutory sector providers already offers evidence-based psychological therapies but some areas have limited plurality of provision. Using an existing local provider forum – or setting one up – can help engage the provider community constructively and

transparently about priorities and issues for market shaping and development.

Costs should be transparent between the independent or third sector and the statutory sector to encourage competition and drive cost-effectiveness. Value-formoney criteria should be included in any tender for new services, as well as criteria to assess the quality of care, so that effective services are commissioned.

Contracts and specifications with mental health trusts and psychological therapies providers should encourage collaborative working, particularly when individuals move between providers along the stepped-care pathway.

Perverse incentives that become a barrier to people receiving the most appropriate level of care need to be avoided. For example, contracts that fund activity alone can lead to delays in people stepping up to another provider.

Commissioners can secure costeffective, high-quality provision by clearly specifying the outcomes they expect to see and they should collaborate with providers on commissioning expectations in advance of the tender stage, through local provider forums, including clear guidance in the service specification document.

Mental health problems account for nearly 40 per cent of people on incapacity benefit and take up a third of all GPs’ time with patients.

Only a third of people with diagnosable depression and less than a quarter of those with anxiety disorders are in treatment.

Studies suggest that depression is associated with a 50 per cent increase in the costs of long-term medical care.

The Hillingdon chronic obstructive pulmonary disease (COPD) trial saved £70,000 over six months, by investing £25,000 a year in CBT. Among those with diabetes, depression is associated with a 50 per cent to 75 per cent increase in health service cost.

Providing psychological therapies for those suffering with Medically Unexplained Symptoms (MUS) can produce a reduction of 50 per cent in GP visits by these patients.

For more information please visit www.iapt.nhs.uk

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R eturn

to wellbeing : delivering on the IAPT framework Occupational health is rising up the agenda as employers realise that a fit and well workforce is their greatest asset. Dr. Mark Winwood, Director of Psychological Services at AXA ICAS, explains how the company is applying its experience in employee wellness programmes to NHS settings.

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XA ICAS is the UK’s largest and one of the longest established, provider of corporate psychological wellness programmes, with more than 20 years experience working with organisations to develop healthy workforces. We have an international presence via subsidiary companies and strategic partnerships around the globe.

Our approach to psychological wellness is pragmatic. We focus on short term, focused, strategies to alleviate distress and promote wellbeing.

Key to our pragmatic approach to psychological wellbeing is our LifeManagement™ service. We understand that psychological issues can have wide ranging causes and can be triggered – or exacerbated – by social issues such as financial worries or housing problems.

If a depressed individual has a social issue, there is an increased chance of resolution if interventions include strategies to address both the psychological and social aspects of the problem.

People using our services will therefore have access to a clinician as well as having the opportunity to talk to a number of other experts, such as legal advisors, childcare experts, or financial experts.

When contracted by an organisation, our services help to improve the health and wellbeing of the staff.

The state of the UK’s Mental Health has been the subject of much debate recently. Inequality in the provision of psychological services was highlighted by Lord Richard Layard in 2005 in a report on improving access to psychological therapies (IAPT). This report focused on the huge amount of working days lost due to psychological ill health, which, in turn, are costing employers and the Department of Work and Pensions a fortune in salaries and benefits.

Layard found that therapy provision around the country was patchy, as was the quality and variety of the psychological interventions delivered. He tasked the government with funding the

impacted by social circumstances and these should be addressed.

AXA ICAS is well-placed to meet the objectives of IAPT, offering a full range of psychological support and information services. Pathologising distress and removing people from the workplace can sometimes have an adverse affect on psychological wellbeing – evidence suggests that working is good for you. We have the experience to keep the context of our therapies firmly in the workplace and support people back into the work setting where appropriate.

Pathologising distress and removing “ people from the workplace can sometimes have an adverse affect on psychological well-being – evidence suggests that working is good for you

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provision of evidence based therapies across the country. These evidence based therapies included therapy such as Cognitive Behavioural Therapy, which is recommended by NICE (National Institute for Clinical Excellence in Health) as effective at treating mild to moderate depression and anxiety.

The report also makes it clear that, like AXA ICAS, Layard realised that psychological absence from work is also

AXA ICAS and the NHS AXA ICAS has initiated projects with several PCTs, transferring its expertise to the national healthcare sector. These projects are specifically aimed at patients who have problems resulting from the economic downturn – they may have lost their jobs or are suffering financially from a partner who has lost a job. We are able to provide psychological support up to level 2 of the IAPT ‘stepped care’ model, plus provide social support to help

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patients deal with financial and other issues. This service has a pragmatic shortterm focus to help people resolve their concerns as quickly as practicable.

Outside these projects, AXA ICAS is able to deliver support at levels 1, 2 and 3 of the ‘stepped care’ IAPT framework of intervention, and partner with organisations who are able to deliver steps 4 and 5.

AXA ICAS has the infrastructure and flexibility to be able to plug gaps in NHS provision quickly and effectively. Central to this is our experience of managing therapists remotely. Our three support centres employ teams of therapists to answer calls from patients – this service is available 24 hours a day, 7 days a week. In addition, we have a UK-wide network of counsellors, psychotherapists and psychologists who can support NHS services via our comprehensive case management systems.

All clinicians are highly qualified and experienced in delivering a wide variety of interventions and exceed the requirements for ‘low intensity workers’ as required by IAPT. Those delivering ‘high intensity’ interventions are

appropriately qualified psychotherapists and psychologists supported by our inhouse team of senior clinicians.

The skills developed in our EAP work transfer very well to NHS settings. A key feature of IAPT models is the collection of outcome data. This is essential to ensure the quality of the interventions being applied and to help monitor clinical improvement. AXA ICAS is well-versed in outcome measurement, having used similar protocols to the IAPT structure for many years.

Building new services Because we have a large network of people working for us throughout the UK, we can build a service very quickly in any given area. AXA ICAS therefore has the capability to invest in a large contract by relocating services to that area. We are flexible enough to add value to NHS services and our awareness of IAPT will enable us to apply for further IAPT tenders in the future. We are fully committed to supporting our clinicians and partners to deliver on the IAPT model.

For more information please contact Dr Mark Winwood Director of Psychological Services Tel: 01908 285239 Email: mark.winwood@axa-icas.com www.axa-icas.com

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T he B oorman R eview : invest in your greatest resource Programmes and services that support staff health and well-being are a worthy investment, and will save trusts money and improve patient care. That’s the principal message Dr Steve Boorman hopes those involved in NHS procurement will take from his Interim Report into staff health and well-being, which was published on 19 August 2009.

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t is fair to ask how, with serious funding squeezes being mooted after 2011, NHS organisations can afford to make a trust-wide investment in staff-focused support services. I would argue that they can’t afford not to.

The report showed that the NHS loses 10.3 million working days annually due to sickness absence alone, costing £1.7 billion per year. With a future public spending squeeze seemingly inevitable, provider organisations cannot afford to lose so much every year as a result of staff absence, reduced productivity, and continuing bills for temporary staff.

Reducing service-wide absence rates by a third would mean an extra 3.4 million working days a year, and annual direct cost savings of over half a billion pounds (£555 million). There is no doubt that these savings can be achieved through well-constructed programmes

and effectively targeted investment.

Organisations which have invested strategically in health and well-being services have achieved major reductions in absence rates, with BT they reducing rates by 30 per cent from 3.5 per cent to 2.43 per cent in 5 years, and in Royal Mail by 40 per cent from 7 per cent to 4.2 per cent over a similar period.

The Review discovered that NHS trusts who have devoted serious resources to improving workforce health and well-being often outperformed commercial organisations in the reduction of absenteeism. Sandwell and West Birmingham Hospitals NHST, for example, saw rates fall from 4.78 per cent to 3.86 per cent in just two years, having implemented an impressive trust-wide staff engagement programme.

Gloucestershire Hospitals NHS Foundation Trust provides an excellent example of how targeted investment in

absence from 13.6 to 6.8 days; a decrease in waiting time for MSD appointments and the majority of patients being assessed and managed by physiotherapists without the need for medical input, with significant cost savings for the Trust.

West Suffolk Hospitals NHS Trust achieved similar success. The Trust spent £21,000 introducing a system of priority referrals to a local physiotherapist for injured staff. The system achieved over £170,000 of savings in the direct cost of musculo-skeletal injuries. Days lost as a result of sickness absence also fell by 40 per cent.

Both of these trusts are sterling examples of how investment in occupational health services can be generate a significant financial return as a result of cost reduction and reduced absenteeism. However, the case for change set out in our Report is not solely a financial one.

The Interim Report also concluded that organisations with healthy, happy staff are far more effective in delivering high quality patient care. An overwhelming majority of staff we surveyed believed the state of their health directly affected the quality of the care they were providing. Our research showed that trusts who maintained and improved their staffs’ health and well-being scored higher on general performance measures such as patient satisfaction and Annual Health Check Scores for ‘quality of services’ and ‘use of resources’.

Addenbrooke’s hospital, part of Cambridgeshire and Peterborough NSHFT, is an example of a high performing trust

service-wide absence rates “ Reducing by a third would mean an extra 3.4 million working days a year, and annual direct cost savings of over half a billion pounds

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improving staff health can drive down absenteeism. As our report showed, musculoskeletal problems are the single largest cause of sickness absence in the NHS. Recognising this, the Trust introduced an OH department based Physiotherapy Musculo-Skeletal Disorders (MSD) assessment service for NHS staff.

This resulted in a reduction in sickness

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that has benefited from a comprehensive, organisation-wide commitment to improving staff health. The hospital received an ‘excellent’ rating for the quality of services in last year’s Annual Health Check, and achieved the highest possible scores for safety and cleanliness, dignity and respect, standard of care, and waiting times.

Addenbrooke’s is a shining example of the strides that can be made when hospital management commits to investing in the health and happiness of their staff. Regular staff health-check days offer employees blood pressure and BMI checks, dietary guidance and exercise and fitness advice. A health and well-being intranet site has been set up, offering information about public health initiatives like the Know Your Limits campaign. And an admirable amount has been done to motivate staff and encourage them to enjoy their work, with the hospital organising fitness focused social events like five-a-side tournaments.

Organisations like Addenbrooke’s are reaping the benefits of improved occupational health provision; it’s no surprise that last year’s Annual Health Check also gave them an ‘excellent’ rating for ‘use of resources’.

Gloucestershire Hospitals NHS Foundation Trust, West Suffolk Hospitals

NHS Trust, and Addenbrooke’s hospital, along with many other high performing organisations, have demonstrated what can be achieved when time and resource is devoted to supporting staff health and well-being.

Unfortunately, occupational health provision across the NHS is patchy at best.

To ensure that staff and organisations are fully equipped to meet the challenges of the coming months and years, a servicewide culture change is required, placing far greater emphasis on the importance of workforce health and well-being.

This increased commitment should be supported by board level responsibility for staff health and well-being, ensuring that workforce health becomes part of the core business of the organisation. Proper resourcing for occupational health and staff support services is imperative, with a clear understanding that this represents investment that will deliver both longterm savings and improved patient care.

The Review team will publish our Final Report in November of this year.

This will include a full complement of recommendations for provider organisations, as well as useful guidance for effectively maintaining and improving staff health and well-being services.

In the meantime, we would suggest that those looking for further detail on

our recommendations download the Report itself, at the Interim Report page of our website. The Review continues to gather and incorporate ongoing thoughts and feedback through this site, www.nhshealthandwellbeing.org; our Interim Report feedback page gives users a chance to make comments and suggestions on specific areas of the report, and the interactive ‘Ask Steve’ section offers visitors the opportunity to put their thoughts, ideas and questions directly to me.

We continue to welcome any questions or feedback on the Report’s findings, as well as any suggestions or examples of best practice that would be helpful in producing our Final Report.

I believe that this Review is sending a clear message to the leaders of the largest workforce in Europe about the importance of occupational health. Employers have no greater resource than fit and motivated employees. This is why it is all the more important that they invest in the health and well-being of their staff.

For more information please visit www.nhshealthandwellbeing.org

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new path of provision – true integration of mental health care Lower level interventions can help individuals to access support quickly, to stop further deterioration in their mental well-being and to help them get back on top with other areas of their life. Sue Harris, Director of Strategic Business at Turning Point, looks at the development of a new service and its pioneering attempt to truly integrate an individual’s care.

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iven the current economic environment more people around us are experiencing deterioration in their ability to cope with life. With unemployment rising, with relationships strained and with people facing the threat of losing their homes, the number of people suffering from depression and anxiety is likely to increase.

People with depression and anxiety disorders are being offered more talking therapies, through significant government investment in the Improving Access to Psychological Therapies (IAPT) programme.

Most people who pay for therapy have come to their own conclusion that they need it. The IAPT programme means a new generation of people visiting the GP because of a physical health complaint may hear the last thing they expect: that they are being referred to a mental health service. We know that the vast majority of

clinical diagnosis. This capability allows all professionals to view an individuals’ whole needs. The software will inform GPs that a patient had a housing referral; Turning Point will access the files to see the success of psychological interventions provided; and therapists will be able to monitor trips to the doctor.

people suffering with, for example, lower back pain, have associated depression, with the likelihood that both conditions will keep them off work. It is right that these people get the help they need for their whole range of problems.

Imagine 45 year-old Alison: she has lower-back pain, for which she goes to the GP. She also has housing problems, debt issues and is a drug user. Underlying everything is a high level of anxiety. What Alison needs is ‘360 degree’ support.

As one of the largest social care providers in the UK, Turning Point is embarking on delivering a new service model entitled ‘RightSteps’ an outcome focused service, delivering integrated open access mental health provision and case management. RightSteps is designed to provide that ‘360 degree’ support.

At the heart of this new service is a purpose-built, fully customisable software system able to provide holistic care plans that can respond to a range of health, social and economic needs.

The importance of coordination Monitoring the client’s progress centrally will be a Turning Point wellbeing coordinator. These are trained staff who guide people through the complex system of care.

They will make sure that someone’s care, whether it comes from statutory or third sector services, is joined up. Our coordinators can monitor a person’s history, whether it’s self-help sessions for anxiety, a meeting with housing agencies or treatment for drug use. The initial GP visit is primarily a way of capturing mental health problems to open the door for someone so that they access a range of agencies that provide a more tailored package of care.

Turning Point want to work “ with people sooner: to offer a preventative approach so that we can assess the risk of someone falling into crisis

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This is a pioneering attempt to integrate people’s care, by offering assessments that all professionals contribute to. The software system tracks people’s progress and gets them access to support that they would not have had a chance of getting in the past, so that the idea is based on need, not solely on

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Even more crucial is what professionals then do. Wellbeing coordinators can mentor that person appropriately. So it is not just about mental health but mental well-being.

Traditionally clients have had to wait for things to go wrong, to become depressed or anxious and only then have they been referred to get the support they need.

Turning Point want to work with people sooner: to offer a preventative approach so that we can assess the risk of someone falling into crisis if, for instance, their debt problems are mounting up.

referral. Since its launch, the service has seen referrals grow threefold. Between January and July 2009, RightSteps received 1,500 referrals, without increasing pressure on more higher intensity interventions or increasing waiting times.

Turning Point is now looking to start operating a similar approach at Bristol, Somerset, Wakefield, Derbyshire and East Sussex, having recently been commissioned to enhance the local care pathway, often with NHS partners, in these areas.

RightSteps in action RightSteps Kingston was established in January 2009 to offer local people a rapid-access route to mental health services and social support. A groundbreaking partnership between Turning Point, South West London and St George’s Mental Health Trust, Kingston Primary Care Trust and the London Borough of Kingston.

As the first RightSteps service, RightSteps Kingston offers targeted, practical help and treatment to more than 300 people per month. Supported by wellbeing coordinators and local GPs, people are contacted within 48 hours of

Economic downturn Depression and anxiety should be key concerns, especially during this time of economic downturn. There are so many people, perhaps even a third of those in GP waiting rooms, who haven’t been getting the appropriate support.

Traditional treatment is often haphazard: it does not matter whether you have anxiety, depression or severe mental health issues; you tend to get referred in the same way. If someone is on the verge of going into crisis because they are about to lose their house, maybe it’s sensible to see them in a more timely fashion than their current place on a long waiting list.

We hope that RightSteps services will encourage others to adopt a preventable approach. The mixture of therapy, social care and the right software to bind it all together is a model that we feel is making a difference.

To find out more about Turning Point RightSteps services please contact us Tel: 0161 238 5261 Email: rightsteps@turning-point.co.uk www.turning-point.co.uk

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R egulated F ertility S ervices – A C ommissioning A id People seeking NHS help with fertility problems have encountered many problems in accessing services equitably. Clare Lewis-Jones MBE, Chief Executive of the Infertility Network UK, explains.

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n February 2004 the National Institute for Health and Clinical Excellence published a set of guidelines called Fertility: assessment and treatment for people with fertility problems.

The Guideline recommended that eligible couples should be offered three full IVF cycles if the woman was aged between 23 and 39 years of age and there was an identified cause of infertility or unexplained infertility of at least three years duration. It also recommended that Intra-cytoplasmic sperm injection (ICSI) should be considered for those with specific male fertility problems or in whom previous IVF treatment cycles have been unsuccessful.

In 2009, about 30 per cent of primary care trusts are providing fertility services in accordance with the NICE guideline.

This is a considerable improvement from two years ago, when the figure was 5 per cent. However, there is still a great deal of scope for improvement as PCTs realise the importance of fertility provision – a field where technology is continually developing. In some areas, provision remains poor and inequitable. This is very hard for patients to understand. The inequities apply right across the UK. A particular obstacle that patients encounter is the hugely varying access

criteria being applied by PCTs across England, in particular in relation to the age of the female and previous children.

As mentioned above, NICE recommended treatment where the female was aged between 23 and 39. However, many PCTs are applying varying age related criteria such as 36-39 or 25-37. The majority of PCTs refuse treatment if either partner has a child from a previous relationship.

With funding from the Department of Health, Infertility Network UK has worked with PCTs to help implement the

also recommended that consideration was given to the establishment of a clear clinical pathway and national tariff for regulated fertility services.

To address that issue, in June 2009 the Expert Group published an online Commissioning Aid for regulated fertility services. The Aid acknowledges that fertility services pose particular challenges for commissioners. The purpose of the Aid is to assist NHS commissioners in developing their services and sets out the background to fertility services, describes what they comprise of and how they are accessed and outlines an approach to commissioning them. It includes information on infertility techniques, commissioning principles and gauging uptake and outlines best practice on planning, specifying and managing the provision of quality treatment services.

The Aid also includes vital information on regulation of fertility treatment and the role of the Human Fertilisation and Embryology Authority as well as advice from the Department of Health and information about the move to minimise the number of multiple births by restricting the number of embryos being transferred to one for those patients considered to be most at risk.

Key commissioning principles for infertility services identified in the Commissioning Aid include:

There is still a great deal of scope for “ improvement as PCTs realise the importance of fertility provision – a field where technology is continually developing

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full NICE guideline by identifying and sharing good practice in the provision of infertility services. This work was extended to include working towards standardising the access criteria being applied by PCTs. In June 2009 Infertility Network UK published a tool to help commissioners work towards standardisation of access criteria and is available via our website at www.infertilitynetworkuk.com In June 2008 the Department of Health established an Expert Group on Commissioning NHS Infertility Provision. In its interim report, among other important recommendations, the Expert Group recognised that expert commissioning skills and resources needed to be developed if fertility services were to be commissioned in an equitable way to meet patients’ needs. The Expert Group

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• In developing their policies, commissioners should have regard to World Class Commissioning • Commissioners should take account of the needs of differing communities

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Infertility Network UK… … is the UK’s leading infertility support network, and offers information and support to anyone affected by fertility problems. and groups with regard to the provision of infertility services and make appropriate material available to explain local policies • Commissioners must ensure that they take account of all relevant factors in reaching their judgements • Among the factors that commissioners should consider are: • What government ministers have said that they expect • What the NICE clinical guideline recommends • What the evidence shows is effective • What other calls for increased investment they face.

• Commissioners should engage actively with the public and those with infertility to discuss the policy options

• Commissioners should develop a service specification which describes the service to be commissioned Finally, the Aid makes recommendations on procurement including the fact that the current lack of a national tariff (which is now under development), the large market share of independent providers and the variability of prices and provider performance underline the importance of considering all potential providers before committing.

All in all, the Aid is essential reading for all those involved in commissioning fertility services, but perhaps most of all, the Commissioning Aid sends a clear message to PCTs that fertility treatments like IVF are an essential service for those who need it.

Infertility Network UK, in conjunction with The National Infertility Awareness Campaign (NIAC), has been campaigning for fair and equitable access to fertility services since 1994.

References DH survey of PCT provision of IVF www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_101073 Commissioning aid www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_101070

For more information please visit www.infertilitynetworkuk.com

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F ertility

preservation for young female cancer patients Dr Gillian Lockwood, medical director of Midland Fertility Services, considers the potential of ‘egg freezing’ to preserve the possibility of future genetic motherhood for young women diagnosed with cancer.

date (September 2009), MFS is the only clinic in the UK to have achieved live births using the mothers’ own frozen eggs, following the birth of four babies.

In December 2008 it also became the first clinic in the West Midlands to offer vitrification egg freezing, the ‘flashfreezing’ method which offers improved pregnancy rates by increasing the survival rates of oocytes after thawing from 65 per cent to 95 per cent.

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he progress made in recent years in life-saving therapies available to young cancer patients has rightly focused emphasis on fertility-sparing treatments, and if these are not available, on methods of fertility preservation. While sperm freezing for male cancer patients has been available, effective and funded by the NHS for many years, for young women, oocyte (egg) freezing before chemotherapy, radiotherapy or surgery currently remains the only available modality to give a chance of genetic motherhood in the future.

The NICE recommendation regarding fertility preservation for female cancer patients is: ‘Women preparing for medical treatment that is likely to make them infertile should be offered oocyte (egg) or embryo cryostorage, as appropriate, if they are well enough to undergo ovarian stimulation and egg collection, provided that this will not worsen their condition and that sufficient time is available.’

Midland Fertility Services (MFS) has already established a reputation as the UK’s national centre for fertility preservation for cancer patients and to

Reassurance of ownership Freezing eggs before chemotherapy or radiotherapy begins, offers a young woman the chance of future genetic motherhood while avoiding the ethical ownership issues which may result from creating embryos – where the man whose sperm was used to fertilise the oocytes shares the same rights as the woman over storage or use of the embryos.

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cancer patients and the unit’s dedicated NHS contracts manager, Linda Tanner, has secured funding from other PCTs (or equivalents) on an extra contractual rate (ECR) basis.

The ECR cost per cycle is around £3,350 and includes drugs, counselling, ovarian stimulation, monitoring, oocyte retrieval and freezing and storage for the first year. PCTs that contract MFS to deliver oocyte cryopreservation services benefit from a discounted costing structure, determined by the number of required treatment units.

Clinical and scientific expertise Ten years experience of egg freezing has led MFS to create a dedicated team for fertility preservation for young cancer patients. The team can be available at short notice, including weekends, to maximise access to the service and minimise delay to the start of cancer therapy. Working closely with the patient’s oncologist, an assessment for the viability of oocyte freezing may be made at a single consultation and the patient placed on a short protocol of follicle stimulating drugs. Egg collection is performed under conscious sedation local anaesthesia approximately two weeks after the start of stimulation.

Counselling is available at every stage of treatment and clinical follow-up is offered to address the patient’s concerns about her fertility.

In the laboratory, MFS has proven experience of the dehydration slow-freeze process and has now also vitrified eggs for 15 women, to improve the outcome of the future thawing process, but as with

Current research suggests that the chance of conceiving with IVF using vitrified frozen eggs is the same as with ‘fresh’ eggs

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Funding future hope Since MFS was granted a licence to cryopreserve oocytes in 2000, the unit has frozen eggs for 149 women, including 55 young women diagnosed with cancer, from all over the UK. Initially restricted to patients with haematological cancers such as lymphoma, egg freezing is now available for a wider range of malignancies including breast cancer.

Some of the PCTs with which MFS has contracts to deliver tertiary fertility care also fund the cost of egg freezing for

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CASE STUDY

Case study: Kate is 24 years old and currently studying for a post-graduate teaching qualification.

In June 2006 while studying in Europe, she noticed a pea-size lump under her skin near her collar bone. The following month, she saw a local GP and then a hospital consultant who conducted various tests, including a CT scan, which showed two areas of swelling in her chest and shoulder, indicating the possibility of Hodgkin’s Lymphoma (HL).

Within a week of returning to the UK Kate had seen a GP and consultant and had a biopsy, where three lymph nodes were removed from her shoulder. The surgeon confirmed stage two HL. Her surgeon advised that she would be treated with ABVD chemotherapy over about six months but data suggested a high recovery rate for young women following chemotherapy and radiotherapy. While this treatment can harm a woman’s fertility, there is some evidence that it can recover over some years, but that the patient will probably have a premature menopause. A friend suggested Kate ask her oncologist about egg freezing to increase her chance of being able to conceive in the future.

The consultant researched egg freezing treatment and contacted MFS. Kate’s cancer consultant agreed that her chemotherapy could begin the following month, allowing time for the course of fertility stimulating drugs required before egg retrieval. Two weeks later staff at MFS collected 28 eggs from Kate, which are now stored in liquid nitrogen. In the future, if the effect of the chemotherapy on Kate’s reproductive system has been permanently harmful and she is unable to conceive naturally, she will be able to try to conceive with her frozen eggs.

Two days after her egg collection, Kate began her chemotherapy. After 12 treatments over six months and following a PET/CT scan, Kate was told that treatment appeared to have been successful. A follow-up blood test in May 2007 revealed no active cancer cells and she continues to be in remission today.

conventional IVF, the age of the woman when the eggs are retrieved is the biggest determinant of a successful outcome.

Dedicated to service delivery Founded in 1987, MFS is the longest established independent provider of advanced fertility treatment in the Midlands, delivering fertility investigation, treatment and preservation services to NHS-funded patients via long-standing PCT contracts, and also to privatelyfunded patients.

MFS is licensed by the HFEA and is registered as an independent hospital by the Care Quality Commission.

Accreditation by BSI BS EN 9001:2008 and Investors in People recognises the organisation’s commitment to providing a quality service. Success rates can be viewed via www.midlandfertility.com.

For more information please contact Linda Tanner on 01922 455911 or via linda.tanner@midlandfertility.com Tel: 01922 455911 www.midlandfertility.com

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CATERING & NUTRITION

H ospitals

get the hot beverage treatment

T

Nestlé professional® comes up trumps…

he challenge for hospitals is how to introduce a new, dynamic hot beverage service that allows a site to take full advantage of the massive growth in coffee shop sales. A service that could be enjoyed by visitors, patients, staff and students across 24/7 needs.

Increasing sales from hot beverages provides hospital management with the opportunity to reinvest profits back into the hospital. However, it is vital that any new service remains professional and efficient to all users of the service.

‘We know that in the healthcare sector, delivering a great hot beverage service to meet a diverse range of needs is an absolute necessity,’ said Martin Lines, Marketing Director for Nestlé Professional®. ‘In that sense we have to consider every site on its own merit, that means auditing all potential locations, variations in traffic through-flow, health and safety policies, availability of staff support, which is all in addition to consumer and staff needs’.

Nestlé Professional® invests in its business partnerships, and provides innovative business solutions across its brand portfolio including NESCAFÉ® Coffee and AERO® Hot Chocolate which Mandy Cartmill, Catering Services Manager, Leighton Hospital knows only too well is a pull for her at the hospital; ‘There is no compromise when it comes to our customers. Serving a good quality trusted brand, such as NESCAFÉ®, which remains the UK’s number one favourite coffee, is enjoyed and appreciated by all our on-site consumers.’

addition to the range of systems on offer, providing an alternative hot beverage to tea and coffee as well as a reward for those looking for a treat.

Hot beverage systems can also prove profitable for hospitals in main restaurants and snacking areas that offer snacks and drinks to go. For larger capacity serveries, the hot beverage offering has to be fast, consistent and high quality.

Latté, cappuccino and espresso are now the norm – but hospital staff can’t spend minutes serving each customer so the delivery has to be quick and efficient (through self-service), and the end beverage has to taste and look good.

Nestlé Professional® has previously created stunning ® ‘Coffee Islands’ which play host to both NESCAFÉ® MILANO™ and AERO® Hot Chocolate machines.

Coffee Islands enable the easy through-flow of customers, and are supported by a creative range of POS and visual graphics.

Most importantly, they can comfortably accommodate the pressure peaks across the hospital day.

In addition, a professional vending service can provide a 24/7 service where needed – such as in A&E departments and nursing.

is no compromise when it comes to “ There our customers. Serving a good quality

trusted brand, such as NESCAFÉ , which remains the UK’s number one favourite coffee, is enjoyed and appreciated by all our on-site consumers Mandy Cartmill, Catering Services Manager, Leighton Hospital

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”

All change…

Introducing a Coffee Bar into a hospital’s main reception area can provide great visual appeal giving a warm welcome to staff and visitors, some of whom are inevitably visiting under difficult circumstances. Compact and attractive table-top systems such as NESCAFÉ® MILANO™ prove popular with its consistent delivery in offering café style coffees at the touch of a button.

AERO® Hot Chocolate is also an appealing

Increased volume – increased profits Significant up-sell can be achieved in terms of volume and profit per cup.

Hospital caterers can market our coffees to compete with high street chains. The profit potential is huge and means that

CATERING & NUTRITION

Nestle

Professional®

hospitals can reinvest the profits back into the catering department or elsewhere in the hospital.

Nestlé Professional® continues to focus on building strong working relationships with its customers. Martin Lines concludes: ‘Through effective partnership and strong collaboration, we work to put the right solutions in play across hot beverages. It’s about creating shared value with our customers.’

… is a major supplier of beverage solutions to the hospitality industry.

Its success is based on working with customers to find the right beverage solutions that suit their needs.

The company has a range of systems from soluble tin and spoon, single serve drinks through to a onetouch table top system and vending machine. This, combined with a unique portfolio of products, allows the flexibility to provide the very best package for customers.

The NESCAFÉ® MILANOTM soluble hot beverage machine (top left) was cited as a compact one-touch table top system.

It delivers an assortment of eight drinks including a full menu of coffees, hot chocolate and water for tea. The system is easy to operate, convenient and offers a fast dispense mechanism.

The AERO® Hot Chocolate machine (right) is a compact touch button system with an electronic self-clean facility. AERO® differs from the hot chocolate available from the NESCAFÉ® MILANOTM machine; producing a thicker, creamier and bubblier hot chocolate drink. It has great appeal for a younger audience – students and kids alike.

For more information please contact NESCAFÉ beverage solutions team on Tel: 0800 742 842 www.nescafé-beveragesolutions. co.uk

HEALTH SERVICE PROCUREMENT REVIEW I 97

CATERING & NUTRITION

I ncreasing

your revenue stream through hospital catering

We are all used to operating within tight budgets, and ever increasing demands from our customers, whether they be patients (in or out-patient), staff or visitors. These pressures are bound to increase further over the next few years with the promise of less money coming in from central government. Kevan Wallace, National Chairman of the Hospital Caterers Association, explains.

O

ne way to protect available catering budget is to look for ways in which to increase our income from various customer groups.

There are several opportunities that can generate income for the catering department within the hospital environment:

Burns Supper, Valentines Day or a sporting event (the 2012 Olympics present many opportunities for the creative catering manager!). A mid-week carvery is always a favourite, along with a salad bar for the healthy eater as well as the traditional call order bar for the grab and go customer, with omelettes, burgers, and other fast food products.

The supper menu can also be based around the patient supper menu with less choices and this really depends on the type of clientele using the restaurant.

discerning and will expect the same standards as they find in their favourite high street eateries. They have choices.

Menus can vary from one part of the country to another to take advantage of regional preferences and the best place to start is to take a look at the patient menu which can form the basis of your restaurant menu. This also means that staff and visitors have the same type of food as the patients and means that relatives can see how good the hospital food actually is. This also helps to reduce food waste and double ordering. Menu prices should not be excessive, neither should they be unrealistically low as to make a loss, but should be good value for money.

Visitor café/coffee shop The visitor café/coffee shop should offer pastries, cakes and sandwiches and have the potential to sell hot grab and go products, for example hot pies, jacket potatoes with various hot and cold fillings, toasties and paninis.

The ability to offer fresh coffee, herbal teas and cold drinks all add to the choice available.

Using a ‘bean to cup’ machine means you are offering more than a cup of coffee and you can explore the different types of coffee that you will find on the high street, thus creating an opportunity to promote coffees that command a premium pricing. Compete with Costa Coffee why don’t you!

The aptitude to provide business “services to a proficient standard is

• • • • •

becoming an ever increasing requirement within the Healthcare sector

Staff and Visitor restaurant Visitor café/coffee shop Fresh Baguette and Sandwich bar Vending Machines Patient lounge

If you are serious about generating revenue from your retail outlets, then it must be on a business basis with realistic budgets for staff, training, salaries, set-up costs, supplies of food and equipment, and not least, marketing.

Staff and visitor restaurant The staff and visitor restaurant needs to be light and airy with a modern look and be easily accessible to all. It should not have dated décor or a look like a seventies canteen. Customers are very 98

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”

Opening times will depend on the type of service you want to provide and availability of staff required to run this service. A comprehensive service in the morning with the offer of a full cooked breakfast, always popular, and available throughout the morning, along with filled rolls and toasted sandwiches with only a short break before lunch service.

The lunch service incorporating the patient menu with additional choices of meals would attract customers from across your hospital. Other ways to attract additional custom is to introduce theme days – for example Chinese New Year,

Fresh baguette and sandwich bar The fresh baguette and sandwich bar – a favourite on any high street – can easily be introduced into a compact area of the visitor coffee shop. Freshly made baguettes and sandwiches, with your own choice of fresh fillings is always going to encourage customers in, and offering cold drinks and other snack items (crisps and

CATERING & NUTRITION

chocolate) is a good way of increasing spend per head. Compare local pricing for similar items to make sure you are competitive.

Vending machines Vending machines are also a good source of revenue as long as they are sited in a heavy footfall area such as A&E, where visitors are waiting for relatives, or in front entrance areas were you may have passing trade and impulse buying. Placing vending machines in out of the way places will not help your income stream and if you are paying rental on them will not even cover your costs.

The choice of self-operated or fully serviced vending machines will depend on how much revenue and control you want over the machines. The self-operated machine gives you the flexibility to sell products you want and at the price level to maximise your revenue.

Patient lounge One area not yet covered is the patient lounge/restaurant – similar to the staff restaurant but for patients only.

It’s an area that could potential offer an income stream from relatives and visitors and from mobile patients.

An area, where if they wish, they can have a meal with friends and relatives who, of course, pay for this themselves, or the opportunity to have an alternative

or more expensive meal. This offers many benefits – giving the patient more choice, offering them social eating – which can only benefit the patient. And if they trade up, means extra income for you.

Marketing your various outlets Marketing isn’t all about promoting your product. You first need to establish demand. Why set up a variety of catering outlets when there are no customers for them? This could be because you simply don’t have the numbers through your hospital or because their needs are already satisfied through local businesses. Once you are happy that there is a demand, you need to be sure of your product – make sure it is what your target customers will want. Check your pricing against comparable suppliers and ensure you can offer a product of high enough standard to impress and generate repeat purchase.

Once all this is satisfied and your outlet(s) is opening, enthusiastically target your market. Advertising doesn’t need to cost you very much – you’re not going to be advertising on the TV after all. Produce relevant in-house posters and distribute them around the buildings, concentrating on thoroughfares. Place an advert in the staff newsletter or the hospital intranet and don’t forget to use your hospital website. Encourage people to tell their friends about how good your food is – word of mouth is the best form of free

marketing. And use your imagination – think about new marketing media – Facebook, Twitter and anything else that springs to mind.

The aptitude to provide business services to a proficient standard is becoming an ever increasing requirement within the Healthcare sector. Customers these days are very discerning and will expect the same standards as they find in their favourite high street eateries. They have choices.

In April 2008 the Hospital Caterers Association published a ‘Good Practice Guide to Retail and Commercial Services Standards – an operational guide to services’. The guide sets out some simple steps and leads you through a process to help improve retail services to staff and visitor areas. It’s a valuable tool kit to ensure that you look at all aspects of a commercial enterprise from a healthcare perspective.

This article is based around opportunities for an in-house catering team and not where there is contractor arrangement. The contractor may have access to high street branding which will help them to set up facilities within a hospital setting.

For more information, and to order a copy of the Good Practice Guide, please visit www.hospitalcaterers.org

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CATERING & NUTRITION

A ll

the comforts of home

In January 2008, Cadbury announced the establishment of the Cadbury Cocoa Partnership (CCP). It is a historic initiative in which Cadbury is investing £45 million over the next ten years to secure the sustainable socio-economic future of cocoa farming in Ghana, India, Indonesia and the Caribbean.

K

ate Harding, Trade Communications Manager at Cadbury, comments: ‘We invested £1 million in 2008 as a seed fund to establish the Cadbury Cocoa Partnership, with annual funding levels rising to a steady rate of £5 million from 2010. The total investment will be around £45 million over 10 years. By 2018, the Cadbury Cocoa Partnership will have helped communities take the lead in identifying long-term goals and find solutions towards achieving these goals.’

In 2009 Cadbury Cocoa Partnership is extending its activities to focus on improving farm income levels by developing farmer education programmes that explore best cocoa management practices leading to high quality and increased yields.

As well as seeking to make an immediate impact on farmers’ lives, the Cadbury Cocoa Partnership is exploring carbon reduction techniques to secure more sustainable cocoa farming.

By 2018, Cadbury estimates it will have made a difference to the lives of around half a million Ghanaian farmers.

Cadbury commits to going Fairtrade Cadbury announced plans in March 2009 that they will be working alongside the Fairtrade Foundation to achieve Fairtrade certification for Cadbury Dairy Milk and Cadbury Hot Chocolate by the end of summer 2009. This groundbreaking move will result in the tripling of sales of cocoa under Fairtrade terms for cocoa farmers in Ghana, both increasing Fairtrade cocoa sales for existing certified farming groups, as well as opening up new opportunities for thousands more farmers to benefit from the Fairtrade system.

Purple Goes Green Cadbury is committed to reconciling long-term business growth with the social and environmental pressures of only having one planet. As part of this commitment, Cadbury launched the Purple Goes Green programme in June 2007, which sets aggressive environmental targets for 2020.

Kate Harding, Trade Communications Manager at Cadbury, comments: ‘In 2007 we revolutionised our approach to the environment in response to the challenge of climate change. We created a new, industry leading environmental programme called Purple Goes Green in conjunction with experts such as Forum for the Future and the Carbon Trust.’

Purple Goes Green targets are: 50 per cent reduction in our absolute carbon emissions, 10 per cent reduction in standard product packaging and 25 per cent for seasonal and gift ranges, and 100 per cent of ‘water scarce’ sites will have water reduction programmes in place.

We campaign for change with colleagues, suppliers, customers, peers, civil society and consumers.

Cadbury also supports the “ Hospital Caterers Association annual

conference, which gives NHS catering managers an opportunity to sample Cadbury products

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The Cadbury and Fairtrade partnership will result in the amount of Fairtrade Cocoa coming out of Ghana to increase threefold. 40,000 existing Fairtrade farmers will receive an increase in the benefits they currently receive from Fairtrade and a further 10,000 new farmers will benefit from 2010.

On 22nd July 2009, Cadbury Dairy Milk launched its new Fairtrade-certified chocolate bars, becoming the first mass market chocolate to gain certification from the Fairtrade Foundation. The independent FAIRTRADE Mark appears on the new packaging for the brand, and will bring the logo into millions more homes in the UK for the first time.

Hot chocolate market overview Although within the Out of Home channel the Hot Beverage category has declined in volume terms by 1.3 per cent, with coffee and tea recording -1 per cent and -3 per cent respectively, hot chocolate was the only category to maintain its growth at +1.3 per cent. Cadbury is the number one manufacturer in the hot chocolate category in the food service market, with a 63 per cent market share.

CATERING & NUTRITION

Cadbury Highlights hot chocolate For 2009, Cadbury has revamped Cadbury Highlights, the low calorie drinking chocolate with only 40 calories per serve, with a new recipe and packaging design.

The new Highlights recipe has an even more chocolatey taste, as consumer insight into low calorie hot beverages has shown that consumers are treating low calorie hot beverages as a chocolate substitute. The packaging is predominantly brown to reflect this, and with a colourful, feminine design, the new packs stand out on the shelf and are designed to be more appealing to the brand’s female target audience. The re-launched range also sees Café Latte and Fudge variants renamed to Chocolate Mocha and Chocolate Fudge.

Kate Harding, Trade Communications Manager at Cadbury, comments: ‘With the re-launch of Cadbury Highlights there is an opportunity to drive growth by increasing permissibility of hot chocolate as a treat, with its extra chocolatey taste, eye-catching new packaging and only 40 calories per serve.’

Cadbury hot chocolate in hospitals Cadbury is partnered with Café Bar and has fully Branded Hot Chocolate Dispense machines available via Café Bar. Cadbury also supports the Hospital Caterers Association annual conference, which gives NHS catering managers an opportunity to sample Cadbury products and ask questions about specifications and product fit within their environment.

Cadbury’s hot chocolate range includes Cadbury Instant Hot Chocolate, Cadbury Drinking Hot Chocolate and

Cadbury Cocoa and Cadbury Highlights.

The core range for hospitals is split into Patient and Staff/Visitors.

Hot chocolate for patients is about making them feel at home. Cadbury Drinking Chocolate add milk and Cocoa add milk are a great way of helping patients to drink milk yet at the same time giving them that comfort feeling.

Key Cadbury products for patients are: Fairtrade Cocoa 250g (add milk), Fairtrade Drinking Chocolate 500g (add hot milk), Fairtrade Drinking Chocolate 2kg tub (add hot milk) Hot chocolate for staff and visitors is about offering them a pick me up, something to tide them over or a treat.

The recommended products if manually prepared are Highlights Sachets (Only 40 calories per serving), Instant Chocolate Sachets (add hot water),

Instant Chocolate 2kg tub (add hot water). If a dispense machine is used, recommended products are Instant Chocolate Dispense 1kg and Highlights Dispense 500g.

For more information, please contact Tel: 0800 6526592 Email: colin.philip@cadbury.com For more information on the Cadbury Cocoa Partnership, please visit: www.cadbury.com/ourresponsibilities/ cadburycocoapartnership/Pages/ cadburycocoapartnership.aspx

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D ysphagia , nutrition and patient safety Caroline Lecko, Nutrition Lead at the National Patient Safety Agency (NPSA), discusses the risks associated with dysphagia and the work being done to ensure that patients with the condition receive appropriate care and nutrition.

D

ysphagia can be described in many ways, however, the most frequently used definition is: ‘the difficulty in moving food from the mouth to stomach’ (Logemann 1998) – put simply dysphagia is difficulty in swallowing.

Dysphagia can occur in all age groups due to a wide range of congenital and acquired disorders and is often a secondary symptom of a larger disease process. Some of the most common neurological diseases associated with dysphagia include traumatic brain injury, cerebral vascular accident, Parkinson’s disease, dementia and cerebral tumours.

Dysphagia is also observed in disease states such as head and neck cancer, oral-pharyneal structural abnormalities or trauma to the swallowing structures and the nerves that control them.

The risks associated with dysphagia include malnutrition, dehydration, choking and aspiration pneumonia (Logemann 1998, Cichero 2006).

The number of people affected by dysphagia is not clearly understood within the United Kingdom. In 1999 it was estimated that 22 per cent of the world’s population over the age of 50

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years were affected by oropharyneal dysphagia, difficulty with swallowing in the mouth and throat or pharynx, with approximately 20-30 per cent of patients within acute care hospitals and 59-60 per cent of residents in long term care having dysphagia (Cook IJ, Kahrilas PJ 1999). In May 2006 the Department of Veterans Affairs issued a Directive relating to the management of patients with dysphagia or feeding disorders in which it was identified that ‘more than 60,000 people die annually from complications related to dysphagia, making it the sixth leading cause of death in the United States’.

The National Reporting and Learning Service (NRLS), a division of the National Patient Safety Agency is undertaking a programme of work to improve the safety of patients with dysphagia following analysis of the Reporting and Learning System which identified themes relating to the management of dysphagia having the potential to cause harm to patients.

Areas of key concern were related to patients receiving inappropriate diets, the inconsistent language used to describe different types of texture modified foods and fluids and the management of choking episodes.

Progress to date Nutrition and Hydration Alert Signs Analysis of the Reporting and Learning System data identified that patients were often receiving inappropriate diets and that there, at times, appeared to be inadequate communication between clinical and catering teams.

‘I was reviewing the patient charts outside her side room when the

housekeeping staff came round with the beverage trolley and offered the patient a cup of tea. I asked the housekeeper if they were aware the patient required thickened fluids. They knew nothing about this, so I asked if they knew how to thicken the drink and they said no. I therefore advised them not to give the patient the drink as it was, unthickened.

The reason being that the patient has been advised by the Speech and Language Therapist to only have syrup thickened fluids as otherwise may be at risk of aspiration pneumonia.’

The NRLS have been working with stakeholders from professional organisations and industry to develop Nutrition and Hydration Alert signs which relate to range of nutrition patient safety risks such as allergies and nil by mouth. The Nutrition and Hydration Alert Signs also have signs that correspond to the National Descriptors of Texture Modification in Adults.

To date the NRLS have undergone an initial pilot phase to test the understanding of the signs with frontline staff with one NHS Trust. Evaluation of this pilot phase has demonstrated that the Nutrition and Hydration Alert Signs were easy to interpret and understand and that there was improved communication between the healthcare team. Of interest the NHS Trust identified that by introducing the Nutrition and Hydration Alert Signs highlighted a knowledge gap in relation to texture modification of diets and fluids.

It is envisaged that the there will be a second phase of the pilot to evaluate more formally the impact of

CATERING & NUTRITION

the introduction of the Nutrition and Hydration Alert Signs in clinical areas.

In addition to the Nutrition and Hydration Alert Signs being available in clinical areas the NRLS is working with the NHS Supply Chain and industry to evaluate the feasibility of the texture modification related signs being reproduced on a range of packaging.

Dysphagia Expert Reference Group The NRLS has also established a Dysphagia Expert Reference Group with representation from the Royal College of Speech and Language Therapists, British Dietetic Association, Hospital Caterers Association and the National Nutrition Nurses Group. A key aim of this group is to gain consensus on the National Descriptors for Texture Modification for Adults to promote a common language related to texture modification: ‘Pt previously assessed by SALT as requiring a Soft Grey Diet / meal arrived

with boiled pots, whole peas & sweetcorn, should have been mashed pot, mushy peas & no sweetcorn.’

‘Pt unwell due to fact he was given normal food instead of pureed diet.’

programme will provide the learner with a basic level of understanding of dysphagia and has been developed with advice from the Dysphagia Expert Reference Group.

The module will be free to all NHS staff.

It is hoped that the clarity of the language used to describe texture modification will assist both in-house catering departments and industry to provide consistently safe products.

The Dysphagia Expert Reference Group have also been involved in a tasting session for the NHS Supply Chain contract for ready prepared dysphagia meals and will be working with the NHS Supply Chain and the manufactures of dysphagia products to ensure that the focus of production is to ensure meals are safe.

Future plans To establish the evidence base in relation to the number of people affected by dysphagia and to the benefits of texture modification in relation to outcomes and the cost to the NHS. The NRLS will be undertaking a review of the literature to establish the evidence base in relation to the number of people affected by dysphagia and the implications of dysphagia on the NHS. It is envisaged that the literature review will be completed during 2009 and 2010 with a report being published in 2010.

The NRLS will be commissioning the production of a video which will be placed on the NRLS website. The aim of the video will be to give frontline practical guidance on the management of choking situations.

Dysphagia e-learning module The NRLS has part funded a dysphagia e-learning module which will form part of the NHS Core Learning Nutrition and Hydration e-learning programme. The

References Logemann J A (1998) Evaluation and Treatment of Swallowing Disorders 2nd Edition Austin Texas.

Cichero J (2006) Respiration and swallowing. In: Cichero J, Murdoch B Dysphagia: Foundation, Theory and Practice Chichester UK John Wiley and Sons (2006); 92 – 111 Cook I J, Kahrilas P J A (1999) A technical review on management of oropharyngeal dysphagia.

Gastroenterology; 116 ; 455 -478 As citied infelt P (2006) Nutritional Management of Dyphagia in Healthcare Settings: Recognition and Action are Everyone’s Responsibility Healthcare Caterer ; Spring 2006 : 11 – 14 Department of Veterans Affairs (2006) VHA Directive 2006 – 032 Management of patients with swallowing (dysphagia) or feeding disorders. Veterans Health Administration Washington, DC 20420

For more information on the NRLS dysphagia programme of work please contact Caroline Lecko, Nutrition Lead via email at caroline.lecko@npsa.nhs.uk

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NUTRITION

Cod with carrots and mashed potato served with a watercress sauce

F indus C are C uisine : bringing back the joy of food Eating difficulties such as an inability to chew or abnormal swallowing (dysphagia) can drastically affect the quality of life for many patient groups. They are common in the elderly but often also appear as a side effect of other diseases and conditions – such as stroke, neck & throat cancers, head trauma and other neurological conditions.

G

iven that food is a key source of daily enjoyment for most people, caterers can face difficulties in finding meal solutions for these patients.

While the problem can be looked at from a pharmaceutical or specialist healthcare perspective, the major European food group, Findus, has taken a culinary approach which builds on the fundamental need for nutritious, great tasting food first – then adapts this to meet the needs of those with different types of eating difficulties.

In order to better understand the needs of patients, in 2008 Findus collaborated with the BDA’s Nutrition Advisory Group for Elderly People (NAGE) and freelance dietician, Dr Carrie Ruxton, to survey dieticians’ views about texture modified meals (TMM).

Thirty five NAGE members responded to the online survey. Twelve different characteristics of commercially sourced TMM were presented to the respondents.

Those rated as the top five most important were:

their list of priorities for target patient groups. This research gave Findus valuable insight when developing its new Care Cuisine range for people with dysphagia.

It emphasised the need for meal solutions which answered not just the fundamental need for successful feeding, but which combined good nutrition with an eating experience which is more like a ‘normal’ meal for the patient.

“

the chance to participate in their own meal and menu choices, bringing back some of the interest and excitement which may have been lost with the onset of eating difficulties.

Company nutritionist for Findus, Matthew James, says: ‘Research shows that 30-50 per cent of elderly people will at some time experience swallowing problems – 10 per cent of whom will receive modified meals. Add the factors of an increasingly elderly population and the greater emphasis on public sector food quality and it’s clear that the pressure on caterers in the caring professions will continue to increase.

Findus Care Cuisine is a solution which recognises that residents and patients need to be treated with dignity, compassion and personal service and that special diets should look good, taste good and be as much like everyone else’s food as possible. Our range has been developed with all these factors in mind – it is a simple route for NHS catering managers and offers risk free quality, choice and consistency.’

Findus has taken a culinary approach which builds on the fundamental need for nutritious, great tasting food first then adapts this to meet the needs of those with different types of eating difficulties

• Palatability • Manufactured to a high standard of microbiological safety • Attractive appearance • A range of consistencies in line with the British Dietetic Association’s National Descriptors • Quality of ingredients.

It was notable that respondents did not give a high rating to TMM that was low in fat, sugar or salt – suggesting that healthy eating targets were not high on 104 I HEALTH SERVICE PROCUREMENT REVIEW

”

The Findus Care Cuisine range is therefore designed with an emphasis both on balanced nutrition and enjoyment.

It offers frozen meal solutions in a variety of textures which meet the UK National Texture Descriptors and is a convenient, flexible and cost effective way to feed patients with dysphagia.

The range is constructed around a delicious selection of purées and individually moulded portions across all the major food groups: proteins such as cod, salmon & chicken; vegetables including peas, sweet corn and broccoli; carbohydrates, and fruit including pineapple, blackcurrant and raspberry.

There’s also a new selection of plated meals for whole meal solutions.

Using Findus Care Cuisine, healthcare managers and dieticians can offer patients

To find out more about Findus Care Cuisine contact Dylan Lloyd Jones Tel: 07818 573010 Email: dylan.lloydjones@ finduscarecuisine.co.uk www.finduscarecuisine.co.uk

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MediastorM C O M M U N I C AT I O N S