Health Business 14.3

VOLUME 14.3 www.healthbusinessuk.net

ENERGY

PROCUREMENT

REFURBISHMENT

EVENT PREVIEW

HEALTH + CARE

Bringing together clinicians, commissioners, providers and social care teams

CLEANING

INFECTION CONTROL

Harnessing technical innovations to help keep hospitals bug-free LEGIONELLA

MAKING WATER SAFE Cost-cutting can put vulnerable patients at risk, says the Building and Engineering Services Association

PLUS: MARKET RESEARCH • LONE WORKER PROTECTION • FLEET MANAGEMENT & MORE

HEALTH BUSINESS MAGAZINE ISSUE 14.3 VOLUME 14.3 www.healthbusinessuk.net

ENERGY

PROCUREMENT

REFURBISHMENT

EVENT PREVIEW

HEALTH + CARE

Bringing together clinicians, commissioners, providers and social care teams

CLEANING

INFECTION CONTROL

Harnessing technical innovations to help keep hospitals bug-free LEGIONELLA

MAKING WATER SAFE Cost-cutting can put vulnerable patients at risk, says the Building and Engineering Services Association

PLUS: MARKET RESEARCH • LONE WORKER PROTECTION • FLEET MANAGEMENT & MORE

Comment

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

MENTAL HEALTH TRUSTS TO CONDUCT LIFESTYLE MoTs I am writing this comment at the end of the newly launched Mental Health Awareness Week 2014, which took place 12-18 May. Dr Martin McShane, NHS England’s director for long-term conditions, said at the launch: “Depression and anxiety make up 66 per cent of the mental health need in England as well as 30 per cent of GPs’ workload, therefore it is imperative we provide good access to the invaluable therapies which help patients, whatever their age, manage their conditions and improve their quality of life.”

It’s a fitting week then for the Department of Health to launch a new scheme incentivising mental health staff to give lifestyle ‘MoTs’ to patients as well as assessing psychological health. This is to reduce the amount of avoidable deaths, as NHS England claims that mental health patients die from physical health problems, such as cardiovascular disease, lung disease and liver disease, about 15 years earlier than the general population.

Mental health trusts will receive financial rewards for carrying out the checks, including smoking status, diet, weight, blood pressure, glucose and fats or lipids, and ensuring identified illnesses are treated.

In this issue of Health Business, we focus on legionnaire’s disease in the health sector. Last September Basildon Hospital in Essex was ordered to pay £350,000 in fines and costs after two patients died from Legionnaires’ disease in 2007 and 2010. In the hot and cold water systems for large buildings, such as hospitals, legionella can be present and can pose risks for patients, particularly older, more vulnerable ones. The feature starting on page 57 gives advice on how to tackle the problem.

Angela Pisanu, editor

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 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 Patrick Dunne, Jeremy Cox, Tomas Lee, Ben Plumber, Azad Miah, Lucy Rowland ADMINISTRATION Victoria Leftwich PUBLISHER Karen Hopps REPRODUCTION & PRINT Argent Media

© 2014 Public Sector Information Limited. No part of this publication can be reproduced, stored in a retrieval system or transmitted in any form or by any other means (electronic, mechanical, photocopying, recording or otherwise) without the prior written permission of the publisher. Whilst every care has been taken to ensure the accuracy of the editorial content the publisher cannot be held responsible for errors or omissions. The views expressed are not necessarily those of the publisher. ISSN 1362 - 2541

Volume 14.3 | HEALTH BUSINESS MAGAZINE

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CONTENTS

07 NEWS

39 FACILITIES MANAGEMENT Alex Mirkovic looks at ways that healthcare facilities can control costs, whilst keeping waste management environmentally responsible

NHS chiefs told to ‘think like taxpayers’; Miliband wants 48hr appointments

15

11 PROCUREMENT

Chris Doyle of supply chain organisation GS1 looks at how the NHS might achieve procurement efficiencies through the smart use of technology

43 FLEET MANAGEMENT

15 LEGISLATION

47 PARKING

The Chancellor’s 2014 Budget revised tax rules for fleets. ACFO chairman Damian James outlines the changes

What will Clause 119 of the Care Bill, dubbed the ‘hospital closure clause’ mean for clinicians? Michael Boyd of business law firm DWF, discusses the options

Kelvin Reynolds of the BPA on important aspects to consider when arranging the provision of parking systems in hospitals

51 INFECTION CONTROL

Lee Baker of the British Cleaning Council examines how hospitals have harnessed technology to keep clean and safe against a background of budget cuts

19 RECRUITMENT

Vicky O’Brien of the Recruitment and Employment Confederation believes that achieving a sustainable NHS workforce requires genuine collaboration with recruitment agencies

57 LEGIONELLA

Bob Towse of the Building & Engineering Services Association explains how cost cutting can put vulnerable patients at risk from the threat posed by Legionella

23 MARKET RESEARCH

Jane Frost, CEO of the Market Research Society explains how research influences decision making

33

63 ASBESTOS REMOVAL

The newly created Asbestos Removal Management Unit (ARMI) provides expert support, explains ARCA

25 MEDICAL RESEARCH

Dr John Parkinson, director of the Clinical Practice Research Datalink, examines the potential benefits that utilising health data would have for patients, the economy and public health

65 ICT

Investing in data infrastructure will benefit patients, according to Luke Readman of BCS Health

27 REFURBISHMENT

69 DOCUMENT DESTRUCTION

Bringing ageing properties up to date is a problem that faces many NHS estate managers. Health Business highlights some successful recent projects.

51 57

Contents

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Treating end-of-life ICT assets as waste is misguided, says Steve Mellings of ADISA

73 LONE WORKER PROTECTION

31 MODULAR BUILDING

James Kelly of the BSIA explores the modern security measures to combat threats to healthcare staff

Many hospitals are turning to modular buildings for a fast way of extending space, reports the MPBA

77 EVENT PREVIEW

Taking place on June 25-26, Health+Care brings together clinicians, commissioners, providers and social care teams for networking, seminars and keynote speeches from policy makers

35 ENERGY

Identifying measures to save energy in the NHS often requires specialist support writes Gregor Paterson-Jones

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PATIENT SERVICES

Miliband promises GP appointments within 48 hours Labour leader Ed Miliband has pledged to reintroduce patients’ right to see a GP within 24 hours, a target that was scrapped in June 2010, and that patients needing to be seen quickly would have same-day appointments.

Miliband said Labour would invest an extra £100 million annually to fund an additional three million GP appointments a year, and that this money would come from revoking competition requirements and from cutting back on what he referred to as ‘quangos’ such as the Trust Development Authority.

He said: “I can announce the next Labour Government will put in place a new set of standards: a same-day consultation with your GP surgery with a guarantee of a GP appointment if you need it that day, a GP appointment guaranteed for all within 48 hours, and the right to book further ahead

with the GP of your choice if your priority is to plan ahead or see your preferred doctor.”

“This will be better for patients, because they have better access to their GP surgery,; better for the NHS, because it will save money currently spent in A&E; and better for Britain, because it is the kind of health READ MORE: service we tinyurl.com/mbyh2dx need.”

Diabetes UK report criticises ineffective use of NHS funding The NHS is using its annual £10 billion budget for diabetes care ineffectively, a new Diabetes UK report claims. The report says that the vast majority of this money is spent treating complications that may not have arisen had better healthcare been provided earlier on.

The organisation’s research highlights ways to resolve these issues without having to increase spending, such as improved education, the introduction of multidisciplinary foot teams to prevent amputation, and having specialist diabetes team on hospital wards.

Chief executive Barbara Young said: “The NHS is spending an eye-watering amount on diabetes but the money isn’t being used effectively, which is running up a huge bill for the future.

“Too often, the focus is on cutting costs in the short-term such as restricting access to blood-glucose test strips and poorly planned transferrals to primary care. This is making it difficult for those with diabetes to manage the condition and is offering poor value for money for taxpayers.”

NICE GUIDELINES

Court warns CCG to comply with NICE guidelines A court has ruled that clinical commissioning groups (CCGs) cannot choose to disregard NICE guidance because they disagree with it, even where there is no statutory duty to comply. This followed the case of Elizabeth Rose, a young woman suffering from severe Crohn’s disease who when her condition deteriorated was recommended to undergo bone marrow transplantation and chemotherapy. As this treatment can lead to infertility, Rose sought NHS funding for egg cryopreservation, a measure that Thanet CCG refused in May 2013 on the grounds that its effectiveness was unproven.

This contradicted NICE guidelines from February 2013 stating that oocyte cryopreservation is an appropriate treatment for women of reproductive age facing treatment that can limit their fertility. The NICE fertility guidance was in the form of a clinical guideline rather than a technology appraisal or specialised technology appraisal, meaning CCGs do not have a legal duty to follow this advice.

Nonetheless, the judge ruled that Thanet CCG had not found a compelling reason for non-compliance and that mere disagreement was not sufficient. NICE chief executive Sir Andrew Dillon said: “This court ruling highlights that CCGs cannot simply ignore NICE guidelines without having a clear clinical case for doing so. NICE guidelines are based on the best READ MORE: available tinyurl.com/mlzdy4j evidence.”

STAFF WELFARE

STANDARD OF CARE

Overworked nurses put patients at risk

Hospitals in South Wales slammed for ‘completely unacceptable’ failures

The National Institute for Health and Care Excellence (NICE) has published governmentbacked draft guidelines saying that wards where nurses are charged with the care of more than eight patients on a regular basis pose an increased risk of patient harm.

This follows the release of evidence presented by the National Nursing Research Unit showing that a ratio of more than eight patients to one nurse is associated with higher mortality rates and patient harm. The NICE guidelines cover certain ‘red-flag events’, including basic care equirements not being met like assistance with bathroom visits and medicines being administered READ MORE: at the correct tinyurl.com/mowsso4 time.

A recent report commissioned by the Welsh Government has raised concerns about the standard of care provision in Neath Port Talbot Hospital and the Princess of Wales Hospital in south Wales. The report was called for following the neglect of 82 year old Lilian Williams who had been a patient in both hospitals. Abertawe Bro Morgannwg University (ABMU) Health Board has apologised for the case, saying it was “completely unacceptable”.

Serious issues cited in the report include: variable or poor professional behaviour and practice in the care of frail older people; a lack of respect towards and involvement of patients and relatives; a lack of qualified, motivated staff, especially on night shifts; and staff who were ill equipped to meet the needs of dementia patients.

News

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The report says: “there are aspects of the care of frail older people which are simply unacceptable and must be addressed as a matter of urgency.

“ABMU has not at any point been ‘another Stafford’. But no one should be in any doubt that there are aspects of the care of frail older people which are simply unacceptable and must be addressed as a matter of urgency through action by the Board of ABMU and the Welsh government.”

Health minister Mark Drakeford said: “I have been shocked by some of what I have read in this report. I am determined that nothing of this sort will be tolerated in Abertawe Bro Morgannwg University Health Board or indeed anywhere else in READ MORE: Wales in the tinyurl.com/m2bvk39 future.”

Volume 14.3 | HEALTH BUSINESS MAGAZINE

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EXPENSES

NHS chiefs told to ‘think like taxpayers’ NHS chiefs have been issued with a ban on claiming expenses for first class rail tickets, and told to take public transport instead of using taxis. Simon Stevens, the new NHS England chief executive, has said that his colleagues should “think like a patient and act like a taxpayer.” The announcement came after the Telegraph revealed through a freedom of information request that nine NHS England board members had spent almost £200,000 on food, travel and hotels during 2013/14.

Katherine Murphy, chief executive of the Patients’ Association, told the Telegraph: “It is an absolute disgrace when patients are waiting longer for care, when frontline staff are so overloaded, and when there are such difficulties in some parts of the service, to see this scale of excess at the top of the organisation. It truly beggars belief.”

NHS England was set up in 2011 as the NHS Commissioning Board in order to streamline bureaucracy. Stevens, who took a voluntary pay reduction of £20,000 upon taking the job, said: “NHS England

has set new standards for openness and transparency in all of its operations, compared with what went before.

“And I’ve set myself and our organisation the goal in everything we do of ‘thinking like a patient, and READ MORE: acting like a tinyurl.com/mlgw2gl taxpayer’.”

News

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NEWS IN BRIEF BMA launches GP investment campaign

The British Medical Association (BMA) has launched a campaign which calls for long-term investment to help resolve some of the issues facing general practice. Your GP Cares will aim to address the challenges arising from increased workloads, in particular handling older patients with complex conditions.

The BMA says that there are more patients seeking GP appointments overall and that premises are deteriorating, both of which contribute to low morale among GPs and affect doctor recruitment and retention. The new campaign seeks funding to hire more GPs to improve patient care, hire more nursing and support staff, and improve practice buildings.

READ MORE:

tinyurl.com/mseq9p6

NICE GUIDELINES

NICE: Labour wards not for straightforward births Draft recommendations from the National Institute for Health and Care Excellence (NICE) argue that healthy women whose pregnancies are without complication should be advised to give birth in a midwifeled unit and not a traditional labour ward. NICE says that to prevent excessive intervention, hospital labour wards should be used mainly in complicated births.

The announcement came after the National Perinatal Epidemiology Unit’s (NPEU) Birthplace study found that midwife unit deliveries, previously thought to carry risk for mothers, are as safe as doctor-led care for low-risk births. The study also found that for women with low-risk pregnancies who had already had at least one child, home births are as safe as hospital deliveries.

Christine Carson, clinical guideline programme director for NICE, said: “Every woman should ultimately have the freedom to choose where she wants to give birth and be supported in her choice.

“We’re pleased we are now able to propose more definite advice to help pregnant women choose the best option for them.

We now want to hear what others think so that we can ensure the final, updated guidance will promote the safest possible care for women and their babies.”

NHS staff to have access to research A one-year trial overseen by NICE will see NHS staff receiving free access to published medical research. Scientific journals making research available through the trial include AAAS, Oxford University Press, Royal Society of Chemistry and Springer.

READ MORE:

tinyurl.com/kr8dq7t

New asthma research centre launched

The Royal College of Obstetricians and Gynaecologists (RCOG) said: “We support choice for low-risk women who have had successful previous births to give birth at home, provided transport arrangements are in place for hospital transfer in the event of an emergency or should there be a request for pain relief.

“Based on the findings from research, there are issues around the risk assessment of pregnant women and the RCOG is in favour of alongside midwifery units (AMUs) for women who may need multidisciplinary READ MORE: care during tinyurl.com/kbhlcnq delivery.”

Asthma UK has announced the formal launch of the Asthma UK Centre for Applied Research. The centre is the first of its kind in the UK and will focus on developing better treatments and making them available to patients more quickly. It will be led by asthma experts Professors Aziz Sheikh and Chris Griffiths, and will be co-ordinated through the University of Edinburgh and Queen Mary, University of London.

Professor Sheikh said: “I am delighted that some of the UK’s top asthma researchers are contributing to this unprecedented initiative where they can share expertise and insights to drive forward major improvements in asthma.”

READ MORE:

tinyurl.com/lum4j3v

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Procurement

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PURCHASING

HARNESSING GREAT PURCHASING POWER

The UK’s banking, manufacturing and retailing sectors have achieved procurement efficiencies through utilising technology solutions. So what can the NHS learn from this? Chris Doyle from independent global supply chain standards organisation GS1 UK explores how shared data solutions can enable NHS Trusts to drive efficiency in procurement and focus resource on quality patient care “The NHS wastes billions on procurement”; the greatest purchasing power of any “This Trust buys the same gloves as that business in the UK, but the way in which Trust but pays 7.5 times more”; “Public it manages this process is vastly inefficient. procurement is a shambles.” These are It is estimated that trusts can save £1.5bn just some of the headlines pulled from a by the end of 2015-16 through taking a Google news search on NHS procurement. cohesive approach to procurement based on The recognition that ‘something needs global standards, national infrastructure and to be done’ in relation to the way the local delivery. These savings will then free up NHS manages its annual £30bn of money to be invested in front-line care. non‑pay spend, including £20bn Introducing this scale of change on goods and services, has obviously brings challenges been around for years. alongside it, but precedents The is t n Quite how this issue should exist in the global e m n be tackled has been, and healthcare sector and gover address o t continues to be the subject the UK’s banking, g n i s v n o i ha t s e of some debate, but what manufacturing u q is clear is that there is no and retailing difficult d how it n u more time for delay. The sectors through o r e a ith th w government is having to the way in which l a e d will address difficult questions they have utilised crisis g n i d n around how it will deal with technology solutions u f e h the funding crisis facing the to revolutionise their facing t NHS and failure to evolve the business operations.

S H N way in which any area currently All the developments operates is no longer an option. discussed here have already been successfully implemented AN APPROACH TO BETTER PURCHASING at least in part somewhere else.

So why is the procurement function so In this article we explore how shared data important? Put simply, the NHS may possess solutions can enable trusts to drive efficiency

in procurement and focus resource on the provision of high quality care to patients.

PROCUREMENT PROGRAMME In August 2013 the Department for Health published Better Procurement, Better Value, Better Care – A procurement development programme for the NHS, which laid out four key initiatives to improve the procurement function of “every employee who influences purchasing decisions or spends money with suppliers.” This included a series of interventions to deliver immediate efficiency and productivity gains, and actions to improve data, information and transparency.

It also involved an initiative to engage clinicians more fully in procurement decisions through clinical procurement review partnerships, and the creation of a new national ‘enabling function’ to support leadership and build better capability throughout the procurement system.

The strategy for delivering on these initiatives comprises taking in the best elements of existing technology and systems from a range of sectors and sources and crafting them into a practical system for Trusts to implement. The key elements of this system are outlined below. E

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PURCHASING  NHS GS1 DATAPOOL Master data relating to the products and services the NHS procures represents the core of this strategy. Master data is loosely defined as all the information about a product necessary to perform business transactions (core attributes such as product description, dimensions, packaging levels, manufacturer’s address, minimum order volumes etc).

A datapool is a central repository for this master data which is stored and accessed in a standardised way by suppliers and buyers.

The use of a datapool ensures unequivocal identification of products and provides a synchronisation capability ensuring that buyers have up-to-date information at all times.

NHS PIM SOLUTIONS There are a number of datapools around the world linked by what is known as the GDSN (Global Data Synchronisation Network) which operates in over 150 countries and includes product data for over 10 million items from over 25,000 producers. In order to ensure that Trusts’ product catalogues only contain the data they need, a system which interfaces with the datapool to ‘pull’ the required information is used. PIM (Product Information Management) solutions will be provided centrally by the Department for Health to enable good catalogue management by trusts.

NHS GLN REGISTRY While a datapool helps to unequivocally identify products and services (the ‘what’ of procurement), a GLN (Global Location Number) registry identifies the ‘where’. GLNs are a GS1 identifier used to uniquely identify legal entities, delivery and storage locations.

A central registry of GLNs means that the physical location of where to deliver goods and the destination of all business messages (purchase orders, invoices, advance delivery notifications, proof of delivery, remittance advice etc.) is similarly unambiguous.

PURCHASE TO PAY The combination of accurate master data, good catalogue management and consistent location identification enables, through local systems, a fully integrated purchase-to-pay process with little human intervention.

Systems like these have been used for many years in retail environments and are estimated to save the UK retail industry some £11bn each year through error reduction, better stock availability, more accurate forecasting and a myriad of additional benefits derived from increased visibility.

DIRECT PATIENT BENEFITS The general benefits that the retail industry experiences from the use of such automated technology often translates fairly directly into the healthcare environment, but the true value of improved care delivery and better outcomes for patients bears a little more analysis. The procurement systems outlined

above, when integrated into other systems, can deliver benefits far beyond the purely logistical and commercial. Considered in the light of correct patient identification, Electronic Health/Patient Records (EHR) and wider hospital systems the real impact on better care delivery becomes clearer.

PATIENT IDENTIFICATION Parents often retain the wristband issued to their children when they were born. The light blue and pink bands featuring a midwife’s neat handwriting may provide a sentimental reminder of a happy event, but as the basis for a rigorous and unequivocal method of patient identification they are little use. Since October 2013 it has been a required standard (NHS ISB 1077) for NHS hospitals in England to issue patients with printed wristbands bearing basic demographic information, the NHS number, an optional hospital PAS number and to have this information coded into a GS1 DataMatrix barcode.

This identification wristband can be used as the key to accessing a patient’s EHR, to confirm identification before drugs are dispensed and to uniquely allocate instruments used for implants given to the patient, and is fundamental to enabling the wider benefits of automated procurement

Procurement

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pharmacy) to verification of medicines and devices at the point of use (for authenticity, date validation etc.) to the automated replenishment of stocks used (direct to the manufacturer through aggregated systems pooling demand from a number of units to achieve best prices and volume discounts).

In addition, the amount of time saved through not having to look for patient notes and equipment can be drastically reduced (one estimate, from Bolton in 2011, puts this time-saving alone at one hour per eight-hour shift). Combine all these potential benefits with consequent improvements (such as in relation to product recalls, reduced cancellation of procedures due to lack of the correct equipment etc.) and it is not difficult to see how the management consultants at McKinsey estimated that, globally, adoption of GS1 standards in healthcare could save up to 43,000 lives, avert up to 1.4million disabilities and save up to $100bn.

WHAT NEXT? Most hospitals in England have made some progress with the adoption of GS1 standards. Many patient identification systems, surgical instrument decontamination systems, robotic pharmacy systems and inventory management systems rely on GS1

Driving through these changes will pose some challenges but it should not prove costly if implemented properly, and will enable huge improvements to healthcare standards for all those involved in the provision of care in this country systems. In addition, the NPSA has for a long time recognised the safety benefits of consistent patient identification on the wristband and the positive impact this can have on a range of never events.

ELECTRONIC HEALTH RECORDS Whether all hospitals will meet the target of becoming paperless by 2018 remains to be seen but, irrespective of the actual timescales for the removal of paper processes, the use of EHR will become ubiquitous over the coming period. The information which makes its way into these records and the way the record system interacts with other systems will be another key factor which supports the promised efficiencies of cost and safety enhancements.

In a recent presentation Judie Finesilver, eProcurement Pharmacist at the Commercial Medicines Unit, followed a patient though a simple admission, diagnosis, treatment and follow-up pathway and identified 33 touch-points along the journey where Auto-ID technology could enhance current processes. These ranged from automated completion of EHRs (in theatre, clinic and

standards (commonly without realising it).

To fully implement the new procurement strategy each trust will be required to adopt a board-approved GS1 standards adoption plan. This plan will drive four main activities which can be started now: Identification of people (patients and care‑givers) using NHS ISB 1077; Identification of places (using GS1 GLNs); Identification of things (assets in the hospital and, through supplier engagement, products supplied to the hospital); and Integration of systems using GS1 as a global language.

Locations and people are the easiest places to start; supplier engagement is the best next step and integration of systems will come with consistency in upgrading and replacing existing systems.

Driving through these changes will pose some challenges but it should not prove costly if implemented properly, and will enable huge improvements to healthcare standards for all those involved in the provision of care in this country. L FURTHER INFORMATION www.gs1uk.org

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Inspiring the world to move well

Hospital Closures

LEGISLATION

Written by Michael Boyd, DWF

DEBATING THE HOSPITAL CLOSURE CLAUSE Michael Boyd, healthcare sector head at business law firm DWF, discusses what Clause 119 of the Care Bill, dubbed the ‘hospital closure clause’ will mean for clinicians and how the law in this area has developed Clause 119 (formerly clause 118) is a section of the Care Bill which, once passed, will allow trust special administrators to close down or downgrade any hospital or A&E within 40 days if a neighbouring trust is in financial trouble.

The controversial clause, branded by some as the ‘hospital closure clause’ has sparked a huge amount of debate, with MP Andy Burnham criticising the bill for increasing the scope to close down good hospitals and removing decision‑making from local communities.

A DEVELOPING LEGAL FIELD The development of hospital closure legislation Clause 119 has emerged from the development of the Trust Special Administration (TSA) process. The TSA process was introduced in 2009 as a method of preserving the continuity of NHS services where an NHS trust faced insolvency. The scope of the process was extended to NHS Foundation Trusts by the Health and Social Care Act 2012.

The TSA was first used in relation to South London Healthcare NHS Trust (SLHT). Although many of the Trust Special Administrators’ recommendations were adopted with minimum fuss, when proposals for downgrading the A&E department

at Lewisham Hospital were introduced, they were met with vociferous opposition – mainly from the local population.

Local pressure groups were successful in challenging the powers of the Secretary of State to close the Lewisham A&E department.

The success of this well-orchestrated local campaign was significant.

In adopting the TSA process in relation to the SLHT, the government hoped to be able to demonstrate that it was able to deal effectively and speedily with failure in the NHS. The successful judicial review judgement (supported subsequently by the Court of Appeal) attracted unwelcome headlines and highlighted that, in its current form, there were clearly gaps in the TSA process.

The TSA requires a consultation process to be undertaken, to allow discussion around the Trust Special Administrator’s draft recommendations. However, this prescribed consultation is shorter and more closely defined than would normally be the case under the ‘consultation and involvement’ requirements.

The objector’s case was founded on the unlawful extension of the TSA process to the Lewisham A&E department, which meant that there had been an absence of what they claimed was ‘proper’ consultation.

Clause ds en 119 ext of the pe the sco endations recomm ting from emana process to the TSA hich are not trusts wect to the CLOSING THE GAP subj ocess The Government has sought r TSA p to include provisions in the

SHORTCOMINGS OF THE PROCESS Although the TSA process was applied to SLHT, the difficulty arose because Lewisham A&E belonged to another trust which was not subject to the TSA: Lewisham Healthcare NHS Trust.

Care and Support Bill which seek to close the legal gap highlighted by the Courts. In essence, Clause 119 extends the scope of the recommendations emanating from the TSA process to trusts which are not themselves subject to the TSA process and removes the requirement for a broader consultation. Had Clause 119 been in force at the time of the SLHT process, E

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Hospital Closures

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

LEGISLATION  the Lewisham objectors would have found it much more difficult to challenge the proposals about their A&E department.

THE IMPLICATIONS In an organisation that has thus far gone to considerable lengths to emphasise the significance of transparency and local involvement in decision-making, there is no doubt that the use of Clause 119 represents a significant change in approach.

Existing statutory guidance published by the Department of Health, which continues to apply in non-TSA cases (together with other guidance published by the Cabinet Office) highlights the importance of proper consultation, especially in the context of major decisions. In addition, it also makes it plain that the way in which the consultation takes place needs to take account of a wide variety of different factors so that a process can be structured which takes these factors into account.

This is because it is intended to cater for a very broad range of possibilities, ranging from the re-siting of a chiropody service to the closure of an A&E facility (or even a hospital). As such, the question as to whether any solution adopted under the engagement obligation was sufficient (in terms of scope, information and time) would be influenced by the subject matter and gravity of the plan, proposal or decision.

As a result of Clause 119, users of services which neighbour financially failing trusts could find themselves being affected by the recommendations of the Trust Special Administrator and will find themselves subject only to a ‘consultation-lite’ process. In particular the TSA process is a much blunter instrument when compared to the flexibility that is allowed for in the case of non-TSA consultations. It is prescriptive in terms of what is required, how long the process should take, who should be consulted and how it ought to be carried out. As such, the TSA process adopts much more of a ‘one size fits all’ approach, which is contrary to the engagement principal and reflected in the guidance that would, but for Clause 119, apply to decisions affecting non-TSA trusts.

ONE SIZE FITS ALL Although certain aspects of the TSA consultation process are capable of being adjusted to fit the circumstances, it is much more rigid in terms of what is required and how it should be carried out. This is at odds with the statutory engagement principal, which caters for a broad range of possibilities within the nature of the process – in terms of scope, information and time – being influenced by the subject matter and gravity of the plan, proposal or decision. As such, depending on the nature of the recommendations in the draft report and the consultation carried out, the TSA consultation process may not be sufficient

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One of the main reasons that Clause 119 was introduced was to facilitate speedier resolution of fundamental issues to allow local populations to feel that they have had adequate involvement in important decisions which affect them and to provide important and often complex information.

Clause 119 removes the ability for objectors to prevent TSA changes in the same way that the Lewisham objectors did by eliminating the requirement for full public consultation. Although the consultation period on the draft proposals has been extended from 45 working days to 65 working days, this is still quite a brief period of time to facilitate an informed dialogue on often complicated proposals which could have far-reaching effects on local populations.

OPPOSITION The use of Clause 119 is, in effect, an acknowledgement that problems affecting unsustainable trusts go beyond the walls of the TSA trust itself. Although the TSA process has been used only sparingly, the hostility to the Clause 119 proposal is borne out of the number of trusts which are currently in financial difficulty. As such, there is concern that the TSA process will become more widely used and that important decisions will be made in the absence of the level of scrutiny and debate which people have come to expect from the NHS. In its defence, Government would point out that the TSA process is very much a last resort and is a vital tool to help resolve issues which require speedy resolution in the interests of patients. However, in many cases the complexity of issues facing a trust requires a much broader negotiation and consensus to achieve a complete resolution than just the TSA process alone. Although guidance for administrators makes it clear that TSA is not a method of ‘achieving service reconfiguration by the back door’, there is considerable scope to doing this as a result of the use of Clause 119.

The public are notoriously protective of local NHS services. The use of a curtailed

consultation process is unlikely to reduce the level of objections or challenge. However, it will mean that objectors will have to be more creative over the grounds on which they launch judicial review actions.

THE BIG PICTURE One of the main reasons that Clause 119 was introduced was to facilitate speedier resolution of fundamental issues affecting a sector in which change is difficult to achieve quickly. Although the debate around Clause 119 has focused on its impact on transparency and local democracy, there is perhaps a more fundamental question that should be asked. How is it possible that a key service like health could be allowed to find itself in a position where the various elements of it are allowed to function almost independently of one another?

Although a degree of independence is helpful to ensure that local needs are properly taken into account, it also fosters the development of self-interest within organisations and the ability to veto important change which may be required in order to deliver sustainability across a health economy. The development of hospital chains is helpful in encouraging collaborative approaches between organisations. However, not everyone is currently acting in this way.

Therefore the restoration of the strategic role previously played by Strategic Health Authorities needs to be revisited so that a broader and longer-term view of the local landscape can be taken with the ability to require change to be implemented. The current structure does not even lend itself to the delivery of incremental change. This means that we are now faced with the necessity of fundamental change through the blunt instrument of Clause 119. L FURTHER INFORMATION www.dwf.co.uk

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Path to the heart of healthcare

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AGENCY STAFF

BRIDGING THE GAP Achieving a flexible and sustainable NHS workforce will require genuine collaboration with recruitment agencies, believes REC policy advisor Vicky O’Brien, who examines progress in this area In order to achieve this, the Department of Health’s ‘Better Procurement, Better Value, Better Care’ report published last summer also recognised the need for a new approach to supplier engagement; that recruitment agencies and their clients should “jointly take waste out of the system and smooth the pathway for innovation.”

The REC agrees that nurturing a genuinely flexible and sustainable NHS workforce is going to require a shift from simply supplier engagement to genuine collaboration with recruitment agencies. Unfortunately, progress in this regard has been slow.

BRIDGING THE GAP In our recent correspondence with the Health Minister Dan Poulter, we argued that side-lining agencies risks creating a void that alternatives such as staff banks are unlikely to fully cover.

Written by Vicky O’Brien, policy advisor, REC

Reforms recommended by the Francis inquiry and Keogh review could cost healthcare providers up to £1.2bn, several times the originally anticipated cost, according to new research by the Foundation Trust Network.

Health Education England recently announced they were conducting Skype interviews with doctors in India in a desperate bid to tackle the alarming shortage of A&E specialist doctors coming through.

For Recruitment and Employment Confederation (REC) members who work daily with NHS as trusts across the UK who are facing ever decreasing budgets and staff shortages, these recent headlines are particularly frustrating. We have long called for an overhaul of procurement but continue to face a fixation on reducing agency spend rather than innovation in cost-effective workforce management and planning. Faced with spending cuts and increasing demands for better value, it is imperative for recruiters and employers faced with the challenge of resourcing the public sector to work together more effectively than ever before.

Recruitment agencies continue to the bridge the gaps left by the crisis in NHS workforce management. Our data shows that demand for both temporary and permanent nursing/medical/care staff is strong and it is the second highest sector for both permanent and temporary demand for candidates according to the latest REC/ KPMG Report on Jobs. Demand for both temporary and permanent staff in the sector has been on a steady increase since 2011.

Report on Jobs also reveals that there are some specific roles where recruiters are struggling to find candidates to fill the positions that they have on offer, including registered general nurses and registered medical nurses, and are subsequently looking abroad. However, other agencies are finding talented health and social care professionals with ease; with many long-term NHS employees turning to agency work citing poor remuneration and workplace cultures as the key motivations for making the move.

The good news is that agencies are slowly starting to be seen as partners in the difficult project of building a flexible but sustainable NHS workforce.

The Department of Health recently commissioned the NHS Commercial Alliance to assist with phase one of a Temporary Agency Staffing project to help NHS trusts deliver £450m of efficiency savings towards the NHS’s total £1.5bn to £2bn efficiency savings target. The REC’s Health and Social Care sector group has welcomed the opportunity to contribute to this development of a national temporary staffing strategy, and will be sharing insights on how to effectively manage agency spend as well as making the case that temporary agency staff are indispensable to any cost‑effective workforce strategy in the NHS.

Recruitment

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

g Nuturinle a flexibinable ta and suskforce will r NHS wo a shift from require engagement r supplie ecruitment to r agency ion rat collabo

COMMITTED PROFESSIONALS We continue to champion the commitment and compassion of agency health and social care professionals. Specialist recruitment agencies provide a 24/7 service to the NHS, ensuring suitably skilled and properly vetted staff are placed into front line roles, often at extremely short notice. Many agency workers are former or current direct employees of the NHS and have gained invaluable experience working in a number of care settings. Yet despite the crucial role agency workers have played ensuring safe staffing levels, they continue to be treated as second-class citizens within the NHS. This is something the REC’s Health and Social Care group will continue to challenge.

We also believe that a strong focus on quality and viable opportunities for SMEs – in line with Government commitments in this E

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Medical recruitment that bridges the gap Providing solutions and opportunities to cut spend and increase efficiencies Interact Medical are an award winning recruitment agency that specialise in the placement of high calibre locum doctors into the NHS and private sector.

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• Web based portal with individual user control permissions and security • Supply chain management • Clinical governance risk management throughout supply chain • Full IT training and helpdesk support for our web based portal “Acclaim”

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AGENCY STAFF  area – has to be part of any procurement strategy to build sustainable supply chains that deliver value for public services. This is particularly crucial within social care.

Many recruitment agencies involved in complex umbrella and other supply chain arrangements struggle to not only navigate the tendering process but also to receive crucial feedback and references from clients about the performance of their workers.

NHS trusts should also be assured that the REC continues to drive professionalism and standards in the recruitment industry. All our members must abide by the REC Code of Professional Practice. When agencies join the REC they sign up to the REC code, which requires basic statutory compliance as well as higher ethical standards. REC members must also pass the REC’s compliance test on entry to the REC and then must pass again every two years to retain membership. If an agency uses the REC logo it means that they have passed the initial compliance test and are required to adhere to the REC code.

WORKING IN PARTNERSHIP On the ground, many of our members enjoy working partnerships with trusts based on mutual support and trust. REC member HCL worked with Worcestershire Acute Hospitals NHS Trust that provides hospital-based services to a local population of around

Recruitment

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

The Department of Health recently commissioned the NHS Commercial Alliance to assist with phase one of a Temporary Agency Staffing project to help NHS trusts deliver £450m of efficiency savings towards the NHS’s total £1.5bn to £2bn efficiency savings target 550,000 through three main sites in Redditch, Kidderminster and Worcester. To deliver sustainable services to that population, the trust identified the need to optimise its resources, governance of risk and demonstrate true value for money. Spend on medical locums was one area of significant cost – in the last financial year the trust spent over £7m on this staff group. Although vital in supporting the delivery of safe patient care, the trust felt it was not realising value for money from its temporary staff supply chain.

Claire Billenness, Managing Director Client Solutions at HCL: “We acknowledge the complex nature of the NHS and the pressures trusts are under – we want to help trusts become better informed about their supply chain, ensuring value for money and efficiencies that can then be reinvested into the provision of frontline care. In just

one year HCL Clarity, our managed services division, helped Worcestershire Acute Hospitals NHS Trust to save an indicative £1.3million through working with the trust to streamline their preferred supplier list, renegotiating framework rates, building a case for permanent recruitment through real-time reporting and significantly increasing the bank size. By working with HCL Clarity, the trust can now make informed decisions about their supply chain, enabling further financial savings and freeing up medical resources.”

We want to champion these stories and support other members to achieve similar partnerships.

But building a cost‑effective temporary staffing strategy for the NHS is going to take genuine openness and commitment from both sides. L FURTHER INFORMATION www.rec.uk.com

Doctors.net.uk – the largest and most active online professional network for all UK doctors The internet has opened up a world of career opportunities for time-pressed doctors by enabling them to keep abreast of job vacancies in the NHS and beyond at the touch of a button. It has also allowed recruiters and employers to engage with doctors in an informed and highly measurable way via niche, professional services.

Maintaining strong relationships with target jobseekers is key to the success of niche networks. To make it even easier to connect doctors and employers, Doctors. net.uk is building a new CV database, which will identify the types of roles that individual doctors are seeking. By encouraging doctors to keep their CVs regularly updated, Doctors.net.uk Career will be able to keep abreast of their career plans too.

Each month about 30,000 GMC registered doctors visit the digital careers centre run by M3-owned Doctors.net.uk – the UK’s largest and most active online doctor network.

Doctors are able to view vacancies ranging from NHS jobs to becoming a medic for the Ministry of Defence, working in the pharma industry or with private healthcare providers, plus a host of overseas opportunities.

The Doctors.net.uk career service gives

recruiters access to a large pool of potential candidates while allowing them to refine their search by targeting jobseekers according to their seniority, specialty, location or job type, In addition to identifying doctors, the service indicates who recruiters are able to reach and they can then see who has engaged with their advertisement, as well as who has applied. As a result, it enables them to measure ROI in a very transparent and effective way.

Andrea Thornton, head of careers services for Doctors.net.uk, said: “Professional online services like ours and the introduction of a CV database will enable recruiters to identify the right candidates quickly by providing accurate and insightful data on thousands of active jobseekers.

“As well as attracting the best talent, by seeing who has engaged with their advertisement, as well as who has applied, recruiters can also measure ROI on their advertising spend to ensure they are obtaining optimum value.”

FURTHER INFORMATION Contact: Andrea Thornton Tel: +44 (0)1235 828400 andrea.thornton@eu.m3.com www.doctors.net.uk

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Market Research

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

Why taking part in specialist pharmaceutical and healthcare market research is so important Taking part in market research gives you an opportunity to make real impact on which products, services and information may be available in the future. Your input in market research studies may help to ensure a pharmaceutical company gives patients or healthcare professionals the right information they need, but also it might help the company to understand everyone’s different needs in terms of support, education or sponsorship.

When taking part in market research studies with Oracle, your anonymity is guaranteed because the company abides by the codes of conduct of the Market Research Society and the BHBIA. Oracle is looking for your personal views and opinions and not those of the hospital trust, CCG or any other NHS organisation that you may be employed by. All your details are kept securely, and Oracle adheres to the rules and regulations set by the Data Protection Registrar.

The company will never sell, or pass on your personal information to any third party and will only ever contact you to invite you to a market research study.

Oracle will never harass you, or send you junk mail. On average, you’ll only be

contacted a handful of times per year to take part in market research studies.

At no point in the process will the company try and sell you anything, promote anything or try and sway your views or opinions, and the company respects your right to withdraw from the interview at any time or refuse to answer any particular question.

Oracle has a combined 30 years’ experience in the qualitative market research industry performing healthcare and medical market research for numerous clients.

The company specialises in medical, pharmaceutical and healthcare recruitment and its clients include full service agencies; independent researchers; pharmaceutical companies; marketing and communications companies and advertising agencies.

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www.zatpark.com 22

HEALTH BUSINESS MAGAZINE | Volume 14.3

Oracle regularly speaks to doctors of all levels and all specialities, patients and carers, pharmacists, nurses, CCGs, SCGs, payors, dentists, hygienists and all healthcare professionals.

The company has a team of specialist medical fieldwork recruiters based across the UK and Ireland who have many years of experience in this field, therefore Oracle regularly conduct research in all the major cities across the UK and Ireland as well as the smaller towns and cities.

If you’d like to register to be contacted for suitable market research studies or if you’d like more information please visit the website.

FURTHER INFORMATION www.oraclefieldwork.com

PATIENT DATA

Jane Frost, CEO of the Market Research Society explains how research can influence decision making across the health sector There have been a number of damaging reports in the care sector recently both in terms of wider care for vulnerable people and, specifically, health services. The NHS is under more pressure than ever before to improve its services. Questions have been raised regarding patient treatment and quality of care, and the organisation has been exposed as ill-prepared to handle the UK’s ageing population. Financial uncertainty is creating a fear of further cuts which is stalling decision-making across the organisation.

If the NHS is to improve, there must be a better comprehension of the challenges it is facing. Society and technology are evolving faster than the NHS – the country’s growing elderly population is intensifying service pressures, and the organisation is not always utilising new technology as quickly as it could. Without in-depth analysis of these changes alongside better engagement with patient needs, the organisation will struggle to catch up and improve its service.

One way the NHS could glean further understanding is through carefully considered market and social research. Evidence leads organisations in the right direction, allowing them to respond to real needs more quickly. It ensures both intelligent changes that lead to positive transformations and helps avoid costly commitments that don’t answer needs in a cost-effective manner. For the NHS this could mean a more tailored service which values patient engagement and offers opportunities to make savings across stretched resources.

GETTING THE MOST FROM DATA It is understandable that in the NHS, more than any other organisation, the focus will often be on immediate solutions and reactive management. Yet especially now, when spending is being scrutinised, it is critical that valuable funds are not wasted on implementing poorly researched solutions.

Decisions are increasingly reliant on insight.

The quality of data and the insight gained from it will be critical to the supply chain.

Research that doesn’t complement an organisation’s goals and isn’t focused on outcomes will lead to changes being implemented on a lack of evidence – changes that could cost far more to rectify than research outlay.

However, healthcare researchers in particular face a challenge. Patients often don’t want to divulge information about their health status and vulnerable patients must be protected. Regulations surrounding patient data often stop researchers from obtaining the information that they want. Meanwhile hard-to-reach groups – those who are not heard and those that do not want to be heard – can prevent a complete picture from forming, and leave further knowledge gaps.

These should not be seen as barriers to successful research, but as catalysts for innovative research methods that produce equally valuable results. Insight can be obtained in a number of ways. Whilst ‘big data’ may be the most talked about method of the moment, it’s not always necessary or worth the expense, and it can be difficult to apply its findings on a personal level. Data can be unreliable, and is always contextual. It is good at the ‘what’ and ‘how’ but not very good at the all-important ‘why’. The beauty of tailored research is that it’s flexible and adaptable to specific needs, such as circumventing language barriers for non-English speaking patients, and in this manner can bring the public closer to the resulting decisions.

RESEARCH METHODS Focusing on a streamlined method and explicit goals is of mutual benefit to both research providers and commissioners. Such research might reveal unexpected results and change the course of action, or it could confirm an intuitive response – what is most important is that it provides evidence that guides confident, positive change based on real responses.

Across the healthcare sector it is vital that those commissioning research are aware of the variety of methods available. It is important to choose a supplier who will prescribe the best-fitting research approach – one that complements the research aims and can take into account methodological restrictions. For example, a quantitative approach could work on a larger scale with issues that are less sensitive, giving a broader insight, whereas qualitative

ANALYSING RESEARCH The analysis that follows research is just as important as the methodology used to obtain it. Qualified professionals can ascertain more than just the facts from research.

Understanding the ‘why’ and not just the ‘what’ drives better communication between the public and the healthcare provider, and enables professionals to understand the impact of a treatment on a personal level.

The positive value of placebo is recognised, but it does depend on confidence which is an emotional state based on trust. By defining what a person values in their care it is possible to prioritise resources and save elsewhere.

Research conducted in this sector must be fit for purpose not only methodologically but from legal and ethical standpoints too.

The Market Research Society (MRS) Code of Conduct is set out with this in mind. It is regularly updated to cover the inception, design, execution and use of good research, and following these regulations preserves standards while promoting confidence in data.

Proven methodologies and legal and ethical frameworks should underpin all professional research and will ensure best results while protecting providers, buyers and respondents.

Written by Jane Frost, Market Research Society

FINDING MEDICAL SOLUTIONS FROM PATIENT RESEARCH

research works well with matters that are more personal, such as patient engagement, and can bring about more detailed results.

Market Research

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

CARE.DATA The NHS’s data sharing scheme Care.data could be an invaluable resource; using information about actual patient care will enable improvements to treatments and allow the organisation to better gauge performance. However, it must take very careful steps to ensure that the data is not misused. A Global Research Business Network study from February showed that 76 per cent of people considered their health records to be sensitive data – this should be a priority consideration for the NHS as it moves to implement the scheme later this year.

The responsibility for gaining public trust lies with the organisation, and concern regarding the safety of personal information could be reined in if certain data protection strategies are put in place. The Fair Data trust mark, launched by MRS last year, sets out 10 core principles on the fair collection and use of data.

By committing to these, the NHS would go a long way to restoring trust in its approaches to research and data handling and open the door to wider research participation. L FURTHER INFORMATION www.mrs.org.uk

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system. By doing this, people could potentially be saving someone’s life or helping to find a new treatment for a rare disease.

Dr John Parkinson, director of the Clinical Practice Research Datalink, examines the potential benefits that utilising health data would have for patients, the economy, and public health The economy is rarely out of the headlines and when healthcare is mentioned by financial journalists, it’s usually a negative story about a hospital services being reduced due to financial pressures or a criticism of a lack of investment in the NHS. What is rarely talked about in the news is the potential for health research to attract investment into the UK which in turn can create jobs and improve the economy.

At the end of March 2012, the government launched the Clinical Practice Research Datalink (CPRD) – an e-health secure research service – that aims to improve public health, develop new treatments for patients faster and attract investment in the UK’s life sciences sector and economy.

A UNIQUE DATA SET The CPRD is a key part of the government’s economic plan for growth is the service set up to enable health researchers to access anonymised person level NHS data and linked NHS data such as GP and hospital records. Access to the anonymised data is only granted to approved researchers for approved research projects.

The NHS is a unique health system that, unlike most other countries in the world, has a rich source of information about millions of patients with important health information spanning many years. This NHS information is attractive to health researchers who work for universities in the UK and abroad and international pharmaceutical companies who are developing new medicines and medical devices for patients across the world.

Approved studies using anonymised information from the CPRD service are already being funded by commercial companies that are based overseas. This will see income coming into the UK rather

than all health research being funded from government/public money. And potentially, overseas investment will help to improve the economy and may lead to the creation of more jobs in the UK. CPRD information has so far helped to produce published health research papers on over 1,000 research studies including: the investigation of childhood cancers; preventing thromboembolic events (blood clots etc) in the elderly; understanding the causes of pain and depression; and identifying genetic risk factors for serious adverse drug reactions.

HEALTH BENEFITS The use of people’s GP and hospital medical records for health research may help to attract investment in the economy but clearly it must benefit people’s health too.

Recent media coverage of the debate about why people should share their medical records has reinforced people’s concerns and confusion about why their personal information is being extracted and who is having access to it.

People can object to their medical records being used by the CPRD by speaking to their doctor. While I understand some people’s view that they may want to do this, I want to explain why I feel it is important people don’t object.

So that we reach all our goals of successfully fighting disease and preventing illness in family and friends we really need every person to share their medical records and every GP to allow their practice to join the

Written by Dr John Parkinson, CPRD

CONNECTED DATA FOR IMPROVED HEALTHCARE

SAFETY INFORMATION In addition to health research, anonymised medical records give a valuable insight that helps the NHS to assess if clinical care guidelines are appropriate and that the right treatment is used at the right time in the right patient. For example, through the extraction of people’s GP and hospital medical records, health researchers can study the benefits and side effects that may occur in the use of treatments used in the elderly. For instance, this will include patients who have a range of other diseases, may be on other medications and may not actually take every dose of every drug.

This real world safety information is crucial to providing safe, high quality healthcare for people and this data shines a key light on medicines used during pregnancy, in children and importantly about vaccine use and medical devices, like pacemakers.

Research by international pharmaceutical companies and international academia should be seen in a positive light. Researchers from pharmaceutical companies are the people who can deliver much needed new medicines.

Once a drug is on the market, the safety and effectiveness need to be monitored. The data also has a large part to play in getting new improved treatments into the NHS for both common and rare diseases. Information from medical records can make an invaluable contribution to clinical trials. Powerful efficient clinical trials means there is the chance to enable the treatment to be available sooner.

Medical Research

OPEN DATA

CONFIDENTIALITY The vast majority of health research takes place using anonymised medical records that are only released to approved health researchers under very strict obligations covered by legal agreement. The confidentiality of health data used outside of clinical records is overseen by a range of independent committees and ensures that the data stewardship approach is of the highest level. In over 20 years working in this area I am unaware of any privacy issue with research use of medical records.

Using people’s medical records for health research requires very little time of GPs and other healthcare professionals. If you see health research like the ultimate jigsaw, it may be that you are struggling to find that missing piece of the puzzle. If people object, the picture may not be complete. L

The a NHS is alth he unique at unlike th system er countries h most otich source of r has a ation about inform s spanning patient y years man

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Refurbishment

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Etac launches its new Relax shower seat at Naidex 2014 Etac develops products and services that help enhance the lives of people with disabilities and their carers. Scandinavian design and innovation are the company’s foundation and with over forty years of experience, Etac offers a wide range of solutions including Molift hoists and slings, Etac manual transfer products, Etac daily living, Etac toileting and bathing as well as Etac manual and powered wheelchairs.

The company’s products are developed in close co-operation with consumers and industrial designers, resulting in an ergonomic design and high quality that is unique in the market. Etac’s products are designed to be the best in terms of quality, simplicity, function, reliability and comfort to ensure the well-being of the user and care giver.

Etac launched its new ‘Relax’ shower seat at Naidex in April. Etac Relax is a smart, elegant shower seat that is perfect when space is limited as it folds flat to the wall.

Relax can be tailored to suit the users needs and comes in twelve variations.

The Etac Relax shower seat has been developed with care and consideration for every little detail, in order to make the users shower experience more enjoyable.

Scandinavian minimalistic design provides maximum comfort and a more stylish

bathroom. Relax comes in two colours – white and lagoon green and is easy to fit in any shower area. It requires only three mounting attachments.

The Relax shower seat can easily be adapted to suit the user’s needs with several comfortable accessories, such as back support, foldable arm supports and supporting legs which can be easily added or removed.

Relax offers a large seating area, even though the external dimensions are compact. It extends only 8cm when folded and looks great raised or lowered.

The seat’s soft ergonomic design and heat reflective back support ensure comfort for the user. The soft non-slip arm supports are designed to provide the best possible grip when needed. ”I’m very proud to present our new shower seat. The design is sleek and soft, at the same time as Etac Relax provides security, so I’m confident that it will be appreciated by many”, says Morgan Ferm, industrial designer who has been involved in product development.

FURTHER INFORMATION Tel: 0121 561 2222 enquiries@etac.uk.r82.com www.etac.com/etac-uk

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HEALTH BUSINESS MAGAZINE | Volume 14.3

RECENT PROJECTS

RENOVATING THE NHS FROM THE GROUND UP

NHS estate managers have been criticised for failing to bring ageing properties up to date. Health Business looks at the issues facing hospitals and highlights some successful projects According to a recent report from the King’s Fund looking at how NHS estates might be used more effectively, “The NHS has many under-utilised properties, and a significant amount of its estate is in poor condition or not fit for its current purpose.”

This poses unique challenges for hospital and estate managers, who are required to fulfil a range of obligations including improving building quality, keeping buildings safe, warm and clean, and ensuring that the estate portfolio is used effectively, all while trying to keep down costs.

The report by Nigel Edwards, called NHS Buildings: Obstacle or Opportunity? argues that NHS buildings are not being used to their

full potential, and that front line services could suffer as a result. In light of this, we take a look at refurbishment projects, some recently completed and others still under way, that show how investment in the NHS estates portfolio can deliver greater comfort to patient and improved clinical outcomes.

REPORT The King’s Fund report issued in July 2013 outlines some of the key issues in this area, for example the problem of facilities that are out of date: “The

Refurbishment

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rapid pace of change in medicine means that it is very difficult to future-proof large‑scale investments and, once built, there are very few mechanisms for these assets to be changed. Many hospitals are still planned in ways that perpetuate practices that may be inefficient or out of date.”

Edwards writes that the NHS has also been criticised for lacking a clear management vision when it comes to its estate, resulting in space being wasted and certain facilities underused. The King’s Fund report says: “A significant amount of the NHS estate houses back-office functions and services that could be provided in much lower cost buildings. High-cost buildings and equipment are, in general, substantially underused.”

COMBINING SERVICES Edwards’ report calls for NHS managers to be more ambitious in using health buildings to integrate disparate care models: “The objective of any change needs to be to support and encourage new or improved models of delivery that bring healthcare, social care, housing, private sector provision of long-term care and other related services together in a more integrated way and create more value for the wider community.”

The report points to the E

Carb reducti on an incre on is importa asingly as the fi nt goal benefit nancial efficiens of carbon cy understbecome ood

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RECENT PROJECTS

“The NHS has many under-utilised properties, and a significant amount of its estate is in poor condition or not fit for its current purpose” Nigel Edwards, the King’s Fund  improved Townlands Community Hospital in Henley-on-Thames as an example of a successful project. This involved the original site being split into three sections. The first section, the site of the original hospital, was sold freehold, with listed buildings refurbished. The second was sold on a long lease to Order of St John to build an Alzheimer’s care home. Proceeds from these two sales helped to fund the building and maintenance of a new community hospital.

BARNSLEY HOSPITAL Barnsley Hospital reopened in January of this year following a £1.7 million refurbishment project that included the demolition and reconfiguration of the 500‑bed South Yorkshire hospital’s Emergency Observation and Resuscitation wards. A competitive tender process sought to identify a health service refurbishment team who could demonstrate expertise in working in live clinical environments.

The successful team, Styles&Wood, worked alongside the Barnsley Hospital NHS Foundation Trust’s estates department to

plan an appropriate schedule for works to take place while other wards were open and operational. This included implementing a specialist infection control system to ensure work areas were fully segregated, preventing the spread of dust and debris across the site.

CHESTERFIELD ROYAL HOSPITAL Last summer saw the completion of a £1.2 million refurbishment project at Chesterfield Royal Hospital in Derbyshire, also carried out

by Styles&Wood. The 21-week project involved the complete strip-out and remodelling of the hospital’s Women’s Health Unit and Trinity Ward, to bring its gynaecology services together in a modern high quality facility.

Linda Gustard, head of midwifery and senior matron for gynaecology at Chesterfield Royal Hospital, said: “We’re absolutely delighted with the way the two wards look and, in particular, how it will improve the privacy and dignity of the WHU patients by bringing all gynaecology outpatient clinics into one place. The WHU has three clinic rooms where we’ll see patients who previously came to outpatient suite one,

Refurbishment

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we also have a completely separate area and waiting room for the women coming to our early pregnancy assessment unit along with other separate areas for outpatient procedures and day case surgery and completely private areas for changing.

“Our gynaecology patients will notice a big difference as will anybody returning to Trinity Ward. We’ve incorporated the same styles, furnishings and relaxing artwork that you will have seen in our birth centre. It will allow for a much smoother transition from the birth centre to the maternity ward, and additional features there include a milk preparation room and parent’s rest room.

The feedback we’ve had from our patients has been overwhelmingly positive.”

ENERGY Carbon reduction is an increasingly important goal in hospital refurbishment, as the financial benefits of carbon efficiency become better understood.

A recently completed project overseen

by GVA Grimsley in Haslemere Hospital, Surrey saw the 1920s building refitted with a new roof and windows, resulting in significantly improved insulation.

The roof was made using foam board and TLX Gold, a combined multi-foil insulation and breather membrane. The insulation material was chosen for clinical reasons as well as efficiency – it was found to be the most breathable of the multi-foil products on offer, eliminating the risk of condensation, which can contribute to infection outbreaks.

Gordon Day, estates project manager at NHS Surrey, said that the new design “will prolong the life of the building and help NHS Surrey to deliver on its carbon reduction targets.

“The design has taken into account the age of the building and has been sympathetic in the materials used. For example, the new fire escapes have enabled us to utilise the second floor, which had been unoccupied for several years, and the new insulation will reduce our running costs.”

IN THE PIPELINE The refurbishment case studies presented here show what can be done to provide safer, more modernised services, even in hospitals originally built over a century ago. Similar schemes have been announced recently – for example, NHS Property Services has said it is carrying out feasibility studies for the repurposing of the derelict Marie Foster nursing home in north London.

The Royal Sussex Hospital in Brighton, which has some of the oldest buildings currently being used by the NHS, is also to receive a major redevelopment. £420 million is to be spent demolishing several buildings on the site and replacing them with modern facilities. L FURTHER INFORMATION Read the King’s Fund report in full at tinyurl.com/mtgtr7x

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HEALTH BUSINESS MAGAZINE | Volume 14.3

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MODULAR BUILDINGS

AN ALTERNATIVE BUILDING METHOD Offsite construction has become a buzz word in the building industry, but it is not new to modular building sector. The industry has been manufacturing buildings offsite for in excess of 75 years. Modern factories now produce hi-tech buildings and delivery dates are met with no delays due to weather conditions.

Today’s modular buildings need not look like’ boxes’ or the old image of ‘site huts ‘without any character. In fact, the industry has reached a point where it is difficult to tell them apart from traditional developments. These buildings can be designed to meet both needs and budgets restraints that are all too important today.

For the health sector, often in urgent need of additional hospital space but without causing disruption to its services, the modular approach to building can offer a fast and cost effective solution.

When looking at either replacing, extending or adding to existing structures, modular buildings is flexible enough to meet all applications specified by the client.

Layout and design services are available from suppliers including expert advice on planning issues, building regulations and safety requirements.

Fast installation with minimum disruption can be achieved, as transport, site work, and commissioning can be part of a turnkey package by using just one company.

BUILDINGS THAT COMPLY The new building regulations that came into force from April 2014 has given the modular industry a further opportunity to prove its ability to meet the challenges presented with energy efficiency. Both traditional and modular buildings now and for the future need to be more energy efficient. Modular constructions built in a controlled factory environment can already demonstrate more energy efficiency.

From 2020, buildings will be required to be zero carbon to meet European Legislation. This year the new regulations continue to go part way towards that target and more will be expected by 2016.

All too often when discussing these subjects, end users are given the impression that it is a complicated issue. In actual fact buildings that can be provided by the modular building industry will be able to tick all the boxes.

The industry sector is fully aware of what

Five-storey wards and theatres at Kings College Hospital in London were constructed using Elliott’s ibespoke steel frame modular system

they need to do to comply and in many cases is ahead of what is expected.

A GOOD ALTERNATIVE Modular buildings are still a very good alternative if budget restraints are an issue; there is the option to hire buildings or purchase refurbished buildings, which is an area that many are not familiar with.

Buildings that are readily available for hire or reused buildings available for purchase that were built prior to 2014 will still meet the specified requirements within the new regulations. These buildings can be provided with the required documents to prove ‘Energy Efficiency Compliance (EPC) and regulations.

We would recommend when looking for new buildings, adding to existing buildings, buying refurbished or hiring, to choose a supplier that will complete each project precisely on programme and meet the deadline for completion on time needs to be high on the agenda. What’s more, a vast majority of work can be undertaken off site. Companies familiar with this type of contracts are well aware that buildings have to be completed with minimum disruption to existing operational facilities.

SIMPLE STEPS TO TAKE If you are looking for a building make sure that you talk to industry direct.

This will without doubt save money.

Ask the company to provide a turnkey package, as this reduces the number of

RADIOLOGY ON A ROOF-TOP Bradford Royal Infirmary turned to the modular building industry when it needed a new radiology facility on a short timescale and in a tight location on top of an existing building.

A weekend delivery avoided disturbing other departments, while the modular construction meant there was less noise and disruption than with a wholly traditional build.

Actiform’s managing director, Stefan Dransfield, said: “The fact that we are a bespoke manufacturer, coupled with the flexibility of the Actiform system enabled us to meet the requirements of such a tight site and the irregular shape of the footprint. Such a solution would not have been achieved with typical modular accommodation.”

Meanwhile, Papworth Hospital in Cambridgeshire used a modular extension to an existing traditionally built building to provide a new private 12 bed surgical ward.

It was a rather complex two storey building with storage and access on the ground floor and ward accommodation to the top floor. The complexity came with the two portal frames, one of which spans 10 new car parking spaces and the level of land creating the requirement for two different sizes of ground floor module.

(Text Provided by The Actiform Group).

Written by Jackie Maginnis, Modular and Portable Building Association (MPBA)

Many hospitals are turning to the modular building industry for a fast and cost effective way of gaining much needed hospital space, reports Jackie Maginnis from the MPBA

people that you have to deal with. Make sure you have a clear idea of your requirements. If in doubt take advice from the industry before expensive plans are drawn as fancy buildings can be costly.

Look at healthcare buildings that have been built in modular and used for the same purpose. Talk to colleagues at other locations that are familiar with the systems.

If in doubt, talk to the industry association, an association that understands the industry and will give free impartial advice.

Design & Build

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KINGS COLLEGE HOSPITAL Five-storey modular wards and theatres at the country’s leading Hepatology (liver transplant) centre were constructed utilising Elliott’s innovative new bespoke steel frame modular system.

The scheme was funded through a SSAP21 compliant Operating Lease arranged through an NHS Leasing Framework specialist to ensure compliance with the strict accounting rules.

The building was completed in less than 12 months ensuring that critical operational dates were met and that disruption to the hospital was kept to a minimum.

The project was challenging logistically as the site is almost completely enclosed with minimal space for contractor’s site set up.

The design ensured that the new facility links to the hospital street and fits closely to the outline of the adjacent Nightingale Wards. (Text provided by Elliott Group). L FURTHER INFORMATION www.mpba.biz

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‑ENERGY

SIX ENERGY-SAVING WAYS TO MODERNISE HOSPITAL STEAM SYSTEMS

There are many opportunities to upgrade your existing steam systems to raise energy efficiency, lower overall running costs and reduce risk. The added incentive of the Green Investment Bank’s NHS Energy Efficiency Financing Programme is making such modernisation even more compelling

The impetus to modernise hospital steam systems has been given a powerful stimulus by the April 2014 launch of the UK Green Investment Bank’s NHS Energy Efficiency Financing Programme. Many steam system upgrades deliver short payback periods by cutting fuel bills; now the new funding support is likely to make such energy-saving measures viable within existing budgets.

“Existing steam plant in many hospitals is open to modernisation to reduce energy consumption and bring other ways to cut operating costs, for example through less maintenance,” says Sheldon Banks, director, UK & ROI Sales, Spirax Sarco.

“Every day our engineers see examples of systems in hospitals that could benefit by applying innovative technology to bring substantial cost savings, as well as reducing risk by aiding compliance.”

So what are the key measures that can be applied to cut energy consumption in hospital steam systems?

START POINT: STEAM SYSTEM ENERGY AUDIT One of the first steps is to implement a steam system energy audit tailored to the installation and the available budget. An audit can include the complete steam distribution loop, starting with pre-treatment plant,

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right through to heating and sterilisation applications and condensate return.

The audit can be used to analyse the entire system and its operation, and can focus on energy efficiency, health and safety or operational best practice. Following the on-site survey work, a detailed and comprehensive report will be available together with recommendations for upgrades.

RAPID PAYBACK STEAM TRAP SURVEYS A steam trap survey will help to keep a system running smoothly and will almost certainly reveal impressive savings through reduced fuel and water consumption. An analysis of 50 steam trap surveys conducted

by Spirax Sarco revealed an average potential annual energy saving of £28,400 per survey. The average payback time, including the cost of replacement products and their installation, is about two months.

A survey will provide an asset list of all steam traps in the system, inspect their installation and suitability and apply ultrasonic and temperature testing to each one. An evaluation report is written, detailing a recommended plan of work and equipment specification for replacing inappropriate and failed components, correcting faulty installation and adding new equipment to improve the system’s

performance. The proposal will include full costings, scope and schedule of work and, importantly, payback calculations.

Hot water for space heating and domestic duties such as hand washing and cleaning is a major contributor to the overall energy bill in hospitals. Yet many facilities still rely on outmoded technology to deliver their hot water. Traditional systems use steam to heat the cold make-up water in large shell-and-tube calorifiers, which either store the water in the body of the vessel or in additional hot water storage tanks. Storing hot water is inherently inefficient because it’s losing heat all the time.

A more modern solution, such as Spirax Sarco’s EasiHeat™, uses steam to heat hot water on demand via a compact, plate heat exchanger. As the external surface area of the system is much smaller and the water is not left in storage, such systems typically save up to 20 per cent of energy when compared with shell and tube calorifiers.

Many sites throughout the NHS estate are already reaping the benefits of the technology.

For example, St George’s Hospital in Tooting is saving £45,000 per year by an upgrade to one of its plant rooms. Five EasiHeat systems now serve the Lanesborough wing of the 1,000-bed hospital. Three provide heating and two deliver domestic hot water in a duty/ standby arrangement. Heating was previously provided by three shell-and-tube calorifiers, while four more calorifiers provided hot water.

The subsequent savings are a combination of improved energy efficiency and reduced maintenance. As pressure vessels, calorifiers need to be stripped down regularly for insurance inspections, every two years in the case of St George’s. EasiHeats are generally exempt from insurance inspections.

MODERN TECHNOLOGY Returning condensate, which typically contains around a quarter of the useful energy in the original steam, to the boiler feedtank can save thousands of pounds per year in energy alone. Using condensate to heat the feedwater means less fuel is needed to produce steam in the boiler. Every 6°C rise in feedwater temperature equates approximately to a

1 per cent fuel saving. However, there is a limit to the amount of heat from recovered condensate that can be fed into the feedtank because if the feedwater is hotter than 85°C to 90°C, cavitation in the boiler feedpump can occur. This can quickly damage the pump.

If the amount of heat available from the condensate recovery system exceeds this, as sometimes happens when a laundry is present on site, energy is often wasted.

A valuable upgrade to overcome this restriction is to implement a pressurised low loss condensate recovery system which allows virtually all the energy from both the condensate and any flash steam it produces to be used.

Just such a system was implemented

by Leighton Hospital in Crewe. The Spirax Sarco skid-mounted system is fitted on the condensate return from the hospital laundry. Around 1,500 kg/h of condensate heads back to the boiler house from the laundry, but an estimated 14 per cent of this was previously vented to atmosphere as flash steam.

The new energy recovery system retains all this useful energy within the system and uses the flash steam to pre-heat the feedwater for the laundry boiler. The feedwater used to pass directly from the feedtank to the boiler at around 80°C. The flash steam now heats it under pressure to between 120°C and

140°C, a rise of over 50°C. This upgrade cut the hospital’s fuel bills by over £10,000.

PREVENTATIVE MAINTENANCE TO STAY AT PEAK EFFICIENCY Having invested in modernisation and installed equipment, it’s important to maintain a plant’s full energy-saving potential through regular, preventative maintenance. Unfortunately many teams can find it hard to apply the necessary time and resources for regular maintenance programmes. They also sometimes lack the skills needed to service specialised plant. Maintenance training by Spirax Sarco can help to meet the skills challenge.

Additionally, a Spirax Sarco Service Agreement implements preventative maintenance as well as covering faults, inefficiencies and breakdowns. Typically lasting from one to five years, a Service Agreement can include unplanned service call-out days. Also available is a 24 hour priority response option to support hospitals needing to provide uninterrupted services.

As well as maintaining energy efficiency, a Service Agreement helps with health and safety compliance by ensuring plant and equipment is operating safely and is inspected and maintained according to any legislative requirements. Furthermore, maintenance costs become easier to budget, which improves planning and forecasting,

as well as minimising the need to order and hold spares stocks on site. Productivity also improves because well-maintained systems are more reliable, reducing plant downtime.

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TRAINING FOR ENERGY EFFICIENCY AND COMPLIANCE Achieving the highest energy efficiency also requires hospital engineers to stay current with the latest steam system technologies and the latest best practices for operating plant. Training is the key here. As well as ensuring systems are run safely, training engages staff and shows the organisation is willing to invest in its personnel.

The BG01 ‘Guidance on Safe Operation of Boilers’, published in late 2011, recommends boiler operators and managers complete a Boiler Operation Accreditation Scheme (BOAS) course to promote safe and competent boiler operations. There has been a significant uptake for the BOAS course, with the certificate lasting for five years. After this period a re‑assessment examination needs to be taken to retain accreditation. Engineers coming up to their five-year BOAS anniversary can stay compliant with BG01 by attending a two‑day Spirax Sarco BOAS Renewal course. L FURTHER INFORMATION Tel: 01242 521361 ukenquiries@spiraxsarco.com www.SpiraxSarco.com/uk

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If it’s outside your business focus, it’s core to ours.

Energy Services

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Energy-saving projects can include biomass boilers

FINANCE

Identifying measures that optimise carbon and financial savings in the complex NHS environment often requires specialist support, and the government-backed Green Investment Bank is well placed to provide that help, writes Gregor Paterson-Jones In an organisation as complex and energy intensive as the NHS, it is no surprise that energy costs are high and that a significant amount of energy is being wasted.

The NHS spends more than £750 million on energy each year. Hospitals run a 24-hour a day, 365 days a year service, often in old facilities that are ill-suited to modern health care needs.

Reducing that waste, and realising valuable carbon and cost savings, is, rightly, a significant strategic priority in all parts of the NHS across the UK. Of course, it is easier said than done.

However, the UK Government backed Green Investment Bank (GIB) can help. We estimate that energy efficiency measures could cut the NHS bill by up to 20 per cent, saving £150 million a year. To realise these opportunities, a fundamental change in mindset is required, certainly in terms of how new technology is deployed and how it is financed.

INFRASTRUCTURE OVERHAUL GIB can help modernise energy infrastructure within the NHS estate and the significant overall savings will come from reduced energy demand, protection against rising energy prices and lower maintenance costs.

Reducing carbon intensity creates a significant and obvious financial opportunity.

The NHS sustainable development unit suggests annual saving can be increased by £180 million through further energy efficiency and low carbon technology upgrades, staff engagement and better procurement.

However, identifying measures that

optimise carbon and financial savings often requires specialist support and GIB is well placed to provide that help. Created by the UK Government and capitalised with £3.8 billion of public money, our mission is to help the UK transition to a greener economy by supporting projects that are both

have some very positive case studies showing what’s possible. Projects can include combined heat and power plants, boilers, building retrofits, lighting and energy reduction technologies for production processes.

Funding examples include the UK’s largest health sector energy efficiency project – the energy innovation centre with Cambridge University Hospitals NHS Foundation Trust.

Serving Addenbrooke’s and Rosie hospitals, the £36 million funding package put together

by GIB and Aviva Investors is a 25-year deal. Housing a combined heat and power

Written by Gregor Paterson-Jones, UK Green Investment Bank

A MODERN ENERGY INFRASTRUCTURE FOR THE NHS

Energy

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Created by the UK Government and capitalised with £3.8 billion of public money, the Green Investment Bank’s mission is to help the UK transition to a greener economy by supporting projects that are both green and commercial green and commercial. One of GIB’s priority areas for investment is public sector energy efficiency, especially in the NHS where we have established a track record of activity and have developed an innovative offering.

EFFICIENT HOSPITALS The GIB Health Sector Energy Efficiency Programme allows us to use the full spectrum of financing across debt and equity with the ability to fund long-term projects. We have a dedicated team of energy efficiency project and finance experts established to work with private and public sector organisations and co-investors.

The time is right. Energy efficiency technology is mature and well-proven and we

unit, biomass boiler, dual fuel boilers and heat recovery from medical incineration, the centre will reduce costs by £6 million a year.

The combined heat and power technology (CHP) has been shown to be effective in terms of carbon reduction and financial savings. In simple terms, it is an engine that generates electricity with heat from the exhaust gases being recovered and used to supplement a local heating system. Reducing the carbon footprint, it also reduces reliance on electricity from the national grid. By producing electricity at the NHS facility, there is also the potential to export excess electricity back to the grid and benefit from the feed-in tariff.

The opportunity is significant. According to the Carbon and Energy Fund (CEF), the E

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MapReferrals

Having it all: efficient and effective Having it all: efficient and effective r referral management Map Referrals allowsallows GPs to access Map Referrals GPs tocomprehensive, access comprehensiv evidence‑based local guidance at the point of care, and helps at theachieve pointtheir of care, helps CCGs achieve their q CCGs quality and and productivity targets.

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Map Referrals optimises Map of Medicine’s existing

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of delivering and managing care to develop a tool that enables efficient and effective referral management for both GPs and Commissioners. Map Referrals:

To out more to care book a demonstration 1. find Helps clinicians deliveryor quality by providing local best

practice information at the point of care please contact richard@mapofmedicine.com or call 0207 492 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.

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FINANCE and audits. The health entity would then identify outline investment opportunities and potential carbon savings.

referral management ve, evidence-based local guidance quality and productivity targets.

THE BUSINESS CASE The next step involves setting out the business case, considering a ‘spend to save’ option and commencing with initial funding opportunities, before moving to the market for procurement options. Existing frameworks or a new OJEU process can be used.

Procurement framework consultants can advise the financing solution that best works with the set of measures required. Once a detailed energy efficiency solution, evaluation and selection of a delivery partners occurred, various financing options can be investigated.

Following on from the Addenbroke NHS development, we created the Aviva ReALM Energy Centre Fund. This is the third energy efficiency fund to be supported by GIB, after SDCL and Equitix were established earlier in 2013.

The Aviva ReALM Fund is not the only funding solution GIB has developed for the NHS. We have partnered with Societe Generale Asset Finance to provide £50 million of asset financing for contractors to EE projects in the NHS.

as worked with those on the front-line of aging care to develop a tool that enables ve referral management for both GPs and ap Referrals:

s delivery quality care by providing local best ation at the point of care

essly with the GP workflow and provides eferral forms that auto-populate with patient

introduction of CHP within NHSexpert England deployment Finally, Ecovate is a rough  Map of Medicine’s could save more than 232,000 tonnes of strategic partnership with and nearlya £50CCG. million a year. The King’s College Hospital uptakeCO2across

n,

take-up of CHP is growing and there are various ways to access funds to reduce energy bills and consumption in the NHS. The CEF is the most widely used framework assisting the NHS across the UK to meet its energy efficiency and carbon reduction goals. CEF simplifies the procurement process by bringing together the specialist expertise in the NHS and by consolidating the procurement of advisors and contractors.

PROCUREMENT FRAMEWORKS

2 6300 The London RE:FIT framework is now

available to all public sector organisations in the UK. Using a mini competition process, an NHS organisation would select one of 13 pre-qualified Energy Service Companies (ESCOs) for the design and implementation of energy conservation measures.

Another option is Essentia, created in 2012

by Guy’s and St Thomas’ NHS Foundation Trust bringing together professionals experienced in procuring healthcare infrastructure.

Essentia is in the process of establishing a framework agreement to provide a model for implementing energy efficiency and local energy generation measures into public sector estates.

Energy

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

DELIVERING SAVINGS The recently announced energy efficiency refurbishment of Rampton Hospital was concluded by Societe Generale Asset Financing and corresponded with the announcement of our partnership.

The funding will be used to build a new CHP plant, biomass and dual fuel boilers, an effluent treatment plant and various upgrades to its control systems.

The specialist energy efficiency fund manager, SDCL, recently announced a low carbon combined cooling, heating and power solution for St Bartholomew’s Hospital delivered under its ‘Powering Health’ partnership with GE, Clarke Energy and the NHS Confederation.

Another first, it is a fully financed private finance initiative to fund a low carbon combined chilling/heating and power (CCHP) solution delivered by Skanska.

These are all tangible examples of what can be achieved. Large or small, energy efficiency investments will deliver savings.

Last year, a pilot project encouraging staff to turn off lights at Bart’s Health NHS Trust in London saved £100,000. Saving energy is no longer solely an environmental issue; it makes perfect commercial sense. L

Last year, a ct oje pilot pr ng staff gi encoura ff lights at o to turn Health NHS Bart’s n London Trust i ved sa 0 £100,00

NHS Foundation Trust (KCH) to help other public sector organisations realise significant financial and carbon benefits.

At GIB, we know there is a funding gap and we are actively working with private finance partner providers to create solutions. We accept there is no ‘one size fits all’ financing option for NHS energy efficiency projects.

Each of our finance options is based on consistent principles: spend to save; attractive rates; taking a long-term approach; and flexibility. Our business model for the NHS is established and our products and finance partners include Aviva ReALM Energy Centre Fund, Societe Generale Equipment Finance alliance and our GIB Energy Efficiency Funds: SDCL and Equitix.

From feasibility through to installation, the process can be completed in as little as twenty months. Payments don’t start until the plant has been proved to be working in accordance with contract specifications.

Although every project is different, a typical NHS energy efficiency project will begin with information gathering, survey

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Volume 14.3 | HEALTH BUSINESS MAGAZINE

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WASTE DISPOSAL

Alex Mirkovic looks at ways that healthcare facilities can control waste costs, whilst keeping their waste management systems practical, environmentally responsible and compliant The management of waste in hospitals and other healthcare facilities is complex, with a wide array of wastes streams, extensive legislation and many practical constraints such as limited space. Unsurprisingly, the NHS spent over £71million on waste disposal in 2007/08 alone, and this figure is believed to have increased by 20 per cent since then. Yet careful management and efficient solutions can ensure that the cost of waste management is minimised. This article looks at ways that healthcare facilities can look at controlling, and even reducing, their waste costs whilst keeping their waste management systems practical, environmentally responsible and compliant.

KNOWING THE WASTES GENERATED Without understanding which types of waste an organisation is producing, in what quantities, where in the premises those wastes are generated and what it is costing, it is extremely difficult to control costs and identify areas for cost savings.

Carrying out a characterisation waste audit will help an organisation understand the nature of their waste. This is likely to change over time, new wastes will be introduced and the quantity of wastes that are generated will vary.

It may be possible to obtain this information from waste contractors’ management information reports but otherwise, a waste analysis will need to be carried out. Recyclables and even general waste can be physically sorted but for health and safety reasons, other wastes such as food, sharps and other clinical waste need to be visually checked.

REVIEWING WASTE SYSTEMS Whilst the management of clinical and hazardous waste requires controlled treatment and disposal, much of the waste generated in healthcare facilities is defined as domestic or general waste, the market for which has changed dramatically over the last few years.

The availability of alternative collection services

and treatment technologies has increased significantly, offering greater scope for landfill diversion. For example, small volume collections of glass were almost of unheard of 15 years ago and of food five years ago, but now they are both commonplace.

With this in mind, and as waste management requirements change over time, a waste management system that has been in place for many years without review is unlikely to be fit for purpose. An effectiveness audit will help an organisation understand whether they have the right bins in the right places, whether the bins are labelled clearly and whether their waste collection service is appropriate for their requirements.

This information helps ensure that waste practices, and the service delivered by waste contractors meet an organisation’s changing requirements, and that they aren’t spending money on bins and services that aren’t required.

Changing an organisation’s waste management methodology, for example the type of storage container used, can achieve far greater impact on cost base than a unit cost reduction.

USING THE CORRECT WASTE STREAMS The cost of disposing of clinical waste is at least five times that of domestic waste yet sandwich wrappers, leftover food and crisp packets are regularly found in clinical waste bins. Ensuring that only clinical waste goes in these bins is critical to controlling costs and can have the biggest impact on cost reduction. Similarly, disposing of confidential waste costs much more than recycling. Whilst confidential documents such as patient records and letters, must be protected by confidential shredding, recycling non-confidential documents will save money.

At the same time, recyclables that are unclean and contaminated with non-recyclables (particularly food waste, liquids or dangerously, hazardous and clinical waste) will not be recyclable. In this instance, recyclables may be rejected by a waste contractor (requiring the waste producer to remove the contaminants and those materials they have contaminated) or the waste contractor may send the whole load to landfill or for incineration (depending on the nature of the contaminants). In either case, the higher costs will be borne by the waste producer.

Ensuring the correct waste goes in the correct bin can only be achieved through regular waste analysis and thorough communication, which I come back to later in this article.

ck Feedba be should t staff le given towhat has know ieved; tell h been achat happens them waste when to w es the it leav ing build

MOVING WASTE UP THE HIERARCHY Treating waste in line with the waste hierarchy is now required by legislation but it can also be a significant source of cost saving. Waste prevention in offices can include simple steps such as setting printers to automatically duplex print and more involved steps such as refurbishing office furniture, rather than purchasing new desks and chairs, and leasing, rather than purchasing, equipment. Waste prevention in operational healthcare areas is undoubtedly more difficult but steps can be

Written by Alex Mirkovic, WCRS, on behalf of the British Institute of Facilities Management (BIFM)

A WELL-MANAGED WASTE STREAM

taken in procurement, stock control and product usage. For example, better stock control can reduce the amount of out-of-date products going to waste and improved practices in theatres can prevent whole trays of theatre sets being discarded (for no longer being sterile) where often only one item is used.

Coordinating waste prevention initiatives can be challenging as responsibilities lie across many different areas of the organisation but the cost savings can make the effort very worthwhile. Reuse can also produce cost savings from the reduction in waste. This can include sending items such as unwanted furniture and IT equipment to charities and returning packaging to suppliers.

Facilities Management

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

ALTERNATIVES TO LANDFILL TAX One in every hundred tonnes of domestic waste in the UK is generated by the NHS and much of this goes to landfill. Whilst their figures relate to 2007 and recycling rates have increased significantly since then, landfill remains a major disposal route for the healthcare industry.

On 1 April 2014 the standard rate of landfill tax increased by £8 to £80 per tonne, a cost which is passed on to waste producers. The Chancellor confirmed in the budget that landfill tax will continue to rise from 2015 in line with inflation so these costs are not E

Volume 14.3 | HEALTH BUSINESS MAGAZINE

39

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 going to fall in the foreseeable future. More environmentally responsible forms of treatment are becoming more and more cost effective.

Separating more materials for recycling is a quick and easy way to stop paying Landfill Tax and reduce waste management costs.

This can include recycling more of the same materials as well as recycling different materials.

A waste audit, as I discussed above, will help an organisation to identify where recycling can be increased. Good communication with those generating the waste in the first place is critical to achieving results.

Food is a heavy waste. If this is removed from domestic waste, the weight of what is sent to landfill will reduce significantly. Food waste generated in kitchens or canteens can be sent for composting or anaerobic digestion to make fertiliser that can be used on agricultural land to grow more food. Residual waste (otherwise referred to as general waste), with food removed, can be processed and used to generate energy‑from‑waste. Recovery is the preferred option in the hierarchy above landfill but only once all recyclables have been removed.

CONTAINERS AND COLLECTION As I mentioned earlier, an organisation’s waste management requirements will change over time. An effectiveness audit and a review of the management information provided by waste contractors should help an organisation determine

whether waste containers and collection service are fit for purpose or wasting money. The right containers and collection frequency is a balance that minimises transport costs whilst meeting practical requirements. Overly frequent collections and bins that are too large or too small can both result in unnecessary waste costs.

IMPROVING COMMUNICATION Good communication is vital to successful waste management and controlling of waste costs. Patients, staff, visitors and contractors who are generating the waste, need to know what is required of them and why in order to enable and encourage participation.

Clear signage on, and ideally above, every bin is the first and most important step, particularly as this may be the main way to communicate with patients and visitors. Other initiatives should support this, particularly to ensure staff and contractors are informed and engaged.

Hospitals should communicate to new starters as part of their induction so that they know, from day one, how to use a waste management system correctly and why it’s so important.

There should also be training sessions for staff, explaining the legal and financial implications of their waste management decisions. In-house marketing or internal communications teams can help raise awareness, as they should know how best to communicate messages using an organisation’s established channels. Hospitals

should ensure communications are professional to help them get noticed and give them a sense of importance. All available communication channels should be used, from posters on notice boards and in-house magazines to Intranets, newsletters and other online media. Additionally, open days can remind staff and regular visitors what is required of them, introduce any changes to systems and tell them about successes Feedback should be given to staff and other internal stakeholders to let them know what has been achieved, tell them what happens to waste when it leaves the building and thank them for contributing towards the achievements.

Whilst close management of waste takes considerable resources and the commitment of a wide range of stakeholders, the financial (and environmental) benefits of good waste practices can’t be ignored. Reducing the waste burden on healthcare facilities can help to ensure that ever stretched budgets go on patient care, rather than being spent on avoidable waste. L

Facilities Management

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

Alex Mirkovic is Commercial Director of national recycling and waste management broker, Waste Cost Reduction Services (WCRS), a Corporate Member of the British Institute of Facilities Management (BIFM).

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OSBORNE’S MESSAGE TO FLEETS

The Chancellor’s 2014 Budget revised tax rules for company fleets, with incentives for low emission vehicles playing a bigger role. ACFO chairman Damian James outlines the changes Public sector cutbacks mean that the NHS has been charged by the government with trimming millions of pounds from budgets so that savings generated by improving fleet vehicle efficiency can be redirected towards frontline patient care.

While delivering patient welfare remains the number one priority across the health service, cutting vehicle emissions and therefore an organisation’s carbon footprint has a double benefit – saving money and reducing air pollution which improves the health of the public at large.

Air quality concerns remain uppermost in the thoughts of Government, which is why in Budget 2014 Chancellor of the Exchequer George Osborne is driving fleets down the

‘green’ road at an ever more rapid speed.

All vehicle-related taxes – company car benefit-in-kind tax, Vehicle Excise Duty, capital allowances and the lease rental restriction – are linked to carbon dioxide (CO2) emissions and the Chancellor’s message could not be clearer: choose zero or low emission vehicles or pay the price.

Vehicle manufacturers have already started introducing a wide range of low emission cars and over the coming months and years the choice will progressively widen.

COMPANY CAR TAX While the Chancellor did not tinker with Vehicle Excise Duty, capital allowances or the lease rental restriction in this year’s Budget,

Written by Damian James, chairman, ACFO

he has announced increases in company car tax over the next five financial years to the end of 2018/19.

Taken at face value the increases appear significant, but ACFO continues to believe that company cars represent good value for money notably when compared with paying tax and National Insurance, a tax in all but name, on salary.

Therefore, it could be that demand for salary sacrifice car schemes across the health sector could rise as employers and staff do the maths and discover that by giving up some of their earnings – and choosing the ‘right’ low emission vehicle – company cars really are a valuable benefit.

But let’s first look at what the Chancellor announced in this year’s Budget in relation to company car benefit-in-kind tax.

With Budget rne sbo 2014, Oiving is dr n the ow fleets d’ road at ‘green ver an e id p more rad spee

Fleet Management

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

BENEFIT-IN-KIND TAX Fleets, including those in the health sector, are extending replacement cycles to cut costs and as a consequence of the ever-increasing reliability of today’s vehicles. That is why ACFO has been calling on HM Treasury to announce company car benefit-in-kind tax rates further into the future. Historically we have only known benefit-in-kind tax rates for three years, and occasionally four years, in advance. However, as businesses have retained company cars into a fourth and even a fifth year in some cases, employers and employees have been left in the dark as to what benefit-in-kind tax bills will be in the final year or two of operation.

Budget 2014 changed that with tax rates now known for the next five years, up to and including 2018/19. ACFO hopes that this five-year benefit-in-kind announcement cycle is retained in future Budgets.

Benefit-in-kind tax rates up to the end of the 2016/17 financial year were already known.

Changes already announced mean that: from April 6, 2015 the introduction of two new company car tax bands at 0-50g/km of CO2 and 51-75g/km of carbon dioxide (CO2); and that from April 6, 2016 the removal of the current three per cent tax surcharge on diesel company car thereby treating them the same as petrol-engined models for benefit-in-kind purposes. That means drivers of diesel cars with emissions above 75g/km will actually incur the lowest tax bill rises over the next five years.

In the Budget the Chancellor announced that in 2017/18 and 2018/19 the appropriate percentage of list price subject to tax would increase by two percentage points for cars emitting more than 75g/km of CO2, to a maximum of 37 per cent.

However, the Chancellor has changed his mind in relation to previously announced E

Volume 14.3 | HEALTH BUSINESS MAGAZINE

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BUDGET 2014  increases in rates for the two lowest thresholds – 0-50g/km and 51-75g/km – and altered the differential between those rates and the 76-94g/km threshold.

In Budget 2013, the Chancellor said that the differential between the 0-50 and 51‑75g/km CO2 bands and between the 51-75 and 76-94g/km bands would be three percentage points in 2017/18 reducing to two percentage points in 2018/19. However, in Budget 2014 he said the differential would be four percentage points and three percentage points respectively reducing to two percentage points in 2019/20.

GREEN INCENTIVES By maintaining a higher threshold differential than was previously announced the Chancellor can claim to be incentivising the take-up of ultra low emission low emission cars – defined by the Government as those with emissions of 75g/km and below; but the reality is that in choosing such models drivers will still face major increases in their tax bills over the next few years.

For example, an employee choosing a pure electric Nissan Leaf (0g/km) will have zero per cent tax liability in 2014/15 rising to paying 13 per cent of the model’s P11D value over the next five financial years. Meanwhile, an employee choosing a Toyota Prius Plug-in hybrid (49g/km) will see their tax charge rise from five per cent in 2014/15 to 13 per cent in 2018/19, an eight percentage point increase and more than doubling their tax liability.

Move up a further tax band threshold and the driver of a Lexus CT200 Hybrid (87g/km) will see the tax charged moving from the 11 per cent bracket to the 19 per cent bracket over the next five years. That eight percentage point rise for the Lexus driver is identical to the rise for the employee at the wheel of a Ford Fiesta 1.0 Zetec (99g/km) and for other drivers choosing cars with higher emissions.

However, because the government has chosen to abolish the diesel tax surcharge in 2016/17 the tax “winners” will be employees at the wheel of diesel models. For example an employee choosing a Peugeot 208 1.6 e-HDi (95g/km) will see their tax charge rising from 15 to 20 per cent over the next five years having actually reduced in 2016/17 compared with 2015/16.

Simultaneously, while employees will see their company car benefit-in-kind tax bills rise employers will incur increases in Class 1A National Insurance contributions, which are due on benefits-in-kind.

WHAT FLEETS CAN DELIVER Although there has been much focus on the increased taxation of company cars, especially zero and ultra low emission vehicles, it remains ACFO’s belief that company cars continue to offer value to employees and employers alike.

Not only that, but there remains significant concern among employers across the public, private and voluntary sectors in

respect of employees driving their own cars on business from a occupational road risk management perspective.

It should be remembered that it is easier to manage a company 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.

Managing employees’ privately owned cars can be administratively time-consuming for managers with checks on vehicle documents including insurance, services and MoTs having to be routinely undertaken.

Today, an employee paying basic rate tax choosing a Ford Fiesta 1.0 Zetec three-door (99g/km) will pay £249.58 in benefit-in-kind tax (11 per cent) rising to £508.82 in 2018/19 (19 per cent).

In the five years 2014/15 to 2018/19 that employee’s total company car tax bill will be £2,008.50. It is impossible for that same employee to buy, maintain and insure the same car at a similar cost.

Therefore, while ACFO acknowledges that benefit-in-kind tax rates will rise over the next five years, employees choosing low emission vehicles will pay a lower rate of benefit-in-kind tax than previously envisaged due to the Chancellor delaying the reduction in differentials between the three lowest CO2 tax thresholds for longer.

However, look at the value of a company car another way. The zero emission electric Nissan Leaf costs £25,990 and in 2014/15 is zero per cent rated for benefit-in-kind tax, but that will rise to 13 per cent in 2018/19 when the liability for a basic rate taxpayer will be £676 or 2.6 per cent of the value of the car.

EFFECTIVE MANAGEMENT Car salary sacrifice schemes are proving to be extremely popular in health authorities and it could just be that using this mechanism to analyse a car’s value versus the cost of salary could further boost interest in the solution.

After all the cost for a basic rate taxpayer of choosing salary is 32 per cent – tax (20 per cent) and National Insurance (12 per cent). For higher rate taxpayers the effective tax rate of a company car rises from 2.6 to 5.2 per cent, but their tax and NIC liability increases to 42 per cent.

Undoubtedly what is required by fleet decision makers is the careful management of vehicle choice lists, while keeping a watchful eye on the technology improvements being made by vehicle manufacturers to ensure employee tax bills are kept to a minimum. Taking that course of action will prove rewarding with tax bills under control and an organisation’s carbon footprint reducing. L FURTHER INFORMATION www.acfo.org

Other Budget 2014 announcements impacting on fleets

Fleet Management

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

Fuel September’s planned 1.6p per litre rise in fuel duty was cancelled.

It means that there will be no rise in fuel duty prior to the 2015 general election.

Vehicle Excise Duty From April 1, 2014 VED rates increased in line with RPI. The Government has frozen VED rates for Euro4 and Euro5 light goods vehicles in 2014/15.

Car fuel benefit charge 2014/15 The fuel benefit charge multiplier for company cars increased from £21,100 in 2013/14 to £21,700 in 2014/15.

Van benefit charge 2014/15 The van benefit-in-kind tax charge increased from £3,000 in 2013/14 to £3,090 in 2014/15.

Van benefit charge on zero‑emission vans – for five years until the end of 2014/15 zero‑emission vans are exempt from benefit‑in‑kind tax.

However, from 2015/16 the charge paid by zero‑emission vans will be 20 per cent of the rate paid by conventionally fuelled vans, followed by 40per cent in 2016/17, 60 per cent in 2017/18, 80 per cent in 2018/19 and 90 per cent in 2019/ 20, with the rates equalised in 2020/21.

The Government says it will review van benefit charge support for zero‑emission vans in light of market developments at Budget 2016.

Van fuel benefit charge 2014/15 From April 6, 2014 the van fuel benefit charge multiplier increased from £564 to £581.

Enhanced Capital Allowances For zero-emission goods vehicles have been extended to April 2018. However, to comply with European Union state aid rules the availability of the allowance is limited to organisations that do not claim the Government’s Plug-in Van Grant.

Road repairs The Chancellor announced a £200 million “potholes challenge fund”. Billed as “emergency funding”, local authorities will be able to bid for the cash to repair up to 3.2 million potholes following the winter’s severe weather.

Volume 14.3 | HEALTH BUSINESS MAGAZINE

45

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46

HEALTH BUSINESS MAGAZINE | Volume 14.3

FACILITIES MANAGEMENT

A BETTER PARKING EXPERIENCE What should be the most important consideration when designing and managing parking at healthcare facilities in the UK? I believe it should be the patient/customer experience.

Let’s start with the premise that most people would rather not pay for parking and few people choose to be in a hospital or healthcare environment. So we are dealing with a reluctant consumer who may be worried, concerned, even frightened. Surely we should make the parking experience simple, easy to understand and appropriate for the situation?

People don’t ‘park’ to park. They park on their journey to do something else. The parking is ancillary and should be smooth and simple regardless of whether it’s paid for or not.

There are broadly three types of arrangements when parking is paid for which are firstly: pay on arrival. Secondly: pay on departure and thirdly: pay on account.

In my view, the first option may not be entirely suitable for a healthcare environment unless there is a flat fee arrangement and not a fee based upon time parked for example. No one can predict how long they are likely to be in an emergency department for example. Pay on departure is likely to be much more suitable and a variety of options exist to cater for patients and visitors with special needs of almost any kind. Staff are more likely to be those who use pay on account arrangements, season tickets and permits often paid via salary sacrifice or similar arrangements. Prepaid schemes can also be used for other regular users.

WHEN THINGS GO WRONG One NHS Trust went out to tender for a new MSCP and made the builder responsible for procuring the necessary parking control equipment for the car park. They in turn contacted one of the access control companies working for the Trust, who it turns out had little experience in revenue parking equipment or management. This

company was then chosen to provide the new control equipment which was purchased from an overseas supplier with little experience of the UK market.

After 12 months of problems with the equipment chosen, constant breakdowns and complaints from patients and visitors as well as the parking staff, a consultant parking professional was called in. The consultant undertook an analysis of the parking control equipment installed as well as the needs of patients, visitors, staff and also taking into consideration the site logistics, made recommendations that the equipment chosen was not fit for purpose and there was little chance it could be improved to perform to a satisfactory standard and the only solution available was to purchase new equipment that was capable of meeting the requirements.

Ultimately the original system was removed and the new arrangements put in place.

Now it works. But what a waste of time and NHS money. All of which could have been avoided if the original scoping document and specification for the car park had included a proper equipment specification that incorporated the needs and expected outcomes for patients, visitors and staff.

CAUSING CONFUSION This story is not unique. I hear many similar examples of inappropriate parking systems being deployed in healthcare environments which cause confusion and add to the worries of an already concerned person.

Sometimes outpatients are admitted to hospital – what arrangements are in place to deal with the vehicle in the car park? I’ve heard of situations where fees continue to rise as outpatients become in patients and vast sums of money become payable or are written off.

People paying to park need a choice when it comes to methods of payment too. Do you have six pounds in coins in your pocket

ONGOING INVESTMENT Car parks require ongoing investment and that costs money. Hospitals themselves are constantly undergoing redevelopment as services and facilities are upgraded and added.

The Royal Liverpool and Broadgreen University Hospitals NHS Trust recently underwent a £429m regeneration of its city centre Royal Liverpool University Hospital (RLUH).

The first element of this PFI project to be commissioned was a new multi-storey car park with an overall budget of £8m, equal to £11,436 per space. The project was created via the National Health Care framework Procure 21+ and built by VINCI Construction UK, to a design by architect Nightingales.

The car park has 706 spaces across seven levels and is open 24 hours a day, catering for a wide range of users. Secured

by Design principles have been employed in the development of the scheme design and landscaping, and the building design was developed with reference to standards as set out in the Safer Parking Scheme Park Mark® guidance. Drawings formed part of a Park Mark® submission in order to attain the award.

An open aspect has been included in the design to provide good visibility around the parking areas. CCTV is employed throughout and lighting had been designed to maintain good visibility at all times.

This major project and significant investment led to Royal Liverpool Hospital Car Park winning the Best New Car Park Award at the 2014 British Parking Awards. L

Written by Kelvin Reynolds, Director of Policy and Public Affairs, British Parking Association

There are many examples of inappropriate parking systems in place at hospitals which cause confusion and add to the worries of an already concerned person. But there is also evidence of hospitals that have got it right, writes the BPA’s Kelvin Reynolds

now? Few people carry large amounts of coin and yet so many parking places do not accept payment cards or bank notes. Some believe the answers lay in systems which allow customers to pay by text or mobile phone; you can even get reminders about paid-for time expiring soon and even top-up your parking time if needs be. All very good in the right environment, but wait. Aren’t I supposed to switch off my mobile phone in hospital or healthcare environments?

The point I’m making is that parking in the healthcare environment needs careful thought and specialist advice to ensure that the needs of patients, visitors, staff and those with special needs are properly catered for and appropriate management arrangements put in place.

Whilst many people attending healthcare facilities, either as patients or visitors, expect car parking to be free, the limits on space, costs involved and demand for spaces means that car parking needs to be managed properly. Often the most effective way to do this is by charging for parking. There is no such thing as a free parking space; someone somewhere is paying for it. Should that be car park user or the healthcare budget?

Parking

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

FURTHER INFORMATION www.britishparking.co.uk

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PARKING MANAGEMENT SOLUTIONS FOR THE NHS

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When it comes to hospital parking, it is important to strike a balance between effective parking management and being fair to patients, visitors and staff. In this article, UKPC demonstrates that the parking industry can be professional, accountable and community focussed

What springs to mind when you think of parking controls? It may be wardens who suddenly seem to appear from nowhere and pounce on your vehicle. Or it could be camera controls where the camera is covertly hidden out of view just so that they can catch you unawares.

Let’s be honest, parking management is an area that a lot of hospitals and clinics are reluctant to address. It can be difficult to balance the needs of patients, visitors and staff, particularly when the reason for visiting is often emotionally charged. The issue is not helped by some unscrupulous operators, with untrained and unprofessional personnel, giving the industry a less than satisfactory reputation.

HOW IS UKPC DIFFERENT? UKPC is one of the UK’s leading providers of bespoke parking management solutions and services with over 25 years of industry experience, employing over 200 staff nationwide. UKPC is fully committed to providing the highest standard of customer care in the delivery of its services. The company takes immense pride in setting and exceeding industry standards while providing its clients with total solutions that meet their needs, and the needs of the community. As established members of the British Parking Association’s Approved Operator Scheme, UKPC is an active supporter of the BPA Healthcare Parking Charter, and recognises the importance of striking the right balance

between effectively managing parking on site and being fair to patients, visitors and staff.

UKPC aims to add value at every stage.

This can be from the consistent and responsive delivery of professional services, innovative and efficient products, to outstanding customer relationships. The company already partners with many of the UK’s most prestigious and respected public and private hospitals and clinics, as well as retailers, leisure parks, management agencies and landowners.

Happily, over the past eighteen months or so, there have been significant changes to the legislation around parking management. UKPC welcomes any positive change to the industry that supports its mission to demonstrate that the parking industry can be professional, accountable, community focussed and brand aware.

ARE SOLVING PARKING PROBLEMS COMPLICATED? Not when you have the right people and the right solutions. You already know that in a hospital or clinic environment, sensitivity and empathy are the key qualities that are needed to resolve issues. This applies to parking management as well. A fine balance is required to ensure that the fundamental parking terms and conditions are met, whilst being aware of the particular sensitivities that hospital or clinical environments create.

People and technology should play a key

role in parking solutions. UKPC believes that solving parking problems doesn’t start and end with vehicles. Many people attending healthcare facilities expect car parking to be free, however, the limits on space, costs involved and demand for spaces means that this is not always possible. Whether you charge for parking or not, it is important to recognise the value of a well managed car parking facility which delivers a clear and fair service to all users in the community.

HOW CAN I IMPLEMENT A PARKING STRATEGY? In times of budget constraints and stringent legislations, there are many ways that UKPC can add value to your parking management strategy. UKPC has an extensive portfolio of services to support your parking strategy including its Self Ticketing Service, Warden Patrol Service, ANPR, Pay and Display and Pay on Foot. There are no expensive up-front costs, many of our services can be provided on a cost neutral basis and can even provide you with an additional revenue stream.

If you have your own on-site security personnel, UKPC can set up a Self Ticketing Service that gives you the flexibility to manage your car parking areas while UKPC provides you with the back-office functions of administration, phone calls, payments and appeals. In addition, UKPC can provide a Warden Patrol Service, at no extra cost, that works in direct support of your existing security team, without impacting on your headcount or the core activities of your security staff. UKPC’s fully trained professional wardens are experienced in working closely within the community and can also be enhanced DBS checked where required.

With fully trained, professional staff, UKPC’s clients are given the confidence that its service is implemented and maintained in a manner that is appropriate, professional and, at all times, accountable when working on sensitive sites.

Rupert Williams, MD of UKPC says: “Our ultimate aim is always to ensure that we meet the high expectations of our clients and we achieve this through the people we employ and the solutions that we provide.” L FURTHER INFORMATION www.ukparkingcontrol.com

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CLEANING

THE FIGHT FOR SANITATION STANDARDS g Cleaninors t contrac to the en have ris ge set by challen rnment in e the govg new higher n observi dards, but stan ve gone a many h nd that beyo

One of the biggest challenges the cleaning industry has faced in recent years has been sanitising the nation’s hospitals in the face of huge budget cuts.

The deadly organisms and bacteria that can develop and spread quickly in hospitals, such as MRSA, C. diff, Norovirus and CRE, have become a huge issue for all stakeholders, and have even led to emergency measures from the government.

Written by Lee Baker, British Cleaning Council

Lee Baker of the British Cleaning Council examines how hospitals have harnessed training and technological innovations to keep hospitals clean and safe against a background of budget cuts

Infection Control

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

DEEP CLEANING In the early 2000s infection rates increased to worrying levels, leading then prime minister Gordon Brown to order a deep clean of each of the UK’s 1,500 hospitals. Not everyone, though, was convinced about the merits of a deep clean. Some experts claimed that the government was just pandering to populism.

A report in the medical journal Lancet said at the time that the deep clean programme lacked ‘scientific evidence’, adding that the effects would only last a few weeks.

The cleaning industry was also sceptical of the government’s motives for the deep clean. The Cleaning and Support Services Association (CSSA) said that more day-to-day thorough cleaning would have prevented the need to do the deep clean in the first place. They placed a lot of the blame on budget cuts that, they said, simply went too close to the bone. Keith Sammonds of the Health Facilities Consortium, the body that oversees hospital cleaning, warned that the £897 million allocated for the cleaning of hospitals in 2011-2012 was 15 per cent below what was needed to keep wards safe.

More worryingly, it started to emerge that nurses were often being used to clean wards and toilets where there wasn’t sufficient funds to provide a round‑the‑clock cleaning service.

This practice of using nursing staff to clean is not only professionally wrong, as it impacts on patient care, there is also huge potential for dangerous infections to spread due to untrained staff simply not having the time to do the job thoroughly.

Against this backdrop of superbugs, budget cuts and political intervention, the cleaning industry has been quietly getting on with the job of keeping the nation’s hospitals as clean as they possibly can be. But the public and politicians have to be constantly reminded that healthcare cleaning is a highly skilled activity and requires the appliance E

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NEW TECHNOLOGY On the whole, cleaning contractors have risen to the challenge set by the government in observing new higher standards, but many have gone way beyond that, finding new ways of working as well as bringing the latest technological innovations on-board as they become available.

One example of this is a hand hygiene system, which features a chip in a camera that can tell if an operative has washed their hands properly. It registers the various stages of hand washing and once all stages are complete a green light appears.

Another new system that’s proving useful is one that can track patients’ movements around the ward and allows cleaning staff to know exactly where that patient has been. This can be a huge time saver, and means no new patient needs to be admitted to a potentially contaminated bed.

One of the biggest areas of change for cleaning has been the greater use of microfibre in the health sector, as it helps to prevent cross-contamination. New designs have made cleaning products far more ergonomic which makes them easier to use, and much easier to clean, for instance operatives now have the opportunity to use two-sided mops, and more mobile scrubbing machines.

Digital innovations have also found their

way into the cleaning industry with new IT systems bringing changes in working practices, enabling managers to schedule cleaning activities around other hospital activities and patients occupation levels.

With so much scrutiny now on hospital cleanliness, the trend is now for cleaning contractors to work much more closely with hospital staff, like ward sisters and infection control personnel. This can help with efficiency, as managers and supervisors on the ground can use staff where they are most affective.

ASSISTING HEALTH PROFESSIONALS Working as closely as possible with the hospital seems to be the key to running a successful operation. At Hull Royal Infirmary, the Association of Healthcare Cleaning Professionals (AHCP) recently recognised Mitie in its annual awards for their innovative approach and for ‘working in partnership’ with the hospital.

Mitie’s success in Hull has been built around integrating closely with nursing staff, building up close working relationships, i.e keeping the same cleaners looking after the same areas each day, and by becoming an integral part of the hospital team.

The other key component at Hull has been put down to staff training, with over 85 per cent of cleaners on site trained to NVQ levels, and all supervisors required to take a management qualification.

This integrated approach, together with modern technology, new working practices and

New ive innovat gies o technol hand such as tems with sys hygiene and camera a chip d stages recor ive hand at of oper shing wa

qualified staff helps to keep infection levels down, meets all government guidelines – in many cases going much further – and also enables the contractor to enjoy a great working relationship with the hospital.

Infection Control

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

WORKING AROUND AUSTERITY With the general election now just a year away the NHS will be one of the key battle ground issues, and hospital cleaning should be at the fore front of that debate – with the huge strides made by the cleaning industry in the battle against the superbugs heard loud and clear.

As we have discussed, new innovations and working practices have led to a significant fall in infection levels, but with budgets set to be tight whoever wins the election, we must make sure that healthcare cleaning is high on the list of priorities for those who hold the purse strings.

We have come too far for complacency and without the dedication and professionalism of the cleaning professionals infection rates could rise once again.

Only experienced and specialised cleaning contractors can deliver the services that can prevent deadly superbug outbreaks. Only they have the knowledge and access to technology that can deal with this problem. And, considering the consequences both financial and reputational to an outbreak, politicians and healthcare managers should not take their eye off the ball for one moment. L FURTHER INFORMATION britishcleaningcouncil.org

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Around one in ten patients admitted to hospital contract a hospital acquired infection (HAI). A National Audit Office report puts the number of patients contracting HAIs in hospital at over 300,000 every year, while figures provided by the British Medical Association estimate that HAIs cost our economy up to a staggering £11 billion annually. In excess of £4,000 is spent treating each single infection, trusts can be fined upwards of £10,000 for every outbreak and patients can spend up to three times as long in already overcrowded hospital wards.

With so much at stake, can any Infection Control Team in any healthcare environment afford to take risks with Hospital Acquired Infections? Ten years of research across the globe, designed to minimise the risk to patients of contracting potentially lethal viruses such as Norovirus and Clostridium difficile, have come to the same, simple conclusion – transmission of pathogens on the hands of healthcare workers is the most common cause of cross infection occurring directly from patient contact or indirectly via contact with the environment.

Staggering as it may seem, despite these findings hand hygiene compliance amongst healthcare workers has been found to be as low as 5% in some hospital environments. At the same time, while hospitals and clinics across the country spend billions on promoting awareness of infection control, there are some who are still unaware that alcohol-based hand cleaners are NOT effective against two of the most dangerous viruses, Clostridium difficile and Norovirus and can, in some instances, exacerbate the infection.

There has never been a time when decision making in the field of infection control has been so crucial and mistakes so costly. What better time to put Medi9 to work to help save time, labour and, ultimately, lives? Medi9 is a revolutionary range of alcohol free sanitisation products, independently proven to kill 99.9 per cent of bacteria, spores, viruses and fungi on contact, including Clostridium difficile, MRSA, Swine Flu and Norovirus.

Being alcohol free means Medi9 will not irritate the skin and will not cause any cultural issues to users. More importantly, unlike alcohol based hand gels and wipes which have no residual protection, Medi9 is proven effective up to 45 minutes after application. This cumulative and residual effect means incidences of re-infection will reduce and surfaces will become biologically cleaner for longer. In short, Medi9 will stop outbreaks of infectious disease and save money and lives.

Recent studies suggest that simply using a hand sanitiser alongside a basic educational program could produce a staggering 21% cut in staff absenteeism. Medi9’s extensive range of products and one-stop approach to infection control can cost as little as 0.01p per person and, coupled with the Nine Group commitment to ongoing trials and on-site product training, the introduction of Medi9 will prove a vital and extremely cost-effective resource in the fight against infection.

Free sample packs and detailed information on the complete Medi9 range of sanitisation products are available from www.medi9.com.

Medi9 – a revolutionary new ally in the fight against Infection

Legionella Control

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

NPS North East – the specialists in keeping your organisation and its water systems safe Part of the NPS Group, NPS North East is a provider of high quality property, design and construction consultancy services.

Employing over 1200 staff across 26 UK offices and with an annual turnover in excess of £80 million, NPS has a wealth of experience in helping its clients understand their property assets and ensuring their property portfolio is performing as it should.

The company’s water hygiene team provides a range of water safety management solutions offering independent expert water safety advice and consultancy, from the collection of samples, through to risk management, control schemes and management systems.

Legionella bacteria is common in nature and can easily colonise in man-made environments such as hot and cold water distribution systems. Once bacteria has grown in the water system, inhalation of water vapour can lead to legionnaires disease.

With an estimated 250 cases in the UK each year, and approximately 18 per cent of these resulting in fatalities, NPS North East’s water hygiene team provides you with an assurance that you are statutory compliant and that water hygiene risks are minimised.

The team has the skills and expertise to

Water hygiene management staff hold the required certification and are audited on a regular basis by an independent external body.

Work includes management of the following activities: Risk assessments to identify risks from legionella, E.coli, and other waterborne bacteria; reporting to comprehensively list any remedial works required; water testing and analysis; creation of bespoke programmes for planned preventative maintenance; complete and comprehensive monitoring and management regimes; system cleaning, disinfection, and chlorination requirements; system upgrades to reduce risk; staff awareness training, and independent external audits of existing company management and control systems.

The company is flexible in its approach and is able to provide individually designed solutions to suit your requirements, all in accordance with the Legionella Control Associations Code of Conduct for Service Providers.

keep customers safe, and the company’s services ensure that water systems are comprehensively monitored and controlled.

This responsibility involves a management programme of measures to identify water hygiene risks and prevent infection. In this way, you can avoid exposing members of the public and your employees to health problems such as legionnaires disease.

NPS North East helps its customers by managing water hygiene control in accordance with the relevant legislation, including the Health and Safety Executive’s Approved Code of Practice (ACoP) L8, the Health and Safety at Work Act and the Control of Substances Hazardous to Health (CoSHH) Regulations.

FURTHER INFORMATION Contact: Graeme Taylor Tel: 01977 628431 graeme.taylor@nps.co.uk www.nps.co.uk

delivering innovation and excellence integrated design services joint ventures and partnerships agency and estates management management and consultancy surveying and maintenance

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NPS Group Navigation House, Whistler Drive, Castleford, West Yorkshire, WF10 5HX Tel: 01977 628300 Fax: 01977 628301

www.nps.co.uk

agency and estates management

surveying and maintenance

integrated design services

HEALTH BUSINESS MAGAZINE | Volume 14.3

joint ventures and partnerships

management and consultancy

HEALTH & SAFETY

Legionella Control

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

Written by Bob Towse, head of technical & safety, B&ES

MAKING AN INVESTMENT IN SAFER WATER SYSTEMS The threat posed by Legionella is well understood. But, as Bob Towse of the Building & Engineering Services Association explains, cost cutting can put vulnerable patients at risk

These days we know quite a bit about the bacteria that can cause outbreaks of Legionnaires’ disease, but that doesn’t seem to have made us any better at stopping outbreaks. There are around 300 reported cases in the UK every year, but experts believe the figure is more like 9,000 because it is often misdiagnosed as other forms of pneumonia. E

There d un are aro rted o 300 rep gionella f le cases o every year, K in the Uperts believe but ex re is nearer the figu 0 due to 9,00 nosis misdiag

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Water Management Society ONE or TWO DAY CONFERENCE & AGM

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HEALTH & SAFETY

Hospitals are particularly vulnerable because of the amount of hot water they use and the relative old age of the equipment used  120,000 people are thought to have died in the US since the cause of the disease was established there more than 30 years ago. It was first identified and received its name following an outbreak among delegates at a meeting of the American Legion in a Philadelphia hotel in July 1976.

Around 12 per cent of cases are fatal, but the proportion is much higher among the old and infirm where up to 50 per cent die. That is why it should be such a major concern for those charged with running hospitals and other healthcare facilities.

The risks are increasing and some experts believe the bug is mutating and can, in some instances, survive in water that meets current safe temperature guidelines.

It is also showing resistance to some of the chemicals designed to kill it.

SHORT SIGHTED There are also problems with the way in which water systems in care homes, hotels, schools and a host of other establishments are monitored and treated. Reportedly some of the logbooks designed to identify areas at risk, particularly within internal pipework, are not being filled in properly.

This is extremely risky and short sighted.

Cuts to building maintenance budgets were among the worst side-effects of the recession and the intense pressure on public sector spending. The whole topic of maintenance is poorly understood by some managers, who often regard it as an optional extra and struggle to understand where it can add value.

It has been widely reported that spending on water treatment designed to guard against the threat of legionella has been cut in hundreds of buildings meaning that the frequency of dosing with chemicals, for example, is reduced to dangerous levels. A risky way to deliver budget cuts, but a risk many seem prepared to take and keep on taking.

Ironically, aside from the health and safety implications, planned and well organised water treatment will also reduce building running costs by improving energy efficiency so managers could actually earn a rapid return on a modest investment. However, that requires a clear understanding of the issues and a willingness to invest for the medium to long-term.

WATER SYSTEMS The greatest risk from legionella bacteria is found in the hot and cold water systems in buildings where water is delivered as

an aerosol or fine spray through taps and shower heads and can, therefore, be inhaled. The bacteria is present in a great many places, it is only once it is airborne that it becomes a threat.

Legionella bacteria also thrive in water temperatures between 20-45 degrees Celsius, but some mutations are thought to be surviving in even higher temperatures – up to 60degC. The bacteria will multiply into large numbers if water is stored at these temperatures.

Hospitals are particularly vulnerable because of the amount of hot water they use and the relative old age of the equipment used to both heat and store it. ‘Dead legs’ in pipework – another common feature of old-fashioned systems – will provide ideal breeding grounds for the bacteria that can then be circulated around the rest of the system when those sections are flushed out.

Poorly maintained cooling towers and air conditioning systems can often be the source of the bacteria, which then proliferates and circulates around the piped water network of the building. There is also evidence of a growing resistance to some of the biocides designed to kill legionella bugs.

Legionella Control

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

DANGER Risks are also increasing because many water heating systems are being shut down for periods, or hot water temperatures lowered, to save energy. This means the temperature of the stored water drops into the ‘danger zone’ where the bacteria proliferates. E

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LEGIONELLA: YOUR RESPONSIBILITIES Under Health and Safety legislation, you should be taking steps to understand and control the risk of exposure to legionella bacteria on your premises. These potentially dangerous bacteria can be present in man-made systems such as cooling towers, showers, air conditioning units and other water storage systems on your property.

HOW WE CAN HELP As a Legionella Control Association member, we have an experienced and dedicated team to help meet your requirements by providing a full range of services in line with Health and Safety Executive L8 Approved Code of Practice and Guidance.

To discuss your needs, please email scientific@scottishwater.co.uk.

Visit our website for more information: www.scottishwater.co.uk/scientific

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HEALTH & SAFETY

 The increased use of renewables can create problems because these systems generate hot water at lower temperatures than conventional heating. Again, without the proper controls and maintenance, these systems can create the ideal breeding conditions for legionella bacteria.

Rainwater harvesting systems are also becoming more common and they are a particular threat because they store large amounts of water that could already be contaminated.

There is a pressing need for everyone involved in building maintenance and management to understand where the risks lie. In particular, building owners and users and facilities managers must be aware of the increasing dangers posed by the disease, especially to the infirm, and must ensure that adequate steps are taken to control the circumstances in which the legionella bacterium is likely to thrive. Risk assessments are a vital starting point and these must be updated to take new factors into account as technologies and building layouts change.

One additional risk is the fact that, in many places, staff numbers have been reduced to meet budget cuts. The resultant higher workloads on those remaining mean there is more room for human error. For example, monthly temperature checking and manual flushing can be compromised. And even if monthly checks are meticulous, who knows what is happening, day-in-day-out, as temperatures fluctuate within any system?

CONTINUOUS DOSING One solution, which is becoming increasingly popular, is ‘continuous dosing’. This is designed to maintain water systems in a permanent state of excellent hygiene at all times. There are a number of dosing systems capable of releasing controlled levels of chemical treatment into the water system at a set times or in response to changing conditions in the water so removing some of the potential for human error or omission. By reducing the labour intensity of the process it can also help hard pressed managers meet their

Legionella Control

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

A planned ated seriously ill patients histic and sop nce regime and a £100,000 fine. It a appears that managers maintenter systems had ignored warnings t a s for w e of the be from regulators n o e g b n i and consultants d d l l i u u co ts a b n e and reduced their m t s e inv r ever spending on chemical operato es treatment of their water mak system. Pascal Bates,

cost cutting obligations, but this time without compromising safety.

Well-planned and resourced water treatment also reduces energy consumption, another saving. For one thing, systems that are continuously maintained do not have to be run at high temperatures in order to guard against legionella build up. A number of buildings run their heating systems all hours of the day and night just to guard against the threat, but that is not necessary if the system is properly treated and monitored.

COST Continually running heating systems at high temperatures also increases the build-up of scale, which further reduces efficiency and shortens the operating life of expensive heating and hot water equipment. Scale acts as insulation inside pipes and heat exchangers so reducing heat transfer. Each millimetre of limescale reduces energy efficiency by eight per cent.

Also, extremely hot water – a common feature of many hospitals – increases the risk of scalding injuries to patients and staff.

Many building owners have had to introduce thermostatic mixing valves at considerable expense to address the problem, but they could save themselves time, trouble and money on a number of fronts if they could maintain water at a more civilised temperature.

Properly treated systems also suffer from fewer breakdowns, so reducing the need for costly repairs. All in all, a planned and sophisticated maintenance regime for water systems could be one of the best investments a building operator ever makes – both in terms of critical health protection and running costs.

The cost of cutting back on water treatment was demonstrated all too tragically last year at Basildon Hospital in Essex where the resulting outbreak led to two deaths, six

prosecuting the case for the Health and Safety Executive (HSE), revealed that the hospital cut spending on chemical treatment of the water system in an “inappropriate cost saving measure”.

L8 GUIDELINES There are of course onerous legal responsibilities on the managers and overseers of buildings charged with preserving the health and wellbeing of occupants. These legal obligations are clearly set out in a single document, published by the Health and Safety Commission (HSC), called Legionnaires’ disease – The control of legionella bacteria in water systems. This is the Code of Practice (ACoP), commonly referred to as L8.

Under L8 it is the building owner’s responsibility to put a proper control strategy in place that includes a system for managing the maintenance of water systems; regular monitoring with the records kept for five years; and training for everyone in the management chain with their skills updated periodically.

L8 is a legal document, so if a building operator does not follow its instructions they leave themselves open to legal action. They are also subject to the legal measures outlined in the Health and Safety at Work Act, which includes wider provision for protecting employees.

Accurate record keeping, corrective action and complete audit trails are essential parts of the guidance. Anyone who thinks these might be sensible things to cut back on to meet short-term budget targets is taking a huge and unnecessary risk. L FURTHER INFORMATION www.b-es.org

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SOMERSET COLLEGE

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HEALTH & SAFETY

Asbestos is a hazardous and challenging material that should only be handled by trained professionals. The newly created Asbestos Removal Management Unit (ARMI) aims to provide expert support to asbestos professionals, explains ARCA Asbestos is a naturally occurring fibrous material that has been a popular building material since the 1950s. Although it’s hard to recognise if a building contains asbestos, as it’s often mixed with other materials, if you work in a building built before the year 2000, it’s likely that some parts of the building will contain the material.

There have been a few cases in recent months of asbestos found in hospitals. Dust from asbestos pipes at several Glasgow hospitals, including the Southern General and the Royal Infirmary, has been claimed as the reason for killing a top GP who worked at the hospitals in 1986.

And City Hospitals Sunderland NHS Foundation Trust, Kayll Road, Sunderland was fined £3,000 and ordered to pay £4,582.40 in costs after pleading guilty to breaching asbestos control regulations, when contractors drilled through door surrounds containing asbestos.

RECOGNISING PROFESSIONALS A brand new institute has been launched in the UK that will represent the professional individuals working in the asbestos removal industry. The Asbestos Removal Management Institute (ARMI) will recognise the many dedicated individuals that work in this hazardous and challenging industry.

ARMI is a joint venture between the three main trade associations representing HSE licensed asbestos removal contractors, ARCA, ACAD and the NFDC. ARMI has been established as the professional body to recognise and promote effective leadership

and management within the asbestos removal management industry. Members of ARMI are recognised as professionals within the asbestos removal management industry and can demonstrate this by the use of letters after their name.

ARMI MEMBERSHIP The requirements for the grades of membership offered, Fellow, Member and Affiliate are fully described in the Rules of Membership. ARMI members are required to hold recognised qualifications in asbestos management and leadership and management.

In addition, members are required to attend a professional interview in order to satisfy ARMI of their suitability for membership, and to participate in the Institutes’ Continuing Professional Development Scheme. ARMI requires its members to pursue exemplary standards of leadership and management.

Members are encouraged to develop a culture of continuous improvement and to demonstrate competency.

JOINING Membership of ARMI is aimed at employees of licensed asbestos removal companies who have a leadership and management role and a direct influence over the way that asbestos removal work is carried out.

In effect this means supervisors, contracts managers and senior managers / directors.

In order to apply for membership of ARMI applicants are required to complete the membership application form and

PROFESSIONAL REVIEW Subject to the applicant providing evidence of holding acceptable qualifications, and paying the appropriate fee, an appointment to attend the professional review meeting will be made. It is intended to hold these professional review meetings at various locations around the country, namely Hemel Hempstead, Burton upon Trent, Darlington and Glasgow. The professional review meeting will be conducted by one ARMI assessor and the meeting will be audio recorded for quality control purposes and for review in the event of any appeal.

The object of the professional review is to assess the applicant’s knowledge and competence of work with asbestos and their approach to leadership and management within the role in which they are employed. The professional review will last between 45 minutes and one hour. Depending on the overall level of response of the applicant the assessor will recommend the membership category that can be offered to the applicant.

Written by The Asbestos Removal Contractors Association

WORKING IN A HAZARDOUS FIELD

return it to ARMI. In order to be considered for membership certain qualifications need to be held, depending upon the grade of membership applied for.

It is important to bear in mind that the decision as to whether a leadership and management qualification meets the requirement for membership will be decided by the board on a case by case basis. In making their decision, the board will consider whether the qualification is at the right level for the membership grade applied for, in doing this the qualification must be able to be mapped to the appropriate Qualifications and Curriculum Framework (QCF) level.

In effect these are the types of qualifications provided by the Chartered Management Institute (CMI) of the Institute of Leadership and Management (ILM). General health and safety qualifications or waste management qualifications, such as those issued by NEBOSH or WAMITAB will not usually be acceptable, unless they meet the criteria relating to managing people and teams, etc.

Asbestos

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ACCEPTANCE INTO MEMBERSHIP Subject to meeting the membership requirements and paying the appropriate fees an applicant will be accepted in to membership. The member will be able to display letters after their name indicating that they are members of ARMI and the grade of membership which they hold.

Members and Fellows are required to participate in the Institutes Continuing Professional Development Scheme. Members at all grades of membership are required to abide by the Rules of the Institute and the Institutes Code of Conduct. L FURTHER INFORMATION www.armi.org.uk

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Providing fibre, bandwidth and site facilities

Versatile connectivity in the UK For 20 years customers from the public and private sector have depended upon Surf Telecoms to provide the infrastructure to carry their data.

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Using the very latest technology we continue to provide solutions delivering security, reliability, scalability and best value.

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www.varlink.co.uk 4/8/2014 5:08:19 PM

ICT

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Luke Readman, vice chair strategy & policy, BCS Health

BIG DATA

USING DATA TO MEET CHALLENGES IN HEALTHCARE

The move toward full disclosure of clinical data has been hit by obstacles in the past. Luke Readman of BCS Health talks about how investing in data infrastructure will benefit patients The demand for accurate data to measure improvement in the quality and delivery of NHS services has never been greater. In a constrained financial climate this places a significant burden on organisations.

Increasingly the inability to contribute such data in itself is seen as failure for organisations irrespective of their performance. The data demand varies widely from well‑known regulatory performance standards that demonstrate the length of time it takes for patients to receive treatment (where 4 hours in emergency settings is the hospital standard or 18 weeks in elective care when a patient is referred by a GP) to outcome measures such as numbers of patients acquiring infections in hospital. These measures have been driven by changes in policy over a number of years and are designed to set a minimum set of

standards that the public can expect.

Back in February, the Francis Report exposed the deficiencies of the Mid Staffordshire trust and stressed the need for more accurate, useful and relevant information.

Important information on mortality such as Hospital Standardised Mortality Ratios (HSMR) and Summary Hospital-Level Mortality Indicators (SHMI) for example, has been brought into common public use.

These sorts of measurements are not just a hospital requirement but are at the heart of every sector.

Primary care and community, mental health and ambulance services each have their own minimum standards.

THE NEED FOR OPENNESS Increasingly, data and reporting about the medical performance of services is developing. The HSCIC reports and publishes data on over 50 different elements of services. Indeed much if not all of this has been driven by medical professional effort to drive improvement in their own areas of interest. Support from the medical colleges has been essential in driving this process as well as ensuring engagement from doctors themselves. The public expect to be able to see this data and current national policy is driving this development even more widely and to increasing levels of detail. In a move that was deemed a ‘major breakthrough’ in NHS transparency, NHS England published data on the mortality rates of a number of common surgical procedures, not at hospital level, but rather at named consultant level. This is not new – cardiac surgery mortality rates have been published at consultant level for a number of years and the process to get there was a very difficult one for the individuals involved. 

ingly Increas ility to the inabibute contr s failure seen a tions s i a t a d nisa for orgaective of irresp eir th ance perform

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Advertisement Feature

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PRINTING

EASING THE JOURNEY TOWARDS ‘PAPERLESS’

Why does a company that is primarily involved in making and selling printers want to help the NHS and other health organisations to go paperless? Rob Brown, OKI business manager for managed document services answers the question Why does a company that is primarily involved in making and selling printers want to help the NHS and other health organisations to go paperless? It’s a good question.

In reality, we believe that for a long time yet there will still be a need for printing and printers. After all, in a recent OKI survey of 2000-plus office workers across all industry sectors, 92% of those polled said that they still printed at least one document every day.

There’s no reason to assume that workers in the health sector are any different.

Even if patient records and referrals become paper-free, nobody can stop people sending letters or wanting hard copies of documents

Department for Environment, Food and Rural Affairs (DEFRA), for example, saved 47% of its energy emissions by adopting a managed print strategy and rationalising its printer fleet from 1,384 devices to just 548.

Many more organisations are benefiting in a similar way by adopting a managed document service strategy. So how does this work and what benefits can be achieved?

OKI’s managed document solutions comprise an integrated suite of software, technologies and tools to improve print and document workflow, management and security within an organisation. The complete managed process begins with an OKI audit of existing

OKI System UK’s managed document solutions comprise an integrated suite of software, technologies and tools to improve print and document workflow, management and security within an organisation for legal reasons; at least until today’s ‘digital natives’ become pensioners. So, although we recognise that paperless is the ideal, we can also see that it isn’t practical right away. Most departments are still progressing through various hybrid states before reaching the ultimate, paper-free goal.

The main problem at the moment is that health organisations rarely have a clear view of their spend on document output and management. And the costs and impact of printing are often overlooked when it comes to energy savings, carbon emissions.

Oki Systems UK’s business is to help manage printing and documents more effectively – helping save costs and energy, while also enhancing productivity. The NHS is under pressure on all these levels with rigorous targets to become paperless by 2018, to cut carbon emissions by 10% by 2015 and to make £20 billion of efficiency savings by 2015. Buying printers and printing in the right way can drastically cut paper use and help significantly towards the latter two goals. The

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printing practices, measuring outputs and assessing printing types. This gives the audited organisation or department a transparent view of what is really happening and where budget is being spent.

OKI then uses the audit results to develop a long-term plan. Top of the agenda will be to ensure that the right printers are being used for the right job. For example, replacing multiple desktop printers and scanners with a smaller number of multifunction printers can cut energy consumption and costs and

accelerate workflow. New OKI multifunction printers come with an open platform enabling the customisation of the user interface to integrate all document-related tasks into an organisation’s document workflow.

This enables a move from a manual to an automated workflow, making it easier to track and reduce printer usage.

There are also printers that enable users to store documents prior to printing on the printer’s hard disk drive or Secure Data (SD) card. It is only possible to access this content with a four digit, user-defined pin and only with the right credentials can the document be printed. By reducing the amount of paper documents lying around on desks, or worse left uncollected on the printer, and restricting printing only to those who really need it, these also help keep sensitive data out of sight and secure.

Significant costs can be saved by having just the one contract for all printing and document needs, including printers, supplies, technical support and maintenance. This enables easy monitoring of on-going costs, reduces capital investment and helps control budgets. In turn, this also frees up the time of internal staff to focus on core tasks. OKI can also help establish printing best practices such as setting double‑sided and mono printing as default options.

Working closely with a managed document services provider such as OKI will help develop a flexible strategy, making way for mobile printing when needed. There are now ranges of multifunctional printers with wireless connectivity. Smartphone and tablet users can find these and print from them via an app which can be downloaded directly from the mobile device.

Many NHS departments still have printers that are over ten years old, but keeping them running is often a false economy. Newer printers typically use far less energy than these older devices, include significantly more capability and take up far less space. When documents and printing are managed more carefully and expertly, paperless becomes less of an issue. Working with a managed document services supplier can mean a smooth and realistic evolution towards this ultimate goal. L FURTHER INFORMATION Tel: +44 (0)1784 274 300 www.oki.co.uk

ICT

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

BIG DATA

Only from the knowledge that the data is accurate and the ability to provide real time data for clinicians on demand will we be successful in supporting our clinicians  As more such data is made available, the need for public policy to continue moving toward full openness and disclosure with data will only increase. Indeed, NHS national director for patients and information Tim Kelsey has been very clear about the need for complete data covering the whole of the medical record to be submitted by hospitals in the next couple of years. This includes information covering prescribed medicines at patient level from hospitals; an ask that will stretch many institutions.

UPGRADING INSTITUTIONS So what are institutions to do? There is pressure to support clinicians to accurately record detailed clinical information, as well as pressure to submit increasing numbers of national datasets speedily. Without substantial informatics infrastructure in hospitals we will not be able to properly support our clinical staff and rendering us unable to fully report our clinical performance.

More importantly, the public will not have the information on which to form a view and we will have let them down.

The policy from 2002 was to computerise the hospital medical record via the National Programme for IT, but this has failed at the national level. Of course there are hospitals that stand out but these are exceptions.

If instead of using measurement to assess clinical care we use measurement to assess the maturity of our hospital information systems and ask ourselves just one question, how many hospitals have achieved HIMSS level 7 in the English National Health Service, the answer is none.

Most other European countries have at least achieved this in one hospital and in North America multiple times. GP practices have for the most part completely computerised their record and a normal part of every GPs job is to code the record in real time.

This has happened over a number of years and was in part driven by incentives.

Incentives are now no longer on the table – the emphasis is instead on a mechanism which will penalise if clinical performance is poor, with more severe penalties where data is not provided.

I do not know what the public view of this is but I know as a patient myself that I expect no less than this. For hospitals and clinicians we now have to provide a comprehensive electronic record and systems that clinicians will use in real time. Our connectedness with other parts of the healthcare system and with patients is also an essential requirement.

THE CHALLENGE AHEAD Let us not underestimate the difficulty of achieving a comprehensive electronic hospital record or the prolonged effort required. Only from the knowledge that the data is accurate and the ability to provide real time data for clinicians on demand will we be successful in supporting our clinicians. I firmly believe that hospitals that achieve this position in the next couple of years will be the ones that succeed in the long term. We are at a tipping point brought about by public expectation, public policy and fiscal restraint, but let us ensure we invest our scarce pounds in clinical informatics infrastructure to support clinical improvement.  FURTHER INFORMATION www.bcs.org

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IF QUESTIONED, COULD YOU SAY WITH ABSOLUTE CERTAINTY THAT NO DATA HAS ESCAPED YOUR PREMISES? Have you seen the process taking place? Have you tested the process?

What we are asking is; could anything improve the security of your data destruction policy?

Many of our NHS clients choose to work with ICEX as we can physically shred the hard drive in front of them at their own premises. No need to wave your data bearing assets bon voyage and place your trust in the recycler to manage these correctly, regrettably this type of reliance has resulted in some large ICO monetary penalties for NHS trusts.

ICEX can perform a range of data eradication processes at your premises. Whether your policy is destruction or erasure (or a combination of both) we are able to perform these functions in full view of you and place in your hand certification confirming the process is complete.

And the cost? Well many of our NHS clients find there are residual values in their PCs and mobile devices which cover the charges for on-site data erasure or hard drive destruction.        

EXISTING NHS SERVICE PROVIDER ADISA ACCREDITED ITAD ON-SITE ERASURE OR DESTRUCTION OF ALL HARD DRIVES MOBILE DEVICES AND TABLETS SECURELY SANITISED GENEROUS AND TRANSPARENT REMARKETING POLICY COMPREHENSIVE ASSET REPORTING – COMPLIANCE WITH ALL DATA PRIVACY LAWS, ICO GUIDELINES AND ENVIRONMENTAL LEGISLATION FREE CONSULTATION AT YOUR PREMISES UK WIDE SERVICES

Call the ICEX Client Services Team on 01376 503900 or email: enquiry@icex.co.uk Web: www.icex.co.uk

DATA PROTECTION

Treating end-of-life ICT assets as waste is misguided, says Steve Mellings of the Asset DIsposal and Information Security Alliance (ADISA), who outlines an approach that may serve hospitals better Although the ‘W’ in the WEEE directive stands for waste, categorising ICT assets at end of life as waste is at the core of our problems when dealing with this business process. As users, at the end of each working day we leave, piled up in our bins, the waste we have produced. We place zero value on the wrappers from our lunch, the free newspaper carried into the office and broken old pens, which reside in our waste bins. We don’t spare a thought on our journey home about what is happening to this waste and who has access to it. We simply assure ourselves that it won’t be there tomorrow, that someone else has made the problem go away.

This approach can extend to addressing redundant ICT equipment.

It is left on shelves, in store cupboards or piled

unceremoniously into rooms because it’s old; we’ve finished with it and it is therefore someone else’s concern. Interestingly, should the releasing company wish the asset to be re-sold for revenue generation then the Environment Agency’s own definition confirms that the asset should not be classed as waste as there is ‘no intention to discard’.

So in order to write a narrative on the problems faced with redundant ICT, I must first start by challenging the very perception of this process. If we approach ICT disposal with our thoughts stuck in an indifferent approach to waste management we are destined to fail. A failure to address the physical asset,

software as an asset and finally, and most importantly, data as an asset will ultimately lead to risk taking, non-compliance and most of all, missed opportunities.

WHAT ARE THE CHALLENGES? Technology has changed significantly in the past 10 years and yet within ICT disposal attitudes have not. Companies make sweeping statements without considering other data carrying media, or say they use CESG approved software without understanding that CESG has not approved software overwriting on NAND based storage such as solid state. Unless the business process of ICT disposal is given more thought, then these types of flippant comments result in poor policy, poor process and poor relationships.

There is no quick fix for security technologists to deploy when dealing with ICT disposal. The roadmap to secure ICT disposal starts somewhat unfashionably with policy, which leads to good processes.

Together these form the foundations for a disposal solution incorporating great partners, industry leading solutions and most of all, compliant, management oversight.

Written by Steve Mellings, director, ADISA

A DIFFERENT OUTLOOK ON ICT DISPOSAL

ICT Disposal

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WHO BEARS RESPONSIBILITY? Overall responsibility for ICT disposal is often difficult to identify. Many businesses split responsibility for the physical assets across a range of functions and therefore disposal responsibility is often also shared. Facilities may look after the mobile phone contracts and printer estates whilst traditional IT E

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ICT Disposal

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INFORMATION DESTRUCTION

The UK’s most secure IT disposal company ICTR is a natural first choice for healthcare businesses’ IT disposal. It is the first and only company to receive the highest possible accreditation for data security (ADISA distinction with honours).

This means ICTR is officially the most secure IT disposal company operating in the UK. “After a rigorous selection process, we are delighted to partner with ICTR, the only company to receive the highest possible ADISA accreditation.

The combination of security of operations, quality and professionalism of their staff, ability to meet our local requirements, and value for money made ICTR our first choice.” – Jo Andrews, information governance manager, Ealing Hospital NHS Trust.

The company is part-owned by the public sector, which means that half of all profits

We are specialists in the management of IT Asset Disposal Hardware change is inevitable - and it can be a complex, costly process.

We work with clients to deliver the opportunities that hardware change can present… operating in an environment where compliance and security can’t be compromised and budgets are finite.

are directly invested into local communities through its groundbreaking partnership with public sector owned social enterprise, iESE (www.iese.gov.uk.)

Contact ICTR if you would like to find out more about how to remove the risks of IT disposal.

FURTHER INFORMATION Tel: 0800 043 0103 info@ictr.co.uk www.ictr.co.uk

stage of the process.

We guarantee data security by controlling every data-bearing asset from the point of decommission to final data destruction, eliminating all risks at every

We deliver sustainable solutions that minimise the impact on the environment and increase the residual value of your technology hardware… ITAD that works.

We are one of the few companies that has Government approval for secure destruction of sensitive items.

Contact us on:

contactus@theitadworks.com www.theitadworks.com

01483 201240

FootprintMatters2u – the waste electrical recycling and secure data erasure specialists FootprintMatters2U is a waste management company providing expertise in the recycling of electrical goods, hazardous waste and secure data asset management.

With over 27 years of experience in the recycling industry, the team are passionate about diverting waste from landfill following processes that are environmentally sound and sustainable and follow the data protection act guidelines.

FootprintMatters2U works with its clients across the public sector including local authorities, schools, colleges and NHS trusts.

In the private sector there are long standing relationships with private companies of all sizes, from SME’s to global blue chip companies such as Panasonic and Rolls Royce. Footprintmatters2U has its own environment agency licenced treatment facility based in South East Wales, and also has strategic partnerships throughout the UK. Currently, a data breach could cost up to £500,000 per breach. This will soon change to 2 per cent of global turnover – a huge impact for the future. Footprintmatters2u uses Tabernus Data Erase Software, to comply with legal requirements under the data protection act 1998 and can erase all traces of personal and data sensitive information from PC’s and

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portable storage media. Footprintmatters2u complies with the latest ADISA standard and the whole package can be designed specifically for you, for total peace of mind.

An electronic auditable report is produced for each successful secure hard disc erasure. The report includes all hard disc details (size, serial number, make, etc) and the company welcomes arranged duty of care visits to observe the process in operation. Tabernus is approved to UK and USA requirements and also to MOD and NATO specification CESG v5.3.

Research proves beyond doubt that when upgrading to the newest versions, reusing

computers and electrical items is far better for the environment than recycling them. Reusing a computer is 20 times more effective at saving life cycle energy use than recycling it.

Given the substantial environmental cost of production, it is imperative that we recover the full productive value of every PC and electrical item through reuse before eventually recycling it to recover parts and materials at its true end-of-life.

FURTHER INFORMATION www.footprintmatters2u.co.uk or wwww.footprintmatters2u. wordpress.com

DATA PROTECTION

Overall responsibility for ICT disposal is often difficult to identify. Many businesses split responsibility for the physical assets across a range of functions and therefore disposal responsibility is often also shared

 departments look after user technology such as PCs and laptops. Within healthcare there are further complications, as there are outsource partners such as Health Informatics involved.

In addition, senior information risk owners (SIRO) or information governance managers (IG) have overall responsibility for IG governance, without perhaps being able to influence operations in the way that they would wish. These roles, and that of the new Data Protection Officer (a legal requirement within the terms of the new Data Protection Act) are going to be increasingly important as the focus from the regulators on Data Protection and Privacy is being magnified by the changing EU Data Protection Act. This re‑write will see many changes when passed into UK law (2016) with the headlines understood at this point to include an increase in potential fines, changes in breach notification and a change in the processor/controller relationship.

To summarise the challenge, we have a business process which is perceived indifferently by many, which has poor central policy due largely to the lack of central ownership of the process and which is delivered by a range of different entities within a single business. This results in a lack of acceptance of responsibility and in a range of inconsistent and uncoordinated processes being in place and a range of suppliers providing services.

These elements are ignored generally, and are only scrutinised when a problem has occurred. When we put this into the context of a changing and increasingly aggressive regulatory environment we can see that as

responsibility for the data continues until that data is no longer available, then ICT disposal will become the final stage within the business’s data protection effort. Only when the asset has been sanitised in a controlled manner will the legal liability end and potential regulatory action subside.

ROADMAP TO COMPLIANCE There is an ever-growing list of requirements for all businesses to be compliant with and the greatest challenge is actually understanding, ‘what should we do to actually be compliant?’

For ICT disposal the overarching law is the Data Protection Act, which is changing significantly, although the objective for ICT disposal will be same: to sanitise data on every data-bearing asset so that it is no longer recoverable, and of course to comply with software and environmental laws.

Within the UK the data regulator is the Information Commissioner’s Office (ICO) and it is to the ICO that we should look for guidance.

In November 2012 a set of simple guidelines was released which allowed businesses to review and map across the requirements to their own business operations. These can be found on the ICO website and a simple GAP analysis would be a good starting point.

In January 2014, ADISA undertook a freedom of information project into Acute Trusts within the NHS. The good news was that, in my opinion, there was significant improvement from a previous telemarketing project we had performed in 2010. Trusts generally seem to be putting structures in place from which to grow. In 95 per cent of cases there was an individual responsible for ICT disposal and 96 per cent were aware of the ICO guidance

ICT Disposal

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notes. Despite this ownership and knowledge there was still evidence over the series of questions that between 25 per cent and 40 per cent of trusts were not compliant with the ICO requirements, leaving themselves exposed to regulatory action should something go wrong.

The questions are whether that individual responsible is really able to shape the process within the business and whether they perhaps require greater management support in order to influence compliance within this process.

GUIDELINES At ADISA we adopt a simple five-stage approach to excellence within asset disposal and these steps go some way to helping businesses comply with the ICO requirements.

The first step is to write an overarching asset disposal policy. This should include data categorisation, business impact, threat profiling, risk assessment and finally, this should produce an approved media sanitisation profile.

We then write internal and external policies and procedure statements to measure and mitigate operational and third party risks.

Not only must an ICT disposal policy cover all different media types, but it must also be interpreted into departmental policy, which sits across all hardware streams and all forms of hardware ownership. It is crucial that the processes include the provision and maintenance of the chain of custody of assets throughout. Too many companies have no idea what assets they have released for disposal, with no genuine audit trail in place.

All data processors should have a clear service specification issued to them and this relationship should be governed by a contract, issued as a result of a thorough selection process. This process should measure the processor’s capabilities to perform the services and should be able to be used to show due diligence on the data controller’s behalf.

Step four involves auditing and reporting, which is essential to show compliance.

All internal and external processes need to be measured and assessed.

Finally, review. Too many disposal policies are outdated within months of completion.

Threats change; technology changes and businesses themselves change. The disposal policy should have a 12-month review period.

There are many resources available from ADISA to help, including a white paper on the changes to the Data Protection Act and impact on ICT Disposal and also formal training courses with the University of South Wales.

The starting point would be to participate in a free webinar on 29 May 2014, which has speakers from the Information Commissioner’s Office and from NHS Trusts. The objective is to introduce the ICO guidance notes and offering advice on how to interpret these into sensible operational improvements. L FURTHER INFORMATION www.adisa.org.uk

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SECURITY

BETTER PROTECTION FOR LONE NHS WORKERS

As the NHS grapples with targets to save £20 billion, and with BUPA estimating that £1.7bn could be saved annually by treating people at home, more and more NHS staff are working alone.

Unfortunately, it is inevitable that staff are at increased risk of physical and verbal assault An increasing number of NHS staff work alone or in community settings such as patients’ homes or on outreach work. Like all lone workers, they can be vulnerable and at increased risk of physical or verbal abuse and harassment from patients, clients, relatives or members of the public.

A Royal College of Nursing survey in 2011 showed that approximately 85 per cent of survey respondents spent more than a quarter of their time working alone, and therefore at increased risk.

According to NHS Protect, a department that advises the NHS on safety and other matters, there were over 60,000 reported physical assaults against NHS staff in England in 2012/13.

This is a worrying 5.8 per cent increase from the previous year. Verbal abuse is particularly prevalent, with many staff being affected on multiple occasions. According to the Crime Survey England & Wales (CSEW), 41 per cent of victims of workrelated violence were assaulted or threatened twice or more in 2011/12.

being re-invented. Working arrangements are becoming much more flexible, facilitated by the latest mobile working platforms that include scheduling systems, patient records, and proof-of-attendance systems, all based on the smartphones and tablets that more and more trusts are deploying in the search for cost-savings.

Henry Woods, CEO of Guardian24, comments: “We are seeing many NHS Trusts moving their lone working protection to smartphones and tablets, driven by the need to deploy mobile working systems to secure cost savings. Even if they have no immediate plans for mobile working systems, it makes a lot of sense to protect their investment in Lone Working by getting the technology choice right for the future.”

“As an added benefit we find greatly increased employee engagement and higher utilisation of the smart-phone solutions; they are more intuitive, more familiar, more current.

These days a smart-phone is what people are using day-in and day-out. Their phone is always there, always charged, always ready. That makes it a very safe place to put their Lone Worker safety app. And there is so much more we can do to help them when they have a smartphone; we can text them, talk to them, remind them, re-train them, integrate with other apps on the same device. Soon there will be video and motion-detection. Going the smartphone route is very compelling, both financially and from a technology point-of-view.“

were e r e h T 0,000 over 6 physical HS ted repor s against N , 3 lt assau ff in 2012/1 t n sta per ce the 8 .

5 a m se fro ear a e r c in us y previo

THE NEW GENERATION OF LONE WORKING SOLUTIONS FOR THE NHS There is no doubt, then, that these dedicated staff are increasingly at risk, and more and more NHS Trusts and Boards are moving away from the traditional worker safety solutions based on whiteboards, buddy systems and dedicated devices. And with good reason; information on a whiteboard can easily be erased whilst a ‘buddy’ may not always be available should a situation arise where help is required. There are also limitations to the use of dedicated lone worker devices: staff can often forget to bring this additional piece of hardware with them, leaving it at a desk or in a drawer. And they can forget to charge it, so that even if they do bring it with them it may not be ready for use.

But change is happening very quickly, and the real driver is that as technology advances, the NHS workplace, like every other, is

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GUARDIAN24 LEADS THE WAY Guardian24 has been working with NHS Trusts & Boards for over 10 years, helping to protect thousands of NHS staff each year.

More recently the company has become the clear leader in ‘smart’ lone worker solutions, not just in the UK but also in the USA, where the company has signed a number of contracts with Human Services departments in Philadelphia, Delaware and elsewhere.

“Like other Lone Worker companies, we have worked with feature phones and dedicated devices for many years, and we will continue to

fully support our hundreds of customers who for valid reasons still want to use those solutions.

What we are talking about here is the trends we are seeing for the near future” added Woods.

CALLING FOR HELP Guardian24 allows users to log their daily tasks, get GPS location fixes and any other important information. Should user safety be compromised, they can easily summon help with the press of a panic button on their device. If they do, the service will immediately start to record live audio and notify a nominated respondent or emergency services. L FURTHER INFORMATION Tel: 0207 118 8247 info@guardian24.co.uk www.guardian24.co.uk

STAFF PROTECTION

Security

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

TECHNOLOGY FOR STAFF PROTECTION

The importance of security in the healthcare sector was highlighted at the end of last year, with the publication of the latest NHS security figures revealing a shocking 5.8 per cent rise in the number of physical assaults against health service staff in the past year. Collated from NHS Trusts across the UK, these figures reported that physical assaults against NHS staff in England for the year 2012-13 were shown to have risen from 59,744 in 2011-12 to 63,199 in 2012-13.

Some healthcare staff are, of course, more at risk than others. Those who work in isolation, or out in the community, are at particular risk, and employers across the healthcare sector should be committed to the development and implementation of a comprehensive lone worker policy to protect these employees, and

the organisation at large. Such ‘lone working’ is commonplace in the health sector, with a 2012 study by the Royal College of Nursing revealing that more than 60 per cent of community nurses spend more than half their time as lone workers without immediate access to a colleague for support. Over 70 per cent of respondents to this survey also reported that they had been subject to either physical assault or verbal abuse during the course of their jobs in the two years prior to the study.

LONE WORKER DEVICES Thankfully, the use of lone worker devices by many NHS Trusts and private healthcare firms is helping to alleviate this situation.

Working alongside their clients in the healthcare sector, several

In tal, a hospi g can rin monito ce of mind a offer pepatients and to both rs, knowing visito unwanted that no ssers will trespa rb their distu acy priv

members of the British Security Industry Association have developed highly-effective lone worker devices, which are equipped with mobile phone type GSM technology to connect employees quickly and discreetly with an emergency response system that has direct links to the police. In fact, a number of products are now commercially available from BSIA member companies, including the Reliance Protect solution used largely across the NHS, which is styled like an ID card holder.

Working alongside private security providers is a key element of the NHS’s lone worker protection strategy, and NHS Protect – the central security management body for the National Health Service – is actively involved with the BSIA’s Lone Worker section committee, particularly its work in the development of the British Standard for lone worker protection, BS8484. The adoption of BS8484 lone worker solutions in the NHS is implemented largely through a national E

Volume 14.3 | HEALTH BUSINESS MAGAZINE

Written by James Kelly, BSIA

James Kelly, chief executive of the British Security Industry Association, explores the modern security measures that can help NHS Trusts combat threats to healthcare staff

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BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

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HEALTH BUSINESS MAGAZINE | Volume 14.3

ACCESS CONTROLS

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STAFF PROTECTION

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“Choosing a supplier whose lone worker protection solutions fully adhere to BS8484 is an essential step in mitigating and eliminating the risks faced by lone workers in the healthcare sector. One of the key benefits, aside from a top priority response from the police, is that they enable audio evidence to be captured” Chris Allcard, Reliance High-Tech  Framework Agreement. Chris Allcard, Head of Lone Worker Services at Reliance High-Tech, comments: “Choosing a supplier whose lone worker protection solutions fully adhere to BS8484 is an essential step in mitigating and eliminating the risks faced by lone workers in the healthcare sector. One of the key benefits of BS8484 solutions, aside from a top priority response from the police, is that they enable audio evidence to be captured, which can be used as part of taking action against aggressors and offenders, giving healthcare organisations an added layer of protection. Integrating these solutions into an organisation’s lone working policies and

procedures, coupled with ongoing compliance monitoring, can help provide a comprehensive solution such as is currently evident within the NHS.” PREVENTING ASSAULTS ON STAFF Other security technology used within the hospital, clinic or surgery setting can also help to reduce the risk of assault, while also protecting the vulnerable patients being cared for within. CCTV, for example, provides the healthcare sector with a mechanism to deter or detect criminals and trespassers, while monitoring the activity of authorised personnel such as staff, patients and visitors. In a hospital Video Content Analysis can be used to automatically detect an intruder, or to count the number of people entering or leaving an area

environment, such monitoring can offer peace of mind to both patients and visitors, knowing that no unwanted trespassers will infringe upon their privacy despite the hustle and bustle of a busy healthcare setting.

Such security can stem beyond the four walls of the premises. Cameras can also be strategically installed around the perimeter, particularly around car parks. Hospitals, in particular, are vulnerable to thefts from their long-stay parking, with many visitors staying for a long period of time, particularly if their loved ones are undergoing extensive treatments or lengthy operations. Therefore, thieves may see these unattended vehicles as easy targets. CCTV can closely monitor these areas, deterring thieves from damaging or stealing this property and maintaining a safe environment for those passing through.

VIDEO CONTENT ANALYSIS One particular element of CCTV that is being increasingly employed in a number of sectors, including healthcare, is that of Video Content Analysis (VCA). VCA is the name given to the automatic analysis of CCTV images, which is then used to create meaningful information regarding the content. For example, VCA can be used to automatically detect an intruder, or to count the number of people entering or leaving an area – beneficial, for instance, for keeping track of how many people have entered or left an emergency room during a given period of time.

If the area that needs protecting is particularly extensive – such as the multiple floors and rooms of a hospital building – then multiple screens are often required to be monitored at once. VCA can offer solutions to make this monitoring process as efficient as possible, particularly during the night when fewer staff may be on duty. Advances in technology means that this process can be streamlined through the deployment of either motion sensors for the CCTV – where the cameras only start rolling when movement is detected – or by using fence-mounted vibration detectors that trigger an alert in the security control room. L FURTHER INFORMATION www.bsia.co.uk

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EVENT PREVIEW

HEALTH+CARE 2014

Health + Care 2014

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

On 25-26 June 2014, little over one year on from the biggest reforms in the history of the NHS, Health+Care – incorporating The Commissioning Show – will bring together 7,000 delegates comprising clinicians, commissioners, providers and social care teams for networking, seminars and keynote speeches from practitioners and policy makers This must-attend event comprises six conferences, bringing commissioners and providers of NHS services from all over the UK together under one roof. Over 160 speakers – including past and present health and shadow health ministers Andy Burnham, Norman Lamb and Stephen Dorrell – will be joined by current NHS figureheads including Sir Bruce Keogh and Tim Kelsey, alongside many others. This event is made truly unique by the variety of attendees and the UK’s largest primary care sourcing floor, with more than 400 exhibitors.

Speaking about last year’s show, Andy Burnham MP and Shadow Health Secretary said: “It’s essential that people involved in healthcare and commissioning come to a conference like this because otherwise they can end up just ploughing away in their furrows on their own. That can be quite dispiriting and can make people think that they are the only person in this boat and the only person facing this challenge.”

FINANCIAL CRISIS It is well documented that our NHS is facing a financial crisis and what is required is an open and transparent debate about how our limited resources should be used. Health+Care 2014 provides the perfect environment for all healthcare professionals, commentators, policy makers, procurers and suppliers to collaborate, share ideas and help shape the future of our health service. Last year saw 75 per cent of CCGs and 100 per cent of CSUs represented, and high level representatives from social care, primary care, acute trusts and service providers are expected to be in attendance this year.

Programme director, Mike Broad explains: “Even before the doors closed on last year’s event, we have been working hard with our partners to build a programme that blends hard-hitting policy updates with real life experiences from the front-line of care. From provider owners and managers, care commissioners and heads of service, to ministers of state; there will be updates, advice and ideas from every corner of care provision.”

The delegates in attendance will be invited to create their own programme of events, selecting various workshops and presentations from 14 work-streams.

They will be able to ‘mix and match’ these sessions, allowing a bespoke and relevant programme to be created by each individual.

Delegates will also have the opportunity to network with service providers about administrative and commercial issues affecting

Over 160 speakers – including past and present health and shadow health ministers Andy Burnham, Norman Lamb and Stephen Dorrell – will be joined by current NHS figureheads including Sir Bruce Keogh and Tim Kelsey, alongside many others healthcare and hospital management.

Dr Phil Yates, Chair GP Care, explains why people should attend his discussion on the practicalities and pitfalls of bidding for provider contracts: “This is a critical topic as there must be a good process internally for meeting deadlines, demonstrating capability and staying in the process successfully. Much is not known at the time of initiation of a bid and any provider has to learn as much as they are able as the bid progresses. Judgment calls have to be made about entering a bid – What is the chance of success? What is the risk of financial or service failure from implementing a successful bid? Can the organisation risk losing or, indeed, winning?”

Many aspects and workshop strands of the conference will centre on management

and technology issues, especially on collaboration and gaining value from commissioned services. Launching at this year’s show, Technology First is dedicated to making use of the huge amounts of data generated in the NHS to enable CCGs to make better and more informed decisions when commissioning healthcare services, with a view to improving efficiency, delivery of service and patient outcomes. There will be an opening address from Kingsley Manning, Chair of the HSCIC, focussing on the need for better use of data analysis within the integrated healthcare system.

At the centrepiece of the whole event will be the ‘Big Data’ Showcase, supported by NHS England. This will consist of an entire stream of conference presentations E

Volume 14.3 | HEALTH BUSINESS MAGAZINE

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Synapta : The Patient Engagement Platform

MAKING EVERY COMMENT COUNT

Good

HEALTH

by JIM WARD Good4HEALTH

Bringing FFT Data to Life with Automatic Text Analysis The real service-changing insights that emerge from the Friends & Family Test (FFT), come from the unstructured free-text responses. However, processing huge volumes of text presents a significant challenge for service providers. Synapta’s integrated automatic text analysis offers the best value and performance for service providers to manage and act on free text feedback...

Why do we need to automate?

The comments given by patients in the follow up question to the main FFT question can provide a rich source of information about how patients are feeling, their likes and dislikes and any unmet needs. It’s easy and inexpensive to collect this feedback, yet much of the value is lost in the time it takes to read and interpret it.

How can Synapta help?

Synapta automates the analysis of comments to solve volume, speed and accuracy issues and deliver truly actionable insight to service providers. Synapta ‘reads’ the comments and makes judgments for you based on training it has received about how you prefer responses to be classified then generates a report and charts to highlight themes across your feedback.

How does it work?

A code-frame is created that defines all of the categories that can be used to classify data such as ‘Staff Positive’, ‘Cleanliness Positive’, then Synapta’s knowledge-based system is trained with real-world examples.

Once trained, the code-frame is ready to use as often as required to automatically process batches of response data. What is great for FFT analysis is that we have already generated a generic code-frame that can be instantly put into service, processing data.

Why is Synapta better at this?

over

million free text responses could be generated by patient FFT feedback every year

cards this ack wo db uld e e f g

Not all automatic text analysis tools are equal, Synapta doesn’t use a simplistic dictionary-based or word matching system. Many systems look for stock phrases or particular keywords appearing within a comment to categorise it. This method is fairly unintelligent and provides poor categorisation results as sentiment is lost, along with much of the meaning. Synapta is different, it considers the context of the entire text and can understand sentiment. When someone says ‘the nurses were great but the food wasn’t up to scratch” Synapta recognises the distinct positive and negative feedback from one sentence.

ate er en

us ing

It can also flag up potential problems such as complaints and allow you to drill down into the comments in a structured way.

t of igh e he s th ime .5 t k1 tac as

Is it accurate?

... rest Eve

Synapta is able to code and categorise text more accurately than a human coder. Based

on the quality of examples the IDA (Intelligent Discourse Analysis) module is given and the training, it’s able to behave consistently in the choices it makes about categorising thousands of texts.

Patient comment coding examples...

Doctors and nurses amazingly knowledgeable, responded to me, careful and friendly.I acknowledge it's hard to cook for that amount of people but much of the food sweated under the lids badly Nursing Staff Positive Doctor / Consultant Positive Food Negative

Lovely caring staff, cluttered depressing room Staff Positive Comfort Negative

I cannot fault the treatment, but the worst part was no TV to pass the time General Positive Comfort Negative

For More Information visit our dedicated mini site at www.FFTHealth.com or contact Jim Ward at Good4Health jim@good4health.co.uk +44 (0)1555 666344

EVENT PREVIEW  designed to highlight how the use of data analysis tools can enable the NHS to correctly interpret the data produced.

INTEGRATED CARE The integrated care theatre will feature keynote speeches and interactive debate, bringing you head-to-head with the most influential politicians, leaders, innovators and implementers across health and social care, including the Rt Hon. Norman Lamb, the Rt Hon. Stephen Dorrell, the Rt Hon. Andy Burnham and Lord Victor Adebowale.

We will showcase early results from the Integration Pioneers and discuss how this innovation can be spread at scale and pace.

Other key topics will include: maximising the impact of the Better Care Fund; whole-system transformation of out-of-hospital care; and Labour’s proposals for health and social care and the future role of Health and Wellbeing Boards. Achieving – and measuring – parity of esteem for mental health, overcoming system fragmentation to tackle public health timebombs, such as obesity and alcohol dependency will also be discussed, as will pricing to incentivise innovation and improvement, and the role of regulation as a quality driver. What’s more NHS England’s newly formed Citizen’s Assembly will debate how patients’ can secure their place in the heart of the NHS. Highlights include: the Better Care Fund – is it better for all?; unleashing the power of people and technology on the NHS; and parity of esteem in mental health – are we hotter or colder.

care. There will be presentations on business and financial planning, continuity and risk, management and training, and guidance on business development, marketing strategy, and tendering and contract management.

Furthermore, this stream will bring together leading organisations that are working with commissioners to transform the sector’s role, offering vital services that balance cost, quality, choice and value-for-money.

Delegates will have the opportunity to learn from the trailblazers, and develop the hallmarks of successful, personalised residential care. Highlights include: the future of residential care; golden rules for profitable care businesses – the KPIs that count; and driving innovation in dementia care.

HOME CARE There are over 6 million hours of regulated home care delivered every week in England and the total home care market is valued at £5.5bn, with public expenditure making up £2.2bn of this. With an ageing and more affluent population, this demand for domiciliary care in its many different forms is set to increase, particularly among self-funders.

At the heart of the government’s recent Health and Social Care Act is a drive towards personalised services that promote user control and dignity and enable people to stay in their own homes and communities.

But, despite the potential, the challenges to delivering high quality home care services are considerable. It’s a low profile sector, and fees have been slashed as local authority budgets have been squeezed.

The home care speaker stream at Health+Care offers delegates advice on how to run, and develop, home care agencies in this evolving market. At a strategic level, experts will offer insight into market trends following the government’s Care and Support Bill and the Health Act. But, at a more practical level, high value advice will be presented on effective business and financial planning, business continuity and risk, effective leadership and management, and workforce development.

Furthermore, there will be guidance on sourcing investment for business development, marketing strategy, and best practice on tendering. The home care stream will bring commissioners and providers together to discuss the evolution of domiciliary service provision, and how agencies can make the most of the new opportunities. Highlights include: raising quality in challenging times; improving dementia in the home care setting; and what does personalisation look like in home care?

Health inequalities continue to blight the

Care Health+ vides o 2014 pr rfect e the p ent m environ hcare t l for hea ls to help ona professi the future shape health of our ce servi

RESIDENTIAL CARE There’s a revolution going on in primary and social care. Policy makers want the system to take a ‘whole population’ approach to improving public health and wellbeing and act against the escalation of health and social care needs. As part of this, the Government is seeking a more preventative approach that keeps people in their own homes and, if things go wrong, rapidly rehabilitates them. However, the residential care sector continues to grow with over 21,000 registered care and nursing homes and more than 500,000 residents.

Set against policy drivers and funding constraints are the growing number of vulnerable older and disabled people with complex, long-term conditions and significant support needs. There’s a growing realisation that the UK needs a diverse, high quality care sector that can meet these needs and residential care remains an important part of that.

The residential care stream at Health+Care will help delegates to improve the efficiency of their businesses and effectiveness of their

UK despite our relative affluence. We’ve lagged behind our European counterparts when it comes to key public health indicators, such premature deaths under the age of 75 and on levels of lung and liver disease.

Poor lifestyles persist in many areas of the country and obesity levels continue to rise.

The government has sought to radically reform the public health system through the Health and Social Care Act – seeking a more pre‑emptive, locally determined approach, with responsibility for public health passing to local authorities and Public Health England.

The Public Health stream within Health+Care will bring together public health delegates, GPs, CCG leads, directors from local government, social care and providers to share ideas and experiences. In particular, it will bring together the key players on Health and Wellbeing Boards from all around the country to share live case studies and examine how to improve health outcomes. Highlights include: are local authorities embracing a broader public health culture?; integrating public health, health and social care – lessons from Sweden; and integrated health and care personal budgets – early leaning.

Health + Care 2014

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

CARE COMMISSIONING It’s nearly ten years since the implementation of Every Child Matters, which brought children’s services and education together to improve outcomes and safety. But, with mounting financial pressures, times have changed. The future of working with families is uncertain, and there’s a new set of challenges for senior directors and commissioners alike.

The care commissioning stream at Health+Care will share ‘live’ case studies delivering innovative, proven and child‑centred solutions in the most complex and challenging situations. Speakers will offer practical cost saving ideas for driving efficiencies; leading edge projects on putting the service user at the centre of design and improving performance; the latest research and evidence from the academic world, and updates on policy developments and political thinking.

There will also be a particular focus on commissioning and contracting issues – how to develop better understanding, long-term planning and sustainable funding and services.

Highlights include: delivering improved outcomes for children and financial savings with better joint commissioning; strategic transformation of services through evidence based commissioning; and harnessing the strengths of the community sector in supporting children and families. L

FURTHER INFORMATION The Commissioning Show and Health+Care will take place on 25-26 June at Excel, London. Passes are free for NHS and public sector teams, but you do need to register in advance here http://closerstill.circdata-solutions.co.uk/ Microsites/HC14/

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BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

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HEALTH BUSINESS MAGAZINE | Volume 14.3

Date of preparation: February 2014

Impressive savings for medical practices At a time when staff resources and budgets are under immense pressure in the healthcare sector, cost-effective and time-saving solutions are always welcome.

Practices that currently print and mail appointment letters, vaccination reminders and other important information in-house know all too well how big an undertaking this can be. However, practices could be saving around £7,000 every year by switching to a hybrid mailing system.

With an average saving of 70 pence per printed letter over the traditional method, the Docmail hybrid mailing service offers both time and cost saving benefits, as compared with labourintensive task of a manual postal mailing, without compromising on service or quality.

Docmail offers a tangible alternative for less than the price of a second class stamp. Instead of the time-consuming process involved with printing and

stuffing envelopes, and the cost of postage and stationery items, the Docmail solution allows practices to manage all their mailings with just a few clicks via an online portal, safe in the knowledge their correspondence will reach recipients on time, and looking just as professional as if they had sent it themselves.

The efficiencies of the service have now been recognised by more than 2500 medical practices who have integrated the Docmail solution into their practice processes and enjoy the cost and time saving benefits.

FURTHER INFORMATION Tel: 01761 416311 www.cfh.com

HEALTHCARE

Intrim Medical & Rescue Services – exceptional care at all times Intrim Medical & Rescue Services is based in Long Eaton area of Nottinghamshire with fantastic access to all major routes to the North, South, East and West.

Intrim Medical offers specialist services within the mental health remit and understands patient needs, enabling the company to fulfill the requirements of mental health patients more effectively.

Intrim Medical provides ambulance crews trained to the equivalent of the NHS ambulance services, with added skills in mental health such as cuff and restraint crews.

Intrim Medical works closely with other agencies and

organisations to fulfill the needs of the mental health structure.

Intrim Medical is also able to offer other services, such as non-emergency patient transport services, high dependency care transfers, transplant and organ team/tissue transfers, response cars, emergency ambulances and personnel.

Should you feel your trust, CCG, CSU or service would benefit in discussing ambulance transport facilitation then please don’t hesitate contact Intrim Medical.

FURTHER INFORMATION Tel: 0844 310 0070 info@intrim-medical.com www.intrim-medical.com

Enhancing patient lives whilst delivering real value to the NHS Spirit Healthcare is one of the fastest growing UK healthcare businesses with expertise in supporting long term conditions.

The key to its success is working with the NHS, identifying opportunities to help patients and clinicians to manage conditions, reducing hospital admissions and improving patient quality of life.

Its CareSens N range of blood glucose meters – which includes Voice, a talking meter for the visually impaired – all comply with the latest ISO accuracy standards. Spirit Healthcare’s clinical educators deliver EMPOWER, a structured educational programme designed to provide people with diabetes the knowledge and confidence to help self-manage their condition.

Clinitouch telehealth integration allows high risk COPD and heart failure patients to be managed at home using state-of-the-art

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technology and dedicated nurses who monitor vital clinical data and provide interventional care, reducing hospital admissions and helping to improve patient lives.

Community Photodynamic Therapy helps move appropriate services out of secondary care and closer to patients using Ambulight, an ambulatory light source for treating nonmelanoma skin cancer.

Spirit Healthcare can help make your budgets go further whilst improving patient lives.

FURTHER INFORMATION Tel: 0116 2865000 info@spirit-healthcare.co.uk www.spirit-healthcare.co.uk

HEALTHCARE

Re-designing your GP appointment systems Productive Primary Care is a market leader in re-designing GP appointment systems, specialising in demand management.

The GP led company has a team of associates including practice managers.

The company works with both GP practices and clinical commissioning groups to improve access and reduce A&E attendance and has experience in re-designing appointment systems within the confines of your practice structure to better meet the needs of your patients.

Productive Primary Care is skilled in carrying out audits, understanding demand and matching capacity by reshaping services. The company can help you to understand demand and to know when your patients need help.

The following benefits are all associated with its systems: Patients are seen when they want, by whom they want; the neediest patients are seen

first; DNA’s (Did Not Attends) are improved; complaints are reduced; doctors and staff work in a much more productive and satisfying way; clinicians know what their workload is every day and have greater control over their working life; there are enough appointments for everyone; staff do not have to make decisions beyond their knowledge base.

If you would like to find out more, please visit stand number O50 at Health + Care 2014.

FURTHER INFORMATION Tel: 0800 6990184 Mobile: 0779 5248771 admin@productive primarycare.co.uk www. productive primarycare.co.uk

Volume 14.3 | HEALTH BUSINESS MAGAZINE

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PARKING

PARKING

Local Parking Security (LPS) is a specialist in car park management nationwide, with over 25 years experience in the parking industry.

The company manages a variety of car parks including residential, hotels, pubs, hospitals and shopping centre and manages car parks with any number of spaces.

LPS uses a variety of payment options, including chip and pin, coin only, barriers, pay by phone and permit holders only, and deals with the whole process in-house, from the first phone call through to car park installation, providing all equipment and signage free of charge.

The company is a member of the BPA’s Approved Operators scheme, and has designed its very own solar powered pay

Fast Park Group has been providing unique parking solutions to its NHS, commercial and retail clients, internationally for more than 20 years.

The company provides a turnkey solution; from design through to planning approval, project management, installation and final certification.

Fast Park® is a modular parking system that can be demounted, altered in size and shape or left in-situ. With no traditional foundations, it can be completely relocated with no disruption to the current parking footprint or left as a permanent parking structure.

Fast Park® is supplied and installed within a few weeks from final design approval, causing minimal disruption to existing parking requirements.

As of July 2012, Fast Park

Local Parking Security – the specialists in car park management in the UK

and display machine which is manufactured in the UK. LPS also has a stock of machines ready to be installed, cutting the lead time down to a maximum of two weeks.

If you are experiencing problems with your car park, or to arrange a free, no obligation survey please call or visit the website.

FURTHER INFORMATION Tel: 01789 293273 www.localparkingsecurity.co.uk

A workable solution to your parking problems

AMBULANCE

SECURITY

Southern Country Ambulance Service is a family run, private ambulance provider serving the south of England from its base in Micheldever, Hampshire.

Southern Country Ambulance provides services to the NHS, private hospitals, clinics, insurance companies, social services, care homes, commercial enterprises, air ambulance providers and private individuals, etc. Its focus is on providing clients and patients with a friendly, professional, personal service, attending to each individual’s requirements whilst in its care.

The majority of the company’s work is non-emergency patient transport services. It assists local health trusts with patient discharges, outpatient appointments, hospital to hospital transfers and admissions.

Southern Country Ambulance Service also handles long distance transfers/urgent organ transfers and ‘last request’ compassionate day trips.

The fleet consists of stretcher

With headquarters in London and regional offices in Rochester, Manchester, Bracknell and Harrogate, Ward Security is a specialist security company that provides a full range of services to high profile companies and healthcare organisations nationwide.

An employer of over 500 security personnel, Ward Security holds the Investors in People Gold Standard and places a continual emphasis on staff training and welfare. The company is an SIA Approved Contractor for the provision of security guarding, CCTV and keyholding and is demonstrably committed to excellence in customer service and the correct licensing of all its staff.

Ward Security prides itself on forging strong client relationships and takes a proactive approach to customer service by continuously thinking ahead and anticipating clients’ needs. The company

Private ambulance services for the NHS

capable and wheelchair accessible ambulances, including a Toyota 4x4 stretcher vehicle and all are extremely comfortable and fully equipped.

Southern Country Ambulance Service also offers an executive car service to doctors and consultants etc, using Mercedes Benz E type saloon vehicles.

All staff are enhanced CRB checked, trained to a minimum of technician level and are ‘blue light’ advanced driver trained.

The company is CQC Registered.

(Cert no: 1-261222958) and is a member of the British Ambulance Association (Member No.12).

FURTHER INFORMATION Tel: 01962 774999 scas999@yahoo.co.uk

Products & Services

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

System UK Branch can offer its clients the option of leasing its parking decks through the company’s NHS approved financial service provider.

This essentially means that Fast Park Group is able to solve your parking problem within a short period of time, with minimal disruption or loss of capacity and it can pay for itself from day one.

For more information on the Fast Park® system or projects undertaken on behalf of the NHS, please visit the website.

FURTHER INFORMATION www.fastpark.com

Providing quality security services for the healthcare sector

creates innovative cost saving solutions by combining the use of modern security techniques such as wireless intruder detection systems to the more traditional approach of manned guarding to provide the best possible security and deterrents.

A key specialism of the company is the provision of search and guard dogs and it has worked closely with the Metropolitan Police on a number of specialist projects utilising its dog section.

FURTHER INFORMATION For more information see www.ward-security.co.uk

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Products & Services

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

FACILITIES MANAGEMENT

UTILITY SERVICES

For nearly 40 years, the Harmer brand from Alumasc has instilled confidence in specifiers and contractors, using methods and materials that have stood the test of time.

Harmer SML Cast Iron Soil and Waste system has been specified for many of the country’s leading healthcare facilities, due to its unsurpassed hygiene qualities and high flow rate performance.

Most recently, Harmer SML is being installed at the new Alder Hey Children’s Health Park in Liverpool – a £288m project, designed by BDP architects, and delivered by main contractor Crown House Technologies and Consulting Engineers Hoare Lea. Alumasc worked closely with BSS Drainage to fulfil both the technical and commercial requirements of the contract, which is due for completion in 2016. This massive installation represents just one of many

If you’re looking to cut your business overheads, let The Utility Warehouse Business Club supply your phone and broadband, mobiles, gas and electricity. The more services you take, the more you can save.

Plus, you can earn up to 18.5 per cent cash back when you buy your everyday supplies.

The Utility Warehouse Business Club is here to help, and it will help you save money.

Unlike other utility companies, it has on-the-ground local distributors that you can call on to help you save money.

The company is committed to providing excellent customer support and has a single number for its award-winning UK call centre, offering prompt and professional help on managing your account and technical issues so you can get on with running your business.

So, if you want a better deal for your business utilities, join The Utility Warehouse

Hygenic drainage solutions from Harmer

successful healthcare applications for SML, with other landmark projects including Royal London & St Barts Hospital’s in London, Derby Hospital, Coventry’s Walsgrave Hospital, Norwich and Norfolk University Hospital in Norwich, Bristol Royal Infirmary and the prestigious London Cancer Clinic in Harley Street.

SML can be integrated with Harmer roof outlets and floor drains, both of which were also specified at Alder Hey and Royal London & St Barts.

FURTHER INFORMATION www.harmerdrainage.co.uk

Welcome to The Utility Warehouse Business Club

FACILITIES MANAGEMENT

CLEANING

When you’re looking for a facilities management partner, it makes sense to choose a company that will use its expertise to add value to your organisation; a company with an outstanding track record in healthcare FM. Robertson Facilities Management is part of Robertson, a group of companies working in infrastructure, support services and construction across Scotland and the North and Midlands of England. Established in 1966, Robertson employs over 1200 dedicated, skillful and enthusiastic people.

The company provides innovative solutions that allow you to focus on your core duties while it takes care of your building maintenance, hard and soft FM services and asset management.

Each organisation, every location, has a unique set of needs. Robertson works in partnership with NHS clients to

Vileda Professional has developed a next generation cut-pile microfibre, which is now used in all of its Swep Pre-prepared Mopping range. It provides 30 per cent more dirt removal, 40 per cent better floor coverage and 10 per cent less friction compared with competitor equivalents. Swep allows you to clean better, faster and further.

The Swep mopping range which includes double sided and single sided microfibre mops in a range of sizes – 35cm, 50cm and 75cm – is a firm favourite amongst cleaning professionals working in the healthcare sector, as it is designed to meet the specific demands of this industry in terms of contamination control and budget.

The Swep range is also environmentally friendly by significantly reducing the amount of water and chemical required for cleaning. There are also no harmful substances used in the microfibre’s raw materials or its production processes, which

Business Club today. Take a look at the website and see for yourself what you can save.

Contact David Lench direct for a personal service, and there is no charge for this.

FURTHER INFORMATION Tel: 01297 33009 Tel: 07957 863363 davelen@country maid.go-plus.net www.utilitywarehouse.org. uk/countrymaid/business

Robertson – your facilities Micro cleaning – lower management partner costs, massive results

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tailor individual service packages that meet their challenges.

These include cleaning, grounds maintenance, lifecycle management, catering, security, energy and utilities management, reception and helpdesk services.

The company also provides consultancy on issues like asset management, space utilisation, emergency planning and legislative compliance.

Backed by the resources of a large and well-established group, operational staff have a firm commitment to the community in which they work.

FURTHER INFORMATION Tel: 01786 431600 www.robertson.co.uk

HEALTH BUSINESS MAGAZINE | Volume 14.3

is independently verified by the Nordic Ecolabel following a rigorous approval process.

As would be expected from Vileda Professional, the Swep range is extremely durable with guarantees of up to 1000 washes, even when used with hypochlorite; its trapezoid shape improves cleaning of corners, edges and stairs; and removes 99.9 per cent of bacteria without chemicals, giving the healthcare establishment, its patients and staff complete peace of mind.

For a free trial and more details on the complete product range call or visit the website.

FURTHER INFORMATION Tel: 01706 759597 www.vileda-professional. com/en-GB.

MARKET RESEARCH

HEALTHCARE IT

Conducting research to measure performance and understand consumer experience is as critical within the health sector as in the world of commerce; but requires a more subtle and tailored approach to be truly reliable and provide real insight.

Established approaches including ‘customer satisfaction’ or ‘likelihood to recommend’ have delivered one dimensional and sometimes misleading results – doing little to help healthcare professionals understand where to act or how to prioritise change.

The industry needs a new way of researching patients’ perspectives.

Healthcare Research Solutions offers research-driven insight that is robust and action-oriented, providing much more than just headline metrics that are of little practical use. Its approach is built on years of market research experience across diverse sectors, including both the NHS

Fragility fractures are a major cause of disability and mortality in the UK. Projections show that based upon current trends, by 2036, there could be as many as 140,000 hospital admissions for hip fracture a year in the UK – an increase of 57 per cent on 2008 admissions.

The cost of treating and caring for hip fractures in the UK could exceed £6 billion by 2036.

Evidence clearly demonstrates the positive impact of fracture liaison services can have on reducing the burden; however there still remains a large gap nationally in terms of the implementation of fracture liaison services.

Health Intelligence is working in partnership with a national primary care lead in osteoporosis and fracture prevention management.

Its aim is to develop a clinical dashboard and supporting service solution to support the delivery of the key strategic objectives in

Tailored market research services from Healthcare Research Solutions

and private sector. Healthcare Research Solutions’ fresh approach to service measurement is based on bespoke online research covering key critical measures of patient experience, combined with a diagnostic element allowing the company to tailor the research to meet the specific needs of each client – it is both cost-effective and unique.

FURTHER INFORMATION Contact: Andy Baker on 01603 673423 or Hugh McCormack on 0115 914 2887 admin@hrs-intelligence.co.uk www.hrs-intelligence.co.uk

MODULAR BUILDINGS

Health Intelligence pathways supporting fracture prevention

Products & Services

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

falls and fracture prevention.

The company’s clinical pathway programme utilises integrated technologies in identifying patients that require interventions, evaluating the effectiveness and impact of interventions across the pathway, supporting the service redesign process in line with best practice and therefore supporting the NHS to improve health outcomes for this complex cohort of patients.

FURTHER INFORMATION Tel: 01270 765124 enquiries@healthintelligence.com www.health-intelligence.com

ENERGY

Clear the path for Streamline your hospital’s improved patient services power efficiency Implementing a new strategy to tackle soaring waiting times can be a stressful experience for healthcare and hospital management teams.

They have to ensure that the patient experience is not disrupted, staff can deliver treatment as normal and also see the results from their new innovative approach.

Portable surgical facilities – including operating theatres, wards and endoscopy units – are an effective way to manage the increased flow of patients by boosting the capacity of existing facilities and preventing patients from being deployed to nearby hospitals. Hampshire Hospitals NHS Foundation Trust had a significant number of patients needing endoscopy treatment.

As such the team at the trust’s Basingstoke hospital knew that some radical changes were required and subsequently devised a yearlong strategy to increase service levels whilst maintaining high levels of patient care. This included renting a mobile endoscopy suite.

The mobile unit was provided by Vanguard Healthcare – a leading supplier of 41 highly equipped temporary surgical units to hospitals across the UK and wider Europe. It was installed on the Basingstoke hospital site to provide the hospital with the additional capacity required to successfully treat nearly 1,800 patients. Not only did this further demonstrate the urgent requirement for an additional endoscopy procedure room but opened the door to achieving JAG accreditation.

The temporary endoscopy unit was operational within two weeks after the necessary water testing and proved to be a great success – helping reduce waiting lists to a near zero at one point.

FURTHER INFORMATION www.vanguardhealthcare.co.uk

In its ground-breaking 2010 MACC (Marginal Abatement Cost Curve), the NHS Sustainable Development Unit identified voltage reduction (widely known as voltage optimisation) as one of the most effective energy efficiency measures for the NHS. To determine how to maximise cost savings from voltage reduction the UK’s innovation agency, the Technology Strategy Board, has contracted Streamline Power to test the impact of significant voltage reduction on motors and lighting in an NHS hospital.

The research began almost one year ago at the Royal Sussex County Hospital and testing and research consultancy, overseen

by BSRIA, is now being analysed.

Streamline Power is seeing indications that virtually the entire NHS estate and most private hospitals can benefit from this energy conservation measure. If your hospital has not yet reduced its voltage to reduce energy costs, contact Streamline Power to determine how voltage control can reduce your hospital’s energy cost, improve motor efficiency and reduce carbon emissions.

FURTHER INFORMATION Contact Dennis Garrison Tel: 07785 353901 dennis.garrison@ streamline-power.com www.streamline-power.com

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Advertisers Index

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

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ADVERTISERS INDEX

The publishers accept no responsibility for errors or omissions in this free service A Team Health Recruitment 18 Alphabet 42 Alumasc 84 Badgemaster 24 Bamboo Creative 30 Brighton Healthcare 76 Certuss (UK) 30 CFH Docmail 81 Closerstill Media 77 Cofely 34 Conferences Hertfordshire-UH 28 Countrymaid Utilities 84 Decorative Panels Lamination 6 Doctors Net UK 21 Dorsavi 14 Easterbrook Hall 74 Easthampstead Park 10 Elliotts Cleaning 50 Euro Payment Systems 41 Fast Park System UK 83 FDB 36 Focus Trovex 38 FootPrintMatters2U 70 Freudenburg Vileda 84 Good4Health 78 Guardian 24 72

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HEALTH BUSINESS MAGAZINE | Volume 14.3

Health Intelligence 85 ICEX 68 ICTR 70 Interact Medical 20 Intrim Medical & Rescue 81 Jackpad 30 John Wiley & Sons BC Kelway IBC Local Parking Security 83 MC2 Market Research 85 Medspace Solutions 52 Multitone Electronics IFC Natas e-learning 62 Nine Group International 55 No Climb Products 62 NPS North East 56 Nuflow Ireland 40 OKI Systems UK 66 Oracle Fieldwork 22 PHS Group 8 Prestige Products 74 Productive Primary Care 81 R82 UK 26 Robertson FM 84 Schneider Electric 12 Scottish Water Scientific 60

Screwfix 4 Sheffield University 22 Smart Protection Systems 74 Southern Country Ambulance 83 Spacebuilder 30 Spirax-Sarco 32 Spirit Healthcare 81 Streamline Power 85 Sunquest Information Systems 17 Surf Telecoms 64 Swiftclean Building 60 Tastecard 82 Taunton Conference 62 Text Help 26 The ITAD Works 70 Trades Hall 46 UK Parking Control 49 Unity 5 46 Vanguard 85 Varlink 64 Volvo 44 Ward Security 83 Wardray Premise 26 Water Management 58 Workflow Dynamics 46

A New Era in Digital Healthcare By working together with Apple, Kelway provides comprehensive Technology Solutions to transform the way healthcare is delivered

The ambitious timetable to digitise services by 2018 is driving efforts to deliver a 'paperless NHS'. Kelway is an established and trusted IT services and solutions provider. By working together with Apple, Kelway offer a unique approach in providing IT solutions that enable Healthcare organisations to become digital.

Apple is central to our IT implementation.

• iOS works seamlessly across all aspects of healthcare provision • Provides an enhanced user experience • A powerful app platform with over 30,000 healthcare applications • Offers comprehensive security • Easy integration and management through Mobile Device Management (MDM) • Scalable and can be fully integrated into an Electronic Data Record solution • Integrates with a simple infrastructure platform, which is guaranteed to deliver Kelway with Apple can provide a cost effective solution that can save time, improve clinical outcomes and create a streamlined patient experience. Kelway's dedicated health team possesses the industry's highest accreditations, and is committed to delivering technically innovative, support-focused solutions and services to the public sector.

For advice on Apple Technology and how to develop a digital healthcare solution please contact one of our dedicated healthcare team or visit www.kelway.com/healthcare

Contact us

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020 7791 6000 or enquire online

@Kelway www.kelway.com