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ISSUE 20.2 www.healthbusinessuk.net

INFECTION CONTROL

HEALTHCARE IT

MENTAL HEALTH

MODULAR BUILDINGS

HELPING THE NHS INCREASE CAPACITY The approach to coping with coronavirus has seen modern methods of construction used to help increase capacity

Transparency and honesty needed to eradicate NHS backlog The BMA has said that the government must urgently outline a credible plan for addressing the huge backlog of patients awaiting NHS treatment in the wake of the coronavirus pandemic.

PLUS: ERGONOMICS | SUSTAINABLE COMMUNITIES | TECHNOLOGY

As we go to press, the doctors’ union has urged the government to be honest about the scale of the task ahead, and to bring together health leaders and staff groups to ensure frontline clinicians are leading discussions on how to prioritise the sickest patients left without treatment due to the redeployment of staff and resources to deal with the coronavirus crisis. A survey of more than 8,000 doctors found that 52 per cent said they were either not very confident or not confident at all in their own department being able to manage patient demand as NHS services are resumed. These numbers are not promising. Of equal concern, more than a quarter of doctors said there had been no engagement with them over how to manage the increase in demand in their place of work.

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The BMA believes that the priorities for the government in addressing the NHS backlog must concentrate on four areas: transparency; capacity; workforce; and learning. A lack of transparency has made this situation worse than it ever should have been, so let’s hope that the government can be honest about needing to correct that first. Over the next few months, the rest will follow. Michael Lyons, editor

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www.healthbusinessuk.net PUBLISHED BY PUBLIC SECTOR INFORMATION LIMITED

226 High Rd, Loughton, Essex IG10 1ET. Tel: 020 8532 0055 Web: www.psi-media.co.uk EDITOR Michael Lyons PRODUCTION MANAGER Dan Kanolik PRODUCTION DESIGN Joanna Golding PRODUCTION CONTROL Lucy Maynard WEBSITE PRODUCTION Victoria Casey ADVERTISEMENT SALES Tara Oakley SALES SUPERVISOR Damian Emmins PUBLISHER Karen Hopps ADMINISTRATION Shelley O’Neill REPRODUCTION & PRINT Argent Media

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Health Business is a member of the Independent Press Standards Organisation (which regulates the UK’s magazine and newspaper industry). We abide by the Editors’ Code of Practice and are committed to upholding the highest standards of journalism. If you think that we have not met those standards and want to make a complaint please contact Michael Lyons or Angela Pisanu on 0208 532 0055. If we are unable to resolve your complaint, or if you would like more information about IPSO or the Editors’ Code, contact IPSO on 0300 123 2220 or visit www.ipso.co.uk

Issue 20.2 | HEALTH BUSINESS MAGAZINE

Contents

Contents Health Business 20.2 07 News

45 Telecommunications

NHS debt ‘write-off’ could cost hospitals millions; Prostate cancer most commonly diagnosed cancer in the UK; Huge backlog in operations resulting from lack of PPE

15 Infection control 25 29

Veronica Johnson-Roffey and Kate Prevc outline the benefits of healthcare facilities management companies employing their own infection control nurse to ensure their staff working in hospitals are trained in infection control

19 Infection control With much in the news covering the social impact of the coronavirus outbreak, Dr. Stephanie Taylor discusses the need to ensure public buildings, such as schools and hospitals, have a humidity level so that viruses cannot spread

25 Mental health When this is all over, will it be said that ‘it took a pandemic to put mental health where it should be – at the front and centre of daily considerations about working lives?’ Adrian Wakeling, Senior Policy Advisor at Acas, discusses

29 Healthcare IT A key focus of the Long Term Plan is empowering people to take control of their own health care - creating a safe and secure means of accessing their health information is critical to that, says Melissa Ruscoe, head of the NHS login programme at NHS Digital

32 Technology

READ MORE tinyurl.com/y8ak6wxk

DATA

NHS will keep data of those with coronavirus for two decades

A privacy notice posted by Public Health England has shown that the NHS will keep personal data about people with coronavirus for 20 years as part of the test-and-trace programme. This means that information, including full name and date of birth, as well as phone numbers and home and email addresses, will be collected and stored for people with coronavirus, or symptoms of coronavirus, alongside data about those symptoms.

Furthermore, those who have been identified as contacts of people with coronavirus will have all but their date of birth collected and stored for five years. However, individuals will be able to ‘request’ that their information be deleted, but PHE warns that ‘this is not an absolute right’. READ MORE tinyurl.com/yc8d7yad

Millions of patients have been getting expert support from family doctors from the comfort of their own homes while the NHS responds to coronavirus. Remote consultations are just one way in which GP practices have changed the way they work to ensure people can get expert care and advice in a safe way throughout the coronavirus pandemic. Health leaders had already signalled the intention to move towards digital first primary care in the NHS Long Term Plan. Progress towards this has accelerated during the pandemic, with 99 per cent of GP practices now activating remote consultation platforms, and NHS bosses are now examining how this progress can be locked in. Now, with GPs and their teams standing ready to assist, one of the country’s top GPs has urged people to continue to come forward for care when they need it, as part of the NHS’ ongoing Help Us Help You campaign. READ MORE tinyurl.com/y85mh65y

VOLUNTEERING

Volunteer Responders reach 250,000 milestone The Duchess of Cornwall has thanked volunteers across the country for the many acts of kindness they provide, as figures show that NHS Volunteer Responders have reached the 250,000 milestone. A quarter of a million tasks have now been carried out by the NHS Volunteer Responders recruited by Royal Voluntary Service to support the NHS and to help the most vulnerable to coronavirus. To aid people isolating during the pandemic, the volunteers have been providing grocery and prescription deliveries, lifts to medical appointments and ‘check in and chat’ calls. READ MORE tinyurl.com/ycfmngjl

Issue 20.2 | HEALTH BUSINESS MAGAZINE

Don’t let false fire alarms disrupt your routine False fire alarms have risen by 20% in three years at NHS Trusts across England*

Thousands of staff hours are lost every year due to false fire alarms, affecting service delivery, business continuity and patient care. Eliminate malicious or accidental activation of manual call points with

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News

SURGERY

Huge backlog in operations resulting from lack of PPE NHS Providers chief executive, Chris Hopson, has said that a lack of vital protective equipment and long waits for coronavirus test results are stopping hospitals from tackling a huge backlog in operations. Speaking to the Guardian, Hopson discussed the cases of patients whose surgery has been postponed because of the pandemic having to face even longer delays

because hospitals are having to wait for as long as 13 days for the outcome of tests. He blamed ministers for repeated failures to ensure easy availability of fastturnaround testing for NHS staff, while trusts have warned about the lack of adequate supplies of surgical gowns since the pandemic began. He also warned that ’the gap between the tone and content of

YORKSHIRE

SEACOLE CENTRE

Clinical imaging services at Nightingale Hospital Yorkshire

First Seacole Centre opens doors as rehab centre

The NHS Nightingale Hospital Yorkshire and the Humber will begin offering clinical CT scans to some patients from across the region from 4 June. NHS Nightingale Hospital Yorkshire and the Humber was set up as part of the region’s coronavirus response. On stand-by since its launch, the hospital is equipped with clinical imaging equipment, which means it can also support the region in its recovery phase. The Leeds Teaching Hospitals NHS Trust and Harrogate and District NHS Foundation Trust will be the first trusts to use the facility and will provide appointments seven days a week. From 4 June 2020, the hospital will provide outpatient appointments for patients with radiology referrals. The temporary hospital is fully equipped and able to provide the service for patients who are well and mobile. The service will provide a combination of diagnostic scans and surveillance scans, which are used to monitor patients with a prior diagnosis of a medical condition. As yet, the NHS Nightingale Hospital has not been needed to care for patients with coronavirus and this will be the first time the hospital has been used to provide patient care. READ MORE tinyurl.com/y7q228qp

The NHS Seacole Centre at Headley Court, Surrey, named in honour of the pioneering nurse Mary Seacole, has received its first patients. The opening means that thousands of people are set to benefit from enhanced community services to help them recover from the long term effects of coronavirus. This week, the NHS Seacole Centre will provide specialist rehabilitation care for patients who are recovering from coronavirus in the Surrey region. NHS England has hailed the efforts of all those involved in getting the

the government’s statements on testing and the difficult reality on the ground is painfully wide and needs to be closed quickly’. Approximately 4.2 million people in England are waiting to have a non-urgent procedure. READ MORE tinyurl.com/yb4ol9sv

new service up and running, and unveiled plans for similar services in other parts of the country. Formerly a disused military hospital, the facility was transformed into The NHS Seacole Centre in just 35 days, thanks to the work of teams across Surrey Heartlands, including Surrey County Council, the military and the NHS – including host trust Epsom and St Helier University Hospitals. READ MORE tinyurl.com/y9sslqtj

BEREAVEMENT

Bereavement scheme to NHS support staff extended The bereavement scheme has been extended to the families and dependants of NHS support staff and social care workers who die as a result of contracting coronavirus. Home Secretary Priti Patel said that the Home Office is extending the offer of indefinite leave to remain, free of charge, to the families and dependants of NHS support staff and social care workers who die as result of contracting coronavirus,

effective immediately and retrospectively. Initially launched in April for health workers in the NHS and independent health and care sector, following mass criticism, the bereavement scheme will now extend to NHS support staff and social care workers. READ MORE tinyurl.com/yaj44fft

MENTAL HEALTH

Key contribution made by NHS mental health trusts praised A report by NHS Providers has highlighted the key contribution made by NHS mental health trusts in confronting the coronavirus pandemic. The report, Spotlight on… the impact of Covid-19 on mental health trusts in the NHS, emphasises the critical role NHS mental health trusts have played in maintaining and adapting mental health services while supporting colleagues in the acute hospital, community, ambulance and primary care sectors. This includes adapting their wards to look after those recovering from the virus, establishing mental health A&Es

and 24/7 emergency service access lines, as well as developing home treatment models and clinical services online. NHS Providers also highlights the changes in demand for mental health services during the pandemic, including increased numbers of people needing urgent and emergency care. It points to concerns that many who need help and support are not accessing services until they reach a crisis point, and warns of pent up demand that has built up during the lockdown. The report says the government and national policy makers must take account

of the pressures mental health services will face in the weeks and months ahead. In particular it points to the need for: PPE and testing; support to prioritise and plan services effectively; full and prompt funding for frontline services that need to expand to meet the extra need created by the pandemic; and a new workable strategic national plan for the workforce, given that the pandemic has exacerbated existing severe shortages. READ MORE tinyurl.com/ycb7yomj Issue 20.2 | HEALTH BUSINESS MAGAZINE

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against a wide range of microorganisms unmatched by standard cleaning practices and other disinfection technologies. It is uniform across the entire target area and not limited to line-of-sight or easy-to-reach spaces. The process is residue-free, proven safe on sensitive electronics and shown to kill a broad spectrum of microorganisms including bacteria, viruses, fungi, spores and more. Bioquell RBDS can be quickly called upon to eradicate coronavirus¹ and other bioburden from a single area, several locations within a facility or an entire building. The service is fully operated by Bioquell’s expert team of bio-decontamination specialists allowing on-site staff to focus on the other activities need to restore operation. In some cases, decontamination can be completed in as little as 24 hours enabling a rapid return to production. It offers the flexibility to retain or recover the microbial integrity of critical areas with every deployment including planning, coordination, setup, equipment, and cycle validation and verification. It provides a complete final report confirming a 6-log kill of the spaces and surfaces that have been treated with the use of biological and chemical indicators. About Bioquell Bioquell, an Ecolab solution, is a well‑established global leader providing validated and compliant surface and airborne bio‑decontamination with 35% Hydrogen Peroxide Vapour for the pharmaceutical, life science and healthcare sectors. With its head office located in Andover in the UK, the company operates

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS | www.healthbusinessuk.net

worldwide through its own sales offices and international distributor network. Bioquell’s Hydrogen Peroxide Vapour decontamination technology is used globally to eradicate biological contaminants including problematic bacteria, viruses and fungi on every exposed surface in any suitable enclosure to ensure maximum uptime. It provides residue-free, safe and repeatable disinfection of rooms, buildings, equipment and sensitive electronics. About Ecolab A trusted partner at nearly three million commercial customer locations, Ecolab (ECL) is the global leader in water, hygiene and infection prevention solutions and services. With annual sales of $15 billion and 50,000 associates, Ecolab delivers comprehensive solutions, data-driven insights and personalized service to advance food safety, maintain clean environments, optimize water and energy use, and improve operational efficiencies and sustainability for customers in the energy, food, healthcare, hospitality and industrial markets in more than 170 countries around the world. www.ecolab.com Follow us on Twitter @ecolab, Facebook at facebook.com/ecolab, LinkedIn at Ecolab or Instagram at Ecolab Inc. L FURTHER INFORMATION www.bioquell.com/healthcare/ systems-and-services/ rapid-bio-decontamination-servicerbds/?lang=en-uk

Infection control

Purchaser and provider working together for infection prevention Veronica Johnson-Roffey and Kate Prevc outline the benefits of healthcare facilities management companies employing their own infection control nurse to ensure their staff working in hospitals are trained in infection control Many healthcare providers contract out elements or all of their soft facilities services and the providers are expected to help in fulfilling aspects of the Hygiene Code in relation to infection prevention and control. It is widely accepted that good facility management is hugely important in helping to prevent and control healthcare infections. Services contracted out are classed as hard and soft facilities. Registered healthcare organisations are required to comply with the Health and Social Care Act 2008 - Code of Practice on the prevention and control of infections and related guidance. The Act outlines 10 criteria which organisations must satisfy the CQC they are meeting to provide safe care. These include having systems to manage and monitor the prevention and control of infections, providing and maintaining a clean environment that facilitates prevention and control of infections, providing suitable information on infections, identifying people who have or are at risk of developing infections in order to treat and reduce risk of spread, systems to ensure that care workers including contractors are aware of and discharge their responsibilities in preventing and controlling infections, have and adhere to appropriate policies and managing occupational health needs of staff in relation to infections, This article discusses some facets of how University Hospitals Coventry and Warwickshire (UHCW) NHS Trust, one of the most modern healthcare facilities in Europe with 1,250 beds, and ISS Mediclean Limited, one of the largest facility services providers in healthcare, collaborated on a project to support the message that, infection prevention and

control (IPC) is everyone’s responsibility. ISS has been providing the soft services facilities to UHCW since it opened in 2006, and the project which involved ISS employing their own dedicated IPC nurse – the first of its kind in ISS nationally - was the idea of the on-site ISS General Manager in 2017 with full support from the UHCW Director of Nursing and their Lead IPC Nurse. What are soft services in facilities management? In healthcare these are the services that make the environment safe, secure, efficient and pleasant for patients, staff and visitors. These services include portering, cleaning, catering, security, waste management, car parking, post, switchboard, helpdesk, and linen and laundry services – all provided by ISS in the case of UHCW. Soft services differ from hard services which are related to the fabric of the building such as heating, plumbing, ventilation, lightning and building maintenance. The purpose of the role is: to ensure Infection Prevention and Control (IPC) was addressed in all aspects of healthcare cleaning and reflected throughout all activity related to the ISS healthcare cleaning provision (and other soft service elements); to ensure infection prevention is taken into account in assessing method statements, cleaning schedules and training activities; and to provide a professional and collaborative link between the soft service provider and the trust’s clinical and IPC teams. The core responsibilities include: being a core member of the trust’s Infection Prevention and Control Committee; developing, in partnership

with the Head of Cleaning and Trust IPC Manager, an annual audit and improvement program which was aligned to the ICNA Audit tool and reflects specific objectives of UHCW Infection Prevention and Control annual program; contributing to the development and implementation of policies, procedures and guidelines; working in partnership with the local Infection Control leads, Matrons and Ward Managers ensuring that the ISS service level inputs are appropriate for the hospital size, activity levels and complexity; ensuring programs of auditing are in place in relation to IPC; ensuring all staff completed mandatory infection prevention and control training and review that training to ensure it was most appropriate and effective; implementing and maintain a continuous hand hygiene surveillance and improvement programme for healthcare cleaning and other soft service elements; supporting Trust IPC team in undertaking Root Cause Analysis (RCA) in cases of infection to identify issues and causes with inclusion of healthcare cleaning staff, especially in relation to changes required in practice as a result of identifying the root cause; providing comment and advice on the purchase/introduction and use of equipment in relation to IPC issues; and promoting effective team working across clinical and soft services staff within the team. The ISS appointed person being a nurse was clinically accountable to the Trust IPC lead who was instrumental in drawing up the job description and recruiting, but was managed operationally and worked closely with the head of healthcare cleaning, although with regards to regular IPC issues was autonomous. E

Issue 20.2 | HEALTH BUSINESS MAGAZINE

Training If staff are informed they tend to be more compliant and more motivated if they feel their work is important. Training was already high on the agenda of ISS but training was an important part of this project. During the project all newly appointed staff including porters, cleaners, catering, ward hostess, retail, security and support teams had two hour face to face IPC training included in their induction. This was important in reiterating the ISS message to staff that whatever their job in the hospital they had a part to play in preventing infections regardless of whether they were patient facing or not. This was an important message because some staff had never worked in a hospital before and had little knowledge of IPC on any level. Training included the basics of standard precautions and practical session on hand hygiene and use of PPE. If the ISS nurse was not able to undertake a session a member from the Trust IPC team stood in, this was also a good way to reiterate that ISS are following the same policies as the Trust and for staff to get to know members of the Trust’s IPC team. One to one hand hygiene sessions were also undertaken with staff on the wards so they didn’t have to be away from their area. This was also a way to show Trust staff that ISS staff such as cleaners and ward hostesses working in their area, were getting hand hygiene training the same as the Trust

staff. Audits of hand hygiene practices by the Trust included any ISS staff in the area and any concerns or good practice were fed back to the ISS nurse to follow up on. The ISS healthcare cleaning manager and supervisors were also updated on their IPC and hand hygiene knowledge so they could be an up to date resource for cascade training in their areas. Audits In line with the national specifications for cleanliness in the NHS: a framework for setting and measuring performance outcomes (NHS 2007) the healthcare environments should pose minimal risks to patients, staff and visitors. Regular auditing of the healthcare environment helps to ensure that high standards are maintained and give an early warning if standards are failing or where best practice prevails. The ISS IPC nurse attended environmental cleaning audits with the healthcare cleaning team managers or supervisors and, if appropriate, the matron of the area or Trust IPC nurse. This supported the cleaning team but also gave extra assurance to the matron that we were working together to improve standards but also again point out where maybe practices on the ward could be impacting on effective cleaning. Historically the trust used two methods of auditing the cleanliness of the environment, the nursing team used the Infection Control Nurses Association (ICNA) Audit Tool for Monitoring Infection Control Standards (2004) and ISS used a Maximiser tool to audit against the contractual specifications for cleanliness requirements. This was at times confusing and staff wanted a single tool that allowed ISS to meet contractual obligations but also include the nursing aspects of environmental infection control management. Together ISS and the Trust IPC team created a single audit tool that produced a single percentage to reflect the overall cleanliness standard of the environment. This provided a single measure that all staff understood and for upward assurance the trust board could understand what score indicated a well-managed area. The scores could also be broken down into areas of responsibility: ISS, estates and the nursing team. A one day workshop facilitated by a researcher from Imperial College worked with the teams to develop a tool that met a number of requirements, this initially was delayed due to contractual concerns but as the benefit was realised by using it for those area that had increased incidence of Clostridioides Difficile (CDT) it was brought into increased use. Having an IPC lead for ISS during this work was mutually beneficial as there was a unique insight into the issues that both sides encountered. Infection Control Committee (ICC) The role required the ISS IPC nurse to be a member of the Trust ICC which was important in supporting the cleaning management who were required to present an environmental cleaning report but also to get updated on

other IPC matters useful for self-development. It was also a good way to give assurance that IPC matters were firmly on the ISS agenda. Outbreaks The ISS nurse was alerted to any outbreaks in the hospital so she could support relevant ISS teams such as enhanced cleaning and ward hostessing in any actions they had to take to help in controlling the outbreak. It was also a good opportunity to provide some education to staff about the organism causing the outbreak to allay fears. When necessary the ISS nurse also supported the Trust IPC team with e.g. contact tracing activities.

Infection control

 Facets of the role Cleaning Healthcare cleaning is an integral part of IPC so a major part of the role involved working with the healthcare cleaning team. ‘A Matron’s Charter: An Action Plan for Cleaner Hospitals’ and ‘The matron’s handbook’ make it clear that matrons have ultimate responsibility and accountability for standards of environmental cleaning and IPC in their areas. Therefore, from the outset it was important to quickly establish a relationship with as many of the 34 Trust matrons. This was achieved by meeting with as many matrons as possible individually but mostly by attending the monthly matrons’ meeting chaired by the UHCW IPC Lead. This was an ideal opportunity to meet the matrons, discuss cleaning audit reports and get feedback from them on any cleaning concerns to feed back to the head of healthcare cleaning and support in rectifying these. It was also a good opportunity to feed back to the matrons any concerns from the cleaning teams which impact negatively on effective cleaning such as ward clutter or access to areas and making the healthcare cleaner feel part of the ward team was always encouraged. The nurse in charge of the shift has direct responsibility for ensuring that cleanliness standards are maintained throughout that shift so if the healthcare cleaner always feels part of the ward team they can be directly approached by the matron, nurse in charge or her staff to rectify any cleaning problems.

Observation Walks The IPC Lead for the trust and the ISS IPC nurse would walk as many wards/areas as possible at least once a week and this visibility was very good again for showing that we were working together and it was useful to highlight any IPC problems that needed attention from ISS or the Trust. The ISS nurse would also do a daily walk around selected wards or depts. with one of the healthcare cleaning managers or supervisor meeting ISS staff and sometimes using it as an opportunity to do ad hoc hand hygiene inspection or to deal with any problems that may impact on IPC. Sometimes this might just be observing staff like porters who are visiting wards or ward hostesses serving drinks and food and making sure they were observing correct practices like hand hygiene and use of PPE where appropriate. It was also a good opportunity during flu season to encourage staff to have annual flu vaccination and also organising out of hours clinics with occupational health for ISS staff on later shifts to get their vaccine. Conclusion We are aware that other similar facilities companies have employed nurses in various roles but to our knowledge none have specifically employed a trained IPC nurse to work with the hospital Trust IPC team in genuine collaboration. Following the project which lasted 20 months, working part time, ISS, UHCW and the appointed nurse, have agreed it was a success and ISS will look to continuing this at UHCW and replicate in any new larger healthcare contracts. This was a part time post but following feedback from the nurse undertaking the role; it’s recognised that a full time person would be able to expand the role further to add even greater value. The IPC team at UHCW felt the role definitely helped to break down barriers and strengthen IPC links between ISS and UHCW and vice versa. The ISS staff felt it was useful to have their own IPC nurse they could directly refer to and some, especially the cleaners, said it made them realise that their role was important. The expertise of the Trust’s IPC team to the service provider can sometimes be constrained by time or clinical priority and therefore an initiative such as this helped to ensure that both organisations were aligned in relation to IPC. L Issue 20.2 | HEALTH BUSINESS MAGAZINE

www.lockncharge.com/eu Phone: +44 (0) 208 441 4107 | europesales@lockncharge.com * May not fit all devices. Please check the dimensions of the device and the Carry Basket. Some Power Adapters may not be compatible. Contact us for details and compatibility. Specifications and images are for illustration purposes only. Final product may differ. iPad and MacBook are trademarks of Apple Inc., registered in the U.S. and other countries. Chromebook is a trademark of Google Inc. Visit lockncharge.com for warranty details. Sources: 1www.lockncharge.com/research, 2www.forbes.com/sites/steveolenski/2017/12/08/is-thedata-on-your-business-digital-devices-safe/#c731e964c6a3, 3www.wandera.com/about-wandera/wandera-in-the-media/press-archive/the-true-cost-of-mobility-u-s-enterprises-spending-1840-per-employee-mobile-device-annually/

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How ventilation keeps your building healthy The way air handling units (AHUs) are designed and managed is playing a big part in the UK’s increasingly urgent campaign to ensure ventilation can maintain healthy conditions inside buildings, according to James Henley, product development manager at Daikin Applied UK The role of ventilation systems in maintaining healthy conditions inside buildings has been under the microscope this year. It quickly became clear during the COVID-19 outbreak that target air change rates in buildings needed to be maintained – even in partially occupied buildings – to minimise the risk of moisture, which could contain the virus, settling and remaining on internal surfaces. Critical health environments, including operating theatres, depend on accurate control of both air change rates and the direction of airflows so that contaminated air is diluted and taken away from patients and the healthcare professionals looking after them. Managing systems to deliver very precise temperature and relative humidity (RH) control is made easier today by the availability of sophisticated digital control systems. Facilities managers are also supported by remote monitoring of systems made possible thanks to internet connectivity that can provide important diagnostics for both maintenance purposes and optimised ongoing operation. Highly efficient filtration systems are also widely deployed in the healthcare sector, but these must be supported by regular maintenance to remain effective. This became an area of particular concern during the COVID-19 emergency because expert analysis showed that the virus laden particles were too small to be captured by even the most sophisticated filters and, therefore, ventilation ductwork and air conditioning systems should be regularly checked and cleaned to reduce the potential for wider transmission. Facilities managers were also advised to switch air handling units (AHUs) to full fresh air mode and temporarily disable any heat recovery recirculation so that potentially contaminated air would not be returned to the occupied space. A vital role in human health AHUs will also continue to play a vital role in the ongoing threat posed to human health by air pollution after the current crisis passes. Polluted outside air is responsible for as many as 36,000 deaths a year in the UK, according to Public Health England (PHE). This has placed AHUs under increased scrutiny because of their role as interfaces between potentially highly polluted outside air and the indoor environment. Modern AHUs are also relatively complex systems

containing a series of active components like fans, heating and cooling coils, and air filters as well as sound attenuation technology and humidification. They are subject to the updated European Ecodesign Directive – specifically ErP 1253, which was first adopted in 2014 and came into force two years later to ensure systems meet exacting energy efficiency standards, but without loss of performance. As a result, most AHUs now incorporate heat recovery in order to reduce the amount of wasted heat. Switching this feature off should only be a temporary and precautionary measure during the COVID-19 outbreak. AHUs are also subject to ISO, CEN and BSI technical standards to achieve compliance with World Health Organisation (WHO) guidelines for IAQ where people work and have public access to buildings in heavily polluted urban environments. The design issue faced by specifiers of AHUs is that harmful particulates are getting smaller, which makes them more dangerous when inhaled as they can penetrate further into the human body. New filtration standards are focused on PM1 particulates (the smallest easily measurable), including those from diesel engines, which have been identified as a Group One carcinogen by the WHO and have also been linked in recent studies to early onset Alzheimer’s disease. This means very high standards of filtration are needed, which has a profound impact on the design of the unit and the system as a whole. F7 filters are becoming a minimum requirement in line with the international standard EN779, although a number of end users are requiring higher filtration standard to F9. This combination of heat recovery and higher specification filters means an AHU will be subjected to higher pressure drops. This has implications for the size of the unit and its fan power, which, in turn, could lead to the use of larger motors that consume more energy. This flies in the face of current design trends, which have been moving towards smaller units to reduce capital cost and free up valuable lettable space in commercial buildings. The importance of basic design principles However, it is perfectly possible to design a system that meets the energy efficiency and

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IAQ criteria without driving up costs to the end user, but it does rigorous application of good, basic engineering principles. At Daikin Applied, we look to meet the client’s requirements by accurately sizing and using technical innovations like EC fans in order to minimise energy consumption. Fan power is also specifically referenced in the revised ErP legislation so is another design aspect that should not be ignored by specifiers. It also calls for multiple fan systems to build in redundancy as well as improving efficiency. The bonus for engineers is that EC fans are more compact than DC equivalents, which means they can help to reduce the size of the system and still meet new energy targets while, at the same time, making sure building occupants are protected from air pollution. Applying these design principles will also mean that systems can easily be adapted to the changing requirements of a healthcare facility over time without any loss in performance or additional cost penalty to the end user. L FURTHER INFORMATION www.daikinapplied.uk

Infection control

Maintaining indoor humidity levels key to fighting the virus With much in the news covering the social impact of the coronavirus outbreak, Dr. Stephanie Taylor discusses the need to ensure public buildings, such as schools and hospitals, have a humidity level so that viruses cannot spread To manage the spread of Covid-19, we The simple factor of maintaining healthy are all working as a global collective levels of indoor humidity is something to manage our behaviours responsibly, that would benefit our health through such as through meticulous attention reducing the burden of Covid-19 as to hand hygiene and social distancing. well as other seasonal viral illnesses. As individuals, these are undeniably key steps for us to protect ourselves and each Dry indoor air other as we fight the current pandemic. In my practice as a paediatric oncologist, However, individual behaviour is just one I was alarmed by how many of my young factor in our efforts to contain the virus patients came down with infections during and limit subsequent disease. The their hospitalisation despite our environment surrounding us best medical treatments. It plays a lesser-known, yet was at this time that I essential role in the became concerned that Among the degree of viral spread there might be another indoor v and in the severity factor at play; the a r that inc iables of Covid-19 illness. indoor climate r e ase the likeliho Since we spend and the hospital most of our lives building itself. After from haod of infection , n in buildings â&#x20AC;&#x201C; such years of work, d h ygiene room c as schools and including obtaining t o l e a astound ning, one workplaces and a masterâ&#x20AC;&#x2122;s degree i our homes â&#x20AC;&#x201C; we in architecture, factor sng common could and should be reviewing numerous tands o u doing more to ensure studies of patient dry ind oor air t: the conditions of these infections and the indoor environments are built environment optimal for human health. and undertaking my own

research, my suspicion was confirmed. Among the indoor variables that increase the likelihood of infection, from hand hygiene to room cleaning, one astounding common factor stands out: dry indoor air. An abundance of data from research in infection control, microbiology and building science show that maintaining indoor relative humidity between 40-60 per cent improves human health through several mechanisms. This relative humidity zone optimises the ability of our immune system to fight viral infections, decreases the bio-burden of infectious particles in our breathing zone (the air) and actually decreases the infectivity of many viruses and bacteria floating in the air and settled on surfaces. When this optimal range of relative humidity is not maintained, it becomes harder for our immune systems to defend against respiratory viral infections even if we maintain high personal hygiene standards. Public buildings like schools, workplaces and hospitals have undoubtedly been hotspots for the spread of the Covid19 outbreak, not just because of viral cross infection via physical contact, but in large part due to the airborne transmission of E Issue 20.2 | HEALTH BUSINESS MAGAZINE

Infection control

 infectious droplets, aggravated by low indoor humidity levels. Despite this, there are currently no regulations on minimum indoor humidity levels in the UK and many other countries. In fact, regulations focused on reducing energy consumptions in buildings have resulted in the lowering of permitted minimum indoor humidity levels, unfortunately at the expense of occupant health. A lack of humidity standards means that building occupants like the hospital workers who have been on the frontlines of the Covid-19 pandemic and patients with compromised immune systems have limited defence against further respiratory viral infection, despite hand washing and social distancing measures. It is long-established knowledge that viruses can be spread through short distance droplet splashing. But the transmission pathway we must now take into serious consideration is distant spread of infectious aerosols travelling through the air. When droplets are released into the air by an infected person sneezing, coughing, or simply breathing, dry air causes these droplets to shrink and desiccate to reach a moisture equilibrium. We now know that viruses carried in those tiny desiccated particles can travel through the air into an HVAC system and re-infect people from a distance and despite having had no immediate contact. Improved humidity standards This transmission route is one of the factors that makes this virus particularly alarming. The concept of airborne transmission is intimidating, but we can help control it by keeping the relative humidity in our breathing zone or in our buildings in the magic zone of 40-60 per cent. Existing regulations on indoor air quality should be updated to reflect the significant body of scientific evidence that 40-60 per centRH is the ideal indoor humidity for health. These improved humidity standards would have numerous positive effects on human health and well-being. Not only would it reduce the burden on society of Covid-19 disease and other upcoming seasonal viral illnesses, but research shows that it would also reduce absenteeism and improve productivity in offices and schools. A recent study of a nursery school found that fewer children missed school when the classroom humidity was maintained above 40 per centRH. (Rieman J, ‘Humidity as a non-pharmaceutical intervention for influenza A’, 2018 ASHRAE abstract). Studies support projected reduction of absenteeism

The concept of airborne transmission is intimidating, but we can help control it by keeping the relative humidity in our breathing zone or in our buildings in the magic zone of 40-60 per cent by at least 20 per cent by simply maintaining healthy humidity levels in buildings. Governments set indoor air quality standards for temperature, fresh air introduction and pollutants. Setting a minimum indoor humidity level in public buildings is easily achievable, will result in net profit for society through increased productivity and reduced healthcare costs. Most importantly, it will save lives.

We must push for these standards to be set to protect ourselves, our children, the elderly, and the health care professionals who are on the frontline protecting us all in the face of the global pandemic. L

Dr. Stephanie Taylor, a graduate of Harvard Medical School, is the CEO of Taylor Healthcare Commissioning Inc. After working as a physician for many decades, Dr. Taylor obtained a master’s in architecture as well as an infection control certification. Her lifelong commitment to patient care includes focusing on improving the health care physical environment and clinical work processes to help patients heal quickly and save hospitals valuable dollars. FURTHER INFORMATION www.taylorcx.com

Issue 20.2 | HEALTH BUSINESS MAGAZINE

RDP was founded in 2000 specifically to design and manufacture its own range of healthcare specific hardware for the UK market. This led to RDP being the first company in the UK to provide powered carts designed specifically for PCs for use in healthcare environments. RDP prides itself on being truly customer focused, designing products specifically to meet the needs of its customers. All of RDP’s products are designed by clinicians for clinicians. By designing and then manufacturing products that customers tell us they need, the business has grown organically to become the leading manufacturer in the UK of mobile computer carts. In March we got a call from NHS England in urgent need of medical workstations to help with the Covid 19 crisis. The aim was to equip the new London, Bristol and Manchester Nightingale hospitals with mobile computer carts within a very tight deadline. Their initial requirement was for 50 carts for the next working day in the London hospital, which has been housed at East London’s ExCeL exhibition centre with space for 4000 beds. We set about achieving this target and managed to turn the order around in 2 hours, delivering them the same day. RDP’s Managing Director, Shyam Sonpal said “NHS England asked us to deliver these carts in less than 24 hours but we were able to ship them out on the same day. I am extremely proud of the efforts from the staff at RDP, many of whom worked extra hours, and also the extremely quick response from suppliers who have helped us with providing essential equipment for the NHS in these unprecedented circumstances.”

www.rdp-group.com

This delivery success led to the discussion of further requirements for each bed at the Nightingale. For the next batch of carts, the Nightingale then wanted RDP to meet the unique intensive care requirements of coronavirus patients and so we set about manufacturing a bedside cart specifically for this purpose. Usually in hospitals they might have roughly one or two carts per ward but at the Nightingale their primary aim was to ensure that all patients and staff remain safe, healthy and protected â&#x20AC;&#x201C; therefore we were asked to provide one cart per bed to help prevent the spread of the virus. The carts are placed by each bedside and houses PCs and screens for doctors and nurses to have easy computer access to patient records, a time-saving device which is invaluable to health professionals. In order to achieve the volume required for NHS England, we had to convert part of our building from a warehouse to a production facility so that we could adhere to the social distancing guidelines. Temporary staff were taken on from the local area and we utilised a network of suppliers in order to keep up with the demand. Our long-standing transportation company rearranged their schedule to put us at the top of their priority list so that we could ship the carts to the Nightingale around the clock. During this time RDPâ&#x20AC;&#x2122;s commitment to its long-standing customers did not waiver and as hospitals increased their own upscaling of ICU beds, RDP where able to support these additional requirements at the same time. As the country begins to slowly recover and patients are increasingly being admitted to local hospitals rather than the Nightingale hospitals, RDP will work with NHS England to redeploy this kit into the hospitals that require it and ensure that it gets put to good use. We are also on standby to provide more carts should we have another peak. RDP is proud to stand along with all the contractors, military personnel and clinical staff who have been involved in building this temporary field hospital and in making it a success.

+44 (0)1444 245 123

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Baxter ICNET: Supporting COVID-19 Public Health Response The ongoing COVID-19 pandemic has presented even the most developed and efficient healthcare systems with unprecedented challenges. Baxter’s ICNET Clinical Surveillance Platform features two products that can assist in the immediate- and longer-term.

Baxter’s ICNET Clinical Surveillance Platform delivers nearly 20 years of real-world experience offering expertise in epidemic outbreak reporting, investigation and management to help healthcare providers and public health bodies effectively manage an evolving global public health challenge. The ongoing COVID-19 pandemic has presented even the most developed and efficient healthcare systems with unprecedented challenges as they’ve had to adapt quickly to manage its suppression. Even as we make headway, public health teams continue to implement strategies that will play an important role for the foreseeable future, such as ongoing contract tracing, surveillance testing, and preparation for a future COVID-19 vaccination program. The ICNET National Suite features two products that can assist in the immediateand longer-term. Outbreak Manager can help with ongoing management of the pandemic, while Protect can support the vaccination program for COVID-19.

ICNET Outbreak Manager There is evidence suggesting that instituting public health interventions for COVID-19 on time can help to reduce transmission, whereas a late response can delay containment and allow further spread.1 Outbreak Manager can provide information needed to support timely implementation of essential interventions. •

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Public health bodies also understand that strategies, such as contact tracing and surveillance testing, will remain the way forward for the foreseeable future.2 Outbreak Manager can continue to support suppression of COVID-19 by offering functionalities that assist these strategies. ICNET Protect Development of a COVID-19 vaccine remains a top priority of the global pandemic response. When a vaccine becomes available, nations will need to manage its rapid deployment where speed is of the essence. Public health experts can take steps now to prepare for the coming challenge of delivering vaccinations to many people at one or more locations in a short interval of time. Protect was developed with the technological capability and capacity to enable public health experts to deliver a well-coordinated program when the time

Its built-in workflow enables health responders to capture the details of an outbreak in near real-time, enabling management throughout its timeline.

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comes. Protect is designed for large-scale vaccination management, including mass vaccinations across whole populations for new vaccine or routine immunisations. It was developed to help manage the largescale, fast-moving scenarios associated with response to pandemic threats. Protect helps facilitate the entire process from ad-hoc clinic set up, to resource management, to vaccine administration. It also delivers role-specific information to the various healthcare providers involved in the vaccination program. Protect is scalable for users’ specific needs – from individual facilities to whole population administration, with configurability to target appropriate members as needed. Other capabilities include support for clinic staffing and rostering for ad-hoc scenarios; tools for management and inventory of vaccine stock supplies; and visual work boards that enable users to coordinate and track progress of the vaccination program from start to finish.L FURTHER INFORMATION www.icnetsoftware.com/covid-response

The ICNET Clinical Surveillance Platform encompasses two differentiated product suites that support integrated disease surveillance to facilitate the goals of their respective users and drive desired outcomes within the populations at risk. ICNET National Suite supports public health communicable disease professionals at the mass population level, while ICNET Hospital Suite supports infection prevention professionals within the healthcare facility setting. UKI/MG128/20-0015 05/20 References: 1.

Zhanwei, D et al., 2020. Proactive Social Distancing Mitigates COVID-19 Outbreaks Within A Month Across 58 Mainland China Cities. [online] Medrxiv. org. Available at: https://www.medrxiv.org/ content/10.1101/2020.04.22.20075762v1. full.pdf Devlin, C., 2020. Coronavirus: PM Jacinda Ardern Says There Will Be Contact Tracing for Foreseeable Future. [online] Stuff. Available at: https://www.stuff.co.nz/ national/health/coronavirus/120836335/ coronavirus-pm-jacinda-ardern-says-therewill-be-contact-tracing-for-foreseeable-future

Mental health

Mental health in the lockdown and beyond When this is all over, will it be said that ‘it took a pandemic to put mental health where it should be – at the front and centre of daily considerations about working lives?’ Adrian Wakeling, Senior Policy Advisor at Acas, discusses Charities and stakeholders have been campaigning for a genuine parity between physical and mental health for decades. We may be social distancing to protect each other’s physical health, the NHS and social care, but what impact is the crisis having on our mental health and what can we do about it? The new normal is mentally challenging We don’t have to look very far for the causes of increased levels of poor mental health. Early findings form an IES survey of the well-being of employees working from home, paints a vivid picture of anxiety and stress: loss of sleep – 60 per cent are losing sleep due to worry; more drinking (alcohol consumption up 20 per cent) and less exercise (down 60 per cent); unhappiness with work-life balance (50 per cent) and a third frequently feeling isolated; worry about job security (21 per cent) and the health of loved ones (41 per cent); and an increase in musculoskeletal complaints, with

survey respondents reporting new aches Of course, technology allows us to and pains in the neck (58 per cent), shoulder stay connected. But it also allows us to (56 per cent) and back (55 per cent). recreate what we had before and for Although we all face many new many this is hours of Skype meetings challenges, much has also stayed the same. instead of face-to-face meetings. Surveys of employees, such as those from And there is the addictive nature of the CIPD, regularly show that work-life technology which means that it takes a balance is a perennial top concern. This lot of self-discipline to turn off devices. may be heightened at the moment – with Technology can’t solve the connectivity the line between work and home problem on its own. I have heard being not so much blurred as of colleagues having virtual completely rubbed out for tea breaks to chat, quizzes many of us – but it very after work and there Surveys of much a dilemma of has been a great employ e e modern working life. deal of therapeutic s , such as thos sharing. But a recent e f r om the CIPD, re Technology: a survey by YouGov, that wo gularly show friend and a foe commissioned by rk-life b Many people have Acas, shows that alance is a per wondered what the people are still e n ni current experience of missing ‘social/informal concernal top this pandemic would interaction’ while have been like a few working from home (71 decades ago, without the per cent) and feeling ‘out internet and social media? of the loop’ (51 per cent). E Issue 20.2 | HEALTH BUSINESS MAGAZINE

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NHS Nightingale – a lesson in working together fast “Amazing”, “astonishing” and “extraordinary” were some of the terms used to describe the opening of the NHS Nightingale Hospital in East London’s Docklands, after a nine-day construction process At the time, Chief Executive NHS England, Sir Simon Stevens, noted that the UK had over 9,000 patients in NHS hospitals being treated for coronavirus, and this number would undoubtedly rise. He further explained the concept: “Under these exceptionally challenging circumstances the NHS is taking extraordinary steps to fight coronavirus. That’s why NHS clinicians and managers are working with military planners and engineers to create, equip, staff and open the NHS Nightingale London, and we’re very grateful for their support. This will be a model of care never needed or seen before in this country.” Project Management NHS Nightingale was a project to deliver a temporary hospital of up to 4,000 beds within ExCel London. Designer, James Hepburn of Building Design Partnership recognised the benefits of utilising a building like ExCel, where many of the service provisions were already in place. To deliver this required collaborative working between a mixed team of NHS clinicians, the British Armed Forces, private contractors and voluntary organisations. For NHS Nightingale, some 700 military personnel were deployed for construction work and logistical support. When ISS Healthcare, as a trusted strategic supplier, were asked to contribute to this unique project, managing director, Chris Ash, recognising the need, did not hesitate in accepting. The masterplan required existing building incumbents such as Compass and Mitie to provide services whilst ISS Healthcare provided the overall operational management expertise; providing clinical cleaning, daily cleaning,

portering services, receipt and distribution, waste management and helpdesk facilities. ISS also engaged colleagues, ISS Restoration who, for the initial three weeks, provided deep cleans and sanitisation of the bed areas prior to patient use and general site cleaning allowing other trades to focus on their works whilst the Restoration team cleaned around and after them. Other key suppliers such as Rentokil, for pest control were engaged, it being recognised the conversion and increased activity would represent an elevated risk in their area of expertise. Collaborative Working Collaborative working on this type of fast track project requires both decisive leadership and agile working. The command model employed was the Gold/Silver/Bronze team approach used by emergency services. Here policy decisions would be made by the Gold team, passed to the Silver Team and thence Bronze for tactical action. During the Nightingale project, the ISS project director supported by an on-site management team would receive direction as part of the Silver Team each morning. They would then immediately brief the rest of ISS team accordingly. In this way executive decisions could be turned into effective action in the shortest time. Agile working was required by everyone involved. ISS’ four core values include Entrepreneurship and Quality, these both inspire working together towards a common goal. On the Nightingale project there was a critical need for face fitting testing of FFP3 masks to support staff working in the clinical areas. A major airport client had restricted their services during the pandemic, this allowed ISS managers to be re-deployed,

bringing their expertise and test equipment with them. This also applied to consumables such as hand sanitising fluid, which were in short supply. Vacant buildings within the ISS portfolio were identified allowing consumables to be effectively sourced. Natural Competitors In normal circumstances some of the organisations within the team would be seen as direct competitors but the overriding goal of ‘Protecting the NHS and saving lives’ meant that natural rivalry was temporarily suspended, and everyone worked together for the greater good. When another commercial company began providing soft services to the Nightingale project at Cardiff Principality Stadium, the ISS London Nightingale team freely shared their organisational knowledge and expertise in real time. Because of the competitive nature of the FM market, ISS Healthcare, along with other private organisations, are experienced in responding to customers’ needs in fast and flexible ways. This leads to a proven mobilisation process with all the necessary competency and experience in meeting this challenge within the operational team. ISS has vast experience in collaborative working having entered earlier formal arrangements using ISO44001:2017, the international standard for collaborative working. Opening the new NHS Nightingale London Hospital, HRH Prince Charles recognised the important role of the temporary hospital in meeting the national crisis when he referenced the original Crimean War healthcare pioneer: “Florence Nightingale, the lady with the lamp, brought hope and healing to thousands in their darkest hour. In this dark time, this place will be a shining light.”. NHS Nightingale inspired a further 7 temporary hospitals in Birmingham, Bristol, Cardiff, Manchester, Harrogate, Belfast and Glasgow. The Nightingale Hospitals will rightly go down as landmarks in the history of the NHS, and as someone has already commented, “Covid-19 has been this generation’s Dunkirk”, and we have risen to the challenge. L FURTHER INFORMATION www.uk.issworld.com

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Mental health

 Technology cannot automatically create good management; and it is concerning that in the same survey, although: 43 per cent of employers have experienced issues affecting their employees related to stress, anxiety or mental health difficulties in the previous 12 months; and only 22 per cent of employees have spoken to their manager about stress, anxiety or mental health in the last 12 months. Good line management always in fashion Helping people to cope in the current crisis relies on many good old-fashioned soft management skills – such as getting to know your staff and finding how to best to communicate with them. For example, social catch-ups can be good for teams but some colleagues might dominate the conversation and over-share; so one-to-ones may work better for some. And video meetings may be good for picking up on visual signs of well-being, but the World Economic Forum have warned of what is being dubbed ‘video call fatigue’, caused by people feeling they have to constantly perform for the camera. There is a course a grey area in all this. Employment law is still employment law, and although some regulations have been put on hold (such a gender pay gap reporting, which has been postponed for a year), employers still very much have a duty of care over their staff. Indeed, this duty of care has arguably never been so important. But it can be tricky knowing how to interpret legal requirements in the current situation. The rise in musculoskeletal

Many people have wondered what the current experience of this pandemic would have been like a few decades ago, without the internet and social media? problems could perhaps have been foreseen, with ONS figures showing almost half of us now working from home. For many of those, this is a new and unexpected development, and we will all know someone who is perched on a stool or using their bed as a workspace. This raises the issue of how to carry out health and safety assessments. Another pressing issue is around managing disciplinary and grievance issues. Unfortunately, conflict has not distanced itself from our working relationships. Everyone still wants to be treated fairly and equally at work and to be protected in doing so. Acas has just published new guidance on how to manage conflict remotely. The same storm but different boats Everyone has their own lockdown story about how they are coping and the challenges they face – whether that’s home-educating young children for the first time; shielding a vulnerable relative; or waiting anxiously on furlough to see if there will still be a job for you. Although there has undoubtedly been a feeling of camaraderie amongst employees and people in society more generally, there is

growing evidence that some parts of society are being affected more than others. The EHRC are concerned about the impact the epidemic is having on disabled people; and the Mental Health Foundation have just issued a report linking financial inequality and mental wellbeing. The Institute for Fiscal Studies has pointed out that ‘groups that are vulnerable to poor health are likely to be hit hardest … and evidence is emerging that the economic repercussions of the crisis are falling disproportionately on young workers, low-income families and women’. The gist of what many charities are saying is that although we may be in the same storm, we are not in the same boat. This year’s Mental Health Awareness Week focused on the theme of kindness and perhaps the kindest thing we can do currently is to look after the most vulnerable in society. At work this means those who are most insecure, financially or psychologically, and those with pre-existing mental health problems that may have been exacerbated. L FURTHER INFORMATION www.acas.org.uk

Issue 20.2 | HEALTH BUSINESS MAGAZINE

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Helping the NHS focus on what matters: how to free up back-office manpower Hospitals across the UK transformed their working practices this spring in order to cope with the massive surge in patient numbers that resulted from the COVID-19 pandemic. Non-essential surgery was postponed, wards were divided into ‘red’ and ‘green’ zones to avoid cross-contamination, and the new Nightingale field hospitals were constructed to accommodate less serious cases of the virus The UK government relaxed some reporting requirements in an attempt to relieve hospitals of some of their administrative burdens, but with many staff self-isolating or sick, this still left a great deal of paperwork to be managed by smaller teams. Patient records needed to be accessible by both clinical and back-office employees – never more so as an increasing number of hospitals established special teams to handle the queries that flood in from concerned families and friends – while documentation relating to equipment orders, invoices and deliveries became more crucial than ever. This process has been easier for those organisations who had already begun to implement programmes of digital transformation before the coronavirus outbreak. A number of NHS Trusts had already recognised that at the heart of achieving an efficient, shared online record system lay the ability to capture the right information in the first place. Not just a scan Although many health organisations had already adopted scanning systems in order to store all paper-based documents electronically, this frequently consisted of simply capturing the image of the document. Without the manual input of contextual data such as patient record number, invoice number or some other identifier, the image would be completely useless. A clinician might scan in an update to a medical record, but further human intervention would be required to link this to a patient, a doctor, a laboratory or an entirely different medical unit. In the meantime, a letter from a GP relating to the same patient might arrive by email, requiring an equal level of manual intervention. The same problem can apply to other unstructured documents. Invoices, purchase orders or delivery notes also arrive in a variety of different formats and demand time from back-office staff to convert them into meaningful information.

Make AI do the filing Real efficiency can only be achieved when everything from admission forms to discharge summaries, and from purchase orders to delivery notes, can be categorised automatically. The technology to do this uses Artificial Intelligence within the scanning process. Instead of simply capturing an image, the software can look at the document, compare this against its own knowledge base and draw a conclusion about what type of document this is. In a clinical context, that might encompass anything from anaesthetic notes to referrals and observations. The next stage is to extract essential information from the document. In the case of medical records, these might range from NHS number or case note number to date of birth or even pharmaceutical reference codes. Using text recognition technology, the software can capture these details and convert them into linkable fields, thereby adding the context that transforms a two-dimensional image into three-dimensional information. In the words of one NHS Trust IT manager, ‘Now you can tell that X is the same as Y’. Putting it all in context Artificial Intelligence is not instantaneous; it takes time for the software to build its understanding of different types of documents and to learn the range of identifying codes, text or numbers. As it does so, however, the amount of intervention required decreases

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steadily, until finally, it’s possible to put a record into a scanner and simply press ‘go’. Anything that the software is unable to identify definitively will be flagged and passed to a human for verification. The result is a bank of electronic information, not simply a folder full of images. Instead of time being spent pulling files off shelves and delivering them to the other side of the hospital, it can be devoted to scanning, validating and reviewing patient records. Administrative staff can devote themselves to delivering smoother patient journeys, while clinicians can be confident that they have all the information that they need about a patient in one place, instantly. And that means better patient outcomes. A vision for the future: collaboration across all services Ultimately, we believe that the integration of records across the entire healthcare community will be achieved – between hospitals, GPs, social care, hospices, community services and possibly others. We still have a long way to go, but the COVID-19 crisis has reminded us how much we depend not only upon our NHS but upon our care system – and we owe it to the frontline staff to give everyone the infrastructure they need. L FURTHER INFORMATION www.ephesoft.com

Healthcare IT

Providing secure capability for patients to use health apps A key focus of the Long Term Plan is empowering people to take control of their own health care - creating a safe and secure means of accessing their health information is critical to that, says Melissa Ruscoe, head of the NHS login programme at NHS Digital One of the main barriers to patients making the best use of digital health services available to them is the challenge in accessing them, such as having to prove your identity in person or memorising multiple passwords. NHS login is a single, secure login that enables the public to access health and social care apps and websites wherever they see the NHS login button. It means that people no longer have to remember many different passwords – if their device allows it, they can even use device biometrics (for example fingerprint) to login and see their personal information. With nearly 600,000 people having already created an NHS login, a figure that is rapidly rising each week, it’s clear it has massive potential to transform the health and social care sector. NHS login will help reduce administrative burden for GP practices - most patients can verify their identity online themselves without

the user that has signed up for them. The concept is very similar to logging in with Google or Facebook but requires the user to prove their identity even more securely because of the often-sensitive nature of the healthcare data or service they wish to access. Before we created our product we tested and researched the user need with the public, and the message was clear: ‘I trust the NHS and if I have to do this to securely access a healthcare app, I want an NHS solution’. So, we set out to produce an NHS-branded identity solution Proving identity with NHS login that included the key controls of likeness and NHS login enables people to be matched to liveness checks to prevent masquerading. their healthcare records and gives We also needed to incorporate the integrating applications existing patient online capability the confidence that the What is to avoid users having to identify connections they make themselves twice if they’ve to healthcare data exciting so already gone through this stores and services a b out NHS log process at their GP practice. E are definitely for in the need to visit their GP surgery. Once created, it can be used for health and care apps and websites where you see the NHS login button. What’s more, because NHS login was made by the NHS, people can trust it - they can also trust we will only use necessary data. Using official photo ID such as a passport or driving licence, plus a likeness and liveness check, a patient can easily prove their identity so they can be matched to information personal to them.

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Issue 20.2 | HEALTH BUSINESS MAGAZINE

Advertisement Feature

Making remote patient consultations the new norm In our Covid-struck world, video solutions have come to the rescue for industries far and wide. The importance of connecting virtually in a time when people are quarantined and isolated is slowly being recognised - and this is true for almost all domains that are in operation. Healthcare is no different. Video solutions that revolutionise healthcare by delivering services right into the patients’ homes are constantly evolving A better and faster patient care, with maximum use of internal resources, is the new norm. General practitioners are having to change the ways in which they normally operate with one key modification being the increased utilisation of telephonic, audio, or video consultations. Many healthcare providers have stopped face-to-face appointments and even hospitals are exploring the use of video consultations to safely and successfully consult patients and provide care, all the while reducing unnecessary close contact. These specialised tools developed as an answer to the questions puzzling healthcare, allow doctors to interact with patients over a video link to view and discuss symptoms, diagnose an issue and arrange treatment. Appointments, prescriptions and many other activities can be taken care of in less than 10 minutes. Hospitals and surgeries can get the most appropriate medical professional involved quickly and easily to deliver timely medical interventions. Safety of procedures While government advice is still under review, MDDUS has reassured people about the overall safety of using remote consultation procedures in these tough times. Keeping all safety concerns in mind, it is a sensible approach that allows patients to get medical advice while protecting other patients, staff and clinicians from possible exposure to the virus. It also helps by reaching people who are not able to travel out of their homes or are self-isolating. Flabba has developed one such specialised solution, known as Remote Patient Consultation, that uses the power of intelligent video tools to bring clinicians and medical professionals closer to their patients than ever before. Colin Rhodes, the founder of Flabba, went from being a trainee lawyer to being a consultant and then a recruiter before finding his calling leveraging video conferencing processes for various industries. His diverse background, experience working with intelligent video solutions and a natural empathy for the healthcare space has helped him and his team come up with an apt solution in these trying times. It can’t be

denied that the healthcare industry has never been in more dire need of efficient patient care solutions. With the number of cases on the rise, and the number of doctors being constant for the most part, it is important to ensure to not overwhelm healthcare providers and at the same time not neglect the patients. Flabba’s solutions simplify booking consultations and make collaboration with other healthcare professionals easier. Flabba are UK Government Security approved. Benefits of remote consultations The benefits of remote consultations can’t be overstated. In a world that’s under Corona’s influence, it becomes all the more important to go remote and online. Going the virtual consultation route will slow down the transmission of Covid by eliminating the need for patients to rush to hospitals and expose themselves to a possible infection. Further, it allows doctors to talk to people who are in isolation or have travel constraints but are in need of medical assistance. These solutions will also relieve healthcare workers of excessive stress and constant motion by allowing them to work remotely and from a safe distance. Remote consultation can also be scaled up, unlike physical consultations, therefore, even as the demand rises, remote consultation will be able to tackle problems better than having doctors physically consult patients. Remote Patient Consultation makes it possible for healthcare providers to

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assist people who need the most medical guidance by reaching out to them from the comfort of their homes. Managing bookings, sharing important documents and providing consultation - all of it is virtually possible by making use of a solution like Remote Patient Consultation. The solution allows doctors to guide patients as easily as if they were sitting in the same room right by their side. It transforms the legacy and practice of consultation by using intelligent video solutions. Apart from that, it also comes with many additional features to streamline the workflow and simplify the process further. In this day and age when healthcare is a primary concern for countries around the globe, it is important to take a step in a direction that promotes a safer environment. At the moment, with the fear of corona spreading fast, the safest route to keep both healthcare workers and patients from any possible harm is to set up virtual solutions that are sophisticated enough to replace the existing approach. While what lies ahead is fairly uncertain, the best we can do is to improve upon what we have today. By staying calm and doing what is needed, we can curb the spread of the disease and pave the way for a much brighter future. And in that regard, Remote Patient Consultation is one sure step closer to it! L FURTHER INFORMATION www.flabba.com

 Balancing security with simplicity We’ve had to navigate a balancing act between security and simplicity as people don’t want to go through a lengthy process of verifying who they are. In the same way people find it a bit onerous to complete a passport application or go through airport security because they just want to get straight to their long-awaited holiday, people just want to swiftly access a new app that they’ve seen or that’s been recommended to them. People can now create an NHS login in a straightforward intuitive way by going through a short ‘prove your identity’ journey involving a photo of an identity document and an additional ‘liveness’ check that confirms they are a real, live, human and match the identity document, in addition to some basic name and address details. The liveness check, often a video or facial scan, is a key component as it replicates people presenting themselves for identification when they require non-digital access or entry to services such as passport control at an airport and can be used to ensure users are not being coerced or trying to access services with fraudulent documentation. We cross-check the information and then send an email to let the person know if they have been successful – all very straight-forward as most of the public has easy access to the right details and documents. Whether they use this method, or enter their existing patient online details, it takes in the region of six minutes for the majority to complete the ‘prove your identity’ journey, and on average under 45 minutes for identity checks to be completed and a decision returned. We are continually working on ways to make creating an NHS login even more accessible for people. We work closely with health and social care organisations to ensure that they know about and can explain the considerable benefits of having one single NHS login to patients. Areas we are working on include other NHS staff and related staff groups (for example pharmacists) being able to vouch for a patient’s identity later in 2020/21.

Healthcare IT

Enabling users to verify their identity at a level that is consistent with the transaction they are undertaking will speed up the transaction process between the user and the digital service Exciting future developments on our roadmap include proxy and delegated access to support family members or carers wishing to set up or access an NHS login for dependents. Multi-tiered identity verification will support the use of NHS login by more integrated services - for example, the NHS App can show users their medical record and so requires the highest level of security, but a service that enables an e-consultation may not need to display a record, so a lower level of identification could be offered. Enabling users to verify their identity at a level that is consistent with the transaction they are undertaking will speed up the transaction process between the user and the digital service. Providing this secure capability for patients to safely use health and care applications supports a growing need for using technology-led, innovative ways to access our health data and the services the NHS provides. In the longer term, ‘Continue with NHS login’ has the potential to become recognised as a industry leading example of online ID verification and authentication product, and one we can see being used by millions of people across a wide variety of innovative platforms and services. L FURTHER INFORMATION https://digital.nhs.uk/

Inspiring the sector to deliver new innovations What is so exciting about NHS login is that it encourages and supports innovation. NHS login can be used across a wide range of digital health products, increasing the options for the public to have greater control over their health and care. Seven products are now live and this is set to increase rapidly during 2020. We have worked in collaboration with the first organisations to use NHS login, to create a comprehensive integration toolkit to support developers to work on the requirements to integrate NHS login in their products. We know that there’s still a lot of work to for us to do. The learning we’ve gained and the feedback we’ve heard will continue to shape our solution. Using a combination of user, supplier and analytics feedback, we’re constantly evolving our product. In the short term, we need to offer a solution for people who are not able to use digital identity methods, but still want to receive the benefits of NHS login.

Issue 20.2 | HEALTH BUSINESS MAGAZINE

Technology

Reliable indoor mobile coverage during lockdown Colin Abrey explains why uninterrupted 4G coverage in public sector buildings and other pop up facilities cannot wait As Covid-19 lingers on relentlessly mobile telecoms and home broadband services are providing society with some semblance of normality. Everyday life involves homeworking on a level the world has never seen, socialising virtually via House Party, Zoom or similar is the new normal, videos are being streamed like they’re going out of fashion and phone conversations are, on average, 35 per cent longer than they were before lockdown. As such, never has there been a greater need for reliable mobile coverage in any commercial, residential, or mixed-use building. This holds particularly true for the Nightingale hospitals, and other pop-up facilities being constructed to aid national efforts to flatten the curve the pandemic. Telecommunications declared a critical sector Telecommunications has already been identified as a critical sector and there is an urgent requirement for uninterrupted voice and data coverage inside hospitals and care homes. It’s one of the core technologies underpinning safetycritical communications; it’s essential to first responder communications, to the quick mobilization of in the field teams and it’s continuously used by paramedics and other blue light services. 4G is also poised to replace the

legacy safety critical communications network, Airwaves, as part a crossparty reform to update our emergency services network (ESN). Uninterrupted mobile coverage will therefore become fundamental to every aspect of safety critical communications inside buildings. Smartphones and tablets are also playing an important role on the wards right now by enabling patient to keep in contact with their families and loved ones now that visiting has all but stopped.

Ubiquitous mobile coverage is central to the smooth running of both; in large field hospitals voice and data services facilitate swift admissions and a positive patient experience. Video calls are replacing real-world visitors and are helping patents overcome feelings of isolation. Even more importantly, a good communications network enables effective internal communications, thus permitting hospital doctors, nurses and clinicians to make sure that vital supplies and equipment are where they need to be.

Pop up facilities to support frontline staff In pop-up supermarkets and pharmacies, reliable mobile coverage allows instore The role of mobile in staff to liaise with stockroom and Nightingale hospitals distribution centre teams so that More than ten temporary shelves can be replenished. hospitals have been built A strong 4G signal also across the UK in just supports automated A good ns io a few weeks thanks vending machine t a ic n u to the efforts of replenishments comm les effective ab n construction and cashier-less e , s k r n o io t ica netw n u workers, the army, payments, thus m m co electricians, minimising staff internal mitting hospital s r n e ia plumbers and levels. Most p ic s n u li th and c s e telecoms engineers. importantly s r u n l , a In parallel, a number ubiquitous mobile doctors ke sure that vit t of supermarkets coverage is a to ma nd equipmen a s are setting up pop basic health and e li d supp ey nee h t up stores in their safety requirement e r e h are w immediate vicinity in the warehouses to be to serve NHS staff and and distribution centres other front-line workers. serving these temporary

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facilities, yet many have inadequate coverage because of their sheer magnitude and perceived high costs involved. Wi-Fi not a viable option in temporary hospitals While many of the buildings being repurposed into Nightingale hospitals already have a preinstalled communications infrastructure, it’s more than likely been designed for very different purpose. Wi-Fi is often seen as the preferred option, but implementation can be complex and does not deliver the performance and quality required for voice calls and current demand for video conferencing. These facilities need voice and data coverage now. The UKs different operators (MNOs) are already working together to meet surges in demand and there’s also provision for additional capacity, should the need arise. However additional capacity does not necessarily equate better coverage inside a large building because mobile phone signals are weaker by default inside any building because materials like metal, glass, iron and reinforced concrete hamper their penetration. Conventional hospital buildings are prone to having poor to non-existent 4G coverage due to the sheer number of internal corridors, clinics, wards, stairwells and basement areas, all of which are notorious mobile black spots. Many of the warehouse and exhibition halls being converted into hospitals may also have

It is crucial that any facility being converted, repurposed or developed to support key workers in their struggle to bring coronavirus under control have unprecedented access to reliable indoor mobile coverage network, regardless of the provider or location limited mobile coverage because of their enormity and coverage is often limited to offices, canteens or break out areas. Taking the outside network indoors is not that complicated The only way to overcome the mobile coverage problem is to take the outside signal indoors using supplementary signal boosting equipment. This has not always been plain sailing either because of long implementation times, cost and strict licensing laws about their usage. Fortunately, thanks to a relaxation in the mobile repeater rules by Ofcom, this is no longer the case. The caveat is that any installed equipment must satisfy the regulator’s mobile repeater licence exemption spec and not many do. Mobile connectivity has long been a key pillar of modern society, but in recent weeks we’ve seen its value more starkly than ever because of the assurance it offers in these

Technology