Health Business 14.1

VOLUME 14.1 www.healthbusinessuk.net

INFECTION CONTROL

ENERGY

FLEET MANAGEMENT

PATIENT SAFETY

A FINAL RESPONSE TO FRANCIS Implementing the government’s recommendations following the Francis Report

HEALTHCARE IT

THE POWER OF BIG DATA Using information to make care better, safer and more affordable DESIGN & BUILD

TAMING EMOTIONS IN A&E How a design-led solution can reduce aggression and improve safety

PLUS: MEDICINES & MEDICAL DEVICES • FACILITIES MANAGEMENT • LEADERSHIP

HEALTH BUSINESS MAGAZINE ISSUE 14.1 VOLUME 14.1 www.healthbusinessuk.net

INFECTION CONTROL

ENERGY

FLEET MANAGEMENT

PATIENT SAFETY

A FINAL RESPONSE TO FRANCIS Implementing the government’s recommendations following the Francis Report

Comment

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

IT’S ALL ABOUT THE DATA A report by the Information Commissioner’s Office has found that GP practices are doing ‘well’ at protecting patients’ data, but still need to improve.

With the patient data opt-in, opt-out debate set to rumble on (see page 7), the Information Commissioners Office has found that GP practices are doing ‘well’ at protecting patients’ data, but still need to improve.

HEALTHCARE IT

THE POWER OF BIG DATA Using information to make care better, safer and more affordable DESIGN & BUILD

TAMING EMOTIONS IN A&E How a design-led solution can reduce aggression and improve safety

PLUS: MEDICINES & MEDICAL DEVICES • FACILITIES MANAGEMENT • LEADERSHIP

The report summarises 24 advisory visits undertaken between April and November last year at GP surgeries across England. The visits found good data protection policies and awareness of issues, including the need for adequate security and patient confidentiality. Practices also tended to have procedures in place around the practical aspects of data handling, including disposal of confidential papers.

But the report also highlights where improvements can be made. Some surgeries didn’t fully appreciate the need to report data breaches, and could improve the way they inform patients about how their information will be used.

Nearly all of the surgeries still had significant volumes of paper records.

Therefore, a serious amount of ‘document management’ work remains. ICO Good Practice team manager Lee Taylor said: “The findings are particularly important as the NHS has been undergoing a period of considerable change.”

Meanwhile, more on data, this time from the Health and Social Care Information Centre, which reveals that trips to Accident and Emergency departments from those aged 90 and above have risen by 81 per cent in the past three years. Overall, 999 trips to A&E rose by 11 per cent. Dr Cliff Mann of the College of Emergency Medicine, said that “lack of good care” in the community was a key factor.

Danny Wright

P ONLINE P IN PRINT P MOBILE P FACE TO FACE If you would like to receive all issues of Health Business magazine for £120 a year, please contact Public Sector Information Limited, 226 High Road, Loughton, Essex IG10 1ET. Tel: 020 8532 0055, Fax: 020 8532 0066, or visit the Health Business website at:

www.healthbusinessuk.net PUBLISHED BY PUBLIC SECTOR INFORMATION LIMITED

226 High Rd, Loughton, Essex IG10 1ET. Tel: 020 8532 0055 Fax: 020 8532 0066 Web: www.psi-media.co.uk ASSISTANT EDITOR Angela Pisanu EDITORIAL ASSISTANT Arthur Walsh EDITORIAL DIRECTOR Danny Wright PRODUCTION EDITOR Richard Gooding PRODUCTION CONTROL Jacqueline Lawford, Jo Golding WEBSITE PRODUCTION Reiss Malone ADVERTISEMENT SALES AJ Baker, Jeremy Cox, Azad Miah, Steve Nicolaou, Nicola Towers ADMINISTRATION Victoria Leftwich PUBLISHER Karen Hopps REPRODUCTION & PRINT Argent Media

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Volume 14.1 | HEALTH BUSINESS MAGAZINE

3

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1874 01/14

CONTENTS

07 NEWS

30 DESIGN AND BUILD

40 per cent of GPs to opt out of care.data project; more details on patient safety programme

11

The Design Council’s Catherine Pratt explains how design solutions have helped to reduce the incidence of violent behaviour in A&E

11 PATIENT SAFETY

A year on from the Francis Report, we learn how NHS boards can learn from its findings to ensure that care standards are upheld

15 MEDICAL DEVICES & MEDICINES

Mick Foy discusses the importance of reporting adverse drug reactions through the MHRA’s Yellow Card Scheme

15

19 INFECTION CONTROL

A recent study demonstrates the benefits of using antimicrobial technology to bring down the contamination risk in hospital wards

23 HEALTHCARE IT

Dr Justin Whatling, Chair of BCS Health, explains why the NHS needs to take a more joined up approach to data analysis to offer more targeted care to patients

23

Contents

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

27 ENERGY

33 FACILITIES MANAGEMENT

The campaign for a living wage can help improve the wellbeing of staff, helping to improve the health of the nation as a whole, writes Caroline Reilly

36 FLEET MANAGEMENT

How can the health sector maintain high standards in employee mobility while keeping an eye on costs? ACFO’s Damian James offers a back to basics approach

39 LEADERSHIP

The idea of a healthcare parking benchmarking survey was discussed at a recent BPA Healthcare Parking Special Interest Group

41 HOSPITAL DIRECTIONS Moving & Handling People 2014 is the must-attend event for those that provide ‘hands-on’ care

43 PRODUCTS & SERVICES

ESTA’s Richard Hipkiss outlines a structured approach to energy management that can help hospitals meet efficiency targets

A look at some of the latest products and services for the healthcare sector

27 30

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5

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HEALTHCARE IT

40 per cent of GPs to opt out of care.data project A recent survey carried out by medical publication The Pulse revealed that concerns over patient privacy are deterring many GPs from opting in to the care.data scheme.

Of the 400 doctors polled, 41 per cent said they intended to opt their patients’ records out, with 43 per cent planning on opting in and 16 per cent still unsure.

The project will involve patient records being extracted from GP practices, connected with secondary care data and then given to researchers and private companies. Care.data proponents argue that the scheme will benefit medical research, and NHS IT staff claim that patient data will only be made accessible in ‘pseudonymised’ form and identifiable data subject to strict privacy safeguards. Dr Francesca Lasman of Huntingdon said: “I think it is vital to develop an understanding of how best to manage complex co‑morbidities which exist in general practice.”

Critics, however, are concerned about the safety of the data being shared.

Dr Marie-Louise Tidmarsh of Derbyshire said: “I think patients have been misled about the ‘confidential’ nature of the data extractions, and it is not clear to whom the data will be sold.”

Extractions of patient data have been approved since April 2013 under certain circumstances, under the Section 251 exemption. 31 such requests have been approved and another 30 ‘provisionally’ approved. An NHS England spokesperson said: “Sharing information about the care you have received helps us understand the health needs of everyone and the quality of the treatment and care being provided, and our work to improve data collection and usage is supported by both the RCGP and the BMA. Everyone has the right to register objection, and to have that objection honoured.”

NEWS IN BRIEF Record uptake of flu vaccine among NHS employees

Public Health England has released flu vaccination figures for winter 2013/14 showing that NHS workers’ uptake to date has already topped last year’s final figure of 45.16 per cent. Between 1 September and 31 December 53.1 per cent of frontline healthcare workers, or over 494,000, were vaccinated.

Dean Royes, chief executive of the NHS employers organisation, said: “Wherever you go, you see staff arranging their jab because they’ve seen colleagues doing it, they know it helps protect patients, and they have good local arrangements.

It’s what we had hoped for.”

READ MORE:

tinyurl.com/obpbafc

READ MORE:

tinyurl.com/p7n5uf3

App gives waiting time for Hull & East Yorkshire A&E

PATIENT SAFETY

More details on patient safety programme

Further information concerning plans to introduce patient safety ‘collaboratives’ was shared in a paper presented at the NHS England January board meeting.

The 15 planned collaboratives form part of what is aimed to be the world’s largest single patient safety improvement programme, announced last November in response to the Francis report.

The paper revealed that the organisations are due to be established by the end of 2014/15, by which time NHS England should have a “nationally consistent system for patient safety measurement across each collaborative.”

News

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

The programme will receive annual funding of £12m for a minimum of five years.

The roles of the proposed collaboratives will be to help people throughout the health sector tackle specific patient safety problems; to improve the safety systems of care; to build patient safety improvement capability; and to use evidence-based methodologies to focus on actions that make the biggest difference to care.

Jane Cummings, NHS England’s chief nursing officer, said: “We will engage with patients, carers, staff, providers, commissioners in looking at improvement at a local level with some national oversight.”

She said the collaboratives would “have a national overview” but local leaders would be responsible for delivering the programme.

NHS England will also appoint 5,000 fellows over the next five years “who are experts in patient safety, experts in safety and improvement and will be able to work at local levels,” Ms Cummings said.

READ MORE:

tinyurl.com/p7sbq92

Hull and East Yorkshire Hospitals NHS Trust has developed an app which gives patients real-time information about their waiting times for A&E and outpatient clinics. The app, believed to be the first of its kind, also gives patient trust news and important notifications about services, such as cancellations.

It is one of a number of new features being rolled out by the trust to improve services – others include self-check-in.

A&E revamp for Medway Medway Maritime Hospital, which was criticised in the Keogh review in 2013 as having major failings, has been given a £5m development fund.

Every department in the hospital will be updated to deal with 90,000 patients annually, with work on key units hoped to be completed by winter 2014/15. The trust’s chief executive Mark Devlin said that the hospital had been designed at a time when its patient intake was much lower, and that the “unsuitable layout and environment” would be improved.

Among the planned works is a new acute assessment unit expected to be completed by the end of 2014.

READ MORE:

tinyurl.com/o8d4sn8

Volume 14.1 | HEALTH BUSINESS MAGAZINE

7

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HUMAN RESOURCES

Study shows extent of NHS reliance on non-British staff

MENTAL HEALTH

Rise in Mental Health Act detentions The number of people detained under the Mental Health Act has risen by 12 per cent in the past five years, the NHS regulator has said. The Care Quality Commission has criticised the widespread application of the act, pointing out that it was used to detain a record 50,000 patients last year.

The CQC also objected to the enforcement of blanket bans on access to outdoor space and internet use, and denounced the practice of police detention when health facilities were available. Campaigners have pointed to a lack of community support as a factor.

Mind chief executive Paul farmer said: “We are concerned at the evident lack of therapeutic activities available on some wards – it is essential that services focus on recovery rather than simply containing READ MORE: people who tinyurl.com/qdezux7 are in crisis.”

New statistics issued by the Health and Social Care Information Centre (HSCIC) show that the NHS is reliant to a significant extent on foreign nationals to make up its healthcare teams, the Guardian has reported. Employees of more than 200 nationalities make up the 11 per cent born outside the UK, a figure that goes up to 14 per cent for qualified clinical staff and to 26 per cent for doctors.

The British Medical Association (BMA) said in response that without the help of non-British staff, “many NHS services would struggle to provide effective care to their patients.”

Countries providing high numbers of NHS employees include India, the Philippines, and Ireland and other EU nations. African countries like Nigeria and Zimbabwe also make up a significant part of the labour force. The highest proportion of non-British doctors and consultants were Indian nationals (7 per cent) while the

most nurses came from the Philippines.

A BMA spokeswoman said: “Overseas doctors have for many years made a valuable and important contribution to the NHS, especially in key services where there has been a historic shortage of UK-trained doctors. This includes consultant posts in emergency care, haematology and old-age psychiatry. Without the support of these doctors many NHS services would struggle to provide effective care to their patients.”

Tim Finch, from the Institute for Public Policy Research thinktank, said the statistics held lessons for immigration policy.

“If the single thread of immigration policy is just to get the overall figure down by any means, you’ve got to look at the consequences of that on the NHS.”

CARE STANDARDS

TREATMENT

Views sought on CQC registration changes

NICE supports remote-controlled rod for curved spine treatment

The Department for Health has drafted up proposed regulations that would enshrine in law the fundamental standards that all providers of health and social care must meet in order to register with the Care Quality Commission (CQC), and is seeking public views until 4 April.

The CQC intends to use these measures of safety and quality in the inspection and regulation of care providers. The proposed standards include pledges that care must reflect service users’ needs and preferences; that they must not be subject to abuse; that their nutritional needs must be met; and that complaints must be investigated and appropriate action taken in response.

These standards were recommended by the READ MORE: Francis tinyurl.com/qbg79lz Inquiry.

READ MORE:

tinyurl.com/pzpkprw

Remote-controlled rods attached to a spine could soon become a treatment available on the NHS for children with curved spines after the National Institute for Health and Care Excellence (NICE) supported its use in draft guidance.

Extendable titanium rods are attached to the ribs or spine of the child near to the curved section of the spine in a similar way to the implantation of conventional rods.

But the new Magec (Magnetic Expansion Control) system does not require periodical surgical incisions to lengthen the rods as it uses a remote device instead, which controls magnets in the rod to adjust its length.

This means the child will not have to undergo general anaesthetic and can have their rods altered in an outpatient clinic.

In new draft guidance, Nice has supported

News

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

CANCER CARE SURVEY

Welsh cancer patients satisfied with care 89 per cent of cancer patients in Wales have rated their treatment and care as excellent or very good in a new survey, but there was variation in scores across hospitals and different types of cancer. Patients suffering from lung cancer and rare cancers were less positive about treatment than those with more common cancers. The Cancer Patient Experience Survey was carried out by the Welsh government and MacMillan Cancer Support. Respondents singled out Velindre in Cardiff, Llandough in the Vale of Glamorgan, and Ysbyty Gwynedd in Bangor, Gwynedd as providing especially good care.

the use of the Magec system in children with scoliosis aged two to 11, but it only recommends the device if conventional methods such a back brace have not worked.

Professor Carole Longson, director of Nice’s Centre for Health Technology Evaluation, said: “For children who need treatment for scoliosis, and for whom standard treatment such as a back brace hasn’t worked, surgery to implant conventional growth rods is an option. But the repeated surgical procedures that are needed to extend the rods can be difficult for the child.

“By avoiding the need for the repeated surgical procedures, the committee accepted claims that the device can reduce the incidence of surgical complications and infections, cause less pain and distress and less time away from school.”

Volume 14.1 | HEALTH BUSINESS MAGAZINE

9

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FRANCIS REPORT

A year on from the hard-hitting Francis Report, Tony Yeaman and Emlyn Williams of Weightmans LLP review the NHS response to date, and outline an approach for boards to meet new guidelines It’s nearly a year since the publication of the Francis Report and at least six other reports have been published in the interim, including the Government’s initial response ‘Patients first and foremost’. We now have ‘Hard Truths’, its comprehensive response to the 290 Francis recommendations.

‘Hard Truths’ builds on the Government’s initial five key themes of preventing problems, detecting problems quickly, taking action promptly ensuring robust accountability and ensuring staff are trained and motivated.

The clear message is that patient safety and care is the responsibility of all within healthcare. It is understood that the Department of Health will review progress annually – something for boards to take notice of as there is a real will to ensure that lessons are learnt, and real and measurable change made. So how are management to make sense of and implement these

UNDERSTANDING THE SYSTEM All these themes are adopted in ‘Hard Truths’ – but in reality are unlikely to be overcome quickly and will need investment in systems, processes E

Whilst t o this is ntime t the firs e been av there h s of care failure NHS, what he within trs different is appea ppetite for the a nge cha

Written by Tony Yeaman & Emlyn Williams, Weightmans LLP

STRATEGIES FOR A STRONGER AND MORE OPEN NHS

changes – and those to be introduced over the coming months – whilst running complex and challenged organisations?

What is clear from the reviews such as the Berwick report ‘Improving the safety of patients in England’, is that boards need to address the loss of focus on “quality and safety as primary aims, inadequate openness to the voices of patients and carers, insufficient skills in safety and improvement and [inadequate] staffing for patients’ needs.”

Boards could do worse than consider what Berwick highlighted as the four keys aims for the future of the NHS: placing the quality of patient care, especially patient safety, above all; engaging, empowering and hearing patients and carers; fostering wholeheartedly the growth and development of all staff, embracing transparency unequivocally in the service of accountability, trust and growth of knowledge.

Patient Safety

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

11

Telehealth Project in Dorset Staff and Service The Key Service Outcomes are to improve the quality of life for patients with long term conditions including, but not limited to, Chronic Obstructive Pulmonary Disease (COPD) and Chronic Heart Failure (CHF) through self awareness and self management of their condition and to reduce non-elective/ unplanned hospital admissions for patients, offer care closer to home and assist with directing clinical resources where they are most beneficial/ required.

The main aims of providing the Telehealth service are: 1. Provide individualised technological support for patients to enhance their care management within a community setting; personalised care planning; patient focused interventions across the disease trajectory from health promotion and disease prevention to intensive monitoring and support.

2. Measure the impact of Telehealth on emergency admissions and acute care within a small controlled group receiving Telehealth.

Ensure robust system management including: patient co-ordination and progress updates; clinical advice; supported discharge from hospital and/or patient referral to other services and prevent/reduce unnecessary/ inappropriate hospital admissions.

3. Assist in the clinical decision making, providing patient empowerment and autonomy 4. Test the impact of new technology on case load/work load of community teams.

Prior to the launch of the service in February 2012 meetings were

held with Key Clinicians to engage them and encourage telehealth as “another tool in the toolbox” for patient management: high case loads, reducing carbon footprint, reducing hospital admissions and assisting patients with self monitoring and management of their conditions.

Training was given on the Clinical User Interface prior to recruitment of patients after which each individual Health Care Worker would identify and carefully select those patients who they felt would benefit. Demo pods were distributed to those who required them in order to assist in patient recruitment/selection along with a leaflet campaign to surgeries.

Where we are now 400 referrals received to date with 300 patients currently using.

The project has seen the expansion to other areas such as Oncology, Mental Health and the start of a Diabetes pilot.

Regular Clinical Reference Groups and Patient Feedback sessions are held for networking, sharing best practice on ways of working whilst always looking at ways to improve the service.

Dorset CCG have been shortlisted for an HSJ Efficiency award for the Implementation of Telehealth across Bournemouth, Poole and Dorset.

If you are interested in find out more about deploying an effective telehealth solution contact Medvivo at info@medvivo.com www.medvivo.com @medvivonews

Albert Fudge

“I was diagnosed with Chronic Obstructive Pulmonary Disease (COPD) in 2009 and Telehealth was recently suggested to me by my Practice Nurse.

I was a bit sceptical at first as I wasn’t sure how a piece of equipment could do what my nurse does!

Since starting to use, Telehealth has been a god-send. I have had no admissions to hospital and I haven’t needed to attend my GP practice for routine appointments or tests. I can now do these in my own home, in my own time and at my own pace.

I feel so comfortable knowing my results are being picked up and looked at by the people who know me and understand my condition.

I don’t take up appointments that other people need and I know I can just pick up the phone if I do need to speak to someone.

I would definitely recommend Telehealth, it’s my lifeline!”

Patient Safety

FRANCIS REPORT  and most importantly, in people. The clear message is that in order to change, things have to be done differently.

It is imperative that management have a firm understanding and knowledge of the realities of the whole system and remain connected with those for whom they are responsible, including assuming responsibility to ensure that clinical areas are adequately staffed and safe. Everyone working within the NHS needs the skills to identify and help reduce risks to patients. To do this, management will have to provide the environment, resources and time to enable staff to acquire and deploy these skills.

A good example of how tricky this may be in practice is incremental pay rises. Since April 2013 trusts have been able, under ‘Agenda for Change’, to withhold increments from those staff whose performance is not satisfactory. Indeed, identifying such staff members will no doubt be one of the key metrics for judging whether organisations have put the necessary checks and balances in place, post Francis, to ensure that performance and patient care are up to scratch across their workforce. In theory this is laudable, and it might even save hard up trusts some money, if increments are not automatically awarded. In practice, though, how much progress has been made in implementing the necessary changes?

MEASURING SUCCESS There is no national guidance on how to determine what satisfactory performance is.

There is no nationally agreed process to follow, no steer as to whether there should be the right for employees to challenge the decision to withhold their increment at all, on appeal, via a grievance, or all of the foregoing. So, not an easy step to deliver for HR teams already stretched and seeking to deliver organisational change and support the attempted delivery of huge CIP targets across their organisations.

Boards would also do well to heed the clear messages in the Secretary of State’s opening to ‘Hard Truths’, to ensure their organisations have the ability to hear and see the patient effectively, be clear what their systems actually delivers, be more accountable and build a culture of compassion and care.

Key issues for boards include the need to respond pro-actively to a new system of fundamental standards to be launched by the DH which Francis had recommended, and which the CQC are expected to enforce and review, through a radically reformed inspection regime backed by a series of further criminal sanctions covering such matters as information and lack of safe care.

Boards need to emphasise the need for every individual within the organisation to play their part, noting that external regulators, the police, HSE and commissioners and patients will see this new environment as a way to hold the NHS to account.

Management will need to grasp the new metrics; how these are to be applied by

regulators, patients and staff; implement mechanisms to gather key data, ensure they can meet the new inspection regime and understand what they need to measure and change to enhance patient care and safety. There will be a raft of new measures including mortality data, benchmarking, friends and family tests, responses to staff surveys and meetings with commissioners increasing the demand for transparent access to information and data.

A CULTURE OF OPENNESS Whilst this is not the first time that there have been failures of care within the NHS, or recommendations made for change, what appears different is the appetite for change in the general public, allied to a political appetite to see change effected.

NHS boards will face a number of new challenges, such as the implementation of a statutory duty of candour, over and above that already in place with commissioners, through NHS contracts.

The risk is that a failure to be candid could lead to the organisation itself being liable for litigation costs. Boards will also need to have early knowledge of what goes wrong via an open and robust approach to accountability and self reporting. It will be necessary to have processes which are known to all staff and

on the part of individuals or healthcare providers, including the provision of false or misleading information.

TRACKING PATIENT DATA Foundation Trusts will have to adapt to the far greater powers and involvement on the part of their governors, following on from reforms in the Health and Social Care Act 2012, with governors now able to summon directors, approve or be consulted on key elements and be a link to external regulators.

Boards need to grip key patient metrics including complaints, incident and claims data and make full use of an ever improving and evolving set of relevant data which are likely to be increasingly useful in identifying key issues.

This will require improvements in the gathering of data and a means to target keys areas such as falls or infection. It will require a focused investment, communication and engagement strategy to ensure every member of staff is aware not only of their professional and legal obligations, but their role in the provision of data continuing from the duty of candour. This will be crucial in order to meet the requirement of a website for patients providing up to date ward level data on patient safety, as a means of improving patient care.

A radically-reformed NHS would put clinicians at the heart of commissioning with a willingness to learn and share experience. It is now up to the NHS to take action which protect whistleblowers from possible victimisation – in light of the changes made to the Public Interest Disclosure Act last year.

The board and its directors will need to have their skill sets reviewed to ensure they meet the new proposed fitness test and have the skills to ensure governance across the main themes of the report. Finally, they will have to be able to meet challenges from the CQC and/or Monitor in relation to the capabilities of the board and the organisation.

Organisations face stiffer sanctions with a will to enforce them. This is particularly so in relation to the provision of unsafe care following the creation of a new offence of wilful or reckless neglect

There is now a real mood, and more importantly public and political appetite, for change, with a radically reformed NHS putting clinicians at the heart of commissioning and a willingness to learn and share experience.

It is now up to the NHS to take the action.

The challenge is in delivering this reformed structure in the cash-limited healthcare sector, whilst responding to an ever increasing publication of actions and expectations that require both legal and cultural change not just at the top, but throughout all aspects of every public sector body. L FURTHER INFORMATION www.weightmans.com

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HEALTH BUSINESS MAGAZINE | Volume 14.1

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Medical Devices & Medicines

DRUG SAFETY

Mick Foy discusses the importance of reporting adverse drug reactions through the MHRA’s Yellow Card Scheme and the current focus on making children’s medicine safer Whether for a minor ailment or a serious condition, medicines are taken by millions of people every year without any problems.

However adverse drug reactions (ADRs) can sometimes be an unwanted part of

any effective treatment. Reporting of suspected ADRs is an important element of the system to monitor drug safety.

Medicines and Healthcare products Regulatory Agency (MHRA) Group

Written by Mick Foy, Medicines and Healthcare products Regulatory Agency (MHRA) group manager for Pharmacovigilance

HELPING TO MAKE MEDICINE SAFER FOR CHILDREN

Manager for Pharmacovigilance, Mick Foy discusses the importance of reporting through the Yellow Card Scheme and the MHRA’s current focus on increasing the reporting of ADRs in children.

Many NHS professionals know about the Yellow Card Scheme, the voluntary reporting Scheme run by the UK’s medicines watchdog, the MHRA. The Scheme acts as an early warning system receiving reports of ADRs from healthcare professionals and patients from medicines and vaccines. The MHRA rely on healthcare professionals to report ADRs and they are recognised as key contributors to the Scheme making up 83 per cent of the total reports received.

However, as for all such reporting systems, there is significant underreporting of ADRs with some studies estimating that between 10-15% of serious cases are reported. The level of underreporting varies depending on a number of factors including whether E

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BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

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DRUG SAFETY  the medicine is new and carries the black triangle symbol. With increasing workloads and demands on NHS staff something that is voluntary can often be forgotten despite it being a professional responsibility.

MEDICINE FOR CHILDREN A key area of concern is the safety of medicines used in children where use continues to rise. A recent survey undertaken on behalf of the MHRA found that 59 per cent of parents have self-medicated their child and that 75 per cent of parents would ask a doctor for advice if their children had suffered an ADR. Although increasing numbers of medicines specifically have a licensed indication for use in children, many are still used ‘off-label’. All medicines must undergo extensive testing and clinical trials to ensure that they are safe and effective, but it is more challenging to undertake pre‑market testing of medicines in children as they are vulnerable with developmental, physiological and psychological differences from adults. This means the collection of ADRs for medicines used in children is especially important as, at the time of licensing, there may be limited information available.

All Yellow Cards submitted are treated in the strictest confidence and are not used for any audit or disciplinary purposes.

An extra five minutes taken by you or one of your colleagues to complete a Yellow Card can help to make medicines safer for everyone, especially in children.

WHAT TO REPORT? For medicines and vaccines in children under 18 years old you should report any suspected ADRs even if the reaction is well recognised, you are strongly encouraged to report all: serious reactions (fatal, life-threatening, a congenital abnormality, disabling or incapacitating, resulting in hospitalisation, or medically significant). You should also report any severe reactions (resulting in harm to the patient or more extreme in nature), as well as reactions to black triangle medicines and vaccines, unlicensed medicines and herbal products. What’s more, professionals should report medication errors resulting in harm to a child (including abuse, misuse and overdose), and reactions considered unusual for any reason including those not listed in the product information of a medicine.

Yellow Card reports are evaluated alongside other data to determine whether any regulatory action is required to allow medicines to be used more safely and effectively. This can include restrictions in use, reclassification, refinement of dosage instructions of the introduction of specific warnings INFORMATION ON KEY GROUPS Reporting to the Yellow Card Scheme helps provide important information about ADRs in such key groups as children as well as the general population. Now in its 50th year, the scheme has demonstrated its value on numerous occasions since it started in 1964, when it was conceived in response to the Thalidomide tragedy.

More recently Yellow Card data helped inform changes in advice on how to use medicines containing codeine. The review of evidence available included Yellow Cards and data from pharmaceutical companies and resulted in restrictions in the use of these medicines for children due to an increased risk of overdose, breathing difficulties or misuse.

Yellow Cards from NHS staff can help the MHRA identify new adverse drug reactions and also refine the understanding of factors affecting the clinical management of patients. The MHRA uses Yellow Card data alongside other scientific information to effectively monitor the safety of medicines.

HOW TO REPORT? There are two methods for reporting, online and by using a paper form.

It is easiest to report online (www.yellowcard.mhra.gov.uk) and if you choose to register, you can also keep track of any Yellow Cards that you send.

If you want to report by paper, forms are available at the back of the: British National Formulary for children (BNF-C) or BNF, and Monthly Index of Medicine Specialties (MIMS). You can also email yellowcard@mhra.gsi.gov.uk.

Yellow Card reports are evaluated alongside other data to determine whether any regulatory action is required to allow medicines to be used more safely and effectively. This can include restrictions in use, reclassification, refinement of dosage instructions or the introduction of specific warnings of side-effects in product information. L

MHRA and the Yellow Card Scheme The Medicines and Healthcare products Regulatory Agency (MHRA) is responsible for the regulation of medicines and medical devices and equipment used in healthcare, and the investigation of harmful incidents.

Medical Devices & Medicines

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

The MHRA also looks after blood and blood products, working with UK blood services, healthcare providers, and other relevant organisations to improve blood quality and safety.

The MHRA is a centre of the Medicines and Healthcare Products Regulatory Agency which also includes the National Institute for Biological Standards and Control (NIBSC); and the Clinical Practice Research Datalink (CPRD). The MHRA is an executive agency of the Department of Health.

The Yellow Card Scheme is vital in helping the MHRA monitor the safety of the medicines and vaccines that are on the market. If a medicine has caused a side effect, patients and health professionals are urged to send the MHTA a Yellow Card.

The reports are evaluated and continually assessed by a team of medicine safety experts made up of doctors, pharmacists and scientists who study the benefits and risks of medicines.

If a new side effect is identified, information is carefully considered in the context of the overall side effect profile for the medicine, and how the side effect profile compares with other medicines used to treat the same condition. The MHRA takes action, whenever necessary, to ensure that medicines are used in a way that minimises risk, while maximising patient benefit.

In assessing the safety of medicines, the MHRA is advised by the Commission on Human Medicines (CHM), which is the Governments independent scientific advisory body on medicines safety.

The CHM is made up of experts from a range of health professionals and includes lay representatives.

FURTHER INFORMATION www.mhra.gov.uk/yellowcard

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HEALTH BUSINESS MAGAZINE | Volume 14.1

Antimicrobial Electrium Sales Limited, Commercial Centre, Walkmill Lane, Cannock WS11 0XE Tel: 01543 455010 Fax: 01543 455011 www.electrium.co.uk

ANTIMICROBIAL WARDS

Infection Control

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Written by Dr Andrew Summerfield, Biocote

DECONTAMINATING THE REAL WORLD

In the last issue of Health Business, Biocote’s Dr Andrew Summerfield described the progress antimicrobial technology has made in reducing bacteria. Here, he looks at a recent study which proves its value in hospitals Performance claims of biocides and disinfectants should be substantiated by the commercial organisations taking their products to market. Often laboratory-derived efficacy data are sufficient to make legally acceptable claims but it may be expedient for a manufacturer to present information describing their product’s performance that is directly relevant to that product’s intended use. Examples of information directly relevant to a product’s intended use include antibacterial performance against organisms specific to certain environments and the results from microbiological studies bespoke to particular environments.

THE CHALLENGES OF ANALYSIS Unfortunately, custom studies addressing the microbiology of environments are often costly, time consuming and provide only a ‘snapshot’ understanding of what, in reality, is a complex, dynamic situation. Results from environmental studies need to be interpreted with more caution than those from a ‘simple’ antimicrobial laboratory test on swatches of biocide-treated polymer. In the laboratory product testing is performed under controlled conditions because our standard methods dictate as much. A single test organism is usually used whilst in the real world the same product may well be exposed to a multitude of microbial challenges from several independent sources and re-inoculation of the product is inevitable. Controlling such a situation for the purposes of a

microbiological study is virtually impossible.

Generating meaningful insights into the in situ performance of antibacterial surfaces is, for the reasons outlined, challenging, but it is not impossible provided the science is robust. Teams must be dedicated to engaging in suitable ‘real world’ studies ranging from modest sample collection and recording work through to collaborating with partner companies and universities to generate novel data describing the in situ performance of antibacterial surfaces that are subsequently published as peer reviewed journal articles. In 2009, BioCote published the results of a study describing the performance of antibacterial surfaces in an acute healthcare environment in the Journal of Infection Prevention.

This study added to the on-going debate about technologies and practices of value in supplementing standard infection control procedures. The paper’s authors highlighted the lack of data describing the performance of antimicrobial surfaces in situ.

diverse antimicrobial surfaces. The second ward underwent similar refurbishment as the first, but without the inclusion of antimicrobial technology. Normal clinical activity preceded in both environments as the investigators monitored key microbiological parameters on the surfaces of interest.

On average, bacterial contamination was over 95 per cent lower on all surfaces in the treated ward compared to the control ward. The study also produced the unexpected observation of reduced levels of bacterial contamination on untreated surfaces in the modified ward.

The paper hypothesised that antibacterial surfaces play a role in mitigating the risks of cross contamination in a treated environment.

Other studies of antibacterial surfaces conducted by BioCote and collaborators with similar objectives have produced results and conclusions in general harmony with this prediction: surfaces demonstrating a highly efficacious antibacterial property by laboratory analysis demonstrate that property, to some degree, when applied to ‘real life’ environments.

One way to address the challenges of controlling an in situ microbiological study is to repeat the investigation to unrelated E

ting Genera gful meanin to the in insights rformance e in‑situ ptibacterial of an ces is surfa but it is ging challen mpossible not i

MEASURING THE BENEFITS In brief, two comparable wards were selected from the acute unit for study. The first ward was modified by the introduction of numerous,

Volume 14.1 | HEALTH BUSINESS MAGAZINE

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THE UK’S LEADING ALL-ROUND INVESTIGATION SERVICE Sirs has an incredible team of experienced and capable investigators who can boast more than 250 years’ combined experience. They have been drawn from various backgrounds, including military, police, intelligence services and those that have been entirely trained by us or within the private sector.

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• tracing and recovery • Asset Investigation of illegal sub-letting in relation to social housing, where it is now a criminal SIRS are specialists in tracing assets and assisting in the recovery process all over the world. offence. This can include obtaining solid evidence that the tenant is residing elsewhere, Status/wealth reports can be prepared on individuals and companies for peace of mind or evidence of who is currently residing at the target address, surveillance operations, interviews recovery purposes. and statements from witnesses and the tenants themselves; • Health tourist debts • It is well publicised that bothaction NHS and private hospitals areof experiencing severe problems in relation Investigations to support in relation to mis-use council/government property, againstto debts owed by individuals who have had treatment in the U.K. and subsequently left the country without terms of the lease; paying. SIRS can greatly assist by locating current whereabouts of debtors throughout the world and with the whole recovery process. We can also prepare identity, residential and status reports prior to treatment • in Service ofmitigate documents onofsquatters; order to the risk non-payment.

• reports • Pre-employment Assistance in cases involving “Children at risk”, including tracing and serving documents on parents SIRS can prepare such reports to any level but in generalfor to injunctions include residential, or partners. The obtaining of evidence to required support applications or careidentity orders;and credit checks: Education and qualifications: Prior employment references: Personal referees: Periods of unemployment: Various background checks.

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ANTIMICROBIAL WARDS  situations/environments that share only the presence of antibacterial surfaces.

This approach can allow a persistent, universal antibacterial effect on the treated surfaces to be discerned because compared to their surroundings the antibacterial surfaces will always tend to a reduced level of bacterial contamination.

FIGHTING CROSS CONTAMINATION How does the information generated by in situ studies empower us to understand the potential benefits of antibacterial surfaces in the real world? As mentioned, a consistent finding of these studies is the on average lowering of the number of

bacteria found contaminating antibacterial surfaces compared to related, but untreated surfaces. An obvious benefit, then, should be the reduction in cross contamination within the antibacterial environment and this parameter is, in theory, measurable.

Cross contamination by human hands is a major mechanism by which bacteria are distributed from a source to the surrounding environment and no one would seriously challenge the firmly entrenched view that hand washing is the single most effective way

in which bacteria are inhibited from spreading. Therefore, breaking the chain of how cross contamination works is a potential benefit of antibacterial surfaces.

Infection Control

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

DISINFECTANTS NOT SUFFICIENT The application of traditional disinfectants is a mainstay of cleaning regimes. A disadvantage with disinfectants is their transient effect. The disinfectant does not act continuously on the surface it was applied to, so surface contamination will presumably reoccur at some point.

Disinfectant cleaning is therefore, necessarily, a repetitive process. Antibacterial surfaces, in contrast, operate continuously to reduce the number of viable bacteria contaminating them.

There is a compelling mass of data showing treated materials from fabrics to laminates sustain their antibacterial effect over considerable periods of time.

It should be pointed out that antibacterial surfaces do not remove the need for normal cleaning to operate; rather the antibacterial activity of treated surfaces brings a hygiene benefit in between episodes of cleaning. This concept is supported by the results of in situ studies described above.

No‑one would ly serious the ge challen view that hed entrenc ashing is the hand w effective to most bacteria inhibit ading spre

A GROWING INDUSTRY The antimicrobial industry has been forecast to continue growth in coming years. Over recent years antimicrobial technology has been applied to an increasing range of materials and product types which are then introduced into new industries and environments.

Often an evidence base is required for manufacturers and or end users to adopt antibacterial technology, but the literature describing the performance and benefits of antibacterial technology has now emerged and continues to swell.

It is important we continue to better understand this technology, particularly as new active substances are added to the portfolio of antibacterial products.

Scientific organisations and their commercial and academic collaborators are valuable in adding to our understanding of the technology and its benefits when it is applied to the contaminated real word. L

Part I of this article can be viewed in Health Business issue 13.6, which can be viewed here: tinyurl.com/oovcrg6 FURTHER INFORMATION www.biocote.com

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HEALTH BUSINESS MAGAZINE | Volume 14.1

DATA ANALYSIS

Healthcare IT

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

USING BIG DATA TO MODERNISE CARE DELIVERY

Harnessing the potential of big data is one of the biggest opportunities facing the NHS. It will be at the heart of how we make care better, safer and more affordable in the future. The question, therefore, is not whether big data will transform care, but how to maximise the benefits. The danger for the NHS is that it focuses on data at a macro level, building pictures of health trends across populations. Useful though that is, it merely classifies problems. The real breakthrough comes from using data to identify solutions, helping doctors and nurses to make real-time decisions. The NHS does not need to choose between using data to plot problems or identify solutions; it needs to be ambitious in embracing both, and using big data to transform the quality of care.

OVERCOMING BARRIERS Before the NHS conquers data, however, it first needs to overcome its cultural aversion to sharing it. Some industries, such as retail and banking, have been quick to see monetary value in high quality customer data and have

Written by chair, BCS health and senior director of Population Health at Cerner

The NHS has at its disposal vast amounts of data that could help improve its services. But first it needs to get over its fear of sharing it, writes Dr. Justin Whatling, Chair of BCS Health

We d will neeient developed advanced sharing could be improved t systems to capture, without compromising huge pases to trade and use it for patient confidentiality. a b a t o t da w o commercial advantage.

The Health Secretary h nd The NHS is different. ndersta ple of each Jeremy Hunt has u o The lack of commercial spoken passionately treat petic group, if drivers, combined with about the need to gene wn to the greater sensitivity and improve the quality of legal constraints around data as part of his plan ot do idual n medical data has created to make Britain a “global indiv l a nervousness about sharing hub” for health technology. e v e l it. The consequences for care are It would be naïve to think stark; clinicians are left facing decisions without vital pieces of the jigsaw that did not follow the patient through the system.

Fortunately for big data advocates, the tide is turning on the reluctance of the NHS to share information. In May last year, the Department of Health’s information strategy ‘The Power of Information’ explicitly stated that “not sharing information has the potential to do more harm than sharing it.” This was followed in March 2013 by the ‘Caldicott2’ report, a Government-commissioned review tasked with identifying how NHS information

political will can reverse decades of cultural conservatism overnight, but the direction of travel is the right one.

TRACKING ILLNESS IN THE POPULATION In seeking to harness the power of big data, the easiest approach for the NHS would be to focus on its secondary benefits. This involves joining up data currently locked in silos to identify health opportunities across the population.

Some work has already started on this, with national disease registries and more recently with NHS England’s care.data project E

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Streamlining care in South West Hampshire: using Map of Medicine to meet quality targets University Hospital Southampton NHS Foundation Trust in collaboration with two local primary care trusts (NHS Southampton City and NHS Hampshire) set out to reduce unnecessary demand on secondary care. Specifically, the aim was to deliver safe and affordable, as well as high-quality care efficiently while reducing outpatient readmissions by 10 per cent.

There was also a need to develop a set of referral guidelines that could be communicated easily amongst the health community. In primary care, most best practice information was stored in hard copy by individual GPs. Dr Sonpal, a Hampshire GP, says: “Guidelines and current best practice change frequently and keeping up to date with all is very difficult.

The Map of Medicine collates all of these pathways into one easily accessible place.

Furthermore, I can work through pathways with patients and methodically manage their issue – often without making a referral.”

Map of Medicine was selected to help standardise referrals and provide a central repository for all local guidance.

Commissioners and providers worked together using the Map of Medicine to develop a series of evidence-based, locally relevant

pathways. They worked to present local data in an easy-to-use, intuitive and succinct format for GPs. Contributors were able to communicate key messages for pathways and set local referral thresholds and referral routes.

Plus, they could alert GPs to alternative treatment options available in the area.

Dr Hunter, a Hampshire GP, says: “I look at locally developed maps during the consultation and share these with patients.

This is an effective way to describe and store the agreements we make with providers on the pathways and services we commission.”

“Map of Medicine has supported us in making this project a resounding success by helping us garner strong clinical engagement and leadership and facilitate direct communication between primary and secondary care clinicians,” says Lucie Lleshi, Map of Medicine project manager, South West Hampshire.

Co-operation between primary and secondary care has been a resounding success of the project, increasing communication across care settings to improve the quality of care for patients.

The health community has significantly reduced inappropriate GP referrals by 15 per cent across gynaecology, haematology, paediatric orthopaedics and endocrinology, leading to notable financial savings and quality, innovation, productivity and prevention achievements.

The quality of referrals improved by more than 50 per cent, with the number of referrals rejected from secondary care falling to 112 for orthopaedics and 56 in gynaecology.

FURTHER INFORMATION Tel: +44 (0)20 7492 6300 www.mapofmedicine.com

Having it all: efficient and effective referral management Map Referrals allows GPs to access comprehensive, evidence-based local guidance at the point of care, and helps CCGs achieve their quality and productivity targets.

Monitor and standardise local perforMance Map Referrals optimises Map of Medicine’s existing decision support software by linking the clinical and administrative side of GP referrals to standardise activity.

Locally customised care pathways, referral guidance and referral forms

Map of Medicine has worked with those on the front-line of delivering and managing care to develop a tool that enables efficient and effective referral management for both GPs and Commissioners. Map Referrals: 1. Helps clinicians delivery quality care by providing local best practice information at the point of care 2. Embeds seamlessly with the GP workflow and provides standardised referral forms that auto-populate with patient information 3. Is supported through Map of Medicine’s expert deployment team to ensure uptake across a CCG.

To find out more or to book a demonstration, please contact richard@mapofmedicine.com or call 0207 492 6300

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DATA ANALYSIS  already extracting data from General Practice and seeking to extract and link data from hospitals, and down the line from community and mental health providers across the NHS. The US has arguably gone further. Originally designed in 2003 as an early detection mechanism for bioterrorism, the BioSense project now uses pooled data to track emerging public health problems in real time.

The cloud-hosted system is a model for how the NHS could integrate data to proactively identify and respond to health challenges.

Other secondary benefits of big data for the NHS would include capturing performance data that could benchmark the performance of hospital departments and highlight pockets of poor care. Such a benchmarking system was recommended by the Francis Report into failings at Mid Staffordshire NHS Trust, and would allow for interventions before – rather than after – problems compromised patient safety.

PRIMARY BENEFITS The more ambitious target, however, is for the NHS to realise the direct or primary benefits of improved data that can enhance quality and safety at the level of an individual patient. This means improving the flow of information to clinicians to enable them to make quicker, more informed decisions.

One example is sepsis, which kills close to a third of affected patients. Survival hinges on detecting sepsis in the initial 6 hours of onset, meaning every hour counts. Applied intelligently and in real time, data can directly increase the chance of survival. Cerner’s St John’s Sepsis Agent technology continuously monitors key clinical indicators and where sepsis patterns are detected an automatic alert is sent to care teams who can intervene.

Healthcare IT

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The NHS does not need to choose between using data to plot problems or identify solutions; it needs to be ambitious in embracing both, and using big data to transform the quality of care By using big data to structure and process data directly in clinical practice, the NHS can directly improve care and save lives.

Cloud and real time data analytics will enable the proliferation of algorithms and decision support to direct patient care and the care of patient cohorts. This will expand with the availability of genomics data mapped to patients’ electronic medical records. Decision support using this linked information enables personalised care. Also, the progressing genetic re-classification of disease will change existing handfuls of histopathological cancer types into hundreds of types per cancer.

We will require huge patient databases to understand how to treat smaller numbers of each genetic type, if not down to the individual patient level. By merging the scale of big data with the detail of ‘small’ data, information can be applied to individual patients at the point of care. This is no longer science fiction but an achievable technological reality.

USING DATA TO MAKE SAVINGS In advocating the transformation of care, we have to be mindful of the financial realities facing the NHS. In the short-term, the NHS needs to realise £20 billion of efficiency savings by 2015. Longer-term, a financial time‑bomb caused by the rise of chronic diseases in an ageing population makes the current model of care delivery unsustainable.

Data offers a solution and should underpin the

effort to make care affordable. By mapping health trends across a population, at risks groups can be identified and resources targeted more effectively. At an individual level, enabling patients to manage their own health and avoid hospital admissions dramatically reduces the cost of care. In the US, a pilot to join up patient data between the Department of Veterans Affairs and Kaiser Permanente, a leading Californian care consortium, reduced patient visits by over 26 per cent. If the NHS is to remain affordable, it has to transform how it delivers care.

Harnessing big data to better target resources and prevent hospital admissions should be at the heart of this. Far from undermining the case for investment in big data technology, budget constraint reinforces it.

EMBRACING CHANGE The NHS has much to be proud of as it celebrates its sixty fifth birthday. It remains a model of what an ambitious, progressive society can achieve, even in times of austerity.

But if the NHS is to celebrate another sixty five years, it needs to radically change how it cares for Britain. By embracing data, the NHS has the possibility to improve the quality, safety and affordability of care. The question, however, is how ambitious the NHS is prepared to be. If it restricts itself to secondary benefits of smarter data, the NHS will be a more informed purchaser, with accurate pictures of health trends, hospital performance and at risk patients. To truly transform care, however, the NHS needs to go further, directly applying data into clinical practice to improve outcomes, strengthen patient safety and prevent hospital admissions.

The challenge is not unique; it is the same as that faced by companies such as Google, Facebook and Amazon. In harvesting aggregated data, online companies build a valuable business asset, but their success hinges on analysing and applying that data at the level of an individual consumer.

That allows for tailored interventions, such as targeted advertising on Google or suggested purchases on Amazon that change how consumers behave.

The context for the NHS is different, but the objective is the same; using data to better understand a patient’s health and target specific interventions to improve it. It will require ambition to make it a reality, but the prize of a better NHS makes it worth striving for. L FURTHER INFORMATION www.cerner.com

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How to improve your hospital’s financial health

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ENERGY MANAGEMENT

Richard Hipkiss of the Energy Services and Technology Association (ESTA) outlines some of the steps managers can take to maintain high energy efficiency levels in the health service

FINDING OPPORTUNITIES TO SAVE The question in many professionals’ minds is where those savings are going to come from. One area that continues to provide opportunities for efficiency improvements is that of utility management. This is not because the Health Service is a profligate user of energy and water – far from it in many cases.

Yet advances in technology, together with new approaches to management, hold out the promise of additional savings even where significant initial improvements have already been achieved.

It does however have to be acknowledged that the Health Service, like most other areas of both public and private sectors, still has a patchy record regarding energy.

The experience of ESTA members is that, while some Trusts and health providers have achieved exceptional efficiency levels, others could still find major savings through a more coordinated, strategic approach. We find that on average, savings of up to 20 per cent on energy and water bills are achievable (and in some cases even more) for a wide range of organisations in this sector. When every pound saved here could go on patient services, it surely makes sense to get this right.

Written by Richard Hipkiss, chairman, ESTA

GUIDELINES THAT DELIVER REAL ENERGY SAVINGS

The Health Service is being expected to deliver more and more on an increasingly constrained budget. While its overall funding from Government may be ring-fenced, major efficiency savings are being demanded from it in order to focus a greater proportion of resources on frontline patient care – and this is all against the background of rising costs across the Service.

Energy

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EFFICIENCY THROUGH AUTOMATION A fundamental aspect of utility management remains the identification of waste through careful monitoring of consumption. Only then can comparisons be made against relevant benchmarks, targets set for improvement and continuous monitoring of activity carried out.

In recent years, the fundamental techniques of Monitoring & Targeting have been transformed by automation. Gone is the laborious manual data-gathering and data‑inputting, to be replaced by automatic meter reading, analysis and reporting.

Automatic Monitoring & Targeting (aM&T) has proved so successful that it merits special treatment in the Building Regulations. Added functions, like the automatic production of Display Energy Certificates (DECs) are making this a mainstay of modern energy management. But it is still a developing technology and to find out just how powerful a tool this technology can be and what the latest developments are, ESTA has organised annual conferences.

AN EFFECTIVE FRAMEWORK Technology is only part of the answer though.

Energy management is about delivering efficiency, month-by-month, year-by-year. That E

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ENERGY MANAGEMENT

While individual flair will always have a place in any discipline, there needs to be an underpinning structure that anyone can use  needs a formal structure which is understood – and endorsed – by the wider organisation.

For that to happen the energy manager needs to be able to implement a framework that will command wide acceptance. While individual flair will always have a place in any discipline, there needs to be an underpinning structure that everyone can use. So ESTA was closely involved in the development of the international standard for energy management ISO 50001.

This is built around the same concepts as established standards such as ISO 14001 and the ISO 9000 series.

ISO 50001 provides an internationally accepted framework that will interface with the rest of the operational structure of the organisation. It allows energy to be integrated with many other aspects of day-to-day activity.

It also makes it possible for non-specialists to understand what energy and facilities managers are telling them about ways to improve resource efficiency.

THE BENEFITS OF CLARITY A standard approach to energy management offers other benefits as well. Optimal control of the wide range of energy systems in a building may sometimes call for specialist knowledge which is not available internally.

With ISO 50001, requirements for external help can be set out in a clear and consistent way – and the reports provided in a way that can be aligned with internal procedures.

External consultants should have a good knowledge of ISO 50001 and its workings.

But there are many energy consultants in the market, and it can be difficult to select the best one for a particular project. ESTA together with the Energy Institute have launched a Register of Professional Energy Consultants (RPEC) to give organisations confidence in selecting specialists for particular tasks. RPEC members have, in the large majority of cases, chartered status as well as significant experience.

Organisations can either select candidates from the membership list or alternatively can use the Register as a way of publicising their requirements.

AN ONGOING TASK As all energy managers know, equipment, whether for heating, cooling or lighting all have a propensity to ‘drift’ away from their original operating settings (and sometimes they break down completely). This is why energy management involves continual monitoring and maintenance. The human aspect should not be ignored either: people

Energy

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Monitoring and Targeting conference The 12th annual automatic Monitoring & Targeting (aM&T) conference will be held at the Ricoh Arena in Coventry on Thursday 27 February. It will include sessions on managing energy, dealing with existing and new energy technologies, and the impact of related advances such as cloud storage and apps. There will also be energy ‘clinics’ for participants and an exhibition of products and services related to aM&T. To register for the conference, please visit the ESTA website. are as prone to get into habits which waste energy too. The effects of performance drift can be significant.

Energy management is a process of continual review, revision and improvement. There will always be opportunities for enhancing energy performance, whether through employing new technology, trying different approaches, further training of the workforce, or simply through addressing performance drift. It’s safe to say that the energy manager’s work is never done. L FURTHER INFORMATION www.esta.org.uk

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Design & Build Written by Catherine Pratt, project manager, Health, The Design Council

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

CONFLICT MANAGEMENT

HOW RETHINKING DESIGN CAN MAKE A&E WARDS SAFER

Aggression towards staff poses a significant problem in A&E. Catherine Pratt of the Design Council outlines a recent project which used design solutions to make A&E departments calmer and safer for patients and staff According to the National Audit Office, violence and aggression towards hospital staff costs the NHS at least £69 million a year in staff absence, loss of productivity and additional security. However, a new solution by studio PearsonLloyd called ‘A Better A&E’ has been shown to result in improved patient experience, reduction in aggression and cost saving benefits.

‘A Better A&E’ was commissioned by Design Council and the Department of Health as part of their project, ‘Reducing violence and aggression in A&E: Through a better experience’, which sought design solutions to make A&E departments calmer and safer for patients and staff. The project provides a two pronged solution which incorporates a ‘Guidance Solution’ – signage to guide and reassure patients, and a ‘People Solution’ – a programme to support staff in their interactions with frustrated, aggressive and sometimes violent patients through communications training and reflective practices.

THE GUIDANCE SOLUTION Designed to be implemented in any A&E department, this solution provides a platform to communicate basic information to patients, such as where they are, what happens next, and why they are waiting. Information panels are implemented throughout the department

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so patients always know where they are within A&E and at what stage of care. These panels work as standalone items, as well as a series, and are customised to each Trust. A process map forms the core of the communication, and illustrates the patient journey as a series of stages, with a pause (or wait) between each stage. Displayed at full wall height in the waiting room, patients and visitors can very quickly learn the process for receiving treatment.

A patient leaflet supplements the signage with further information about the department and contact details for other urgent care centres in the local area.

An incorporated tear off questionnaire provides patients and visitors with an opportunity to give feedback.

The print material is complemented by a digital stream that communicates live, up‑to-date information about the department. Existing data is used to automatically update the electronic displays, providing accurate and relevant information at regular intervals.

Newham University Hospital has implemented the ‘A Better A&E’ programme

THE PEOPLE SOLUTION The second design aims to improve staff experience, recognising the key role A&E staff play in delivering a better healthcare service.

For current staff, a reflective programme provides a space for staff to consider – without blame – those factors that undermine their capacity to care for patients. The goal is to identify factors that impact the collective mood and to work to remove the root causes and prevent them from occurring in the future.

An 8-week programme is conducted by an external facilitator with 8-10 members of staff across the department.

The designers developed a new tool, in the form of an Incident Tally Chart, which is used during the programme to help focus on different variables within the system that might hinder the ability of staff to deliver high quality care. The programme findings are reported back to management, helping the department as a whole to understand, learn and improve ways of delivering care.

This is supplemented by an induction pack for staff new to A&E, to inform them of issues they may encounter whilst working in the department. This ensures that staff such as trainee nurses and junior medics, have the required knowledge to work in this high pressured environment.

The s benefit ign es of the dions solut the cost hed outweigations – for implic 1 spent, £3 every £ nerated in was ge nefits be

The solutions have been implemented at two pilot Trusts, St George’s Healthcare NHS Trust in London and University Hospital Southampton NHS Foundation Trust (UHS). The implementation has been rigorously evaluated

by Frontier Economics. Findings show that the project improves A&E in three key ways.

Improvements in patient experience will not only reduce tensions and non-physical hostility, but prevent their potential escalation into more serious incidents

IMPROVED PATIENT EXPERIENCE The design solutions have improved patients’ experiences of A&E through clarification of the A&E process and improvement of the physical environment. These improvements have led to reductions in frustration and therefore a reduction in potential escalation into hostility.

Improvements in patient experience will not only reduce tensions and non-physical hostility, but prevent their potential escalation into more serious incidents, as aggression is often the consequence of accumulated frustrations.

In recognition that poor patient experience is a key driver of patient frustration, patients’ perceptions of the A&E process were assessed pre- and post-implementation, with reactions to the design solutions overwhelmingly positive. 88 per cent of patients said the new signage clarified the A&E process, and 75 per cent said it made the wait less frustrating.

PROVEN BENEFITS ‘A Better A&E’ is proven to be straightforward and readily implementable and can be tailored and retrofitted to any A&E department at a

A process map forms the core of the communication, and illustrates the patient journey as a series of stages

Design & Build

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relatively low cost. The impact results are a conservative estimate and a more extensive study could capture the wider benefits of these design solutions – such as operational efficiency gains – that were outside the scope of the study.

The project has been implemented at five Trusts around England, including Newham University Hospital and Norfolk and Norwich University Hospital. It has garnered interest from many others also, leading PearsonLloyd to establish a stand-alone programme structure, including a dedicated website to help implement the programme at a national level. L FURTHER INFORMATION www.abetteraande.com www.designcouncil.org.uk/ AEevaluation

REDUCED HOSTILITY The design solutions set out to address non‑physical aggressive behaviour, which is a daily occurrence in A&E departments and places additional pressure on A&E staff. While severe aggressive and violent acts, such as the punching and kicking of staff are extremely detrimental when they occur, the number of reported incidents was low, in both pre- and post-implementation observations. However, it is believed that these incidents are under reported.

Since the design solutions were introduced, both patients and staff have observed significant reductions in acts of non-physical aggressive behaviour, with a 23 per cent reduction of offensive language and the incidence of threatening body language and aggressive behaviour being halved. Associated improvements in staff morale, retention and wellbeing have also been reported.

VALUE FOR MONEY To assess the social and economic returns associated with the design solutions, a value for money framework was used to compare the benefits of the solutions against their associated costs. The measurement of benefits focused on the reduction in non-physical aggression generated by the design solutions.

The benefits of the solutions outweighed the costs of implementation by a ratio of 3:1, meaning that for every £1 spent on the design solutions, £3 was generated in benefits. This is a conservative estimate of the potential benefits which could be realised from implementing the design solutions in A&E settings. Therefore, installing the design solutions represents considerable value for money.

Information panels throughout the department let patients know where they are within A&E and at what stage of care

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PAY & CONDITIONS

With poor employment conditions too often contributing to health issues, the Living Wage Foundation’s Caroline Reilly explains how fairer pay and investing in staff can boost employee wellbeing, resulting in a healthier society When Boris Johnson announced this year’s Living Wage rate figure at Great Ormond Street Hospital, it was clear that the notion of a living wage had reached new heights in the UK. It was especially fitting for the announcement to take place on the premises of a Living Wage accredited NHS Hospital.

The story of the living wage movement in the UK started with hospital cleaners asking for a better quality of work and life. Citizens UK, the charity that began the campaign in 2001

The f so benefit living a paying e proven r wage aess, and for in busin and wider health it can result societyalthier lives in he reed-up and f ices serv

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Caroline Reilly, employer support officer, Living Wage Foundation

IMPROVED HEALTH OUTCOMES WITH A LIVING WAGE

have worked tirelessly in cooperation with local community organisations over the last decade and have secured invested involvement from think tanks, hospitals, local government, universities and businesses.

In 2011 this coalition of supporters launched the Living Wage Foundation.

The Foundation accredits businesses with the Living Wage Employer mark, a fair trade mark for responsible pay. All holders of the Living Wage mark have committed to paying no less than the living wage to all who work on their premises.

Many organisations may consider themselves to be Living Wage compliant, but the Foundation determines the extent to which this applies and will only accredit those who take responsibility for the rates of their contracted services staff on site, in addition to their direct employees. The Foundation has grown fast, announcing 100 employers in November 2012 and growing to 500 in the space of one year.

The total listed E

Faciilities Management

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PAY & CONDITIONS  now stands at over 520 which shows an encouraging 2014 for low paid staff.

LEADING THE WAY The health sector initially led and can continue to lead the way forward for the living wage.

Frequent research demonstrates that those on the lower end of the socio-economic scale are the most at risk of ill health. The Marmot Review on Fair Society Healthy Lives in 2008 addresses the significant health inequalities that persist in the UK. It summarises that poorer people become more ill more often, an effect not restricted to the unemployed but perpetuated by the patterns of employment with poor working conditions. The living wage is listed as a key objective in this review.

Recognising that the quality of the work matters to everyone’s physical and mental well-being is what propels this research. It supports the notion that paying better improves people’s motivation on the job, confidence, self-esteem and reduces the hours of work which enables them to also take part in society fully.

Often a worker is trying to survive on lower than the living wage despite working

outsourced staff, and budget cuts and a competitive market can encourage lower pay as a solution. Consciousness of how much all staff are paid as a minimum can be managed simply beyond the core business, through ambitious procurement.

Adopting the living wage under the directive of the Foundation means that the employer has greater influence over the quality of staff as well as their conditions.

BENEFITS FOR THE EMPLOYER For organisations in the private sector, many have been persuaded by the business case for paying the living wage. Professional services firm KPMG has seen the cost of facilities management (FM) service contract delivery fall since the introduction of the living wage in 2006. Guy Stallard, Head of Facilities at KPMG explained: “We have seen an increase in positive feedback from clients who notice the difference in the quality of customer service they receive from our reception teams when they come to our offices. The work of contractor staff in this area is acknowledged through customer and industry recognition. We have experienced

Many organisations may consider themselves to be Living Wage compliant, but the Foundation determines the extent to which this applies and will only accredit those who take responsibility for the rates of their contracted services two or more jobs over a 40 hour week.

This can only perpetuate the cycle of poor health which impacts on families and in turn our wider society. Paying better and utilising the potential skills of workers that can be developed is a great way to introduce the living wage to an organisation.

DANGERS OF SUBCONTRACTING Queen Mary University of London has supported the research and work of the Living Wage Foundation. Their research paper ‘The Living Wage’ by Professor J Wills pays particular attention to present day conditions and reactions to our subcontracted global economy, examining the problem of ‘sweating’ (sweating being characterised by low pay, long hours and poor working conditions). Sweating can often be related to subcontracted work.

A ‘subcontracted economy’ benefits employers as they can bring in specialist workers to deal with tasks that are not part of their core business, freeing up time and resources. This is often the case in the health industry where cleaning, catering, security and general facilities management may be outsourced. However, it can mean that the link is lost between the employer’s awareness of pay and conditions for the

greater staff loyalty on our supplier contracts, as when comparing current levels with 2006 figures, contractor staff turnover has fallen significantly.” Lower staff turnover has had a direct impact on the recruitment and associated training costs on contracts, for a number of organisations, which has a benefit for both the buyer and the supplier.

For KPMG, new employment practices meant an increase in daytime cleaning, flow cleaning, and centralised recycling.

The mail room staff are now multi‑skilled and also provide meeting room support services in their offices. Staff are more committed to the KPMG contract and happier to ‘go the extra mile’.

ADVISING EMPLOYERS Organisations need to consider the way services are delivered, and how arrangements can be adapted to deliver value. Contractors play a significant role in educating buyers on the benefits of paying the living wage for all parties involved, and tailoring solutions for the clients’ distinct needs. With the support of the British Institute of Facilities Management and over 520 other accredited Living Wage Employer organisations, an increasing number of suppliers in the FM market have experience

of working with organisations of all sizes who wish to implement the living wage.

Six FM suppliers have demonstrated sector leadership by engaging buyers and receiving the Living Wage Foundation’s Recognition for Service Providers. These Recognised Service Providers raise the living wage as a solution for every possible delivery at the point of quote, bid or tender.

The foundation has identified key areas that are challenging adoption, in particular retail and social care. With 26 local authorities accredited, the application of the living wage where that authority has a remit of care is challenging. With the foundation working to further the trademark, its parent charity Citizens UK has initiated a Social Care Campaign which offers a better deal for both the carer and the cared for.

Between now and the General Election in 2015, they are bringing together care recipients, communities, care workers, providers, commissioners and Government. The foundation and Citizens UK welcome participation from all who can contribute to the movement. Despite the problems in the sector at large, a growing number of supporters are living wage accredited.

IMPROVING HEALTHCARE FOR ALL In a follow up to the 2008 Marmot Review, a strategic review of health inequalities in England post 2010 was issued in January by the British Academy for humanities and social sciences. The review looked at nine local actions to reduce health inequalities. The study aimed to show local policy makers and D directors of public health how to help local health in communities. One of these suggestions is explained in ‘Addressing health inadequacies through greater social equality at a local level: Implement a living wage policy’ by Professor K Pickett.

Picket describes the impact of poor pay in a community and the cost impact it then has on local services, for example an NHS Trust. The study includes a persuasive argument for local government to address this and set an example to benefit those who use their services which encourages better health for all.

This is already taking shape in places like Islington & York, hand in hand with local Fairness Commissions who work to reduce inequality. The benefits of paying a living wage are now proven in business, and for health and wider society, it can result in healthier lives and freed-up health services. The Living Wage Foundation hopes that other trusts and health providers take inspiration from Barts Health Trust and GOSH by joining the Living Wage movement and looking into accreditation. L

Faciilities Management

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FURTHER INFORMATION www.livingwage.org.uk

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Fleet Management Written by Damian James, chairman, ACFO

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

BUSINESS TRAVEL

HEALTH SECTOR FLEETS COME UNDER SCRUTINY

Budget pressures in the public sector have made fleet management a challenging task.

Damian James of ACFO explains why a back to basics approach can help to strengthen services Economic evidence would suggest that the UK is slowly moving out of recession, but the health sector – like the public sector as a whole – remains under huge pressure to further cut costs. That is why organisations operating across the health sector should adopt a ‘back to basics’ approach in respect of employee mobility.

Managers in charge of travel – whether that relates to ‘company cars’ and light commercial vehicles on a fleet, staff driving their own cars on business trips, or employees using public transport – must refocus.

total cost of ownership figures, are used as the basis for vehicle selection. The cheapest vehicles to operate are those with the lowest wholelife costs – not necessarily those with the lowest list price which, over a typical fleet replacement cycle of around four years/80,000 miles may prove more expensive to run. Wholelife costs reflect all the projected, vehicle-specific costs associated with operating a vehicle over its fleet life, including depreciation (the total difference between the original cost and the residual value projected), funding, service, maintenance and repairs, VED, insurance, fuel (at least the fuel for the business mileage) and Class 1A NIC payments.

FUEL MANAGEMENT If the vehicle is contract hired, then the rental will normally include the depreciation, funding, service, maintenance and repairs and VED. Costs can be shown as per annum, per month, or per mile. Vehicle depreciation is the single biggest vehicle cost, but high fuel prices mean that the cost of petrol or diesel over the lifecycle of a car or van is also a very significant burden. It is therefore critical that managers have a comprehensive fuel management strategy in place based on the ‘eternal triangle’ - miles driven, the volume of fuel purchased and the cost of fuel – all underpinned by a disciplined fuel card regime.

Experts suggest that by taking that approach instead of paying for fuel through employee pay and reclaim, a pence per mile reimbursement system or fuel receipts attached to a weekly or a monthly expense claim valuable financial savings of 15-20 per cent can be achieved. Meanwhile, legislators in both Brussels and Whitehall with an eye on cleaning up the environment continue to put the pressure on motor manufacturers to drive down vehicle emission levels.

Manufacturers have responded by introducing low CO2 vehicles, which also

ations Organischieve must a ing act c a balann budget betwee gement mana nuing to ti and coner a first deliv ervice class s

REVIEWING PRACTICES Organisations must achieve a balancing act between budget management and continuing to deliver a first class service. Cost management, carbon footprint reduction, risk management, business efficiency and effectiveness and time management all impact on business travel. Doing nothing is not an option which is why all existing policies and practices within transport and travel should be reviewed and new initiatives and procedures introduced to deliver savings.

Cost management starts with choosing the most efficient vehicles available while bearing in mind that they should be fit-for‑purpose.

Transport is often the second highest cost base in an organisation after labour so when the pressure is on to save money it is vital to know that the most cost-effective vehicles are being operated. Therefore, expenditure relating to each vehicle and driver – fuel, servicing, accident costs, tyre costs etc – should all be individually recorded.

COUNTING WHOLELIFE COSTS Only by having a clear picture of how much vehicles are currently costing to operate and how much drivers are claiming in mileage allowances can improvements be implemented. That is why fleet experts recommend that vehicle wholelife costs, or

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deliver MPG improvements. Additionally, a trend towards engine downsizing means better performance is being generated from smaller power plants.

EXPLORING NEW VEHICLE TECHNOLOGY Fleet managers must keep up to date with current engine technology, and while continuing to ensure that vehicles remain fit for purpose it is almost certainly possible to better ‘right size’ a fleet in today’s world and generate financial savings without impacting on operating efficiency and effectiveness.

At the forefront of technological developments are electric vehicles. A number of manufacturers have already launched electric cars and vans and during 2014

many more are due to reach showrooms.

ACFO cannot see widespread adoption until electric vehicle list prices start to drop, and as an organisation it is aware of the uncertainty among fleet operators as to the viability of electric vehicle technology and the operational cost of such vehicles.

Nevertheless, the Government, motor manufacturers and vehicle recharging companies are collectively spending billions of pounds on developing the electric vehicle market and bringing zero and ultra‑low emissions cars and vans to the fore.

HEALTH SECTOR SCHEMES Health sector organisations that provide ‘company cars’ to employees, often through some sort of annual ‘lump sum’ leasing arrangement, should analyse whether that vehicle is required. The key here should be the business case and particularly the number of work-related miles travelled in a set period and how essential those journeys were. It may be, for example, more cost effective for the organisation to withdraw the car benefit and introduce a fleet of pool cars or allow employees to hire a car when one is deemed essential. Meanwhile, for health service employees driving their own cars on business trips – the so-called ‘grey fleet’ – the issue of mileage rates also needs to be tackled.

Many public sector organisations have mileage reimbursement levels above the HM

Revenue and Customs’ tax-free Approved Mileage Allowance Payment threshold of 45p per mile for the first 10,000 business miles and 25p per mile thereafter. However, due to financial constraints a number of organisations have already reduced mileage reimbursements rates to the AMAP level or below. Managers should analyse how much they are paying out to individual employees in mileage reimbursement. ACFO has completed some analysis that highlights in many cases it is more cost-effective for staff to be provided with a ‘company car’ or a hire car when transport is required Indeed, a report by the Office of Government Commerce (OGC) on public sector ‘grey fleet’ use concluded that “in some cases, the mileage rates offered may act as an incentive for people to drive their own vehicles.”

Additionally, it should be remembered that it is easier to manage a company car and a hire car from a work-related road risk perspective than a privately-owned car and, in most cases, those vehicles will be more environmentally‑friendly because they are newer.

ALTERNATIVES TO CARS But employers should also focus on making their staff aware of car alternatives and, indeed, whether travel is even necessary for the task that requires to be completed. For example, an increasing number of employers have introduced tele-conferencing and video conferencing facilities. Additionally, travel

by bus, train or plane may be a more viable option as could cycling with the Government offering tax breaks through its Cycle to Work initiative. Also, an increasing number of public sector organisations have introduced car sharing schemes and more and more towns and cities are becoming home to car clubs.

ACFO has published a guide called From A to B – The ACFO Guide to UK Journey Planning, which looks at business mobility and aims to help employers promote the optimum travel solution for each employee when they find the need to conduct some form of business trip. It is almost certain that many of the transport options already highlighted are available in many health sector organisations.

Old habits die hard and neither employers nor employees may be too certain as to how the decision-making responsibilities should work or which mode should be used on a case by case basis. ACFO would suggest that when health sector organisations analyse employee travel they should focus on implementing a sustainable and efficient business mobility strategy. Critically, by going ‘backs to basics’ and assessing the business need for travel and taking note of best practice it is almost certain that financial savings will accrue that can then be diverted to help fund improvements to the delivery of frontline services. L

Fleet Management

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

FURTHER INFORMATION www.acfo.org

Transport is often the second highest cost base in an organisation after labour so it is vital to know that the most cost-effective vehicles are operated 37

BECOME A QUALIFIED SAFER PEOPLE HANDLING TRAINER Our BTEC Level 4 Safer People Handling Trainers course develops consistency of care for residents and clients and the psychological wellbeing of people handling carers. By applying skills and methods taught, your organisation will benefit from improved functional mobility of clients as well as more motivated staff.

This course will provide the skills to teach induction and mandatory training that is bespoke to your organisation based on current best practice and aligned with regulatory legislation.

Courses now scheduled in Birmingham, Cumbernauld, London and Manchester, and can also be delivered within your organisation.

Call our trained advisors for more information on how to become a qualified trainer.

0121 248 2233 enquiries@rospa.com www.rospa.com

Excellent course, the best I have ever been on.

Kevin Fisher, Training Executive, Orchard Care Homes.com Ltd

HOSPITAL MANAGEMENT

In any hospital, leaders are required to make difficult calls.

Pamela Milligan and Michael Moneypenny of the Scottish Clinical Simulation Centre offer a structured approach to aid strategic decision-making One of the primary roles of a good leader is to make good decisions. The consequences of a leader’s decisions include whether or not they stay in the position in the long‑term.

Making decisions is not a simple, isolated process, but depends on the information and time available, as well as the amount of stress placed on the leader.

The book Crisis Management in Acute Care Settings (Springer 2011) outlines five steps of good decision-making, which we will consider in turn.

The first step is to be prepared. Preparedness includes being alert to the need to make a decision, as well as understanding what information you are receiving. A good decision-maker knows when he is stressed, tired or otherwise distracted and takes this into account when forced to make decisions.

ASSESS THE SITUATION By defining the problem you can be selective about the information you are going to use to make your decision. The amount and reliability of the information available will depend on a number of factors including time, complexity of the situation, number and sources of information. It is useful to build a mental model which can be shared with others in order to check your reasoning for errors and to identify gaps in information.

A good decision-maker appreciates that there is a balance between having as much information as possible and the time available to make a decision; as one becomes more expert at decision-making one’s estimate of the time available becomes more accurate.

MAKE A DECISION In his book Thinking Fast & Slow (Penguin 2012) Daniel Kahneman argues that we all have two methods for arriving at a decision.

The ‘fast’ method is a gut feeling, unconscious and automatic. The ‘slow’ method is rational, conscious and requires mental effort. These two processes can be used by a leader to make any number of decisions, whether long-term strategy or short-term purchases.

However, a leader who is aware of these two approaches can ask themselves which

method they are using, because they have benefits and risks; they should be used at the right time by the right person.

You should use the fast method when you are an expert in the given field, as experts have the knowledge and experience required to be able to make decisions based on the ‘big picture’. For example chess grandmasters can get a ‘feel’ for the board and the next good move by glancing at the positions of the pieces when time is limited but a decision is still required (the decision not to make a decision because time is limited is still a decision).

You should use the slow method when you are a novice – novices need to make logical, reasoned step-wise decisions. Novices do not have the experience required to make a decision based on a rough overview. You should also use this method if you are an expert confronted with a new situation to act as an overseer of fast decisions, i.e. when

REVIEW YOUR DECISION This may be the most important step in decision-making. It is inevitable that we will make poor decisions. Reviewing our decisions allows us to mitigate the effects of the poor decision as quickly as possible, and to reduce the number of future poor decisions by learning from our mistakes. Reviewing your decisions needs to be an active process and can be greatly improved by requesting feedback from others including coaches and experts. In the Scottish Clinical Simulation Centre we

Written by Pamela Milligan & Michael Moneypenny, Scottish Clinical Simulation Centre

THE KEY SKILLS OF EFFECTIVE DECISION-MAKING

you want to keep an eye on a fast decision and be able to change it if necessary.

So next time you have a gut-instinct about a decision, ask yourself if you are an expert in this field. If not, your gut-instinct is likely to be wrong.

Your decision-making will also be influenced by your leadership style. If it is democratic then your decisions will have to reflect the opinions of others. If it is autocratic this will be less of an issue.

Decisions should have maximum efficiency divergence. This means that the decisions must have a likely good outcome (efficient) and allow the maximum possible additional decisions to be made (divergence).

Once you have reached a decision, the next step is to act on your decision. Little is gained from delaying its implementation.

It is useful to ensure that the decision is carried out as you intended it to be by having a method of checking on its execution.

In addition, be explicit in communicating your goals, providing sufficient direction without stifling individual innovation.

Leadership

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

Reviewing our decisions allows us to mitigate the effects of poor decisions as quickly as possible, and to reduce the number of future poor decisions by requesting feedback from others use video-assisted debriefing to allow the participants to review their own actions and decisions in a crisis scenario. This review is facilitated by a trained member of staff and uses input from other team members.

AN ONGOING PROCESS As mentioned in the introduction, a good leader makes good decisions.

However, this is an acquired skill, and as with all skills it requires deliberate practice with coached feedback to ensure that your expertise develops.

Using decisional aids and being open to feedback on your performance may help you make the transition from good to great leadership. L FURTHER INFORMATION www.scsc.scot.nhs.uk

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PATIENT CARE

HOSPITAL’S INVESTMENT IN ALGEOS’ DOPPLERS EXCEEDS EXPECTATIONS

NHS Greater Glasgow and Clyde transformed its patient care by investing in a number of Algeos Diaped Dopplers. David Wylie, the hospital’s podiatry service manager and professional lead, explains more Here, David Wylie reveals to Algeos the reasons behind the NHS Greater Glasgow and Clyde’s purchase of 64 Diaped Dopplers: Our podiatry department provides care for around 75,000 patients, delivering over 220,000 treatments each year. A team of 200 clinicians delivers patient services from 75 clinical locations across the area.

The podiatry department only had a small number of Dopplers available to staff working in multidisciplinary acute teams, whilst staff working in community clinics just had limited access to Dopplers to assist them in vascular assessments.

A Doppler is used to identify reduced blood pressure at the ankle. This assessment might be the first indication that a patient is at risk of cardiovascular disease. Patient groups more likely to suffer from reduced flow are those over 60, people who smoke or those who have diabetes.

I wanted to ensure that our whole team of staff had the equipment they required to confidently assess vascular risk. By providing Dopplers for community podiatrists, they were able to identify patients without palpable pulses but with adequate perfusion to allow them to be managed in a lower-risk category.

THE PRODUCT The Algeos Diaped Flux-200 Vascular Doppler was chosen for a number of reasons: Algeos Podiatry has been a regular supplier of clinical products for many years. Their product support and the professional and personal ethos of the company has supported our service delivery and redesign in the context of an ethical and highly professional relationship; it is a handheld, portable device, which is ideal for use in either our hospital or community-based clinics; we have been able to put in place a series of vascular workshops

for use across the service was crucial to give our staff the tools they needed to do their job effectively and to give our patients the level of vascular assessment they required.

TRANSFORMATION OF PATIENT CARE The benefits for patients include, when the staff training is complete, all patients within the service will have access to a Doppler test whenever they need one. Plus, there are more appropriate onward referral to vascular services for community podiatrists.

IMPROVED SERVICE DELIVERY MODEL The podiatry team has benefitted as it now has the equipment it required to deliver quality patient care in the community.

There is now more effective use of time and resources, which enables the team to make more confident clinical decisions.

that have delivered enhanced vascular assessment skills for community-based staff. We plan to deliver this training to all staff to ensure the investment in the Dopplers yields maximum clinical impact; and it comes at a competitive price for a reliable product, which makes absolute sense for us in the current economic climate.

SECURING FUNDING In order to get the required funding in place for the Dopplers, the NHS Greater Glasgow and Clyde podiatry service received some quick-spend funding at the end of the financial year to be spent on capital equipment.

Therefore, an investment in 64 Dopplers

By providing Algeos Diaped Dopplers for a team of community podiatrists, they were then able to identify those patients without palpable pulses but with adequate perfusion to allow them to be managed in a lower-risk category 40

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WORKING WITH ALGEOS The NHS Greater Glasgow and Clyde’s reasons for buying from Algeos are: it is one of the UK’s market leaders in the podiatry sector, giving access to a wide range of podiatry equipment and consumables at competitive prices; the company’s sales team is made up of qualified Allied Healthcare Professionals who understand the clinical environment. Their commercial and technical expertise help you to make the right product selection for your organisation; and the dedicated customer service team support you during the sales process and are there to answer your questions during aftercare.

The Doppler purchase was a significant investment by the NHS Greater Glasgow and Clyde podiatry service to support and enhance vascular assessment and risk classification.

The quality of service and support the hospital received from Algeos in commissioning this service development has been exemplary. The products themselves are dependable and competitively priced, and we have received excellent customer service and support. L FURTHER INFORMATION Tel: +44 (0)151 448 1228 sales@algeos.com www.algeos.com

EVENT REVIEW

HOSPITAL DIRECTIONS: THE LEADING FORUM FOR NHS MANAGERS

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In November 2013, the largest free-to-attend conference for secondary care leaders returned for a second year of crucial training, aimed at those involved with delivering a better NHS reconfiguration, and service redesign featured some of the most influential speakers.

Janice Scott-Williams, estates officer at Berkshire Healthcare NHS Foundation Trust, said: “The presentations have been fantastic, provided a lot of information and have given me lots to think about. I have made some really good contacts. It has been absolutely perfect and been a brilliant place to start learning things for my new job.”

A flexible seminar programme ran alongside interactive workshops, where NHS professionals were able to discuss the significant issues affecting hospitals and find practical solutions through hearing tried-and-tested case studies.

Over 1,000 NHS leaders took part in two days of important hands-on learning and practical seminars delivered by expert key figures from the sector. A flexible seminar programme ran alongside interactive workshop areas, where NHS professionals were able to discuss the significant issues affecting hospitals, as well as finding practical solutions through hearing tried-and-tested case studies.

Helen Bevan, conference speaker and member of the NHS Quality and Delivery Team, said Hospital Directions is the only show of its kind in the sector: “The Hospital Directions conference is great because there isn’t anything else that is designed for this sector.

The programme is amazing because of the sheer variety and relevance of the speakers.

This conference is about getting people feeling energised and full of good ideas.”

Seven streams covering key areas of the NHS, such as procurement and finance, technology, estates and facilities, leadership, the future of hospitals, workforce and

INSPIRING TRANSFORMATIONAL CHANGE Representatives from America’s leading integrated managed care consortium Kaiser Permanente, spoke exclusively to Hospital Directions delegates. Gregory Adams, executive vice president, group president and regional president of Northern California’s Kaiser Permanente, told the conference the NHS inspired transformational change at the American healthcare giant.

Alide Chase, senior vice president, Medicare Clinica Kaiser Permanente, said: “People come to a gathering like this to get ideas and hear other people’s stories. It’s a good way to get motivated, to get charged up and find new ways of approaching a problem in a way they haven’t thought of before.”

Controversial healthcare policy analyst, writer, broadcaster and commentator Roy Lilley chaired one of the theatres at Hospital Directions, which included keynote speakers: Mike Farrar, chief executive, NHS Confederation, and Helen Bevan, member of the NHS Quality and Delivery Team and Kaiser Permanente. Lilley said the range of products available from the Hospital E

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EVENT REVIEW E Directions exhibition floor was excellent: “The programme is amazing because of the sheer variety and relevance of the speakers.

There is so much choice and diversity,” Lilley said.

“It’s also a chance to get off the hamster wheel for a couple of days and think about things, such as what is great practice? Or, how can I do things differently? There is a battery charging energy aspect to it as well. This conference is about getting people feeling energised and full of energy.”

INNOVATIVE SOLUTIONS Interactive workshop areas enabled delegates to find innovative solutions in a unique environment designed to inspire new ideas.

Vanguard, the world’s leading temporary surgical facilities provider, showcased its state-of-the-art modular units at Hospital Directions. Delegates were able to tour a ‘pop-up hospital’ and discover how temporary facilities can increase clinical activity during refurbishments. They also found out how they can generate more income.

Vanguard’s marketing manager, Richard Cluett, said: “Hospital Directions exceeded our expectations in terms of engaging with senior NHS managers from across the UK.” The Procurement Zone offered delegates the opportunity to partake in open discussions and hear real-time case studies from experienced leaders with expert knowledge.

Key topic sessions run by expert leaders

presented free skills training in developing procurement capability in the NHS, outsourcing in other sectors, clinician involvement and implementing a category management approach in the NHS. THE LATEST SOLUTIONS TO COMMON PROBLEMS The learning and training opportunities didn’t stop there. The Presentation Theatre showcased the most innovative suppliers to the NHS, displaying the latest solutions to common problems facing the NHS. Topics included reconfiguration of services, social networking and locum expenditure.

Suzanne Breen, communications manager at Leeds Teaching Hospitals NHS Trust, said: “There is a lot to learn by attending Hospital

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Ninety per cent of delegates stated that Hospital Directions is important to them. With over 70 per cent of the floor plan already secured by exhibitors, the 2014 conference is set to become the most important date in every NHS leader’s diary.

Directions. I’m very interested in transformation, change, quality and patient safety – most of what has been focused on here.”

Delegates had the unique chance to meet with the UK’s leading secondary care suppliers in the Hospital Directions exhibition and sourcing hub. Examples of innovation and transformation were all on display during the two days, offering both time and money saving opportunities for delegates. In the post-show survey, 100 per cent of attendees confirmed their learning and sourcing objectives were successfully met at the event.

A BETTER STANDARD OF CARE Hospital Directions ran alongside Acute & General Medicine conference, a clinical

attending Hospital Directions is important to them in their current role. Furthermore, with over 70 per cent of the floor plan already secured by exhibitors, the 2014 conference is set to become the most important date in every NHS leader’s diary.

Ralph Collett, managing director of CloserStill Media and event director of Hospital Directions, believes NHS managers should not be restricted by ongoing cuts in training budgets. Collett commented: “Hospital Directions is fast becoming the go to event for leadership teams in hospitals.

Recent government legislation has thrown down the gauntlet for hospitals to provide better and more cost-efficient integrated healthcare solutions.” L

training event for hospital doctors. The two events brought a total attendance of 4,001 secondary care professionals, looking to deliver a better standard of care, practice key skills, gain clinical CPD and develop their roles.

Feedback has been extremely positive with 90 per cent of delegates stating that

FURTHER INFORMATION Hospital Directions 2014 returns on 26-27 November 2014 at ExCeL London.

Free passes for the event are available for hospital leadership teams. Call 020 7348 5271 to be added to the waiting list for a complimentary pass.

FIRE SAFETY

Classical leadership from Trafalgar Fire Sun Tzu wrote in The Art of War that leaders must be ‘smart, trustworthy, caring, brave and strict’.

One of the few books valued and protected despite changes in Chinese politics and regimes over the centuries, Sun Tzu’s book – written on bamboo strips – is still found in ancient burials, amongst private collections and in the libraries of successful business people and academics.

Modern strategists still value and learn the lessons in Sun Tzu’s writings that are as much about succeeding in a competitive environment as they are about winning in war, and are as relevant today as they have ever been.

Understanding five principles goes to the core of who Trafalgar Fire is: experts in its field; industry trained and accredited by leading manufacturers (including Notifier

by Honeywell); trusted by serious property owners to care for the safety of their property and people,

from The London Clinic to The Oval; having the courage to stand up for the high standards it sets itself and its partners; backed by attention to detail through robust and consistent management, processes and audits.

Without the baggage of a large corporate structure – but with the attitude, professionalism and flexibility of a serious organisation determined to do the best for its clients – Trafalgar Fire’s client base is growing, and increasingly includes the medical sector.

PHARMACEUTICAL

How much could you save on emollient prescribing?

In England, the NHS spends £110m on emollients pa.[1] Many of these are branded emollients, which could be substituted for a similar Zeroderma emollient, saving the NHS £12m pa, without compromising on patient care.

Zeroderma products are similar in formulation to around 40 per cent of currently prescribed emollients and offer cost savings of up to 37 per cent.

Many clinical commissioning groups (CCGs) are now using the Zeroderma range and one Northern CCG is predicted to make savings of £250,000.

The Zeroderma range from T+R Derma includes four creams, one ointment and two bath oils: providing complete emollient

therapy for moisturising, washing and bathing. All products in the range are from Sodium Lauryl Sulphate (SLS). Research has indicated that SLS can aggravate the skin of eczema sufferers.[2] All Zeroderma products are available on prescription and many are now listed on NHS contract.

Contact Zeroderma for more information or samples for patient evaluation.

Products & Services

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

Ref: [1] NHS PCA data for England 2012.

[2] Tsang M and Guy RH – Effect of aqueous cream BP on human stratum corneum in-vivo, BJD, 2010.

FURTHER INFORMATION Tel: 01484 842217 zeroderma@thorntonross.com www.trderma.co.uk

FURTHER INFORMATION Tel: 0844 848 1440 sales@trafalgarfire.co.uk www.trafalgarfire.co.uk

PATIENT SAFETY

INFECTION CONTROL

With over half a century of expertise in the design and manufacture of high quality hospital beds, healthcare furniture specialists Sidhil has designed its latest models around optimising patient safety, infection control and tissue viability.

Dubbed ‘the modern ward bed with intelligent thinking’, the new Innov8 iQ features Sidhil’s latest ‘iQ Contouring’, with backrest and kneebreak operating together to reduce shear and friction, preventing pressure ulcers. This system works intuitively to prevent patients slipping down in the bed, retaining a correct and comfortable position. The bed also provides a tilt function with auto regression, achieving a ‘one touch’ full chair position, facilitating open airways, improved circulation, a good nutritional position and clear vision around the ward to enhance the patient environment.

The Aquadron® system eradicates pathogens such as Legionella and Pseudomonas.

It operates 24/7 keeping your water systems safe and clean.

It is cheap to run and it is guaranteed to work.

The system can allow you to reduce your hot water temperature; this saves you money from day one. It also means that your hot water can be supplied at lower temperatures reducing scald risk, which is a benefit to clients.

And the system also replaces periodic chemical cleaning and flushing of the water system.

The system is proven: it is used in continental Europe and is widely used in German hospitals, care homes, schools, swimming pools and even in food and beverage production – it is now available in the UK. It complies with all relevant UK and European Standards and guidelines, such as Approved Code of Practice L8.

Multi-purpose ward beds designed for maximum safety and performance

Falls prevention is a major risk management consideration,and Sidhil’s Innov8 Low features a minimum platform height of just 218mm – one of the lowest available on the market. The bed has been developed to provide total flexibility in terms of bed specification for applications from utility ward beds through to high dependency environments.

FURTHER INFORMATION Tel: 0142 223 3000 www.sidhil.com

Manage Legionella and save money from day one

Why wait? This will reduce your Legionella risk and save you money from day one.

To find out more about the Aquadron® and for a free survey please contact New Energy Management.

FURTHER INFORMATION Tel: 0121 285 8785 info@newenergy management.co.uk www.newenergy management.co.uk

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FIRE TRAINING

FIRE SERVICES

According to the Department of Health, ‘the increasing prevalence of building fire strategies for healthcare premises are likely to intensify the need for enhanced fire safety management.

However, in a healthcare environment including very high dependency patients, it is unlikely that any amount of physical fire precautions on their own can reduce fire risks to an acceptable level.

Adequate risk mitigation can only be achieved with the provision of a sufficient number of suitably trained staff, an environment in which the fire precautions are well maintained, and effective emergency action plans that have been sufficiently rehearsed.’

Vulcan Fire Training has a number of courses which will ensure that your appointed fire manager has the training required to put in place practical, and legally compliant, fire safety solutions for your healthcare facility and workforce,

M&G Fire Protection (Essex) is a supplier of high-quality fire alarms and fire extinguishing products and services, with a wealth of experience working within the NHS: from small GP surgeries to hospitals.

The company can work on all types of fire alarm systems, from small stand-alone panels to large multi-panel networked sites. It can also service all makes of fire extinguisher. As the company is not tied to any one specific supplier, you are therefore guaranteed to get the best products for your needs.

M&G aims to provide a solution to your service needs and work with you to solve problems with systems that are often overlooked by its competitors.

Importance of fire training for hospitals

including the Fire Manager Certificate, leading to professional fire safety qualification. The Fire Risk Assessor course is provided over three to five days for up to 12 delegates in-house or public.

The Fire Warden-Healthcare half-day course trains staff for essential duties. Fire Extinguisher & Awareness is a ninety minute theory and practical course using water and CO2 extinguishers on a fire simulator. All courses are accredited and approved by Institute of Fire Safety Managers.

Solutions to protect your business from fire

44

The company’s vehicles are fully stocked so it can normally provide a first attendance fix to problems faced by clients.

M&G covers Essex, London and Hertfordshire and holds these accreditations: ISO 9001:2008; BAFE scheme SP203 for the design, installation, commissioning and maintenance of fire alarm systems; BAFE scheme SP101 for the contract maintenance of portable fire-fighting equipment; Constructionline; Safecontractor; and CHAS. Contact M&G Fire Protection (Essex) for a no-obligation quote.

FURTHER INFORMATION Tel: 01621 840999 info@mgfire.co.uk www.mgfire.co.uk

FOR MORE INFORMATION Tel: 01933 271756 info@vulcanfiretraining.co.uk www.vulcanfiretraining.co.uk/ fire-training-courses.html

FIRE SAFETY

Fire can devastate your business so you need to be vigilant about fire detection to protect your staff and customers.

However, choosing the right system can be time-consuming and confusing. Most business owners stick with the company they’ve always used yet this may not give you the best value for money.

Advance Commercial Installations (ACi) is a specialist, long-established provider of complete fire alarm packages, including configuration, supply, installation and maintenance of all types of fire detection and fire suppression systems as well as high-sensitivity smoke detection equipment.

The company works with a wide range of businesses to advise and make sure they have exactly the fire detection system they need – one that keeps the business safe, within budget and meets all current regulations.

ACi is completely independent of any equipment manufacturer

Quality fire alarms and fire extinguishing products

so its advice is entirely impartial and the approach is friendly and flexible. ACi won’t sell you what you don’t need.

As you would expect, the company is ISO 9001:2008 certified, holding BSI certification accreditation. All of the company’s team are employees – it does not subcontract.

Get in touch with ACi to find out how it can prevent your business from being at risk from fire without burning money.

FURTHER INFORMATION Tel: 01438 368 888 www.acionline.co.uk

HEALTH BUSINESS MAGAZINE | Volume 14.1

FIRE SAFETY

Fire detection & suppression systems and servicing Flamefast specialises in the design, supply, installation and maintenance of the following fire detection and fire suppression systems: fire detection systems; gaseous fire suppression systems; Ansul kitchen fire suppression systems; gas interlocking systems for commercial kitchens; water mist and sprinkler systems; portable fire extinguishers; and voice alarm and public address systems.

The company offers the complete fire detection solution, from small conventional fire systems to large multipanel networked systems.

The fire suppression technologies Flamefast offers ranges from portable extinguishers through to large fixed fire suppression systems, which are installed to meet the clients requirements.

Flamefast is proud to be a partner for the Siemens system, which is fully compliant to British Standards.

The Siemens system also has a revolutionary new smoke detector to ensure the highest degree of safety and fast, very early reaction to flaming fires.

What’s more, these are immune to deceptive phenomena, such as steam, dust or gas.

Flamefast is also the largest installer of kitchen fire suppression (Ansul) in the UK and has been awarded the distributor of the year by Ansul for the last four years.

FURTHER INFORMATION Tel: 01933 420733 Salesouth@flamefast.co.uk www.flamefast-firesuppression.co.uk

INFECTION CONTROL

INFECTION CONTROL

Storage solutions to help in Alcohol-free sanitiser from the fight against infections the one-stop shop for With the ongoing risks of and to be effective against a halal-approved products healthcare-acquired infections an wide range of bacteria and ever-present problem, new methods to reduce cross-contamination have to be sought.

While the priority is on the maintenance of exceptional hygiene standards at all times, Link 51 – the UK’s leading manufacturer of healthcare storage solutions – confirms that technology also plays an important role in keeping the risk of infection at a minimum.

Storage is vital in any healthcare setting but there are areas, if not managed correctly, where potentially harmful bacteria can multiply and spread infection.

Link 51 works to minimise this risk by using Biocote® to coat all of its healthcare storage solutions (including the new trackless mobile system, pictured), HTM71 tray storage, lockers and staff changing facilities. This anti-microbial powder coating is scientifically proven to minimise the risk of cross-contamination

fungi, it is also guaranteed during the product’s lifetime.

In clinical tests, BioCote, a silver ion-based technology, was found to reduce levels of bacteria on treated surfaces by 99.9 per cent in just two hours over a 24-hour period, compared to non-protected surfaces, where bacteria can proliferate at dramatic rates.

Furthermore, Link 51 holds the NHS Supply Chain framework agreement reference FAG000015351 and the Government Procurement Service framework contract RM 1501/3.

FURTHER INFORMATION www.link51.com

SteriZar is an alcohol‑free halal antibacterial sanitising product, that has been tested and proven to be effective against a wide range of bacteria and viruses: containing no irritants, tested to be skin and food safe, and is perfectly safe for all ages to use.

One property of SteriZar that makes it so different is it has active barrier technology which allows the bacterial agent to continue to be effective on the skin for up to six hours and hard surfaces for up to 30 days.

All claims made regarding effectiveness of SteriZar have been substantiated by independently recognised testing laboratories in the UK and meet the criteria laid out for the appropriate British Standard, all of which are

Products & Services

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

readily available.

Tests using the product have been successful against norovirus and the recently highlighted bacteria NDM-1, to add to the already achieved excellent test results showing the effectiveness of the product against many harmful and potentially life-threatening micro-organisms that exist in today’s working environment.

SteriZar products have been certified as fully Halal compliant by the International Halal Federation (IHF). The full range of Halal-compliant SteriZar products are available through its distributor All Things Halal.

FURTHER INFORMATION Tel: 0330 660 0098 info@athalal.com www.athalal.com

SAVE MONEY - FREE-UP DOCTOR TIME Q “ Ideal for pre-assessment.”

Q “ We have saved hundreds of appointments.”

Q “ This has been one of the best investments in equipment that we have made in the last 20 years.”

Q “ Our practice nurses are now great fans of the monitor and encourage their patients to use it regularly.”

Q “ Rapid pay-back time.”

WITH THE MEDICAL HEALTH POD Automatic Kiosk User Friendly Audio & Visual Instructions Unsupervised Monitoring and assessment Free NO OBLIGATION trial minimum two weeks duration

Measures: Q Height Q Weight Q BMI Q Blood Pressure Q Pulse

Q Results displayed & printed Q Ticket options Q Buy or Rent

Complies with directive 90/384/EEC (Class III) for non automatic weighing instruments Complies with directive 93/42/EEC (Class IIa) for blood pressure measurement

Healthcare Monitors, Kidderminster, Worcs., DY10 4EU • Tel: 01299 250321 • www.health-monitor.co.uk

Volume 14.1 | HEALTH BUSINESS MAGAZINE

45

Advertisers Index

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

INTERNATIONAL MANAGEMENT RECRUITMENT & CONSULTING SERVICES SINCE 1985

BE PART OF THE HEALTH CARE BOOM IN ARABIA UFg is pleased to announce the requirement for several key management personnel required by our Client in Saudi Arabia to assist in the expansion & ongoing development for their Health Care organisation. The employer offers the assurance of 2- family generations of trading & is also well known to UFg for 20 years.

DIRECTOR OF FACILITY MANAGEMENT (ENG) & SAFETY Degree in mechanical / electrical engineering or similar with 10- years exp in a responsible role for all technical facilities & equipment within Health Care operations.

Specialist knowledge of medical equipment maintenance is ideal.

DIRECTOR OF SUPPLY CHAIN Degree in Business Admin , Logistics Finance or similar with min 10- years exp in procurement within the medical industry. Familiar with JCAHO standards.

CHIEF OF HOSPITALITY SERVICES Degree in hospitality management or similar with 10- years management role of a 4/5 star hotel or high class private Residential Care operation. Successful Hotel GMs considered.

PROJECT MANAGER FOR NEW UNITS (DESIGN / ARCHITECTURAL CONSTRUCTION) Degree in construction engineering with bias in Architecture. Experience in hospital design, working from plans & minimum 5- years as Project Manager.

Salaries on offer are IRO UK£ 6,000/- month tax free with free living costs, except food.

More details can be found on the job hunters link on the home page of www.ultraforce.co.uk & then click on TASKFORCE or TECHNIFORCE. Immigration regulations apply for Expatriates working in Arabia. Call for detail if not known.

Contract terms are minimum 2- years with options to renew. Family status possible. Job descriptions available upon application & telephone enquiries welcomed.

CV applications in confidence to headoffice@ultraforce.co.uk All shortlisted UK based applicants to be seen by UFg in London, Southampton & Manchester.

TEL: +44 (0)1590 676 379 FAX: +44 (0)1590 677 500 HEADOFFICE EM: headoffice@ultraforce.co.uk GROUP WEBSITE: www.ultraforce.co.uk All trading names protected under Trade Mark & privately owned by The UltraForce Group (UFg)

ADVERTISERS INDEX

The publishers accept no responsibility for errors or omissions in this free service A Algeo 40 Advanced Commercial 44 ATH 45 Bailey Instruments 14 Burgess 18 C & L Investigations 14 Ceratech 18 Closerstill Media 41, 42 Commulite 28 Countrywide Signs 32 Decorative Panels IBC Electrium Sales 18 ERBE Medical UK 14 FDB 24 Flamefast UK 44

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HEALTH BUSINESS MAGAZINE | Volume 14.1

Green Acorn 28 Healthcare Monitors UK 16 ICAEW 16 Link 51 45 M & G Fire Protection (Essex) 44 Marmot Resources 28 Multitone Electronics IFC New Energy Management 43 OKI Systems UK 34 One Birdcage Walk 32 Oughtred & Harrison 22 PHS Group 18 PHSC 10 ROSPA 38

SCC 6 Schneider Electric 26 Scott & Mears 22 Sidhil 43 Sirs Europe BC Sonosite 4 Telehealth Solutions 12 Tenthmatric Information 22 The Intelligent Network 22 Thornton & Ross 43 Trafalgar Fire 43 Ultra Force Group 46 Voice Connect 8 Vulcan Fire Training Co 44

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THE UK’S LEADING ALL-ROUND INVESTIGATION SERVICE Sirs has an incredible team of experienced and capable investigators who can boast more than 250 years’ combined experience. They have been drawn from various backgrounds, including military, police, intelligence services and those that have been entirely trained by us or within the private sector.

In general terms we serve the following sectors:Councils & Government  Corporate Sector  Insurance Industry  Finance Industry Legal Profession  Insolvency Sector  Regulatory Authorities We in in tracing individuals, companies and assets throughout the U.K. and all over the all world.

We are arespecialists specialists tracing individuals, companies and assets throughout the indeed U.K. and indeed over We can investigate frauds and obtain evidence for prosecution purposes.

Some of the areas that are relevant to this the world. We can investigate frauds and obtain evidence for prosecution purposes. Some of the areas feature highlighted below: that areare relevant to this feature are highlighted below:

• Tracing of individuals and companies Tracing ofteam individuals and experienced companiesininthe relation to our outstanding debts,have including council tax, • SIRS’ trace are the most U.K. and trace department processed over one business rates, rent arrears andtwelve othermonths claims.our Over the last months our tracing million trace reports. Over the last success ratetwelve has been in the region of 87%.success Trace instructions can region be accepted on subjects in the U.K. orour anywhere the world. rates; rate has been in the of 87%, greatly increasing clients’incollection

• tracing and recovery • Asset Investigation of illegal sub-letting in relation to social housing, where it is now a criminal SIRS are specialists in tracing assets and assisting in the recovery process all over the world. offence.

This can include obtaining solid evidence that the tenant is residing elsewhere, Status/wealth reports can be prepared on individuals and companies for peace of mind or evidence of who is currently residing at the target address, surveillance operations, interviews recovery purposes. and statements from witnesses and the tenants themselves; • Health tourist debts • It is well publicised that bothaction NHS and private hospitals areof experiencing severe problems in relation Investigations to support in relation to mis-use council/government property, againstto debts owed by individuals who have had treatment in the U.K. and subsequently left the country without terms of the lease; paying. SIRS can greatly assist by locating current whereabouts of debtors throughout the world and with the whole recovery process. We can also prepare identity, residential and status reports prior to treatment • in Service ofmitigate documents onofsquatters; order to the risk non-payment.

• reports • Pre-employment Assistance in cases involving “Children at risk”, including tracing and serving documents on parents SIRS can prepare such reports to any level but in generalfor to injunctions include residential, or partners. The obtaining of evidence to required support applications or careidentity orders;and credit checks: Education and qualifications: Prior employment references: Personal referees: Periods of unemployment: Various background checks.

• Obtaining evidence of anti-social behaviour in support of applications for “Asbos”,

particularly on housing estates or town centres; • Long-term sickness SIRS can investigate long-term periods of sickness and ascertain whether or not employees are genuinely example, involved in other forms of work, which is frequently themounted case.

• incapacitated Investigationor, offor benefit fraud.

Sophisticated surveillance operations can be in order to obtain sufficient proof for prosecutions.

The above services are a few of the wide ranging services that can be offered throughout the UK (and The above services are a few of the wide ranging services that can be offered throughout the UK overseas if required). We currently have contracts and long standing arrangements with both central and (and overseas if required).

We We currently have contracts andand longDPA standing arrangements with both central local government departments. are fully insured, licensed registered.

and local government departments. We are fully insured, licensed and DPA registered.

We obtaining thethe very best We take take our our work work very veryseriously seriouslyand andare areentirely entirelycommitted committedtoto obtaining very best results for our clients. We strongly suggest you visit our website, www.sirseurope.co.uk, results for our clients. We strongly suggest you visit our website, as below, for details for details of the precise service in which you are interested or telephone of the precise service in which you are interested or telephone Keith Stowell on 01932 862879 or Chris Taylor on 07974 406474.

Keith Stowell on 01932 862879 or Chris Taylor on 07974 406474.

World Association of Professional Investigators

Strategic Intelligence and Risk Services (Europe) Ltd Strategic Intelligence and Risk Services (Europe) Ltd The Firs, Sandy Lane, Cobham, Surrey, KT11 2EP The W: Firs, Sandy Lane, Cobham, Surrey, KT11 2EP T: 01932 868911 www.sirseurope.co.uk www.sirseurope.co.uk/councils-government T: 01932 868911 Offices in Surrey, London W: andwww.sirseurope.co.uk Leeds with contacts worldwide