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Jeremy Hunt’s mixed legacy Not long before Jeremy Hunt helped secure much-needed funding for the NHS, he became the longest serving Health Secretary in British political history, having taken on the role in 2012. While his move to the Foreign Office was rather hasty, making sense of his achievements and shortcomings as Health Secretary takes slightly longer to digest. The better-than-expected funding settlement is likely to positively taint some impressions, but it is hard to forget his unwavering commitment to creating a seven-day NHS and his much-criticised handling of the junior-doctor contract row. Hunt set about changing the ‘Monday to Friday’ culture in hospitals, but under his time in office waiting times have lengthened, staff morale has dropped, and, with the health sector facing uncertainties over Brexit, recruitment and retention of staff has been inadequate at best. If funding over the next few years changes the winter crisis trend that has been established, history may see Hunt as having ended on a positive note. However, recent funding aside, his departure has not been mourned in many hospital corridors. While many strongly believe that social care should be the top priority for the Department of Health and Social Care going forward, technology is likely to feature highly in new minister Matt Hancock’s in-tray. With a strong background in digital, Hancock is likely to appear regularly in our HiT Business columns, the background to which you can read on page 104.

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Finally, a word of congratulations to the NHS and it’s 70 years of brilliant service. In a culture that is quick to criticise, the array of praise has been heart-warming. Michael Lyons, editor

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Volume 18.4 | HEALTH BUSINESS MAGAZINE

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07 News

Matt Hancock becomes Health Secretary; over 200,000 patients waiting over six months for treatment; and 9,000 fax machines owned by hospitals

16 Finance

In our first financial feature, Joshua Walker and Emma Knowles explain why the structure of financial flows in the NHS needs to change, before Robert Colvile writes that, while recent NHS funding increases are welcome, it is imperative to properly examine how that funding is spent

29 Design & build

The Design Council says that by embracing a design-led approach to NHS refurbishment and building work, hospitals can drastically improve outcomes for both staff and patients in hospitals across the country

37 Healthcare Estates

October’s Healthcare Estates is set to help estates managers find innovative ways to save money, increase efficiency, and enhance the patient experience

44 NHS 70 44 107

As part of July’s anniversary celebrations, we have published a number of interviews with those working within and for our NHS. Here, we speak to Norman Lamb MP, NHS Confederation’s Niall Dickson, Janet Davies, of the Royal College of Nursing, and Ian Smith, chairman of King’s College Hospital NHS Foundation Trust

63 Wayfinding

Hospitals are a labyrinth or corridors, waiting rooms, clinical areas, wards, theatres and offices. HB reports on the success of wayfinding apps

67 Fire safety

What steps need to be in place to deal with a fire on hospital premises? HB looks at the significance of staff and patients being aware of evacuation plans

73 Lone working 113

There are over six million lone workers in the UK. Here, Nick Whiteley discusses the issue of lone worker protection

Health Business magazine

79 Infection control

On behalf of the Water Management Society, Dr Paul McDermott and Susanne Lee write about the the control of Legionella risks and other water-related hazards in health care environments

95 UK Health Show

The UK Health Show connects senior healthcare decision makers, influencers and buyers from across the NHS and the entire UK healthcare sector. Health Business previews the themes of September’s event

99 Diabetes

Chanelle Corena sets out why tackling the prevention of Type 2 diabetes is so crucial and the steps that Diabetes UK is taking to transform the health of the nation

104 HiT Business

The convergence of healthcare and IT has registered somewhere between evolution and revolution, says HiT’s Ben Plummer. This section details the latest news and articles in healthcare IT

107 Barcoding

Glen Hodgson, head of Healthcare at GS1 UK, explores the growing role of barcode technology in the future of acute trusts in England

109 Care integration

Current health services need to change to reflect a population which is living longer and with increasingly complex health and care needs. Here, we look at a pilot project being undertaken by NHS Digital and the LGA

113 Technology

As the NHS celebrates its 70th year, Dr Amanda Begley discusses how some of the new technologies and innovative solutions being supported to spread are making a real difference to patients and NHS staff

117 Health & Care Innovation

As the NHS celebrates its 70th anniversary, it’s a great time to reflect on how much our health service has transformed since 1948, and how it will continue to develop in the future

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Contents

Contents Health Business 18.4

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News

NHS 70

NHS 70 year success result of brilliant staff NHS England chief executive Simon Stevens marked the health service’s 70th anniversary by sending a message of ‘heartfelt thanks’ to staff, saying that the NHS’s enduring success is down to their ‘brilliance’. Shared online on the official anniversary on 5 July, the video message pays tribute to the achievements of the 1.5 million doctors, nurses, ambulance staff, therapists, porters, caterers and countless others who, along with volunteers and those working behind the scenes make up the biggest care team in the world. He said: “We’re marking the 70th birthday

of the National Health Service. It’s a time for celebration looking back over seven decades when we’re all living a lot longer and healthier – more than 10 years extra. We’ve seen amazing medical advances, whether it’s organ transplantations or new cures for cancer or vaccines. But the reason why the health service does so well is frankly due to the brilliance of the staff.” Prime Minister Theresa May announced that the NHS in England will receive an extra £20 billion a year by 2023 as part of the government’s 70th anniversary ‘present’. The announcement means that the current £114

billion budget will rise by an average of 3.4 per cent annually, starting with an initial 3.6 per cent rise for 2019-20 and 2020-21, and then 3.1 per cent for the next two years, and 3.4 per cent in 2023-24. While undoubtedly welcome, the increase remains less than the 3.7 per cent average rise the NHS has had since 1948. It is also short of the four per cent extra a year that former Health Secretary Jeremy Hunt had been campaigning for. READ MORE tinyurl.com/ybecl9b5

DHSC

SURGERY

Hunt ‘promoted’ as Hancock moves to Health

Over 200,000 patients waiting over six months for treatment

Having secured £20 billion in NHS investment and become the longest serving Health Secretary, Jeremy Hunt has been promoted to Foreign Secretary following Boris Johnson’s resignation this month. In a day of controversial resignations and cabinet reshuffles, Hunt’s move to the Foreign Office prompted the Prime Minister to appoint Matt Hancock, previously Culture Secretary, as his replacement. Having just been awarded funding as part of the NHS 70 anniversary celebrations, it appears the most difficult part of Hancock’s opening few weeks and months will be to ensure equal attention is given to the social care crisis. Hunt, who was a Remain campaigner during the EU referendum, has said that he is a convert to the Brexit cause and is standing ‘four square’ behind Theresa May and the controversial and much-debated agreement she presented at Chequers on 6 July. That agreement instigated the resignation of Brexit Secretary David Davis, who has now been replaced by former Housing

Minister Dominic Raab. It has not escaped attention that most of the top cabinet posts are now held by those who were in favour of remaining part of the European Union. Brexit minister Steve Baker and two ministerial aides also resigned. While Hancock’s health experience may be lacking in comparison with Hunt, who some believe may still have his eyes set on No. 10, Hancock proved very popular and involved at the Department of Digital, Culture, Media and Sport, where upon becoming Culture Secretary he launched his own smartphone app to better ‘connect’ with his constituents. His digital background and enthusiasm could prove very beneficial in promoting the equal distribution and promotion of technology and innovation in all areas of the health service. READ MORE tinyurl.com/ybc5n2p5

SURGERY

Innovative new treatments to be routinely available on NHS Following the NHS 70th birthday celebrations, the NHS has announced plans to provide a host of new treatments that will now be routinely available for thousands of patients on the NHS. Under the plans, hundreds of patients each year are expected to benefit from left atrial appendage occlusion, a procedure which reduces the risk of stroke in patients with atrial fibrillation (irregular heart beat), who cannot take blood thinning medication. NHS England believes that 400 patients will be treated in the first year, with over 1,000 patients treated each year by year five. Additionally, treatments for selective dorsal rhizotomy (SDR) will now be available immediately in named hospitals across England, allowing children who

were previously unable to walk to become mobile and independent. The treatments aims to relieve tight and stiff muscles for cerebral palsy sufferers, particularly in children, which can cause movement and balance problems. Amongst other treatments set to be made available are a surgical procedure to relieve the intense pain of chronic pancreatitis, two new cutting edge treatments to be introduced for patients with haemophilia, three cancer treatments, a new treatment for osteoporosis in men and a new treatment to restore sight. READ MORE tinyurl.com/yc23lb2x

New NHS England statistics show that the number of patients waiting longer than six months to start planned NHS hospital treatment has now exceeded 200,000. The ‘referral to treatment’ figures for this May reveal that 211,324 patients waited longer than six months to start planned treatment, which is 48.4 per cent higher than the same time last year. The data also highlights how the government target of seeing 92 per cent of patients within 18 weeks has now been unmet for 27 consecutive months, with 88.1 per cent of patients seen within 18 weeks. This is a drop on the 90.4 per cent figure for the same period last year. The number of patients waiting longer than 18 weeks for planned treatment in May 2018 was officially 485,201. Susan Hill, senior vice president of the Royal College of Surgeons, said: “Not enough has been said about how the NHS plans to deal with the backlog of patients that built up over last winter. Hospitals must get their waiting lists under control before the next winter creeps up and we find ourselves in an even worse position. The NHS has been promised a very welcome birthday cash injection which we hope will help hospitals begin to chip away at these very long waiting times. Meeting planned surgery targets must be prioritised in the NHS’s forthcoming 10-year plan.”

READ MORE tinyurl.com/ycjpwkv8

Volume 18.4 | HEALTH BUSINESS MAGAZINE

Dream Family

News

NHS TRANSPLANTS

Transplant service short of necessary staff and equipment The Guardian has reported that potential organ donations are at risk because UK hospitals are extremely short of transplant surgeons and specialist nurses. Having seen an unpublished NHS Blood and Transplant document, the paper claims that teams of organ retrieval specialists are facing ‘extreme stress’ while understaffed transplant centres are struggling to keep up with existing demand. Legislation is currently passing through

Parliament which would change organ donation policy from opt-in to opt-out, potentially saving up to 500 people a year from dying unnecessarily and shifting the balance of presumption. The legislation has the backing of Prime Minister Theresa May and the majority of health leaders. However, the Guardian says that the paper warns of not being able to harvest all of the increased number of organs that are expected after presumed consent becomes law, mainly

as a result of hospitals remaining increasingly short of key specialists and equipment needed to keep organs viable. It also finds that England’s 27 transplant units face a potential ‘failure to transplant all retrieved organs arising from an increase in donors’ because of a lack of ‘staff [and] ward capacity’. READ MORE tinyurl.com/yazfxt83

AMBULANCES

NHS fleet of ambulances to be boosted next Winter A £36.3 million investment will see 256 stateof-the-art ambulances added to the current NHS fleet across the country this winter. The investment will also finance ‘make ready’ hubs at ambulance trust headquarters, where specialist staff will be able to re-stock, refuel and clean vehicles to get them back out faster to treat patients. The new ambulances will be distributed across the country. London Ambulance Service is set to increase

its fleet with an extra 25 double-crewed ambulances as a result of £3.85 million investment, and Yorkshire Ambulance Service will increase its fleet with 62 double-crewed ambulances, due to £7.5 million in funding. Announcing the new funding, Health minister Stephen Barclay said: “In some of the most worrying and vulnerable moments in our lives, dedicated ambulance staff are there; providing expert, calm and reassuring care to patients in often highly

pressurised and sometimes dangerous situations. They are there for us 24 hours a day, seven days a week, so we want to make sure that in the 70th year of the NHS we’re supporting them with state of the art equipment, meaning they can provide a better service to patients.”

tinyurl.com/yalkj6pe

OPERATIONS

INFECTION PREVENTION

Immediate curb on £10 million to tackle antimicrobial resistance mesh operations BEREAVEMENT

New guidance to help trusts learn from deaths Understanding that families’ experiences and insights are a valuable source of learning, the NHS has published guidance to help trusts work with bereaved families and carers. The Care Quality Commission recently stressed that families and carers should be treated as equal partners to identify opportunities for improvement, prompting NHS England to work with over 70 families and carers on the guidance, which will provide advice to hospitals, mental health and community trusts on how to involve families following the death of a loved one. The new guidance calls on trusts to involve families throughout by providing bereavement support, signposting families to advice and advocacy support along with examples of how trusts are working with families and good practice guidance on specific subjects. READ MORE tinyurl.com/ycd5jklp

NHS England has accepted the advice of a new review looking at harm reported by women who received mesh operations for stress urinary incontinence and is placing an immediate curb on the treatment. Chaired by Baroness Julia Cumberlege, the review said that it was ‘appalled at the seriousness and scale of the tragic stories’ that the team has heard, with many women reporting implants causing them agony by cutting into tissue and some being left with life-changing injuries. The health watchdog NICE has already recommended that vaginal mesh operations for treating organ prolapse should largely be stopped in England. A number of Scottish health boards have already stopped using mesh implants altogether, and in Wales the procedures are seen as a ‘last resort’. NHS England says that most patients suffer no ill effects, but it is estimated that more than 100,000 UK women have had a mesh fitted. Professor Dame Sally Davies, England’s Chief Medical Officer, said that mesh would remain a treatment of last resort for some ‘carefully selected’ patients. READ MORE tinyurl.com/y8a22mof

The Department of Health and Social Care is launching a £10 million research competition to fund innovations to tackle antimicrobial resistance (AMR) in humans. Without a better understanding of how to tackle and prevent the increasing threat of AMR, which includes bacterial resistance to existing antibiotics, treatable infections could become life-threatening. The £10 million will be made available in research grants funded through a Small Business Research Initiative (SBRI), which will be run by Innovate UK on behalf of the Department of Health and Social Care. The funding follows the global ‘Call to Action’ conference by the Wellcome Trust, the UN Foundation, and the UK, Ghanaian and Thai governments, to accelerate action in this area.

READ MORE tinyurl.com/y867l6v4 Volume 18.4 | HEALTH BUSINESS MAGAZINE

Finance Written by Joshua Walker, PwC, and Emma Knowles, HFMA

Making money work in the health and care system Recent research has highlighted an overwhelming consensus that the structure of financial flows in the NHS needs to change. Joshua Walker and Emma Knowles explain why Last month PwC, with the Healthcare Financial Management Association (HFMA), launched Making money work in the health and care system. In the period since, the government has announced its intention to increase annual spending on health by an average 3.4 per cent in real terms over the next five years, to mark the NHS’ 70th anniversary. This should be welcomed. But it would be a mistake to see this as a cure-all to the health and care system’s challenges, for several reasons. First, this growth in funding is slightly below the 3.7 per cent historical average growth in real terms funding seen between 1949/50 and 2016/17. Between 1955/56 and 2015/16 average growth was 4.1 per cent. The 3.4 per cent figure had been estimated by the Institute for Fiscal Studies

and others as being around the level of growth in funding needed to maintain, rather than improve and modernise, our health system. Furthermore, the funding uplift has been described in terms of the NHS England budget, rather than the full remit of the Department of Health and Social Care, which leaves questions open about the funding for other arms length bodies and key services such as public health and social care. Second, there is likely to be a long list of immediate, existing, priorities that will be in competition for prioritisation when the additional funding becomes available. This will include money to fund the capital investment outlined in system transformation plans (estimated at £10 billion), money to

Throug our rese h arch we wer e s t r uck by the ove r w helming consen s u s th structu re of finat the ancial flows in needs t the NHS o chang e

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bring down NHS trust and foundation trust maintenance backlogs, and to bring down deficits across the acute provider sector. Finally, as argued in Making money work in the health and care system, the way money is currently used in the system is in need of reform if additional funding is to have a chance of driving additional value. Appetite for change Through nine months of research with the HFMA, PwC worked with over 300 individuals in the health and care service in England, through round tables, interviews, and polling – from frontline finance teams to the Secretary of State – to understand current attitudes, and how funding flows can catch up with the changing direction of the health and care system. We found that there is appetite for change, even in a sector which often feels like it is suffering from change fatigue. 76 per cent of those we polled felt that the current funding mechanisms weren’t fit for purpose. 83 per cent felt this meant a conflict between short term cost saving and long term sustainability. 78 per cent believed budgets for health care, social care and public health should be pooled. And, importantly, 70 per cent felt moving towards integrate systems would improve value for patients. Money talks. However, in the health and care system at the moment, it’s not always clear what it’s trying to say. Providers and systems are obliged to deal with myriad of complex funding mechanisms which incentivise, at times, what feel like contradictory behaviours. A large amount of good thinking has been

Finance

done in recent years to clarify the direction of the health and care system in England, both within the NHS and by others (including the PwC report Redrawing the health and social care architecture). And we have seen changes such as some devolution of health and care budgets and the introduction of Integrated Care Systems that are a definite step in the right direction for patients, those accessing social care services and those providing care. However, a stated desire to move focus towards prevention, to build out of hospital options for care, and to increase innovation and use of technology has not been followed by changes to payment systems to incentivise these activities. Instead, payment by results pushes activity towards acute settings and the myriad of ways the funding flows from the centre to organisations builds confusion. Often the challenges in the care system are presented as problems with a clear diagnosis but no cure. We believe that there are a number of changes that could be implemented â&#x20AC;&#x201C; even in an environment with limited scope for legislative change and a political agenda focused on Brexit â&#x20AC;&#x201C; in order to give those working in the system the clarity they need to move towards a system which works better for people receiving care. We have structured our recommendations in two phases. The first being those we believe are deliverable within a oneâ&#x20AC;&#x2018;two year time horizon (short term), and the second being those which are likely to take longer to implement. Short term: The capital funding system should be redesigned to allow reduction in the maintenance backlog and longterm investment in infrastructure. This should include prohibition of capital to revenue transfers and the creation of a National Restructuring Fund. Internal NHS debt should be restructured to bring down high interest costs associated with historical provider deficits.

The approach to future financial support to providers in deficit should also be changed so that providers are supported to get out of financial difficulty rather than hampered by a growing debt burden. Organisation-based control totals should be replaced with system-wide targets. The closer alignment of NHS England and NHS Improvement should facilitate this, with combined regulatory voice holding systems to account rather than creating pressure for commissioners and providers to work in conflict.

budgets should be brought closer together using the existing statutory mechanism in s75 of the National Health Services Act 2006. The five year financial settlement that was announced in June for the whole NHS should be replicated throughout the system to allow local health economies to plan and invest for the long term. A detailed assessment should be undertaken of how financial incentives for frontline and management staff can be used to improve cross-organisation working along patient pathways.

Through nine months of research with the HFMA, PwC worked with over 300 individuals in the health and care service in England to understand current attitudes, and how funding flows can catch up with the changing direction of the care system The National Expansion Plan for personal health budgets should be accelerated if the target of 100,000 patients holding their own budget is to be reached by 2020. Evidence suggests personal budgets result in higher patient satisfaction and better outcomes. A further stretch target should be set. We have suggested that one million of the estimated 15 million people living with long term conditions should be targeted by 2025. Long term: Payment systems for healthcare delivery should be redesigned to reward outcomes rather than volume of activity. Local systems should be given the freedom to determine their own internal financial mechanisms, with guidance from the centre on pros, cons, risks and mitigations associated with different contractual structures. Local health, social care and public health

Of course, funding is not the only challenge that the health service faces. We have suggested that long term workforce planning, changes to the way that we assess the performance of the system from access measures to outcome measures, and adoption of new technological opportunities all require consideration if it is to be the best it can be. But through our research we were struck by the overwhelming consensus that the structure of financial flows in the NHS needs to change. Long term sight of the funding available to the service is a welcome 70th birthday present. Creating financial structures that ensure money drives behaviour towards the right outcomes should now be a priority. L FURTHER INFORMATION www.hfma.org.uk www.pwc.co.uk

Volume 18.4 | HEALTH BUSINESS MAGAZINE

NHS funding Written by Robert Colvile, director, Centre for Policy Studies

Time for economic reform in the NHS? A recent report by the Centre for Policy Studies says that while recent NHS funding increases are welcome, it is imperative to properly examine how that funding is spent. Robert Colvile, director of the Centre, explains why In the run-up to the 70th birthday of the NHS, there was feverish debate about the level of the funding settlement that the government was promising to announce. Would it be three per cent, as the Treasury wanted? Or four per cent, as NHS leaders were demanding? The revelation of the final figure - a real-terms rise of 3.4 per cent over the next five years - was greeted with pronouncements from the experts that this was enough for the NHS to stand still, but a figure of, say, 3.7 per cent would have permitted genuine advances in care. The implication of all of this debate is that the NHS operates according to a simple equation: money in, treatments out. In fact, that there is some precise measurable ratio between funding and outcomes: raise the former by X, and you will cure Y more patients. Yet this obsession with funding has obscured a deeper truth.

In the run-up to the spending announcement, we at the Centre for Policy Studies carried out a simple piece of analysis. We plotted NHS funding against productivity since 1995, when figures for the latter were first produced. What we found is that there is a negative correlation between the two: the NHS tends to do less with more, and more with less. This makes rational sense. In the later Blair and Brown years, as money poured in, there was almost no political pressure to ensure that it was spent wisely. Once austerity was imposed, the service was forced to consider how it could deploy its resources more wisely - and did so. Higher productivity meant that the NHS has actually coped admirably well with its more straitened circumstances, although we are all aware that there are areas where the cracks are beginning to show. Our research showed that if you were to increase NHS funding by four per cent for

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a decade, you would end up spending 10 per cent more than if you had increased the budget by three per cent - yet outcomes would be only five per cent better. It also showed that the difference between a highproductivity NHS and a low-productivity NHS is cavernous - dwarfing the impact of the various funding solutions. If annual NHS productivity growth over the next 10 years were to run at the same level achieved in the best five years since 1995, it would mean an increase in health service output of 73 per cent. The improvement in efficiency delivered would be the equivalent of 219,000 more nurses on our wards, 5.5 million more cancer treatments, 74,000 hip replacements and so on and so forth, across every aspect of NHS operations. However, if NHS productivity matched the five worst years in recent decades, we would see an increase in NHS output of less than 20 per cent. Compared with the high productivity scenario, this would mean the equivalent of 159,000 fewer nurses, four million fewer cancer treatments and 58,000 fewer hip operations. And again, such poorer outcomes would, on average, be replicated in every part of the NHS. Money alone is not enough From this comes a simple lesson: that money alone is not enough. We need to think boldly and strategically about how it is spent, ensuring that it goes into areas which drive higher productivity and better outcomes for patients in future, rather than

comes along. These awards

The sim can be worth up to £77,320 p l e per year, yet they are truth is completely disconnected t h a t the NH from a given hospital’s S , wh cherish clinical priorities. ed insti ile a Goldsmith’s report t ution, Dr is not re also showed that the m o produc tely as reporting about NHS wage caps and pay could - tive as it freezes has been deeply o should r even misleading. Automatic - be pay progression along the

Reforming pay structures To give just one example of an area where the NHS could benefit significantly from reform, take the issue of pay and pay structures. Of the money that we as taxpayers give to the NHS, the overwhelming majority goes towards salaries - some 65 per cent of NHS England’s budget, and a similar proportion elsewhere in Britain. The NHS is, famously, the world’s fifth largest employer, behind only the US Department of Defense, the People’s Liberation Army, Walmart and McDonald’s. Yet a recent CPS report by Dr Paul Goldsmith, a consultant neurologist, pointed out that the NHS’s pay structure is also hideously inefficient, providing absolutely no mechanisms through which hospitals in poorer parts of the country can attract better staff, or through which managers can motivate, incentivise and reward staff for reaching particular goals. For example, the NHS makes less use of performance-related pay than practically any other organisation in the country, public sector or private. The only major bonus scheme, the Clinical Excellence Awards, is only for consultants, rather than other team members, and is essentially a lifetime achievement award, being handed out upon application and then retained until a better candidate

‘pay spines’ that sit within each pay band means that in fact, the average NHS pay rise between 2012 and 2017 was between 2.5 per cent and three per cent - and probably towards the upper end given that the report was deliberately cautious in its methodology. Yes, nurses are still underpaid compared to their international equivalents - but doctors are actually paid more. And whatever the actual pay level, the misguided reporting about pay freezes acts as a deterrent to recruitment, and distorts the discussion about what the priorities for any new spending should be. This is not, ultimately, a political question but a moral one. We owe it to the patients that the NHS treats to ensure that every pound is spent wisely, that the NHS is operating to the peak of its potential. As it is, for all the good that the NHS does it is still lagging behind its international equivalents in many areas, most notoriously survival rates after cancer diagnosis. Some of this may have to

do with money, but much of it does not. Our analysis is clear that, all other things being equal, the NHS tends not to spend extra funding as well as it might - and should. That is why we have consistently argued that we need to prioritise productivity, efficiency and reform. Why, as Alan Mak MP asked in another recent CPS report, on the NHS and technology, is the health service still using so many pagers and fax machines? He gives the example of one hospital trust in St Helen’s which invested in going completely paperless - and has saved roughly as much, every year since, as the project originally cost. Why can’t we roll out the same system elsewhere? Shouldn’t we be embracing automation, and recycling the cost savings into better care for patients? One of the curses of our political culture is that those who criticise the NHS - or even just critique it - are immediately accused of betraying it. Argue that patient choice and diversity of provision can be powerful drivers of performance improvement, and the tired old lines come out about privatisation, about sinister conspiracies to flog the healthcare service to American profiteers. The simpler truth is that the NHS, while a cherished institution, is not remotely as productive as it could - or even should - be. We owe it to the NHS’s staff and patients, and to the health service itself, to do all we can to put that right. L

NHS funding

just putting sticking plasters on existing problems. This is a lesson that the government has taken on board. The delivery of the extra funding for the NHS is dependent on NHS leaders - by which is meant Simon Stevens, the head of NHS England coming up with a 10-year plan to make the health service work better (which is expected to be rather similar to the vision set out in his Five-Year Forward View). There are many encouraging aspects to the original Stevens plan. Yet we worry that an opportunity has been missed. For the past two years, the Centre for Policy Studies has been calling for a Royal Commission on the NHS, in order to carry out a bottom-up re-examination of how the health service is working and suggest how it can be put on a stable footing for the decades to come. This is not intended to denigrate Simon Stevens, Jeremy Hunt or anyone else. But the truth is that there are things which it is much harder to say when you are within the system, having to balance the interests of endless competing stakeholders. And it is also the case that, given public scepticism towards politics and politicians, a properly crossparty commission is one of the only ways to explain the reality of the NHS to the public, and to get their support for any changes that may need to be made. (Our suggestion was for the commissioners to take the Stevens plan as the basis for their own work, but to elaborate and expand as necessary.)

FURTHER INFORMATION www.cps.org.uk

Of the money that we as taxpayers give to the NHS, the overwhelming majority goes towards salaries - some 65 per cent of NHS England’s budget, and a similar proportion elsewhere in Britain

Volume 18.4 | HEALTH BUSINESS MAGAZINE

PROUD SPONSORS OF NHS70 AWARDS WORKING WITH MEDICAL PROFESSIONALS FOR OVER 1OO YEARS

Congratulations to the Dorset Armed Forces Community Health and Wellbeing Project, winners of the NHS Excellence in Mental Health Care award 2018. This award represents the dedication and hard work of individuals and teams who are at the forefront of improving support available to those with, or at risk, of mental ill health. This is something that can affect anyone at any time. Wesleyan recognises the importance of Mental Health and values the insight that we gain from our members and customers, many of whom are actively working in industries where mental health is of a real concern. Wesleyan was established in 1841 to help workers in Birmingham save for sickness and funeral expenses during the Industrial Revolution. Today we provide specialist financial advice and solutions to doctors and dentists, recognising the importance of not only looking after our customers but also our communities. Being a mutual is an integral part of who we are and with no shareholders, our focus is on our members and customers. Follow us for regular updates on social media

@wesleyan

If you would like to arrange a no obligation financial review with your local Wesleyan Financial Consultant, simply use one of the methods below. As they work exclusively with your profession, they understand your career path and are ideally placed to advise you. Whether it’s guidance on the NHS Pension Scheme, reviewing your investment options, planning ahead for your retirement, or more general financial needs, they can help.

facebook.com/wesleyanAS

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Advice is provided by Wesleyan Financial Services Ltd. ‘WESLEYAN’ is a trading name of the Wesleyan Group of companies. Wesleyan Financial Services Ltd (Registered in England and Wales No. 1651212) is authorised and regulated by the Financial Conduct Authority and is wholly owned by Wesleyan Assurance Society. Wesleyan Assurance Society is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. Incorporated in England and Wales by Private Act of Parliament (No. ZC145). Registered Office: Colmore Circus, Birmingham B4 6AR. Telephone: 0345 351 2352. Fax: 0121 200 2971. Telephone calls may be recorded for monitoring and training purposes. HD-AD-28 07/18

As the National Health Service celebrates its 70th anniversary this year, the government’s announcement of £20 billion in additional funding by 2023 was welcome. But the birthday gift included a stern warning – that the NHS would need to be more efficient or the funding increase would be swallowed up before it reached the frontline. One way to ensure that patients feel the benefit of this extra funding is to make every pound work harder. In a sector where medical and technological innovations can render high-value equipment obsolete within a relatively short period, leasing frequently makes more sense than buying outright. It’s simply not efficient to continue using broken or slow technology in an effort to justify the original investment cost of the equipment – especially when the clinical outcomes of state-of-the-art equivalents would improve NHS productivity and patient care. What is leasing? Leasing usually involves paying a regular charge for the use of the asset over an agreed period of time, so avoiding the full cost of buying it outright. The leasing company (lessor) buys and owns the equipment on behalf of the customer (lessee). The customer pays a rental for the use of the equipment over a predetermined period. There are two main types of lease: an operating lease and a finance lease. An operating lease would be appropriate if the business does not need the equipment for the entirety of its working life. The leasing company will take it back at the end of the agreement and will be responsible for maintenance throughout the lease period. A finance lease would be appropriate if the business intends to keep the equipment for most or all of its working life. As such, finance leases transfer all the rights and obligations of ownership (like maintenance and insurance) to the lessee, and over the lifetime of the agreement, the lessee will have pay at least 90 per cent of the fair value, or market value of the asset. Leasing is extremely flexible and can be used to fund any asset – from telephones and photocopiers to specialist medical equipment or IT – and it could be the perfect solution if much-needed new equipment would otherwise be unaffordable.

Where to find it? Over 90 per cent of asset finance (leasing and hire purchase) providers in the UK are members of the Finance & Leasing Association (FLA) and you’ll find them listed in our Annual Review. Doing business with an FLA member means you are dealing with a reputable firm, whose agreements are subject to the FLA’s Business Code.

of aligning public sector accounting with IFRS 16, and our main point is that any changes must improve the current situation which treats finance leases as debt – so their use by schools and non-trust hospitals is only allowed with the permission of the Secretary of State. The government’s recently Leasing published consultation paper on public sector is extrem e accounting contains Procurement l y flexible proposals that would NHS Supply Chain has been a n d could b have the effect of tasked with implementing perfect e the putting all leases the Future Operating Model, on the lessee’s set up by the Department of much-n solution if e balance sheet, and Health as a solution to the e d e d equipm new which would abolish problem of NHS trusts paying en the old distinction a variety of different prices for otherw t would between finance the same basic equipment. Part unaffor ise be and operating leases. of this model includes Category d a ble While, on the face of it, Towers of procurement consortia this measure looks like it that have been contracted by NHS ought to allow all kinds of leases Supply Chain to provide particular types of to be used by the public sector, we need to products. The kind of leasing undertaken by make absolutely sure that this is what the FLA members falls primarily under Category government actually intends, and we are Tower 7, (Large Diagnostic Capital Devices pursuing the point with them at the moment. including mobile and consumables). While supportive of the new procurement process, How big is the market? the FLA will be liaising closely with the In 2017, our members provided £128 Department of Health and NHS Supply Chain billion of new finance. £32 billion of to keep them apprised of our members’ this was provided to businesses and feedback on the ongoing implementation. the public sector, representing over a third of the UK investment in machinery, IFRS 16 equipment and purchased software. L Early in 2017, the EU endorsed the new international accounting standard for lessees, IFRS 16 – with an implementation date of FURTHER INFORMATION January 2019. We have been discussing www.fla.org.uk with the government the possible effects

Volume 18.4 | HEALTH BUSINESS MAGAZINE

Written by the Finance & Leasing Association

Leasing is extremely flexible and could be the perfect solution if much-needed new equipment would otherwise be unaffordable, writes the Finance & Leasing Association

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The NHS provides some of the finest care in the world. Babies born at 25 weeks survive and thrive. Older people are fixed up and able to enjoy independent life for many more years than ever in history. Diseases that killed in the 1950s have been eradicated or controlled. But the NHS (as numerous studies and reports have shown) doesn’t handle other non-care things in a world class fashion. It’s not paperless. It’s labour intensive. And time spent on manually handling ‘stuff’ in a hospital, is time not spent at the frontline – helping patients. One of the first places to start is better management of inventory. The return on investment is massive. Business cases show savings of over £250,000 per year for around £60,000 per year outlay. Year after year. Reduce the manual processes, reduce stock, reduce obsolescence, improve accuracy and ensure you have just what is needed, when and where it is required. Just like most modern businesses. This is best achieved by implementing world class specialist systems, such as those from Assistive Partner. Track & Trace with GS1: Improving patient safety and enhancing care All acute trusts have a target to be fully GS1 compliant within the next couple of years. There are a number of benefits. First and foremost, safety. A carefully planned implementation of new, modern inventory management software with scanning at the point of care will ensure GS1 compliance is part of the rollout. A simple scan of a wristband and another single scan of the implant and surgical instrument or machine is all it takes to record

the essentials. And save lives. Lookup old data (who had what) in a heartbeat. Recalls done in minutes not months.Extend the use of these globally unique barcodes to hospital stock locations and delivery points and the trust is ready to start EDI or P2P. That’s paperless ordering and paperless invoicing – machine to machine. Most major organisations have been doing this for years and saving a fortune in administration and paper. Yet more time that nursing staff can focus on the patient, doing what they do well – care! Patient level costing — Transforming sustainably In healthcare it is critical that there is an accurate record of who did what to whom. Electronic data. Instantly available for analysis. How long it took. How much it cost. Is there room for improvement? Can we get meaningful comparisons to drive up quality and continue the excellent NHS tradition of continuous improvement in care? It’s made really easy, with the introduction of barcode scanning and interoperable computing. A simple scan of where, what and who means that data is captured in a database alongside accurate timings. This accuracy is the core detail to ensure sustainable transformation and continuous improvement. As Assistive Partner has gradually extended into more hospitals, scanning at the point of use and managing stock and supplies, we have witnessed a more efficient use

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Inventory management – Assisting time-pressured clinicians of theatres as a direct result of better data and information – once again sustainable transformation. Doing more with less Savings in processes and supply chain management. Every process put under the microscope. Potential savings calculated. Ranked, with the best return on investment top. Non-clinical staff released from constantly fire-fighting as a result of outdated paper based systems. Set up to move on, down a proactive, systems-driven, paperless pathway. Clinicians cease administration tasks which add little value, gaining more bedside time. Accurate, electronic, easy to interrogate records. No more PIP implant scandals, where thousands of patients are still vulnerable and at-risk because of inadequate record-keeping procedures (nothing whatever to do with clinical competence). Think of live status reports on the whereabouts of vital hospital supplies or important pathology samples on route to the laboratory. Internal package distribution managed with the same GS1 compliant software tools. Assets too, can have a barcode or electronic (RFID) tag added and their whereabouts or service requirements tracked and recorded easily. Peace of mind. Effective, safe controls to ensure that the most efficient support services are in place. Backing up clinicians. Enabling nursing staff to focus on patients. Without the worry and distraction of chasing ‘stuff’. New inventory management and tracking systems will lead to less space required for storage, reducing the stress on property as well. Speak to us today about the help Assistive Partner can give to help you build a robust business case for digital modernisation. FURTHER INFORMATION Assistive Partner creates software for healthcare. In recent years, their UNIQUS software suite has been a core enabler for their customers winning awards such as HFMA Cost Savings (Derby) and Excellence in Public Procurement (Croydon). Their trusted UNIQUS software is in continuous use by over 28,000 healthcare professionals throughout the UK. L

Volume 18.4 | HEALTH BUSINESS MAGAZINE

Scanning solutions for Healthcare

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Pursuing paperless and digitising patients records This month it was revealed that Leeds and York Partnership NHS Foundation Trust is set to become the first NHS mental health provider in the country to adopt CareDirector software for its electronic patient records Writing for Health Business magazine at the start of 2017, Andy Kinnear, chair of the BCS Health & Care Executive, wrote that ‘digitising the health service is no longer simply about improving the efficiency of its day-to-day mechanics or about ensuring information flows to support planning and financial The management’. Instead, we have ‘passed N HS h the point where by providing services long sinas ‘online’ is considered a value-add, ce it is simply the norm’ and patients recogn i s e d rightfully ‘expect to interact digitally benefit s of dig the for the services they receive’. itising its patie Long before former Digital Secretary Matt Hancock took over and ma nt records n the reigns of the Department of docum aging its Health and Social Care, the NHS e more e nts in a recognised the benefits of digitising fficient its patient records and managing its m a nner documents in a more efficient manner and has invested millions in trying to the care we provide achieve it. Paper files can take time to locate, our patients.” access and move, whilst physical notes can As mentioned previously, be hard to care for, and can be illegible, Leeds and York Partnership NHS Foundation incomplete or untraceable - both of which Trust will become the first NHS mental health create a slower, more frustrating health provider in the country to adopt CareDirector service. Simply put, technology has changed software for its electronic patient records. and public expectation has changed with it. Produced by Dublin-based CareWorks, the software’s flexibility and usability for Electronic patient records clinicians will be important in helping Back in April, a project which linked the the trust work more effectively together, electronic patient record (EPR) systems enabling the efficient delivery of services and at West Suffolk NHS Foundation Trust making a real difference to patients’ lives. and Cambridge University Hospitals NHS Leeds and York Partnership NHS Foundation Foundation Trust (CUH) went live in a UK Trust plans to introduce CareDirector, which first. Both recognised as Global Digital will replace their current electronic patient Exemplars by NHS England, the two trusts record system, after a two year preparation are now able to easily and securely access period in a ‘one-step approach to minimise clinical information on a patient that is held disruption and clinical risk. As well as within the other trust’s EPR system. This is reaching costs, the decision should also the first link in the UK between hospitals’ ‘create more effective work and information electronic health record systems, provided flows’ and help the trust to ‘drive up the by two different suppliers - Epic at CUH and quality of the services and care’ it delivers. Cerner Millennium at West Suffolk Hospital. Clinicians in the accident and emergency Utilising data departments can access real-time, digital If the NHS is going to achieve its target of information if a patient has been treated being a wholly digital institution by the at the opposite hospital within a 12early 2020s, as outlined by the government, month period. This is fairly common it will need to evaluate how it utilises data given the hospitals’ proximity. in order to improve the delivery of care, Dermot O’Riordan, chief clinical information as well as, in the face of a projected £2 officer at West Suffolk Hospital, said: “Many billion deficit by the end of this financial of our patients’ healthcare is shared between year, create new metrics by which it both of our hospitals, in areas such as cancer measures its performance and efficiency. care, vascular surgery and emergency care. We live in a time where our lives are This innovation is a natural extension of inextricably connected to the internet, and our partnership, and is already making data in its infinite forms can be recorded noticeable improvements and efficiencies to and transmitted instantly to the Cloud –

what is referred to as ‘big data’. This opens the door for medical professionals to be able to assess statistics and indicators, in huge volumes, from a bird’s eye view like never before. It’s important to be able to differentiate the various classifications of data in order to make best use of its applications to healthcare, and, broadly speaking, there are three considerations to take into account that can help extrapolate the potential benefits and pitfalls of data in healthcare. As the NHS continues its initiative to become paperless, there are new technologies that allow nurses to carry out assessments and calculate early warning scores digitally, through mobile technologies and bedside terminals. This data is recorded and then transmitted to a central system, which is accessible to doctors and nurses across the hospital, who then get notified of any developments in the patient’s condition in real time. Having remote access to this kind of data means that caregivers can not only react more efficiently in clinical terms, but as the data is available to all hospital staff, it can improve on the often complicated rota system, which promotes better time management. The landscape of innovations that harness health data is constantly shifting and evolving, but one constant factor that remains is skepticism from the public as to whether they trust the NHS – and the broader government – to handle some of their most intimate details. As such, it is important to take into account, and create a specific strategy for handling and using these two separate tiers of data in order to make them clinically and operationally beneficial. L Volume 18.4 | HEALTH BUSINESS MAGAZINE

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CCube ePaper – paper to digital without scanning Digital technology within the healthcare sector aims at improving patient experience and data handling whilst saving costs. CCube has developed ePaper software to streamline processes and modernise the way information is recorded

CCube ePaper key features & benefits Use existing paper forms and create digital versions using tools provided Organisations benefit from archiving and accessing digital documents Patient information The healthcare sector manages a wealth of patient data, from medical notes and clinical records, patient consent forms to new patient documents. The capture and processing of this information must ensure that sharing and interoperability can be streamlined and must be compliant with established guidelines for Information Governance and data-sharing standards. Paper-based processes With a long history of working with paper-based processes, the healthcare sector has been hindered by methods of working that are time-consuming, expensive and prone to human error. These legacy systems can be a significant drain on healthcare’s resources. They can also prevent the level of digital maturity needed to meet the Five Year Forward View and healthcare’s overall goals for change. Healthcare’s digital technology must provide the step change needed to streamline processes, share information, improving the patient experience and to dramatically reduce costs. Healthcare must digitise in order to achieve its goals in providing high quality, safe, accessible, patient-centred care. Electronic solutions Good progress has been made and continues to innovate, minimising dependency on paper. However, paper is not going away in a hurry. Electronic forms that can be used on many different types of devices including smartphones are on the increase and do enrich the user experience. Where processes remain dependent on use of paper, developments in writing technology are paving the way forward – to allow users to continue using paper and pen for recording information and seamlessly create digital records, without scanning. Digital pens have been around for some time, but these are costly and require special paper.

ePaper software CCube Solutions has developed the ePaper software which uses Wacom’s Clipboard. This solution allows users to use existing paper forms to complete and sign documents using an ink pen (included with the clipboard). It then converts the documents to a digital version in real-time – the user can fill out the paper form as they normally would. All the strokes made by the pen on the clipboard are captured and streamed to the host device and immediately applied to the digital document. Biometric handwritten signatures can also be captured and attached. The digital documents can then be saved as read-only documents (eg. PDF) and sent into any IT system, including EPR, Clinical Portals, and document management systems. With the introduction of the CCube ePaper, hospitals can maintain their patient-facing processes – patients still fill out existing paper forms, such as consent forms – the completed forms are automatically saved as a digital record, without scanning. The paper form can be handed to the patient as their signed copy – no need to keep or scan the paper in the hospital. With the introduction of the Wacom Clipboard, businesses can maintain their customer-facing processes – having their customers still fill out familiar paper forms, either A4 or letter size. However, they can easily gain efficiencies of digital document management without scanning. FURTHER INFORMATION www.ccubesolutions.com

Customers can fill out familiar paper forms on the electronic clipboard Secure, biometric eSignatures can be included with the digital document Forms can be completed over time Can be used standalone or with any IT system Supports Open Standards for data capture, eg. HL7 FHIR Completed forms can be sent electronically into any IT system Supports standards-based data sharing

The Wacom Clipboard key features & benefits Authoring tool makes it easy to lay out forms or documents and create a corresponding digital version Organisations benefit from archiving and accessing digital documents Customers can fill out familiar paper forms on the electronic clipboard Secure, biometric eSignatures can be included with the digital document Handwritten data can be captured and converted using handwriting recognition The barcode scanner integrated into the Smart Pad helps automatically syncs the paper form with its digital version

Volume 18.4 | HEALTH BUSINESS MAGAZINE

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BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS | www.healthbusinessuk.net

Feature&Heading Design build Written by the Design Council

Embracing a design-led approach in the NHS The Design Council says that by embracing a design-led approach to NHS refurbishment and building work, hospitals can drastically improve outcomes for both staff and patients in hospitals across the country. Here, outlining the work undertaken at the Whittington Hospital pharmacy, the Design Council explain how better design can improve the patient experience ‘Being patient is difficult when you are the patient’ says chief pharmacist, Dr Helen Taylor, who opened the doors to the new pharmacy at The Whittington Hospital, north London last July. Taylor shares the success of embracing a design led approach to improve patient outcomes in a busy London hospital. Until recently, collecting a prescription was not a pleasant experience for many patients entering the pharmacy department at the Whittington. Patients entered a space dubbed by many staff and patients as the ‘bus shelter’. It was cold, confined and lacking in any warmth. Most people coming to the pharmacy were unwell and anxious, and for most, the pharmacy represented the last leg of an already long journey through the hospital system. Efforts had been made over the years to try and improve the situation. The hospital regularly asked patients to share their views on how to improve the pharmacy but little feedback was received and very little changed. In 2016, the department received a scathing letter from a patient who described her experience visiting the pharmacy. Taylor said: “I received a letter from a patient and it was very truthful. I used this as an opportunity to engage this patient and ask her to help me and the team improve the waiting experience. I also wanted to improve the working environment for pharmacy staff. It was difficult and confined.”

Taylor felt sure the answer lay with design, so she turned to Design Council’s public services transformation programme to bring about change. Design Associates Anna White and Sean Miller were parachuted into the pharmacy to work alongside Taylor and her team to analyse the service and pinpoint areas where improvements could be made. She adds: “We engaged the Design Council who enabled us to engage with designers, architects and our patients, to explore how best to use the space and speed up the process inside the pharmacy” she said. “The collaborative design process made us stand in the shoes of patients and think about what it was like to be a patient in our pharmacy and this was really insightful.”

Embrac designing approa led really imch can outcom prove e and pa s for staff hospita tients in ls acro country ss the

A co-design approach Working together the team identified three aims for their change programme: improving the experience for patients, using every intervention as a health promotion opportunity and developing a retail offer to offset expenditure. The team engaged a specialist design agency to assist and they adopted a codesign approach, which focused on enabling pharmacy users to collaboratively create a space that would work best for them. This began by establishing a programme

of workshops with representatives from patient, staff and management groups. Taylor comments: “As pharmacists, we know what is important but the designers brought the principles of design, and taught us to think about it as a design process. They made us think in a different way. We would probably have done something quite conventional if the designers had not been engaged, but by applying the co-design process we were able to gather feedback from patients in real time. We also engaged with people we have traditionally struggled to engage in the past, so we could get feedback from a more diverse group of people, including those who do not traditionally respond to these surveys. This allowed us to obtain a broad range of new insights that I am convinced we would never would have been able to get if we applied the same methods we have used before”. The unhappy patient who contacted Taylor with her concerns was invited to the project: “I asked the lady who complained to became actively involved. She did, and she presented to the Trust board and secured buy-in from senior management. She has since become an advocate for the project which is fantastic.” The patient experience One of the key insights identified early in the process was a lack of clear communication between the pharmacy and the patient. Many patients wondered how long they would have to wait and this was frustrating to patients and caused further anxiety. Working together, the change team made up of staff, patients and design experts came up with new ideas for how the space could work. Ideas were tested and retested, first in model form, then at E Volume 18.4 | HEALTH BUSINESS MAGAZINE

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 half scale, and finally at full scale. Patients provided real-time feedback as they interacted with the new prototype elements in the pharmacy. The full-scale prototype developed from a model and an idea into a new look live pharmacy in July last year. Taylor and the team have been overwhelmed with compliments and positive feedback from staff and patients since they re-opened. Taylor says: “The feedback from patients has been extremely positive. Our pharmacy has transformed from a cold and unwelcoming place to a professional modern pharmacy service that patients like to visit. It is open, patients can see staff, communication is clear and information is presented more visually and therefore more clearly . It is bright, clean and you can get coffee and purchase items while you wait. The pharmacy is a calm place now. Patients can see staff working. Previously they were hidden away. The relationship between staff and patient is much improved”. Following the success of the Whittington

Pharmacy re-design, importantly for the hospital, it has also produced a design model that can be applied to other spaces within its walls, and a willingness to experiment. The hospital was so pleased with the success of this project it applied the same co-design process to help create their major new ambulatory care centre at the hospital. Since the design, build and launch of the centre, the ambulatory care given to patients in this environment has been rated as outstanding by the CQC. The Whittington has also been commended on how they manage medicines in their pharmacy and their overall outpatients rating has improved since the service re-design. Taylor said: “As we get funding for different projects, we implement the design approach. The hospital’s management team feels strongly that we should just push work like this through because it has such a good effect on patients.” Meanwhile, in other NHS hospitals, design thinking is being adopted to improve

the waiting experience in A&E. Design Council’s ‘A Better A&E programme’ uses a design approach to reduce hostility and aggression in A&E departments in order to prevent lost productivity and reduce security costs which is believed to cost the NHS millions of pounds every year. Design Council partnered with three NHS trusts across the country (Chesterfield Royal Hospital NHS Foundation Trust, Guy’s and St Thomas’ NHS Foundation Trust and University Hospital Southampton NHS Foundation Trust) to research, develop and test solutions in operational A&E departments. A team, led by design studio PearsonLloyd, worked with specialists in organisational dynamics and clinicians to create ideas for new communication systems, staff support services and secure spaces. The design team sought to create solutions that would improve the patient experience. For patients, this meant being better informed at every stage of their journey through A&E and remaining in control of decisions. For staff, the focus was on creating safe secure environments to work in. Embracing a design-led approach can really improve outcomes for staff and patients in hospitals across the country. Design Council supports the NHS and health sector across the UK. L

Design & build

Design Council’s ‘A Better A&E programme’ uses a design approach to reduce hostility and aggression in A&E departments in order to prevent lost productivity and reduce security costs which is believed to cost the NHS millions of pounds every year

FURTHER INFORMATION www.designcouncil.org.uk

Preventing the spread of disease using Selectaglaze secondary glazing for healthcare Controlling the environment within hospitals to avert the spread of disease and infection is very important. Selectaglaze secondary glazing creates an excellent barrier to help prevent this and has a wide range of healthcare products; from switchable glass, anti-ligature furniture and units that are Secured By Design accredited. Many hospital buildings of traditional construction are not particularly energy efficient and suffer from poor insulation. Secondary glazing with low-E glass can reduce U-values to less than 1.9. The speed of patient rehabilitation is important, with sleep playing a major part in the healing process. Selectaglaze secondary glazing systems can reduce noise levels by 42-45dB with standard glass and even higher levels achieved with thicker glass. Selectaglaze products are well suited for a number of areas such as secure mental health units where there is a need to protect patients from self-harm. Also, pharmacies and laboratories where sensitive or dangerous materials are stored and used benefit from secondary glazing, as well as data centres where patient data is stored. St. Mary’s Hospital developed a stateof-the-art 16-bed Critical Care Unit.

Selectaglaze was called upon by main contractors, Howard Electrical, to design and install secondary units which, in conjunction with the primary windows would help provide the required sterile and controllable environment. Selectaglaze answered the brief with the installation of its Series 45 side hung casements featuring 6mm toughened glass and fitted with special removable key handles, to prevent unauthorised opening of the windows. A total of 62 secondary glazed units were installed. Barts Hospital has seen the refurbishment of many buildings bringing them back to their eighteenth century glory. Working

closely with main contractor Skanska, the initial task was to provide acoustic insulation to eradicate external site noise and prevent ingress of dust from the demolition works into the remaining buildings. The Wards provided a challenge as they had to remain functional at all times, whilst the Series 46 fixed glazed panels were installed. The second phase of the involvement was providing secondary glazing in ten of the operating theatres, ensuring they maintained the highest standards of sterility and controlled conditions. Series 41 side hung casements were installed allowing the complex combination of specially developed power roller ‘privacy’ binds, together with ‘blackout’ blinds, which were essential in containing lasers used within the theatres. Founded in 1966, Royal Warrant Holder Selectaglaze has worked on all types of buildings, from Listed hospitals to new build hotels. FURTHER INFORMATION Tel: 01727 837271 enquiries@selectaglaze.co.uk www.selectaglaze.co.uk

Volume 18.4 | HEALTH BUSINESS MAGAZINE

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Daikin Applied UK supplies a range of fan technology within the healthcare sector. The air handling units are easy to maintain and have increased resilience, providing efficient and reliable solutions for air quality.

An air handling unit (AHU) is a ventilation device which is generally connected to ductwork, pipework, electrics and controls, which distributes conditioned air throughout a building/space. It is typically a large ‘box’ containing various active components from fan sections, cooling and heating coils, air filter systems, sound attenuators, humidification, dampers and most importantly heat recovery. Design The design of an AHU is a science which carefully considers a wide number of factors including heat transfer, acoustics, vibration, filtration, fan performance, spatial restrictions and power consumption amongst other factors. All of these criteria need to be considered when producing the best overall solution. Within a healthcare setting the role of the AHU is to provide specific conditions for patients to recover as well as maintain the health and safety of staff and visitors. The Health Technical Memorandum (HTM) 03-01 – ‘Specialised ventilation in healthcare premises’ provide clear guidance for Air Handling Unit design and specification. Initially the design airflow needs to be established so that the AHU structure and size can take shape with the crosssectional area of the AHU calculated based on a maximum coil face velocity of 2.0m/s. Despite of the design coil velocity below 2.0m/s there is a requirement for removable eliminators on all cooling coils to ensure that there is no moisture carry over into the occupied space optimising air quality. Air quality The primary objective is providing good indoor air quality which is a key requirement in healthcare applications. The primary function of Air filters is to help protect patients and staff from infections by reducing the level of airborne contaminates within the airstream. Metal framed filters are preferred for ease of cleaning and the construction of the filters should be such that they do not combust. Current standards require a G4/F7 filter grade on supply and G3 filter grade on the return air stream. However, with the new ISO16890 standard

requirement may enhance this requirement further, increasing the filtration and the filter pressure drops. The new ISO standard considers both the outside environment and the internal target air quality looking at the size and weight of the containment particles classified now as ePM1, ePM2.5, ePM10, ePMCoarse. In the healthcare sector special consideration should be used to tackle the smaller / lighter containment particles which requires the most attention as these are the most harmful, frequent and have the greatest permanence. Filters Current F7 grade filters achieve ePM1 50‑75 per cent, however envisage this requirement increasing to F8/F9 (ePM1 70-85%, ePM1 >85 per cent respectively) on supply and M5 (ePM10 >50 per cent) on return air side when taking into consideration of EU1253/2014. This will achieve SUP1 considering a city type outside environment which is vital to ensuring the internal environment is optimised for patient recovery and staff alike. In addition to the increase filter standards providing improved air quality more recently we have seen an increase use of ultraviolet lights within the healthcare sector. UV light options are available to be mounted on the downstream side of all cooling coils and above the unit drain pan. The lamps are used to destroy contaminates including mould and bacteria, resulting in improved efficiencies and increased heat transfer through cooling coils. One of the main benefits being improved indoor air quality by destroying surface microbes including cold, flu and other viruses. The HTM requirements for healthcare buildings lays out some standard best practices that should be applied to all healthcare AHUs for consistency of supply throughout the sector. With everything from the component sequence which should be positioned as per the graphic representation: The diagram below shows most items are

under positive pressure, with all drain pans on the positive pressure side of the fan. Daikin Applied A shift from Daikin Applied in terms of fan technology in the healthcare sector has seen the introduction of fan array which are particularly well suited to healthcare applications as they can easily be provided giving the increased resilience and redundancy if one fan were to fail to maintain air flow and treatment from the unit to the occupied space. Additionally the EC fan array uses high efficiency IE4 motors that are at the top end of fan class efficiency, leading to a very efficient solution helping to reduce SFP figures and saving on footprint. For the maintenance purposes the fan has an in-built CPU using MODBUS giving many data points that can be picked up by the BMS for either control or reporting and diagnostics. As well as air quality the HTM document also ensure ease of maintenance and cleaning of the AHU. Daikin Applied UK’s Professional range of AHUs are designed so all parts are easily and safely accessible for inspection, service and cleaning purposes. 500mm access doors complete with lighting and viewing ports are allowed for to all items that require routine service such as filters, coils, humidifiers and fans, along with the inclusion of stainless steel drain pans with a 1 in 20 slope in all directions to the drain outlet position for the cooling coil sections. Also with regards to cleaning Daikin Applied’s new anodised aluminium frame incorporates a rounded internal curve. This provides a great solution when cleaning units down coupled with the anodised frame that provides a lifetime corrosion resistant solution. Overall all there are a vast number of very specific requirements to be considered for the AHU application in relation to HTM in the healthcare sector. These are important to provide the best air quality with a consistent solution throughout healthcare applications providing resilience whilst maintaining high efficiency. FURTHER INFORMATION www.daikinapplied.uk

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Medstrom Healthcare partners with Doncaster and Bassetlaw Teaching Hospitals to put patients first and control costs Doncaster and Bassetlaw Teaching Hospitals (DBTH) is one of Yorkshire’s leading acute trusts, serving a population of more than 420,000 people across South Yorkshire and North Nottinghamshire. The trust currently trains 30 per cent of professional healthcare students and 25 per cent of all medical students in the region Employing more than 6,000 members of staff, the trust provides a full range of local care services across Doncaster Royal Infirmary, Bassetlaw Hospital in Worksop, and Montagu Hospital in Mexborough. Medstrom Healthcare has been contracted by the trust to improve its bariatric bed management through expert clinical support, asset monitoring, training and cost-saving solutions in order to better serve its patients. Identifying opportunities for improvement With obesity rates rising nationally, and as part of its commitment to working as closely and as efficiently as possible with its suppliers, in 2016 DBTH’s medical equipment team undertook a review of its bariatric equipment provision. Richard Somerset, acting director of Procurement at the Trust DBTHFT confirms: “Switching suppliers can present its own unique challenges, yet we believed that a new partner could improve our service, reduce unnecessary costs and provide a better service for our patients. After conducting a comprehensive review, we estimated that spend could be reduced by approximately £50,000 per year through a combination of better asset management and processes.” Mapping the route to enhanced bariatric asset provision In an effort to reduce cost, better support clinical staff and improve patient care, the Trust initiated a tender process to test the market. The specification was robust, with competing organisations being asked to clearly evidence their ability and experience in relation to asset monitoring, clinical support, value for money, quality and patient focus. Following an extensive evaluation

process, Medstrom Healthcare – the UK’s only independent provider of bed management services to the NHS – was awarded the contract in August 2017. Commenting on the selection process, Nicki Sherburn, matron of the Surgical Care Group, said: “Medstrom was selected because of the clinical evidence it was able to offer in relation to clinical efficacy on products, clinical support, education and training, and cost. No other supplier was able to offer all of this. Together with the company’s obvious clinical expertise and ethos, awarding the contract to them was a clear choice.” Echoing these sentiments, Richard Somerset added: “Medstrom was not only the most personable company to deal with - clearly aligned with the vision and values of the trust - but also the most price competitive and highest scoring in quality evaluation. Following the award, the transition period was well-handled by Medstrom. We faced none of the challenges you may expect with change of this scale, which further evidenced that we made the right decision to switch to Medstrom.” Adding up the benefits Since transitioning to Medstrom’s bed management services, DBTH has recorded numerous benefits. For Andrew Leverton, medical technical services manager, the decrease in rental charges has been significant. He said: “We’ve noticed a tangible drop in rental charges since working with Medstrom, which is partly due to the increased visibility we now have over assets thanks to Medstrom’s iTracker software. This helps us to quickly and simply match invoices with rental periods, while facilitating a clearer picture of where equipment is. Medstrom

listened to the problems we were facing in the past, and provided exceptional solutions.” In addition, Medstrom’s key performance indicator (KPI) reporting is enabling the trust to not only have real time access to performance data, but quickly and accurately respond to requests from auditors and demonstrate financial accountability. Helping the trust provide the right product, to the right patient, at the right time – and empower staff to intervene should a product be unsuitable for a patient’s needs – is adding genuine value, as Tracy confirms: “Medstrom has done exceptionally well to match the specification of what was needed. We wanted clinicians in need of bariatric beds to make one call and feel confident that a complete package of care would follow. Medstrom have gone above and beyond to meet this expectation.” Moving to Medstrom’s bed rental service has been a rewarding decision for DBTH. The trust plans to take its relationship with the specialist bed provider a step further by introducing wider provision, to include tilt-in-space chairs and ultra-low beds. The goal of creating a ‘one-stop shop’ is on the horizon and will help the trust achieve its vision of providing all patients with the most appropriate equipment to support the provision of harm-free, high quality, personalised care. Quickly, efficiently, and cost effectively. To speak to a member of our RN and RGN-qualified clinical team about our bariatric rental service, please contact Medstrom on 0845 371 1717 or email info@medstrom.co.uk FURTHER INFORMATION For more information about our products and service visit www.medstrom.com Volume 18.4 | HEALTH BUSINESS MAGAZINE

Healthcare Estates

‘Our Heritage, Your Future’: Improving healthcare estates The 2018 iteration of Healthcare Estates is now less than three months away. With a conference theme of ‘Our Heritage, Your Future’, Health Business looks at what the show will teach us about the importance of hospital estate management through a selection of stand-out sessions The future is looking exciting with new technology, innovation, and streamlining of processes and working methodology in the NHS, to save money, increase efficiency, and enhance and improve the patient experience and patient care. This year, Pete Sellars, outgoing IHEEM president, will open the conference followed by a special performance to mark IHEEM’s anniversary and the NHS’s landmark 70th birthday. Plenary sessions will begin with a Keynote presentation from Simon Corben, director and head of Profession NHS Estates and Facilities, NHS Improvement. A second Keynote presentation from Nick Hulme, chief executive for East Suffolk and North Essex NHS Foundation Trust, STP lead for Suffolk and North East Essex STP will be followed by a panel discussion with key representatives from the healthcare sector, including Rose Gallagher, professional lead for Infection Prevention and Control, Royal College of Nursing. The conference is divided into three parallel streams that run across both days of the event: Strategy and Leadership, Engineering and Facilities Management, and Planning, Design and Construction. The first day of the

emphatically encourages good provision of natural light, as does related technical guidance from CIBSE, but it is not always clear what this means for the procurement team, or the design team, when embarking on a new project. In his day one session, Dr Gareth Jones will explain why Climate Based Daylight Modelling (CBDM) is uniquely placed to improve daylight design for healthcare environments, and that its use should result in better buildings, with better health outcomes for patients. Oxford Brookes University’s Michael Esvelt will use his seminar slot to outline the Five Steps To Energy Savings in Healthcare Estates. The EiE team in the Faculty of Health and Life Sciences at Oxford Brookes University It’s will help facilities and univers estates teams reduce energy by working agreed ally that with the provision of natural d care by making the a y l i g h good fo t i s case for improving occupa r building energy efficiency nts: for by making best use being, w ellprodu of current tools E

conference will cover the following themes: strategy; sustainability; procurement, risk and funding, energy; well buildings; light in healthcare environments; design for efficient operation, and a module each from Architects for Health and Procure 22. The second day’s Keynote presentation from Dr Hyaatun Sillem, chief executive of the Royal College of Engineering, will be aligned to one of IHEEM’s initiatives, in discussing women in engineering, and a new initiative to enhance diversity and equality in healthcare engineering, and the role of the apprentice. NHS Improvement will also be delivering a ‘surgery’ on the morning of the 10 October at Healthcare Estates, covering best practice and the NHSI’s action themes now, and for the future. Lighting the way It is almost universally agreed that natural daylight is good for building occupants: for well-being, productivity and health outcomes. HBN documentation

and he ctivity a outcom lth es

Volume 18.4 | HEALTH BUSINESS MAGAZINE

We’re Building Lives Less Ordinary At Willmott Dixon Construction we believe it is our responsibility to take the ordinary and make it extraordinary. That’s why every project we take on has to deliver a positive and memorable impact.

Willmott Dixon is at the forefront of primary and community healthcare design and construction having completed over 20 award winning primary care facilities. These have included the Olympic Polyclinic, later refurbished as a health centre for the local community, Houghton le Spring Primary Care Centre in Sunderland, the first BREEAM ‘Outstanding’ healthcare facility in the UK and Akerman Road Health Centre in Lambeth which won the 2014 Civic Trust Award.

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£2.5 million community investment last year.

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We are currently delivering the prestigious Pears Building’s Institute of Immunology and Transplantation on the Royal Free Hospital site. The facility will provide a research space for clinical academics and scientists to accelerate research on diseases such as cancer, HIV and hepatitis.

61,000 hours of staff time invested in the community.

7,293 We are building on our experience and are developing a pre-designed community healthcare hub in response to the NHS Five Year Forward View and the plans presented in the STPs. This hub will be added to existing pre-designed facilities for the education, leisure and law and order sectors.

Our product offers clinical flexibility, with customisation to suit specific local needs; certainty of programme and cost achieved through evidence based design; a pre-selected, trusted supply chain; significantly reduced pre-construction period and efficient off-site construction techniques.

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Operation cost savings On site car parking and staff car usage are significant issues facing NHS trusts, whose sites often have a higher demand for parking spaces than are available and they often incur significant administration costs for staff using their own cars when travelling on hospital business. A number of techniques can be used to both reduce costs and also to free-up car parking spaces used by staff to maximise those available for visitors. Work undertaken for Oxford Health NHS Foundation Trust comprised preparing a trust-wide umbrella Travel Plan and the development of numerous site specific ones under this. At York Teaching Hospital NHS Foundation Trust, the introduction of a car club for business trips resulted in significant annual savings through lower transport costs has enabled the trust to manage health and safety more effectively. The trust no longer has to be responsible for employee’s cars being road worthy as the car club owner takes over that responsibility. In addition, the vehicles’ presence on-site has reduced the need for trust employees to drive to work and enabled them to take public transport instead, cutting traffic and commuter mileage. Through the provision of a car club they can travel by a noncar mode and then use the car club car during the day. The development of a well thought through Travel Plan, detailed traffic flow analysis coupled with innovative car usage can significantly reduce the demand imposed by staff on on-site parking and reducing overall congestion within the site.

Healthcare Estates

 within the national policy and guidelines. Following from this, the EiE team will discuss reviewing healthcare provision to identify where operations can support energy strategy. Cases of integration are used to help address common barriers and developing an action plan to integrate reduction goals into current staff development practices and how to measure improvements to both care provision and efficiency. How can you deliver facilities that meet operational demands in the most efficient way, providing consistent quality, programme and cost certainty and a level of choice within a predesigned product? Willmott Dixon is working with a full design cost and management team to address the challenges of the NHS that were previously successfully tackled in the education sector. The initial programme of designing new schools from scratch each time triggered a policy reaction from government that was efficiency, cost and time driven. The concept for healthcare, called Salus, responds to the NHS Five Year Forward View and the recommended transformation strategies. These are exemplified in the Vanguard Projects, namely integrated care provided in the community centred around general practice with improved local access and navigation tools for patients. This Willmott Dixon-led presentation will cover the benefits of predesigned products, the efficiencies they bring and the process of how we successfully develop them.

In the future, health services across the world are likely to take full advantage of emerging advances to focus on pre-emptive health checks – preferring prevention to the provision of treatment aimed at solving problems raised by the patient Simon Bourke will provide more detail on this at Healthcare Estates on 9 October. Also discussing transport efficiencies, Andrew Chatten, Nottingham University Hospitals NHS Trust’s director of Estates and Facilties, will speak on Queens Medical Centre Hospital becoming the first UK hospital linked by a tram. Delivered on a budget, the project reduced travel times for patients, staff and visitors, which then led to a reduction in patients missing appointments. The potential of surplus land NHS Property Services brings property and facilities management expertise to its primary care portfolio, acting as both landlord and service provider. Its portfolio is around 10 per cent of the NHS estate, worth over £3 billion in value consisting of 3,000 properties and 7,000 tenants. In their session on transforming the NHS estate, NHS Property Services will share examples of how it has supported trusts and CCGs to make vital system improvements by freeing up surplus land and releasing capital for investments, as well as how to recycle existing asset capital for healthcare re-provision and land release and free surplus land and property for creating new housing. Historically, health projects and estates have been driven by project briefs that defined function, equipment and the space needed

to accommodate patients, medical, nursing and support staff. Estates professionals rightly extol the virtues of decisions based on running costs, whole life costing and energy efficiency, but priority is usually given to the immediate challenges of patient service delivery. However, with demand seemingly neverending and both medical science and technology developing dramatically, it seems likely that in 30 years’ time, healthcare and the buildings will be very different from what they are now. So what will the future look like? In the future, health services across the world are likely to take full advantage of emerging advances to focus on pre-emptive health checks – preferring prevention to the provision of treatment aimed at solving problems raised by the patient. It is a small step to consider the impact on working patterns of a huge shift from emergency work to planned work and the health, time and financial benefits that this will bring. Health problems will be picked up earlier, patients will be more satisfied, and pressure will be lifted from NHS staff. Equipment will continue to get smaller, creating less demands on space and using less energy; techniques will continue to become less invasive, resulting in quicker recovery times and less demand for beds; more conditions will be diagnosed remotely, requiring less waiting space, and patient E Volume 18.4 | HEALTH BUSINESS MAGAZINE

Rosehill have been supplying quality contract furniture for over three decades We have products to fit all areas of your building including: Waiting room beam seating Patient and visitor chairs Meeting room and side chairs Reception furniture Breakout area tables and chairs Staff room furniture and lockers Office furniture and filing cabinets

Our seating can be upholstered in antiâ&#x20AC;&#x2018;microbial and antiâ&#x20AC;&#x2018;bacterial vinyl to be hygienic and easy to clean.

Come and see us at stand F7 at Healthcare Estates in Manchester on 9th/10th October

To discuss your requirements or for advice and quotations please contact Rosehill on: 0161 485 1717 or view www.rosehill.co.uk

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS | www.healthbusinessuk.net

 handling. Estates will be more compact, without loss of function. For this to happen it will need a radical rethink, not just by the NHS but by the attitude of the public and politicians who respond to the tide of opinion through policy and action. Paul Wilson, managing director of Provelio, will demonstrate how other industries and government departments have started down this road in his talk on ‘Are We on the Verge of a Health Estates Revolution?’. Creating Hospitals for Continuing Change Healthcare is changing dramatically. These changes are driven by various influencing factors in the short term and long term – increasing cost, continued shift to the outpatient setting, an ageing population, increases in non-communicable diseases and chronic conditions and leaps in both diagnostic and treatment technology. Healthcare providers are also increasingly pressured to respond appropriately to catastrophic events like hurricanes, floods, acts of war, contagious epidemics and local, regional or global pandemics. Healthcare facilities are a fundamental core to deliver safe, high quality, sustainable and economical health services. These demands require hospitals for today and for the future to be both flexible and adaptable. Flexibility and adaptability has been talked about a lot, but has the question ever been answered – why should we do it this way? As an industry, we need to challenge ourselves as to how we can better build hospitals and clinics with longevity and make Flexibility and Adaptability an integral and valued component of the design process. HKS and Mott McDonald will present their futuristic thoughts on how to design and to deliver Flexible and Adaptable healthcare infrastructure. The problems that the NHS is facing are well reported, primarily increasing and changing demand with limited resources. The response to these challenges is evolving through the Sustainability and Transformation Plans (STPs), the Carter report and Naylor report. A common theme is the recognition of the importance of the estate to support the transformation in service delivery with the estate described as one of the enablers for STPs. How does the NHS unlock the potential of the estate as an enabler addressing the realities of backlog maintenance in an ageing estate supporting a long term vision whilst responding to short term requirements? Simon Boundy will explore the challenges and opportunities that estates teams commonly face in developing and delivering comprehensive estates strategy in his session ‘Planning for the Long term, Delivering Now’. The new Dulwich Health Centre is designed to provide scope for a true transformation in the delivery of healthcare, with clinicians from all sectors working together and with a legal occupation structure intended to enable boundaries to be porous in response to changing requirements. Care will be provided in the first instance by three Foundation Trusts and an APMS, supported by a pharmacy and the voluntary sector, so it is important that demises can support collaborative practices in the hope that this can be a truly ‘one-stop-shop’. Dulwich is an NHS Property Services-owned site, part presold to the Education Funding Agency for local council provision of a school and with several site risks to be managed. A large number of stakeholders involved in providing integrated local delivery of primary, community and outpatient care concentrating on long-term conditions. Issues to be resolved involved demises, cost certainty, timing, inter-agency agreements. The Dulwich Health Centre’s procurement route is through a new wave of NHS LIFT schemes being delivered by Community Health Partnerships (CHP) within an NHS assurance regime from 2009. However, following the dissolution of PCTs LIFT knowledge and expertise was truly lost from the system. Now, for the first time in the history of LIFT, CHP can act as the central resource for new development knowledge in the Public-Private Partnerships arena, enabling us to standardise and streamline delivery of new facilities to the advantage of the wider health economy. Currie & Brown has been instrumental in the process

Healthcare Estates

The future is looking exciting with new technology, innovation, and streamlining of processes and working methodology in the NHS, to save money, increase efficiency, and enhance and improve the patient experience and patient care with their knowledge of the healthcare and delivery processes. Presenting will be the key team members responsible for getting the project to site, funds allocated in a time of financial restraint and provider organisations ready to work out how to deliver collaborative services. Cancer care Elizabeth Devas, interim design lead at Macmillan Cancer Environments and architect Guy Barlow, director at The Manser Practice, will give a joint presentation interrogating what ‘quality’ means in the context of cancer care environments, and investigating the ways in which quality can be evaluated and improved during the design process to ensure it is delivered in the final building. Based on Macmillan’s extensive evidence-based research, they will attempt to define what ‘quality’ means for patients and for staff, then illustrate the implications this can have on the design process, and how ‘quality’ can substantially affect the way cancer buildings operate and feel. The presentation will include a look at the design tools developed during these investigations, and consider how art and branding should be integrated into buildings, using built examples show the audience what ‘good practice’ looks like. This presentation will look at recent UK projects including the new NGS Macmillan Unit at Chesterfield Royal Hospital, to illustrate what we have learned and how this is being applied to healthcare design. L FURTHER INFORMATION www.healthcare-estates.com

Aqua free: Your specialist for water hygiene Aqua free is a specialist supplier of water hygiene solutions specifically designed for use in the most sensitive hospital departments and to support the treatment of the most vulnerable patients. As an ISO 13485 Certified company, Aqua free operates to the highest quality standards ensuring that every product is specifically designed and tested for its intended use. Aqua free products can be characterised as centring around the point-of-use, being quick and easy to install, and offering an immediate solution to water hygiene challenges with a range of solutions including: WRAS approved shower and tap POU filters, high capacity in-line filters, Birth/Burn Pool in-line and POU filters, ENT, endoscope washer/ manual rinsing and dental filters. Aqua free filters comply with HTM04-01 and deliver sterile filtered water, free

from any harmful bacteria such as pseudomonas aeruginosa and legionella. Complementing its medical range Aqua free offer a stand‑alone, automatic flushing system to prevent water stagnation and the award winning HygieneSiphon – the cost effective solution to infection from the washbasin waste system. Aqua free filters are CE Marked, Class I Medical products with proven performance in over 1,000 hospitals and medical centres across Europe.

FURTHER INFORMATION Tel: +44 1484 483045 info@aqua-free.co.uk www.aqua-free.com

Volume 18.4 | HEALTH BUSINESS MAGAZINE

DCW units for superior

Legionella and Biofilm removal The DCW solution is engineered based on customer criteria to eliminate Biofilm and Legionella in water systems in a safe, efficient and reliable way. With a Danish Clean Water unit, you get a solution that:

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Lift Consultants Our Lift Consultants provide independent advice on all aspects of lift engineering, from conceptual design through to final build. We have expertise on compliance and advice on existing lift portfolios we undertake condition surveys to assist with forward planning and budget management. Phone: 08003029331 Web: www.hemsworthassociates.co.uk Email: info@hemsworthassociates.co.uk Address: 86-90 Paul Street London EC2A 4NE

Ready to discuss a project? Contact us today for friendly help and advice. falconcontractflooring.com t: 01527 919 988 w: falconflooring.com

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BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS | www.healthbusinessuk.net

Willmott Dixon: Building lives less ordinary

Contract furniture for healthcare environments

Willmott Dixon is a privately‑owned contracting and interior fit-out group. Founded in 1852, the company is dedicated to leaving a positive legacy in its communities and environment and, in 2018, Willmott Dixon was one of only six companies to receive a Queen’s Award for Enterprise in the promoting opportunity through social mobility category. Willmott Dixon is behind important projects like a new home for the Met Office supercomputer, fit-out of the Design Museum and restoring Alexandra Palace to its former glory. The company’s passion is to create spectacular outcomes for its customers in the knowledge that its projects have a huge beneficial impact for the UK’s economic growth and prosperity. The organisation also likes to think there’s no better place to work, and this is underlined by coming 14th in the 2017

Rosehill Furnishings Ltd has been supplying quality contract furniture for over 35 years to healthcare, education and public sector customers. The UK’s leading supplier of loose contract furniture, Rosehill has a wide range of furniture to suit various areas of your building, including: waiting rooms, reception areas, meeting rooms, staff rooms, offices, conference halls and breakout or dining areas. Rosehill also has a wealth of knowledge and is happy to offer advice to help you find the right products to meet your needs. Exhibiting on Stand F7 at

Sunday Times list of Top 100 companies to work for – better than any other contractor! The organisation creates value for customers, stakeholders and communities by working in a sustainable and responsible way to shape the built environment and make a positive impact to society’s well-being. Each year, it invests £2.5 million to improving the well-being of local communities, and this was recognised in 2017 by the Sunday Times which awarded us its top Giving Something Back award.

FURTHER INFORMATION Tel: 01462 671852 www.willmottdixon.co.uk

Healthcare Estates in October, the company’s products and designs are inspired by innovation using only the best quality materials and trends. Rosehill is a team of creative thinkers, can‑doers, trend‑spotters and hard‑workers, and is dedicated to providing its customers with only the best products at the forefront of innovation.

FURTHER INFORMATION Tel: 0161 485 1717 sales@rosehill.co.uk www.rosehill.co.uk

Open invitation to trial conceptual ideas

Water disinfection in public buildings and facilities

Static Systems Group is renowned for the provision of industry-leading bedhead services solutions for the acute healthcare sector; incorporating trunking, nurse call and other associated systems. The company’s Design & Innovation Centre (D&IC) houses the P22 Repeatable Room and new Concept Ward. Supported by a number of leading suppliers, the facility can be used by clients and the wider industry to trial conceptual ideas and innovative solutions, with the ultimate aim of supporting improved health care outcomes for all. Key to Static Systems’ proven track record and prolonged success is the company’s close collaboration with client teams who play an important role in helping shape product development and design. Visitors to Static’s stand (C3) at Healthcare Estates this year will be able to find out more

Danish Clean Water is one of Europe’s leading providers of top quality, reliable disinfection systems, specially designed to eliminate Legionella and biofilm in water without using harmful or toxic chemicals. The company was first set up back in 2008, with the head office located in Sonderborg in Denmark. DCW specialises in producing, developing and selling state of the art disinfection units, and have built up a strong reputation because of the outstanding disinfection of hot and cold-water systems, with clients as housing associations, hotels, institutions, commercial buildings, cooling towers, hospitals and everywhere else where legionella threatens the health of residents and employees. DCW disinfection units produce a disinfectant liquid called NEUTHOX®, which contains Hypochlorous acid,

about the latest initiatives and developments being introduced to improve patient experience and patient safety, enhance workflow efficiency and support engineering teams. Experts will be on hand to give demonstrations, and visitors will be able to arrange to visit the D&IC or book to use the facility for their own event or research.

FURTHER INFORMATION Tel: 01902 895551 sales@staticsystems.co.uk www.staticsystems.co.uk

known for its disinfection properties. NEUTHOX® is also environmentally friendly, with only water and salt being the only residue after NEUTHOX® has degraded. It is also safe for handling by employees and users, and the technology is extremely cost-effective in operation. During a two-year project, DCW documented that the units eliminated legionella below the limit of detection, and at the same time, it also prevented the formation of biofilm on the inside of water piping systems.

FURTHER INFORMATION Tel: +45 70 29 09 00 www.danishcleanwater.com

Volume 18.4 | HEALTH BUSINESS MAGAZINE

Comment

NHS 70: A celebration for a fantastic achievement At the start of this month the NHS celebrated its 70th anniversary, recognising the role that the National Health Service has played in improving and sustaining the health of the nation. As one of the largest employers in the world, the NHS treats more than 1.4 million patients every day. That is a phenomenal amount of people who are cared for with compassion and dedication, and the 1.5 million doctors, nurses, ambulance staff, therapists, porters, caterers and volunteers who have made the system a success have been rightly recognised. But while this month has provided a great opportunity to reflect on the history of the NHS, from Aneurin Bevan launching the health service in Manchester in 1948 to the most recent funding announcement, it is also appropriate to look forward. The progress in technology over the last decade alone has heralded a new era for innovation in healthcare. With the population getting older and living for longer with more illnesses, the need to integrate health care and social care is at the forefront of the national agenda, while mental health is beginning to experience the much-needed attention it requires, both inside and outside the hospital.

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Over the next few pages we interview some of the people at the forefront of care in the UK, discussing the success of the NHS to date and the steps it must take next. The NHS is under more pressure than it has ever experienced before. The success of the next 70 years depend on the action taken now and the ongoing hard work of our integral NHS staff. Michael Lyons, editor

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Printed on recycled paper

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NHS 70

NHS 70 interview: Norman Lamb, MP and former Care Minister As part of July’s NHS 70 anniversary celebrations, Health Business will be publishing a number of interviews with those working within and for our health service. Here, we pose some questions to Norman Lamb, former care minister and Liberal Democrat MP for North Norfolk Writing alongside Commons Peers Sarah Wollaston and Liz Kendall earlier this year you said that a cross-party approach to solve underfunding of health care is needed. What must change in order for us to have the ‘mature rational debate’ needed to come up with a lasting solution to this crisis? I understand that it is very difficult for governments of any political complexion to be seen to be ‘letting go’ of responsibility for policy decisions. However, there are sometimes issues such as the sustainable funding of the NHS and critically the social care system where traditional partisan politics is not delivering a solution. That is because the issues are difficult politically. It involves raising taxes and we also need to think about how public money is currently spent. I now receive free prescriptions having recently turned sixty – I cannot justify this given that many people on much lower incomes have to pay the full prescription charge. There are many other examples. This is why the government needs to embrace the idea and allow politicians from across the political spectrum to commit to finding a solution. With will it could happen, but at the moment the government seems too cautious to embrace the idea. As Health Minister you worked to reform the care system introducing a cap on care costs and ensuring that carers get the support they need. With Th cases where patients main need are somere is for social care increasing, issues s etimes what must the government s ustaina uch as the do to act accordingly on the N ble funding this previous pledge?

H o the soc S and critically f ial care system where t r a d i green paper. t ional partisan We were p o not del litics is expecting ivering this before the solution a summer recess.

It was disgraceful that the government legislated to introduce the cap on care costs (I was the Minister that took this through Parliament) yet once the Conservatives were returned as a majority government in 2015 they postponed the introduction of a cap and then abandoned it completely in 2017. Subsequently, they indicated that there would be a cap but have never indicated at what level this would be set. Now they promise a

It has now been delayed to the Autumn and it could be delayed again given the change of Secretary of State. This issue has been pushed into the

long grass since the late 1990s when the then Labour government set up a Royal Commission and then did not implement the key recommendation. Again, there needs to be a sustainable means of funding social care. I have argued the case for a dedicated (hypothecated) NHS and Care Tax. If people knew that this tax was going to fund the health and care system they would be more willing to consider increases in that tax. E Volume 18.4 | HEALTH BUSINESS MAGAZINE

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NHS 70

 Ensuring that mental health gets treated with the same priority as physical health is something that you are regularly heralded for. The last two Prime Ministers were also stressing the need for this. What needs to be done to actually achieve this? The 2012 Health and Social Care Act included a commitment to ‘parity of esteem’ between mental health and physical health. Sadly, the reality is very different. In 2014, we published the first-ever maximum waiting time standards for mental health. Until then, there was a complete mismatch between rights of access to physical health care and to mental health care. At the same time we published a vision to introduce comprehensive maximum waiting time standards in mental health. Sadly, the government has never committed the resources to implement this and we are still a long way away from getting there. We need to make equality of access and equality of treatment a reality – not just rhetoric. This requires investment. The whole principle of early intervention is widely accepted. You get better outcomes if you act quickly. Long waiting times completely conflicts with this basic principle. When we interviewed you in December2016 you said that ‘pooled budgets and joint, coordinated commissioning will go a long way to solving the problems in the current system’. To what extent has the Department for Health and Social Care addressed this? And what else needs to be done to make joined up care a daily reality in the NHS? Very little progress has been made on pooling budgets. We introduced the Better

Care Fund to start the process of bringing health and care funding together but the government has not embraced this and developed it in the way that I had hoped. My view is that the government should set a date by when health and social care budgets should be completely pooled in a locality with single commissioning. Following the sort of model that is being developed in Greater Manchester seems to me to be a good way forward for other parts of the country – more devolved responsibility, more control over the finances and a greater

enough information about an individual is shared between different agencies. Improved healthcare can be achieved through better sharing of information but the critical thing is that the individual should be in charge of their own data and have access to it on their smartphones and iPads. L

Norman Lamb has been the Liberal Democrat MP for North Norfolk since 2001. After serving as a minister in the Department for Business, Innovation and Skills, he was appointed Minister of State for Care and Support at the

It was disgraceful that the government legislated to introduce the cap on care costs, yet once the Conservatives were returned as a majority government in 2015 they postponed the introduction of a cap and then abandoned it completely in 2017 power to determine local priorities and to make changes which will improve the health of the population in the longer term. With Yorkshire and Humber and Thames Valley recently added to the Local Health and Care Record Exemplar scheme, do you think that one shared Local Health and Care Record for the regions of the UK is likely to work? Yes, I think this is a vision and ambition that we should follow. Sharing data is one of the big challenges that we face and people rightly get anxious about data privacy. However, no disaster has happened as a result of sharing too much information. Failures of care often happen because not

Department of Health in September 2012 and served in this position until the end of the Coalition Government. As Health Minister, Norman worked to reform the care system and led the drive to integrate health and social care, with a greater focus on preventing ill health. He also challenged the NHS to ensure that mental health was treated with the same priority as physical health, including the introduction of access and waiting standards in mental health for the first time. He was elected as the Chair of the Science and Technology Select Committee in July 2017. FURTHER INFORMATION www.normanlamb.org.uk www.libdems.org.uk

Volume 18.4 | HEALTH BUSINESS MAGAZINE

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Choosing the right EPMA system – St. Helens & Knowsley Hospitals focus on patient safety and digital maturity NHS organisations are wrestling with the challenge of raising their digital maturity and implementing transformation and change to benefit patients, clinicians and improve outcomes and efficiency

A central and challenging part of this process in the acute sector is the implementation of ePrescribing and Medicines Administration. Whilst some are still starting this journey others have deployed successfully and now are reaping the benefits of both more advanced functionality and a rich source of data which is being used to help transform Medicines Management and provide further clinical integration and tools for end users to enhance decision support and improve patient safety. Issues around ageing infrastructure, change management and limited resources capable of managing these major projects remains a major obstacle to success. For those who meet these challenges the benefits are considerable. St Helen’s and Knowsley Teaching Hospitals (STHK) recently rolled out JAC’s Electronic Prescribing and Medicines Administration (EPMA) system and describe their selection criteria, the functionality they focused on and the roll out process. Rowan Pritchard Jones, St Helens & Knowsley’s CCIO, said: “Of all our digital projects, e-prescribing is the biggest step forward in patient safety. It reduces errors and ensures the right things get to the right place at the right time.” In April 2017, STHK went live with JAC’s new web-based EPMA system. Purchased under the NHS Safer Hospitals, Safer Wards technology

funding scheme, EPMA works with STHK’s existing JAC Pharmacy stock control module to deliver end-to-end medicines management and is being interfaced with the trust’s new PAS for order communications, discharge data and a range of other functionality. Digital maturity JAC’s new EPMA is also a strategic step forward in digital maturity. Mike McKenna, the trust’s EPMA Programme Manager, said: “It gives us a whole new interoperability environment to share data for things like A&E discharge, remote treatments for mental health facilities and secure patient records for clinicians on the road.” In choosing JAC, the trust opted for an e-prescribing solution with broad functionality, a specialist-designed set of tools and a large and proven user base. Christine Walters, CIO, added: “Since at the time of the selection process we didn’t have an EPR we were free to choose the market leader.” New web benefits The team also wanted a modern web interface that would give remote users quick and easy access to information. Walters comments: “EPMA’s web technology makes the system easier to deploy, add upgrades and link to other applications as our digital environment evolves. Gone are local software reinstalls;

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now we can add updates at the centre and provide users with access via URLs to save time and ensure everyone is on the same version. For remote users, internet data security is assured with firewalls and VPN access codes into the trust server.” Pritchard Jones adds: “In addition to being more intuitive than many systems, the web interface gives clinicians a much greater degree of agility for mobile use.” The digital transition Currently the JAC EPMA is in use on several key wards including stroke rehabilitation and haematology, with Whiston’s remaining 35 wards and departments due to be live by late 2018. When it came to rolling out the new system, the web interface – designed in response to in-depth studies on how users navigate screens – greatly simplified the training process. Dr Francis Andrews, medical director and the project’s chair, says: “I was able to go from paper to working electronically in 15 minutes. As for the nursing staff, nothing would induce them go back now.” The pharmacists were also quickly won over. Having gone through a one-on-one programme of intensive hands-on training to ensure they understood the functionality of the system and how to use it effectively, it was still a big change from what they were used to. Nevertheless, it did not take long for them to become familiar with EPMA. As Dr Andrews points out, the speed with which the hospital’s cultural and technology barriers were overcome is particularly impressive, considering e-prescribing’s complexity which makes it a difficult environment to change. He said: “To start with there’s a vast array of medicines that have to be entered into the system. Protocols and dose banding can be custom configured by the team building the drug database, so they can be tailored to the individual trust and clinician needs. The system also retains alerts for an individual patient’s drug allergies and sensitivities. Because a single error can be life threatening, this explains why medicines management has one of the lowest tolerances to error: It has to be safe.”

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Error reductions This ‘safety first’ attitude is shared by everyone at STHK. Pritchard Jones says: “Of all our digital projects, e-prescribing is the biggest step forward in patient safety. It reduces errors and ensures the right things are getting to the right place at the right time.” According to Dr. Andrews, in just six months EPMA’s impact on prescription errors has already been dramatic: “We used to get a lot of error reports but in the last three months we are seeing relatively few.” Among the safety enhancements of going paperless are the system’s many exception alerts, decision support tools and transcription error reductions (since drug cards are no longer written by hand). Prescription orders and kardexes no longer go astray and in cases when care is speed critical, prescription data and dosage changes can be reviewed and amended remotely. Other benefits EPMA also provides numerous other clinical benefits. One of these is the ability to see a patient’s complete prescription on a single screen. Drug histories and retained patient notes from previous treatments can be called up, free text messages left on the file (at both patient and drug level), and decision support data accessed: all from a single logon. The system’s ability to capture and retain all past and present medicines data means that on readmission a patient’s drug history from the previous admission is already available. On discharge, prescription letters can be processed using data from EPMA to

save re-keying and this should reduce the risk of a transcription error. For patients on large numbers of medicines, this also has the potential to save the discharging doctor a significant amount of time. In addition, all prescription information can be shared with the GP through the hospital’s ICE interface. As for operational and financial efficiencies, since all medicines management data is automatically captured and continually updated in the JAC database, generating reports and analysing data is straightforward. Working with JAC Given the complexities of STHKs EPMA project, with Whiston’s 37 wards and departments and further rollouts planned for St. Helens Hospital, Outpatients, and possible outreach into community hospitals, a good supplier relationship is vital. Says Walters: “Since we use JAC Pharmacy we already had a relationship which has been strengthened as a result of the EPMA implementation. We appreciate the fact they didn’t just send us techies; the team also included an expert who was a former EPMA user with hospital experience and a pharmacy background. He understood immediately what we were trying to do which was reassuring given the challenges we faced in introducing such a complex, key clinical system.” For Dr. Andrews, it was JAC’s confidence in the face of the size and complexity of the project that most impressed him: “With anything of this scope you’d expect a few hiccups, but with EPMA these have been far fewer than most other projects. The

JAC team believe in the product,worked extremely hard, and the company has a good roadmap. All of this makes JAC our trusted partner for the long term.” Basildon-based JAC is the UK’s leading solution provider of medicines management solutions in over 150 hospitals in the UK and 13 leading hospitals across Europe. Its flagship OneMedicinesTM platform draws upon decades of domain expertise and prioritises patient safety, operation efficiency and financial sustainability and includes JAC EPMA (web-based Electronic Prescribing and Medicines Administration), JAC CMS (chemotherapy management) and JAC Pharmacy. Together these three solutions create an integrated workflow with easy links to PAS, EPR, ADT, financial and other related applications. JAC also supports industry-mandated digital transformation initiatives and leads the way in defining interoperability standards for community and regional data sharing. Both JAC and Mediware Europe (CMS specialist), are wholly owned subsidiaries of U.S. based Mediware Inc. (www.mediware.com, NASDAQ: MEDW). Collectively the organisation is the largest global provider of hospital-based pharmacy, e-prescribing, CMS and blood management technology. FURTHER INFORMATION www.jac.co.uk

Volume 18.4 | HEALTH BUSINESS MAGAZINE

NHS 70

NHS 70 interview: Janet Davies, Royal College of Nursing As part of July’s NHS 70 anniversary celebrations, Health Business will be publishing a number of interviews with those working within and for our health service. Here, we pose some questions to Janet Davies, chief executive and general secretary of the Royal College of Nursing The face of nursing today looks very different from how it did when the NHS was first created 70 years ago. What would you say have been the biggest changes over that period? There has been enormous change but the motivation of nurses - enabling people, empowering people, caring for people with compassion - remains exactly the same. What motivated our nurses in 1948 is exactly the same as it is now. But healthcare and health need has changed beyond all recognition. Nurses can now be found leading cutting edge research, prescribing drugs, running clinics, and holding top management positions both in the NHS and independent sector. Specialisms exist now that would have

been unthinkable at the beginning of the NHS, and it is not unusual to find specialist nurses training junior doctors in certain areas. The population and patient need is great and growing so we have now been left in the position where we don’t have enough nurses. As the needs of the population become increasingly complex, the profession must continue to rise to the challenge. At such an important time for the nursing, midwifery and AHP workforce, how is the nursing industry responding to some of the challenges that it is facing in 2018? It’s been a long time coming, but the industry is at last beginning to respond to

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calls for a more flexible way of working that places greater emphasis on staff well-being. Nursing staff have a right to a healthy work-life balance, and flexible working opportunities not only improve staff performance and reduce unplanned absences, but support the recruitment and retention. The RCN has long been campaigning to improve conditions, particularly around nurses missing rest breaks, and lack of access to food and drink. These issues have only become more pressing, as understaffing has left too few nurses covering depleted rotas and trying to do the best they can. In these circumstances it can be difficult to find time for breaks, but they are vital, both for the safety of nurses and their patients. Dehydration, for example, affects

NHS 70

concentration, which triggers fatigue essentially as it is not just a well-being at work issue but an issue of safety. RCN guidance spells out the duties employers have to staff, but also provides clear, practical steps employers can take to make sure staff are able to look after themselves properly, and by doing so provide the best care to patients. Alongside other health professions, leading figures within the nursing sector have commented on the need for services to improve. Realistically, what does improvement look like? Training is key to improvement, yet too many nurses have had career development opportunities snatched away as the Health Education England budget for continuing professional development has been cut by 60 per cent over the past two years, from £205 million in 2015/16 to £83.49 million in 2017/18. Nurses make up half the NHS workforce and, as a society, we cannot afford for their training to be an optional extra. These short-sighted cuts must be reversed. For the sake of patient safety, nurses must be allowed to keep up-to-date with developments and advanced into tomorrow’s nurse leadership positions. Within the history of the NHS, given current problems, one thing that stands out is the magnitude of nurses who have come from overseas and made a contribution to improving care in the UK. This is highlighted with the 70th anniversary of the arrival of Empire Windrush this year as well. Just how important is it that staffing shortages are adequately addressed, both inside and outside of the UK? The NHS has a proudly international history and even now its staff are drawn from 200 countries around the world. But, following the Brexit vote, our European nurses have put up with two years of uncertainty, mixed messages and even being used as ‘bargaining chips’. There are 40,000 unfilled nurse jobs in the NHS in England alone and that number would rise further if EU nationals felt no choice but to leave. Nurses returning home, or giving Britain a miss entirely, are doing so because their rights are not clear enough. Theresa May must use every opportunity to say they are welcome here and valued in health care. Starting to stem the loss of nurses is welcome but the real battle is to inspire young people to join the profession. We need to grow our domestic workforce, and it is vital the government does more to encourage people to study nursing, through incentives and financial support. Staffing shortages are the most serious problem affecting not only the nursing profession, but our healthcare system as a whole, because it has a direct impact on patient care. We need a comprehensive, longterm workforce strategy which determines

Staffing shortages are the most serious problem affecting not only the nursing profession, but our healthcare system as a whole, because it has a direct impact on patient care. We need a comprehensive, long-term workforce strategy the real demands that our ageing growing population places on health and care services. And it’s not enough to stop at the NHS. Given the significant proportion of nurses needed across all sectors, any plan based solely on the NHS, or even the wider public sector, will likely fail. There need to be enough trained nurses in our country that an individual choosing to pursue a career in the independent sector has no detrimental impact on the NHS – tens of thousands of nurses work in social care.

of technology in healthcare. This must be managed to ensure patients, and the nurses who care for them, see genuine benefits. Several hospital pharmacies in the NHS are now using robots to pack prescriptions and reducing dispensing errors. Meanwhile the Edinburgh Centre for Robotics is currently developing SoCoRo, a ‘socially competent robot’, to ‘deliver behavioural training’ for adults with Autism Spectrum Disorder. But increasing use of technology must work in harmony with the profession, not against it, and the RCN is working to understand the challenges and opportunities the future holds for nursing. L

The has a pNHS rou interna tional hdly istory and e staff ar ven now its e dr 200 co awn from u around ntries th world e

The knowledge and skills required from registered nurses today are obviously very different from what was required ten years ago, never mind 70 years ago. With this change likely to continue, what do you expect to change in the next decade? The UK is behind some other countries in its use of artificial intelligence and robotics in healthcare, but we expect to see greater use

Janet Davies is the chief executive and general secretary of the Royal College of Nursing. Janet is a mental health nurse by background who, prior to joining the College, was a Director of Nursing and then chief executive of an Ambulance Trust. FURTHER INFORMATION www.rcn.org.uk

Volume 18.4 | HEALTH BUSINESS MAGAZINE

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Pressure ulcers are a pernicious clinical challenge Every day, in every care setting, health care professionals will perform the essential task of assessing their patients for pressure ulcer risk or actual manifestation. Clinical judgement, informed by validated risk assessment tools such as the Waterlow1 or Braden2 scales help practitioners assess their patients’ risks of developing a pressure ulcer (PU)

If a patient is deemed to be ‘at risk’, a number of preventative interventions such as turning regimens and specialised mattresses/ chair cushions, will be implemented. These practices are complimented by visual skin assessments, intended to detect visibly and tacitly observable changes to the skin’s surface. A positive confirmation of skin deterioration over an anatomy typically triggers additional, targeted or more intensive treatments. A clinical challenge of preventing pressure ulcers is that tissue damage is initiated at the cellular level3, and may not be visible to the naked eye until hours or days after damage has occurred. Waiting for tissue damage to appear at the skin’s surface before taking anatomically targeted interventions is problematic and is a missed opportunity for prevention. The prevention imperative Preventing PU development is central to patient care, effective resource management and is a clinical indicator of care quality4. A recent publication by NHSI identified that between 1,700-2,000 patients per month develop a PU.5 The same report stated that treating pressure damage costs the NHS more than £3.8 million per day 5. While risk assessment tools play a large part in PU assessment, they trigger universal prevention measures designed to prevent the onset of reportable stage 2, 3 and 4 pressure ulcers. These universal prevention measures incur costs, utilise nurse resources, and are based on a whole-body approach rather than targeted to the area most at risk; anatomically targeted interventions necessarily being withheld until a Pressure Ulcer visibly manifests at the skin’s surface. The SEM Scanner works in conjunction with risk assessment and visual skin assessment to provide anatomically specific measures of the first signs of skin and tissue assault; the inflammatory response.

in a localised accumulation of fluid below the epidermal layer of the skin; known as sub-epidermal oedema or sub-epidermal moisture (SEM). The SEM Scanner 200 (Bruin Biometrics LLC) is a medical device which measures sub-epidermal moisture. Measurements are made at the site of areas most susceptible to pressure ulcers, such as heels and sacral areas, to gauge the relative difference in SEM. The difference between the highest and lowest readings, the delta, is used to assess pressure damage. A delta value of 0.5 or less is indicative of low site-specific SEM variance, equating to healthy tissue (healthy tissue is not inflamed), delta values equal to or greater than 0.6 reflect increased site-specific SEM variance, indicative of inflammation associated with incipient pressure damage. Using this method, the SEM Scanner provides practitioners advanced warning that tissue is compromised, even if at the skin’s surface all looks well. This advanced warning has been shown to be five days (median) prior to the PU being detectable by the naked eye6. Evidence from real world usage of the SEM Scanner in pressure ulcer reduction programmes (PURP)7 shows dramatic reductions in PUs, many sites reporting zero PUs when using the SEM Scanner in a prevention focused protocol. In terms of cost savings, a recent example has been developed using an Incremental Cost Effectiveness Ratio, in this example integrating the SEM Scanner into the prevention pathway would equate to £650,000 savings in a 210-bed facility

in the first year of implementation8. Conclusion The SEM Scanner is a simple, hand-held, easy to use medical device, which, when used as an adjunct to existing pressure ulcer prevention pathways, can help to drive reductions in pressure ulcer incidence, ultimately reducing patient pain and distress and enable cost savings for the health care facility. L References 1. Waterlow J. Pressure sores: a risk assessment card. Nurs Times. 1985;81:49–55 2. Bergstrom N, Braden BJ, Laguzza A, Holman V. The Braden Scale for Predicting Pressure Sore Risk. Nurs Res. 1987. 36:205–210 3. Oomens CWJ, Bater DL, Loerakkar S, Baaijens F, Pressure Induced Deep Tissue Injury Explained, Annals of Biomedical Engineering, 2015; 43(2):297-305 4. NICE. Pressure Ulcers. Quality Standard QS89. 2015. Available at: https://www.nice.org.uk/guidance/qs89 5. NHS Improvement, (June 2018), Pressure Ulcer: revised definition and measurement. Summary and Recommendations. Publication Code CG 73/18 6. Oknonkwo, H, Milne, J., Bryant, R. et al. Evaluation of a novel device using capacitance of the detection of early pressure ulcers (PU), a multi-site longitudinal study Accepted and presented at WUK 2017, NPUAP 2018 7. Lawrence R, Hancock K. Pressure Ulcer Prevention Programme* (PURP), Enabling Clinically Effective Management of Patients at Risk of Pressure Ulcers (PU). Poster Presented at EWMA Conference 2018 8. Data on File

FURTHER INFORMATION www.sem-scanner.com

SEM Scanner In response to skin and tissue damage, the body’s inflammatory response results

Volume 18.4 | HEALTH BUSINESS MAGAZINE

NHS 70

NHS 70 interview: Ian Smith, King’s College Hospital NHS FT As part of July’s NHS 70 anniversary celebrations, Health Business will be publishing a number of interviews with those working within and for our health service. Here, we pose some questions to Ian Smith, chair of King’s College Hospital NHS Foundation Trust the evolution of the relationships we have with patients but it will also revolutionise how we care for and treat them as well. Not only will this see changes in how services are run but also impact in areas such as estates and facilities, training and education. A few years ago you published a report on how our health and social care systems can be reformed to better align with the needs of today’s society. If anything, the crisis in our care system has magnified since then, so given the 70th anniversary of the NHS birthday, how can we ensure the two services do not remain ‘stuck in time’?

Now is the perfect opportunity to celebrate the achievements of our health service, but also to analyse the array of opportunities being created by advances in science, technology and information that were not possible in 1948. If we were to review the next 30 years of NHS history on the service’s centenary year, what current area of care do you think will develop to make the biggest change? The area that needs to change the most is out-of-hospital care and the way that it integrates with in-hospital care so that the system is configured around the personalised needs of specific and unique patients. Technology is never an end in itself, but it can play a major role in facilitating this move from the dominance of in-hospital care to care that is centred on the patient – and which mostly tries to keep people out of

hospital, but allowing them to benefit from expert medical care that comes to them rather than the other way round. This is the context within which the universal adoption of new and emerging technologies can have a major impact. That will create the single biggest change in the NHS of the future. The NHS has a real and exciting opportunity to reinvent itself for the future and continue to be the leading healthcare model in the world. As well as the very specific technologies that will increasingly be introduced in to specific patient pathways using virtual reality or nano tech, the wider use of technology at the interface of the patient and our services will also provide us with opportunities that were not even available a decade ago. For example, we are already using technology so that more patients can be treated in their homes and I think that this will have increasing momentum in the next few decades. Not only will this see

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The key is to provide demand-side, patientcentred processes that ‘pull through’ reform. We need to break the cycle of supply-side, top-down initiatives that are well-intentioned but always run into the sand. They are re-launched year after year, the only change being that they are given new names (vanguards, new models of care, initiatives, pioneers, clinical commissioning groups, and so on). These demand-side, patient centred mechanisms are: high quality information on outcomes that citizens can access and understand; ‘choice’ so that citizens can choose to use the services that provide the best outcomes; a commissioning system that encourages and incentivises providers to compete to deliver the best service to citizens; ‘personal budgets’ so that the taxpayers’ money follows the patient/citizen rather than propping up the outdated structures created in 1948. This point about ‘personal budgets’ is vital – we need to put in place customised care packages for the most vulnerable in our society: those living with mental health conditions, frail elderly citizens, many of them living with co-morbidities and dementia, and, of course, those people with acute and chronic medical conditions. Health and social care workers do a fantastic job in this country. They are highly skilled and deeply committed, but their impact on improving the lives of the patients and citizens for whom they care diligently is severely constrained by a system that too often operates to confound them rather than support them.

Access to technology must remain universally available to everyone. Therefore, the challenge is how does the NHS ensure that we keep pace with technology while at the same time ensure that no one is left behind? In that Away from the past report you suggested that social care is being chronically under-funded, with any extra funding for the NHS being eradicated by extra demand caused by under-funded social care. To what extent must the NHS change this in the next few years in order to change that pressure in coming decades? My brother, Professor Steve Smith, published our paper in the Health Service Journal in 2015, and the crisis in health and social care that we predicted then is playing out in reality. It is vital that the two systems – NHS healthcare and local authority social care – are merged immediately, and are underpinned by the patient-centred mechanisms outlined above. And it is clear that a number of other constraints to productive change are removed. Besides more money (some of it raised by deterring abusive or inappropriate use of the system) we need to stop thinking of managers as overhead to be cut, but rather as vital agents in managing a highly complex system in the best interests of patients. And we need to have an education system that gives clinicians a well-defined path to becoming clinician managers. More broadly we need to invest in the workforce both by increasing the number of people in the service, reversing, for instance, the acute shortage of nurses, and by giving them the clinical skills to deliver high quality care in the context of a system that is professionally managed so that taxpayers’ money is spent effectively and so that the patient’s journey is as seamless and efficient as possible. King’s is one of the most-publicised trusts to enter financial special measures. In what ways will the organisation use this as an opportunity to shape a better future and play a key role in delivering excellent and safe patient care for future generations?

our systems and processes?’, ‘How can we improve collaboration between our services?’ and ‘How can we be as productive (especially in using our scarce human and capital resources) as possible?’ We asked these questions of staff across the trust at all levels and we are using their insight and experience to develop our future plans. We are also working with NHSI and the team at Getting It Right First Time/ Model Hospital, looking at specific services like Trauma and Orthopaedics, Ohpthalmology and Neuro-surgery. With their help, particularly Lord Patrick Carter and Tim Briggs, we are identifying ways to improve those services which we will then apply across the hospital. We still have some way to go but I am confident that King’s will emerge from financial special measures not only in a more stable and sustainable condition, but with a clear sense of direction and purpose. The last 70 years has seen myriad innovations transform the way that care is delivered in the UK. Looking at King’s history, what trust innovation or change of behaviour stands out as the most impressive and why? King’s serves a broad demographic and range of patient needs. We are one of London’s major trauma centres, we specialise in a variety of fields including blood cancers, liver transplantation, heart disease and neurosurgery and we offer high quality emergency and outpatient services in some of the most challenging parts of London. In all these services since the creation of the NHS 70 years ago, we have always sought to introduce innovations in care that will benefit our patients. In the past few years alone we have introduced virtual reality into paediatrics, pioneered new brain surgeries that have reduced recovery time and undertaken

long-term research that will benefit patients with certain types of cancer. In the two terrorist incidents last year (London Bridge and Westminster Bridge) and in the tragedy of Grenfell Tower, King’s worldclass trauma and emergency services meant that we cared for a very large number of the victims, despite the events occurring in relatively distant parts of London. The one constant through all of this, and this was especially evident during and after the terrorist attacks last year and since we entered financial special measures, is the continued dedication, commitment and bravery of the staff who make this hospital work. It is the staff who are to me, the most impressive thing about King’s. I make sure that I spend as much time as possible alongside the clinicians – either dressed in ‘scrubs’ observing brain or open-heart surgery, or visiting wards or doing a ‘shift’ with the London Ambulance Service as they come into our A&E department. They make King’s and the care we give to patients special and unique. I am very proud of them all.

NHS 70

Despite financial special measures, King’s has continued to deliver excellent care for our patients and continuing to do so remains our priority. I have always believed, and it is something that I say to staff whenever I can, that financial special measures presents King’s with an opportunity to further improve patient care and make King’s a blueprint for the rest of the NHS when it comes to operational efficiency and productivity. Since December last year, we have asked questions like ‘How can we improve

In 2010, the Equity and excellence: Liberating the NHS white paper was published, emphasising the need to put patients at the heart of everything the NHS does. With the rate of advancement in technology continuing to gather pace, how can the health service make this aim a reality? As I mentioned above, the increasing use of and integration of technology into public cand both in- and out-of-hospital health and social care is the most exciting part of the NHS’ future. However it can only work if access to that technology, be it in hospital or in the community, remains universally available to everyone. That should be, I believe, one of the guiding principles in terms of the NHS and any future relationship with technology. The challenge therefore is how does the NHS ensure that we keep pace with technology while at the same time ensure that no one is left behind? Naturally, some of this is about investment but it is also about collaboration and partnerships both within the NHS – for example King’s Health Partners which has extended to include an academic partner, as well as with external third party organisations, community providers and local authorities. L

Previously executive chairman of Four Seasons Heath Care and chief executive of the General Healthcare Group, Ian Smith has an in-depth knowledge of the health care system and patient needs especially in terms of acute, psychiatric and elderly care. In 2015, Smith published ‘Away From the Past and to a Sustainable Future’ with his brother, Professor Stephen Smith, outlining necessary reforms in the UK health and social care system. FURTHER INFORMATION www.kch.nhs.uk

Volume 18.4 | HEALTH BUSINESS MAGAZINE

Needing to collect that outstanding cash?

Needing to increase cash flow?

Needing to engage your customer base?

Needing to do the above and safeguard your brand?

Then let the professionals help

Contact:

Email: dmcmanus@thezincgroup.com Tel: 01789 203690

The health service sector needs to ensure overdue accounts and debts are collected in a timely fashion, whilst managing its increasing demands on time and its staff. What’s more, this has to be done in an environment of having to reduce costs, improve productivity, and maintain service quality

Health sector innovation The Health sector needs innovation to rise to these challenges. So what approach will be taken? In most cases, when considering an outsource solution, the client wants a better service at less cost. rather than cost as a starting point, why not consider collaboration? What are the core competencies you want to protect? What are the activities you are prepared to share? Allow a partner to be an extension of your own in-house activity. Accept that the partnership has to deliver value for money and concentrate on the whole life costs. Zinc Group Zinc Credit Management part of the award-winning Zinc Group, has been wrestling with this dilemma for several months. The company has been told time and time again that in the current climate, it is imperative that you maximise the cash owed to you. That most valuable asset, cash flow, needs protecting at all costs. Working with the Health sector after winning plaudits in the private sector and adapting its functionality for the Health sector Zinc looks to the future. ‘Zinc Group: maximising customer engagement with digital technology’. These are the words we use to describe how we do things at the Zinc Group, says Dougie McManus, CEO and founding director of the Zinc Group Ltd. For the last 10 years the Zinc Group have been quietly building a reputation as market leaders when it comes to the use of new innovative technologies, which are designed to maximise customer engagement whilst

also enhancing the customers experience and journey through what can be one of the most difficult times anyone can face. In fact, in the previous four years Zinc has managed to win several accolades for the work they are doing in this space, winning two best use of technology awards in the space of just three years. 2018 is set to be another big year for Zinc when it comes to the deployment of new technologies, and this hasn’t gone unnoticed Dougie McManus spent the day with a team from ITN to talk about and demonstrate some of the innovations being used today at the Zinc Group, in an accompanying interview Dougie talks about how technology is helping both consumers and businesses alike when it comes to dealing with overdue accounts and personal debts. (If you would like a copy of the interview please contact us using the detail below) Future investment Dougie McManus said: “The next stage of investment is going to be very significant not

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The challenges of customer engagement only for Zinc but for the whole industry.” Later this year we will be launching the next generation of customer engagement applications which will deliver fully interactive and personalised communications into the hands of our customers, this will allow customers to deal with their accounts at any time of day or night, whilst ensuring the highest levels of treating customers fairly and offering safeguards to vulnerable customers who may not wish to talk directly to an adviser. Dougie went on to say: “We believe that over the coming years more and more customers will wish to deal with their accounts via digital channels, using Smartphone’s and tablets to talk to us and access their information, we currently see 32 per cent of all customer engagement through these channels, and we expect that number to rise significantly, we invested some years ago for just this situation, and we continue to invest to ensure that we are there to greet our customers via any channel they wish to use.” Customer contact The Zinc Group is located over its two sites at Stratford Upon Avon and Glasgow with a capability of 500 FTE, alongside our digital platform Zinc maintains some of the most powerful telephony dialling capability that is also use to enhance customer contact and provide the customer with the answer and comfort level they are looking for to resolve all situations. If you are looking for a solution to recover those outstanding invoices, as part of your credit management, credit control or debt recovery process whilst enhancing your customer engagement then Zinc will have a solution for you whilst protecting your brand and reputation at all times. FURTHER INFORMATION If you would like to learn more please contact Dougie McManus at the Zinc Group on: dmcmanus@thezincgroup.com or please call 01789 207690 Web: www.thezincgroup.com

Volume 18.4 | HEALTH BUSINESS MAGAZINE

NHS 70

NHS 70 interview: Niall Dickson, NHS Confederation As part of July’s NHS 70 anniversary celebrations, Health Business will be publishing a number of interviews with those working within and for our health service. Here, we pose some questions to Niall Dickson, chief executive of NHS Confederation This July is not just an opportunity to celebrate the stories and innovations which define the NHS of the past, but what it will become in the future. If we were to speak again in ten years’ time, what recent or current changes/developments do you think will define the immediate future of healthcare in the UK? We are at a watershed moment in the history of the NHS and with the Prime Minister’s recent funding announcement, it is important we make the right moves for the future. This is an opportunity not to simply prop up the existing system but to transform. A renewed focus on place is key. Systems need to be simplified, locally led and patient centred with care shifted away from hospitals and into the community. People need to be able to get the right treatment, at the right time, in the right place. Further advances in treatment and technology will influence the way patients are cared for and the way they access services, including an increasing ability to use information and data about each individual. For example, DNA profiling could identify individual risk factors, while real time health monitoring could take, transmit and interpret dozens of measurements on a routine basis. Much has been made about a need for an increase in social care funding. With services becoming more integrated and joined-up, how important is it that a sustainable and radical reform of the current system is soon established?

people without the care and support they desperately need. Yet successive governments have ducked the question and it remains dangerous political territory. A funding boost is needed to address inconsistent provision across the UK, and tackle rising numbers of people with unmet care needs which has led to increasing reliance on unpaid care from friends and families. In the next 15 years, there will be 4.4 million people in the UK aged 65 and over. The number aged over 85 is likely to rise by 1.3 million. We are also seeing more people living with multiple chronic conditions. Yet spending on adult social care has fallen since 2009-10. Our report with the Institute for Fiscal Studies and the Health Foundation, Securing the future: funding health and social care to the 2030s, says 3.9 per cent annual increases in social care spending would be the minimum needed, just to continue the current level of service provision for projected demand for social care services. There is demonstrable public support for it too. An Ipsos Mori poll indicated 82 per cent of British people would support a 3.9 per cent funding increase for social care. When you became chief executive of the NHS Confederation at the start of last year, you said that there has never been a more important time for the health system’s various parts to come together locally and nationally. In the last 18 months, how much closer have we come to achieving that intention? And what do our next steps look like?

The concep very NHS ha t of the describ s rightly bee great so ed as one of n of the 2 cial achievem the its prom0th century, wents ise ith cradle tof care from o grave

Health and social care are sister services and, put bluntly, a solution for one but not the other simply will not work. Totally inadequate social care funding is leaving demand unmet and thousands of older

There are certainly outward signs that the system is taking steps both at a national and local level to bring different parts together. One obvious sign is the recent steps taken by NHS Improvement and NHS England to work more closely.

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS | www.healthbusinessuk.net

At a local level, our members are keen to see a different model which is system-wide, longer-term and placebased. The key to delivering this reform lies in developing solutions that bring the whole system together. Progress has been made on integrated systems with senior leaders working together and building relationships and, in some instances, we are even seeing organisations co-locate teams with staff from social care, mental health, community and primary care. But many are still struggling to bring about fundamental change while their leaders are preoccupied with immediate operational and financial challenges. We will need legislative change. Much of what is being attempted now amounts to workarounds and local fixes. As part of the recent Confed18 conference, the top 70 health and social care ‘standout stars’ of the last 70 years were recognised for their contributions to the NHS. As well as exceptional individuals, in your opinion, are there any standout achievements or changes of the last 70 years that deserve special recognition? The very concept of the NHS has rightly been described as one of the great social achievements of the 20th century with its promise to care for the British people from cradle to grave. 70 years ago the cost of medical care was a source of real worry and fear for many families and something which some simply could not afford. At the end of the Second World War everyone agreed something had to be done and the answer came in the form of a state funded National Health Service. It was a controversial model but one which soon became accepted, in broad terms, both by politicians and professionals. Over the years we have seen crises and criticism but one principle has remained almost unscathed: that healthcare should be funded from general taxation and available to all free at the point of use. You said in May that NHS England and NHS Improvement working more closely together has the hallmarks of good move. Looking to the future, where

The relationship between local government and the NHS remains variable but it is incumbent on everyone to work together much more closely than in the past, recognising the interdependency of health and social care else can the health system encourage and adopt collaboration and integration as a way of increasing closer dialogue and improving patient care? The need for care to be joined up around the needs of patients has never been greater and this means further integration between health and social care services. The relationship between local government and the NHS remains variable but it is incumbent on everyone to work together much more closely than in the past, recognising the interdependency of health and social care. The future lies in devising jointly agreed, practical measures that will support patients in the community, prevent unnecessary admissions and reduce delays around discharge. We have to acknowledge that the Better Care Fund was always a ‘work

around’ and our shared goal must be to devise a better long-term solution that goes beyond temporary fixes and has the confidence and support of both the NHS and local government. Ultimately this is not about what is best for local authorities, social care providers or the NHS - it is about how can we make a difference to those who too often are being let down by a fractured system. Jeremy Hunt recently became the longest serving Health Secretary, having been put in that role in 2012. Is there any advice that you would give to the Health Secretary moving forward? The Secretary of State has provided a degree of continuity at a difficult and uncertain time. He should be congratulated for his role in persuading the Prime Minister of the need

NHS 70

Niall Dickson, chief executive, NHS Confederation

to provide additional funding for the NHS. It is important now he helps create the space to allow for proper planning on how the money should be spent. The plans need to be credible and realistic and to do this, they need to draw on the views of the managers and clinicians who are responsible for commissioning and delivering the care. A key task now will also be to live up to his new title as Secretary of State for Health and Social Care, and focus his attention on the long delayed and much-needed reform of social care. This will take political courage but the prize is have tackled the social issue others have lamentably failed to address. L

Niall Dickson is chief executive of the NHS Confederation, which represents organisations across the healthcare sector. Niall has served in some of the most prominent national roles in health and care. Before joining the NHS Confederation, for seven years he was the chief executive and registrar of the General Medical Council and before that for six years he was the chief executive of the King’s Fund. Niall was speaking before Jeremy Hunt’s resignation as Health Secretary. FURTHER INFORMATION www.nhsconfed.org

Volume 18.4 | HEALTH BUSINESS MAGAZINE

A POWER PLANT IN YOUR BASEMENT? LETâ&#x20AC;&#x2122;S MAKE IT HAPPEN

On-site power and heat generation with ENER-G CHP from Centrica Business Solutions. Reducing your energy costs and lowering carbon emissions has never been more possible. We should talk about making your energy work for you. Visit: www.centricabusinesssolutions.com/performance/chp Energy insights. Demand management. On-site generation.

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How can saving energy save lives? Energy systems in UK hospitals could benefit from the latest energy efficiency solutions to the tune of £130 million a year – money that can be poured back into patient care

Like the business sector, NHS trusts are under intense pressure to reduce costs while delivering an enhanced service. Only in healthcare, the risks of having to do more with less are that much higher: a wrong move can, quite literally, cost lives. As a result, operational excellence and cost management are the main focus for practically every NHS facilities manager. Added to that, the cost of energy is going up, which is a massive problem for hospitals, both financially and operationally. With so much at stake, where are healthcare trusts to turn if they are to meet the mandates laid out by the Five Year Forward View? The role that energy can play in operational and cost efficiency is often overlooked – as a result its ‘power’ to effect change in these areas totally under-utilised. Falling costs of renewables mean that large energy users like hospitals can realise significant ROI from solutions like energy efficiency upgrades, on-site generation, renewables and energy storage. They can even generate revenue by taking part in Demand Response programmes. But how do you go about it? Powering performance New energy technologies are opening up a wide range of possibilities in healthcare and there are a number available that can help. Combined Heat and Power (CHP) from Centrica Business Solutions, for example, is a highly intelligent and efficient process that captures and utilises the heat created by the electricity generation process, helping reduce energy costs in facilities requiring combined heat, power and cooling. This has the added advantage of reducing your carbon output to meet those all-important emissions targets laid out in the Five Year Forward View. Reduced running costs By cutting your hospital’s energy costs, CHP enables you to divert a quarter of your energy budget back into patient care. A variety of finance options, including zero

capital outlay, mean you control the cost of installation. And with payback in threefive years and an equipment lifespan of up to 15 years, the savings keep coming long after the technology has paid for itself. Lower CO2 emissions Equally importantly, CHP can help you reduce your energy consumption and emissions by up to 30 per cent. Increased resilience CHP reduces your dependency on the grid – giving you a stable energy source. It can be used to provide electricity if the grid supply fails, providing an extra layer of resilience to your facility. Cutting costs We developed an energy strategy for St George’s Hospital, London, to deliver £1 million annual savings and reduce environmental impact. This was £1 million guaranteed savings per annum over a 15-year contract, with 6,000 tonnes annual carbon reduction Kevin Howell, director of Estates and Facilities at St George’s University Hospitals NHS Foundation Trust, said: “By saving £1 million annually for the next 15 years, the contract will go a long way to help us maximise the resources we can put into patient care. It also massively cuts our carbon emissions and improves our overall sustainability.” Finding the right energy partner Centrica Business Solutions is at the forefront of supporting healthcare facilities around the world to meet their patient care and sustainability targets through the use of new distributed energy sources and technologies. With a combination of deep expertise and a broad range of energy solutions, they enable you to take control of your energy-improving operational efficiency and increasing resilience.

Funding the solution Centrica Business Solutions offer large-scale financing to help reduce risk from purchasing an energy solution. Flexible payment options mean you can have a solution installed with a capital outlay or payment method that suits your hospital’s finances. Discount Energy Purchase This funds all or a proportion of the overall cots. Payment is made via a fixed p/kWh rate for an agreed period and all ongoing maintenance costs are included in the tariff. Energy Savings Agreement This allows for the purchase of electricity and heat at a fixed cost, with maintenance costs included. Capital costs are funded by Centrica Business Solutions themselves, limiting your capital outlay and risk, while savings are immediate and guaranteed. Capital Purchase This is a complete turnkey solution at a fixed price. It allows you to claim Investment Tax Credits towards the cost, with an optional service package to operate and maintain the system. One thing is for certain, failure to drive down operational costs – or meet your CSR responsibilities – can have a dramatic impact on your future performance and the NHS’s public image. So the real question is, can you afford not to? L FURTHER INFORMATION To find out more about powering the performance of your hospital with energy, visit:www.centricabusinesssolutions. com/performance/chp

Volume 18.4 | HEALTH BUSINESS MAGAZINE

creative thinking and practical know-how

Making complex journeys simple Our hospital wayfinding consultancy provides an intelligent and holistic solution that makes use of our broad expertise in signage, interiors and wayfinding design. 20/20 are specialists in Wayfinding Consultancy Signage Interior Design Values Communication Find out moreâ&#x20AC;Ś www.2020projects.co.uk info@2020projects.co.uk 01326 372520 , Tregoniggie Ind. Est., Falmouth, Cornwall TR11 4SN

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BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS | www.healthbusinessuk.net

T| 01274 728831 health@new-vision.co.uk www.new-vision.co.uk/health

Wayfinding

Getting familiar with the layout of a hospital Hospitals are a labyrinth or corridors, waiting rooms, clinical areas, wards, theatres and offices. In 2016, Southport and Ormskirk Hospital NHS Trust helped develop a new way-finding app to enable visitors and patients to get familiar with the layout of the hospital before they arrive. Health Business reports on its success and looks at some other ongoing projects

Developed in partnership with Liverpoolbased company Innove Solutions, Southport hospital became one of the first hospitals in the country to benefit from a new wayfinding app in July 2016. The app, which displays a series of photographs with clear instructions on getting around, can function without internet connection and enables visitors and patients to get familiar with the layout of the hospital before they arrive. Wayfinding apps for smartphones provide the patient with a simple but highly effective tool for guiding them around, and, in many ways, rids them of much of the nervousness and stress that naturally comes with a hospital appointment or visit. What stood the Innove Solutions app apart was that it didn’t rely on GPS or Wi-Fi, which we all know can be touch-and-go at best in hospital departments. By having someone enter the hospital to photograph and map all the routes by hand, with those designs then uploaded onto a proprietary software, the app functions as intended regardless of any connection requirements – and that even includes a standard mobile network connection.

The Christie app Last year, The Christie NHS Foundation Trust created a new wayfinding app which shows patients and visitors exactly where they are in the hospital and the quickest route to their destination through real time navigation. Over 70 bluetooth beacons were located around the hospital to showcase exactly where people need to be, meaning it’s easier than ever to get to your appointment or find the nearest place to get a coffee. The Christie app, developed by technology partner Wayfinder UK Ltd, uses Google ‘blue dot’ technology to guide patients and visitors, step by step, to anywhere they need

to get to on the 97,000 sq. m hospital site. This is the first time such accurate ‘blue dot’ technology has been deployed in an NHS hospital making use of Bluetooth beacons. Key information for patients on the app includes vital phone numbers and details of buses, trams, car parks and taxis. The new app also incorporates 10 defining moments from The Christie’s history, with information popping up on people’s phones as they pass through the hospital close to places of significance in the treatment of cancer for more than 100 years. Speaking last October, Roger Spencer, Christie chief executive, said: E

When considering the use of signage it is important to recognise inefficient movement and flow is frustrating, wastes time and costs money. You should look at signs as a whole system of wayfinding Volume 18.4 | HEALTH BUSINESS MAGAZINE

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS | www.healthbusinessuk.net

Jayne Westwood, commercial director, Reade Signs, said: “We know an effective wayfinding strategy plays a major role in improving the visitor and patient experience. Hospital visits are often stressful; whether you’re in pain, concerned about a relative or worried about getting to an appointment on

time. This, coupled with the fact that hospitals are notoriously complex buildings, means it’s vital to have a clear route to navigate from A to B to reduce confusion, frustration and provide reassurance. Our work with hospitals like Wexham Park, Frimley Park and Benenden aims to optimise

 “This is an exciting innovation for The Christie and will make a big difference to our patients, not only helping them find their way around the hospital, but opening up services and facilities they may not even have been aware of previously. We want patients to feel comfortable and fully informed when they are here - the app provides a rich immersive experience for them. I’d urge all our patients and visitors to download the app today.” Internal wayfinding and signage Hospitals are complex and confusing environments for visitors and many staff alike. Imagine your clinic or hospital as a strange city rather than the place you know. As a stranger you build a sense of orientation through directions and landmarks. Signage can have a part to play, but without being seen as a whole system it can be confusing and rapidly becomes outdated. Confused visitors are under stress and cost you money by wasting staff time. Look at your signage with a fresh eye. Does the language make sense to someone unfamiliar with a medical environment? Is it consistent and easily understood by someone who may have poor eyesight? Hospitals and clinics are full of redundant signs and pointless messages which contribute to a sense of institutional chaos. Safety or statutory information should be minimal and grouped to be relevant. Very occasionally it is vital for temporary signage but this should be short term. A sensible plan is to exert control over adhoc signage and ensure it is someone’s responsibility (particularly effective if it is a board member) to remove unnecessary signs. Signage is a comparatively cheap but important tool in creating a legible and efficient estate asset. There is a large body of material available to help you including standard NHS Guidance. When considering the use of signage it is important to recognise inefficient movement and flow is frustrating, wastes time and costs money. You should look at signs as a whole system of wayfinding, check the coherence of your guidance, and remove irrelevant messages, signs and notices, as they undermine the quality of your organisation.

Wayfinding

A signage view from the industry: Jayne Westwood, Reade Signs wayfinding with elements like consistent, easily understood language and colour coding for different zones. Getting the wayfinding signs, door signs and threshold graphics right from the time the visitor first arrives on campus positively sets up their interactions with health professionals.”

find their way out at the end of their visit – all too often this is forgotten. For a hospital visitor the need for a good wayfinding strategy starts long before they arrive at the facility. For an outpatient, they need to get from home, through reception and to the right department in a timely fashion. This might mean that their appointment letter not only tells them the time of their appointment, and the department but will also provide directions – public transport routes, which car park if they drive, which is the best entrance and how to reach the right destination point. Hospitals should regard wayfinding as just one “touchpoint” in the broader patient care experience. As it is part of the journey it has to be made to join up with all the other elements and fixing isolated parts often falls short of changing the experience. Simplicity is often the key to avoiding information overload – often symbols can be used to break down barriers, and where wording is used, the preference should always be for layman’s language rather than medical terminology. Colour coding of departments can be very effective in providing immediately recognisable and easily understood destination points. This approach will also ensure inclusivity for all users. L FURTHER INFORMATION https://bit.ly/2Lt46x2

A joined-up approach An optimal wayfinding strategy will adopt a ‘joined up’ approach. This means knowing where any journey might start, and understanding how every stage is related. So, direction signs from local roads are important, as well as routes to the right car park and walking routes into the hospital itself. Naturally, not everyone comes from the same direction, or uses the same entrances but too often, signage can often be located assuming everyone comes in the main entrance. Entrances to different departments need to be clearly visible, and once inside a hospital there needs to be a balance Wayfin struck between how much visitors ding apps fo are guided by signage, and how much they interact with smartp r reception staff. From the provide hones arrival areas, people need the pat with a ient to be clearly guided to their simple effectiv but highly destination point, and given reassurance along corridors – for guid e tool and if they happen to make a ing the m mistake, given the opportunity around to get ‘back on track’. The hospita the strategy also needs to help people l sit

Volume 18.4 | HEALTH BUSINESS MAGAZINE

01422 376436

info@checkmatefire.com www.checkmatefire.com

requirement may enhance this requirement further, increasing the filtration and the filter pressure drops. The new ISO standard considers both the outside environment and the internal target air quality looking at the size and weight of the containment particles classified now as ePM1, ePM2.5, ePM10, ePMCoarse. In the healthcare sector special consideration should be used to tackle the smaller / lighter containment particles which requires the most attention as these are the most harmful, frequent and have the greatest permanence. Filters Current F7 grade filters achieve ePM1 50-75 per cent, however envisage this requirement increasing to F8/F9 (ePM1 70-85%, ePM1 >85 per cent respectively) on supply and M5 (ePM10 >50 per cent) on return air side when taking into consideration of EU1253/2014. This will achieve SUP1 considering a city type outside environment which is vital to ensuring the internal environment is optimised for patient recovery and staff alike. In addition to the increase filter standards providing improved air quality more recently we have seen an increase use of ultraviolet lights within the healthcare sector. UV light options are available to be mounted on the downstream side of all cooling coils and above the unit drain pan. The lamps are used to destroy contaminates including mould and bacteria, resulting in improved efficiencies and increased heat transfer through cooling coils. One of the main benefits being improved indoor air quality by destroying surface microbes including cold, flu and other viruses. The HTM requirements for healthcare buildings lays out some standard best practices that should be applied to all healthcare AHUs for consistency of supply throughout the sector. With everything from the component sequence which should be positioned as per the graphic representation: The diagram below shows most items are

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Air handling units for healthcare ventilation under positive pressure, with all drain pans on the positive pressure side of the fan. Daikin Applied A shift from Daikin Applied in terms of fan technology in the healthcare sector has seen the introduction of fan array which are particularly well suited to healthcare applications as they can easily be provided giving the increased resilience and redundancy if one fan were to fail to maintain air flow and treatment from the unit to the occupied space. Additionally the EC fan array uses high efficiency IE4 motors that are at the top end of fan class efficiency, leading to a very efficient solution helping to reduce SFP figures and saving on footprint. For the maintenance purposes the fan has an in-built CPU using MODBUS giving many data points that can be picked up by the BMS for either control or reporting and diagnostics. As well as air quality the HTM document also ensure ease of maintenance and cleaning of the AHU. Daikin Applied UK’s Professional range of AHUs are designed so all parts are easily and safely accessible for inspection, service and cleaning purposes. 500mm access doors complete with lighting and viewing ports are allowed for to all items that require routine service such as filters, coils, humidifiers and fans, along with the inclusion of stainless steel drain pans with a 1 in 20 slope in all directions to the drain outlet position for the cooling coil sections. Also with regards to cleaning Daikin Applied’s new anodised aluminium frame incorporates a rounded internal curve. This provides a great solution when cleaning units down coupled with the anodised frame that provides a lifetime corrosion resistant solution. Overall all there are a vast number of very specific requirements to be considered for the AHU application in relation to HTM in the healthcare sector. These are important to provide the best air quality with a consistent solution throughout healthcare applications providing resilience whilst maintaining high efficiency. FURTHER INFORMATION www.daikinapplied.uk

Volume 18.4 | HEALTH BUSINESS MAGAZINE

Fire safety

Have you got a well-known evacuation plan? Health Business, with the help of the Fire Industry Association, looks at what steps need to be in place to deal with a fire on hospital premises, and the significance of staff and patients being aware of evacuation plans On 10 June the London Fire Brigade were published the day after the fire, the trust called to Barnet, Enfield and Haringey Mental said that ‘fire safety precautions such as Health NHS Trust’s (BEH) Chase Farm site fire doors worked well and contained the to a fire on the ground floor of the Camlet fire’, meaning there was minimal damage 1 Building. With eight fire engines and to the rest of the ward and building. more than 50 firefighters dealing with the two-storey blaze, the hospital was forced Preparing and protecting to evacuate 45 people, seven of which Stripped back to basics, a fire cannot start needed assistance for smoke inhalation without a source of ignition, fuel and oxygen. at the scene, whilst three members of If we think of hospitals alone, these three staff and one patient required additional elements are present in abundance. Then there treatment at Barnet General Hospital. are the less obvious factors that can increase According to the trust, of the 45 patients the risk in hospitals, including the less thought evacuated, 31 returned safely to their wards of patient groups such as the elderly and once the fire was put out, while 14 those suffering from mental instabilities. patients were found alternative The consequences of inadequate The accommodation for the night fire prevention and detection in unaffected parts of the in this sector does not bear trust sa building. BEH provides thinking about; loss of that ‘fir id e care for 176 patients buildings (many historic), s a f e p t recautio y in a secure mental loss of expensive life as fire d ns such health setting at three saving equipment and, o Camlet buildings on of course, the loss of well an ors worked d conta the Chase Farm site. life. Achieving optimum the fire ined The fire caused severe fire safety is a matter for ’ there w , meaning damage to the toilet each health authority to as m area, and smoke and consider and is a delicate damag inimal soot damage to the ward balance between cost, safety e corridor in the hospital’s and ensuring the continued Mint Ward, of which one of core functionality. Each hospital the two wings was damaged. has the potential to adopt every type of While the damage is disruptive for staff fire prevention and detection (and evacuation) and patients, as well as costly to BEH’s solution available in the market; and to management, there is no denying that things install them in large quantities. Unfortunately could have been worse. In a press release budgets in the current economic climate,

particularly in the public sector and the NHS, necessitate careful and extensive deliberation. Time for evacuation If you get an alarm sounding on your fire detection system what do you do? Evacuate? Whilst in a small retail premises the plan of everyone out is probably right, that won’t work for a complex site like a hospital. Here you will have people of varying levels of mobility and some that can’t be moved at all. If you’re in the middle of surgery do you drop everything the moment the bell rings? Of course not. That’s where the evacuation strategy comes into play. Horizontal, vertical or stay put, you need to have this planned. Remember, when the Fire & Rescue Services (FRS) arrive they are there to fight the fire and not to evacuate the patients. The NHS internal reports show that if you have a well-planned and well-rehearsed plan then everyone gets out alive if you do have a real fire. Note the ‘if’. Fire detection systems are designed to detect ‘fire like phenomena’ so when the alarm goes it may not necessarily be a fire. FRS’ across the country are changing how they respond to automatic fire alarms and in many cases unless there is a confirmation of a ‘real’ fire they will not attend. Many FRS’ recognise that hospitals are the worst offenders in terms of unwanted fire signals so this needs to be factored into your plan. You need to know what the policy is for your FRS and, if you manage multiple‑site facilities, what the policy for all the facilities is. It will differ from FRS to FRS. Fire safety legislation It is absolutely vital that everyone fully understands what the law says and what that actually means for buildings across the country, and for the people that own and manage these buildings. In the UK, there are various fire safety laws that vary slightly depending on location, but they all ostensibly say the same thing. For the sake of accuracy and preventing any confusion, here is the full list: Regulatory Reform (Fire Safety) Order 2005 – applicable in England and Wales; Fire (Scotland) Act 2005; Fire Safety (Scotland) Regulations 2006; The Fire and Rescue Services (Northern Ireland) Order 2006; and The Fire Safety Regulations (Northern Ireland) 2010. E Volume 18.4 | HEALTH BUSINESS MAGAZINE

A tailored approach to fire safety… we understand every project is different & so too is every solution

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The Sky’s the limit on Service Delivery! Established in 2013, we pride ourselves on providing a clear and honest approach to fire safety management, advice and training. LS Fire Solutions Ltd work with our clients to provide service packages, which offer excellent savings. Do you require any of the following? • Fire Risk Assessment or Audit • Site Specific Fire Warden Training • Fire Extinguisher Servicing • Fire Awareness Training • E-learning • First Aid Training • Fire Log Book • Policy and Emergency Procedural Documents • Evacuation Aids Sales and Training Contact us for a free no obligation quotation info@lsfiresolutions.co.uk | www.lsfiresolutions.co.uk 01635 292444

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS | www.healthbusinessuk.net

Fire & Security

Mechanical Services

Electrical Services

Gates, Barriers & Access

Building Services

Fire safety

£46 million set aside for Lincolnshire hospital safety upgrades Reports have suggested that United Lincolnshire Hospitals Trust will invest £46 million on fire safety upgrades in the region’s hospitals following a number of fires caused by ageing electrical equipment. The investment will see new fire doors, sprinklers, lighting and a range of other improvements rolled out in Boston Pilgrim Hospital, Grantham Hospital and Lincoln County Hospital. This follows Lincolnshire Fire and Rescue serving the trust with two fire enforcement notices at Pilgrim and Lincoln hospitals, as well as a fire action plan at Grantham hospital last summer. A ULHT spokesperson said: “The

trust requires £46 million of capital resources over three financial years to be compliant across the three sites and some of the improvements we’re making include increased staff training and putting in fire prevention systems, including modernising and upgrading our fire alarm systems, improving our fire doors and enhancing fire barriers around the hospitals. “We have been supported during

 Fire safety legislation applies to all non-domestic properties such as businesses, shops, schools, hospitals, church buildings, festival halls, and leisure centres, for example. But it can also apply to housing associations, landlords, student halls of residence, and care homes. This is not an exhaustive list but it gives an idea of the scale of the need for everyone to understand, apply, and comply with fire safety regulations. Each piece of legislation refers to either a ‘duty holder’, ‘appropriate person’ or a ‘responsible person’ but they mean the same thing. This is the person who will be held liable if there are any failings in the fire safety of the building, and the person who ultimately makes the decisions about the requirements for the building. This could be the employer of a business, or a landlord, or the appropriate body responsible for managing a house of multiple occupation (HMO). All of these pieces of legislation are freely available to download and read from the gov.uk website at the stroke of a keyboard – simply search the relevant piece of legislation. This article couldn’t possibly cover the full breadth of the legislation in one go, so reading through the legislation is recommended. Take action First and foremost, the legislation – regardless of which country you’re in – imposes on the responsible person (or appropriate person/ duty holder) an obligation to ensure that general fire precautions are in place to ensure the safety of any of his/her employees, or of any other relevant persons who may be on the premises. This means that a fire risk assessment must be carried out to identify and evaluate the hazards and risks within the building. The key word here is ‘evaluate’ – because every aspect of the building (including the people within) must be thoroughly considered and analysed. Following that detailed analysis, recommendations for improving the safety of the building must be made, based on the hazards and risks that the fire risk assessment identified. The important thing here is to act on these recommendations. Make the necessary changes as soon as possible; failure to act could be seen as a breach of the law. It is also vital to note that a fire risk assessment is not a ‘once and done’ document – it must be reviewed regularly and kept up to date. Alongside these periodic reviews, the fire risk assessment must also be reviewed whenever any construction or renovation project is planned – and throughout the life of the renovation project (especially since plans can change). When does legislation apply? Knowing and understanding what fire safety legislation means for businesses and the public can get complicated. However, it is vital to understand and comply with fire safety legislation as it is in place not only for the safety of everyone within the building, but also for the security of the business. Falling foul of fire safety legislation can mean thousands of pounds in fines that could have been avoided if the correct steps were taken. At worst, failure to comply with legislation may lead to an actual fire that could devastate not only the building, but the lives of those inside. The key thing to remember here is that fire safety legislation must be complied with at all times. This means considering the legislation at the

2017/18 and 2018/19 with an external capital loan from the Department of Health (DH) of £36 million and have committed £6 million of our own capital resources spread over the three financial years. The trust has requested a further £4 million capital support from DH in 2019/20 to fund the final element of the £46 million programme of works and we are awaiting confirmation of this.”

beginning of a construction project, during any maintenance work or alterations to the building, and during any installation or maintenance work on the fire protection systems in the building, such as fire extinguishers, sprinklers, fire doors, or fire alarms. It is important to note that the responsible person or duty holder must adhere to the legislation throughout the entire life of the building – letting checks lapse may cause breaches to the legislation which could result in a fine or even a prison sentence. Article 45 of the Regulatory Reform (Fire Safety) Order 2005 (for England and Wales) is the ‘duty to consult enforcing authority before passing plans’. This piece of legislation is aimed at local authorities who may be wishing to create new plans for a building, or otherwise refurbish or remodel a building. L FURTHER INFORMATION www.fia.uk.com

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Volume 18.4 | HEALTH BUSINESS MAGAZINE

“Keeping patients safe and helping their recovery ” The ISS Healthcare Team

ISS is celebrating its 50 th Anniversary of operating within the UK in 2018. It has been providing a key role in Healthcare since 1984 and is proud to still be seen as a dependable and loyal partner to the NHS. Every day ISS employees work as an integrated part of each Client NHS Trust, ensuring that service value is created through ‘The ISS Way’ of customising and delivering our service solutions.

FACILIT Y MANAGEMENT

CLEANING

SUPPORT

PROPERTY

C AT E R I NG

SECURITY

uk.issworld.com

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Happy birthday NHS, from ISS Healthcare This year sees the 70th Anniversary of the National Health Service, so it seems quite right that we should spend a little time in reflecting just how much things have changed over those years. early days most of the new managers were recruited directly from the NHS. This was an easy decision because these were the people that understood the service and the ethos that it stood for. Because of this the company grew up with the NHS being part of its DNA and the company motto of ‘People Serving People’ still reflects the belief that ISS Healthcare, and other contracting organisations, have a part to play in the delivery of a modern service.

When Aneurin Bevan launched the NHS, in the aftermath of the Second World War, he envisaged a society that would look after each other, providing care and treatment free at the point of delivery. It seems odd nowadays that we cannot simply expect the NHS to provide us with the treatment we demand but in those early days this was a revelation – many families had to decide between seeing the doctor or putting food on the table. It was as simple as that, but over the years we have held that simple belief close to our hearts and there can be very few people in the nation now that wouldn’t wish the NHS a very ‘Happy Birthday’. Since its introduction the NHS has become a national treasure, as was demonstrated in the opening ceremony of the 2012 Olympics. It takes something very special to gain such a place in the hearts of a nation. At the outset all employees who worked in local hospital organisations were brought under the umbrella of the NHS and they became public servants but it shouldn’t be forgotten that, prior to 1948, the private seector had already been playing a role in the provision of healthcare.

Innovation in support services Of course things have changed enormously, and normally for the better. Whilst everyone marvels at the advances made in medical science things have also been moving on in the non-clinical services that support the delivery of first class healthcare. Be it in cleaning, catering, laundry, logistics and all the other support services or in hard FM (facilities management) innovation has been the key to success. ISS was the first to introduce microfiber cleaning technology into the healthcare environment whilst others pioneered the improvements in food delivery, giving everyone the ability to make their own choice of what they want to eat and when. Advances in technology In more recent years we have seen the introduction of advanced Information Technology. The use of robotics to deliver scheduled cleaning, medicines, supplies, laundry and meals are now being built into the hospital environment whilst the Internet of Things (IoT) is being harnessed to make the buildings much more receptive to their use and helping to reduce costs. Sensors can identify when areas are not being used, thus reducing the demand on energy by dimming the lighting or lowering the temperature. Touch screens can reduce the time nurses spend in administrative duties, freeing them for

providing direct patient care, and the finance teams can identify exactly where costs are being incurred, allowing for better budgeting. Imroving healthcare workplace environments Chris Ash, managing director of ISS Healthcare, looks forward saying: “In the next few years, in partnership with IT and HR, facility managers working alongside the NHS are in the unique position of being able to provide the tools that can drive improvements in the performance of every employee – and facilitate a healthcare workplace environment that can bring together people, place and process to enable better health based outcomes.” The opportunities of new technology are endless but one thing that remains constant is the fact that everything must be centred on doing the best for the patient – an individual who has his, or her, own requirements and that still needs a ‘Human touch’. Something that ISS Healthcare’s employees are well placed to provide. NHS’ Future In making the NHS a reality, Aneurin Bevan said: “The NHS will last as long as there are folk left with the faith to fight for it.” It may have been through many changes over those 70 years but one things seems certain – the NHS is in good hands. There are still folk out there who will ensure that the NHS continues for many years to come, so let’s look forward to next major milestone. L FURTHER INFORMATION To find out more about how ISS Healthcare plays their part in the NHS visit www.uk.issworld.com or contact them at: enquiries@uk.issworld.com

ISS Healthcare For half of the NHS’ existence ISS Healthcare has been providing essential non-clinical services, having been established in 1984. Today it provides a wide range of services but originally it was invited to deliver cleaning services at Hammersmith and St. Helier Hospitals. Within weeks they had added hospital porters and shortly after that they were awarded their first patient catering contract at the Bristol Royal Infirmary. In those Volume 18.4 | HEALTH BUSINESS MAGAZINE

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Lone working Written by Nick Whiteley, HFX

Lone workers – your hidden workforce There are over six million lone workers in the UK which represents about 20 per cent of the UK workforce. They represent the ‘hidden’ workforce that is under represented in an office they rarely frequent. Nick Whiteley discusses the issue of lone worker protection Lone workers can be found in most, if not all, organisations across industry and performing a varied set of functions for the business. The NHS is one such organisation, employing up to 100,000 healthcare professionals who work on their own every single day, representing nine per cent of its workforce. There are significant challenges for organisations with lone workers that are often underestimated by senior management and misunderstood by managers. This can often manifest itself by regarding lone workers as a ‘nuisance’ or ‘heavy maintenance’ because systems, processes and procedures are often designed around the majority, which is usually office-based staff. Office based on-boarding processes and procedures are generally well understood: desk, chair, space, landline, laptop can be often allocated and deployed without issue, but lone workers often have differing requirements, and these can easily

be interpreted as staff being ‘awkward’ or a ’nuisance’ rather than simply having a different set of requirements to office-based workers. This can create resentment from both management and lone workers themselves. Positive relationships Maintaining a coherent company culture that is often cultivated informally within an office environment (the so-called ‘water cooler’ chats) are weakened through remote and lone workers and more proactive and organised interactions and events are required to ensure company values and culture are shared and embodied equally among staff. Of equal importance is the need to ensure positive relationships across the organisation. Whilst hierarchical structures might appear to be the main mechanism in order to execute strategy, the reality is that at ground level, it is positive relationships which are

responsible for getting the job done. Remote and lone workers have less interaction and therefore the potential for less positive relationships exist and this can negatively affect productivity within and across teams. The issue of duty of care also becomes more complicated when staff are not office-based and must be dealt with thoroughly. The law requires employers to consider carefully, and then deal with, any health and safety risks for people working alone. (Health and Safety at Work etc Act 1974; the Management of Health and Safety at Work Regulations 1999). There is no magic process for this given that lone workers work in a variety of settings and environments, from working in a petrol station, working at home or in a care setting visiting a patient. Each scenario is different and requires a detailed analysis of risks along with a mitigation plan. Lone workers, by their very nature, are E Volume 18.4 | HEALTH BUSINESS MAGAZINE

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BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS | www.healthbusinessuk.net

Areas organisations should consider Conflict management training: The ability to de-escalate a situation before it becomes physical/violent.

Real-time risk assessment and awareness training: There are many situations that cannot

Whilst hierarchical structures might appear to be the main mechanism in order to execute strategy, the reality is that at ground level, it is positive relationships which are responsible for getting the job done be foreseen or turned into a process/procedure so the ability for the lone worker to make this assessment and take appropriate action is critical when unable to contact their manager.

The provision of protective equipment and medical kit: Where appropriate and specific to their task these can be essential. Technology, mobile tracking and alerting: There are solutions that enable lone workers to be – by consent – tracked during their working time so that management can exercise their duty of care. Some systems also have a panic button on the mobile device that can alert staff and/or alert staff when they have not received a GPS position after a certain amount of time or indeed haven’t changed position after a set amount of time. Culture and relationships: It is important for the organisation to create opportunities to build relationships with both office-based and lone worker staffing groups recognising that this doesn’t happen naturally. Examples of this could be company days, office days, or events held off-site and bring staff together

Lone working

 at greater risk than office-based workers and need additional support. As many as 150 lone workers are either physically or verbally attacked every day, according to the British Crime Survey, with the Royal College of Nursing noting that more than six per cent of lone workers in the NHS had been physically attacked. These statistics should provide a stark reminder to those responsible for risk assessment and mitigation that such risks should not be treated as a theoretical tick-box exercise but a reality that needs to be addressed. Risk assessment and mitigation needs to include the environment that the lone worker is subject to, the tasks the lone worker is expected to carry out, the associated risks with both environment and activities as well as compiling a list of potential scenarios and how they could be addressed. This should include procedures, training, tools, technology and equipment that either prevent, mitigate or provide for the ability to escape harm and/or rapid response. The very nature of lone working means that neither colleagues or management are ‘by their side’ to help advise, assist, support the lone worker in case of an adverse event.

in a neutral environment. This also creates opportunities to reinforce company culture and values within and between teams. Part of this is not just recognising there are different staffing groups but also explaining these differences and communicating the value each bring to the organisation. The value of doing this should not be underestimated or disregarded as a ‘warm and fuzzy’ initiative but key to ensuring that part of your workforce isn’t unseen and undervalued. In conclusion, whilst lone workers are rarely seen in the office, it is imperative that they do not become your ‘hidden’ workforce. Their voice, their views, their requirements must be heard in equal proportion to the workers you meet every day. Only by ensuring they are fully integrated, engaged and considered will you be able to ensure not just their needs and safety are met but also maintain and improve productivity levels across the whole of the organisation. L FURTHER INFORMATION www.hfx.co.uk

Volume 18.4 | HEALTH BUSINESS MAGAZINE

Emergency Services Show

Free CPD medical and trauma training The Emergency Services Show returns to the NEC, Birmingham from 19-20 September, offering a host of free learning opportunities for those working in emergency medical response With CPD-accredited seminars covering topics such as the opiate epidemic and the Manchester Arena attack, to interactive first aid and trauma challenges and the College of Paramedics Workshops, there is plenty to pack into a visit at the Emergency Services Show. Entry to the exhibition and seminars, as well as parking at this unique and growing two-day event, is free. Last year it attracted 7,599 visitors and buyers and this year’s pre-registrations are already 15 per cent up on 2017. Always a popular feature of The Emergency Services Show, the 30-minute College of Paramedics workshops will, in the light of new laws which came into effect in April, cover paramedic prescribing, as well as mental health, working in a custody setting, human factors, maternity, caring for victims of rape and sexual assault and emergency surgical airway procedures. No pre-booking is required and all those attending will be provided with CPD certificates. Speakers include: Andy Collen, Medicines & Prescribing Lead for the College of Paramedics, who will review paramedic medicine mechanisms, explaining how these keep patients safe and how paramedics can approach medicines with confidence; Sam Thompson, forensic paramedic with Kent Police and a senior lecturer at St George’s University of London, who will look at the JRCALC guidelines for treating victims of rape and sexual assault, and discuss how both the immediate care and long-term outcomes for these vulnerable patients can be improved; Richard Steggall, custody paramedic, who will explain what every paramedic attending a patient in a custody suite should know; Aimee Yarrington, paramedic and midwife for West Midlands Ambulance Service, who will share her top tips for newborn resuscitation; and mental health charity Mind, who will

explain how paramedics can support their colleagues’ mental health and well-being through its Blue Light Programme. Meanwhile the ATACC Group, an established market leader in pre-hospital training, clinical education and clinical governance, will also be offering advice and free CPD-accredited training at the show. Live Demonstrations Elsewhere on the exhibition floor, West Midlands Fire Service will be hosting an Extrication and Trauma Challenge with full commentary and an area for spectators. This will incorporate a First Aid and Trauma Challenge within an Educational Immersive Tent. To add authenticity to the trauma scenarios, West Midlands Fire Service Casualty Simulation Group will be providing casualties with realistic make-up and prosthetics. Their knowledge of first aid and trauma, combined with their understanding of excellent patient care, will give teams competing in the challenge, as well as spectators, a full and completely realistic experience. On the exhibition stands there will be numerous opportunities for visitors to test and improve their skills, handle new kit and speak to medical training experts. Over 450 exhibiting companies and organisations will be showcasing the latest solutions in communications, emergency medical care, protective clothing, uniforms, outsourcing, training and vehicles.

Key names such as Aero Healthcare, Bristol Uniforms, MedTree, Openhouse Products, Oxylitre, Prometheus Medical, RDT, Shawcity, Steroplast Healthcare, Stryker, Vimpex, WAS UK, Zenith Hygiene and Zoll have all booked stands again this year but there are also over 60 new names to discover. Among these is the British Burn Association (BBA), a non-profit making charity for people interested in supporting and promoting burn care in the UK and Ireland through study into burn prevention, burn treatment and burn care, for the benefit of the general public. Its core aims are to educate and to encourage research into all aspects of burn injury, its treatment and prevention. Networking Meanwhile, the Collaboration Zone offers visitors an opportunity to network with other responders including voluntary organisations and NGOs. The British Ambulance Association will be exhibiting for the first time this year, alongside the Association of Air Ambulances and the Independent Ambulance Association. North East Ambulance Service, South Central Ambulance Service, South East Coast Ambulance Service, South Western Ambulance Service and West Midlands Ambulance Service have all booked stands for recruiting staff. Public Health England (PHE) will launch the recently updated Chemical, Biological, Radiological and Nuclear Incidents: Clinical Management and Health Protection handbook. PHE’s health protection services responded to many public health emergency events over the past year including the London Bridge terrorist attack, Grenfell Tower and the Salisbury nerve agent attack. This experience and expertise is used to supply Emergency Planning Resilience and Response (EPRR) services that in the past 12 months included a series of mass casualty exercises for NHS England. Its Radiation Protection Services - the UK’s primary radiation protection authority working to advance knowledge of the risks of radiation and how to identify and mitigate these risks - will also be exhibiting. Four CPD-accredited seminars programmes will also run during The Emergency Services Show this year

Fo CPD-ac ur cred semina rs prog ited ramme will also r u n during s the sho of thes w and many e se be relevssions will a ambula nt to nc visitors e

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS | www.healthbusinessuk.net

Lessons Learnt Emergency services and partner agencies will share their experiences of responding to real incidents in the Lessons Learnt seminar theatre (sponsored by UCLan PROTECT). Paul Argyle, Multi-Agency Strategic Advisor to the Mayor and Deputy Mayor of Greater Manchester and the Combined Authority will open the first day by covering the key learning points from the Manchester Arena attack. There will also be a session on preventing occupational exposure to new threats such as Opioids and Fentanyl. Fentanyl represents one of the strongest opiate drugs that has transitioned from medicinal to illicit use. At 50 to 100 times the potency of morphine, even very low exposure levels can be dangerous, especially when unknowingly contracted. This technical session presented by the Vice President of R&D/QA at Ansell, Derek Warneke, will discuss common and uncommon exposure routes and how to ensure that those on the front lines of the opioid epidemic are fully protected. In another key session, emergency communications specialist Christine Townsend from MusterPoint will explore how emergency responders who are not part of corporate communications can ensure public communication is professional, timely and effective and have a positive ESS18adsHPmay.qxp_Layout 1 09/05/2018 19:07 effect on the outcome of an incident.

Health and well-being Following its successful introduction in 2017, the Health & Wellbeing seminar theatre will return for this year’s event. Speakers will include emergency responders who have experienced mental health challenges such as Post Traumatic Stress Disorder (PTSD), and organisations who are implementing change and offering support. Resilience Hub Service Lead and MVS Co-ordinator for Pennine Care NHS Foundation Trust, Helen Lambert will present a session on the psychological impact on those who attended the Manchester Arena attack. It is widely recognised that a healthy workforce performs better and achieves more. Kiran Kenth, director of National & Regional Programmes, Royal Society for Public Health, will discuss how improving health and preventing ill health can help the emergency services to support and protect citizens, businesses and the environment. Jenna Flannagan, co-ordinator for Oscar Kilo Page 5 provide details of the Blue Light Wellbeing will

Emergency Services Show

Response Pastors, a unique volunteer resource that has been deployed to major incidents, including the Grenfell Tower fire, will give an overview of the ways in which it has helped the communities and emergency service workers affected

and many of these sessions will be relevant to ambulance visitors and those working in a pre-hospital care setting.

Framework developed by the National Police Chiefs Council Working Group. The Framework and online resources hosted by Oscar Kilo have been designed so that all emergency services can adopt the same approach in wellbeing best practice. Jenna will share Oscar Kilo’s vision for the future and explain how emergency medical responders can get involved in the culture shift. Mind will also be sharing its expertise and explain how all emergency services can set up and deliver their own Blue Light Programmes offering mental health support that will last into the future. Response Pastors, a unique volunteer resource that has been deployed to major incidents including the Grenfell Tower fire and Manchester Arena attack will give an overview of the ways in which it has helped the communities and emergency service workers affected. L FURTHER INFORMATION www.emergencyuk.com

The Emergency Services Show bravery This unique two-day event brings together all disciplines from the emergency services sector to discover innovative technology and operational solutions, share their experiences and unite in their collaborative approach to public safety. Meet over 450 exhibitors, take advantage of free CPD-accredited seminars and learn from product demonstrations. Hall 5, NEC, Birmingham. Wed 19 – Thu 20 September 2018. Free visitor entry at www.emergencyuk.com.

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Volume 18.4 | HEALTH BUSINESS MAGAZINE

Feature Heading Infection control Written by Water Management Society

Managing water safety in healthcare premises On behalf of the Water Management Society, Dr Paul McDermott and Susanne Lee write about the the control of Legionella risks and other water-related hazards in health care environments together with supplementary guidance The Department of Health provides best Performance specification D08: thermostatic practice guidance to those providing mixing valves (healthcare premises), healthcare services in England to first published in July 2015. assist in the management of the Manag The 2016 version of physical estate in the form of the HTM 04-01 takes a series of Health Technical water s ing a into account the Memoranda (HTM) and f e t r y e quires a recent updates to the Health Building Notes holistic approa Health and Safety (HBNs). In 2006 HTM c h and thi particu Executive’s (HSE) 04-01: The control of si Approved Code Legionella, hygiene, healthc larly true in ths a e of Practice and safe hot water, cold r e setting. some, t associated guidance water and drinking F o h r e HSG274 (Parts 2 and water systems, was infectio potential fo 3), the Healthcare published which water s n via hospita r Associated Infections focused primarily on ystems l may Code of Practice and the control of Legionella less und erstood be Health and the Social risks. Following an Care Act 2008 (Regulated outbreak of Pseudomonas Activities) Regulations 2014, aeruginosa infections in 2012, and provides broader coverage which resulted in three neonatal of water-related hazards and risks in deaths, an addendum to this HTM was health care; not just from Legionella and published in March 2013 to provide advice Pseudomonas aeruginosa, but also other to trusts on how to manage the risks from waterborne opportunistic pathogens. P. aeruginosa in augmented care units. In May 2016 an updated version of the Incorporating a holistic approach HTM 04-01 was published as Safe water The new version advocates a more holistic in healthcare premises, in three parts: Part approach to all water used for treatment A, Design, installation and commissioning; and diagnosis as well as how to design, Part B, Operational management; and Part commission and manage water distribution C, Pseudomonas aeruginosa – advice for systems, and, like HSG274 (part 2), advocates augmented care units, which were released

the World Health Organisation’s ‘Water Safety Plan’ (WSP) approach with guidance included on the aims and objectives of WSPs and the remit of ‘Water Safety Groups’ (WSG) who now play a key role in the governance and management of all healthcare water systems with clearly identified lines of accountability up to the CEO and board. The WSG also has a role in ensuring those engaged to carry out water safety risk assessments can demonstrate their competence in assessing specific risks - not only microbiological, but also from chemical and physical hazards. There is also additional guidance related to clinical and scalding risks where a risk assessment approach is advised for the fitting of thermostatic mixing valves (TMVs) on water outlets, together with advice on water storage capacity and turnover, and resilience to take into account risks from climate change. Perhaps the most striking message delivered in the revised guidance is the greater emphasis on the need for expertise and competence amongst all parties and individuals with responsibilities for delivering water safely, especially those whose actions can have direct influence on water quality and the safety of patients who use it. In Part B of the 2016 guidance, no fewer than 35 references are made to training needs, compared to only six in the 2006 version. As has been said, managing water E Volume 18.4 | HEALTH BUSINESS MAGAZINE

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 safety requires a holistic approach and this is particularly true in the healthcare setting. A properly represented WSG and a well conceived and implemented WSP are central to this, but even the best of these can be let down if tasks - often even simple ones - are not performed correctly. In particular, controlling microbiological risks can present a significant challenge due to the specialist nature of the topic and the complexities surrounding infection control in many hospital areas. All hospital staff that perform tasks on hospital water systems, or who use water for the care or treatment of patients, need to be aware of the risks presented by waterborne pathogens and their own importance in contributing to patient safety. Understanding the consequences of their actions and omissions is likely to increase ‘ownership’ of the risks and result in better reporting of problems and improved patient safety. That’s not to say everybody needs to have a degree in microbiology, but an appreciation of the organisms that cause healthcare‑acquired waterborne infections and the factors that result in them colonising and growing within water systems helps to provide an understanding of the fundamental controls that WSGs put in place to manage risks. The reverse also applies, and a lack of knowledge and understanding can lead to deterioration in standards, loss of effective control and negative impacts on patient safety. Know your responsibility Once these basic building blocks have been put in place, training can focus on the activities carried out by different groups. Estates staff provide and support the delivery of safe water to the point of use across the hospital and their responsibilities centre, amongst other things, on maintaining the infrastructure of water systems and often the equipment connected to it as well. At

times this will involve making modifications to the distribution services and repairing and replacing parts of the system. Engineering and plumbing staff have the potential to introduce contamination into the system when carrying out such modifications or even routine maintenance tasks. Water hygiene awareness training for those working on water distribution systems might include an understanding of what augmented care means and that more stringent precautions are needed when working in these high areas. This should form the focus of training, explaining the importance of hygienic storage and installation of fittings and components and why greater care may be required in these areas to avoid cross-contamination, e.g. by using separate, dedicated tools and overalls. Nursing staff provide invaluable hands-on care to hospital patients, and their training provides a sound understanding of conventional infection prevention and control practices. However, for some, the potential for infection via hospital water systems may be less understood. There are subtle differences in the modes of transmission for different waterborne pathogens and nursing practices can have a significant influence on the potential for infection, particularly where patients with impaired immunity receive treatment. So training of nurses should focus on the activities where either they come into, or their patients come into ,contact with water or water systems. This is likely to include washing, bathing and shaving patients, as well as disposing of wash water and other fluids. Maintaining hospitals in a clean and hygienic condition is an important part of any infection control regime, and cleaning staff have a vital role in maintaining water safety and minimising waterborne pathogen infection risks. In carrying out their day-to‑day duties cleaning staff open water outlets, which allows water to flow through pipework,

Infection control

Providing training to domestic cleaning staff presents a significant challenge to many hospital trusts partly because of the numbers of staff involved, but also because there tends to be a relatively high staff turnover in this sector

avoiding stagnation in the supply that can encourage proliferation of harmful bacteria, and drawing through hot water and biocide (if applied) to the periphery of the water system to exert its bactericidal effect. Running outlets during cleaning helps increase the overall turnover of water throughout the system, which in itself is an effective control measure. However, it is crucial that cleaning staff appreciate fully the dual aspects of the important work that they do. Experience has shown that, where insufficient information has been provided, the infection control element of their work may not always be conducted as planned. This is perhaps understandable; if staff believe that the only purpose of their cleaning activities is to ensure that water outlets and surrounding areas appear clean, then those outlets have not been recently used and therefore appear clean, so they may not be flushed through because there is no apparent need. Unfortunately, this type of situation is most likely to occur in hospital wards where patients are so poorly they cannot use the hygiene facilities provided and in particular, en-suite outlets can go unused, both by the patients and cleaning staff for prolonged periods. It is also the case that patients in these hospital wards are likely to be among the most susceptible to waterborne pathogen infection if they are then exposed to water from these unused outlets subsequently. The way in which cleaning activities are conducted is also pivotal in reducing cross-contamination from outlet to outlet and is again of particular significance in augmented care areas of the hospital. Defined procedures detailing precisely how water outlet stations should be cleaned, for example clean to dirty, top down, the use of different cleaning cloths and cleaning products and their disposal, are required. Providing training to domestic cleaning staff presents a significant challenge to many hospital trusts partly because of the numbers of staff involved, but also because there tends to be a relatively high staff turnover in this sector and English may not always be the first language of workers. In conclusion, the new version of HTM 04-01 provides comprehensive advice and guidance to healthcare management, design engineers, estate managers and operations managers on the legal requirements, design applications, maintenance and operation of hot and cold water supply and storage and distribution systems, together with training and competency requirements, in all types of healthcare premises, and is applicable to both new build and existing sites. There is a requirement that both management and staff are aware of their individual and collective responsibilities for the provision of wholesome and safe hot and cold water. However, as with the HSE guidance, following this HTM 4-01 series is not mandatory, but if a healthcare facility chooses otherwise it must demonstrate that equally effective measures are in place. L FURTHER INFORMATION www.wmsoc.org.uk

Volume 18.4 | HEALTH BUSINESS MAGAZINE

YOU CAN’T MANAGE WHAT YOU CAN’T MEASURE Equipping health care workers with the best possible digital technology will reduce workload duplication, simplify labour intensive tasks, provide for improved access to data at the point of care and result in improvements in delivery of care and patient outcomes.

Neil Wigglesworth, Deputy Director, IPC, Guy’s and St.Thomas', NHS 'The infection control team in GSTT have implemented the MEG audits system based on its ease of use, quality of reports and value for money. MEG's support and partnership in adapting the system to our needs has been very helpful and will help to maintain our hygiene standards and increase the eﬀectiveness of our team'.

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IPS Conference

Tracking emerging threats in infection prevention The Infection Prevention Society will discuss the latest emerging threats and state-of-the-art research to help improve your team, your practice and your patientsâ&#x20AC;&#x2122; outcomes. Health Business explores the programme, as well as the new Infection Prevention Show Infection or disease may be caused by bacteria, fungi, viruses or prions and can result in a wide variety of infections, such as urinary tract, wound, respiratory, blood, bone and skin infections. Not all infections are transmissible but some, such as C. difficile, influenza and norovirus have the potential to spread from one patient to another, causing outbreaks of infection with serious implications for health care organisations, facilities or nursing homes. Understanding how infections occur and how different microorganisms act and spread is crucial to their prevention in all settings, not just health and social care. The UK is currently experiencing an increase in respiratory illness associated with viral infections including influenza. This expected increase is causing challenges to NHS care providers and the capacity to admit patients. According to the World Health Organisation,

The World Health Organisation also claims that effective infection prevention and control reduces health care-associated infections by at least 30 per cent. This covers hand hygiene, surgical site infections, injection safety, a stronger focus on AMR and other health care interventions.

one in ten patients get an infection while receiving care. Health care-associated infection (HAI) results in prolonged hospital stays, Infection conference long-term disability, increased resistance of Beginning in Glasgow on 30 September, the microorganisms to antimicrobials, massive 2018 Infection Prevention Society Conference additional costs for health systems, high costs for will provide a comprehensive series of patients and their family, and unnecessary presentations, meet-the-expert sessions deaths. Although HAI is the most and specialist streams, targeting frequent adverse event in the topics of: wound care, health care, its true global paediatric care, mental health, Septem berâ&#x20AC;&#x2122;s burden remains unknown audit/surveillance and annual because of the difficulty international engagement. confere in gathering reliable There will also be one-day data: most countries conferences dedicated showca nce s e lack surveillance to Infection Prevention s t h largest systems for HAI, and in Care and at Home infectioe n those that do have and, for the first time, prevent them struggle with Infection Prevention and exhibiti ion the complexity and Antimicrobial Resistance. on in the UK the lack of uniformity of The one-day Infection criteria for diagnosing it. Prevention in Care and at E Volume 18.4 | HEALTH BUSINESS MAGAZINE

Infection Prevention 11th ANNUAL CONFERENCE

SUNDAY 30th SEPTEMBER – TUESDAY 2nd OCTOBER Scottish Event Campus Glasgow, United Kingdom Join the Infection Prevention Society for our annual conference, Infection Prevention 2018, the premier event for all those involved in infection prevention and control. The three-day conference will welcome many world leading experts to impart their knowledge and share what they are doing to tackle current issues relating to infection prevention and control.

Professor Wing Hong Seto

Dr Ron Daniels

Professor Jennie Wilson

Professor Shaheen Mehtar

Professor Andreas Voss

Highlights to include: • Innovative programme including dedicated one-day conferences on Infection Prevention in Care and at Home and Infection Prevention and Antimicrobial Resistance • E.M. Cottrell Lecture to be presented by Professor Jennie Wilson and the Ayliffe Lecture by Professor Shaheen Mehtar • The largest UK infection prevention exhibition • Infection Prevention Show – New for 2018 • Networking opportunities with like-minded colleagues • Invitation to submit your research at conference as an oral presentation or poster • Full social programme including: A Sunday Fun-Night, Annual Awards Ceremony and A Gala Dinner

If you are a healthcare professional with an interest in any aspect of infection control then you will benefit from attending this conference.

Online registration is available at 84

www.ips.uk.net/conference

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@IPS_Infection | #IP2018 Infection Prevention Society

Antimicrobial Resistance The Infection Prevention and Antimicrobial Resistance conference, also running across one day, takes an in-depth look at infection prevention and antimicrobial resistance by applying a coordinated, collaborative, multidisciplinary and cross-sectoral approach to address potential or existing risks from the perspectives of environment, animal and human. The programme includes a wide range of scientific and national strategies regarding antimicrobial resistance. Sessions cover topics such as antimicrobial stewardship, presented by Dilip Nathwani, honorary professor of Infection, University of Dundee, reducing antibiotic overuse in hospitals, delivered by Martin Llewelyn, professor of Infectious Disease at Brighton and Sussex Medical School, optimising antibiotic use across the surgical pathway, discussed by Dr Esmita Charani, senior research pharmacist, Imperial College London, and prosthetic joint infection, offered by Bristol Southmead Hospital’s Jason Webb. Infection Prevention Show Thought-provokingly and in a departure from previous years, IPS will present the first ever Infection Prevention Show at this year’s event. This exciting event on the 1 October will provide a platform for showcasing the

More research is critical, which is why the UK government is calling on some of the country’s brightest minds to come up with new ways to prevent, control and combat these infections in the future

latest innovational technologies and products. The audience will be able to interact with experts and personalities whilst learning of the exciting possibilities offered by these latest innovations. Hosted by Dr Phil Hammond, NHS doctor, BBC broadcaster, Private Eye journalist and comedian, it will focus on the challenges we are increasingly facing in a financially challenging time and provide a platform to showcase the latest innovative infection prevention technologies and products. Commercial organisations are crucial to the health of the IPS and, therefore, the society has embarked upon a corporate affairs programme which seeks to ensure that they get great value for their continued support. Such value usually comes in the forms of having mutually collaborative opportunities to present to IPS members on their technologies, forming personal relations with opinion leaders and decisions makers and keeping live intelligence systems into the NHS to determine how best to frame and focus their sales activities. Exhibition The IPS annual conference showcases the largest infection prevention exhibition in the UK. The IPS exhibition hall is dedicated to infection prevention, showcasing innovative products and services from about 100 companies. Attendees enjoy exclusive exhibition hours each day to learn about new science, technologies, advances, and products that provide solutions to infection prevention challenges and

IPS Conference

 Home is tailored for those who work providing services for people in care and those receiving care at home. The programme will focus on achieving excellence in infection prevention practice to reduce the risk of infections for this vulnerable population. Infection prevention is high on the agenda for every healthcare organisation and finding expert affordable training for you and your team can be problematic. However, the Infection Prevention Society is offering this study day which will discuss some of the 21st century challenges we face in care homes and care at home looking at the latest evidence and applications for practice. This day is relevant for all staff and in particular those senior staff with the accountability for infection prevention within the organisation. Speakers presenting their ideas as part of the Infection Prevention in Care and at Home programme include Elaine Ross, Infection Control Manager at NHS Dumfries and Galloway, who will present the welcome to the one-day conference, and NHS Education for Scotland’s Sarah Freeman who will present on training the trainer. Also speaking will be Dr Dona Foster, Microbiology and Healthcare Associated Diseases Researcher at the University of Oxford and a session on making hydration matter, delivered by Lesley Shepherd, from Health Protection Scotland. In addition to a comprehensive programme, the day includes access to an extensive infection prevention exhibition featuring over 100 companies, with new innovative products and practical solutions. These companies will provide you and your home with access to information on the latest developments to combat the problem of infection prevention and control and healthcare associated infection.

strengthen infection prevention programs. IPS provides exclusive exhibition hall hours offering uninterrupted networking time. Workshops and educational sessions are not scheduled during these times, thereby eliminating any competition to the Exhibition Hall. Collect quality leads from dedicated infection prevention and control professionals who are passionate about learning and improving their facilities with your products. IPS provides complimentary refreshments and lunch in the hall for attendees, so they don’t have to leave the convention center. This allows them to maximise their time spent with exhibitors. The IPS annual conference is the largest infection prevention and control exhibition in the UK and it is expected to attract over 1,000 professionals in this field. Antimicrobial resistance research competition The Department of Health and Social Care is announcing the launch of a £10 million research competition to fund innovations to tackle antimicrobial resistance (AMR) in humans. AMR, which includes bacterial resistance to existing antibiotics, is on the rise and poses a significant threat to health across the world. Without a better understanding of how to tackle and prevent AMR, treatable infections could become life-threatening and the advancements made in modern medicine over recent decades are at risk of being reversed. The competition follows the E Volume 18.4 | HEALTH BUSINESS MAGAZINE

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IPS Conference

The Department of Health and Social Care is announcing the launch of a £10 million research competition to fund innovations to tackle antimicrobial resistance in humans, including bacterial resistance to existing antibiotics  announcement of £30 million to fund research and development projects as part of the Global AMR Innovation Fund (GAMRIF) in May 2018 with CARB-X, the Foundation for Innovative New Diagnostics (FIND), the Argentinian government, and Canada’s International Development Research Centre (IDRC). The £10 million will be made available in research grants funded through a Small Business Research Initiative (SBRI). It is being run by Innovate UK on behalf of the Department of Health and Social Care, with the aim of supporting the implementation of the UK Five Year Antimicrobial Resistance Strategy. In 2016, a government-commissioned review by Lord Jim O’Neill highlighted the need for more research and development to reduce the global threat of AMR – prompting the government to commit to an additional investment of up to £55 million over 5 years from 2016/17 towards promoting excellence in AMR research and development in the UK. The competition, which makes available a maximum of £10 million in funding to successful bids, forms part of funding announced in October 2017 at the global ‘Call to Action’ conference by the Wellcome Trust, the UN Foundation, and the UK, Ghanaian and Thai governments, to accelerate action in this area. Chief Medical Officer, Professor Dame Sally Davies, said: “Antimicrobial resistance may seem like a distant threat, but people are already dying needlessly in their thousands across the world, including in this country, because they have a drug-resistant infection and we do not have effective drugs to treat them. This problem is only getting worse – we urgently need to find solutions. “More research is critical, which is why the UK government is calling on some of the country’s brightest minds to come up with new ways to prevent, control and combat these infections in the future. I know there are exciting projects needing support in this area – this competition presents a fantastic opportunity for the UK to lead this work.” L FURTHER INFORMATION www.ips.uk.net

Reducing outbreak incidence and duration Talley Group understands that safe, effective, harm-free care, are clear and recurring themes across the Department of Health and Social Care, the NHS, the Care Quality Commission and NICE. Although creating and maintaining safe, clean clinical environments is only one piece of the infection prevention jigsaw, Talley recognises the importance that the environment plays in reducing infection outbreak incidence and duration. With NHS trust board reports and locally developed Sign up to Safety plans clearly targeting safe, effective patient care as a way to drive reductions in infection incidence, the company feels that responsible medical device manufacturers must play their part in delivering the safest, most effective cleaning, disinfection and hygiene products to healthcare providers, clinicians and patients. Talley’s unique TECcare cleaning,

disinfection and hygiene products offer unparalleled safety and performance. When used routinely as part of a comprehensive infection prevention care bundle they can help reduce both outbreak frequency and duration. Visit the friendly and approachable Talley Group team on Stand 434, collect your free safety gift and discuss how the company’s clinically proven, TECcare product range can help you reduce the risk of infection to your patients.

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Volume 18.4 | HEALTH BUSINESS MAGAZINE

Leadership Written by Stephen Hart, national director for leadership development, Health Education England & managing director, NHS Leadership Academy

The importance of leadership training in the NHS What can we do to ensure people in positions of influence role model inclusive leadership, with dignity and compassion? Stephen Hart explores the importance of leadership training in the NHS Leadership in the NHS has been reviewed, revised, studied and addressed throughout the past 70 years. Leadership approaches and styles have evolved and changed in the NHS as they have across society and business. Heroic, transactional, and competitive leadership approaches have each come, and gone. Each change has taken our service forward, but like other parts of the public and private sector, the NHS is still searching for leadership nirvana; a leadership strategy that unlocks the vast resource of individual and collective potential held within the staff of the NHS. Pursuit of such an aim is more than wistful; it is in keeping with the high ambition and societal status of the NHS. However, despite investment of huge global resource and creation of a ‘leadership development industry’ to meet demand, there remains scant evidence of which leadership approaches work, and even less for how to develop ‘successful leadership’ in individuals or groups. In recent research only 20 per cent of

globally surveyed CEOs believed that leadership development had any clear business impact, and only 11 per cent of surveyed executives strongly agreed with the statement that ‘leadership development interventions achieve and sustain the desired results’. Despite this lack of confidence in the impact of leadership development, the global industry is worth over $50 billion and is still growing. The evidence that establishing cultures of outstanding leadership is at the heart of delivering long-term organisational success is clear. This link has also been explicitly made for NHS organisations. Cultures of outstanding leadership lead to improved staff engagement, and improved staff engagement results in improved outcomes. For the NHS there’s a strong argument for the link between outstanding leadership and patient safety. This is something that came into stark focus in the Francis report following the shocking events in Mid-Staffordshire. In fact, these events - and the subsequent

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recommendation for improved leadership to help avoid future incidents - led in 2012 to the creation of the NHS Leadership Academy. The Academy is charged with supporting the NHS to develop cultures of outstanding leadership across NHS-funded services that improve health, enable efficiencies, and lead to better lives in communities. My view is that developing outstanding leadership across a system requires progress in four areas. Developing leadership behaviours The NHS has made great progress, but there is more to be done. Firstly, progress is needed in identifying and developing leadership behaviours linked to the NHS’s strategic priorities. These have been identified through evidence and published by the Academy and 12 other Arm’s Length Bodies - including the Care Quality Commission, Department of Health, NHS England and Public Health England - in the Developing

Transfer learning Following on from identifying and developing leadership behaviours linked to the NHS’s strategic priorities, it is also important to develop those behaviours in a way that is designed to transfer learning. The Academy has created a suite of development programmes for leaders at all levels. These internationally award-winning programmes focus on the implementation of improved leadership. Our measurement of their impact isn’t assessed through the satisfaction of participants with the programme - important though that is - it’s on assessment of the impact of these interventions on organisation performance. Recent findings show that over 80 per cent of the NHS leaders who responded judged that the Academy had had a positive impact on leadership in the NHS. But there’s scope for better in this dimension of leadership development performance. Training that transfers learning must be linked to the roles that colleagues do while they’re on - and especially once they’ve completed - development programmes. The local and national system talent management approaches required to enable such a link aren’t currently in place. The Academy is developing such approaches

Following on from identifying and developing leadership behaviours linked to the NHS’s strategic priorities, it is also important to develop those behaviours in a way that is designed to transfer learning

and has piloted a Regional Talent Board in the Midlands and East Executive Team scheme. Early results are encouraging. Sufficient scale and reach The NHS has some distance yet to travel in this area. There are currently 276,000 NHS colleagues working at Band 6. These front-line leaders are at the ‘bleeding edge’ of leadership in the NHS and too many are taking on leadership roles having had insufficient - or even no - development support. While seminars, masterclasses, and leadership toolkits all have their place; they’re no replacement for focused and deliberate personal development that supports leaders to develop the behaviours that really matter and to transfer this learning into practice. The Academy is currently scaling up development programme offers so that capacity matches service. This also means the Academy letting go of responsibility and providing leadership development programme content to frontline organisations and systems. This enables team leader development, and from later in 2018 mid-level leader development, to be done in-place. Furthermore, it is worth highlighting the significance of implementing processes and structures that support the demonstration

Leadership

People: Improving Care Framework. This framework describes the inclusive and compassionate leadership behaviours needed to ensure that staff and patients are listened to, understood and supported, and that leaders at every level of the health system truly reflect the talents and diversity of people working in the system and the communities they serve. The framework also identifies: the need for leaders who are able to collaborate across traditional boundaries and create new partnerships and alliances; and the need for leaders at every level to have knowledge of improvement techniques and how these can be applied. Of the behaviours described in the framework, it’s worth dwelling on those required to create cultures of inclusion. Despite sustained attention, the pace of change around equality, diversity and inclusion across health and care has also been too slow. For example, it’s estimated that the NHS would need to recruit a further 500 women for NHS boards to become representative by 2020. NHS WRES survey data also paints a deeply concerning picture of the NHS’s approach to ethnicity and race. It’s clear that there’s a need for new knowledge in the fields of leadership practice, and leadership development practice to support progress on inclusion. To develop this knowledge, the Academy is embarking on a major project: ‘Building Leadership for Inclusion’. Based in five pilot sites in health and care systems across the country, the research will share evidence and knowledge on how leaders can create cultures of inclusion. This work is exciting, challenging, and necessary. The 2017 Cabinet Office Race Disparity Audit challenged us all to show leadership, take accountability and identify where we need to do things differently’ – Building Leadership for Inclusion is the Academy doing just that.

of great leadership. Effective leadership development needs the right systems and processes to lock in change. Here too the NHS is on a journey to even better. The NHS is not a single organisation; it’s a complex and interconnected system of systems, organisations, supporters, and enablers. Creating and embedding process across this network of networks is no easy task and cannot, as in other industries, be done by dictate or declaration. The Academy, in partnership with stakeholders and influencers across regions, is convening and enabling Regional Talent Boards to bring together those whose collaboration is necessary to embed change. Progress is furthest advanced in the Midlands and East region, but these are planned for every region in England. Effective leadership development is about enriching, explorative and impactful development opportunities. But there’s so much more. Given the known impact of outstanding leadership on the performance and outcomes in health and care, the effort and resource required to create outstanding leadership development offers a rich return on investment. L

Effectiv leaders e develop hip about e ment is nr explora iching, and im tive p develop actful opportu ment nities

FURTHER INFORMATION www.leadershipacademy.nhs.uk

Volume 18.4 | HEALTH BUSINESS MAGAZINE

Asbestos Written by Sarah Hallam, Asbestos Removal Contractors Association

Asbestos: the hidden killer in UK hospitals Managing the risks from asbestos in hospitals is a legal duty, says Sarah Hallam of the Asbestos Removal Contractors Association The risks from asbestos must be taken seriously because it is a class 1 carcinogen which is the greatest cause of work-related deaths in the UK. Current figures show that approximately 4,500 people die each year in the UK from asbestos related diseases (predominantly mesothelioma, lung cancer and asbestosis). These people are not just those who have worked on construction and demolition sites, but also teachers and doctors. According to an article in The Guardian from 2000: ‘A plastic surgeon died of an asbestos-linked lung disease, more

than 20 years after he unwittingly inhaled blue asbestos dust in hospital corridors. He was 47 when he died of mesothelioma in August 1995. Under the hospital were underground passages carrying a network of cables and pipes covered with asbestos lagging. The passages were used by staff and students to travel between buildings, especially the main hospital and the medical school.’ The same paper reported last year that a ‘teacher died from cancer after decades of

When asbesto is mana s well, in ged exposu advertent prevent re can be health ed so that the an individu d safety of als put at r is not isk

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exposure to asbestos. Inquest rules death was a result of industrial disease, after years spent pinning pupils’ work to boards resulting in asbestos dust inhalation.’ Inadvertent exposure It is vital that organisations take the risks from asbestos seriously and deal with asbestos in a controlled and safe manner. When asbestos is managed well, inadvertent exposure can be prevented so that the health and safety of individuals is not put at risk. UK law places responsibilities on property owners to ensure that both employees and non-employees are not exposed to health and safety risks as a result of the presence of unmanaged asbestos. The Health and Safety at Work Act 1974 places a duty on every employer to ensure, so far as is reasonably practicable, the health, safety and welfare at work of all employees and non-employees who may be affected by the employers’ activities. The Control of Asbestos Regulations 2012 (CAR 2012), places a legal duty to ‘manage asbestos in non-domestic properties’, on those who own, occupy, manage or have responsibilities for premises that may contain asbestos. Lastly, the Construction (Design and Management) Regulations 2015 (CDM 2015) places explicit responsibilities on clients, for example, if asbestos removal is required the client needs to appoint a competent asbestos removal contractor. To explain the Control of Asbestos Regulations 2012 (CAR 2012),

Regulation 4, a little more, it places a legal duty on those who own, occupy, manage or have responsibilities for premises that may contain asbestos. Those who have these responsibilities will either have a legal duty to manage the risk from this material; or a legal duty to cooperate with whoever manages that risk. The CAR 2012 places a legal duty to ‘manage asbestos in non-domestic properties’ by: finding out if there is asbestos in the premises, the amount and what condition it is in; presuming the materials contain asbestos, unless there is strong evidence that they do not; making and keeping an up-to-date record of the location and condition of the Asbestos Containing Material’s (ACM) or presumed ACM’s in premises; assessing the risk from the material; preparing a plan that sets out in detail how to manage the risk from this material; taking the steps needed to put this plan into action; reviewing and monitoring the plan and the arrangements made to put it in place; and providing information on the location and condition of the material to anyone who is liable to work on it or disturb it. The requirement is to manage asbestos If materials are in good condition and managed so that they cannot be disturbed, a periodic check might be all that is needed. For some premises, that see a large number of employees and visits, such as hospitals, maintenance work is inevitable and accidental damage is often possible. Therefore, all premises which were constructed prior to the year 2000, will require an asbestos management plan based on a management survey. The purpose of the management survey is to manage asbestos containing materials (ACMs) during the normal occupation and use of the premises. The duty holder can compile a management survey where the premises are simple and straightforward. Otherwise, an asbestos surveyor is needed. When a premise, or part of it, needs upgrading, refurbishment or demolition a refurbishment/demolition survey is required. This survey, normally carried out by an asbestos surveyor, is to locate and identify all ACMs before any structural work begins at a stated location or on stated equipment at the premises. Asbestos removal is a licensed industry, meaning to undertake most asbestos removal projects clients, like the NHS, need to appoint a licensed contractor (licences are granted by the Health and Safety Executive - HSE). Also, under the CDM 2015 regulations they need to appoint suitably competent people, they need to make reasonable enquiries to satisfy themselves that contractors are appropriately resourced and competent for the work. One way is to choose a contractor who is a member of a trade association/professional body. Guidance on the CDM 2015 regulation states: ‘When considering the requirements for designers and other construction professionals, due weight should also be given to membership of an established professional institution or body. For example, do these bodies have arrangements in place which provide some reassurance that health and safety is part of the route to membership of their profession?’. However, do clients assume what that membership, that logo, means? Don’t assume what a logo means as they can mean different things. At the Asbestos Removal Contactors Association (ARCA) we believe membership is more than a logo. Members don’t just pay to join ARCA, they have to continually prove that they can meet the standards which the logo represents. For example, ARCA is the only trade association for licensed asbestos removal contractors, who conducts all site audits of members as ‘unannounced’. These audits are a requirement to maintain membership and provide reassurance that health and safety standards, and good practices, are continually demonstrated. The asbestos issue for the NHS The asbestos problem facing the NHS is essentially no different to the problems faced by any property owner/employer with a

Asbestos

The asbestos problem facing the NHS is essentially no different to the problems faced by any property owner with a large portfolio of premises constructed prior to the year 2000 large portfolio of premises constructed prior to the year 2000. That is, they are responsible for ensuring that employees and non-employees are not exposed to health or safety risks as a result of the presence of unmanaged asbestos. In the case of the NHS this includes in-house maintenance teams, members of the public visiting the premises and external contractors. The main difficulties for the NHS arise due to scale. The NHS is responsible for a large number of pre-year 2000 properties and a large number of employees. BBC London recently reported that 94 per cent of hospitals in the capital contain asbestos, and about 1,000 people have died from mesothelioma since 2011 in London, seven of whom were doctors and nurses. All asbestos projects require good coordination and cooperation between all parties. Clients’ decisions, actions and inaction have an enormous impact on how work can be delivered, causing contractors to fail to meet industry and legal standards, and potentially leaving clients with substantial criminal and civil liabilities, lengthy delays and disruptions to projects. With a well communicated structured approach to asbestos management, the NHS can ensure that they continue to meet the challenge to comply with health and safety regulations across their extensive portfolio. L FURTHER INFORMATION www.arca.org.uk

Providing an effective and efficient asbestos consultancy service

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Volume 18.4 | HEALTH BUSINESS MAGAZINE

Award winning power protection systems from 400VA to 6MVA

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With electricity accounting for more than half of a hospital’s total energy costs, Chris Cutler of Riello UPS explains how moving to modular uninterruptible power supplies (UPS) is leading to healthy efficiency improvements.

According to the Carbon Trust, the UK’s healthcare sector spends upwards of £400 million on energy every year. Medical equipment such as MRI scanners, heart-rate monitors, and X-ray machines all consume substantial amounts of electricity. It goes without saying that these life-saving devices need to be available 24-7, 365 days a year. Then think of everything else in a hospital that needs power to function. Heating, air conditioning, lighting, telephones, laboratories, pharmacies, vast IT systems, and data storage facilities. It shouldn’t come as any surprise that hospitals have the fourth-highest energy use out of all UK sectors and industries. Comparison website Finder.com found hospitals consumed more than 26 billion kWh of electricity in 2016, a figure only topped by private offices, chemical manufacturing, and food manufacturing. And even though the past decade has seen great strides made to improve efficiency, healthcare still leaves a sizeable carbon footprint. In fact, NHS England produces more than 22 million tonnes of CO2 a year. With health budgets squeezed and only likely to get tighter in the coming years, executives and managers at clinical commissioning groups, health boards, and GP surgeries must keep identifying areas where they can cut energy costs without compromising on service delivery. Fortunately for them, help is at hand in the form of the uninterruptible power supply (UPS) systems found in many medical environments.

Doing more with less: Modular UPS A UPS acts as an organisation’s ultimate insurance policy, protecting against disruption to the electrical supply and minimising the risk of IT failure or equipment downtime. In critical settings such as an operating theatre, A&E department, or laboratory, even the slightest fluctuation to the power supply can ruin research, spoil patient scans, or cause IT systems to crash. It can be the difference between life and death, literally. Up until recent years, the UPS units installed at hospitals tended to be large, static cabinets taking up significant space. Such equipment only really operates at peak efficiency whilst carrying heavy loads of 80-90 per cent. But to deliver the redundancy required to keep the system online if a fault was to occur, many initial installations were oversized and so systems run at low, inefficient loads. This wastes huge amounts of energy and generates unnecessary carbon emissions. Fortunately UPS technology has improved with the introduction of modular designs. Such systems replace the sizeable standalone units with individual rack-mount style power modules. Modules are linked together in parallel to deliver the necessary capacity and redundancy. The modular approach eliminates the risk of oversizing as the number of modules closely mirrors the system’s power load requirements. It also gives facilities managers flexibility to ‘pay as they grow’ by adding in extra modules as and when the need arises. Where a modular UPS really comes into

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Modular UPS: The NHS’s secret energy saver its own for hospitals is the ability to do more with less. Using transformerless technology, modular units run at efficiency levels up to 96 per cent even when carrying loads as low as 20 per cent, leading to a substantial reduction in energy consumption. The new units also generate far less heat than the older static types, cutting the energy-intensive air conditioning needed to keep them cool and operating safely. And as modular UPSs are smaller and lighter, they deliver these performance and efficiency gains in a vastly-reduced footprint. This is particularly relevant for hospitals, where IT infrastructure often isn’t given the highest priority and equipment can be shunted into any available corner of the building. Should your hospital move to modular? Clearly a hospital or GP’s practice can’t just upgrade its critical power protection at the click of a finger. Any spending needs to be justified in these cash-strapped times. Fortunately though, every UPS has a lifespan. Industry best-practice advises a system should be replaced roughly every seven years or so. That means many UPSs installed throughout the NHS over the past decade will soon be ready for replacement. We’ve experienced that ourselves first-hand over recent months, where we switched older, inefficient units to modern, modular ones for the East Lancashire Hospitals NHS Trust. In a similar vein, we’ve also worked with the Betsi Cadwaladr University Health Board, where we’ve installed our modular Multi Power product at both Wrexham Maelor Hospital and Glan Clwyd Hospital in Bodelwyddan. All three of these hospital partners are now benefiting from enhanced UPS efficiency and lower energy bills, while they have the simple scalability they need when the time comes to expand their capacity. Riello UPS is a leader in the design, manufacture, installation, and maintenance of UPS and standby power systems that minimise downtime and promote uptime in sectors as diverse as data centres, manufacturing, transportation, education, and emergency services. In the healthcare sector, Riello UPS has a proven track-record of working in partnership with clinical commissioning groups (and their predecessor primary care trusts), health boards, local authorities, the emergency services, and private healthcare providers. L FURTHER INFORMATION Tel: 0800 269 394 www.riello-ups.co.uk

Volume 18.4 | HEALTH BUSINESS MAGAZINE

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Penetration testing and information security

The importance of UPS in healthcare

It is vital for an organisation to effectively respond to any breach. Dionach is a Cyber Security Incident Response (CSIR) provider, and has helped many organisations through understanding and limiting breaches, and mitigating the risk of potential future breaches. Headquartered in Oxford, UK, with offices across three continents, Dionach is a leading independent provider of information security solutions certified by CREST, NCSC CHECK, ISO 27001 and PCI QSA. With nearly two decades of experience delivering the highest calibre of assurance, compliance and response services, the Dionach team sets itself apart through its industry-leading skills

In mission critical medical environments like an operating theatre, A&E department, or laboratory, a robust and reliable electricity supply isn’t simply desirable, it’s non-negotiable. Even the slightest fluctuation to the quality of the mains supply can ruin vital research, scupper crucial patient scans, or cause crucial IT systems to crash. It can literally be the difference between life and death. An uninterruptible power supply (UPS) is your ultimate insurance policy, protecting your power supply against disruption and minimising your risk of downtime. And if the worst ever happens and you do suffer an outage, a UPS gives you priceless breathing space that keeps your medical equipment and IT systems running safely until the back-up power kicks in. Riello UPS has a proven trackrecord of providing critical power protection to clinical

and knowledge combined with a tailored and service-led approach to risk mitigation for each client. The company’s areas of specialism include penetration testing, security auditing and consultancy and incident response. Dionach is committed to continually monitoring and updating clients’ security strategies based on the very latest insights into emerging threats and vulnerabilities identified by its in-house research and development team.

FURTHER INFORMATION Tel: Oxford - 01865 877830 Manchester - 0161 713 0176 Edinburgh - 0131 541 0118 www.dionach.com

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS | www.healthbusinessuk.net

commissioning groups, health boards, local authorities, GP surgeries, the emergency services, and private healthcare providers. The company’s award-winning product range spans 22 solutions suitable for all medical environments and eventualities. In addition to manufacturing industryleading power protection products, Riello UPS offers the most comprehensive package of UPS installation, servicing, and ongoing maintenance support to guarantee quality, continuous power throughout the medical sector.

FURTHER INFORMATION Tel: 0800 269 394 www.riello-ups.co.uk

UK Health Show

Overcoming the challenges of digital transformation The UK Health Show is the UK’s leading live event platform connecting senior healthcare decision makers, influencers and buyers from across the NHS and the entire UK healthcare sector. Health Business previews the themes of September’s event The UK Health Show focuses on four of the biggest challenges and opportunities facing the modern healthcare system and delivers this through four main conferences, a further seven seminars and a trade show floor feature 180 leading partners and suppliers. With support and contributions from the Department of Health and Social Care, NHS England, NHS Digital, NHS Improvement and the World Health Organisation, in 2018 the UK Health Show will feature the conferences of: Healthcare Efficiency through Technology; Commissioning in Healthcare; Procurement in Healthcare; and Cyber Security in Healthcare. The Digital Challenge The Healthcare Efficiency through Technology (HETT) and Cybersecurity in Healthcare (CSIH) conferences, which are running concurrently at the UK Health Show, are ready to set the tone of discussion for the coming year. Interwoven themes covering a broad range of topics from artificial intelligence, interoperability, electronic health records, information governance and institutional readiness for future attacks are scheduled to be addressed over the two-day event. The UK Health Show will recognise the connected nature of many of these challenges and just how important it is to adopt a holistic view of the health sector. Siloed thinking will not solve the existing problems nor set in place the preventative measures needed. The show has been working closely with NHS Digital to deliver both the HETT and CSIH plenary programmes, with Noel Gordon,

chair NHS Digital, chairing day 1 of the Digital To complete this systemic view and to NHS Stage and Cleveland Henry, programme complement the operational delivery of director for Innovation, Digital Futures and new data-driven transformation projects Digital Collaboration Service, chairing day 2. including artificial intelligence, e-Health As the flagship conference element, HETT records and interoperability, the immediate will be bringing together a range follow up is often ‘who safeguards the of high profile speakers from data?’. This topic will be addressed across the NHS, private and in the Cyber Security Symposium Data third sectors, including where Dame Fiona Caldicott, is the NHS England’s CIO National Data Guardian for operati Will Smart, who will Health and Social Care, will v e w ord of the day be discussing the be covering information an auth and to find ongoing challenge governance, national o r i t of system wide opt-outs and patient a t i v to prov e voice data interoperability control of their data. To i d e g uid look no and whether that understand the importance further ance specifically is the of data management, the t t h h a e Digita greatest challenge has reportedly spent l NHS n inNHS to successful roll out excess of £1 million to Stage of new IT systems. become GDPR compliant. To contextualise the issue Data is the word further, in healthcare, the expansion of Increasing digitisation generates vast information systems, and because of this quantities of new data. Data is the operative the raw amount, intricacy and assessment word of the day and to find an authoritative of data has become increasingly hard to voice to provide guidance look no further than manage. Especially in the NHS where a the Digital NHS Stage where on Day 1 will fragmented organisational system is battling be Dr Ramesh Krishnamurthy, senior advisor to collaborate in key areas that have been at the World Health Organisation, who is strategically devolved to local organisations. an international expert on interoperability, On this, Ben Bridgewater, the CEO of Health e-Health and delivering strategic operational Innovation Manchester will be presenting on implementation of e-Health projects. the Local Health and Care Record Exemplars Dr Krishnamurthy will be setting out a (LHCREs) on the Digital NHS Stage, seeking vision for the NHS on delivering a truly to shed some light on the challenges that interoperable Health Information System Manchester have faced and how they (HIS) and drawing on his long experience. are pioneering innovative solutions. E Volume 18.4 | HEALTH BUSINESS MAGAZINE

To find out more, visit us at www.fgwilson.com

Commissioning for the Future The commissioning landscape has never been short of transformation initiatives and new models of care. Now, transformation has reached a new era of reform with attention shifting towards integrated care systems (ICSs) and integrated care organisations (ICOs), modelled on the accountable care organisations (ACOs) introduced in the USA with the ultimate goal being to defragment a historically siloed health and care system. However, with this vision comes great challenges that create hurdles to collaboration. Some of the most formidable ones include how to get everyone on the same page; how to manage complex contracts; aligning priorities; expectations and funding across all stakeholders; and how to create the capacity to share local patient care records across all components of the system. Bringing these transformation plans to life, Commissioning in Healthcare will be joined by a collection of esteemed exhibiting partners, each working in tandem with the health and care sector to overcome these challenges. Closely aligned to the HETT elements of the UK Health Show, the array of exhibiting companies on display offer digital technology platforms and solutions for systems integration and contract management creating the perfect environment to conduct direct business, network and share best practice. Conference content will feature expert strategic and operational insights from leading health and care professionals from across the UK, driving forwards the government’s integration strategy. Sir Malcolm Grant, chair at NHS England and Sarah Pickup, deputy chair at Local Government Association, set the scene with opening discussion on supporting sustainable transformation and integration. Sandwiched with case studies on devolution and ICOs, Sir Robert Naylor, author of the Review of NHS Property and Estates headlines in an unmissable panel discussion

UK Health Show

 As systems become more complex however, and despite these systems contributing to increasing the quality of healthcare delivery, the information sources are distributed, diverse in character, large and complex. The Health Information Systems (HIS) need to communicate to share information and to make it available at any place at any time. Therefore, it emerges the need to create a global system that brings together all the islands of information shared between services. It is necessary to develop a solid and efficient process of integration and interoperation that must take into consideration scalability, flexibility, portability and security. The NHS has developed a clear and actionable plan to manage these new data challenges, which is something that Dan Taylor, head of the Data Security Centre at NHS Digital, will be covering in the Cyber Security Symposium. Themes will include what the Data Security Centre has already begun to do in the wake of the WannaCry attack, the ongoing CareCERT programme and outlining a wider vision of cybersecurity for the NHS.

With cost savings of a possible £5 billion projected by reducing unwarranted variation, trusts have since been tasked with delivering this these efficiency savings and as a whole have made over £250 million of savings up to September 2017 through changes in procurement on NHS Estates following the government’s pledge of £760 million capital funding for STPs to transform buildings and services. All-in-all the show serves to provide health and care professionals with the tools to enable them to assure successful commissioning for the future. Procurement transformation Following Lord Carter’s 2015 review, procurement transformation fast became the key focus for NHS Improvement and the Department of Health and Social Care (DHSC). With cost savings of a possible £5 billion projected from Lord Carter’s review by reducing unwarranted variation, NHS trusts have since been tasked with delivering this these efficiency savings and as a whole have made over £250 million of savings up to September 2017 through changes in procurement. Many of these savings were established through programmes such as the introduction of Scan4safety (which has already resulted in over £700,000 worth of savings), the introduction of GS1 standards (will allow an average saving of £3 million each year for each NHS trust in England), with a further annual saving of £268 million proposed by adoption of the Getting It Right First Time (GIRFT) programme. The most recent change however comes from the introduction of the Future Operating Model, a new system to replace the original NHS Supply Chain set to realise £615 million

of savings in real terms over the next three years, scheduled for launch in March 2019. The Procurement in Healthcare conference at the UK Health Show brings together key procurement and finance professionals with industry suppliers to engage, connect and trade, conducting strategic level business designed to propel their trust towards realising the mammoth savings they are tasked with. With providers of managed services, facilitators in technology procurement, e-procurement providers and direct suppliers of goods to the NHS, Procurement in Healthcare provides a onestop-shop for those looking to improve NHS productivity through procurement excellence. Delivering 14 hours’ worth of content across the two days, the Procurement Transformation main stage will host keynote presentations from sector thought leaders including, Lord Carter of Coles, non-executive director at NHS Improvement and senior representatives from the Supply Chain Co-ordination Limited (SCCL) and DHSC. Each keynote will divulge unique thought-provoking insight into the direction of national strategy and what the Future Operating Model will mean for trusts and suppliers across the country. L

The UK Health Show takes place on 25-26 September 2018 at ExCeL London. FURTHER INFORMATION www.ukhealthshow.com

Volume 18.4 | HEALTH BUSINESS MAGAZINE

“While we

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www.dexcom.com/littlethings *For a list of compatible smart devices, please visit www.dexcom.com/compatibility. †Dexcom refers to Dexcom G5® Mobile CGM System. ‡Internet connectivity required for data sharing. Following requires the use of the Follow App. Followers should always confirm readings on the Dexcom G5 Mobile App or Receiver before making treatment decisions. §If your glucose alerts and readings do not match your symptoms or expectations or you are taking medications containing paracetamol/acetaminophen, you should perform a finger prick to confirm your blood glucose level. A finger prick is needed every 12 hours to calibrate. © 2018 Dexcom UK & Ireland. Dexcom UK (Distribution) Limited, Watchmoor Park, Camberley, GU15 3YL (10040080). VAT 241 2390 40. LBL015328 Rev001.

Diabetes

Diabetes is the most devastating and fastest growing health crisis of our time, with around 90 per cent of diabetes cases classified as Type 2 diabetes. Chanelle Corena, Type 2 Diabetes Prevention Lead at Diabetes UK, sets out why tackling the prevention of Type 2 diabetes is so crucial and set out the steps that the charity is taking to transform the health of the nation by the time they leave primary school. Living with Type 2 diabetes impacts both people’s quality and length of life, as well as putting an enormous amount of pressure on our While t healthcare system. We also know that without proper is curre here intervention the health cure fo ntly no of millions could be r d iabetes the goo affected by the increased , d three in news is that risk of developing the complications associated Type 2 five cases o diabete f with diabetes. This prevent s in turn has placed an ed or d can be incredible financial elay through burden on an alreadylifestyle ed strained NHS – spending £10 change s billion a year to treat diabetes. Despite the number of people affected by diabetes in the UK, our recent survey showed

The number of people diagnosed with diabetes in this country has more than doubled in the last 20 years to 3.7 million, with further increases predicted. Approximately 12.3 million people, around one in five of the population, are at an increased risk of developing Type 2 diabetes. There are several risk factors for Type 2 diabetes, but the rise in cases is mainly connected to the behaviours that lead to being overweight or obese. And the increased risk is starting earlier and earlier, with one in three children overweight or obese

Written by Chanelle Corena, Type 2 Diabetes Prevention Lead, Diabetes UK

Turning the tide of Type 2 diabetes

that many people are dramatically underestimating the severity of diabetes, with 75 per cent of the 1,000 asked unaware that sight-loss and amputations were complications of diabetes. In reality, there are more than 160 amputations each week. Alarmingly, even fewer were able to name kidney disease or heart problems as complications. Complications also represent around 80 per cent of the financial burden of diabetes for the NHS. While there is currently no cure for diabetes, the good news is that three in five cases of Type 2 diabetes can be prevented or delayed through lifestyle changes such as healthy eating, weight management and becoming more active. Where someone has already been diagnosed with diabetes, we know that employing these same techniques will make it much easier for that person to manage their diabetes and to keep their blood fats, blood sugar and blood pressure within a healthy range, reducing their risk of diabetes complications. Type 2 diabetes is a condition that could affect every family in one way or another in the UK, and making sustainable lifestyle choices at a population level could have a lasting and profound impact on the health of the nation. Diabetes UK’s approach to preventing Type 2 diabetes The time to respond is now: a rapid increase in diagnoses of Type 2 diabetes (including in children) has resulted in prevention being a key feature in government policy, and a significant focus for the media. We need to find a way to authentically engage E Volume 18.4 | HEALTH BUSINESS MAGAZINE

Raising awareness Many people are not aware of the risk factors of Type 2 diabetes or their own individual risk of developing it. This is why it’s so important for people across the UK to find out, and understand their risk. Our Know Your Risk tool, available on the Diabetes UK website, developed with the University of Leicester, helps people to find whether their level of risk is low, increased, moderate or high, and what to do to lower it. The tool, which has been used over 1,000,000 times, considers age, gender, ethnicity and waist measurement so that people can fully understand the environmental and genetic factors that impact their risk. Knowing where they stand, they can then take steps towards reducing their risk by making changes to their lifestyle. Linking individuals and families to the right services and support We’re working to make sure there is more support for people at high risk of Type 2 diabetes. In England, the NHS Diabetes Prevention Programme – a partnership between NHS England, Public Health England and Diabetes UK – supports thousands to reduce their risk of Type 2 diabetes, leading to a delayed diagnosis or preventing it altogether. The programme

provides a combination of healthy eating advice, tips on how to increase physical activity and weight management. Since 2016 the NHS Diabetes Prevention Programme has been reaching ambitious targets for people in England going on the programme and for the weight loss they achieve. Helping society make the healthy choice the easy choice We want to create a society where the healthy choice is the easier choice. We’re working across the UK, at the local and national level, for a comprehensive approach to tackling obesity and the rise of Type 2 diabetes. This includes supporting Public Health England’s programmes to reduce calories and sugar in everyday foods; calling for

stricter rules on the marketing of junk food to children: and the introduction of the levy on the sugary drinks industry, commonly known as the sugar tax. As a steering group member of the Obesity Health Alliance, one of our major recent successes has been the publication of Chapter Two of the governments Childhood Obesity Plan in June. It set a national ambition to halve childhood obesity by 2030 and proposed a range of ambitious measures to help us get there, including consultations on a 9pm watershed for the advertising of unhealthy foods and on banning promotions of unhealthy foods by price (such as BOGOF offers) and location. It also committed to a consultation on mandatory calorie labelling in the out of home sector, as major focus of our Food Upfront Campaign. Our Food Upfront Campaign was one Diabetes UK’s first campaigns to launch as a result of our Future of Diabetes insight work, where we spoke to over 9,000 people with diabetes. Through this, we heard that people with diabetes wanted more information about the food they eat at home and out and about. Being able to make an informed decision about food choices, while out and about, would clearly not just benefit those

We know we should be doing everything we can to stem the tide of Type 2 diabetes and the reality is that we need to effect change from the micro to the macro levels of our society

Diabetes

 with people to raise awareness of the seriousness of diabetes, and to influence organisations to take action. Often it’s assumed that there’s little or nothing to be done, but this isn’t the case, and we need to ensure that Type 2 diabetes prevention remains firmly in the spotlight. Encouraging people to take action to reduce their risk of developing Type 2 diabetes and creating a society that makes the healthy choice the easy choice are both key parts of how we contribute to tackling the diabetes crisis. We have already begun this journey. We have already developed resources, commissioned research, built strong partnerships and influenced the government in this area. And, most importantly, we have listened to the people who need support. Our ambition, in partnership with others, is to reduce the rate of people developing Type 2 diabetes by: supporting people, by raising the awareness of the risk factors to developing Type 2 diabetes, and linking people to services, and helping to create a society where the healthy choice is the easy choice, by advocating for policy change, and working in partnership to deliver quality services. If we are to achieve what we need to transform the UK’s health, we need learn as much as possible about the key barriers and motivations for those at increased risk of developing Type 2 diabetes. We need to work closely with local community groups, every level of the NHS, and industry to create the right interventions. To change behaviour, we need to acknowledge that it is both about building an individual’s capability, and also about changing their environment.

living with diabetes, but would help anyone looking to cut their risk of Type 2 diabetes and the health of the whole population. We were delighted to see the proposed commitment to clear, consistent calorie labelling in restaurants, cafes and takeaways because it sets out a promising route for people looking to have a healthier diet. Research has shown us that having this information available helps consumers make healthier choices, so this could, when implemented full across the country, be an incredibly positive step in the right direction. We know we should be doing everything we can to stem the tide of Type 2 diabetes and the reality is that we need to effect change from the micro to the macro levels of our society. Small changes can have a huge impact over time. We’re supporting people across the UK to find out their risk and take action to reduce it. But this problem is too big to tackle alone, which is why we’re working alongside healthcare providers to make it easier for people to make healthy choices every day. L FURTHER INFORMATION www.diabetes.org.uk

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DAVID WILSON PARTNERSHIP Connecting people and spaces

www.davidwilsonpartnership.co.uk devon@davidwilsonpartnership.co.uk

01271 374485

Creating Healing Spaces Architecture and Landscape Architecture

In light of our strong partnership and history with various NHS Trusts throughout the UK, KOK congratulate all in the NHS and their supporting suppliers for their remarkable achievements over the last 70 years.

Keelagher Okey Klein have worked for 38 years with NHS Trusts across the North upon projects ranging from Measured Term Contracts (MTC), through P21+ to £230 million PFI, providing Quantity Surveying and Building Surveying services, Principal Designer Duties and training. KOK have also been appointed on the NHS Shared Business Services Construction Consultancy Services OJEU compliant Framework and can be brought on board via this procurement route quickly and efficiently to assist with Public Sector works of all scales and scopes.

Major works we have provided services for include a £4M New-Build 24 Bed Intermediate Care Unit for Penine Acute Hospitals NHS Trust, the multi‑million‑pound Proton Beam fit‑out at The Christie Hospital in Manchester which was a first of its kind and only seventeenth in the world and also providing services for the second Proton Beam Therapy works in London with a combined value of £250M, and the award winning £38M Primary Care Centre in Birkenhead.

www.kok-surveyors.co.uk

Contact Tel:01925 654158 | Email: enquiries@kok-surveyors.com

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BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS | www.healthbusinessuk.net

Construction is not just about bricks and mortar. There are a whole host of consultancy services – like project management and civil engineering – required to ensure capital projects, such as refurbishment and design and build, are successful. To support the NHS and other public sector organisations in this area, NHS Shared Business Services (NHS SBS) has managed a framework providing access to these services since 2014. The Construction Consultancy Services Framework is one of more than 65 OJEU compliant frameworks we offer in total, covering a huge range of products and services, which – from March onwards – are all free to access for any NHS or other public sector body. Since its inception, this particular specialist framework has saved the public purse in excess of £12 million, due to typical savings of between 10-15 per cent when compared to buying from suppliers direct. And in March, due to increased demand, we re-launched a new and improved version of the Agreement. It now includes more than 200 suppliers ranging from SMEs to national providers – split by service provision, geographical region and project value band – and offers access to a much greater range of specialisms.

and match their requirements or tailor something more individual. It is no wonder then that our Construction Consultancy Services Framework has already been used to draw together the right team for a number of projects in the NHS, ranging from those that have attracted international attention, to the more ‘business-as-usual’ requirements of a busy NHS trust. One of the UK’s leading specialist trusts, for instance, sourced project management and quantity surveying services on a new landmark cancer treatment centre. An NHS hospital in the Midlands, meanwhile, generated savings of around £5 million in a £50 million scheme, and we supported a major trust in the South of England as it refurbished sections of office space. In using the framework, these organisations have not only ensured they can access precisely the right suppliers in a cost-effective, simple and streamlined manner, they have also been able to save time and effort for their procurement teams. The providers and local authorities we work with generate considerable savings for their organisation, meaning more money can be diverted to frontline health and social care. L

Cost savings as standard Use of this framework can help NHS procurement and estates teams be more effective in several ways. Most obviously, it can assist them in trimming project costs. Savings can be generated through a range of discount structures and pricing options, for example, prompt settlements, volume discounts and volume spend rebates. The use of Level 2 BIM technology – collaborative working between different teams and underpinned by digital technologies, which enables teams to develop more efficient methods of designing, delivering and maintaining buildings throughout their lifecycle – further reduces spend. Another major advantage is that suppliers are all already vetted in key areas like financial standing, public liability and professional indemnity. The wide range of suppliers and specialisms is another major benefit to procurement teams, as finding the right supplier for the right job is where a lot of public sector organisations struggle. Many have told us that while they often might have preferred to use a local supplier on a project, they simply did not have the time – and often the specialist knowledge – to identify and assess local SMEs, meaning they have usually been reliant on the major national players. Trying to identify suppliers of more niche ancillary services, such as acoustics experts or town planners, has also caused them similar problems.

www.sbs.nhs.uk/ica-construction-consultancy-services

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The right supplier, every time And this, they felt, often meant projects did not perform optimally. First there were often hefty travel expenses associated with hiring a national supplier, pushing up costs. Second, there is a perception that national suppliers working on smaller projects have a tendency to send in what one of our partner organisations described as ‘their B or C team’. Use of the framework avoids this by enabling procurement teams to pinpoint the right team for the job, using a variety of very precise criteria to ensure they are working with the ‘A Team’ every time. Another advantage of the framework is the flexibility it offers in relation to different procurement routes. Organisations can either directly award projects or run mini-competitions depending on the needs of their project. When a project is likely to have very specialist requirements – for example the refurb of historical buildings – a competition may be the most appropriate way to source the right skills. Procurement teams can also make use of a number of model contracts, making it easy to mix

FURTHER INFORMATION

Written by Phil Davies, director of Procurement, NHS Shared Business Services

NHS Shared Business Services’ Phil Davies explains how a new, free-to-access Construction Consultancy Services Framework is helping NHS trusts achieve maximum value from capital spending projects, whilst saving the public sector around £16 million over the next four years

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Maximum value from capital spending projects

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BUILDING CONTROLS

PROCESS MAPPING

> Mobile | +44 (0) 7765 220235 > Email | s.dunn@antas.org > Web | www.antas.org antas.org

Volume 18.4 | HEALTH BUSINESS MAGAZINE

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Comment

VOLUME 18.4 www.healthbusinessuk.net

Delivering digital healthcare

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The convergence of healthcare and IT, and the breakneck speed with which the two are becoming near-synonymous both in the provision of professional care and in the approach we take to wellness in our daily lives, has registered somewhere between evolution and revolution. The famous Mark Zuckerberg approach to innovation - ‘move fast and break things’ - is entirely at odds with responsible deployment of new, potentially disruptive (and, by extension, dangerous) forms of tech into an environment where lives are eternally at stake. However, just as how the smartphone and wireless technologies have transformed the way we interact with the world, there is a gradual but undeniable metamorphosis taking place in every facet of our healthcare system. Wearable technology, sensors, AI, virtual and augmented reality, electronic patient records, barcoding and more, are all key to maximising the potential of the ever growing pool of health data and the powerful connected computing capabilities that are a reality in 2018.

Follow and interact with HiT Business on Twitter: @BenPlummerHiT

Britain’s life expectancy is falling in the year that our NHS turns 70. In the face of an unprecedented strain on funding and complex issues across the entire healthcare economy, technology needs to be embraced as a foundation on which to build an NHS that is fit for purpose and equipped to take on the challenges of our time.

Follow and interact with Health Business on Twitter: @HealthBusiness_

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NHS APP

Inspired milestone of 70 apps in honour of NHS 70 birthday

NHS app aims to ease access to health services

NHS Digital has revealed that the NHS Apps Library has reached 70 apps in honour of the NHS birthday, offering patients personalised advice, self-care and signposts to health services. The organisation has worked with more than 350 developers to include new apps since the launch of the Apps Library in April last year and has pledged to keep growing and covering many more health and care needs. The most recent new apps cover a range of needs, including support to prevent and manage diabetes, mental health, manage the symptoms of chronic conditions such as asthma and high blood pressure and support

to cope with the impact of breast cancer. Hazel Jones, programme director of NHS Digital’s Apps and Wearables team, said: “We are really delighted to meet this milestone in time for the 70th birthday celebration of the NHS. There have been some amazing developments in technology in health care over the past 70 years and apps are an exciting tool for how patients access health services and make choices about their care both now and in the future.” READ MORE tinyurl.com/y94zgn49

CYBER SECURITY

Three-year strategic IBM cyber partnership NHS Digital has entered into a three‑year strategic partnership with IBM to enhance data security and cyber security response and provide additional defence against increasingly complex, evolving threats in the healthcare sector. The additional services will enhance NHS Digital’s current capability to monitor, detect and respond to a variety of security risks and threats across the NHS, and offer expert advice and guidance. The Cyber Security Operations Centre (CSOC) will also be expanded as a result of the partnership, and will see NHS Digital able to offer tailored and specialist advice to individual NHS organisations, and will give NHS Digital access to IBM’s

X-Force repository of threat intelligence to provide insight, guidance, and advice so health and care organisations can take appropriate action to prepare for, or mitigate against, identified risks and threats. The CSOC expansion will also include security monitoring pilots across selected NHS organisations, a n innovation service which will allow NHS Digital to quickly access new tools technologies and expertise to address new threats as they emerge and enhancement of NHS Digitals current monitoring capability. READ MORE tinyurl.com/ycopmwck

NURSING

Care digital transformation must include nurses The Royal College of Nursing (RCN) has warned that the digital transformation of health care will remain a pipe-dream unless nurses are involved more. The results of a consultation led to the college warning that the NHS won’t be able to realise all the benefits digital technology can bring for patients and staff until it takes better advantage of the expertise and views of nurses, who represent the largest single staff group in the health service. Ross Scrivener, RCN eHealth lead, said: “In the past few weeks leading up to the 70th anniversary of the NHS, we’ve heard a succession of health care leaders arguing that the best way to transform health care in the UK is to utilise the full benefits of digital technology. But our consultation shows that that aim will remain a pipe-dream unless managers, technology providers and IT staff take more account of the views of nurses.

“The responses to our survey reveal some depressingly mundane barriers to nurses’ full participation in digital transformation, from wifi that doesn’t work, to computers that take too long to log on. The single most important theme to emerge from the consultation is that involving nurses in the design and implementation of programmes and systems to improve patient care is not an optional add-on – it is absolutely vital.”