VOLUME 13.4 www.healthbusinessuk.net
NHS FLEETS
DIGITAL HEALTHCARE
LEGIONELLA CONTROL
BEST PRACTICE
CLINICAL COMMISSIONING GROUPS
What should good governance and decision-making processes look like? SPECIALIST EQUIPMENT
OBESITY Equipment to deal with bariatric patients
TRAINING
SIMULATION TRAINING
Patient safety: mastering healthcare on mannequins
HB NEWS: Professor Berwick reports on safety • North East and Cumbria CCGs form collaborative hub
HEALTH BUSINESS MAGAZINE ISSUE 13.4 VOLUME 13.4 www.healthbusinessuk.net
NHS FLEETS
DIGITAL HEALTHCARE
Comment
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PROFESSOR BERWICK’S SAFETY REPORT – ‘SPOT ON’
LEGIONELLA CONTROL
BEST PRACTICE
CLINICAL COMMISSIONING GROUPS
What should good governance and decision-making processes look like? SPECIALIST EQUIPMENT
OBESITY
From both inside and outside the government, there has been widespread acclaim for Professor Don Berwick’s report A promise to learn – a commitment to act: improving the safety of patients in England, which was launched in early August. Commissioned in the wake of the scandal surrounding the Mid Staffordshire NHS Foundation, the report recommends the introduction of a criminal offence for ‘wilful neglect’, but Berwick cautioned against creating a system where staff were unwilling to own up to errors they had made (read more on p5).
Equipment to deal with bariatric patients
TRAINING
SIMULATION TRAINING
Patient safety: mastering healthcare on mannequins
HB NEWS: Professor Berwick reports on safety • North East and Cumbria CCGs form collaborative hub
The report stopped just short of recommending minimum staffing levels, which drew criticism from certain quarters. Dr Kailash Chand, writing for GP Online, said: “We know from both the Francis report and Sir Bruce Keogh’s review of 14 trusts that patients are being put at risk on understaffed wards.” Professor Berwick is one of the world’s leading experts in patient safety. The former Harvard professor spent 20 years leading the Institute for Healthcare Improvement, which worked throughout the world consulting health providers on cutting back on care mistakes and improving practice. In March 2012, Berwick joined the Center for American Progress as a Senior Fellow, and will run for Massachusetts governor. A huge admirer of the NHS, in 2010 he was chosen by President Obama to preside over the US Medicare and Medicaid programmes at a time of major reform to the American healthcare system. He left the following year, following attacks from Republican congressmen who refused to support someone who had been so vocal in their support of the NHS – hated by opponents of government‑led health policy in the US, many of which have investments in private healthcare. Meanwhile, still on the subject of safety, Hull and East Yorkshire Hospitals NHS Trust became the first NHS Trust in the country to have installed a vending machine which dispenses safety products. Amongst other stuff, the machine offers personal attack alarms, UV marker pens, carbon monoxide detectors and high visibility vests. Jill Venables, head of facilities, said: “There are obvious benefits to it being in the hospital – a patient leaving the emergency department late at night would feel that bit safer if they had a panic alarm. Or a member of staff cycling home from work in the dark might want a high- visibility vest to wear.”
Danny Wright
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CONTENTS
07 NEWS
33 HEALTHCARE IT
11 CLINICAL COMMISSIONING
43 HEALTHCARE FLEETS
What should good governance for Clinical Commissioning Groups look like? The ICSA’s Seamus Gillen finds out
Solar panels, aerodynamic designs, electric and hybrid vehicles – we look at some of the innovative ways UK ambulances are becoming greener
15 PATIENT SAFETY
51 INFECTION PREVENTION
Jon Lindberg, associate director of healthcare at Intellect, paints a picture of what digital healthcare could look like
Professor Don Berwick’s reports on safety; New NHS Procurement Strategy; Big interest in Safer Wards, Safer Hospitals Technology Fund
19
The Patients Association examines patient care following the Francis Report
22
19 TRAINING
We preview the Infection Prevention Society’s event Infection Prevention 2013, which takes place at London’s ExCeL from 30 September to 2 October
Michael Moneypenny, director of the Scottish Clinical Simulation Centre, examines the impact of mannequin-based simulation training in healthcare delivery and patient safety
55 LEGIONELLA CONTROL
22 OBESITY
58 HEALTHCARE ESTATES REVIEW
When an outsized patient is delivered to your door, do you have the right equipment to deal with him or her? Tam Fry, spokesman from the National Obesity Forum, investigates the situation
33
Contents
BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net
Jon Murthy from accreditation body UKAS discusses the importance of choosing an accredited legionella risk assessment company
The Energy Theatre at October’s Healthcare Estates event will address the controversial CRC Energy Efficiency Scheme
61 HEALTH+CARE REVIEW
25 ENERGY
Can uniting patient care and energy efficiency result in successful outcomes for both? Chris Large, Partner at charity Global Action Plan, investigates
We review Health+Care 2013 which saw keynote speakers such as former Health Secretary Stephen Dorrell MP make a plea for integrated healthcare
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BERWICK REPORT
NEWS IN BRIEF
Berwick review into public safety looks at staffing and new criminal offences Adopting a culture of learning, ensuring adequate staffing levels and creating new criminal offences for recklessness are among some of the recommendations put forward in Professor Don Berwick’s report into safety in the NHS, which was launched on August 6. A promise to learn – a commitment to act: Improving the Safety of Patients called for ‘systemic change’ and urged the government to use ‘quantitative targets with caution’ and to insist on transparency. It calls on healthcare leaders to ‘abandon blame as a tool and trust the goodwill and good intentions of the staff’. The 46-page report made a series of recommendations including for NICE to establish ‘what all types of NHS services require in terms of staff numbers and skill mix to assure safe, high quality care for patients’. One of the recommendations said: ‘Government, Health Education England and NHS England should assure that sufficient staff are available to meet the NHS’s needs now and in the future. Healthcare organisations should ensure that staff are present in appropriate numbers to provide safe care at all times and are well supported.’ It rejected the Francis reports’ recommendation to create a ‘duty of candour’ for healthcare workers, because it said that this is already ‘adequately addressed in relevant professional codes of conduct and guidance’. It calls for New criminal offences to be created around recklessness or wilful neglect or mistreatment by organisations or individuals and for healthcare organisations which withhold or obstruct relevant information. But the report emphasises that the use of criminal sanctions should be extremely rare and unintended errors must not be criminalised. The report does not recommend the introduction of a statutory duty of candour for healthcare workers. It finds that this duty is adequately addressed in professional codes of conduct and guidance. Berwick’s patient safety report was commissioned by David Cameron to ‘make zero harm a reality’ following the failings in Mid Staffordshire NHS Foundation Trust. Commenting on the recommendations, NHS Confederation chief executive, Mike Farrar, said: “Professor Berwick’s comments on culture are spot on - we must do more to develop and protect every member of staff, every patient, and every visitor who speaks up to help maintain and improve safety. “We have an army of eyes and ears at our disposal to identify the ways we can do things better – we must ensure every one of these people has a voice, so
News
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Large number of applications for Technology Fund cash
Professor Don Berwick
the case for continual improvement of patient safety cannot go unheard.” Prof Berwick left his post as head of the Centers for Medicare and Medicaid Services in 2011 after 17 months when he was criticised by Republicans for his praise of the British health system. He is running as a Democratic candidate for the governorship of Massachusetts, a state whose mandatory health insurance scheme under former governor Mitt Romney has long been a flashpoint in the US healthcare debate. In his letter to senior government officals and NHS executives, Berwick stated: “You are stewards of a globally important treasure: the NHS. In its form and mission, guided by the unwavering charter of universal care, accessible to all, and free at the point of service, the NHS is a unique example for all to learn from and emulate. Faults are to be expected in any enterprise of such size and ambition, and, as you know, the nation’s leaders have the dual duty to continually, unblinkingly recognize and reduce those faults and at the same time to maintain and build confidence in the grand vision of the NHS. “The Mid Staffordshire tragedy and its sequellae offer the chance to do both. Thanks to Robert Francis, the nation can see directly some important problems, worth solving, not just in Mid Staffordshire but throughout the NHS.” Commenting on the recommendations, NHS Confederation chief executive, Mike Farrar, said: “Professor Berwick’s comments on culture are spot on. “We have an army of eyes and ears at our disposal to identify the ways we can do things better - we must ensure every one of these people has a voice, so the case for continual improvement of patient safety cannot go unheard.” Farrar added that: “Blame and fear will get us nowhere.” On the issue of staffing levels, Sue Covill, director of employment services at the NHS Employers organisation, said: “We support Professor Berwick’s view that staffing levels need to be determined through the evidence available to us.” DOWNLOAD PROFESSOR BERWICK’S REPORT: tinyurl.com/q6a7zkh
The £260m Safer Wards, Safer Hospitals Technology Fund has attracted more than 760 expressions of interest from trusts applying for more than £650m. The Technology Fund was announced by health secretary Jeremy Hunt in May to catalyse the adoption of IT in the NHS. Trusts had until 31 July to prepare their expressions of interest with applications focused on four key areas; adoption of the NHS Number as primary identifier; integrated digital care records including information sharing within and between organisations; e-prescribing; and advanced scheduling. NHS England says the fund has received an unprecedented number of applications. Guidance issued in June said £90m will be available in this financial year and £170m in the next. Funding must be spent before the end of March 2015 and trusts must match any funding received. The fund is open to acute, mental health and community trusts in England. DOWNLOAD THE REPORT: tinyurl.com/mhxd2vj
Monitor to investigate NHS England’s provider procurement role Health regulator Monitor has said it would look at steps taken by NHS England covering procuring services, patient choice and competition. The probe covers the introduction of new rules to select providers of some cancer surgery services following the reorganisation of the NHS earlier this year. Complaints have been made by University Hospital of South Manchester Foundation Trust and Stockport Foundation Trust that the process to select future providers, which can include private companies, “is not based on the quality of services, patient outcomes or patient preferences. The investigation will also examine the conduct of those providers involved in the process to reorganise cancer surgery services in the Manchester area. Jonathan Blackburn, Monitor’s legal director for cooperation and competition, added: “The purpose of our investigation is to assess whether the way in which cancer surgery services are being reorganised is in the interests of patients in Greater Manchester.” TO READ MORE PLEASE VISIT: tinyurl.com/ks3a85u
Volume 13.4 | HEALTH BUSINESS MAGAZINE
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CLINICAL COMMISSIONING
North East and Cumbria CCGs get together in collaborative hub Clinical commissioning groups in the North East and Cumbria have formed a collaborative group for joint contracting, system leadership and sharing expertise, according to Health Service Journal. The Northern Clinical Commissioning Collaborative includes all 13 CCGs in the area and is chaired by Northumberland CCG chief clinical officer Alistair Blair. A memorandum of understanding for the group, published in CCG governing body papers, describes a wide range of issues it will cover. It states: “The collaborative mechanism is primarily for the purpose of collective decision making on commissioning issues and management collectively of [foundation trust] contracts across the North East and Cumbria. “It will enable clinical and senior management leaders to make decisions about clinical services across the areas served by the member CCGs, with reference to each CCGs governing body where that is required.”
The document said it would see the CCGs “sharing agreed commissioning intentions and identifying common areas of approach with the aim of improving the quality of services”. The group is also aimed at making it easier for CCGs to communicate with the two NHS England local area teams – the Durham, Darlington and Tees. The move involves no formal transfer of powers from the CCGs to the collaborative. the memorandum says it will also involve “development and adoption of service redesign and best clinical practice across the area – which may include the continuation of local clinical networks in addition to those nationally established”. The collaborative will also “work on system management and resilience” and on “mutual support and aid in organisational development”. London CCGs have formed a clinical commissioning council but no other regions are known to have such groups. tinyurl.com/mb4zmm5
PROCUREMENT
New procurement strategy launched
News
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NEWS IN BRIEF Academy leaders annual conference on 28 June This year’s Academies Conference, run by the The Specialist Schools and Academies Trust, will be structured around six strands: Achievement; Outstanding Teaching; Sponsors and Governors; Funding and Finance; Student Services; and Primary Practice. It takes place at St Paul’s, London. TO READ MORE PLEASE VISIT:
www.ssatrust.org.uk
NHS Direct pulls out of 111 Call Centre deals
NHS Direct has announced it will withdraw from its contracts to run the NHS 111 service. It will continue to operate it at nine sites until alternative providers are secured. It cited financial reasons for its decision to walk away. NHS Direct initially had 11 of the 46 regional contracts, but pulled out of two of those in June which were “unsustainable”.
O2 pulls out of telehealth market due to slow uptake
The Government has unveiled a new NHS procurement strategy which it hopes will save the taxpayer £1.5 billion a year. The strategy – Better Procurement, Better Value, Better Care aims to show how the NHS change the way it buys supplies and does business. Launching the strategy, health minister Dr Dan Poulter, said: “The Government is putting an extra £12.7 billion into our NHS but that money needs to be spent much more wisely by local hospitals. When our NHS is the single biggest organisation in the UK, hospitals must wake up to the potential to make big savings and radically change the way they buy supplies, goods, services and how they manage their estates. “We must end the scandalous situation where one hospital spends hundreds of thousands more than another hospital just down the road on something as simple as rubber gloves or syringes, simply because they haven’t got the right systems in place to ensure value for money for local patients. This kind of poor resource management cannot go on, and this radical new
strategy will help our NHS get a grip on wasteful spending to drive real change and improved procurement practices so that more of our NHS’s resources can be spent on frontline patient care.” The strategy says there is ‘an over-reliance on framework agreements at the expense of the NHS striking radical money-saving deals, like hospitals getting together to bulk-buy equipment for a discount’. To spearhead the strategy, the NHS will recruit a procurement champion who will have the authority to drive better procurement practices across the whole of the NHS. The Government will also mandate hospitals to publish for the first time what they pay for goods and services and setting up a brand new ‘price index’ especially for hospitals, through which they will be able to see how much they are spending on different products compared to other hospitals. The document shows that the NHS spends £1bn on admin and £0.5bn on transport, including fleet costs. tinyurl.com/mqskl6d
O2 Health has taken its telecare and telehealth devices off the market, saying there has been poor uptake of the service. The company has announced that its range of mobile health devices – ‘Help at Hand’ and ‘Health at Home’ – will be discontinued and O2 will stop providing support services to existing private and NHS customers by the end of the year. “The uptake of mobile telecare and telehealth in the UK marketplace has been slower than anticipated,” the company said in a statement. Help at Hand, a mobile-enabled pendant or wristwatch connected to a secure website and alarm receiving call-centre, was piloted by Devon Partnership NHS Trust and Leeds City Council in 2012. Following the successful pilots, O2 launched the product to the high street in March this year for patients with heart failure and chronic obstructive pulmonary disease. TO READ MORE PLEASE VISIT: tinyurl.com/lq72kp3
Volume 13.4 | HEALTH BUSINESS MAGAZINE
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HEALTH BUSINESS MAGAZINE | Volume 13.4
BEST PRACTICE
Seamus Gillen, director of policy at the ICSA, uncovers what good governance and decision-making processes should look like for Clinical Commissioning Groups The UK government’s Health and Social Care Act 2012 moved responsibility for commissioning care to clinicians, by creating clinical commissioning groups (CCGs). Clinical commissioning groups are new statutory NHS bodies making commissioning decisions and healthcare strategy for their community. CCGs are different entities from previous NHS arrangements, with each GP (General Practitioner) practice being a member and clinicians leading commissioning decisions. The CCG is its member practices; the members are the authority and appoint governing body members. In addition to their current clinical and business demands, GPs now have new powers, roles and responsibilities. With the transfer of responsibility for commissioning healthcare and services to CCGs, there will be an increase in the demands placed on GPs, and fellow clinicians, to perform these new statutory duties in a manner that is transparent. It is vital interested parties are able to hold them to account; most notably patients and the public. Good governance is an important aspect for delivering that transparency and accountability, but may not be well understood by those likely to be involved in running CCGs.
SUPPORTING CLINICIANS The Institute of Chartered Secretaries and Administrators has produced a draft code of good governance, specifically created for clinical commissioning groups. The aim is to develop a concise document that outlines governance principles that will support clinicians, and those that work with them, to perform their new commissioning activities and help to maintain public trust in clinicians and the NHS. Feedback from healthcare experts will contribute towards the final version of the ICSA Code. Good governance in NHS clinical commissioning groups plays an important role as one aspect of improving the quality of care commissioned. We have designed six principles to be universal and applicable to all CCGs in England, regardless of their size or collaborative arrangements and whatever the CCG has set out in its constitution. Inevitably, the practice and procedures for each CCG will differ. The application of the principles, however, should be
USING THE PRINCIPLES The high level principles provide CCGs and their governing body members with flexible guidance to be used in a manner that is appropriate to the needs of the organisation, and CCGs are encouraged to adopt an ‘apply or explain’ approach. CCGs will decide how best to implement each principle in order for it to be proportionate and effective, but should consider the best way to communicate to their stakeholders how they apply the principles. It is hoped that all CCGs and their governing bodies will adopt the high level principles and include a statement in their annual reports as to how they apply the principles in order to deliver the group’s strategic aims for patients and the public. UNDERSTANDING EACH OTHER’S ROLES The relationship between GP member practices, who make up the CCG, and the governing body is based on trust and a clear understanding of the position and responsibilities of each. Individual GP member practices regularly contribute to, and develop, the CCG’s vision and work with the governing body to provide such support and guidance as detailed in the Act or in the CCG’s constitution. The individual representative of GP member practices needs to have clear guidance as to their role and relationships within the CCG and the governing body. E
Written by Seamus Gillen, Director of Policy, Institute of Chartered Secretaries and Administrators
COMMISSIONING THE DELIVERY OF NHS SERVICES
proportionate and appropriate for each CCG and its governing body, thereby reinforcing that good governance is an aide to clinicians in delivering the aims of the Act and improving the quality of care and health experiences of patients.
Clinical Commissioning
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With r sfe the transioning is of commhcare to healt e will be her CCGs, t ease in the an incr ds placed deman Ps and on G ans clinici
Volume 13.4 | HEALTH BUSINESS MAGAZINE
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BEST PRACTICE The various committees of the CCG and the governing body need to be open in their communications and dealings with the GP member practices, with dialogue based on the mutual understanding of agreed objectives. GP member practices’ meetings need to be constructive and effective in demonstrating accountability to stakeholders. CO-OPERATION WITH ALL STAKEHOLDERS The NHS clinical commissioning group needs to cooperate with other clinical commissioning groups, NHS entities, service providers, local authorities and other relevant organisations with an interest in the local health economy. It must ensure appropriate relationships and constructive dialogue at the right level with a range of identified current and future service providers, other CCGs and regulatory organisations, are in alignment with the agreed strategic aims. It should maintain a schedule of the specific third party bodies, in relation to which the NHS clinical commissioning group has a duty to co-operate, and identify an individual CCG member, or authorised representative, to lead on those arrangements. Examples include: primary care services, specialised services and the work of the Health and Wellbeing Boards. The CCG should regularly reviewing the effectiveness of these relationships and the processes supporting them, where necessary, taking proactive steps to improve them. It should also develop, and regularly review, written agreements between appropriate partners, including other CCGs and locality boards (where they exist). WORKING WITH EXTERNAL BODIES The CCG, and its governing body, should be clear about the form, level and scope, of cooperation required with relevant external bodies in order to discharge the CCG’s statutory duties: The CCG governing body, and any committees should be aware of, and understand, the role of key bodies outlined in the legal and regulatory framework governing CCGs.
Changes in the legal and regulatory relevant to it. This can include environment should be discussed development of the CCG’s e r a at the appropriate level and strategy, having taken CCGs tities n e t implemented accordingly. into account the views, n e r e HS diff N s Authorised individuals as far as appropriate u o i ev responsible for and practicable, of from pr ments, with maintaining appropriate stakeholders, as well e g n arra actice r relations with each body other functions p P G nd as a each r should be identified. which can be set out e b mem ing a They should provide in CCG constitutions. g n i e d b s lea relevant information It needs to involve clinicianissioning to each organisation in members of the public comm sions a manner that is timely, and patients in the work accurate and appropriate. of the CCG, including the deci planning of commissioning UNDERSTANDING arrangements, changes to those LEGAL FRAMEWORKS arrangements and the decision processes Members of the governing body associated with any such arrangements. need to understand their role and It must ensure the governing body meetings responsibilities collectively and individually are open to the public, unless not in the in relation to the legal and regulatory public interest, with clear criteria as to frameworks that apply to them. when matters of confidentiality or business They need to recognise and respect that sensitivity require private discussions. all governing body members are equally The governing body must fully support the responsible in law (notwithstanding the members of the governing body in fulfilling additional responsibilities of the Accountable their roles, and it must have open and regular Officer) for the decisions of the governing communication informing stakeholders about body, as detailed in a comprehensive the work of the clinical commissioning group. induction and ongoing support. They must ensure compliance with OPEN, ROBUST, AND TRANSPARENT all relevant legislation and regulation Governing body members must demonstrate applicable to the CCG, and the activities it probity and integrity in their governance undertakes, and make appropriate public role and when representing the clinical statements to confirm that this is the case. commissioning group. Governing body members They must assure that all governing body must ensure the CCG adopts and adheres to members are properly appointed and are open, robust and transparent processes. qualified to serve, supported by role descriptions Governing body members must act in and an agreed appointment process. the best interests of the CCG, its patients They must be alert to those matters reserved and the public, in accordance with CCG to the CCG and those delegated and reserved agreed policies, procedures and values. to the governing body, or other committee, They must adopt and adhere to a conflict of including reviewing regularly the scheme interest policy, which is publicly available. They of delegation, list of matters reserved, and must establish and regularly update the register the terms of reference for committees. of interests, which can be easily accessed by the public, as well as ensure conflicted COMPLIANCE AND GOOD GOVERNANCE governing body members are identified and The governing body needs to ensure that the do not participate in decision-making. L CCG has made appropriate arrangements for compliance with such generally accepted FURTHER INFORMATION principles of good governance that are www.icsaglobal.com
Clinical Commissioning
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How to safely address patient demand Productive Primary Care is an NHS-focused organisation that provides innovative systems, training and expertise to clinical commissioning groups in order to improve efficiency, patient experience and clinical outcomes. In a traditional GP appointment system, at 8am patients would nervously contact their GP practice in the hope of securing a face‑to‑face appointment, often redialling or left “on-hold” as the phone lines see a surge. Once connected, patients have the perceived barrier of a receptionist to overcome. If there are no appointments left, then let battle commence for that emergency slot.
This pattern all too often is what stops doctors seeing patients who actually need to be seen, encouraging them to go elsewhere in the system, such as walk-in centres and A&E. The Doctor First system is an efficient
method for managing patient demand by allowing patients rapid contact with a senior clinician, usually a GP. Instead of patients having to go through the lottery of “fastest finger first” or jump through hoops to get an appointment, GPs use their medical knowledge to help those in order of clinical need, leading to improved patient safety. FURTHER INFORMATION Tel: 0800 699 0184 dillon.sykes@productiveprimarycare.co.uk www.productiveprimarycare.co.uk
Volume 13.4 | HEALTH BUSINESS MAGAZINE
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Advertisement Feature Written by Simon Hudson, Director of SharePoint specialists, Cloud2
BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net
IT SERVICES
A PAPERLESS NHS BY 2018? COULD IT EVER HAPPEN?
Despite the advent of electronic communications and records, paper is still used extensively for communicating and recording information. However, paper is a flawed medium for this in many ways, with limitations in the way it can be shared, transferred, updated, governed and protected “Inevitably, NHS Trusts and the wider health service today deal with a large quantity of paper in their day-to-day activities; yet pilot projects, technology implementations and new ways of working have strongly demonstrated that replacing paper with a digital equivalent offers substantial benefits,” says Simon Hudson, director of SharePoint specialists, Cloud2. It’s been well publicised that the NHS should go paperless by 2018 and that could lead to savings equalling billions, improve services and help meet the challenges of an ageing population. Health secretary Jeremy Hunt said that patients should have compatible digital records so their health information can follow them around the health and social care system. This would mean that in most cases, whether patients need a GP, hospital or a care home, the professionals involved in their care could see patient histories “at the touch of a button”. The GP community is a particular focus since the great majority of legacy patient information continues to be stored as paper, most commonly in the form of 5x7in wallets. In the 1960s there was an aborted attempt to move to A4 records, which went about a quarter of the way to replacing these before foundering on a combination of underfunding, change of administrators and inertia. Today, many practices are able to scan paper documentation and append it to a patient’s record in the practice’s Electronic Patient Record System (EPRS). This is generally referred to as being “paper light”. But historical information continues to be stored, accessed and transferred in paper
format. These records are often large, representing many years’ worth (theoretically a full lifetime’s history) of notes and many episodes of care. And it should be pointed out that clinical notes are only one aspect of the legacy paper-based systems, many other processes rely on paper yet could be easily replaced with efficient digital equivalents. In NHS Trusts, we are already seeing a desire to introduce and develop more robust internal systems with a view to widening that out to patient solutions in the future. Take Cloud2’s Hadron 8020 enterprise intranet solution, for example, which is built on hugely successful Microsoft SharePoint technology. At the heart of Hadron 8020 is an Information Architecture that has been built specifically for the NHS. It enables documents and other information vital to their operation to be safely managed, stored, searched and retrieved; ensuring up-to-date approved information is instantly available to all users. Cloud2’s ROI calculator indicates savings in the millions, even for non-clinical documents. Cloud2 absolutely believes the 2018 goal is achievable but will require a very different way of thinking and acting, for users, buyers and suppliers of health and care solutions and services. The pace and processes used for digitising records notwithstanding, we need to recognise that we are unlikely to achieve universality of data, systems and processes. The pace of change within the healthcare system means that we’ll never reach a perfect moment to deliver just the right solution, at just the right time. While many will see this as a challenge, however, Cloud2 sees it as an opportunity. There are solutions, including those the company has developed, that can deliver all the foundations necessary for
a paperless NHS. To give you an example, Cloud2 is working with Norfolk & Suffolk NHS Foundation Trust, who is introducing an integrated intranet, extranet and internet solution to better engage with staff, professionals and patients. The joined-up solution builds on the Trust’s Hadron 8020 intranet with public websites, a professionals’ portal and referral form integration. Cloud2 is really excited about the commitment the Trust has made to proactively explore new ways to apply these technologies to improve the way it operates, not just for the Trust, but for its patients, too. Going paperless isn’t especially easy. A few things are harder; computers and networks need to be up to the job and users need to embrace change and learn new things – but this is a truism in any information‑rich organisation. But some things are astonishingly better as a result. Cloud2 would like its NHS colleagues to experience this astonishment, and then for that to become the new normal. The journey towards paperless is as much about culture as technology. The 2018 paperless goal is only going to become reality if the NHS, and its users, want it to be. It can be achieved and, almost certainly, within the timescale the health secretary has set, if there is the will. L FURTHER INFORMATION Tel: 01274 308378 sales@cloud2.co.uk www.cloud2.co.uk
“Pilot projects, technology implementations and new ways of working have demonstrated that replacing paper with a digital equivalent offers substantial benefits.” Simon Hudson, Cloud2 14
HEALTH BUSINESS MAGAZINE | Volume 13.4
HEALTHCARE
If we want to see real improvements to patient safety following the care failings at Mid Staffordshire, then health leaders must act decisively, urges the Patients Association
There is a tradition of romanticism when it comes to the NHS and often with good reason. At its best, it is a world-leading healthcare system. But the problems experienced by many patients at Mid Staffordshire NHS Foundation Trust, in one of the darkest episodes in its history, exemplified the very worst of the health service. Revelations that as many as 1,200 patients could have died as a consequence of substandard care sent reverberations of shock across the whole country, forced patients to question how safe they were in hospital and fundamentally damaged public confidence. The Francis Inquiry into Mid Staffordshire Hospital NHS Foundation Trust, the fifth major public investigation into the Trust, identified specific inadequacies within the Hospital Trust but, critically, also pointed to systematic failings across the whole NHS. In the words of Robert Francis: “The system as a whole failed in its most essential duty – to protect patients from unacceptable risks of harm and from unacceptable…inhumane, treatment that should never be tolerated in any hospital.”
TURBULENT TIMES At present, the future of the NHS looks turbulent. The NHS 111 non-emergency service, piloted in March was beset with problems from the very outset and full roll out of this service has been put back until 2014 with patients left in the dark. In a recent survey by the Patients Association, 76 per cent of those polled said they would not feel safe using their local out-of-hours service. A whole raft of evidence – from letters to the Health Secretary, to reports from medical colleges and statistical data – put beyond doubt, the fact that emergency departments are being flooded and they cannot cope with demand. At the same time trusts are being asked to make £20 billion of efficiency savings. We have recently learned that the NHS is facing a budget shortfall of up to £30 billion by 2020 whilst the NHS management is hit by scandal after scandal.
Written by the Patients Association
PATIENT SAFETY: TURNING WORDS INTO ACTION
the Berwick Review into Patient Safety. All the reports have done is to confirm much of what we already know. The findings of the Keogh Review were yet another addition to the huge body of reports and investigations that have all identified the same barriers to the delivery of good care. The Cavendish Review said that healthcare assistants were performing the same duties as doctors and nurses but the notion of statutory registration was not even included in the terms of reference. Now of all times is not the time to play politics with patient safety.
Patient Safety
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dard Substancare health ked the shoc deaths ntry and WHAT NEEDS cou nts to e i TO HAPPEN? t a p Robert Francis QC has forced n how safe been explicit about questio were in what needs to happen. they ital Those that run the NHS p hos have to put the patient at its
DRIVING CHANGE Widely regarded as a watershed, the Francis Report puts out 290 recommendations which he felt were needed to drive through a profound change in culture in the health service. So what has the government done so far about Francis? Has patient safety really improved? And what can be said about public confidence in the NHS? The government’s initial response, Patients First and Foremost, was promising. Agreeing to implement the Francis proposals, it set out plans to introduce three chief inspectors; one for GPs, one of hospitals, and one for social care. We welcomed this announcement and the fact that patients and their families were being encouraged to join inspection teams. But on the whole we have been disappointed. Instead of moving quickly to implement the Francis recommendations, the government has dragged its feet. Rather than act decisively we have seen three further reviews: the Keogh Review, into 14 outliers for high mortality rates; the Cavendish Review, into regulation of healthcare assistants; and
centre, involving them in service design and in decisions about their care. It needs to implement the findings of the Francis Inquiry, reform the ineffectual complaints procedure, ensure sound overall leadership and regulate Healthcare Assistants. Finally the government needs to listen to the concerns of patients and professional groups and review the support being given to both the primary care sector and out-of-hours services. The government’s patient safety tsar, professor Don Berwick, said that: “There is no reason why English healthcare cannot aspire to be and become the safest health care in the world.” If the NHS really does have the potential to be the safest healthcare system in the world and if we want real improvements to patient safety, then health leaders must act decisively. L FURTHER READING www.patients-association.com
Volume 13.4 | HEALTH BUSINESS MAGAZINE
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When every penny counts.
Helping NHS Trusts recover money, even in the most delicate of situations. Optima Legal. A flexible, responsible and results-driven law firm. The debt litigation specialists. • Salary overpayment • Disputes Non-payment of treatment •
www.optimalegal.co.uk Voted Litigation Team of the Year 2013 by Credit Today, the voice of the UK credit industry
DEBT RECOVERY
A LEGAL VIEW: RECOVERING SALARY OVERPAYMENTS
There’s no denying that we find ourselves in an age of austerity, and nowhere does this ring truer than in the public sector: getting accounts paid and keeping the debt levels under control are more important than ever. But some areas require more sensitive handling than others, and overpayment of wages is a good example. Normally litigation, and the threat of it, can have the desired result on debtors, and get the outstanding sums in reasonably quickly. But when there’s an employment relationship involved, other considerations arise. Contrary to popular belief, the general rule is that money paid out by mistake can be recovered from the person who received it. This is known as restitution or “gains-based” recovery, which has fairness at its heart. But whilst the Employment Rights Act 1996 protects workers against unauthorised deductions, it is permissible for an employer to take back salary payments at source, provided that the right to do so has been referenced in the contract – which is the usual position – or where there is a separate consent. In this context, “worker” can mean contractors, as well as employees. So, in theory at least, there’s never a problem, but an employment contract will also have an implied term that imposes a duty of mutual trust and confidence between the parties. It is arguable that any attempt to rely on the clause without further communication would breach the duty and risk a constructive dismissal situation arising. This does not strictly
arise in the case of a contractor but, in both cases, there is often the ongoing relationship to bear in mind, and neither party would benefit from an approach that is contractually permissible, but overly antagonistic. However, there may be surrounding circumstances that mean that the overpaid money is not recoverable. This can result in “estoppel”, which essentially means recovery is prevented where it would be unfair. For example, the worker had been led to believe he was entitled to treat the money as his own, or he couldn’t reasonably be expected to notice the overpayment. If the “extra” money had been spent in good faith, it is likely that a court would not order repayment of the sum. And what if the effect of the overpayment deduction is to reduce the salary to beneath the minimum wage? Well, perhaps surprisingly, this is permissible, although in the case of an employee, the duty of mutual trust and confidence should be borne in mind. It is worth noting, too, that “wages” in the legislation is defined as including any payment made in connection with the employment, including fees,
deduction, leaving the employer vulnerable to a claim. Any such clause would be subject to the usual rules that govern contracts, raising the possibility of defences based on unreasonableness or unenforceable penalty, in which case the sums claimed would have to be pursued in the county court. Optima Legal suggests this approach in dealing with overpayments: (A) Defining the status of the worker, i.e. employee or contractor; (B) Identifying the nature of the overpayment; (C) Being satisfied that it has arisen as a result of a genuine mistake, and there has been no expectation on the part of the employer that would suggest the employee was entitled to receive it; (D) Agreeing a repayment schedule that is affordable and realistic in its extent at the earliest opportunity; (E) Setting out as a matter of policy how overpayments and other clawbacks will be handled, to create certainty and consistency. If litigation is necessary, and the overpaid worker has left the jurisdiction, it should not normally prevent the claim being brought in
Written by Nicola Hoskins, Head of Learning and Development, Optima Legal
A wage overpayment could be the result of a number of factors, but often it’s a genuine mistake by the employer. Nicola Hoskins of Optima Legal explains what can be done to put right such an error
Advertisement Feature
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Contrary to popular belief, the general rule is that money paid out by mistake can be recovered from the person who received it bonuses, commission or holiday pay, so it goes further than simply looking at remuneration, and the ability to deduct overpayments is extended accordingly. A final point to consider: the law only permits these deductions for genuine overpayments of wages. If an employee was liable to repay sponsorship agreement course fees or other training costs, then the Employment Rights Act 1996 could not be relied upon to justify that deduction. More likely, there would be a contractual provision in the agreement permitting the deduction of costs in certain circumstances, e.g. where the employee fails to complete the course or leaves the employment. But in the absence of such a provision, an attempt to clawback those sums would be an unauthorised
this country, although the rules on service of proceedings overseas will need to be complied with and consideration given to how any judgment obtained will be enforced. Ultimately, these matters are debt recovery but with added hurdles along the way: an employment relationship is more than just a business arrangement. Understanding the nature of that relationship is key to dealing with overpayment situations. L FURTHER INFORMATION www.optimalegal.co.uk
Volume 13.4 | HEALTH BUSINESS MAGAZINE
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HEALTH BUSINESS MAGAZINE | Volume 13.4
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Training
SIMULATION
Michael Moneypenny, director of the Scottish Clinical Simulation Centre, examines the history of simulation in healthcare, and the impact of mannequin-based simulation training on patient safety Simulation in healthcare, in the broadest sense, covers a wide range of techniques and technologies, from computer-based simulation, to part-task trainers (such as cannulation arms), to simulated actor patients, to mannequin-based simulation. This article will focus on mannequin‑based simulation, primarily because this is the simulation modality most frequently employed at the Scottish Clinical Simulation Centre (SCSC). The earliest simulators included Chinese bronze statues which showed the surface anatomy for acupuncture and, in the 18th century, Giovanni Antonio Galli built an obstetric simulator with a glass uterus and flexible foetus which students had to deliver blindfolded. The first mannequin which attempted to replicate cardio-respiratory physiology and allowed for changes in response to medical intervention was Sim One. Developed and manufactured at the University of Southern California in the mid‑1960s, Sim One could blink, breathe, had a heartbeat and palpable pulses. Unfortunately only one Sim One was ever built due to the expense of the mannequin and the lack of sufficient demand. It was not until 1987, when Dr David Gaba and colleagues
constructed CASE 1.2, that a full‑bodied mannequin was used in the training of medical personnel. The sophistication and complexity of the mannequins has increased over the past 25 years and today’s mannequins are able to realistically replicate an increasing number of pathologies. THE STATE OF THE ART In the United Kingdom there are currently three main suppliers of high-fidelity mannequins: CAE Healthcare, Gaumard, and Laerdal. Each manufacturer provides a range of mannequins, both in terms of price and figure being replicated (e.g. pregnant woman, baby, adult man, etc.) The top of the range mannequins can replicate signs such as convulsions, bleeding and “falling asleep” in response to anaesthetic gases. A number of mannequins now also provide feedback to the controller regarding the actions that are being performed on the mannequin such as chest compressions, de-fibrillation and movement of the head. Many mannequins will allow the controller to note when certain events have occurred, such as the provision of oxygen, calling for help, and so on. This means there is synchronous development in physical replication, software physiological modelling
Early ors simulated includ tonio ni An Giovan 8th-century Galli’s 1ic instrument obstetr glass uterus with a flexible and us foet
and software integration with educational objectives. The concept that accurate replication of anatomy and physiology is not the end-product, but rather a means to an end is discussed in the next paragraph. SIMULATION TRAINING AND TEAM RESOURCE MANAGEMENT (TRM) Although he has now fallen from grace, Lance Armstrong’s book title “It’s not about the bike” could be slightly modified to create a truism in simulation: “It’s not about the mannequin.” Mannequins are only useful if the training which is carried out on them is of value. Dr David Gaba realised this from the outset and used the CASE 1.2 mannequin to evaluate and improve team performance during simulated critical illness. Gaba modelled his programme on the aviation industry’s “Team Resource Management” (TRM) training, which aims to maximise team-working, effective communication and leadership while reducing errors. Although there are significant differences between aviation and healthcare, similarities include the risk of death or disability and the position of fallible human beings at a number of crucial decision-making points. There has been significant progress in the development of healthcare-specific programmes and methods for assessing healthcare personnel such as the Anaesthesia Non-Technical Skills (ANTS) and the Non-Technical Skills for Surgeons (NOTSS) behavioural rating scales. The mannequins are therefore most educationally effective when they are used as part of a programme or course which has defined learning objectives (LOs). LOs should be derived from the needs of the healthcare personnel. These requirements in turn may be obtained from a needs analysis E
Volume 13.4 | HEALTH BUSINESS MAGAZINE
Written by Michael Moneypenny, director of the Scottish Clinical Simulation Centre
MASTERING HEALTHCARE ON MANNEQUINS
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HEALTH BUSINESS MAGAZINE | Volume 13.4
SIMULATION which uses data from a variety of sources such as adverse incidents, complaints and personnel feedback. LOs must be specific to the specialty (e.g. nurses, dentists, healthcare assistants) and their level of experience (e.g. student, post-graduate, returning to work). A course which is designed around specific LOs can be organised to ensure that the mannequin’s capabilities are used to maximise the chances of addressing the LOs. The LOs are addressed during the simulation course by carrying out debriefs after every scenario. The debrief varies between simulation centres but generally it involves a facilitated discussion between the participants regarding their actions, thoughts and behaviours in the scenario. The well-run scenario guides the participants to reflect on the LOs and to take away concrete steps for improving their future performance. It is hoped that this improved performance by healthcare personnel will lead to improved patient safety. SIMULATION AND PATIENT SAFETY In 1999, the United States’ Institute of Medicine (IOM) published “To Err is Human: Building a Safer Health System.” This landmark report revealed that the healthcare sector is responsible for a large number of preventable deaths and injuries. Subsequent reports from
Training
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around the globe have confirmed the IOM’s findings. The IOM report also claimed that the vast majority of preventable errors are due to human error. In effect, healthcare personnel, due to poor communication, leadership, team-working, planning, and so on, are responsible for thousands of deaths per year. Because Simulation-based medical education (SBME) focuses on these specific behaviours, one would expect that SBME would result in improvements in patient safety. According to a 2011 review of the literature by McGaghie et al, SBME has shown this level of results in specific areas such as catheter-related bloodstream infections, obstetric complications and cataract surgery. Confounding factors and the number of participants required to show effect will continue to make studies showing patient safety improvements difficult. Lastly, although SBME can be effective in improving patient safety, it is not the solution but only part of the solution. SBME needs to be integrated within a wider programme of patient safety which includes governance, safety culture and an ethos of making patient safety the number one priority. L FURTHER INFORMATION www.scsc.scot.nhs.uk The control room: mannequins are remotely controlled behind a one-way mirror
The Scottish Clinical Simulation Centre Established in 1998 and part funded by NHS Education for Scotland, the Scottish Clinical Simulation Centre (SCSC) is a state-of-the-art training and education facility. Originally based in Stirling, this national resource has the new Forth Valley Royal Hospital in Larbert as its home. The SCSC has a long record of delivering high quality education to multi professional groups through simulation. The centre boasts a range of mid and high fidelity mannequins including adult, child and baby simulators accommodated within two multi-purpose simulation suites. These areas can be transformed to represent virtually any clinical location of your hospital, affording maximum flexibility and adding to the unique psychological fidelity that the SCSC experience provides. The Centre’s faculty of clinical educators has a wealth of collective experience reflected in a national and international reputation in areas of education, research and assessment.
Volume 13.4 | HEALTH BUSINESS MAGAZINE
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SPECIALIST EQUIPMENT Health and Safety Executive advice, published in 2007 & 2010 respectively, had not be put together for fun and should no longer be ignored. Failure to address this situation could mean, as US lawyers will testify, costly clinical and medicolegal consequences. So read on, cheerfully, and face the fact that the sometimes dramatic additional costs are not something that you can’t afford but should be regarded as investments in the future. Obesity is a cradle to the grave disease – whether it be with very overweight pregnant women requiring extra long needles for epidurals at childbirth or XXXL freezers in the mortuary – and, believe me, will be around for a long time.
Written by Tam Fry FRSA, spokesman, National Obesity Forum
Obesity
BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net
If en’t you hav had alreadyze your rsi to supe equipment l hospita patients for u THE DAY-TO-DAY tone, yo s IMPACT 5 2 r e ov y or Bigger freezers are only are luckent the half of it. Though overall levels of obesity are neglig
SUPERSIZED PURCHASING
allegedly declining, the fatter are continuing to get even fatter. This means that pretty much everything you work with on a daily basis should be considered for upsizing: larger examination couches, scales, commodes, beds, mattresses, wheelchairs and hoists – you name it – will have to exist side‑by-side with your standard equipment when outsize patients are delivered to your door. The onus will still be on you to ensure that you can care for them with dignity and your colleagues can do so without fear of personal injury. It’s not just the big stuff, either. Along with the epidural needles, standard surgical instruments including scissors, graspers and needle holders are no longer long enough for keyhole surgery on some obese patients. If delivering these patients to your door is not your headache, it will be one for somebody. Though the corridors, landings and general wards in your premises may already be big enough to accommodate wider beds and assorted paraphernalia, chances are somewhere along the way doors may have to be refitted, lifts strengthened and additional ramps constructed to allow beds to be manoeuvred safely.
Wherever you come in the NHS supply chain, if you haven’t already had to supersize your hospital or community equipment for patients over 25 stone, you are either lucky or negligent. In a poll published last year the Royal College of Surgeons failed to identify a single South West England hospital
THE IMPACT ON AMBULANCES Then there are the ambulances. Ah, yes! At up to £90,000 a throw, these beasts, with reinforced chassis and double-width trolleys strong enough to take patients weighing up to 70 stone, are now familiar vehicles in the regional services. Since it would be inappropriate to allocate such expensive vehicles simply to ferry overweight patients to and from their homes around and about, reinforced mini-buses have also had to be purchased for day-to-day transport. So the NHS bill goes up. But it’s not over yet. The cost of a fire crew
When an outsized patient is delivered to your door, do you have the right equipment to deal with him or her? And are you able to care for them with dignity and handle them without fear of personal injury? Tam Fry spokesman at the National Obesity Forum, examines the impact of obesity on the NHS
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HEALTH BUSINESS MAGAZINE | Volume 13.4
accepting acute surgical admissions as having bought all the recommended equipment. Even when upgraded handling equipment had been acquired, nursing staff were not necessarily aware of its existence [Ann R Coll Surg Engl (suppl) 2012: 94: 338-41]. The poll’s conclusion was that National Patient Safety Agency and
to prize people from their houses may have to be paid for, too. Do not believe that a team of rescue specialists called in to assist paramedics in the transfer of a 63s stone lady from her first floor bedroom to an ambulance may have no charge attached to it. In this infamous case in South Wales it took the team the best part of a day to do the job at an estimated £100,000 cost. Graciously fire chiefs tend not to make more than a token charge for such work but don’t bet on this state of affairs continuing. ASK THE ZOOKEEPER The NHS might have to pay zoos invoices, for instance. Though no UK zoos have admitted to hiring their animal scanners to hospitals whose own CT and MRI units can’t accommodate the very obese, they have certainly been asked to. The Royal College of Surgeons of England warns against such a situation occurring here, but points to US where zoos have been so utilised. However degrading this might be, one obesity specialist has been quoted as stating “you can’t die of shame – but not having a scan when you require one might kill you!” THE FINAL RESTING PLACE So death, finally, has to be reckoned with. Not just because of the mortuary fridges but because of crematoria capable of accommodating cadavers up to 50 stone
and coffins that need to be 40 inches in width. The local authority in Burnley also instructed funeral directors to cremate fat people before 9.30am because their ashes clog up crematorium burners and, in extreme cases, JCBs have also had to be called in to for coffins, at three times their standard size, to be lowered gently into their final resting place. Mind you, the NHS and society in general shouldn’t quibble about the cost. We have brought all this on ourselves following years of unbelievable negligence by politicians and the Department of Health [DH]. Obesity was flagged up as a mainstream “issue“ over a generation ago in the report, the Health of the Nation, but official inertia guaranteed that the issue didn’t go away. The 1991 prediction was that, by 2000, the proportion of obese adults should be seven per cent or less – spirited away by a few leaflets urging behaviour change and a healthy lifestyle. The actual figure was double that figure and to-day, 13 years later, a 350 per cent increase in the obesity statistics stands testimony
Obesity
BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net
to Westminster’s continued inaction. At the moment the inaction is costing the country some £5.2 billion a year so a few thousand quid here and there for supersize equipment is cheap at the price. Some enlightened action was once proposed but quickly shelved. The idea was that three-yearly checks on adult height and weight would be helpful in routinely spotting, and dealing with, individuals who were piling on the pounds. It was deemed questionable however to task GPs with widespread measurement of body mass index [BMI] so a compromise was reached. Quality Outcome Frameworks [QOF] payments would be paid to GPs for “establishing and maintaining a register of patients age 16 or over with a BMI ≤30 in the preceding 12 months,“ but no QOF money was earmarked for GPs to do anything useful with the data! The consequence is that GPs continue to pick up a tidy sum for compiling lists of their fattest patients but the patients themselves receive little benefit. L
Obesity to dle is a cra sease – i grave d it be with r whetheght pregnant i overwe needing long women al needles, or epidur mortuary XXXL zers free
FURTHER INFORMATION www.nationalobesityforum.org.uk
Benmor Medical: offering equipment and solutions to support the needs of bariatric patients Equipment for bariatric patients varies, both in quality and suitability, therefore needs to be designed with a number of criteria in mind. As well as being capable of having an adequate safe working capacity (SWC), the equipment must also accommodate the extra widths required. The equipment must also be simple to operate, have full functionality and, above all, be of an aesthetic design thereby maintaining the dignity of the patient. Probably the most important piece of equipment when caring for patients of a larger size and weight is a hospital bed. There are countless cases of bariatric patients being admitted through emergency departments where there is simply nowhere to put them. Patients are often put on beds that are unsuitable or even on a mattress on the floor. This is neither a safe nor dignified way to treat a patient who may already be self-conscious about their condition and this can also raise big problems from a manual handling point of view. Benmor Medical’s Aurum Expandable Bariatric bed is width-adjustable from 36-48”(900-1,200mm) and can support patients of up to 65st/414kg. The bed
can be supplied with a choice of either a foam, dynamic air or turning mattress to combat the pressure sores and other pressure-related skin problems associated with patients of this nature. This four-section bed can be articulated into numerous positions, including Trendelenburg positions, chair, knee-break and emergency CPR at the touch of a button. It is also available with an integrated weighing system. Benmor Medical has a selection of bariatric chairs available, ranging from special actuated riser/recliner chairs to static or high-dependency chairs, all of which cater for various weight and width needs. Toileting and washing aids can also be supplied, such as bariatric bedpans, extra-wide commodes, shower chairs or trolleys. Manual-handling equipment, hoisting and transfer solutions are available,
together with a variety of walking aids for more mobile patients. Benmor Medical (UK) is a specialist bariatric solutions company and it offers a full range of equipment, for sale or rental, 24/7, 365 days a year. The company’s large fleet of rental vehicles offers full UK coverage and its technicians will provide assembly and positioning of equipment, together with full training in its safe use. Benmor Medical’s clients are mainly from the NHS and community sector, where the company’s name has become synonymous with supporting bariatric care. FURTHER INFORMATION Tel: 0333 800 9000 www.benmormedical.co.uk
Volume 13.4 | HEALTH BUSINESS MAGAZINE
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Advertisement Feature
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RENEWABLE ENERGY
GET YOUR PUBLIC SECTOR ROOF TO WORK
Solar PV is one of many technologies producing renewable energy, yet it is one of the most accessible and readily available “green” solutions as well as being an extremely stable platform Fronius’ photovoltaic system in Sattledt, one of the largest solar power facilities in Austria
Both efficient and affordable, and with no need to obtain planning permission any more*, solar PV is definitely a viable economic decision for large commercial or public sector buildings. From an office block to a large hospital with several buildings, solar PV can reduce energy bills and carbon footprint – in line with government sustainability goals – and generate an income whilst promoting green ethics within the local community. What’s more, the usage patterns of commercial buildings means high levels of self-consumption, lowering operating costs but still benefiting from the Feed-In Tariff (FIT) in most cases. The fundamental fact is, the larger the space, the more solar panels can be installed and therefore the greater the amount of electricity can be produced. As solar panels are usually installed on rooftops, they are in the main unobtrusive, particularly on tall commercial buildings, and the maintenance of the entire system is extremely low, with no surprise costs later on. GOVERNMENT’S FIT SCHEME Many commercial buildings are eligible for the government’s FIT scheme. The income generated from this can vary depending on the size of the system and, from 1 July 2013, varies from 6.85p/kWh for a large system above 250kW, up to 14.90p for a small domestic system. This is received even if you consume all the electricity your system produces. Additionally, zero wastage is achieved, with any unused energy automatically being
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HEALTH BUSINESS MAGAZINE | Volume 13.4
sold back to the grid at 4.64p/kWh. To find out more about the government’s FITs, visit www.energysavingtrust.org. One place that has set its roof to work is Network Rail, at the iconic Grade 1 listed building, King’s Cross Station. In 2011, this award-winning 240kWp AC installation
be used to power consumers within your business or be fed back into the grid. The quality of your inverters is essential to ensuring the maximum amount of available solar power is converted reliably. As a leading producer of domestic and commercial inverters, family-run Austrian firm Fronius is constantly developing innovative solar electronic solutions. With one of the lowest failure rates on the market and its MIX™ technology, which combines several power modules, you are ensured to achieve maximum yields whatever the weather – even at dawn or dusk. For over 60 years Fronius have been creating new technologies and solutions for monitoring and controlling energy. It has been involved in solar electronics since 1992 and provides a range of high specification products for the commercial install, each suitable for specific sizes and types of installation. MONITORING IS KEY As a PV system owner with sustainability goals, you need the reassurance that your investment will operate at promised performance levels, maintaining CO2 reductions and cost savings at maximum levels. Fronius offers web-based monitoring that can be accessed on all tablet and smartphones. This free application enables you to view the yield from your system, your earnings and CO2 reductions, graphically, from anywhere in the world. Free online service Fronius Solar.TV enables numerous PV system values to be displayed clearly and in a promotionally effective way in public spaces – perfect for promoting your green credentials. Integrated into the Fronius data communication network via the internet, this live view can be positioned for public interest and shows a series of diagrams to provide an overview of the PV systems. Perfect as an educational tool for visitors.
As solar panels are usually installed on rooftops, they are in the main unobtrusive, and the maintenance of the entire system is extremely low was commissioned by Sundog Energy and is designed as a self-consumption system. All the electricity produced will be used at the station itself to reduce operating costs. With an estimated annual yield of 175,000kWh, this will see a saving of approximately 100 tonnes of CO2 per year. Non-conventional solar panels have been used to create an attractive array in the station’s roof, with bespoke glass laminate units from Romag. CHOOSE AN EFFICIENT INVERTER The cornerstone to any effective PV system is an efficient inverter(s). This critical piece of equipment converts direct current electricity generated by PV panels into a form that can
MEET SUSTAINABILITY LEVELS Fronius has a qualified network of installers to assist public sector organisations and meet the sustainability levels required. This team of installers are able to install, service and, in the unlikely event of something going wrong, repair Fronius products. These installers are known as Fronius Service Partners, a list of which can be found at www. froniusinstaller.com. *Certain conditions must be met, visit www.planningportal.gov.uk/permission. L FURTHER INFORMATION Tel: +44 (0)1908 512 300 info-uk@fronius.com
CARBON REDUCTION
Energy
BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net
Written by Chris Large, partner, Global Action Plan
UNITING TWO AGENDAS
Will keeping the patient at the forefront of the agenda when devising an energy efficiency campaign improve its chances of success? Chris Large, partner at Global Action Plan, uses a pilot project at Barts Health NHS Trust to demonstrate that it can In a pilot project at Barts Health NHS Trust, Global Action Plan – in partnership with Skanska and GE – has explored how hospital staff can be convinced and assisted to adopt energy saving measures. We have demonstrated that the more energy efficient wards show improved patient experience, with better sleep and privacy. The results could transform energy efficiency campaigns across the NHS. For people seeking to cut energy consumption across the NHS, this is an exciting outcome. Our pilot project showed that frontline staff will change their actions to achieve their core goal – improving the patient experience. Taking energy saving actions on the wards creates a better hospital for patients, or a “healing environment” as described by Dr Steve Ryan, the Medical Director of Barts Heath. If nurses care about patient experience, and patient experience is improved by energy efficiency, we can get nurses to care about energy efficiency.
SIGNIFICANT SAVINGS The pilot programme ran in a quarter of Barts Health’s estate and achieved a one-year payback, saving £105,000 per annum and 800 tonnes CO2. We identified a total of six per cent energy savings available when the pilot is rolled out across the whole estate. If replicated throughout the NHS, similar programmes could deliver £35m in savings. Barts Health and its three partners took on the challenge of this project because they knew that a typical energy efficiency campaign was unlikely to succeed. We wanted energy efficiency actions to become part of “business as usual”, which meant proving that energy efficient operations are better for hospitals.
In a pilot arts, at B project ction Plan A Global lored how has expstaff can be l hospita ced to adopt convin gy-saving ener ures meas
WHAT INTERESTS YOUR AUDIENCE? Typically, energy-saving messages have been based on a request for staff to take action to save their organisation money, or to reduce their impact on the
planet, with messages like “Turn the light off, save a polar bear!“ and “Unplug the photocopier and save us £1,000 per year.” The problem with these campaigns is that while many staff agree that saving the NHS money and reducing environmental impact is important, these factors cannot compete with the desire to give patients the best care in hospitals. If a nurse came to work primarily to save the NHS money, he or she would be in the procurement office, not a hospital ward. It’s not that frontline staff don’t care about the planet, but just that they care about something else even more. Global Action Plan, as an environmental charity, has for the last 20 years been helping organisations prove that achieving a lower environmental impact has much wider benefit, and is actually better for us. For any change to be “better for us” it must appeal to our existing desires. In a hospital where staff care about patient recovery, we can suggest that they dim the lights during the day and maintain the temperature settings to help patients get better sleep. This shifts the dynamic to giving staff a helping hand to achieve their existing ambitions, which is a much more effective route to change. E
Volume 13.4 | HEALTH BUSINESS MAGAZINE
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CARBON REDUCTION As patient care is a uniting factor across NHS frontline staff, this approach should be replicable across the NHS. If you have the ambition to make an NHS Trust more energy efficient, what practical steps make up a patient care-focused engagement programme? PROGRAMME DESIGN The programme had three stages. The first was scope; understanding the people in the organisation, the motivators and barriers to change and the actions they can take that will make a difference. The second step was action; making messages compelling, getting out there and talking to people, recruiting key influencers who share your ambition and listening to peoples’ reactions. The third step was to evaluate; continually reviewing the success of interventions, measuring impact and celebrating successes. In the scoping phase we first determined what frontline staff could do that would make a material difference to the Trust’s energy bill. In the new world-class Royal London Hospital, individual rooms are set at different temperatures and the air is exchanged up to 10 times per hour in each room. This made the action of closing doors important to help the heating, cooling and air exchange system work efficiently. Lighting could be controlled by staff as could much of the equipment. But how did these environmental actions help staff achieve great patient care? Firstly, discussions with clinicians highlighted that good quality sleep is very important for patient recovery. Where patients may be disorientated through illness or recovering from operations, it is also much safer for patients to stay in their rooms. When treating immunosuppressed patients or highly infectious illnesses, isolation is important. Our three actions – turning off lights and unused equipment and closing doors – do help patient sleep, improve safety, care and privacy. OPERATION TLC The best campaigns have a snappy identity. We needed one that led with a message about patients, and highlighted the three actions that
Energy
BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net
The pilot programme ran in a quarter of Barts Health’s estate and achieved a one-year payback, saving £105,000 per annum and 800 tonnes CO2. If replicated throughout the NHS, similar programmes could deliver £35m in savings help improve patient care. Giving the building a dose of tender loving care means that it looks after your patients – so we came up with the name Operation TLC, which in our case also stood for the three actions – Turn off, Lights out and Close Doors. We knew from our scoping phase that some staff were already taking energy efficiency actions. We reinforced why their existing actions were great for patients, and helped colleagues follow their lead. The ethic of teamwork is strong on the wards and staff like to be rewarded as teams. We provided treats for teams where at least one team member was photographed doing a TLC action. With those photographs we produced small leaflets tailored to each ward. This intervention utilised a number of recognised social science and behaviour change techniques – social norming, self‑efficacy and positive reinforcement. We asked volunteers, matrons and ward leads to champion the initiative, and then provided many reminders such as branded pens (nurses always have a pen on them), one-off events at the hospital entrances and screensavers on PCs. The screensavers featured senior members of staff, such as the medical director, or estates director, endorsing the campaign. GETTING FEEDBACK Global Action Plan’s engagement experts made 100 visits throughout the four-month campaign, to hear people’s reactions first hand, to thank them, to answer questions and to spread good practice. For example, when some wards heard that other wards dimmed their lights each afternoon to help patients sleep, we helped them find the lighting controls in
their new hospital. Finally, the evaluation stage measured the impact of the campaign through ward‑walk audits, energy metering data, patient surveys and qualitative conversations with ward leads and champions. We used so many different measurement methods so that we could tell whether change had occurred, if it was down to staff changing their actions and whether patients gained benefit. LESSONS LEARNT What is our main lesson from the pilot? If you understand what people in any workplace are trying to achieve, and your energy efficiency suggestions help them reach their aims, you’ll be a help, not a hindrance. So where next? What’s beyond the hospital door? As well as Operation TLC continuing throughout the trust, Barts Health has seen the potential to combine environmental and health ambitions in its East London community. We’re supporting Barts Health on two further programmes that help prevent patients needing hospital treatment and lower environmental impacts. In one project, we will enable clinicians to recommend free insulation and boiler replacement for vulnerable patients suffering in cold homes. Another project will utilise the reach of the Trust to address traffic problems and improve air pollution which causes 4,300 premature deaths across London each year. More on this wider community health and sustainability agenda will be published in Health Business in October. L FURTHER INFORMATION www.globalactionplan.org.uk
Narec DE: independent renewable energy specialists Energy is becoming increasingly expensive, at the same time the NHS is coming under increasing financial strain. Too much money is wasted on energy, which could instead be used on patient care. By encouraging staff to become involved in energy-efficiency measures, energy savings can be made, estimated to the amount of £35m over the whole NHS. Further measures, such as ensuring that heating systems are running optimally or carefully tuning the Building Management Systems, can save further money. In addition to energy-efficiency measures, the NHS can achieve further savings by generating renewable energy. Solar panels
that generate electricity (photovoltaics) are now priced at an all-time low. These systems can pay for themselves in less than 10 years, and provide a profit afterwards. Wind turbines, biomass boilers and solar thermal systems all offer possible financial savings.
Narec Distributed Energy is part of the UK’s National Renewable Energy Centre group. It provides advice on a wide range of energy efficiency and renewable options, is independent of manufacturers, and will always give an honest opinion. Narec’s services include: technical and financial feasibility, specifications for tenders, snagging and training (design, installation and maintenance). FURTHER INFORMATION Tel: 01670 543 009 info@narecde.co.uk www.narecde.co.uk
Volume 13.4 | HEALTH BUSINESS MAGAZINE
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Energy
BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net
Resuscitate your hospital’s finances In straightened times, wouldn’t it be great to source substantial extra income from your existing resources? Now you can, thanks to solar energy which hits your roof daily and can be harvested for your hospital’s financial benefit. By installing Solar PV, you can create a government-guaranteed annual income and put the money to good use. It couldn’t be simpler. Helping the environment and improving your finances sounds too good to be true but it is a fact and ICB can prove it. There is no catch: the system generates cash immediately and income will cover installation costs typically in eight years or less. It then generates pure profit and free electricity for 12 years. A typical installation will generate over a quarter of a million pounds of profit.
ICB does everything from initial survey and design to installation and commissioning. The company then registers the scheme so you can start claiming your income and reaping the benefits. Contact ICB today and it will provide you with a free proposal with no obligation. This proposal will show the cost, your profit and explain how much the planet benefits, too. FURTHER INFORMATION Tel: 01202 785200 info@icbprojects.uk.com www.icb.uk.com
CP Electronics brings healthy doses of energy saving to buildings CP Electronics has established itself as a manufacturer of high-quality controls and firmly believes that control is key to achieving maximum energy efficiency. Even the most efficient item of equipment, whether it’s a light fitting or an air-conditioning unit, will not achieve its maximum potential unless controlled effectively. Offering a wide range of products for most applications, CP has also built a reputation for providing lighting control to the healthcare sector. CP can supply simple-to-install lighting control systems using presence detectors – ideal for use in hospital rooms and corridors. The company’s Vitesse Plus system with corridor function allows corridor lights to be left on when consultant offices/ treatment areas have finished for the day. Any movement detection in other areas automatically switches lights on, or the system
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can be set to half-light which is ideal for nurses’ station areas where lighting comes into full output once presence is detected. Detectors can be installed either as a ceiling-mounted PIR version or long-range microwave sensor for large space detection. Both are suitable for absence/presence detection and daylight dimming. CP’s wide range of products offer low-installation costs, ease of retrofitting to existing installations and quick payback. FURTHER INFORMATION Tel: 0333 900 0671 mike.brooks@ cpelectronics.co.uk
HEALTH BUSINESS MAGAZINE | Volume 13.4
Solar and biomass: Renewable Energy Solutions that have come of age Most healthcare practices operating today are having to look increasingly into energy saving due to fluctuations in fossil fuel prices. Energy costs are one area where cost savings can still be made, and indeed income gained, courtesy of the Governments Feed In Tariff (FIT) Scheme for Solar Panels, and Renewable Heat Incentive (RHI) scheme for Biomass Energy. Both renewable technologies have come of age within the last couple of years, and both are surprisingly easy to implement as part of an Energy Management Strategy. Both the RHI and FIT incentive incomes are index linked for 20 years. For example, Ambridge Health Centre spending £10k per year on oil fired heating converting to a mix of 30kiloWatt (kW) solar and 130kW biomass would annually earn £6422
from solar electricity generation, export and FiT payments alone, save £3100 on fuel, plus earn £13,119 RHI payment, all RPI linked for 20 years, with 100% Enhanced Capital Allowance write off in year one. Commercial Solar and Commercial Biomass specialise in installation of solar and biomass to commercial institutions. Working alongside management, the companies can provide an extremely cost effective solution. FURTHER INFORMATION Tel: 01963 33705 Mobile: 07951 055703 www.commercialbiomass.com
Generate your own electricity and save money Frankensolar UK specialises in wholesale, design and installation of commercial solar PV projects. Its specialised team sources the best components for your individual solar PV system, designs the best systems with 3D simulation software and coordinates the complete installation from A-Z. The company only uses experienced installers with qualified staff and all necessary MCS-qualified electricians and craftsmen. Frankensolar UK has a great advantage of not being tied to any manufacturer and it can find the best products at the best prices. The company can also organise financing for your system. Individual centres will be able to generate clean solar electricity
every year. As well as energy savings, the Trust will receive money from the government’s Feed-in Tariff, use most of the energy generated during daylight hours and sell unused electricity back to the National Grid. Blackouts and power cuts are imminent, and installing solar PV would help prevent this from happening to high-energy users. Protect yourself from soaring prices of over 45 per cent within the next 20 years and ensure your project is the perfect way to hedge against even steeper price hikes in the future. FURTHER INFORMATION Tel: 01903 477980/721640 sales@frankensolar.co.uk www.frankensolar.co.uk
Bespoke spaces that respect the environment Leeds Environmental Design Associates (LEDA) is a multidisciplinary team of engineers, architects and energy consultants with over 15 years’ experience in creating sustainable buildings. LEDA has specialist knowledge of using renewable energy systems in buildings, with particular experience in health centres, teaching and residential accommodation. The skills within the LEDA team means that as well as providing energy audits for buildings, the team can put their recommendations into practice with detailed designs and specifications for upgrade works. LEDA’s building services engineers can provide low-energy designs in refurbishments and new-build projects.
The input LEDA provides is more than standard building services design: its knowledge of design issues, such as daylighting, solar gains and natural ventilation, helps the team create buildings with a pleasant internal climate. As well as an enthusiasm for designing sustainable low-energy developments, LEDA aims to provide buildings that are easy to maintain and simple to operate. In contrast to the traditional “belt and braces” approach to services design, LEDA prefers to develop a “lean” strategy for efficient building services to create a high-comfort, low-impact, people-friendly environment. FURTHER INFORMATION Tel: 0113 200 9380 www.leda.coop
Energy efficiency or energy conservation?
We can all conserve energy by switching off lights and turning down the thermostat, but we’ll be in the dark, cold and not very effective at what we are supposed to be doing. Energy efficiency, on the other hand, enables us to conserve energy without detracting from our working environment. The Utility Forum has over 30 years’ experience in doing just that, with over 300 Carbon Trust audits, 250 MAS audits and numerous private audits to its credit. The company’s principal, Chris Holdsworth, is a member of the recently formed Register of Professional Energy Consultants. Using the Utility Forum’s Energy Reduction Spiral methodology, the company conducts an
Energy
BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net
audit and gathers information; monitors consumption, data logger on sub-metering; benchmarks, internally and externally; forms an action plan to an agreed ROI criteria; targets and controls, implements agreed actions and sets targets; and budgets and controls, sets consumption and cost budgets in-line with the action plan. All data collected is channelled through and presented by Utility Forum’s web-based “Inspiring Software”. Other services include energy procurement, bill verification and revenue recovery. FURTHER INFORMATION Tel: 01253851818 info@theutilityforum.co.uk www.theutilityforum.co.uk
Generate an income stream Exceptional facilities with Quantum Energy management in healthcare
Electricity prices are increasing. The actions you take today to manage this will have a great impact on what you face in the coming years. There is a window of opportunity to take advantage of a government initiative, the Feed-in Tariff (FIT), which will enable you to reduce your costs and generate an income stream. Solar PV utilises your roof space to generate your own electricity. It’s quiet, requires virtually no maintenance and installation does not impact your vital 24/7 operation. The benefits are that you reduce your electricity bill and, through the FIT, get paid for every kilowatt that is generated.
The FIT rate is decreasing and will probably not be available indefinitely. Organisations that want to maximise the payback period and income stream, should act now. You have probably heard this before, but there is never enough time to look into it. Quantum Energy takes pride in providing a complete solution where your input is minimised. Quantum Energy provides the information, explains it and manages the entire process – and finance is available. Call Quantum Energy today to see how you can benefit.
Norland is a facilities, energy and project management services company, operating from a network of offices throughout the UK, Ireland, Europe and the US. It works with NHS Foundation Trusts, acute hospitals, GPs, dentists, nursing and residential homes, mental health and rehabilitation centres. Your patients, visitors and staff are central to all that Norland does and its working practices adhere to HTM and HBN guidance. Norland endorses the Seven Steps to Patient Safety process and participates in Patient Environment Action Teams. A preferred supplier of NHS framework agreements, the company is well-suited to be the partner of choice for the NHS.
Norland’s healthcare capabilities cover: HVAC planned and preventative maintenance, mechanical and electrical maintenance, specialist theatre cleaning and general cleaning, theatre, emergency and general lighting, exhaust ventilation, and energy services and carbon reduction. Plus, water compliance, sterilisation, decontamination and infection control, capital projects (such as CHP plant installation), helpdesk and front of house, soft services (including security, grounds and catering) and building fabric maintenance. FURTHER INFORMATION Tel: 0844 324 8700 www.norlandmanaged services.co.uk
FURTHER INFORMATION Tel: 01738 707172 www.quantumenergy.co.uk
Volume 13.4 | HEALTH BUSINESS MAGAZINE
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PERFECT SPACES.
AT CROWNE PLAZA NOTTINGHAM
With value for money high on any agenda when planning a meeting Crowne Plaza Nottingham are the prefect solution. We have space to provide the ideal location for all types of conferences, meetings and events. With years of experience we are completely flexible and can adapt to whatever your event dictates at a competitive price. Behind the scenes our Team Members are true professionals who are passionate about delivering exactly what you need. If you haven’t already discovered what we have hidden in our fantastic venue here is a quick glimpse: • A central location in the heart of Nottingham • A range of purpose built conference and event rooms perfect for all types of events • The Refurbished Royal Suite that can hold up to 400 guests theatre style, features its own bar and reception area and is ideal for annual conferences, award dinners and large parties • All inclusive Day and Stay packages • 210 stylish bedrooms all with individually controlled air-conditioning and work spaces with wi-fi* • Lacemaker Restuarant and Swatch Bar and Lounge • On-site parking for 600 cars • From early 2014 our new look Royal Spa opens after a major refurbishment • Seal of Assurance which guarantee 100% satisfaction • Specialist teams who understand your requirements • Accessibility for all
CROWNE PLAZA NOTTINGHAM T: +44 (0) 115 9369988 w. www.crowneplaza.com/cpnottingham E.cpnottingham@qmh-hotels.com A.Wollaton Street, Nottingham NG1 5RH * Charges may apply
NOTTINGHAM
FACILITIES MANAGEMENT
With just eight of the UK’s 2,300 hospitals benefiting from changing toilet facilities for use by the disabled or wheelchair-bound, Robin Tuffley of Clos-o-Mat looks at how more could be done to incorporate these better accessible toilets One in six of the British population is registered disabled, 20 per cent of whom use a wheelchair. One in 10 people have either bladder or bowel incontinence. They all visit hospitals and many need the help of a carer, particularly to go to the toilet. Yet of the 2,300 hospitals in the UK, only eight have appropriate facilities: a Changing Places toilet. Community health facilities and other health centres are similarly lacking. Standard (Building Regulations Approved Document M type) accessible toilets do not have the space, nor the equipment, for people who need the help of a carer. Users therefore either cannot avail themselves of the toilet facilities or have to be changed on the floor. NEW BUILDING REGULATIONS By law, (the Equality Act 2010 which replaced the Disability Discrimination Act) service providers are required to make reasonable changes – including to the built environment – where a disabled customer or potential customer would otherwise be at a substantial disadvantage. Previously, such changes were only required if it would have been impossible or unreasonably difficult for the person to access or use the service. Under new Building Regulations (Approved Document M 2013), it is now “desirable” that in buildings to which numbers of the public have access, a hygiene room or Changing Places toilet is included. “Bigger and better” than standard accessible toilets, Changing Places toilets have more space (a minimum of 12m²) and more equipment, particularly a hoist, adult-sized changing bench, privacy screen, peninsular
WC and washbasin. The Document’s view is that toilet accommodation needs to be suitable for all people who use the building, and builds on Good Practice guidelines, laid out originally in BS 8300:2009 Design buildings and their approaches to meet the needs of disabled people. ESSENTIAL ELEMENT Code of Practice BS 8300:2009 advises that disabled people should be able to find and use suitable toilet accommodation no less easily that non-disabled people. The time taken to reach a toilet is an essential element to be taken into account in its siting. Where space is limited, there should be provision of a single accessible unisex peninsular WC for assisted use that caters for all needs, and it should be sited as close as possible to a building’s entrance/waiting area. The Standard further recommends that any larger building should have a Changing Places facility where the public has access in numbers or where visitors might spend longer periods of time. CHANGING PLACES TOILET PROVISIONS A Changing Places toilet aims to meet the needs of people who need a carer to assist them, and it provides as a minimum: the right equipment, such as a height-adjustable adult-sized changing bench, height-adjustable washbasin, and track or mobile hoist system. There should be enough space to enable manoeuvring for the disabled person and up to two carers, for a centrally located (peninsular) toilet with room either side for carers, and a screen or curtain to allow some privacy. A safe and clean environment, which includes wide tear-off paper to cover the bench, a large waste bin and a non-slip floor. ENSURE COMPLIANCE To help estate and facilities managers ensure compliance, Clos-o-Mat has produced a white paper on Changing Places for the healthcare sector, which can be downloaded from www.clos-o-mat.com. Kent County Council is ahead of compliance, through its use of Clos-o-Mat. In
Written by Robin Tuffley, Marketing Manager, Clos-o-Mat
PROVISION OF CHANGING PLACES TOILETS IN THE HEALTHCARE INDUSTRY
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its three new Multi-agency Specialist Hubs (MASH), the toilets surpass the requirements of a Changing Places toilet: in addition to the necessary equipment, the Council has a Clos-o-Mat Palma Vita shower toilet. The Palma Vita can be used as a conventional WC, but it has in-built douching and drying facilities, eliminating the need for manual cleansing with toilet tissue. This further improves hygiene and helps with certain medical conditions, such as bottom abrasion. With optional lateral supports, the Palma Vita is Medical Device Class 1 certified. COUNCIL APPROVAL Kent County Council’s project manager Tim Watts explained: “The aim is for disabled children, their parents and carers to only have to go to one place to access support. It was also important that the MASH combined necessity with pleasure, hence our inclusion of sensory play and short-break activities. Conscious that because there was so much in one place that visitors may be there for a while, it was essential we provided appropriate toilet facilities, too. The hygiene room with a Clos-o-Mat met as many people’s needs as possible.” L FURTHER INFORMATION Tel: 0161 969 1199 info@clos-o-mat.com www.clos-o-mat.com
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DIGITAL HEALTH
Healthcare IT
BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net
THE DIGITAL HEALTHCARE EXPERIENCE Here’s what a day in the life of digital health could look like in England: “I have a heart condition and diabetes; I am 65 years old and can manage on my own. I have a few devices and sensors in my home to enable me to better monitor my condition and my day-to-day activities. I have an intuitive app that tracks my exercise and diet, and another device that checks my blood pressure and oxygen levels. Today I receive an alert on my smartphone from one of these devices telling me that the latest readings indicate that I should contact my GP. I click on the link in the alert which triggers a secure chat session with my GP’s practice nurse. The nurse checks with my GP and we agree that I should be referred to a consultant. I can book a consultant’s appointment as easily as booking a flight or a hotel. My GP sends me an electronic referral ‘ticket’ (much like a boarding card) that I use to book an outpatient appointment of my choosing using the new E-Referrals system. But first I seek other patients’ opinions of the hospital consultant, not from the hospital website but from a trusted independent healthcare review – a ‘Tripadvisor’ for hospitals. My work commitment is not too high at present so I volunteer to go on the E-Referrals “standby” list to be called at short notice if there is a cancellation at any clinic within a 25 mile radius of my home or a 10 mile radius of where I work. ONLINE HEALTH RECORDS I manage my own health record online and I can give consent to healthcare providers of my
choosing to access the parts of my record that are relevant, and exclude those parts I want to keep private. I review the notes that my GP has recently added and then enable access for the hospital consultant at the hospital where I have an appointment. My GP gets an alert to say that my appointment has been made and that the consultant wishes to speak with my GP first. My GP clicks on the Skype link and is connected to the consultant. They discuss my case, jointly review my online record. I need some diagnostic tests performed. I consult my Health Services app (similar to Yelp) to locate the nearest pathology lab, checking first their average waiting time before booking an appointment with the press of a button. At the pathology lab, my blood is taken and as soon as the test results are available I get an alert from the My Health app on my smartphone that informs me that everything is normal. It advises me that my cholesterol level is a little too high so I should watch my diet. Hmm...”
Written by Jon Lindberg, associate director – healthcare, Intellect
The insurance industry, the travel industry, the banking industry, and the retail industry have all successfully embraced digital services. So why hasn’t the NHS – an industry which conducts over 250 million interactions a year? Jon Lindberg, associate director of healthcare at Intellect, examines the situation
WHAT’S THE REAL EXPERIENCE Instead of this scenario, we have the following patient experience in England. A colleague of mine recently had to see a GP to have her knee checked. She called the GP, got lucky, there was a slot free next week. Last time she had to wait four months. She even received a text reminder a few days before. At the GP practice she underwent a paper based consultation; the GP filled out a piece of paper, and said he would post this to the Physiotherapists. The Physiotherapists would then review and post a letter to my colleague asking when she could meet for an appointment. My colleague would then have to post a reply and wait for a response. When she asked what the timescale would likely E
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Healthcare IT
BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net
Achieving a paperless NHS with Ascribe’s electronic document record management solution The NHS is under siege; a victim of its own success, it is beset by rising costs, increased demands, financial constraints and an ever-increasing rise in demand for patient information. Paper has been highlighted by the Department of Health as a focus for change, and they have decided that the NHS needs to move towards being paperless; the target date announced by Jeremy Hunt is 2018. Costs associated with paper extend far beyond the operational costs associated with storing, moving and even finding errant printed records – there are consequences to our reliance upon paper that go far deeper. The fact is that clinical information and workflows are impeded by our dependence on these perishing documents, our ability to deliver informed care can be compromised. When a clinician is told that they must request patient records at least five working days before they are needed, the ultimate victim is the patient. A single lost report can lead to repeated tests and significant
delays in the determination of a patient’s care pathway. Not only does this impact upon the patient in question, it also increases delays for other patients for whom tests may need be rearranged. Using a scanner to digitise a record may seem like a complete solution but, in isolation, it is simply another means to create a maze of data; it can actually increase administrative costs if the implementation and management is labour intensive (manually keying in data is laborious and expensive). The solution therefore requires a combination of intelligent software that can automate the capture of critical and
profile data, together with a robust scanning hardware platform that is easy to implement. Ascribe, Microsoft’s Public Health Partner of the Year, has developed a comprehensive electronic document record management (EDRM) solution that enables healthcare organisations to digitise records from multiple sources and automates the classification and profile generation for each record. These records can then be accessed through a secure clinical portal, allowing clinicians to review a holistic and searchable view of their patients’ medical history, thereby enabling clinicians to make care decisions based on a more informed view. The EDRM solution reduces document retrieval time from over ten days to less than a second. Ascribe’s EDRM, developed in the UK, enables Trusts to store and retrieve patient information quickly and at reduced expense; the solution ensures compliance with the NHS Code of Practice and UK data governance regulations. FURTHER INFORMATION paperless@ascribe.com www.ascribe.com
Help your hospital to go paperless Hit your paperless targets using our fast and cost effective electronic document records management system. Automate your capture of patient data and enrich your electronic health records and clinical portals. Clinicians can access scanned records easily, and remain compliant with the NHS Code of Conduct and all legal provisions.
Email paperless@ascribe.com or call 01942 852500
www.ascribe.com
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HEALTH BUSINESS MAGAZINE | Volume 13.4
DIGITAL HEALTHCARE
Healthcare IT
BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net
be for this, the GP looked at her and smiled. He didn’t know. This fairly straightforward transactional process is dealt with online, in seconds, in the rest of our country today. In the NHS it can take months. Is that not odd? If you think about it, the NHS deals with over 1 million patients every 36 hours, and over 250 million interactions a year. Is a paper and postage system that can take months the most effective way of providing care today? In any other industry that volume of interaction would be ripe for digital transformation, and it has. The insurance industry, the travel industry, the banking industry, and the retail industry have all successfully embraced digital services with millions of interactions taking place online every day. IS THERE THE DEMAND? If we look at the demand for digital health, we can’t blame a lack of interest for our failure of not having a digital health service today. A recent survey of 7,000 patients and 1,400 GPs show there is a strong demand for digital health services. We want digital health because we are digital everywhere else. Over 80 per cent of us are regularly online interacting made. Taking into account growing and transacting on a daily demand for health services, basis. Moving to digital health, The s l this sounds like a very starting with the straight a e NHS d illion effective way of optimising forward transactions, resources in the NHS. wouldn’t be as difficult with 1 m every n s If you look at online as we might think from t n e i t lio pa l i m a user perspective. banking, it has only 0 5 s, 2 But if the demand for taken us a few years 36 hour interactions. l digital health is not a to get over 50 per a u ann er and p strong enough reason on cent of the population a p a Is its own for digital health, to manage their bank care postage e most we need to explore what account online. th else will and can drive it. Tim Kelsey, National system ctive? Efficiency and cost? The Director for Patients and ffe e NHS has to make efficiency Information at NHS England savings of £20bn from its £110bn+ believes the new integrated budget between 2011-2016 to meet the gap customer service platform can save the between demand and supply. After 2016 NHS more than £1 billion by encouraging we are likely to see another round of £30bn patients to get involved in online self-care. Is quality and effectiveness a driver? Digital efficiency savings to be met as demand health allows data and information to be continues to grow, outstripping the supply captured, stored and used electronically. The and funds available to the health system. benefit of having data electronically is that A visit to the GP cost £36 and a visit to it drives up quality – no more illegible hand the A&E cost between £59-117. In total we written notes, or lost notes. The data can visit a GP or the A&E over 200 million times be easily accessible wherever the patient a year. It has been reported that over 51 and carer are using modern technologies million of these are unnecessary, such as such as tablets and smart phones over 40,000 GP visits a year for dandruff. If 51 a wi-fi or 3G (soon 4G) network. million visits can be avoided we can save Using digital solutions enables care anything from £1.8bn to £6bn. A digital to be joined up. Information that was service, such as finding information about previously inaccessible because they were dandruff on NHS Choices cost 13p a visit. stored in deep, locked silos can now be accessed by those who need it when they SUBSTANTIAL SAVINGS need it. Patients can be at the centre, in It is unlikely we will succeed in avoiding control, the information following them, 51 million visits by turning on a digital and carers join up around the patient solution today, but over time as user volume collaboratively through digital channels. goes up we can, and the savings will be
The digital data created will be more effectively used by commissioners and providers to optimise care delivery by analysing, measuring, predicting and planning. Hospitals can get a real time view of how they are performing by monitoring activities taking place, seeing where blockages are, where spare capacity can be utilised and so on. Similarly if we manage to reduce avoidable interactions, professionals will have more time to provide care for those who need it the most; our rapidly growing population of long term conditions patients who currently account for 70 per cent of the NHS cost. If we can provide better care for them we may be able to avoid future costly hospital admissions and a better life for those patients. HOW DO WE DO DIGITAL? The technology that allows for the NHS to become digital is available today. And NHS England has just announced an initial fund of £260m to make this a reality. That’s the upside. The downside is that the current NHS information technology architecture is restricting the innovation and scaling of these solutions to professionals and patients. In Intellect’s The NHS Information Evolution report, we outline what we need to do to get there; from a business and collaboration perspective to the technical architecture we need to put in place. These are not radical proposals but do require sideways thinking and a new imaginative approach to how we use information in the NHS. L FURTHER INFORMATION www.intellectuk.org
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HE LL o
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Specialist suppliers in ink consumables: saving you pounds on your printing Think Pink Cartridges specialises in saving the health sector money on printer cartridges and toners. The company takes pride in saving them at least 40 per cent. With budgets being cut constantly, Think Pink Cartridges knows it is important for the health sector to make their tight budgets stretch as far as possible. The company’s expertise is in remanufactured and compatible toners/inks, and they all come with a full 12-month guarantee. That also covers the printer you are using with Think Pink Cartridges’ inks, so you are covered in all aspects. This year, the company has been excited to launch the long-awaited Premium Range Gold Brand; the original chassis-manufactured toner that is ISO 9001 accredited.
All sectors that were previously buying the extortionately priced OEM toners and cartridges are now enjoying the massive saving compared to what they were spending. Especially as they come complete with a 24-month warranty for total peace of mind. Think Pink Cartridges offers nationwide next-day delivery.
Preparing for the 2018 paperless target Digitising, socialising (safely) and mobilising medical records is complex but can be transformative in reducing costs in medical records, storage and estates, while improving patient care. This will increase the clinical value of historical records as well as enabling them to be shared with partners, patients and carers (safely). Projects must start with a clear business case that articulates both the scanning strategy, its impact and the EDM solution. As part of this, a procurement strategy should be agreed. This needs to consider the routes to market (OJEU procedures, frameworks, etc.) and dividing requirements into “lots”.
Healthcare IT
BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net
Apira has delivered EDM business cases for Trusts and national bodies, such as the DH and HSCIC, gaining approval for investments. The technology providers are developing their solutions and the potential of them has grown way beyond digitising paper records to cover eForms, associated workflow as well as mobilisation and crossorganisational sharing. Understanding your deployment model is vital before going to market so that payment can be linked to delivery. Apira has the experience and expertise to help. FURTHER INFORMATION Tel: 07831 502 138 geoff.broome@apira.co.uk www.apira.co.uk
FURTHER INFORMATION Tel: 01935 427900 sales@thinkpink cartridges.co.uk www.thinkpink cartridges.co.uk
Will PRISM kill the cloud? Not if you use PretaGov CMS SaaS
Helping you achieve a realistic return and deliver superior customer service
PretaGov designs, builds, and maintains secure, fully supported websites and mobile apps for governments and their agencies. Every PretaGov site ensures: flexible solutions that meet your needs every time; one hundred per cent open source SaaS in a private cloud. Do as much or as little design or backend input as you like, working to your budget. UK data sovereignty and data privacy: PretaGov UK is hosted in UK-based, tier 4 data centres. No other country can take your data. The company complies with the Data Protection Act. Watertight website security: The company chose Plone, which has the best published security record of any CMS. Comprehensive support when you need it as the helpdesk has guaranteed response times. Guaranteed uptime even with traffic spikes as provided by geo-redundancy in UK data centres. Enhanced citizen engagement: advanced analytics, social media
Netcall’s dedicated solutions help organisations manage the ever-changing demands of their customers efficiently and cost-effectively, to increase customer/patient satisfaction. The company offers a platform with a range of innovative market specific solutions for end-to-end customer engagement; incorporating intelligent contact handling, workforce optimisation, business process management and enterprise content management. The solutions available are scalable and can be delivered on-premise or in the cloud. The government says “the patient experience” is a crucial part of quality healthcare provision while the NHS constitution reinforces the need for patient-centred care. Therefore, healthcare organisations must seek new ways to maximise their resources and reduce costs while meeting these demands for an
integration, real-time engagement and accessibility compliance. PretaGov has worked with more than 35 government clients in health, transport, emergency services, education, and family and community services. It understands the needs of government clients and has a record of delivering innovative solutions under tight deadlines. PretaGov is included in the G-Cloud Services III Framework Agreement and has services available in the HM Government CloudStore. FURTHER INFORMATION Tel: 08703 927071 john.pickles@pretagov.co.uk www.pretagov.co.uk
improved service to patients. Working in partnership with healthcare customers helps provide the feedback needed to create solutions to help them achieve savings and improve patient contact and experience. Netcall’s customer base has over 750 organisations in the public and private sectors, including NHS Acute Trusts, London borough councils, BT, University of Cambridge, Prudential, Spire Healthcare and Thames Water. FURTHER INFORMATION Tel: 0330 333 6100 www.netcall.com
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Technology is going to re-define how healthcare is delivered over the next decade. As health goes mobile, CentraStage can help your team manage and secure thousands of mobile devices, we can also ensure those devices have secure access to the latest NHS systems and remain up to date and compliant.
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Leading location-based information services
Clinical understanding for safe medicines management
With over 20 years’ experience, thinkWhere (formerly Forth Valley GIS) is one of the UK’s leading geographic information system (GIS) consultancies. Its NHS customers have seen the difference GIS can make: from facilities mapping, analysing demographic change and the impact on services, improving asset management or multi-agency data sharing, GIS is the perfect tool for supporting the diverse nature of health services. ThinkWhere can help NHS organisations reduce costs and share information by switching them from local GIS systems to Location Centre; the company’s innovative, online GIS platform. Based on open source technologies, Location Centre reduces the costs, risks and dependencies associated with GIS implementation and provides online access to information anywhere and anytime.
E-prescribing offers Trusts a proven solution for improving patient care, delivering financial benefits and improving organisational efficiency in the face of ever-increasing pressure on health services. E-prescribing and medicines administration from JAC includes integrated in-patient and out-patient prescribing, discharge prescribing, decision support for providing warnings on allergies, drug-drug interactions and therapeutic duplicates, as well as bedside medicines’ administration support and recording. JAC is the leading supplier of specialist closed-loop medicines management solutions to the UK’s NHS and to key sites in the Republic of Ireland and South Africa.
ThinkWhere has reduced data management overheads by providing access to a national datastore of maintained Ordnance Survey and OpenData products. It has also helped the NHS and its partners improve the planning and coordination of services by using GIS as a data-sharing platform. ThinkWhere’s staff and services provide valuable insight and the skills to exploit GIS effectively. Thousands of public sector staff use thinkWhere products and services; saving money, improving service delivery and making efficiencies.
Healthcare IT
BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net
With over 30 years’ experience, JAC’s UK user-base accounts for around half of all NHS trusts in England, as well as sites in Scotland, Wales and Northern Ireland. JAC’s solutions support the safe and effective prescribing, administration and dispensing of medication. It also manages supply chains and specialist processes – analytics for clinical portals, financial reporting and business intelligence – in a platform environment that is comprehensive from procurement to patient; adaptive to support continuous improvement; and proven to deliver rapid results. FURTHER INFORMATION Tel: +44 (0) 1268 416348 www.jac-pharmacy.co.uk
FURTHER INFORMATION www.thinkwhere.com
A fresh approach to all your printing needs
CTG knows the G-Cloud and can take you there
Fresh Printing UK offers a wide range of high-quality great-value printing services, including those for small, medium and large businesses and individual canvas printing. The company offers services for stationery, business cards, leaflets, brochures and mailers, as well as annual reports, posters, carbonless sets and continuous forms. If you need invitations or security cheque printing, Fresh Printing UK can cater for this, as well as canvas printing memorial printing services. You could have your favourite photos put onto canvas or you can transform your favourite pictures into a unique piece
CTG is proud to be part of the G-Cloud iii framework, offering services in the Infrastructure as a Service (IAAS) and Specialist Consulting Services (SCS) categories. CTG has operated in the NHS for over nine years. The company has been providing Trusts with expert clinical change knowledge and project management services and it also has been helping the Trusts to manage their suppliers and get the best value for money from their existing IT investments and new IT implementations. As Trusts begin to consider Cloud solutions by utilising the G-Cloud iii framework, CTG’s Cloud Migration Service team in the Specialist Consulting Services category is well-positioned to support and provide insights to help de-risk this move.
of art. Whether you want a scenic holiday snap, a wedding photo, a picture from your garden, a family portrait, your favourite old car or a vintage old photograph – it would look “stunning” on your wall. The services on offer from Fresh Printing UK are ideal for anniversaries, birthdays, Christmas, weddings or just that special thank you gift. Various sizes are available at very competitive prices. Contact Fresh Printing UK for more details. FURTHER INFORMATION Tel: 020 8942 7766 steve@freshprintinguk.co.uk www.freshprintinguk.co.uk
CTG’s experience across central government, coupled with its track record in UK and international healthcare service provision, places the company in a unique position to offer the public sector focused and economically competitive solutions via the G-Cloud iii framework. FURTHER INFORMATION Tel: 01189 750877 graham.ring@ctg.com www.ctg.eu
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BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net
Ultima Business Solutions to host ‘Clinical Desktop’ event in London, Thursday 3rd October 2013 Ultima understands the NHS faces unique IT challenges; therefore we have developed unique solutions to help Healthcare organisations reach their desired state of IT optimisation. Ultima’s uHealth solution is based on a suite of technical and strategic services designed to help reduce risk and costs, improve productivity, and meet new challenges posed by on‑going reforms within the NHS. We offer a robust solutions framework that will enable your organisation to optimise, upgrade and integrate with new platforms, all underpinned by an ITIL-based support service with N3 network connectivity from our dedicated, UK-based 24x7x365 Technical Support Centre. Attend our half-day event to understand the benefits of Clinical Desktop and uHealth: • Single Sign On Clinical Desktop, based on Microsoft technology, saves busy clinicians time and effort by letting them sign-in once, using a single password, NHS smartcard and/or proximity badge to access all applications • Mobility As clinicians are constantly on the move; Clinical Desktop enables mobility across devices, whether hand-held or office-based. A smart log-off feature ensures the previous session is automatically terminated, and securely with no adverse effects on data or programs • Session Persist Changing device or location usually results in lost time logging in and out of systems; with Clinical Desktop users can move seamlessly from one device to another and continue working on the same patient records; with ‘Follow-Me Data’ records are loaded automatically and securely • Patient Context Having located a patient in one application on Clinical Desktop, users can quickly find data linked by a patient’s NHS number in all other relevant applications, improving efficiency and saving time • Fast User Switching For multiple clinicians using ‘Workstations on Wheels’ within a ward, switching quickly between patient records with tap-in, tap-out access allows for real-time updates. Ultima’s team of uHealth Consultants are currently deploying a Clinical Desktop and associated infrastructure solutions at Imperial College Healthcare NHS Trust in London. We are very proud to confirm that Kathy Lanceley, Deputy CIO & Head of ICT Operations at ICH, will be joining our event to share the Trust’s future vision. For more details or to register your place, please visit www.ultimabusiness.com/events
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Email: Phone:
uhealth@ultimabusiness.com 0870 60 86 860
Event Location: Registrations: Seminar Times:
Microsoft Cardinal Place, 100 Victoria Street, London SW1E 5JL 9.00 9.30 – 13.00
HEALTH BUSINESS MAGAZINE | Volume 13.4
NHS RECORDS
PAPERLESS HEALTHCARE: MYTH OR REALITY?
Advertisement Feature
BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net
In a bid to get NHS patient-related data digitilised and for Trusts to embrace a culture of compliant information management practice, Jeremy Hunt’s aim is for this to be carried out by 2018 Health secretary Jeremy Hunt wants the NHS to be paperless by 2018. In a directive, issued this year, Hunt wants patients to have digital records so their information can follow them. But, unlike previous large-scale, top-down directives, he wants this driven bottom-up and by 2018 any crucial health information should be available to staff at the touch of a button. Most NHS sites hold patient-related data on a variety of different media, such as paper, microfilm and digital. It is currently difficult to identify exactly what information may be held on a given patient. This has resulted in falling standards for maintaining the patient’s acute medical record; increasing risk and leaving patients and clinicians at a disadvantage. COMMON SENSE APPROACH To address this, cost-effective solutions based on established electronic document and records management (EDRM) technologies offer the chance for Trusts to embrace a culture of compliant information management practice to deliver paperlite healthcare, if not paperless. There is no magic bullet solution, just a common sense approach that focuses the available technologies on specific processes to ensure that the solution delivers what is expected of it. The core technology has been around for over 35 years and is in use across many industry sectors. Lessons have been learnt through careful application of EDRM technologies. Systems have become more affordable and are delivering real and measurable benefits. KEY POINTS There are key points to keep in mind: it is vital to understand that simply digitising paper records is not enough, the solution must offer facilities to stop producing new paper through generation, management, and integration of electronic records. Patient information resides on many disparate systems within Trusts. The electronic medical record cannot sit in a document management system that remains unconnected with other hospital systems and processes: information must be exchangeable and shareable amongst all practitioners. To be optimally effective the electronic record has to be delivered to key users when and where they need it. A solution that
offers a standard interface for all users will provide limited functionality to most users. UNDERLYING PROCESSES A number of Trusts took the bold step towards paperless healthcare some years ago and achieved paper-lite healthcare using EDRM, by paying great attention to the underlying processes. So, what have they achieved? Savings gained through process efficiencies achieved by minimising dependencies on paper, by delivering the electronic patient record to those who provide care, at the right time, and by guaranteeing the accuracy and quality of information delivered. St Helens & Knowsley NHS Trust already has all of its patient records accessible online for doctors, nurses, GPs and community services. Savings gained through realisation of real estate to provide more treatment facilities and better quality of care. The recently launched e-LGs managed service (digitisation of Lloyd George records) is a great example of how a “low-tech” service is helping GP practices to release muchneeded space in the surgery for clinical activities without breaking the bank. Digitising patient records makes it easier to control access and sharing. The Hunt directive of “…information following the patient…” is both practical and readily manageable. One step leads to the next: innovation is within reach instead of being unreachable. Advances in IT and its consumerisation means rapid progress towards the wider digital revolution can be made within the
NHS IT, to help deliver timely and accurate information. Use of electronic forms, for example, to capture, store, manage and deliver information electronically. ACTIONABLE DATA Similarly, the vast amount of information locked in paper records is now being transformed into actionable data: systems that can understand content and deliver it to those who need it, when and where they need it. These are no longer predictions. We have access to real data complied over the last few years – data that makes the case for going digital compelling. So, why isn’t everyone doing it? Given the bad press about large-scale IT implementations, two valuable lessons must be learnt: not all Trusts are ready for the top-end solutions. Each must accommodate the technology and its implementation gradually to suit a number of local conditions, including budgets, IT infrastructure and user training. A core application cannot be driven top-down without involving the people who will actually use it and who will be held accountable. While it is good to see that the Hunt directive is accompanied by a financial commitment (£260 million), each Trust must make its case for improvement and demonstrate willingness to change. Simply throwing money at a problem will lead to yet another IT failure. The bottom-up approach means that the digital revolution in the NHS is achievable, gradually and over time, rather than committing astronomical sums on large scale IT projects. L FURTHER INFORMATION www.ccubesolutions.com
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SUSTAINABILITY
ADDRESSING AMBULANCE EMISSIONS
Healthcare Fleets
BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net
The NHS has been tasked with cutting carbon emissions by 10 per cent by 2015 and 80 per cent by 2050. In response to this, Ambulance Services up and down the country are taking measures to reduce the carbon emissions of their operations The NHS employs more than 1.7 million people, and of those 18,687 are ambulance staff. It has environmental targets of a 10 per cent reduction in carbon emissions by 2015 and 80 per cent by 2050. In response to this, the UK’s Ambulance Services are taking great strides to become greener. Yorkshire Ambulance Service (YAS) is the first ambulance service in the UK to participate in the Carbon Trust Carbon Management Programme. It is actively working to reduce spending on fuel and reduce the carbon footprint of the Trust by 30 per cent by 2015, and is also looking at ways to reduce spending on fuel. As part of this commitment, YAS is trialling an extended-range electric vehicle in its emergency fleet in the York area. The Vauxhall Ampera car will operate as a rapid response vehicle responding to emergencies in the city to see how rangeextended electric vehicles might be incorporated into the Trust’s 900+ vehicle fleet (emergency and Patient Transport Service) in the future.
The Ampera is essentially an electric vehicle, in that it is always the battery that powers the motor. But when the battery runs out of charge, a small petrol engine kicks in to power a generator which creates electricity to continue to power the battery. This extends the range and addresses the limited range capacity of a pure electric battery vehicle, making it a safer option for use by emergency services. COMMITTED TO CUTTING CARBON City of York Council has agreed to support the trial by making plug-in electric recharging points available across the city. As part of its low emissions strategy, the Council is working to reduce air emissions across York and over the next 12 months will be introducing some electric vehicles into its own fleet, rolling out electric vehicle recharging points in council car parks and launching the Eco-stars fleet recognition programme. Councillor Dave Merrett, cabinet member for transport, planning and sustainability, said: “I very much welcome Yorkshire
The s NHS ha ntal me environ s of a target reduction cent 10 per on emissions in carb 015 and by 2 ent by c 80 per 50 0 2
Ambulance Service’s move to introducing lower emission vehicles into their fleet.” Dick Ellam, Vauxhall special vehicles manager, said: “We are delighted that Yorkshire Ambulance Service is trialling the multi award-winning Ampera. The Ampera is the first electric vehicle suitable for use by the emergency services and its sophisticated propulsion system offers all the benefits of electric driving, without any of the range anxiety associated with pure electric vehicles.” FURTHER GREEN INITIATIVES Elsewhere in its operations, YAS has introduced eco-driving programmes for some drivers, which can result between five and ten per cent on fuel bills. The Trust also changed its car lease policy so that those entitled to a vehicle now have to select one that emits under 130g/km, and is actively encouraging hybrids or electric vehicles. YAS is also working with Leeds University to look at the potential savings that can be achieved with aerodynamic ambulances. Initial findings suggest that drag forces acting on the common box-body ambulance designs could be reduced by 20 per cent by employing aerodynamic styling. E
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Company Profiles
BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net
Free Public Sector Sustainability Conference for industry managers EMSc (UK), manufacturer of the Powerstar range of voltage optimisation energy saving solutions, is holding a free Public Sector Sustainability Conference with partner Imtech. The event on 25 September 2013 at Epsom Downs Racecourse, will address sustainability issues across the public sector. It will also provide information on how to improve energy efficiency, as well as advice on industry best practices. Industry experts will enlighten the audience on the numerous environmental pressures facing public sector organisations. The Conference will be of interest to key decision makers in the public and private sector healthcare arena, including: procurement managers, sustainability managers, energy managers, facilities managers, head of estates, operations managers, head of services, directors and chief executives.
Speakers include: Greg Markham, president of the Institute of Healthcare Engineering and Estates Management; Dr David Hickie, executive director of the Public Sector Sustainability Association; Paul Burnett, group development director of Imtech; Rob Scoulding, regional energy and environment manager from the Co-Operative Group; EMSc (UK)’s public sector business consultants Terry Shemwell (Local Authorities) and Duncan Agnew (NHS). Bookings can be made via www.ems-uk.org. FURTHER INFORMATION Tel: 0114 2576 200 www.ems-uk.org
Priorclave: excelling at autoclave manufacture Priorclave is the name associated with the UK’s most successful autoclave design and manufacturing centre. The Priorclave brand is renowned for its superior build quality and machine reliability. Such is the value of investing in a Priorclave autoclave that in addition to a strong UK market it exports around 70 per cent to destinations including Asia Pacific, the Middle East as well as North and South America. Some notable countries where Priorclave steam sterilisers have been installed include Russia, Papua New Guinea, Mauritius and Ecuador. The London-based manufacturing centre has been producing autoclaves for more than 25 years, creating an extensive range of standard steam sterilisers with chamber capacities from 40 to 700 litres. The range includes compact top and front autoclaves suitable for bench-top, free-standing medium to high capacity top and
front-loading autoclaves, as well as power door and pass-through double-entry machines. In addition to this comprehensive range of over 40 different models, Priorclave is able to design and build autoclaves to suit specific requirements. All autoclaves leaving the UK manufacturing plant are built under stringent production control policies to ensure they meet international standards that are recognised virtually everywhere. FURTHER INFORMATION Tel: +44 (0) 208 316 6620 sales@priorclave.co.uk www.priorclave.co.uk
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HEALTH BUSINESS MAGAZINE | Volume 13.4
SUSTAINABILITY SOLAR PANELS South Central Ambulance Service NHS Foundation Trust (SCAS) is the first ambulance service in England to introduce solar panels on to its Rapid Response Vehicles (RRV). The Trust started trialling solar panels in January 2012 and from September 2012 started fitting them on all new RRVs. To date solar panels have been installed on 36 of the Trust’s RRVs to supply power to the secondary battery system that powers all emergency equipment on these vehicles. SCAS is currently in the process of fitting solar panels to a double crewed ambulance to evaluate their use on these. SCAS Green Team Co-ordinator Brian Miller said: “South Central Ambulance Service NHS Foundation Trust is taking the initiative to introduce solar panels to its Rapid Response Vehicles (RRVs) to reduce fuel consumption, fuel and battery replacement costs, the Trust’s carbon footprint and the need for RRVs to return to base and traditional shoreline systems to recharge vehicle batteries.” BETTER PATIENT CARE The introduction of solar panels means that vehicles no longer need to standby with their engines running to recharge essential battery systems, or to return to base to recharge vehicle battery systems using static shoreline systems which mean that the vehicles are unable to respond to emergencies whilst batteries are being charged. The use of solar panels means that the Trust’s fleet of RRVs can be fully mobile at all times to provide the best in mobile healthcare services to patients suffering life threatening injury or illness across the four counties of Berkshire, Buckinghamshire, Hampshire and Oxfordshire. The introduction of solar panels to SCAS’ RRVs means that the Trust effectively has more vehicles more able to respond to more incidents more of the time, thus helping to ease demand
South Central Ambulance Service NHS Foundation Trust is the first ambulance service in England to introduce solar panels on its Rapid Response Vehicles, after a trial in 2012 on the service against a background of a general increase in demand for the service of in excess of more than 10 per cent per annum. SCAS will be trialling solar panels on Front Line Double Crewed ambulances generating more benefits for more of our patients and increased operational cost savings. The Trust is charged with having to make savings of £30 million over five years, equating to around four per cent of its budget every year for five years. The introduction of solar panels to its fleet is just one example of the imaginative ways in which it is achieving these savings whilst delivering an enhanced quality service and best care to its patients as well as benefitting the environment. ELECTRIC AMBULANCE IN SCOTLAND The Scottish Ambulance Service is trialling its first electric ambulance as part of the Patient Transport Service, which takes patients who have a medical or mobility need to and from healthcare appointments. It has a range of approximately 100 miles between charges, depending on operational use. It can be charged in around five hours. Other than a much quieter journey, patients will notice no difference from a normal patient transport ambulance. The introduction of the electric ambulance is part of a wider investment to upgrade the Patient Transport Service, which undertakes 1.2 million journeys every year, with a new direct booking system for patients and state of the art mobile technology in all vehicles. The
Healthcare Fleets
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new system has been launched in the north and west of Scotland and goes live in the east of the country later this year. It is delivering a more accessible and personal service for patients that has greater flexibility to better meet their needs. Attending the unveiling, Scottish Health Secretary Nicola Sturgeon said: “Our NHS is embracing new technologies – and not only are these electric ambulances environmentally friendly, they also support the best possible patient care.” Dr Sam Gardner, Senior Climate Change Policy Officer at WWF Scotland said: “It’s great to see such leadership from the Scottish Ambulance Service. This trial shows that electric vehicles can play a role even in very demanding roles across the public sector fleet. Previous WWF research has identified that electric vehicles need to replace 300,000 conventional cars by 2020 to help ensure we meet our climate emission targets, and fleets will play a major role. We hope that SAS plan to introduce many more EVs as they replace more than 570 vehicles over the next four years. “While much more transport spending must be redirected to encourage people to walk, cycle or use public transport, we must also take steps to reduce emissions from the cars on our roads. Alongside measures to get people out of their cars, a switch to electric vehicles is going to be an essential part of tackling climate change.” L FURTHER INFORMATION www.scottishambulance.com www.yas.nhs.uk www.southcentralambulance.nhs.uk
Solar panels enable the Rapid Response Vehicles to be fully mobile at all times as they no longer need to recharge essential battery systems with their engnes
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Eco-Efficient Mobility is on the Move. At Alphabet we’re always developing new, more eco-efficient ways of moving employees from A to B. It’s all part of our vision for the future of sustainable mobility. Existing forms of fleet management underpin this vision. But there’s certainly more to come. Take GreenCARE for example. A clever way to help you identify your fleet’s CO² emissions, benchmark your carbon footprint against our best performing customer, and reshape your fleet to minimise future costs. AlphaCity, our ground-breaking car sharing scheme, offers eco-efficiencies too. With fewer cars serving more staff it’s good for your pocket and the planet. Both are just yet another step forward in clever green thinking from Alphabet.
Find out more:
Tel: 0870 50 50 100 Email: alphabet@alphabet.co.uk www.alphabet.co.uk
FLEET MANAGEMENT
Innovative, fresh alternatives are required in fleet management to avoid increased hidden costs, while saving time and energy
The economic climate means austerity measures have become a way of life for many organisations, not least in the public sector where the spotlight shines brightest on perceived unnecessary spending. This has led to a sometimes negative view of fleet management; some organisations have been tempted to demonstrate headline budget cuts, such as removing leasing and contract hire, without always seeing the longer-term impact on costs and safety that comes from switching to grey fleet. COST & TIME-SAVING SOLUTION Rather than introduce such drastic cuts, which often increase hidden costs such as grey fleet, more organisations are now starting to look at innovative alternatives that can save time and energy. Alphabet’s corporate car-sharing product AlphaCity, an exciting alternative to pool cars, is becoming increasingly popular as a cost and time-saving solution. According to Alphabet’s Fleet Management Report 2012/13, around 70 per cent of public sector fleets had reviewed their provision in the previous 12 months and 83 per cent were evaluating the total cost of ownership of their fleet. Such reviews have prompted new solutions to the business travel challenge, with the public sector taking a flexible approach to corporate mobility in order to better manage the total cost of organisational travel. AlphaCity is the perfect solution.
A FRESH ALTERNATIVE The award-winning AlphaCity scheme is delivering flexibility and savings to organisations across Europe. A fresh alternative to traditional pool cars, AlphaCity is the first initiative of its kind in the UK. It offers public sector bodies on-demand, technology-driven business and personal mobility, reducing the need for hire cars, taxis and private vehicles. AlphaCity uses dedicated leased cars to provide a self-managing internal car club, giving the organisation complete control over access to their scheme. Employees book a car and unlock it by holding their membership card up to a reader on its windscreen. After responding to instructions from an in-car touchscreen, and entering a security PIN, they press the engine start button and drive away.
The initiative has scooped two major industry awards since its launch last year: the Innovation in Fleet Services and Systems category at the Energy Savings Trust’s annual Fleet Hero Awards, and BusinessCar Magazine’s Innovation category in its annual fleet technology awards, the “Techies”. Clive Buhagiar, head of public sector at Alphabet, commented: “Public sector organisations can save significant amounts of money each year simply by adopting AlphaCity. The public sector is paving the way for innovative, outsourced systems to manage shared vehicles. “While AlphaCity is not a solution for every organisation, it can significantly reduce transport costs and increase staff satisfaction levels for those fitting the right profile. Indeed, the Alphabet team undertakes careful analysis of the existing corporate mobility mix to provide a real picture of vehicle use, so that tangible recommendations can be made on how best to manage business travel.”
Written by Clive Buhagiar
AWARD-WINNING ALPHACITY PROVIDES PERFECT POOL CAR ALTERNATIVE
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CUTTING COSTS, DELIVERING VALUE Ultimately, it can be all too easy to look at company cars in the public sector and see them as an opportunity to deliver headline-grabbing cost reductions. However, it is important to remember that snap decisions to remove employee benefits and business-critical solutions can often have far longer-term repercussions. Indeed, the costs and risks associated with grey fleet alone should be enough to keep any local government or NHS fleet manager up at night. With the ongoing evolution of the fleet sector and the provision of far greater flexibility and capability of mobility solutions to the public sector, it is important to remember that the time spent auditing the transport needs of the organisation now could pay dividends in the long-term. Buhagiar adds: “Financial savings is only half the story. The cars are aspirational. The experience of using AlphaCity is fun and hi‑tech. And the membership aspect fosters a feeling of shared responsibility that mitigates against colleagues returning cars late, dirty or without fuel. AlphaCity isn’t just a new way of delivering mobility; it helps employers drive desired behaviours, too.” L FURTHER INFORMATION Tel: 0870 50 50 100 www.alphabet.co.uk
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COST EFFECTIVE PRINT SOLUTIONS FOR HEALTH CARE ORGANISATIONS AFFORDABLE Our devices are manufactured to the highest standards of quality and technology. We are so convinced of the quality and reliability of our products that we offer an extension of the standard warranty to 3 years on all our products.
EFFICIENT Having the ability to achieve more with your printer means nothing if the device it too big for your office. OKI’s tried and tested LED technology means our devices are compact with modern styling that easily fit into the smallest of offices.
SMART Making printers affordable and helping customers print smarter is the overriding driving force behind a range of new and updated products from OKI. No matter what your business, we have the perfect print solution for you.
THE NEW MC700 SERIES: Designed to integrate seamlessly into your document workflow The MC700 colour multifunction printer combines high performance copying, scanning and printing together with an ‘open architecture’ for seamless integration into your workflow requirements.
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OF PRINTING COSTS THE CHALLENGE: Managing printers is one of those responsibilities that is often tagged on the end of a job description. However, it can be an extremely time-consuming, costly and a thankless task. For further information on OKI Multifunction Printers visit: bit.ly/OKI-MC700
Aut Even Hospital had a variety of printers from different manufacturers and no maintenance support agreement for any of them. These devices were used to print all the hospital’s documentation, including patient labels, wristbands and care plans for new admissions, patient information leaflets and exercise sheets for physiotherapy patients.
THE SOLUTION: OKI’s first step was to assess the volume of the printing carried out by the hospital. Using these figures, OKI managed to rationalise the fleet by 10%. A second benefit is the remote monitoring and management of the fleet together with 24/7 support, consisting of: • Consumables ordered as and when needed rather than stock piled which freed up valuable storage space. • A fixed monthly payment plan resulting in better budgeting and visibility of print costs. • Printer settings being defaulted to mono and duplex modes resulting in considerable savings in not only consumables usage but also reduced the paper consumption by almost half. • Security benefits experienced through secure pin release for confidential patient records. OKI also recognised how critical some of the printers are and has included spare devices in its service contract.
Print Smart. Print OKI
A 41% reduction in surgical site infections1 isn’t just statistically significant
It marks a significant change in how we view SSIs by challenging the wisdom of the old with evidence for the new. And it shows how a simple change in skin prep could help patients get back where they need to be after surgery.
Setting a new standard in operating procedures Prescribing Information ChloraPrep® (PL31760/0004) & ChloraPrep with Tint (PL31760-0001) 2% chlorhexidine gluconate w/v / 70% isopropyl alcohol v/v cutaneous solution. Indication: Disinfection of skin prior to invasive medical procedures Dosage & administration: ChloraPrep – 0.67ml, 1.5ml, 3ml, 10.5ml, 26ml ; ChloraPrep with Tint – 3ml, 10.5ml, 26ml. Volume dependent on invasive procedure being undertaken. Applicator squeezed to break ampoule and release antiseptic solution onto sponge. Solution applied by gently pressing sponge against skin and moving back and forth for 30 seconds. The area covered should be allowed to air dry. Side effects, precautions & contra-indications: Very rarely allergic or skin reactions reported with chlorhexidine, isopropyl alcohol and Sunset Yellow. Contra-indicated for patients with known hypersensitivity to these constituents. For external use only on intact skin. Avoid contact with eyes, mucous membranes, middle ear and neural tissue. Should not be used in children under 2 months of age. Solution is flammable. Do not use with ignition sources until dry, do not allow to pool, and remove soaked materials before use. Over-vigorous use on fragile or sensitive skin or repeated use may lead to local skin reactions. At the first sign of local skin reaction, application should be stopped. Per applicator costs (ex VAT) ChloraPrep: 0.67ml (SEPP) - 30p; 1.5ml (FREPP) - 55p; 1.5ml – 78p; 3ml
– 85p; 10.5ml - £2.92; 26ml - £6.50 ChloraPrep with Tint: 3ml – 89p; 10.5ml £3.07; 26ml - £6.83 Legal category: GSL Marketing Authorisation Holder: CareFusion UK 244 Ltd, The Crescent, Jays Close, Basingstoke, Hampshire, RG22 4BS Date of preparation: January 2013 Adverse events should be reported. Reporting forms and information can be found at www. yellowcard.mhra.gov.uk. Adverse events should also be reported to CareFusion Freephone number: 0800 0437 546 or email: CareFusionGB@professionalinformation.co.uk © 2013 CareFusion Corporation or one of its subsidiaries. ChloraPrep is a registered trademark of CareFusion Corporation or one of its affiliates. All rights reserved. Reference: 1. Darouiche R et al. N Engl J Med 2010; 362: 18–26. Date of preparation: May 2013
For more information, please visit: www.chloraprep.co.uk or contact our sales team on telephone number: 0800 917 8776 or email: uk-customer-service@carefusion.com
0000CF01522 Issue 1
EVENT PREVIEW
THE UK’S LARGEST INFECTION PREVENTION EVENT Following a successful conference in Liverpool last year, the Infection Prevention Society’s annual conference is coming to London with Infection Prevention 2013, to be held at London’s ExCeL from 30 September to 2 October Organised by the Infection Prevention Society, this is the major infection prevention conference and exhibition of the year. The conference has been awarded 14 CPD points by the Royal College of Pathologists. There will be in excess of 600 delegates in attendance and over 100 exhibitors. The scientific programme will deliver an array of renowned speakers covering all your infection prevention needs. The exhibition at Infection Prevention 2013 will feature products and services from over 100 companies, and offers the opportunity to discuss your particular requirements with a huge range of specialist companies. THE PROGRAMME This event offers delegates the latest in research, education and expertise, with inspiring speakers and informative sessions. Confirmed speakers include: past president Martin Kiernan who will deliver the EM Cotterill Lecture, professor Barry Cookson who will deliver The Ayliffe Lecture, chief nursing officer for England Jane Cummings, professor Dale Fisher, Dr Michael Gardham, Dr Hugo Sax MD, Dr Walter Zingg, Dr Phil Hammond, and many more. There are four concurrent specialist study days also on offer. For those working in the field of general practice, a GP study
day will focus on key issues including wound care, antimicrobial prescribing and registration for CQC. The dental study day will include CQC registration and decontamination requirements. For those working in theatre, a comprehensive study day will look at patient safety and perioperative practice. Finally, the IPS is also running a specialist day focusing on the care-home environment. MONDAY’S SESSIONS The inaugural session at Infection Prevention 2013 is from professor Dale Fisher, chair of Infection Control and head of Infectious Diseases at the National University Hospital, Singapore, who will be talking about opportunities for gaining organisational buy-in to infection prevention. Within this session Fisher will explain why successful infection prevention and control requires “buy-in” at all levels of an organisation, and will discuss why executive support is crucial, but can be difficult to obtain in financially challenged organisations. Dr Michael Gardam, an infectious diseases consultant from Toronto, will be speaking on “Using frontline ownership to improve patient safety”. In this session, Dr Gardam will introduce complexity science and how it can be used to improve patient safety.
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He will introduce frontline ownership, positive deviance, and liberating structures approaches, and will share his experiences of using these approaches in North America. Internationally renowned speaker Dr Hugo Sax, MD, head of the infection control program at University Hospital of Zurich is talking about “Hand hygiene: the ultimate microbiologybehaviour challenge”. Dr Sax will reflect on microbiological risks in the healthcare setting, consider risk perception and its impact on mental models and look to understand what this means for the case of hand hygiene. Martin Kiernan, nurse consultant, infection prevention, at the Southport & Ormskirk Hospital NHS Trust, will deliver the EM Cottrell Lecture on “The life and times of the urinary catheter”. Kiernan’s research interests currently centre on surveillance and urinary catheter-associated infections and his other professional interests include wound management, environmental hygiene and the adoption of a common sense, practical approach to the subject. The afternoon features a wealth of speakers and sessions, including: Dr Fidelma Fitzpatrick, consultant microbiologist HSE/RCPI clinical lead, Ireland, will look at “Implementing national guidelines at a local level”. Within this session Dr Fitzpatrick will identify what the challenges are when implementing national guidance, explain how we can tackle these challenges and will outline how we can measure success. Concurrently, microbiologist Catherine Makison Booth will look at “Vomiting Larry – norovirus control”. Within this session the objectives are to understand transmission in relation to environmental contamination and discuss new knowledge to support best practice. Dr Walter Zingg from Switzerland will be speaking on “ECDC SITE Project”. Within this session Dr Zingg will explore effective infection prevention strategies, understand hospital organisation, management and structure to E
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BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net Days Conference Ad 86x125mm v3_Layout 1 26/06/2013 17:00 Page 1
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HEALTH BUSINESS MAGAZINE | Volume 13.4
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MCC & Hotel is an unbeatable city centre venue, equipped with state of the art AV, along with professional and versatile conference suites and theatres. With 117 bedrooms, a bar and restaurant onsite, MCC can provide all elements to ensure your event is a success.
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EVENT PREVIEW improve quality of care, and explain structure and process indicators to measure success. One of the final sessions on the first day is on “Patients’ experience of MRSA screening: a south London perspective” from Dr Carol Pellowe, a senior lecturer in infection prevention and control from London. Dr Pellowe will analyse the similarities and differences in patients’ experiences of screening, identify where there are deficits in the service, and consider the means of improving the screening service. The day concludes with a session by Professor Peter Wilson, consultant microbiologist, clinical microbiology and virology, UCLH NHS Foundation Trust on “Controlling MDR-Gram-negatives”. This session will look to describe the emerging threat of multidrug-resistant Gram negatives, outline evidence-based control strategies (with limited evidence) and highlight areas requiring urgent research to develop optimal strategies. TUESDAY’S SESSIONS Specialist streams will be featured, on “Infection control in the critical care setting”, “infection control in the paediatric setting” and “Infection control in the built environment”, which also continues into Wednesday. The critical care stream features a range of sessions from experts within the field of critical care. This stream will appeal to those working in critical care settings as well as infection prevention professionals. The stream will open with Dr Ron Daniels speaking on his work to reduce mortality from “Sepsis”, this is followed by Dr Robert Garcia from the US on “Prevention of ventilator associated pneumonia/complications”, “Developing and implementing care bundles” by Dr Lee Cutler. Stéphane Paulus and Sara Melville from Alder Hey will discuss their work on “Preventing central line associated blood stream infections in hospitalised children”, and the difficult area of “Aerosol generating procedures in an intensive care unit” will be discussed
by Katy-Anne Thompson from PHE. Infection control in paediatrics runs adjacent, joining with the critical care stream for the final two aforementioned sessions. The sessions in the paediatrics stream include: Louise Cool from PHE discussing “Re-emerging childhood diseases – is it all Andrew Wakefields’ fault”, David Green reviewing “Vaccination, measles and whooping cough screening”, and Dr Roberto Vivancos about “Lessons learned from measles outbreak”. Estates and the built environment is always a popular topic at conference and this year a specific Estates and Built Environment Stream runs across two days and covers a comprehensive range of topics. These include: “Can the use of copper help to prevent infection?” by Professor Tom Elliott, “The infection control challenges in a 100 per cent single-room hospital” by Gail Locock, “Is it time to consider automated ‘no-touch’ room disinfection systems?” from Professor Dale Fisher, “Ventilation in the operating theatre” from Professor Hilary Humphries, “Quality management systems” by Wayne Spencer, “Green waste management” from Mary Thomson, and “Endoscopes and probes” by Christina Bradley. WEDNESDAY’S SESSIONS Conference will open with a keynote address from Jane Cummings, chief nursing officer for NHS England on “Infection control: the way forward”. Cummings will describe how she plans to embed the values of compassion, communication, and commitment in healthcare. The morning also features “Was Florence Nightingale the first infection control nurse?” from Gemma Quinn, infection prevention and control manager from Mid West PCCC. The objectives of this session are to discuss the leadership role of Infection Prevention and Control Nurses, discuss the qualities that Nightingale expressed, and to highlight how her principles are similar to those used today. Professor Barry Cookson, from University College London will deliver The Ayliffe Lecture entitled “MRSA past; present and
Further information on Infection Prevention 2013
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Featured are just some of the highlights from Infection Prevention 2013 and there are numerous other sessions to keep delegates interested, visit www.ips.uk.net and follow the link to Infection Prevention Conference 2013. Tel: +44 (0)1506 811077 or email ipsconf@fitwise.co.uk. Follow on Twitter @IPS_Infection or search/use #IP2013.
future”. Within this session, Professor Cookson will consider what has been learned relating to MRSA practices around the world, and will reflect on what needs to be done to avoid history repeating itself. PENULTIMATE SESSION The penultimate session will be from doctor, journalist, broadcaster and comedian Dr Phil Hammond speaking on “Recipe for success in health and social care”. Dr Hammond is a practising GP, a radio presenter and medical correspondent for Private Eye. He is an active campaigner for open data in the NHS and better support for whistleblowers. Conference will be brought to a close by IPS’ president Julie Storr and its new patron Didier Pittet, renowned worldwide for his work on improving compliance with hand hygiene. L
ChloraPrep® patient pre-operative skin preparation CareFusion understands that infection prevention is the key to reducing healthcare associated infections. It helps customers improve patient care by working in close partnership with hospitals to protect both the operating team and patients, through the provision of clinically proven infection prevention products. With innovative healthcare products, CareFusion is a global corporation serving the healthcare industry with some of the most widely recognised products and services. ChloraPrep® is the only licensed and evidence-based skin preparation system that meets the new Department of Health’s
High Impact Intervention, to prevent surgical site infection. The two per cent chlorhexidine concentration is proven in 39 outcome studies and recommended in 12 evidence-based guidelines. ChloraPrep® is a medicinal product
containing a solution of two per cent chlorhexidine gluconate (w/v) in 70 per cent isopropyl alcohol (v/v). It is a licensed, single-use, sterile, “non-touch” skin antisepsis system, available in a variety of applicators. ChloraPrep® is applied with a back and forth motion for 30 seconds and then allowed to air-dry prior to invasive procedures. CareFusion is committed to providing a safer environment for everyone. FURTHER INFORMATION Tel: 0800 917 8776 uk-customer-service@carefusion.com www.chloraprep.co.uk
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Company Profiles
BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net
Specialists in security to meet your safeguarding responsibilities
Ergonomically designed seating to reduce back and shoulder pain
Security, whether in a hospital, college or university environment, can be a highly emotive subject, especially with recent severe financial budget reductions that has put tight constraints on spending. Safeguarding patients, staff and vulnerable members of society, including equality and diversity, is of the utmost priority. Other high-risk activities that need evaluating include the provision of personal care, social work, health care and the transportation of patients. But how do you identify the security risks whilst ensuring that your establishment has a safe and secure environment that meets your both your needs and budget? M Zurich has been providing security services for over 12 years, and provides security solutions for every part of the healthcare sector, both public and private. This can range from a multi-discipline security solution
Murray Equipment is a respected UK manufacturer of clinical and medical seating for operatives and clinicians working in the NHS. Murray’s ergonomically designed seats, reduce back and shoulder pain, especially for clinical staff who have to sit for long periods or in specific positions. In addition, Murray’s also concentrates on reducing the infection control issues that are a concern when purchasing seating for a clinical area. Typically used in operating theatres, recovery, ICU, HDU, ultrasound, delivery suites, ophthalmology, and all clinical areas. Over the past few years, Murray’s has won all PFI tender it has bid for, and latterly won the OJEU clinical seating contract for Barts and the London NHS Trust. The deciding factors for all these contracts were based on ergonomics, infection control, build quality and the
or a simple cost-effective patrol and response service. The company can also provides comprehensive security consultancy services. M Zurich’s services are tailored to meet the need for stability and security, and to ensure everyone whose care is entrusted to it receives the highest levels of service, care and respect. To find out how M Zurich can assist with your safeguarding, visit www.mzuricheuro.com. FURTHER INFORMATION Tel: 0207 887 1336 info@mzuricheuro.com www.mzuricheuro.com
long-term cost advantages Murray’s seating offers. Whilst these large contracts are rewarding to win, Murray’s recognises that its core business is to supply from 1-50 chairs at departmental level. As and when you need to replace any clinical/medical seating, Murray’s would welcome the opportunity to be involved. It has experience in all types of clinical areas and has helped departments choose the most appropriate seating for the task. FURTHER INFORMATION Tel: 01243 811881 will@murrayequipment.co.uk www.murrayequipment.co.uk
Cut your energy spend by Pool Maintenance: over 10% with a payback preferred suppliers to MOD to Pool Maintenance, space tanks, such as balance in just 9 months – no catch! Welcome specialist swimming pool tanks, wash water holding Healthcare is facing higher energy bills at a time when we can least afford it: www.ewgeco.com can reduce such bills. Voted one of the century’s most exciting inventions by The British Library, it is a unique device that non-technical staff can readily understand, with its user-friendly traffic-light red, amber and green display showing real-time energy consumption at any given moment. Simply keep the bars “in the green” and you will save money that could be better spent elsewhere in healthcare. By knowing how much energy is being used and the true cost, people do alter their behaviour. Ewgeco’s cloud-based system really works – no catch. A nursing home owner commented: “We were told reducing usage by just 12p
54
per hour with our Ewgeco display would save £1,050 a year. When we installed Ewgeco, we were using £2.91 per hour. Within 10 minutes, we found 42p of savings simply by walking around and just turning things off. Within 4 months our system has paid for itself.” FURTHER INFORMATION Tel: 0131 331 5445 info@ewgeco.com www.ewgeco.com
HEALTH BUSINESS MAGAZINE | Volume 13.4
engineers and preferred suppliers to the Ministry of Defence. The company has been in the water treatment industry for more than 35 years and, as such, it has accumulated a vast reserve of expertise and experience that enable it to guarantee the operational performance and upkeep of even the most demanding applications. Not only does Pool Maintenance specialise in servicing and maintenance contracts to swimming pools worldwide, but it also offers the following disciplines: full cleaning and biofilm removal to all forms of confined
tanks and portable water tanks; new pool installations; full refurbishments; filter vessel design and manufacture; chemical installations and UV treatment. Pool Maintenance’s client base includes: MOD, NHS, equine facilities, schools and local authorities. With water, Pool Maintenance can: heat it, clean it, treat it, bend it and form it. The only thing the company cannot do is walk on it.
FURTHER INFORMATION Tel: 01457 765533/ 07748 908201 www.poolmaintenanceltd.com
Legionella Control
HEALTH & SAFETY
Written by Jon Murthy, UKAS
LEGIONELLA RISK ASSESSMENTS
How can procurers in the healthcare sector be sure that the services offered by Legionella risk assessment companies are fit for purpose and will help them to discharge their legal obligations? The answer lies with accreditation, writes Jon Murthy from accreditation body UKAS Deriving its name from the American Legion convention in Philadelphia where it was first discovered in 1976, Legionnaires’ Disease has rarely been out of the headlines since. Each year in the UK there are around 500 cases reported, approximately 35 of which are fatal. Preventing incidents of Legionnaires’ disease is a priority for anyone who is responsible for managing
premises that utilise wet cooling
systems, process water For the e systems and domestic hot/ r a cold services. For the healthc r, healthcare sector, the secto lly naturally compromised a r the natud immune immune systems of many patients in mise hospitals increases compro ms of many the risk posed by the syste increases s patient posed by Legionella bacteria. ASSESSING THE RISK the risk nnella Health and Safety legislation Legio
in the UK requires all employers
to consider the risks from Legionella and to take the appropriate precautions. Although Legionella bacteria are common in natural water courses such as rivers and ponds, they rarely pose a significant danger to the population when in their natural environment. However, within engineered water systems, Legionella can readily grow, with cooling towers, evaporative condensers and domestic water systems most commonly associated with outbreaks of the disease. Nearly all outbreaks of Legionnaires’ disease can be attributed to a failing in management control of some kind. The majority of organisations do not have the E
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BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net
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HEALTH & SAFETY in-house resources to assess and tackle the threat of Legionella sufficiently, so will utilise the services of specialist risk assessment companies. Identifying companies to assist with assessing the risk of Legionella is relatively straightforward. However, a key question is how can procurers in the healthcare sector be sure that the services on offer are fit for purpose and will help them to discharge their legal obligations? The answer, increasingly, is accreditation. ACCREDITATION Under EU legislation, every country has a single National Accreditation Body (NAB), whose role is to carry out the independent third-party assessment of organisations that offer testing, calibration, inspection and certification services. The United Kingdom Accreditation Service (UKAS) has been the sole accreditation body recognised by government since its formation in 1995 and was made the official NAB for the UK in 2010. By effectively checking the checkers, the process of accreditation determines in the public interest the technical competence and integrity of companies offering these assessment services. Achieving UKAS-accredited status is a rigorous and continuing process that does not end with the initial assessment visit. The organisation applying will undergo a four year assessment cycle, consisting of two thorough visiting assessments and two further surveillance visits. During each of the visits the organisation will have to demonstrate that it is technically competent, that its staff is suitably qualified, its working practices are fit for purpose, and the appropriate equipment is being used. Internationally recognised standards are employed, meaning that once achieved accredited status can be utilised in 135 economies across the world. But how does this apply specifically to Legionella risk assessment?
order to underpin The Health and Safety Executive (HSE) Approved Code of Practice and guidance document L8 (Legionnaires’ Disease: The control of Legionella bacteria in water systems). ISO/IEC 17020 is the internationally recognised standard that sets out the requirements for organisations performing inspection. In addition to being specifically aimed at inspection services, ISO/IEC 17020 includes an assessment of an organisation’s technical competence – a key differentiator over the commonly held ISO 9001 quality management standard. Being accredited for Legionella risk assessment is not mandatory. However, as with all health and safety services, there is a drive towards companies offering these services having to prove their competence. Conducting Legionella risk assessments with impartiality and integrity are key components of the new BS8580 standard. In addition to establishing the technical competence of staff and appropriateness of resources and facilities, UKAS accreditation also demonstrates that the services are impartial. This is becoming increasingly important to procurers of Legionella risk assessment services, as Mike Rose, commercial director of risk assessment company RPS explains: “In the past procurers have had very little guidance over what constitutes a suitable and sufficient Legionella risk assessment. They may have had a suspicion that some companies providing the full package of assessment and remediation services have been offering assessment services at below cost price, safe in the knowledge that they will profit from any remedial works that their assessment identifies. UKAS accreditation assures
While being or ed f accredit lla risk Legionet is not yet en assessmequirement, it r a legal t becoming is fas siness a bu on conditi
clients of a company’s integrity and that the assessment report provided will be an unbiased appraisal of the Legionella risk in that particular building.”
Legionella Control
BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net
BENEFITS OF ACCREDITATION Beyond giving organisations confidence in the quality and integrity of services they are procuring, using UKAS accredited services can provide them with other more tangible benefits, as Mike Rose outlines. “It goes without saying that the main motivation for assessing Legionella risk is the health of employees, patients and others. However, there are also sound financial reasons for preventing outbreaks of Legionnaires’ Disease. Firstly there are the financial costs of being successfully prosecuted such as legal fees and fines to consider. But perhaps more importantly, the negative impact on an organisation’s reputation can be very damaging in the long run, especially within the healthcare sector.” Using an accredited provider can also help demonstrate due diligence in the event of a claim. In addition to benefitting clients, becoming accredited can have a positive effect on those offering Legionella risk assessments, as Mike Rose explains. “Initially clients were seeking assurance that our assessments complied with the HSE L8 guidance, whereas now they are asking if we are accredited to BS8580, as this is the first heavyweight standard for our industry. This indicates that whilst it may not yet be a legal requirement, being accredited for Legionella risk assessment is fast becoming a business requirement.” FURTHER INFORMATION www.ukas.com
ACCREDITED LEGIONELLA RISK ASSESSMENT The Health Protection Agency has stated that “UKAS accreditation assists clients in their selection of assessors and leads to greater consistency of Legionella risk assessments, with consequent improvements in protection of the public health.” UKAS, together with industry and other relevant stakeholders, has helped to develop a framework for accrediting Legionella risk assessments under both British Standard BS 8580:2010 (Water Quality – Risk assessments for Legionella control – Code of Practice) and ISO/IEC 17020 (General criteria for the operation of various types of bodies performing inspection). The British Standard has been produced in
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Healthcare Estates
BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net
EVENT PREVIEW
POSITIVE OUTCOMES FROM TWO DAYS AT HEALTHCARE ESTATES
The Healthcare Estates event at Manchester Central on 8-9 October features a section where visitors can participate in its Energy Theatre to find out more on the controversial CRC Energy Efficiency Scheme, especially when hospitals are being warned they face paying higher fees and bigger fines
Hospitals are being warned they face paying higher fees and bigger fines following changes to the controversial CRC Energy Efficiency Scheme (CRC)*. This initiative was originally introduced in 2010 and had a range of reputational, behavioural and financial drivers to encourage large public and private sector organisations to cut their energy use. For starters, hospitals had to report on carbon emissions annually and buy carbon allowances from the government based on this energy use. The aim was to keep increasing the price of these allowances to encourage organisations to continue reducing their level of use. Initially the price paid for allowances was £12 per tonne of CO2. But this only covered Phase 1 of the programme, with Phase 2 still due to be introduced in April 2014. It will run until March 2019. It is expected the update will bring fresh challenges for hospitals across the country. Firstly, the price of allowances is likely to increase as new legislation suggests that in the future they may be auctioned or sold on the open market. Secondly, fines for failing to report on annual emissions could increase. Currently, organisations are fined a one-off payment of £5,000; paying a further £500 for each subsequent day reports are delayed, up to a maximum of 40 working days, or £20,000.
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DEDICATED ENERGY SECTION Healthcare Estates Exhibition & Conference on 8-9 October 2013 at Manchester Central (GMEX), provides visitors with a dedicated energy section, incorporating the Energy Theatre offering free presentations to pre-registered visitors to the show.
a regular basis by the government and there appears to be no sign of this changing. The report provides an overview of the scheme and sets out the likely changes that will soon come into force. And it charts the changes that have already been made following heavy criticism of Phase 1. These include the abolishment, in 2012, of the CRC Performance League Table, which was said to place an unnecessary burden on organisations. At the same time, the government revealed that a full review of the CRC would take place in 2016 and provided more detail on its “simplification package”, setting out 46 changes that aim to create a “new, leaner, simplified and refocused CRC”. CRC affects all public and private sector organisations consuming more than 6,000 MWh/year through their half-hourly meters. This equates to approximately £500,000 plus energy spend per year. Between them, these organisations are said to be responsible for 10 per cent of all UK carbon emissions. Other simplifications include reducing the number of
For estates and facilities departments, architects, consulting engineers, construction companies, suppliers and those involved in managing estates and facilities, the exhibition and conference is critical to helping you run your organisation Supported by the Carbon Energy Fund and Carbon Trust, the area boasts key companies offering advice. Companies supporting the area include: British Gas, Low Carbon Europe, GE Corporate, Sabien Technology, Whitecroft Lighting, Dalkia, E.ON, Lucy Switchgear, DPS Bristol, IRT Surveys, Sentinel Performance Solutions, Turner EPS, Damar Group, Thorlux Lighting, ENER-G and Vital Energi. ENER-G, one of the exhibitors, has published a Quick Guide to the updated CRC Energy Efficiency Scheme*. Despite its simplification, the CRC can impose a significant cost and resource burden on an organisation. In addition, the scheme is being amended on
fuels participants must report on from 29 to two (electricity and gas, the latter for heating) and removing the 90 per cent rule, which required organisations to account for at least 90 per cent of their carbon footprint. The government has simplified the CRC Energy Efficiency Scheme, but the legislation can still impose a significant cost and resource burden on organisations,” said Dr Cedric Rodrigues, managing director of CMR Consultants. “There are two key areas that organisations must consider urgently, which are qualifying and registering for Phase 2 and developing a carbon reduction strategy ahead of Phase 2.”
ENERGY THEATRE Supporting the main conference, the Energy Theatre features presentations from the Carbon Energy Fund with a “bidders teach-in”, further presentations will also be made by Cynergin, Dalkia, E.ON, British Gas, Spirax Sarco, GE Corporate, Mitsubishi Heavy Industries and Trend Control Systems. The exhibition provides visitors with an opportunity to find out about the latest changes and implications for you and your teams. For estates and facilities departments, architects, consulting engineers, construction companies, suppliers and others directly involved in managing estates and facilities, the exhibition and conference is critical to helping you run your organisation. The exhibition brings together suppliers and customers in the UK healthcare sector. With 180+ exhibitors and key organisations representing over 200 companies providing presentations to visitors. HEALTHCARE PROFESSIONALS’ VIP PACKAGE The organisers, who work closely with IHEEM, will ensure healthcare visitors get maximum value from the show. Qualifying visitors from the NHS, Department of Health, private health, hospices, care homes, Mental Health Trust, primary care or Strategic Health Authority will be offered a VIP package to cover parking costs and refreshments on‑site, a dedicated area to network and meet key suppliers exhibiting at the show. Help can be arranged to help you plan your day effectively, set up meetings with suppliers and to find accommodation. Healthcare professionals need to pre-register before 21 September and will be sent a range of benefits and information to help plan their visit. CONFERENCE The Healthcare Estates conference features 80+ speakers on a range of topics, including: Estates & Facilities, Engineering, Energy Savings Solutions, Design & Construction, Infection Prevention, Research & development, Property & Premises Management. Delegates also benefit from free sessions and “fringe” events during the day, and are provided with meeting areas to catch up with colleagues and meet new contacts.
MORE PRODUCTS, MORE CHOICE By experiencing the range of products on offer, you can be sure to make the right decision, and Healthcare Estates exhibition provides you with the opportunity to see products demonstrated – essential in an industry where actually touching or using the product is part of the buying process. With the whole industry together, Healthcare Estates is also the perfect place to network: customers and suppliers rub shoulders with their peers, competitors and future suppliers. Visitors will also benefit from discussions around the hottest topics of the moment. Lots of companies invest in training on a regular basis, but there is nothing better than learning from experts and highly experience speakers. Healthcare Estates is being held at Manchester Central (GMEX), just a short walk from Piccadilly station, and it is surrounded by hotels and facilities to make your visit worthwhile. Entrance to the exhibition is complimentary and registration couldn’t be simpler, online (www.healthcare-estates.com) or turn up on-site and register for free.
Healthcare Estates: providing answers
DINNER AND AWARDS The IHEEM dinner and awards will feature Mark Colbourne MBE, Paralympic gold medallist and motivational speaker. Mark is Great Britain’s newest gold medal Paralympian in the sport of cycling. After Mark broke his back in a near fatal paragliding accident in May 2009 and was left with lower leg paralysis and drop foot in both feet, he fought for 12 months to learn to walk again with walking aids and now prides himself as a full-time professional para-cyclist. He won the first medal for Paralympics GB at the London 2012 games, winning silver on the track in the 1km individual time trial. The following day, Mark broke the 3km pursuit World Record twice in one day: he annihilated the current record by 7 seconds in the morning and then went on to beat it again by 0.2 seconds in the Final that night. He won the 3km pursuit and obtain his first Paralympic gold medal. As a determined professional athlete, Mark didn’t stop there with his haul of medals, he then entered the 10-mile individual road time trial five days later. Mark finished a close 12 seconds behind the gold medal winner and was very proud to win his second silver medal of the London 2012 Paralympics in style. At the The IHEEM dinner and awards, Mark will talk about his life-changing experiences, support from the healthcare sector, as well as his own positive attitude to life and sport. He will focus on the highs and lows of having a life-changing experience and competing on the international stage at
the London 2012 Paralympics. Mark can link the lessons he has learned through sport towards improving any aspect of your life or business. In a world where the smallest margins are the difference between winning and losing or living and dying, Mark Colbourne can explain what it takes to not only push our body and mind to its limit in order to achieve your dreams against all the odds, but also to enjoy life while you can. L
Healthcare Estates
BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net
For all those involved in the running, maintaining and delivery of the healthcare estate, this event is important to you. Tackling issues of cost control, reducing energy and return on investment makes attending even more valuable to you and your team. Visiting the show will enable you to create your own toolbox to ensure your facility remains a risk-free environment. You will also be able to plan appointments and plan training for everyone attending in one of the four theatres or fringe events, all free to pre-registered visitors. Make sure you book today at www.healthcare-estates.com to get the most from the show.
FURTHER INFORMATION Tel: 01892 518877 healthcare@stepex.com www.healthcare-estates.com *www.energ-group.com/cmr-consultants/ information-centre/ news/2013/06/ quick-guide-toupdated-crc-energyefficiency-scheme/
The IHEEM d an dinner feature will awards Colbourne Mark ralympic MBE, Padallist and gold meivational mot ker spea
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The Little Green Button is a software panic alarm that is perfect for organisations of all sizes that face the public. It appears as a discreet, positionable icon that floats on-top of your other applications; simply double-click to request assistance. Launched in 2004, the Little Green Button now supports many thousands of healthcare, governmental, educational and commercial sites around the globe. The low price, simple installation and low maintenance continue to make it the number one choice for computer based panic alarms. If your traditional, hard wired, system has not kept up with your expansion and the change of use of rooms, the Little Green Button is ideal. The cost of adding one new button to fixed systems is usually many times the annual fee for the Little Green button. Indeed, many new builds have dispensed entirely with hard-wired systems and specified the Little Green Button as the panic alarm from day one. Other key features include : • It’s a server-less system, buttons communicate peer to peer. • Standard licence covers up to 50 workstations. • Hosted entirely on your network - no dependency on other applications or off-site links. • Compatible with all current versions of Windows™. • Optional hardware switches and strips for mounting under desks or on walls. • Volume licence discounts available for larger sites or group purchases. • Free upgrades for life.
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What our customers say about the Little Green Button “…we have had occasion to use this in many genuine circumstances - patient collapses at the reception desk and even outside in the street - in the treatment room area and to summon help when a patient has become aggressive in the consulting room. It has been effective in 100% of cases. The tool, part of our overall strategy, is respected and understood by the whole team and we wouldn’t be without it.” “ We found it very easy to install and use. It required minimal staff training.” “…gave us the perfect security tool. It is always there, we know someone will always be available to see and respond. It is not obvious to the patient what is being done, so it does not exacerbate the situation. It also allows a doctor to quietly knock and walk in under some pretext to get the threatened person out of the situation safely. Basically, it is perfect! Thank you for such a well thought out and useful, simple tool!!’
EVENT REVIEW
THE HUB FOR HEALTH AND SOCIAL CARE
Health+Care Review
BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net
Former health secretary Stephen Dorrell tells Health+Care 2013 that integration is the way to deliver a better health service
New show Health+Care, which took place 12-13 June, ended with a ringing endorsement from Government Minister Norman Lamb MP who said the show was “something people should go to.” The Minister of State for Care & Support, Norman Lamb was one of the shows keynote speakers and made an impassioned speech on the merits of healthcare integration. The show itself was created for GPs and healthcare professionals by CloserStill Media to become a forum for debate and learning around the on-going issues of healthcare integration and NHS reform. Using its already well-established Commissioning Show, CloserStill added three new shows; The Home Care Show, The Residential Care Show and the Health+Care Integration conference to complete the line-up. From the 12-13 June, nearly 6,500 people visited the new combined show, which now makes it the largest of its kind in the UK dealing with these issues. The Rt Hon Norman Lamb MP, Minister of State for Care and Support said: “To have this opportunity talking to so many hundreds of people is fantastic from my point of view.
It’s just an amazing opportunity away from the front line to just have some thinking time, to learn what’s going on, and find out what you can do yourself to make your operation better.”
Care Health+nded 2013 e nging i with a r ent from m endorse ent minister In particular I was m pleased with the govern an Lamb MP: growth in exhibitors Norm ent people and delegates, at what was a hugely successful “An ev d go to” two days at the Excel.” shoul
ATTENDANCE UP The Commissioning Show saw attendance grow by 43 per cent from last year. The show is now getting more than 4,000 visitors who attend to discuss, share and learn more about the issues of NHS commissioning. While in its first year, the other parts of Health+Care saw more than 2000 visitors. Ralph Collett, director of Medical at CloserStill Media said: “We set out to create a unique event that brought together our already successful Commissioning Show, with the other areas of care that are so important if we are to create a truly integrated healthcare system for the future in this country.” “I believe the team has achieved that and I am absolutely delighted with the results.
Other keynote speakers at Health+Care included Labour Party Shadow Health Secretary the Rt Hon Andy Burnham MP, Dementia Tsar Professor Alistair Burns and Andrea Sutcliffe, CEO of Social Care Institute for Excellence. Overall more than 300 speakers took part in the show, while it was also backed by leading associations including the National Association of Primary Care, the NHS Alliance, the UK Home Care Association and the English Community Care Association. INTEGRATION IS KEY Former Health Secretary Stephen Dorrell MP told delegates at Health+Care 2013 that integration is the way to achieve a better NHS. Speaking to an audience of GPs, clinical commissioners and carers, Dorrell highlighted the need to improve efficiency E
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NQA and ISO 50001 prove to help companies save “phenomenal costs” Visitors attending the Healthcare Estates Conference & Exhibition (8-9 October, Manchester Central) are invited to visit the team from certification body NQA, on Stand Bz18. The organisation will be demonstrating how energy management systems, certified to ISO 50001 (the international standard for energy management systems), have proven to help energy intensive organisations to save 100s of £1,000s, even before investments in energy-saving technologies. Recently, NQA has been working alongside the UK’s largest coffee chain Costa. NQA helped it to achieve ISO 50001 certification, and consequently make significant cost and carbon savings throughout the business. Overall, by improving its operations, policies and procedures, Costa reduced carbon emissions by 32 per cent per tonne of coffee. This resulted in
a £50,000 per annum saving on utilities at Costa’s principle roaster. Ben Brakes, environment manager at Costa’s parent company Whitbread, said: “Reducing our energy consumption has enabled us to expand our production capability without having to build a new site. Going for certification gave us a platform to say to staff: ‘We are one of the first companies to go for this standard. We’re proud of it and you should be, too.’” See short case study e-movies at www.nqa.com/movies.
How much could you save on emollient prescribing? In England, the NHS spends £110m on emollients every year. Many of these are branded emollients which could be substituted for a similar Zeroderma emollient, saving the NHS an annual £12m without compromising on patient care. Zeroderma products are similar in formulation to around 40 per cent of currently prescribed emollients and offers significant cost savings. ZeroAQS emollient cream costs £3.29 for 500g, a 41 per cent cost saving compared to aqueous cream 500g (£5.55 on the NHS list price). Manufacturer Thornton and Ross’ derma marketing manager, Janet Maclean, says:
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“ZeroAQS is the least expensive branded emollient in the UK and is part of the cost-effective Zeroderma emollient range. A simple switch from aqueous cream to ZeroAQS could save the NHS £4m over 12 months. “Many clinical commissioning groups (CCGs) are now using the Zeroderma range, with one Northern CCG predicted to make savings of £250,000.” All Zeroderma products are available on prescription and many are now listed on NHS contract.
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HEALTH BUSINESS MAGAZINE | Volume 13.4
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EVENT REVIEW
and allocate funds more efficiently in order to fulfil care needs for the 21st Century. He also highlighted that health and wellbeing boards and CCGs could be the catalyst for social change and whoever is in power should attempt to work with the existing infrastructure rather than trying to rewrite the statute. “Most of us would rather see the current system evolve, rather than being torn out by the roots and starting again,” said Dorrell. These comments were part of a debate that closed Health+Care 2013. Other speakers were President of NHS Clinical Commissioners Dr Michael Dixon, Chief of University College London, David Bennett, Chair and CEO of Monitor, Prof David Haslam CBE Chair of NICE, Sir Robert Naylor, CEO of UCL NHS and Ben Page CEO of Ipsos Mori. All of the panel were in general agreement with the need for integration and the desire for no more root and brunch reforms. David Haslam highlighted that “most recent changes have been driven by impatience rather than mistakes.” The debate also touched on the issues surrounding local engagement and national accountability. Dorrell pointed out that the NHS has never been an entirely national, but can never be entirely local. Sir Robert Naylor agreed with this and advocated keeping the N in NHS. Conference director Ralph Collett says: “This closing debate highlighted where we are with CCG’s and health and wellbeing boards. People are getting used to them, and are seeing them as a vehicles for positive change. From what we have learnt over the last two days, there is absolutely no doubt integration is the future for health and care in this country. So everyone at Health + Care 2013 is looking forward to the future, and seeing all these great initiatives become reality.” WORKING TOGETHER Cath Murray-Howard, deputy chief executive of Community Integrated Care,
Health+Care Review
BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net
Speaking to an audience of GPs, clinical commissioners and carers, former health secretary Stephen Dorrell highlighted the need to improve efficiency and allocate funds more efficiently to fulfil care needs in the future took a session looking at how providers, NHS, local authorities need to work together to meet local need. She argued that care providers need to be less awed by the cuts in public spending and more willing to develop practical, lasting solutions to the national dementia crisis. In the current social and economic climate, providers can’t do what they have always done, Murray-Howard argued. They need to be innovative, outwardly focused and genuinely collaborative, working with NHS and Local Authority partners to devise new solutions that are equally cost effective and outcome focussed. The session shared real life and practical examples of how one of the UK’s largest health and social care charities has used collaboration and innovation to develop better dementia services. LEADERSHIP Dr Glen Mason, director of People, communities and local government at the Department of Health, examined the role of leadership in the future of social care. The recent Care and Support White Paper highlighted that high quality leadership is essential to the delivery of the proposals in the White Paper. Mason explained how the department for Health is working with partners to develop a pipeline of leaders who can inspire the sector to deliver high quality care. He explained how the department is looking to establish a Leadership Forum, provide better support to frontline managers and establish new integrated standards that
will define what good quality leadership looks like across health and social care. NEXT YEAR’S EVENT Health+Care 2014 will be held over 25-26 June, at Excel, London, and it will again include The Commissioning Show. Ten per cent of this year’s delegates have already reserved there passes for next year’s event. Tom Vine, event director of Health+Care, said: “After a fantastic first year, we are already looking forward to Health+Care 2014. The debates around healthcare integration will only grow louder over the coming years, so we are delighted that Health+Care is now the forum for them to be heard.” “We will make Health+Care 2014 even bigger with even more expert speakers and exhibitors. It will once again provide the stage for the most senior professionals from all the disciplines, backgrounds and organisations involved in both health and care in 2014 to come together to give a 360° approach to delivery.” Health+Care 2014 is set to play a pivotal role in enabling the senior decision makers in the commissioning and provision of care to take real strides towards delivering change. Health+Care 2014 will bring all the stakeholders together, from all around the country to network, share practical advice, uncover real solutions, and engage with the providers who will help them deliver change. L FURTHER INFORMATION www.healthpluscare.co.uk
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Manufacturer of Servo Drives, Servo Motors, Systems & Bespoke Engineering
info.uk@infranor.com
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+44(0)208 1442152
MECHANICAL PROCESSES
ZERO COGGING SERVO-MOTORS
Using its own servo-motors, servo-drives, controllers and software, Infranor offers solutions – from design to manufacture. This is a look at whether your application could benefit from slotless motors Many design engineers working in the field of motion control are familiar with slotless motor designs, but may wonder if these specialised motors significantly improve machine performance. In many cases, they can. Slotless motors offer more torque per frame size, produce more power, run smoother and achieve higher speeds than their slotted counterparts. SLOTTED SERVO-MOTOR CONSTRUCTION A traditional slotted brushless servo-motor has a stator made of stamped metal sections called laminations that are stacked to form teeth. Wire is wrapped around these teeth and when current flows in the wire, an electromagnet is created in the stator. Permanent magnets are fixed to the rotor. As in slotted motors, the permanent magnets in slotless servo-motors are fixed to the rotor. However, a slotless stator is built without teeth. Motor windings are wrapped around a temporary mould and then encapsulated to keep them in place. Eliminating the teeth yields many benefits. BENEFITS OF SLOTLESS MOTORS A slotless motor’s redesigned stator allows the rotor to be significantly larger, because torque increases proportionally to rotor diameter. Torque from a given slotless motor is significantly higher than that from a similarly sized traditional slotted motor. Due to the absence of teeth, the area available for windings is also greater, which further increases torque. More specifically, torque at a given speed can be increased by up to 25 per cent, compared to a slotted motor. As the magnets pass by the teeth in a slotted motor, a change or modulation in the magnetic flux is created which, in turn, induces voltage in the surface of magnets per Faraday’s Cage Law (e=dØ/dt). These magnets are conductive so a current flows in them. Eddy currents, as they are called, increase exponentially with speed and create heat in the magnets, which in turn diminishes their strength. As slotless motors have no teeth they can achieve speeds in excess of
32,000rpm. Power is calculated by multiplying torque by speed. Because a slottless motor outputs both higher speeds and torques, it can produce more than twice the power of a slotted motor of the same size. As the magnets on a slotted motor’s rotor move past the stator’s iron teeth, they are magnetically attracted. This creates a torque disturbance known as cogging. As there are no teeth in a slottless motor, cogging is eliminated, yielding a smoother motion. Motors with larger rotor inertias can be easier and simpler to tune. If the load becomes momentarily decoupled from the motor (a common phenomenon) the servo loop is less likely to become unstable if motor inertia is high relative to the load. Precise servo-tuning and filtering, which can be difficult to achieve, may not be required with a slottless motor.
A rotor with a larger diameter has greater stiffness because torque increases with rotor diameter and a higher torque motor responds faster to any displacement from the commanded position. The torque displacement curve is steeper. All of the traits above boost the efficiency by up to 25 per cent over slotted motors. DRAWBACKS OF SLOTLESS MOTORS Despite their benefits, slottless motors have their drawbacks and are therefore not suited to every application. For any given size, slottless motors generally have larger diameter rotors and because rotor inertia increases with the rotor’s diameter, inertia can increase significantly. Consider an application where load inertia is very low compared
Slotless motors offer more torque per frame size, produce more power, run smoother and achieve higher speeds than their slotted counterparts
to motor inertia and high acceleration is required. In this instance, a slotted motor may be able to accelerate faster than a slottless one, if the slottless motor’s additional torque cannot compensate for the higher torque required to accelerate the system. A slottless motor may also be difficult to manufacture as the manufacturer may need to develop customer-winding equipment because standard equipment does not do the job. If the choice is made to encapsulate the motor windings in resin to enhance performance and create a more rugged motor, the motor manufacturer must have significant experience with resin materials and the potting process itself. These challenges could increase the cost for both manufacturer and end user.
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APPLICATION BENEFITS Higher torque is beneficial for most applications and is often the first thing an engineer seeks when choosing a motor. More torque usually means higher acceleration and greater machine output. It also means that a smaller motor may be used, which can save money. A motor that can run fast may be the obvious choice for high-speed applications such as centrifuges. But faster speeds can also help reduce overall machine cost and help increase machine output. If the machine’s mechanics can handle higher speeds, a faster move time is possible. If gear reduction can be selected to optimise torque at higher speed, a smaller motor can be used, therefore saving money and weight. Additional power may also eliminate costly secondary mechanics that can shorten machine life and escalate maintenance. Two specific applications illustrate the indispensable slottless motor benefits: grinding – smooth motor motion (generated by slottless motors) is imperative as the cogging affected can produce an undesirable finish on final parts; and battery-powered designs – the higher efficiency and potentially smaller size of slottless motors extends operation. Infranor’s success in precision markets has been strengthened by the successful launch of the Xtrafors Prime series of zero‑cogging servo-motors. These motors offer the latest technology in slotless design. These have been used in Ordinance in feed systems as well as linear and rotational positioning systems, giving the product high torque and speed with modular construction and zero‑cogging all within a compact size. Xtrafors Prime is just one of the servo‑motors designed and manufactured in Europe and available from any of the global Infranor sales teams. L FURTHER INFORMATION Tel: +44 (0)208 144 2152 www.infranor.com info.uk@infranor.com
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The Importance of KPIâ&#x20AC;&#x2122;s in Telehealth Services Telehealth is still at the centre of huge debate as to measurable benefits from a clinical and cost effective perspective. Intuitively we can see that telehealth is part of the solution to enable the cost savings needed by the NHS, to meet the QIPP agenda, help clinicians manage an increasing workload, give patients more control to manage their own health and deliver better clinical outcomes. The outputs need to be quantified as KPIs to demonstrate beyond doubt that telehealth works for the benefit of the health system and patients. The sustainability of telehealth as a service can only come from demonstrating that the savings made are more than the cost of the service. Measurement points should be built into all deployments
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of telehealth, to be effective from initial installation, so that tangible evidence can be given to commissioners as the service progresses. Soon there will be guidelines against which cost effectiveness for disease groups can be compared and we should be ready with evidence of real-life savings. Academic studies have been published here and abroad which look at specific aspects of remote monitoring, and even when favourable results are published sceptics are not compelled and see the findings as out-of-date or irrelevant because they do not reflect a real-world model. This is the challenge Portsdown Group Practice has undertaken, partnering with Imperial College London to evaluate a live telehealth
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