Health Business 18.6

VOLUME 18.6 www.healthbusinessuk.net

FINANCE

RECRUITMENT

OBESITY

HEALTH BUSINESS AWARDS

A REASON TO CELEBRATE The winners of the 2018 Health Business Awards have been announced, celebrating another year of remarkable achievement in the health sector

TECHNOLOGY

MAPPING DIGITAL PROGRESS

With a self-proclaimed tech enthusiast as Health Secretary, we look at the digital developments of 2018

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VOLUME 18.6 www.healthbusinessuk.net

FINANCE

RECRUITMENT

OBESITY

HEALTH BUSINESS AWARDS

A REASON TO CELEBRATE The winners of the 2018 Health Business Awards have been announced, celebrating another year of remarkable achievement in the health sector

TECHNOLOGY

MAPPING DIGITAL PROGRESS

With a self-proclaimed tech enthusiast as Health Secretary, we look at the digital developments of 2018

PLUS: CYBER SECURITY | ESTATES | FIRE SAFETY | MODULAR BUILDINGS

2018 - a year of success and excitement Our 2018 has ended with another highly successful Health Business Awards, where organisations across the NHS were recognised in 22 categories for the unrivalled work and achievements made over the last 12 months.

In July, the National Health Service turned 70 and in the months leading up to that historic anniversary, as well as the months since, the achievements of one of the most renowned organisations in the world have rightly been heralded, with hospitals up and down the country sharing success stories and accounts of transformation that show the progress our health system has made since its creation in 1948.

To celebrate the NHS 70 milestone, Theresa May announced in June that the NHS in England will receive an extra £20 billion a year by 2023. As we wait to see whether the increase will help deter the multitude of issues currently facing the sector, it was welcoming to see Brighton & Sussex University Hospitals NHS Trust win our NHS Finance Award for reducing its deficit by £13 million and identifying a further £30 million of efficiencies for 2018/19.

Let us hope that 2019 will produce similar success stories and that the financial burdens currently weighing down the efficiency and innovative work of our hospitals will begin to clear.

Follow and interact with us on Twitter: @HealthBusiness_

We look forward to bringing you all of the latest news and opinions from within the health service again in the new year.

Michael Lyons, editor

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Contents

Contents Health Business 18.6 07 News

07

Accounts mask the reality of NHS funding pressures; change needed in safety culture to reduce harm; and £1bn for 75 projects to upgrade NHS estates

15 Health Business Awards The winners of the 2018 Health Business Awards were announced at the awards ceremony and dinner at London’s Grange Hotel on 6 December.

Here we list the winning organisations across the 22 categories, including the much-coveted Outstanding Achievement in Healthcare Award

15

19 Finance

Over the last 10 years, NHS spending has grown but less so than at any point in its history. In this article, CIPFA’s Eleanor Roy looks at the way funding flows through the system and how it sometimes presents a barrier to more integrated, place-based care

25 Technology

25 56

In the first of three technology-focused articles, Paul Timms discusses some of the benefits of using the Internet of Things as a basis to transform NHS efficiency, before Adam Stone looks at the role of mobile apps in improving the hospital experience. Lastly, we examine Matt Hancock’s first half-year as Health Secretary and whether his digital agenda is producing the fruit that he ambitiously set out to achieve

33 Cyber security

The WannaCry attack in May 2017 disrupted more than a third of trusts and caused nearly 7,000 patient appointments to be cancelled. Shalen Sehgal explains how healthacre providers can prepare for a similar attack and what steps can be taken to mitigate against business disruption

41 Fire safety

63

How can hospital buildings plan and build structures intended to slow or prevent the spread of fire, and will this promote a better fire safety culture in at-risk buildings?

Using advice from the Fire Industry Association, we look at the current laws and legislation around fire safety

Health Business magazine

49 Estate management

In July, England’s 44 STPs submitted five-year estates strategies to NHS Improvement. Here, Claire Tew and John Wingfield-Hill explore how the NHS can modernise its estate and use its limited funds more effectively

52 Modular buildings

How do manufacturers of volumetric offsite construction ensure sustainability and compliance when the key priority for hospitals is time?

Jackie Maginnis shows how the modular build industry is leading the way

56 Recruitment

Over the past year, almost 4,000 EEA nurses have left the profession in the UK and only 800 have joined the NHS. Discussing ‘Brexodus’, Damon Culbert argues for an immigration plan fit for the purpose of the health sector

59 Infection control

Infection prevention must be the cornerstone of our approach to tackling antimicrobial resistance, says Pat Cattini, president of the Infection Prevention Society, who explains the reasons why

63 Wayfinding

Signage should be a major consideration for hospitals, especially from a health and safety perspective.

Here, we revit the thoughts of Mark Hughes and the Institution of Occupational Safety and Health on the correct use of signage in busy hospitals

67 Obesity

Health professionals across the UK agree that funding prevention services is a key part of lowering the NHS budget. With the NHS suggesting people take better responsibility for their health, how can we lower the burden of obesity on the NHS?

73 Secure storage

80 per cent of thefts in hospitals take place in areas in which members of the public can legitimately be present. What roles does secure storage play in keeping patients, staff and their belongings safe?

www.healthbusinessuk.net Volume 18.6 | HEALTH BUSINESS MAGAZINE

5

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News

FINANCE

Accounts mask reality of funding pressures In its review of NHS accounts, the Public Accounts Committee has warned that appearances can be deceptive and that the financial sustainability of health and social care is a serious and ongoing concern.

Despite an apparent improvement in fortunes when taken as a whole, the committee says that the annual report and accounts ‘masks the underlying deficits’ at a local level and the continued use of short term measures to reduce individual deficits, such as use of the sustainability and transformation fund and money to help with winter pressures.

Recent reports that around a fifth of hospital trusts and health boards across the UK have missed their A&E, cancer treatment, and non-emergency

surgery waiting time targets, hammer home the concerns that are held about the reality of the financial pressures on trusts at local level.

The continuing uncertainties surrounding the long-term funding of social care, the funding of NHS staff pay awards and the UK’s arrangements after leaving the European Union, with issues around workforce and medical supplies, also highlight the challenges the Department for Health and Social Care continues to face.

The Public Accounts Committee recommends that the department should write to the committee by 31 January 2019 to outline how it will address the workforce issues affecting specific specialisms and geographical regions.

And, as soon as the Home Office’s immigration white paper has been published, outline how it will respond to any changes in immigration policy arising from Brexit.

It should also should set out details of its assessment of the impact of Brexit on the supply of medical equipment and, where necessary, what contingencies it has put in place and establish long term solutions for winter through the integration of health and social care. This should be achieved by the time of its government’s costed 10‑year social care plan, due in April 2019.

READ MORE tinyurl.com/y95vayre

WAITING TIMES

DIABETES

NHS waiting lists at highest level in a decade

169 amputations a week as a result of diabetes

New figures show that the number of patients waiting longer than the national target time to start necessary NHS treatments has reached its highest level in a decade. The NHS England data reveals that waiting lists for what is deemed routine treatments rose by nearly 60 per cent from 2.6 million patients in 2011 to 4.1 million in September of this year, breaching the four million mark for the first time since September 2007.

Additionally, over half a million people were made to wait longer than the mandated time to begin non-urgent treatment in September, the highest recorded since August 2008. Of that, 3,156 patients had been waiting more

than a year. The NHS is required to assume all reasonable steps to offer patients a range of alternative providers if it cannot provide treatment within 18 weeks of referral.

At present, the NHS England target remains at the often-missed 18-week requirement for 92 per cent of patients. This September, 86.7 per cent of patients received treatment within that allotted time frame.

The Patients Association says we risk returning to the days of unacceptably long waits for elective surgery.

READ MORE tinyurl.com/y99q6429

PATIENT SAFETY

Change needed in safety culture to reduce harm in NHS The Care Quality Commission (CQC) is calling for a change in culture within the NHS to reduce the number of patients who experience avoidable harm.

A new report from the inspectorate, Opening the door to change, finds that too many people are being injured or suffering unnecessary harm because NHS staff are not supported by sufficient training.

Additionally, due to the complexity of the current patient safety system, the paper says it is difficult for staff to ensure that safety is an integral part of everything they do.

Examining the issues that contribute to the occurrence of never events and wider patient safety incidents in NHS trusts, the CQC is now calling on the NHS and its partners to promote a change in safety culture across the NHS so that safety is given the priority it deserves. At present, approximately 500 people a year are suffering avoidable harm as a result of ‘never events’ – serious lapses in

patient safety that can cause injuries or even death and should be completely avoidable.

Although healthcare is by its nature ‘high risk’, the CQC review found that due to increasing pressures within the NHS, this is not consistently reflected in its culture and practice. In contrast, other safety critical industries accept that their work is high risk, ensuring that this approach informs everything that they do.

While the CQC recognises that healthcare is different, the report claims that there is still much the NHS can learn from these high risk industries to ensure risks are identified and managed proactively, with a greater understanding of team dynamics, situational awareness and human factors, and with safety protocols followed consistently.

READ MORE tinyurl.com/ydasyump

Analysis by the charity Diabetes UK has found that 169 people a week are having to undergo amputations as a result of diabetes.

Diabetes affects almost 3.7 million people in the UK. Between 2014 and 2017, 26,378 people had lower limb amputations linked to diabetes marking a 19.4 per cent increase on the three years previous. The charity says that unhealed ulcers and foot infections are the main cause of diabetes-related amputations.

Diabetes UK is urging NHS England to maintain its £44 million diabetes ‘Transformation Fund’ beyond 2019, which aims to improve patient access to specialist foot care teams to help avoid amputations.

The charity is also reminding those with diabetes to look after their feet and checked them regularly to look out for the signs of problems, as a matter of hours could make the difference between losing and keeping a foot. Previous analysis found that diabetic foot ulcers led to more than 80 per cent of amputations linked to the condition.

Dan Howarth, head of care at Diabetes UK, said: “The shocking number of lower limb amputations related to diabetes grows year on year. An amputation, regardless of whether it’s defined as minor or major, is devastating and life‑changing. A minor amputation can still involve losing a whole foot. Many diabetes amputations are avoidable, but the quality of foot care for people living with diabetes varies significantly across England. Transformation funding since 2017 is working and will help to reduce these variations, but much work still needs to be done.”

The statistics are a reminder of the increase in the number of people with diabetes.

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News

NHS ESTATES

£1 billion for 75 projects to upgrade NHS services

Health and Social Care Secretary Matt Hancock has announced that £963 million of extra funding is being given to 75 health facility projects across England.

Claiming that stopping sending money to the EU after Brexit will allow the

government to invest more in domestic priorities, the Department of Health and Social Care said that 75 projects will receive funding to upgrade facilities so that more people can be treated and more can be done to prevent ill-health in the first place. This includes a new emergency department in Walsall, a multimillion‑pound eye care facility in London and a major expansion of mental health services in Newcastle, Gateshead and Liverpool.

Hancock said: “We want even more patients to receive world-class care in world-class NHS facilities and this near billion-pound

HEALTH & SAFETY

NHS 70

BBC reports of asbestos in nine out of 10 hospitals

Summer’s funding boost not enough to improve care

The BBC has found that nine out of 10 NHS trusts responding to an inquiry report that they have hospitals containing asbestos.

Having sent freedom of information requests to all 243 NHS trusts in Britain, receiving 211 responses, the findings indicate that 198 trusts run hospitals containing the material, once widely used in construction between the 1950s and 1970s.

Since then it has become clear that the presence of asbestos can be dangerous when inhaled and may give rise to asbestos-related diseases such as mesothelioma, which causes more than 5,000 deaths in the UK each year.

The BBC also discovered that 352 claims were made against trusts between January 2013 and December 2017 by people who had developed asbestos-related diseases in NHS buildings, resulting in payouts totalling £6.8 million. However, three legal firms have told the BBC that they had won compensation claims totalling more than £16.4 million in the same period.

In light of the findings, Jo Stevens, chair of the All Party Parliamentary Group for Occupational Health and Safety, has urged the government to conduct an audit to ‘ensure every trust knows the extent of asbestos on their premises and has a plan for dealing with it’.

Mesothelioma UK is set to launch a research project into the impact on hospital workers.

READ MORE tinyurl.com/y997kcjl

A new report has claimed that most of the £20.5 billion pledged for the NHS risks being swallowed up by the ageing population, pay rises, the rising cost of drugs and hospitals’ deficits.

The IPPR thinktank says that as little as £1.3 billion of the increase could remain to fund improvements in treatment, unless the service dramatically overhauls how and where it currently cares for patients.

Shared with the Guardian, the paper, which also contains the thoughts of Ruth Carnall, a former head of the NHS in London, and Hannah Farrar, a former executive at the NHS financial regulator Monitor, says that while the funding will be sufficient to meet increases in day-to-day demand and rising costs, it will not ‘fund significant improvements in care unless the NHS radically increases productivity’.

The authors suggest that providing the extra care caused by the growing number of over‑75s and over-85s would cost £16.1 billion a year, while staff pay rises

boost – one of the most substantial capital funding commitments ever made – means that the NHS can do just that for years to come. This will not only support dedicated staff through the redevelopment and modernisation of buildings, but it will allow additional services to launch for the first time, improving patients’ access to care in their local area as part of our long-term plan for the NHS.” READ MORE tinyurl.com/y8fpuhao

and pensions, the rising cost of drugs and other operating costs would take another £7 billion, while £1.56 billion would be needed to cover deficits built up by NHS providers of acute care.

Outlining three possible scenarios in how the funding could disappear, the worst-case scenario operates under the fact that NHS productivity rises by just 0.8 per cent a year, finding that only £1.3 billion of the total £20.5 billion would be available for improvements.

READ MORE tinyurl.com/yacfuerl

ORGAN DONATION

Organ donors will be asked of religious considerations Those joining the UK organ donation register are to be asked if they want their religious beliefs to be considered in the donation process.

The new measure, to be added to the register by the NHS straight away, will hopefully boost the low proportion of donors from black and Asian backgrounds and aims to reassure people that donation can take place in line with their faith or beliefs, with research indicating that faith and cultural beliefs can be a stumbling block to donation.

NHS Blood and Transplant, the organisation that runs the NHS organ donation register, said this would enable nurses to discuss concerns about the process with families, such as whether a burial would be delayed.

With more than a third of patients waiting for a kidney transplant being from black, Asian and other minority ethnic communities, part of the shortage of donors is believed to be caused by people from these backgrounds choosing not to donate. In fact, 42 per cent of black and Asian families agreed to donate their relative’s organs last year, compared with 66 per cent of families from the overall population.

However, if a person does choose to donate by signing up to the register, families retain the final say on whether their organs should be used.

READ MORE tinyurl.com/y9t5ev36

Volume 18.6 | HEALTH BUSINESS MAGAZINE

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News

GP ACCESS

Evening and weekend GP appointments available

NHS England has announced that patients across England can now experience extended access to general practice appointments in the evening and weekends.

The announcement means that patients

will be able to see a doctor, nurse or other member of the practice team at a time convenient to them, with NHS England predicting an estimated nine million extra appointments per year as a result of the weekend and evening service.

The service is being delivered three months ahead of schedule, as NHS England begins a communications campaign for the run up to Christmas to ensure patients are aware of the evening and weekend appointments.

Dominic Hardy, NHS England’s director of Primary Care Delivery, said: “Strengthening general practice is an important part of the NHS Long Term Plan and local health services

have worked hard to ensure patients have access to our excellent general practice services right across the country. Because of this hard work, we have been able to make these extra appointments available months ahead of schedule and before winter really starts. As well as offering convenience and choice to patients, it will help to reduce some of the pressure on general practice and A&Es and ease some of the wider system pressures we saw last winter.”

READ MORE tinyurl.com/y9hnxmj7

PRESCRIPTIONS

BED OCCUPANCY

Review requested into over-prescribing in the NHS

Care at risk because of hospital overcrowding

Health and Social Care Secretary Matt Hancock has ordered a review into overprescribing in the NHS to ensure that patients are receiving the most appropriate treatment for their needs.

To be led by Chief Pharmaceutical Officer Dr Keith Ridge, the review will look at the issue of ‘problematic polypharmacy’, whereby a patient is taking multiple medicines unnecessarily. Estimated total NHS spending on medicines in England has grown from £13 billion in 2010 to 2011 to £18.2 billion in 2017 to 2018, representing average growth of around five per cent a year.

With nearly half of over 75-year-olds surveyed were taking five or more medicines, the review will also look at creating a more efficient handover between primary and secondary care, improving management of non-reviewed repeat prescriptions, as well as the role of digital technologies in reducing overprescribing. This will create a better picture of overprescribing in their area to allow more targeted action, ultimately

creating better personalised care for patients.

Keith Ridge, Chief Pharmaceutical Officer at NHS England, said: “Doctors, pharmacists and patients need to work together to ensure people are on the right medicines, for the right amount of time. NHS England’s recent successes in reducing unnecessary antibiotics and medicines with care homes and GP practices, on polypharmacy, and on beginning to end overmedication for people with learning disabilities, all show what can be – and indeed now is being – done on this important topic.”

READ MORE tinyurl.com/yanlkom9

COMMISSIONING

Positive progress made in collaborative commissioning A new report has found that although progress is at an early stage, the relationship between commissioners and providers in the health system is on the brink of significant change.

NHS Providers and NHS Clinical Commissioners, who have jointly published Driving forward system working: a snapshot of early progress in collaborative commissioning, claim that commissioners are now beginning to take a more strategic approach, commissioning for outcomes across larger population footprints.

As part of this development, NHS trusts are taking on or supporting activities previously undertaken by clinical commissioning groups (CCGs), such as developing pathways and service specifications.

A number of common success factors are already facilitating system working, with

the two NHS organisations highlighting strong collaborative and clinical leadership transcending organisational boundaries and focusing on delivering care to meet the needs of a local population as one approach proving successful. The report also mentions the benefits of establishing ‘one version of the truth’ that can drive honest open and honest conversations, supporting staff to work flexibly across systems, potentially pooling resources or appointing joint posts and involving all system partners, including local authorities and the voluntary and independent sectors.

READ MORE tinyurl.com/y7ap8nxo

NHS England’s first weekly report of the winter has revealed that nearly 95 per cent of beds are occupied in England’s hospitals, with some having to turn away ambulances because of lack of space.

Health leaders have warned that overcrowding this Christmas period means that patient care is being put at risk, with many hospitals now in what is deemed the ‘red zone’ Bed occupancy limits sit at 85 per cent, with anything above recognised as unsafe.

Ambulance crews should be able to handover patients to A&E staff within 15 minutes of arrival - but in one in nine cases it took over 30 minutes. The data for the first week in December showed that eight A&Es had diverted ambulance crews elsewhere because they were so busy.

It is now more than a year since any part of the UK has hit one of its three key targets for: A&E waits, cancer care or hospital operations.

NHS England has also published its monthly performance figures for November, showing that performance against the A&E four hour target is the worst in any November since the data collection began.

In total, trusts have seen 1,000 more people with four hours in A&E every day in November compared to last year.

READ MORE tinyurl.com/yag45mfp

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News

DIGITAL BOOKINGS

NHS e-Referral reaches online booking milestone The NHS e-Referral Service has hit 100 million bookings since it was launched in 2005 as the NHS Choose and Book Service.

NHS Digital says that the service, which allows patients or clinicians to book appointments in hospital or other care settings online, is now booking around 400,000 referrals every week. The success of the digital service has been shown to reduce the number of people who fail to attend their appointment.

With new guidance having recently been launched for GPs to ensure they are getting the most out of the NHS e-Referral Service,

the system has also proven to reduce the use of paper and save time and money that can be better used for patient care.

Matt Hancock, Secretary of State for Health and Social Care, said: “This is a great example of how technology can save staff time, get patients seen faster and make every pound go further. It is by embracing these sorts of innovations that we will make the NHS the most technologically advanced healthcare system in the world.”

In October all 150 acute trusts in England completed the switch to the NHS e-Referral Service, meaning that

TECHNOLOGY

CYBER SECURITY

Fax machines to be banned on NHS

Lack of cyber security expertise within the NHS

Health Secretary Matt Hancock has banned the NHS from buying fax machines and has ordered a complete phase-out by April 2020.

Part of the Department for Health and Social Care’s tech vision, to modernise the health service and make it easier for NHS organisations to introduce innovative technologies, NHS trusts will be required to invest in new technology to replace outdated systems until they are able to declare themselves ‘fax free’.

It was revealed in July that more than 8,000 fax machines are still being used by the NHS in England. Now, the new phasing out plan means that digital services and IT systems will have to meet a clear set of open standards to ensure they can talk to each other across organisational boundaries and can be continuously upgraded. The government will look to end contracts with providers who do not understand these principles for the health and care sector.

Helen Stokes-Lampard, chair of the Royal College of GPs, said: “A wholesale switchover to electronic communication seems like a brilliant idea but for some practices it would require significant financial investment in robust systems to ensure their reliability was at least as good as the trusty fax machine, as well as having the time to embed - neither of which we have at present as GP teams are already beyond capacity trying to cope with unprecedented patient demand. GPs are tech fans, not technophobes, and we have been calling on the government for significant investment in our core IT infrastructure, some of which is archaic, so that all GP practices have technology that improves communication, works for patients and makes the working lives of GPs easier.”

READ MORE tinyurl.com/yc2js4ck

A new survey of NHS trusts has revealed a large disparity in cyber security skills and spending across the NHS, with most trusts lacking sufficient in-house cyber security expertise.

The three-month freedom of information campaign, undertaken by Redscan, surveyed more than 150 NHS trusts in the UK and reveals a wide imbalance in employee cyber security training and spending between trusts, with a worrying number of NHS trusts likely to be failing to meet training targets on information governance.

The investigation shows that NHS trusts employ just one qualified security professional on average per 2,582 employees, although 24 out of 108 responding trusts having no employees with security qualifications.

With NHS trusts spending an average of £5,356 on data security training, the findings also reveal a significant proportion of NHS organisations conducted such training in-house at no cost or only used free NHS Digital training

all first outpatient appointments must now be booked through the system.

READ MORE tinyurl.com/yar9swad

tools. The variation in spend, which ranged from £238 to £78,000, was also exemplified by the fact that only 12 per cent of trusts had met the NHS Digital mandatory information governance (IG) training requirements that 95 per cent of all staff must pass IG training every 12 months. A quarter of trusts had trained less than 80 per cent of their staff.

READ MORE tinyurl.com/ybxrkevq

CANCER CARE

Welsh cancer patients to receive proton beam therapy Cancer patients in Wales are set to begin receiving proton therapy treatment on the NHS after the Rutherford Cancer Centre South Wales was given the green light.

Having been offering the treatment to private patients since it opened in April, the Newport-based centre is expected to begin treating NHS patients immediately after the Welsh Health Specialised Services Committee gave it the go ahead to accept patients referred through NHS Wales.

Following the Christie cancer centre in Manchester, the Rutherford Cancer Centre South Wales is now the second in the UK to allow NHS proton beam therapy, with The Christie expected to give the treatment to a cancer patient in England next week for the first time.

Roger Taylor, at the Rutherford centre, said: “Proton therapy is not a panacea for

all types of cancer, however we have seen where it can be beneficial in areas such as brain tumours or cancers of the spine or head and neck, and working with the NHS means that adult patients in Wales will now have an option to be treated closer to home.”

READ MORE tinyurl.com/y93l8o5r

Volume 18.6 | HEALTH BUSINESS MAGAZINE

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14

Are you prepared for safe emergency evacuation?

Delivering standby power solutions in the UK

Evac + Chair International is the world’s number one supplier and original manufacturer of evacuation chairs. The chairs are designed to accommodate disabled or mobility impaired people, allowing them to descend a staircase in an emergency situation without the need of great physical strength or lifting.

With over 35 years’ experience, and more than 30 distributors worldwide, including in the USA, Germany, and South Africa, Evac + Chair has become a leading specialist in emergency evacuation, providing comprehensive education, ensuring its customers comply fully with health and safety regulations. This can range from providing products,

Dieselec Thistle Generators (DTG) specialises in providing critical power solutions to the UK health sector and has developed a strong track record in delivering large energy centre projects.

Working with both NHS and private facilities to ensure reliable back-up power for new and refurbishment projects, DTG offers complete end-to-end power solutions: turnkey power packages; diesel generators; gas CHP power systems; consultation and design; project delivery and installation; testing and commissioning; aftermarket service, maintenance and parts; 24/7 emergency response; and temporary hire power.

Providing customers with products, support and advice throughout the life cycle of their equipment means DTG has forged successful, longstanding relationships within the health sector. Working collaboratively with specifiers,

advising on the legalities that surround evacuation planning and deployment to specific and regular maintenance.

The company’s most popular Evac + Chair is the 300H MK4 model which can take a 182kg payload capacity and is also available in AMB format which has larger rear wheels for prolonged/external rough terrain use. It is used as Ecac + Chair’s standard model as it can be used as a one person operation, meaning it is easy to use and light weight at only 9.5kg.

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consultants, construction firms and facilities managers ensures customers find the most costeffective and resilient stand-by power systems to meet their specific requirements.

Operating from its 6.3 acre HQ near Glasgow, DTG has an 80,000 sq ft warehouse space accommodating workshops, parts distribution depot, the biggest load test cell in the country, and the largest stock of generators in the UK. From ten to 2,500kVA – the stockholding is available for immediate dispatch to ensure customers can quickly be provided with the right solution for their power needs.

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Better parking facilities for the health sector

Helping you solve today’s business challenges

The British Parking Association is a not for profit organisation, representing, promoting and influencing the parking and traffic management profession throughout the UK and Europe.

Its membership of more than 700 organisations and individuals includes local authorities, car park operators, retail parks, healthcare facilities, universities, railway stations, technology providers, trainers and consultants.

The association works with its partners to support growth for our communities, improve compliance by those managing and using parking facilities, and encourage fairness to achieve our vision of excellence in parking for all.

The British Parking Association is delighted to support the 2018 Health Business Awards which recognise and celebrate the significant contributions made each year by organisations and

Skyrocketing costs, historic regulatory changes, patient demands for instant access to their records, compliance to GDPR, SAR and freedom of information (FOI) implications, bureaucracy and security concerns help define the healthcare industry landscape.

Indeed GDPR that became law this year poses several challenges, not least the ability to be compliant with stricter data protection rules but also to be able to prove it in a court of law.

By deploying a scanning solution alongside other line-of-business applications and embracing digital transformation, healthcare organisations can gain a strategic hub for managing all content that flows through the enterprise. Key benefits include: centralised storage with enhanced security for all information, including patient records; business process agility that can lead

individuals that work inside and alongside the NHS. Its contribution to the government’s parking guidelines for NHS trusts includes case studies of good practice that other NHS trusts are encouraged to emulate.

The guidance has been produced to outline what measures NHS organisations should have in place and what measures can be implemented that represent good practice in car-parking strategies, and also improve the overall patient and visitor experience.

FURTHER INFORMATION www.britishparking.co.uk

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to productivity gains and cost savings; enhanced compliance throughout all departments with all regulatory guidelines; faster access to patient information, potentially leading to improved patient outcomes, better patient engagement, and better access to critical information across the care continuum; and a notable ROI from the investment.

With the benefits and rapid return on the investment, moving from paper to digital processes will allow healthcare organisations to tackle the challenges facing the industry in the coming years.

FURTHER INFORMATION marketing@uk.fujitsu.com

HB Awards

Health Business Awards winners announced

2018

The winners of the 2018 Health Business Awards have been announced, following a dinner and awards ceremony at London’s Grange Hotel at the start of December Presented by comedian and former doctor NHS Foundation Trust and London Ambulance Adam Kay, multi-award-winning author of Service as its commended organisations.

This Is Going To Hurt, the awards was once Across the remaining 21 categories again staged in order to recognise the many there were notable winners across the examples of innovation and excellence that country in a wide range of specialities and happen every day in our health service. functions, including the University Hospitals 2018 marks the 70th anniversary of the NHS. of Morecambe Bay NHS Foundation Trust, While much remains to be done to ensure which was successful in both the Healthcare it can keep up with changing demands, the Recruitment and Estates & Facilities Health Business Awards took on special Innovation Award categories. The trust was significance this year, staged in order to the first in the UK to introduce an electronic recognise the many examples of innovation system which links the telephones with and excellence that make the NHS what it is. software to centralise the allocation of the job The top-billed Outstanding Achievement requests to hospital porters. Patients can be in Healthcare Award, sponsored by Accruent advised of the estimated arrival time of the UK, is awarded to an NHS organisation porter, which has resulted in significant time that has achieved success in its role and savings on wards and helped helped to reduce brought benefits to the wider NHS through overnight stays and associated inpatient costs. the dedication and expertise of its staff. This Within the recruitment category, the year the award was presented to Kingston trust’s short films, featuring nurses, Hospital NHS Foundation Trust. As the first consultant radiologists and radiographers, acute trust in the region to receive a Care were congratulated for highlighting their Quality Commission Outstanding rating for passion for working at this years’ winning being well-led, this years winner was chosen trust. These were followed up by social to be part of a pilot which aims to reduce media campaigns which resulted in 148 waiting times further. Dementia care, palliative applications for hard to fill roles. care and sexual health services have all received praise from inspectors, as well as Ambulance services from Health Business magazine.

There was also recognition for work Kingston Hospital NHS being carried out in the capital, Foundation Trust with London Ambulance With outshone five Service winning the 2018 m other trusts to Ambulance Trust of a rking the 70t walk away with the the Year Award and h anniv top prize, with the London Air Ambulance e r o s a f ry the NH awards recognising successful in the Air S this year’s c West Suffolk NHS Ambulance Award e r e m ony hel particu Foundation Trust, category, for testing d lar sign North Staffordshire a new blood product i fi c an for all o Combined Healthcare f our ce NHS Trust, The Christie shortlis ted NHS Foundation Trust, trusts Somerset Partnership

on its aircraft. London Ambulance Service, unfortunate not to win in the Outstanding Achievement category, has carried out a successful pilot over seven months to decrease the number of falls and reduce demand on both the ambulance service and hospitals, as well as improving outcomes in later life.

Garrett Emmerson, chief executive of the trust, said:“I am delighted that we have been successful in winning the Health Business Awards Ambulance Trust of the Year Award.

2018 has been a challenging but really positive year for us, culminating with the launch of our five year strategy that has seen us introduce pioneering services including a dedicated mobile mental health response vehicle.

Earlier in the year, the trust was also rated as ‘Good’ by the CQC with an ‘Outstanding’ rating for the care we give to our patients.

This award is a fitting end to 2018 and I’d like to thank each and every one of our staff.”

Sticking with ambulance teams, North West Ambulance Service were also worthy winners in the NHS Publicity Campaign Award category for promoting alternatives to dialling 999, using real life examples of people who had used 999 inappropriately, such as a person who called 999 from an A&E waiting room because they didn’t think they should have to sit with other members of the public.

The Transport & Logistics Award is awarded to the NHS trust that has seen improvements in operational logistics. This years’ winner, Yorkshire Ambulance Service NHS Trust, has introduced three new hydrogen-electric support vehicles to its fleet and is also working with a low emission technology company to build a prototype hydrogenelectric ambulance. Solar panels have also been installed on more than 100 ambulances.

Digital advances 2018 has very much been the year where technology within the NHS has taken centre stage, with new Health Secretary Matt Hancock a vocal supporter of using digital to improve care. Across the country, hospitals have continued to use innovative methods and technological advances to boost patient safety and improve efficiency.

One such trust is Milton Keynes University Hospital NHS Foundation Trust, successful in the Patient Data Award, for using an app which allows patients to manage their appointments directly. Updates are written directly into the trust’s patient administration system, and it has the potential to provide patients with access to their medical records, as well as using health and activity data collected by wearable technology. E Volume 18.6 | HEALTH BUSINESS MAGAZINE

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GDPR and scanning solutions for healthcare in the UK Discover how to mitigate the risk of data breaches and reduce costs by an average of £50,000 per annum, as well as how to facilitate compliance with GDPR Article 15: Right to Access, Article 20: Right to Data Portability and Article 32: Security of Processing Our impressive scanning solution, incorporating iDocs Bindr SAR SafeSend, will enable you to improve your efficiencies of production, de-risk processes and increase security of delivery of your Subject Access Requests (SAR). The healthcare industry faces enormous challenges, including rapidly changing regulatory, financial and technical issues. Electronic Medical Records (EMR) systems help in addressing these challenges, but organisations should also consider GDPR specific electronic content management (ECM) type solutions for even greater improvements in practices and processes.

Skyrocketing costs, historic regulatory changes, patient demands for instant access to their records, GDPR and Freedom of Information (FOI) concerns, bureaucracy and security concerns have all helped define the healthcare industry landscape. In recent years, countless medical organisations from small practices to major hospitals have implemented EMR solutions to replace inefficient paper-based practices. Indeed GDPR that became law last year poses several challenges, not least the ability to be complaint with stricter data protection rules but also able to prove it in a court of law.

The challenges The pressure on healthcare organisations today is unprecedented and the constant criticism about spiraling costs and the need for cost reduction is relentless. With GDPR becoming statute and the fact that patients are more knowledgeable than before and are demanding greater participation in their healthcare decisions, things just aren’t going to get any easier.

Especially in regards to the information associated with patient care, its security and accessibility of that data under FOI act.

Time to respond to a Subject Access Request (SAR) is shorter, organisations can no longer charge a fee for SAR’s, add to that the fact that a large proportion of patient information is still held in paper records further exacerbates the situation. A healthcare organisation will take anywhere from a couple of hours to two days to fulfill just one SAR, depending on size, not to mention the costs associated with it.

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The solution Countless medical providers are implementing EMR Systems as one obvious way to cope with challenges of modern medicine. At the level of individual organisations, trusts and practices are and can benefit from cost efficiencies and enhanced patient services by digitising their medical records. However, healthcare organisations do not run on medical records alone, and EMRs were NOT designed to handle (GDPR) Subject Access Requests – ‘Right to Access by Data Subject’, ‘Right to Data Portability’ and ‘Security of Processing’ including security of Portable Data.

Traditional ECM Solutions can provide important functionality such as; capturing and creating content in a wide variety of formats, including paper and electronic documents; organising information with metadata enabling collaboration. But again they’re not designed to handle SAR’s. One such solution is our scanning solution incorporating iDocs Bindr SAR SafeSend.

The solution takes a unique approach to SAR fulfilment facilitating compliance with GDPR articles 15, 20 and 32. It automatically compiles any file type (scan paper using Fujitsu scanners and ingest electronic documents – including MS Office, paper records, PDF, Audio, Video, CCTV, DICOM image, X-ray, MRI, tiff , gif) into a searchable electronic SAR’s folder. It also creates an Index page(s) on the fly for easy navigation in a machine readable format, presenting the SAR in a catalogue of associated documents containing relevant data. The solution can redact any Personally Identifiable Information / Data (PII / PID) as required. Finally with a second click of a button it will encrypt the SAR folder and transmit it securely (AES 256) to the individual requesting the SAR. Additionally, if required, the solution can, using secure web-forms kick off a workflow of verifying the identity of the individual requesting a SAR. Another feature of the solution can discover PII / PID information held on a subject. Searching by key words such as NHS number, Hospital number, NI number, DoB, name or email which will then be tagged, categorized and have direct links to the documents for easy retrieval and automatic compilation of the SAR folder.

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS | www.healthbusinessuk.net

Vital for healthcare success Healthcare is an information-intensive industry, not just from myriad of documents, charts, images and other data directly related to a patient’s health. Because a lot of patient information often comes from external sources, or legacy patient records held in filing cabinets – paper remains a significant part. In some instances constitutes a large percentage of overall information held. Healthcare as a heavily regulated industry, also produces voluminous data sets. Providers also must adhere to mandates for data security that, if violated, can result in significant penalties, not to mention adverse publicity and reputational damage. Healthcare organisations need systems that will help them securely deliver; SAR’s, medical negligence cases, right to erasure/to be forgotten requests, in fact, any sensitive information and data. Security feature a solution like iDocs Bindr SafeSend is easily able to fulfill.

In a recent business case by a foundation trust, the hospital calculated annual cost savings of £ 50,000 per year (not accounting for staff costs) based solely on removing printing, photocopy and recorded delivery, for the 2,500 SARs they receive every year.

Numbers the trust expects to grow by some 25 per cent as a direct result from the abolition of the fee in May 2018.

Implementing an effective SAR solution – the Benefits By deploying our SAR solution alongside other line-of-business applications, including EMRs, healthcare organisations gain a strategic hub and regulatory advantage for managing content that flow in and out of the enterprise.

Key benefits include: efficiency improvements through automation, greatly enhanced security of SAR and data delivery, cost savings, facilitating compliance with GDPR articles 15, 20 and 32. Better patient outcomes facilitated by quickly accessible, user friendly SAR’s and notable ROI from system implementation of less than one year. L FURTHER INFORMATION www.fujitsu.com

HB Awards

2018

Kingston Hospital NHS Foundation Trust won the Outstanding Achievement in Healthcare Award

 A five-year project involved equipping care homes with sensor‑based equipment designed to monitor residents and alert staff to those in need of assistance was the winning entry in the Telehealth Award.

The initiative, led by NHS Calderdale Clinical Commissioning Group, enabled individuals to call for assistance from nursing staff when needed, as alerts from the equipment are sent to pager-like devices carried by care staff.

Additionally, in the Healthcare IT Award, sponsored by Fujitsu, NHS North of England Commissioning Support worked in collaboration with GP practices to adapt clinical systems to suit the different types of nurse-led appointment. One practice reported potential times savings of up to 65 hours per year. Such achievements saw the organisation win the award, beating AHP Suffolk, University Hospitals Plymouth NHS Trust, Salford Royal NHS Foundation Trust and Nottinghamshire Healthcare NHS Foundation Trust to the accolade.

Reduce deficits and improved mental health Assistive Partner sponsored the 2018 Hospital Procurement Award in which Salisbury NHS Foundation Trust fought off competition from Portsmouth Hospitals NHS Trust and the Countess of Chester Hospital NHS Foundation Trust to win the prized trophy. Commercial income has been generated at Salisbury through a number of projects including the re-launch of range of moisturising creams. The introduction of barcode technology has delivered hundreds of thousands of pounds of efficiency savings and improved patient safety, with the trust now seen as a driving force for innovative change. Elsewhere, in the NHS Finance category, Brighton & Sussex University Hospitals NHS Trust were praised for regaining control over its finance since the appointment of the new executive team, reducing its deficit by £13 million and identifying a further £30 million of efficiencies for 2018/19.

Physical assaults on staff and patients at this years’ winning trust in the Hospital Security Award, sponsored by JKE Security, prompted a security review which led to the implementation of a 24 hour control room. A pilot scheme at the Royal Wolverhampton NHS Trust provided patients and visitors with a method to report crime within the NHS anonymously, and was rightfully recognised at the Grange Hotel.

This year, attempts to lift mental health on par with physical care have taken great strides, but the chasm remains too wide and it will be interesting to see what the Department for Health and Social Care does in the first months of 2019 to correct that imbalance.

Hertfordshire Partnership University Foundation NHS Trust was recognised by Health Business in the Innovation in Mental Health Award, sponsored by ORTUS Conferencing and Events. Service users who have completed their therapy are using drama to spread awareness about mental illness and treatment. Thought-provoking workshops and productions for schools, universities and other organisations

explore sensitive and often painful subjects including self-harm, what it’s like to live with suicidal thoughts and various personality disorders which are inspired by their real-life experiences. L

A full list of winners and the reasons behind their success can be found on the Health Business Awards website.

FURTHER INFORMATION www.hbawards.co.uk

London based Eco-Events at ORTUS ORTUS is a flexible event space suitable for conferences, meetings, workshops, filming and photography, training courses, receptions and a range of other events. Shortlisted for Best Sustainable Venue at the 2018 Global Good Awards and CHS Awards, sustainability has always been a part of the fabric of the building.

ORTUS was purpose built by the Maudsley Charity in order to create an all-inclusive, welcoming space for training, meetings and events for the South London and Maudsley NHS Foundation Trust. Working closely with South London and Maudsley NHS Foundation Trust (SLaM), which provides the UK’s widest range of mental health services, and the world renowned Institute of Psychiatry, Psychology and Neuroscience, King’s College London, Maudsley help fund ground-breaking neurological and mental health research, service

improvements and therapeutic programmes.Profits from ORTUS go back into the trust. Discounted rates on room hire is available to the public sector and charities.

The venue is now open to everyone and regularly used by the public sector and for corporate events, offering a welcoming atmosphere, advanced technology, environmental efficiency and openness. ORTUS has 1500 sqm of dedicated, flexible event space. Larger suites can be divided into 22 rooms, over sevn levels, as and when required.

FURTHER INFORMATION enquiries@ortusevents.com www.ortusevents.com

Volume 18.6 | HEALTH BUSINESS MAGAZINE

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Data is an invaluable asset and should be used accordingly The NHS is one of the most prolific gatherers of data in the world. It’s not surprising as it employs 1.4 million people, caters for a population of nearly 70 million and sees over 800,000 patients every day

Every interaction with a patient, whether on the phone, a home visit, at a GP surgery or a stay in hospital, results in data being generated and stored away in a myriad of systems.

This collection of data will only accelerate over time as new methods of treatment are implemented and the use of technology is extended.

All this generated data is nothing less than gold dust which has far reaching consequences not only for you and me (the individual patient) but can, and does, drive drug development, models of care and government policy in a whole set of areas. Of course, the data can be used in more insidious ways, for example by insurance companies but this happens anyway, try getting reasonably priced life insurance as you get older. What is undeniable is the data collected by the NHS and its affiliated organisations, if or when used intelligently, has the power to transform the lives of all our citizens in this country and the wider world, for the good.

Knowledge of data Analysing data effectively does not come without its challenges. A report by Cumberlege on maternity services in the North West revealed the problem of excess

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data, rather than timely and relevant information. The simple answer to this problem depends on knowledge (of the data), process (making relevant data available to the right person at the right time) and analytical tools which are fit for purpose.

Knowledge and understanding of the data is dependent on the professional users of that data. For example, one expects a clinician to understand all the nuances of a procedure taking place in an acute setting and the significance of all fields (bits of data) contained in a record about that procedure. A layman (IT) can look and read the information but may need to be guided on what is vital in the context and what is not. IT professionals can be guilty of guessing what an end user (in this case a clinician) might want to see but not understanding what is vital. This means, in a report key information can exist but is hidden by too much other information, so its significance is lost. Both parties have a responsibility to avoid this outcome.

Pressure and costs So here is the rub, is all this data leveraged in a way that drives up productivity and efficiency generally within the NHS? This is critical in an era where we have an increasingly ageing population but with

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS | www.healthbusinessuk.net

more and more treatments available, this is a recipe for continuous upward pressure on costs; and this pressure is not going to go away. Is the data made available on a timely basis to the widest possible audience that can use it to good effect to the benefit of everyone? Probably not.

There is, of course, a huge elephant in this room called Information Governance (confidentiality to you and me), but this shouldn’t be an insurmountable barrier.

Data anonymisation is a well understood technique so no identifiable patient details need to be revealed if the data is circulated more widely. There is an argument that even revealing some aspects of the demographic details of data may be too revealing but if you choose to get too cute about all of this nothing would get shared. There will always be the possibility that the data could be used for the wrong reasons but that needs to be managed, not used as a reason for not sharing the data with appropriate parties. So, in a perfect world is the NHS able to leverage this data? The answer, as always, is yes and no.

Yes, because somewhere you will find within this huge organisation centers of excellence when it comes to use of data; however, unlike bad news, good news doesn’t always travel fast so good practice is not necessarily communicated, let alone acted upon.

By comparison you will still find data analysts within the NHS beavering away using inappropriate systems (often spreadsheet-based), trying to make sense of all this gold dust and struggling to deliver meaningful results and/or within a meaningful timeframe. This leads to extreme inefficiency. The retail industry has for decades ‘sweated’ its data assets to become more competitive and ultimately this has benefited the consumer with better products, better choice, better service.

Shouldn’t the NHS be encouraged to ‘sweat’ its enormously valuable data assets (i.e. become a smart NHS) to help drive transformational change, becoming more efficient and which will ultimately benefit the patient with better services. When we have answered that question in the affirmative we will know we are onto a winner. L FURTHER INFORMATION www.totalintelligence.co.uk

CIPFA’s Dr Eleanor Roy looks at the way funding flows through the health system and how it does not support the policy agenda for more integrated, place-based care and in some way presents a barrier

Finance

A prognosis for health finances

Written by Dr Eleanor Roy, policy manager for Health and Social Care, CIPFA

Without a doubt the last 10 years have been tough. NHS spending has grown, but less so than at any point in its history. The crunch has been harder on social care and public health, with funding reductions on both cash and real terms over the same timescale.

So, it’s no surprise that the health and care system is under severe financial pressure.

Rising demand, budget constraints and the need to deliver ‘more for less’ have surely pushed the system to its limits. At the same time, the government’s policy of further integration and the vision for prevention have not been reflected in the allocation of funds, nor the financial frameworks involved.

The additional funding for the NHS announced in the recent budget, although welcome, does little to help. The funding is wholly allocated to the NHS, with no provision for public health or social care, and given the current position, is likely to be utilised to address short-term pressures.

More money alone is not the answer.

The health and care system needs to be adequately funded to ensure it is financially sustainable in the long-term, and the financial architecture must be reformed to make it fit for purpose to meet the policy agenda of greater prevention, and integration – to achieve placebased care with a focus on outcomes.

The c u r re n t app f u n d i n ro a c h t o g and ca for health u n c e r t re c re a t e s ain encour ty and short t ages e decisio rm ns

The way funding is allocated to the health system is complex and subject to a range of statutory and administrative requirements on individual organisations.

The Department of Health and Social Care (DHSC) receives an annual funding allocation, voted by Parliament. This is then allocated to arm’s length bodies such as NHS England, Public Health England and the Care Quality Commission. NHS England in turn allocates funding to Clinical Commissioning Groups (CCGs) to commission services from NHS providers.

At each stage of this allocation process, each individual body has set revenue and capital limits within which it must remain.

Control vs collaboration In terms of financial management in the health system, it appears that a single metric, the ‘control total’ is sacred. These were introduced in 2015-16, when for the first time NHS England almost overspent its budget. The aim was to improve financial performance by setting a minimum level which each individual organisation is accountable for delivering. The

aggregate of the control totals is set to ensure the NHS meets its overall financial targets. Access to other funding streams, such as sustainability and transformation funding, is dependent on achieving the control total.

This creates a perversity in that, it may incentivise the achievement of improved financial performance using nonrecurrent mechanisms, such as the release of provisions, in place of recurrent savings – thus potentially increasing future risk.

In 2018, integrated care systems (ICSs) were introduced - these are a small number of geographically grouped providers, commissioners and local authorities with collective responsibility for planning and delivering health and care services in their local area. Clearly the need to for individual organisations to meet their control total does not incentivise integrated working. Local authorities also have a statutory duty to set a balanced budget. The pressure on each individual organisation to meet its financial obligations – and the disparity between their financial systems - makes it difficult for them to pool budgets, commission services jointly or share risk. ICSs are required to work within a E Volume 18.6 | HEALTH BUSINESS MAGAZINE

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How ‘low’ is low enough to protect patients from falls from the bed?

The UK’s ageing population will continue to add further pressure to the NHS in the coming decades. An ageing hospital population presents associated challenges in terms of patient safety The overall cost of falls in acute settings is estimated to be £506 million per annum and those aged 65 and above are at a greater risk of harm from a fall, accounting for 87 per cent the overall cost.

22 per cent of all falls occur from the bed, meaning a preventative solution will reduce the amount of avoidable harm and the associated higher risk of mortality, along with lowering incremental treatment costs.

Low beds are widely used to prevent falls and reduce harm by lowering the potential height a patient falls.

How do we define a ‘true’ low bed?

A ‘true’ low bed should offer two key benefits: It should offer a height that is low enough to allow shorter patients to mobilise safely from the bed; it should have a minimum height that is low enough to significantly reduce the risk of fall-related injury.

Manufacturers often use terms such as ‘High-Low’, ‘Low Entry’, ‘Low’, ‘Extra Low’ and ‘Ultra Low’, but do these terms actually describe low beds?

How low is low enough?

The optimum position to promote safe mobilisation from the bed is that which achieves a 90° angle at both the knee and hip. This is equivalent to a patient’s popliteal measurement, which is the height from the bottom of the heel to the back of the knee whilst the patient is sitting. Therefore we can conclude that the distribution of popliteal heights of the elderly population should dictate the minimum height required of a bed and mattress combination in order to enable safe mobilisation.

Analysis of popliteal heights in an elderly population to determine the ideal low bed height Analysis of popliteal data from a recent study of ergonomics using anthropometric data can be used to suggest the ideal minimum height of a low bed, in order to provide protection for the widest range of patients.

The study detailed the popliteal heights of a defined population age 65 years and above. This data set was compared to the lowest height that can be achieved

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by combining a range of minimum bed heights with a 14cm foam mattress in order to determine the per cent of this population that would have the potential to achieve the safe mobilisation position.

Based on the data set, a platform height of 21cm combined with a foam mattress of 14cm provides an optimal mobilisation height for over 99 per cent of males and 84 per cent of females.

In comparison, a platform height of 32cm combined with a foam mattress of 14cm provides an optimal mobilisation height for six per cent of males and less than one per cent of females.

Reducing the impact force on falling We can determine the relative risk of injury from a fall from the bed by using a simple physics equation to predict the relationship between bed height and harm.

Gravitational potential energy (GPE) is defined as the energy an object possesses due to its position in a gravitational field and is directly proportionate to the height from which an object falls. The higher the height, the greater the GPE. Can we conclude that GPE can provide an indication of impact force which in turn could be an

indication of the level of potential harm?

The relative increase in GPE based on bed height has been calculated: a bed with a height of 32cm increases GPE by 31 per cent versus a bed height of 21cm; a bed with a height of 38cm would increase GPE by 49 per cent versus a bed height of 21cm.

The Medstrom Range of Ultra-Low Beds The Medstrom range of ultra-low acute beds offers a minimum height of just 21cm. This is low enough for the safe mobilisation of 99 per cent of males and 84 per cent of females aged 65 and above.

Uniquely, the Medstrom ultra-low beds offer the ability to programme a customised height setting for each patient to ensure the safe mobilisation height is achieved consistently.

A low height of 21cm results in a GPE that is significantly lower than a bed that is 32cm+.

Conclusion With 40 per cent of the acute patient population being 65 years and above, a percentage that is growing year on year, there is a strong argument for institutions to consider a bed fleet that offers true, proactive protection from falls by selecting a ‘true’ low bed. L FURTHER INFORMATION www.medstrom.com info@medstrom.com

The graph shows that a fall from a bed height of 32cm creates 31 per cent more GPE than a fall from a bed height of 21cm.

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS | www.healthbusinessuk.net

Finance

 single system control total. Achieving this overall system control, whilst maintaining the individual organisations existing statutory requirements is, to say the least, a complicated exercise.

Competition vs collaboration As if this is not complex enough, the way that money actually flows around the health system can act as a barrier to greater integration. The Health and Social Care Act 2012 increased competition and choice in the health system, but this may act as a disincentive to integration and a focus on outcomes. Commissioners individually contract with providers; the NHS tariff incentivises activity in an acute care setting, rather than place-based care; CCGs bear the most of the risks associated with meeting demand, without holding the levers with which to influence it; and acute provides bear the risk of increasing costs of service delivery, but cannot incentivise the most cost-effective options or refuse to deliver increasing activity.

Yet more complexity is added by ‘add on’ funding mechanisms, such as the Provider and Commissioner Sustainability Funds and Commissioning for Quality and Innovation. To incentivise and facilitate integration the Better Care Fund was introduced, and improved. Whilst it may have incentivised closer working, it has failed to integrate governance and delivery, and added yet another mechanism on a wider system not aligned with the policy of integration. Where integration is working well and systems are maximising pooled budgets, they are doing so in spite of the legislative and administrative constraints.

As the saying goes, ‘money talks’ - the way it is distributed and the associated objectives drive the behaviour of individuals and organisations within the system.

Currently, the financial framework does not promote, or even enable, system-wide efforts to reduce demand, address duplication in the system, or to move to a place-based outcomes focused model of care. Even the dichotomy of eligibility requirements, with health care free at point of use and social care being means-tested, complicates service planning for the needs of individuals.

A realistic view of savings The Five Year Forward View, provided a vision for increased prevention, greater integration, the drive for place-based care, better outcomes and reduced costs – but it gave no direction as to how these ambitions could be met. CIPFA concluded that the financial model behind the plan was untenable, and created significant challenges to meet the

aspirations (and efficiency savings) proposed.

The 2017-18 year-end figures clearly illustrate the current pressures. The provider sector showed a deficit of £986 million, after receiving £1.8 billion in sustainability and transformation funding. There was also a shortfall of £477 million in savings against plans. CCGs overspent by £213 million, following the release of £360 million from the risk reserve. This was offset by an underspend on the commissioning side at national level, giving an overall underspend of £970 million for NHS England as a whole. This demonstrates the reliance on reserves and funding intended for long term transformation just to reduce deficits.

The NHS is ever more reliant on additional funding and non-recurrent savings in order to meet its financial pressures. This said, productivity within the NHS has improved in recent years, but pay restraint and reductions in the tariff have contributed significantly to this. Some of the savings achieved have been illusory – for example, switching capital to revenue to meet short-term pressures whilst draining the capital required for long term investment. Such measures cannot be sustained and future improvements will need to come from more fundamental approaches.

It must be recognised that individual organisations have achieved impressive levels of savings. For example, trusts have achieved almost £7 billion in recurrent savings since 2010-11, in addition to the £20 billion ‘Nicholson challenge’. It is now widely recognised that such opportunities are largely exhausted, with individual organisations reliant on non-recurrent savings or long-term transformation.

A system-wide approach to achieving further savings is required – placing overly ambitious savings requirements on organisations will merely add to larger deficits. Such a system-wide approach needs to be based on realistic assumptions and be underpinned by a clear framework.

The new funding, announced in the summer, is wholly allocated to the NHS, with no provision for public health or social care, and given the current position, is likely to be utilised to address short-term pressures

Time for change The recent NAO report on the government’s overall planning and spending framework highlighted an absence of long term plans, over-optimistic medium term plans and short term decisions impacting on long term value for money, would not have been surprising for those familiar with the health and social care sector.

The current approach to funding for health and care creates uncertainty and encourages short term decisions rather than long term investment and planning for future pressures. The use of sustainability and transformation funding to achieve financial balance clearly demonstrates this – a short term fix at the expense of long term financial sustainability and value for money.

The current financial framework was not designed to work in the manner the policy rhetoric now encourages, and there is widespread consensus that the financial architecture is in dire need of reform to align with the aims of wider integration and place-based care. There are early signs of recognition that the financial architecture is in need of reform. For example, intentions for arm’s length bodies to work more closely together, and indications from the 201920 planning guidance that corrections to financial mechanisms are being considered.

Funding flows must incentivise the behaviours and activities needed to shift the balance of care. Longer term funding is required to allow planning for investment and financial sustainability. Funding needs to be focused on outcomes to drive value with joint accountability across the system. A systemwide outcomes framework may provide clearer incentives, together with the introduction of arrangements for sharing risks and benefits.

The ‘front-loading’ of NHS funding has not changed the underlying position – as the NAO put it: ‘These cash injections paper over the cracks in NHS finances rather than achieve lasting improvement.’

With a commitment that the NHS long term plan will reform the funding arrangements for the NHS and a forthcoming green paper expected to propose new models of funding for social care, the time to take a more stable and sustainable approach to funding the health and care system is now. L FURTHER INFORMATION www.cipfa.org

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Like many technologies 3D Printing has taken its time to find its true vocation where the gains in digital processing are discovered by both leaders and followers

how they work and nearly all using a technology that is related to fusing an already solid material. These printers have the benefit of relatively low costs but suffer in terms of speed and precision.

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3D Printing finds its mark 3D Prototyping Resins available for model making or rapid prototyping not only include the full range of normal plastic type materials in a full range of colours but also bio compatible resins that are certified and come from a range of suppliers.

These resins match exactly the wavelengths cured by the MoonRAY and are suited to a range of applications from ear implants to dental crowns and bridges to podiatry. There are variable material strength properties as well as flexible resins allowing movement.

Prototypes are not just confined to engineering. For example, the speed requirements of producing new medical devices and one off solutions to urgent problems can be tested and honed within hospital, clinic, design or support premises.

With very tight deadlines to adhere to and restrictions on the number of times something can be tried the medical sector is often beyond normal engineering methods. The 3D printing speed of the design to make process or the scan to make process makes many of the medical applications feasible.

Often, new technologies need time to be matched with other skills and processes in order to be fully efficient.

The advances in software, 3D scanners and 3D printers and light sensitive resins has now certainly reached this point.

Awesome Apps Ltd is a European Distributor for the new MoonRay series of DLP printers that are revolutionising the worlds of dental production, investment casting applications and rapid prototyping, among others.

A lot of our work is actually adapting and explaining where 3D printing fits within the modern workflows and while the health sector has experimented with 3D printing; it is less clear and how to use it in everyday processes. The dental sector is now starting to use the tools on a daily basis but the needs of implants and tools is yet to be fully addressed.

The MoonRay 3D printer The MoonRay 3D printer works using the newest technology with an led based light source of defined wavelength. It uses an array of microscopic and individually controlled mirrors to project an ultra violet light onto very thin slivers of a UV resin held in a shallow tray. The layer is cured and begins to solidify before the light is re-focussed on the next layer and cured in the same way. The layers can be as little as 20 microns in height or

about a quarter of the width of a human hair.

The detail produced is more than enough for many applications and there are three differing resolution versions to match the applications. The technology prints particularly accurate models that are dimensionally consistent across the entire build platform and items are not distorted by where they lie on the platform. Driven by easy to use software for the Mac or Windows platforms, the user can position, scale, rotate and duplicate the model at the click of a button. The software runs on a perfectly normal PC or laptop and requires no specialist training to operate.

For parts requiring supports during the process the software automatically generates these, such that they are both easy to remove and useful in ensuring a correct solidification process. The system is commanded by the software via an Ethernet or wireless link and is free to perform other tasks during the actual printing.

This type of 3D printing technology has the net advantage that its is faster than the earlier laser driven (SLA) printers and can produce multiple parts in the time that the laser generation printers take to produce just one and is much less fussy in its handling and life span requirements.

Within the health sector 3D printers have been used largely to demonstrate

Easy application Many health sector entities have rightly prioritised the digital connection between departments, populations and suppliers but there are areas where greater digital communication can be further enhanced by more tactile productions. Pictures and presentations are all good for getting the points across but to really get the feel of a new process or new device an in-house 3D model not only provides a realistic rendition of the idea but also details with room for improvement or modification.

While such investments were initially restricted to outside of the office environment and often costed as major capital spend items, todays 3D printers cost less than a communications server or a web site update.

What seems like a technology leap that is difficult to integrate and even more difficult to relay to administrators students and colleagues can often become straightforward when demonstrated in the form of a realistic model. The rapid turnaround of ideas into concrete examples is the essence of 3D printing and applicable to many more enterprises than are currently in use.

The MoonRay 3D printer offers a compact, speedy, professional and elegant solution backed by the software and thirty year, technology expertise of Awesome Apps Ltd. FURTHER INFORMATION Tel: 01242 370453 www.awesometechnology.eu

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Financial pressures forcing the NHS into a technological revolution NHS trusts in England have reported a combined financial deficit that was nearly twice the amount planned. According to NHS Improvement there was a deficit of £960 million in the last financial year compared with the £496 million planned for

The Department of Health has set savings targets of 10 per cent of non‑pay expenditure per trust. To achieve these ambitious targets there is an urgent need to improve procurement processes and their supporting systems.

Out-of-date systems vs a single source to pay (S2P) solution Most organisations now have eCatalogue, eContract, eSourcing and eP2P systems, but they are often fragmented and loosely integrated. Consequently, information held on one system is not reflected on others and manual intervention is needed to pass information between them. This causes redundancy and wastage, preventing procurement from delivering the savings needed.

Evolve Source to Pay is the first provider in the NHS market to provide a single end-toend solution for managing procurement. It encompasses sourcing, contract management, catalogue management, purchase to pay and inventory management. The solution is based on a suite of proven modular products, that come to together to form a tightly integrated and easy-to-use solution.

Fragmented systems vs a solution built on collaboration NHS organisations are developing shared proposals to improve health and care, working in 44 areas covering all of England.

In many cases this has meant organisations forming shared services, aligning people and processes. This presents a challenge where organisations are using a variety of different systems, which are unable to be either integrated or scaled. Failure to address these problems means many of the

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benefits of collaborative working are lost.

As a true collaborative solution, Evolve S2P allows the set-up of complex organisational structures. This starts with collaboration on sourcing exercises, to develop shared contracts and catalogues. This reduces duplication and leverages expenditure to deliver cash releasing savings. Catalogue content is then easily consumed within Evolve P2P, adopting the rules and controls that apply to a given organisation within the collaborative. Completed transactions data is also seamlessly integrated into a number of third-party finance systems.

Systems without Scan4Saftey vs a solution with Scan4Saftey at its core Scan4Safety is a pioneering initiative led by the Department of Health and Social Care (DHSC) that is enabling the delivery of better patient care, improved clinical productivity and supply chain efficiency in the NHS. The publication of the NHS eProcurement Strategy in 2014 set off the programme of work that has grown into the Scan4Safety programme. The problem faced by many trusts is their current systems are simply not capable of delivering the changes needed.

Evolve Inventory delivers a full Scan4Safety inventory management solution with scanning at the point of care and full traceability. Tightly coupled to Evolve Contract and Evolve P2P, information can be transmitted consistently and reliably, encompassing the complete process.

Performance data, proof of delivery and other critical management information such as volumes and demand forecast can be accessed and reported on in the blink of an eye. There is a factual record of what/who/ where. That can be instantly interrogated to show proof of delivery. And good systems can instantly alert the watchful eye of management if distribution or collection tasks have not been completed in the planned timescale.

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS | www.healthbusinessuk.net

Poor data in systems vs a solution that ensure data quality To deliver on the challenges of the sector, it is important that data is descriptive and accurate. This means DUNS, Companies House and SID4GOV verified supplier data and GS1 verified product information. Most systems require this information to be collated manually at trust level, leading to inconsistent results, causing issues when invalid data is passed to down stream systems.

Evolve has an extensive and mature supplier marketplace, where DUNS, SID4GOV and Companies House data is managed on behalf of trusts. Evolve is a full GS1 partner and uses the GTIN Check Service and GDSN, to ensure product data is kept up-to-date and accurate.

Systems that miss key requirements vs an innovative and experienced solution The technology market is a rapidly changing sector. The challenge for an NHS trust is procuring systems that deliver innovation, whilst fulfilling the core requirements of the process. This dilemma often leaves trusts with new solutions that are not fit for purpose, or antiquated solutions that don’t deliver innovation. Evolve has more than 10 years’ experience delivering solutions and innovating NHS procurement processes. The Evolve approach is to partner and grow with an organisation, sharing its objectives and ambition for improvement.

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As demands change, Evolve partners with its NHS customers to ensure that you have the correct technology when they need it.

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David Elliot, Evolve director, said: “We’ve been involved in local NHS projects showing the positive impact that a source to pay solutions have in ensuring data consistency, collaboration and shared services, and cost reduction.” L FURTHER INFORMATION www.evolves2p.com

Paul Timms discusses some of the potential benefits of using IoT as a basis to transform efficiency and improve the patient experience

Interconnected devices IoT will help improve patient care with interconnected medical devices which allow information to be instantly and efficiently shared with all relevant parties; doctors, nurses, patients, their family, researchers, pharmaceutical organisations, regulators and equipment manufacturers.

Healthcare instruments and practices are, through the collection of data, becoming increasingly ‘intelligent’, they can be used to collect and provide more detailed knowledge of diseases, treatment targets and biomarkers. The data can be shared between all stakeholders to not only improved care for the patient and also feed into long term understanding of treatments and outcomes.

Remote, ongoing monitoring While historic monitoring of patient’s care has been dependant on medical staff physically carrying it out, IoT is allowing constant, noninvasive monitoring of the patient throughout their treatment. Healthcare professionals use IoT to monitor data continuously, algorithms will predict changes and make

recommendations for the nurses, doctors and other healthcare specialist to act on and make any necessary interventions. This frees up staff time, lowers costs, delivers a quicker, more convenient patient service and ultimately better outcomes for all.

This same type of monitoring can also be used to screen medication uptake as well as allowing remote observation of patient’s actions in the home. This means that groups like the elderly can remain in the safety and comfort of their homes with healthcare professionals constantly supervising their treatment. Vital signs are recorded and if any data points raise concerns next actions can be taken without undue delay.

Written by Paul Timms

The Internet of Things (IoT) has a number of potential benefits for the healthcare sector, with the possibility to improve patient experience, free up valuable staff time and provide the ever-increasing range of services in a more timely, more effective way.

Practically speaking, IoT is where devices and sensors are used to link the physical world with the Internet, turning data into insights, and aid the automation of key processes. Ultimately it can be a tool to make processes quicker and more efficient, leading to improved patient care and experience.

budgets, while freeing up scare resources.

To enable a transformation of this scale and to reap the rewards available under the banner IOT it is essential that all medical devices are integrated into a shared system.

This is no easy task given the breadth of devices being delivered, but healthcare businesses are responding to the challenge by ensuring their systems are capable of being fully connected and integrated.

Technology

Leveraging IoT to improve the patient experience

Beyond inventory control IoT is often thought of in terms of monitoring where things are, and in what levels they exist – such as what quantity of a certain drug, or piece of medical equipment is in stock, and where it might be found. This allows for time management of stock to ensure stock is available to meet patient needs, however this is to think in silo terms and underestimates the value IoT can bring.

Our modern hospitals are huge organisations, Smart buildings so even small steps can make a massive Increasingly we are seeing healthcare difference. We’re seeing certain organisations organisations adopting IoT by making taking this a step further, replicating the their physical spaces smarter and more approach taken with equipment to track integrated. This means looking at all the patients. Real time location systems, for healthcare systems in operation and example, can be used to scan patients developing a strategic plan to marry up in to a hospital, and then and record the various systems with contingencies to where they are for more efficient and allow for new approaches and plans. ultimately more effective patient care.

The potential for change with the This approach might be used when a patient introduction of smart hospitals and local checks in for day surgery, allowing their family health practices is huge. As well as specific to know at what stage they are in their IoT enabled devices that play a role treatment and when they will be in patient care, like adaptive ready to go home – freeing heating and lighting in up time for key non-clinical rooms depending on Concer tasks like updating the their use, organisations remain ns a patient’s family on what are also able to r o u t h n e secur d has happened and monitor equipment i and ow ty, privacy the ongoing plans for whereabouts and data, e nership of the patient’s care. usage to ensure speciall optimum performance y given its pers Transforming and best use of patient experience sensitiv onal and e natur IoT presents the e healthcare sector with an enormous number of benefits. However, concerns remain around the security, privacy and ownership of data, especially given its personal and sensitive nature. Another major challenge concerns the legacy issues of offline data, and how to digitise this to integrate with IoT processes. The NHS and private medical businesses face an ongoing period of digital transformation as they continue to navigate these issues, however when it comes to improving the patient experience in healthcare, IoT may be just what the doctor ordered! L FURTHER INFORMATION www.mcsa.co.uk

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With the huge financial and logistical The adoption of apps issues continuing to impact the NHS, it is Whilst in the UK we are at an early stage a remarkable testament to the dedication of delivery and use of mobile apps in and professionalism of healthcare mainstream healthcare we are starting to staff that they continue to provide the see a growing momentum. Encouragingly best possible service to patients. it is not just the demand from staff and Ensuring that a patient’s stay in hospital is patients that is driving this growth, but as comfortable and brief as possible is one is also backed from the top. The NHS of the key elements of the healthcare staff’s Digital Mandate has ensured that digital role. As we enter the winter months we are technology is a central element to the likely to see a huge increase in numbers improvement of patient care and experience. of patients entering the healthcare system Alongside this, an element crucial for the placing further pressures on the NHS. use of mobile applications is Wi-Fi. By 2019 As in other areas of life there is the government has committed an increasing expectation and to ensuring that there is free demand from public and staff Wi-Fi available for both By 201 in hospitals for effective staff and patients across 9 the gov digital solutions, both all NHS estates. to make the patient’s However, as with all has com ernment stay in hospital more things connected m i t t ed to ensurin comfortable and with healthcare it is is free Wg that there homely so they feel crucial that there is i F less shut off from their a thorough process i a v ailable for bot normal life whilst being before any apps are h s t aff patient an inpatient, as well adopted. There are a s acrossand as helping staff to do number of regulations a N ll HS esta their job more efficiently. in place but the points tes We are beginning to laid down in Public see exactly how technology Health England’s Criteria can take some of the strain for health app assessment give away from both staff and patients, an impression of the types of areas removing the complexity of the patient the government predicts where apps care process. Point of care solutions have can and will be used across the NHS. begun to allow healthcare professionals to As well as the fairly obvious key make a real difference in providing a better areas such as security, privacy quality of care. Everything from patient and confidentiality and clinical documentation, improved workflows, and safety, the government has better communication all come together also included elements through mobile applications enabling a better such as interoperability. flow of information throughout the hospital.

The need for Healthcare professionals are the ultimate apps to mobile workforce after all. They have no set desk space and are constantly on their feet.

Giving them the tools that can be used whilst on the move is a game changer for them. As a result, the global mobile health app market is expected to reach US$102.35 billion by 2023 – a huge market and one that is only going to continue to grow.

Written by Adam Stone

Is the healthcare sector ready for the advantages apps can bring? Adam Stone explains how mobile applications can play a part in a better hospital experience for all

share data seamlessly with other clinical systems and software, this is appropriate for apps ranging in use from writing clinical information for GPs to allowing patients to access their own records.

So, it seems much of the processes and demand needed for a wide-ranging adoption of mobile applications are in place.

Whilst we have seen some implementation it continues on the whole to be a slow process. Much of this frustration is down to the procurement processes in place and the continued domination of large, slow moving vendors that have an oligopoly in the market. Many of the most innovative and useful apps come from smaller, more agile companies that can provide the latest technology alongside a more cost-effective pricing model. As we see the NHS change focus from more traditional IT solutions to the latest mobile applications there needs to be a rethink of the procurement processes and how the NHS interacts with smaller tech providers.

There is no doubt that mobile applications are going to play in the future of healthcare.

They offer a real advantage to staff and patients alike. We have seen that there are regulatory guidelines in place and some implementation of apps already. For a wider adoption of apps though there has to be a rethink of how the sector handles its procurement processes and interacts with smaller more innovative companies. L

Technology

Mobile apps and the future of patient care

FURTHER INFORMATION https://rokk.co.uk

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Technology

The Future of Healthcare - where do we go next?

Matt Hancock has promised that outdated and obstructive NHS IT systems will become a thing of the past. Here, we examine the Health Secretary’s plans and what he has achieved so far When Matt Hancock replaced Jeremy Hunt as Health Secretary, following Boris Johnson’s resignation as Foreign Secretary, he made it very clear that advancing technology within the NHS would be his main priority. With Hunt having just secured an extra £20 billion a year by 2023, as part of Prime Minister Theresa May’s 70th anniversary present, he was almost given a clear slate with which to emphasis the importance of digital progression and to create a much needed level playing field for trusts and NHS organisations across the country. In his first speech after becoming Health Secretary, Hancock said that £487 million is to be spent on technology for the NHS, giving more patients access to health services at home.

As Culture Secretary Hancock launched his own smartphone app to better ‘connect’ with his constituents. Upon his appointment at the Department for Health and Social Care, we wrote that 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. Five months later, as the health

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system prepares for the latest wave of winter pressures and predictions are made for 2019, it seems appropriate to assess what has been established, what has been promised and what else should be targeted by the West Suffolk MP. Axe the fax In October, the Health Secretary launched his Future of Healthcare, promising that outdated and obstructive NHS IT systems will become a thing of the past. The pledge included introducing minimum technical standards that digital services and IT systems in the NHS will have to meet and promising that the old NHS IT systems that many organisations relied upon will be phased out. Speaking at the GovTech Summit in Paris in November, Hancock again targeted ‘outdated’ systems by responding to a question on how he would measure success of innovation by saying:

“When I am no longer the world’s largest owner of fax machines.”

The Royal College of Surgeons revealed earlier this year that nearly 9,000 fax machines were in use across the NHS in England, the largest anywhere in the world. True to his word, Hancock has since banned the NHS from buying fax machines and has ordered a complete phase-out of the technology

by April 2020. As such, NHS trusts will be required to invest in new technology to replace outdated systems until they are able to declare themselves ‘fax free’. The decision has been predominantly well received, with Richard Corbridge, Chief Digital and Information Officer at Leeds Teaching Hospital, noticeably saying that ridding the service of fax machines will empower staff and deliver integrated care.

Leeds Teaching Hospital NHS Trust is the first trust to publicly launch an ‘Axe the Fax’ campaign to identify all fax machines within the hospital estate and remove 95 per cent of the machines by 1 January 2019.

Owning 340 fax machines, Leeds Teaching Hospital is using Managed Print Service (MPS) devices and in the period between April and August 2018, 47,905 were sent electronically rather than via fax machine.

At the end of September, the trust launched a campaign to identify all machines within the hospitals, their location, phone numbers and what they are being used for before looking at how they can be replaced with more innovative and cost-effective processes.

However, as the Royal College of GPs pointed out, while a wholesale switchover to electronic communication seems like a brilliant idea, such a transition requires significant funding to ensure that reliability is maintained and communication between GP surgeries and their local hospitals is not disrupted.

Other successes that have been evident in the first period of Hancock’s

Han has ban cock NHS fro ned the fax mac m buying orderedhines and has phase-oa complete techno ut of the lo April 20gy by 20

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS | www.healthbusinessuk.net

Technology

tenure include the 100,000 Genomes Project having sequenced 100,000 whole genomes from NHS patients. Although launched at the start of his predecessors incumbency, Hancock has continued the ambitions of the project, setting his sights on sequencing five million genomes in the UK over the next five years, aided by the launch of the NHS Genomic Medicine Service. This will see all seriously ill children and adults with certain rare diseases or cancers offered whole genome sequencing as part of their care from 2019.

Matt ‘the app’ Hancock Hancock claims to be the first MP to launch his own smartphone app this year. The app features picture galleries and videos of the West Suffolk MP and updates on his activities for his constituents. However, Big Brother Watch argued that privacy was compromised after it was found to collect users’ photographs, friend details, check-ins, and contact information. The idea behind the then Culture Secretary running his own app was that it was more beneficial than using social media because it allowed full editorial control, user privacy and community moderation.

Speaking to BBC’s Newsbeat, Hancock has said that there needs to be more use of apps in the NHS as he follows his ‘passion’ of digital innovation. He admitted that there is still a lot to do in developing apps, but said embracing the technology needs to be pursued to make the NHS more convenient for patients and staff alike. Speaking at the NHS Expo in Manchester, Hancock said that the new NHS app will be piloted in Liverpool, Hastings, Bristol, Staffordshire and South Worcestershire, before national roll-out this month. Patients in the five regions will be able to use the app to book GP appointments, order repeat prescriptions, access their medical record, amend data sharing and organ donation preferences, and gain 111 online access for urgent medical queries.

But while his aims for better use of apps is welcome, it has not been without controversy.

Babylon Healthcare has regularly been in the press over the last few years. Last year, a 24-hour service was piloted in west London offering GP consultations via video link on smartphones. Using GP at Hand, patients in Fulham were able to check their symptoms through the app and then have video consultations within two hours of booking. However, this year the Advertising Standards Authority ruled that the GP at Hand advert promising NHS doctor appointments in ‘minutes’ was misleading.

GP at Hand has been publicly and frequently backed by Matt Hancock, who claims to use the service, and has recently supported the service despite fears in the NHS that its expansion will destabilise traditional GP services. Among others, the Labour Party called for an inquiry last month after Hancock praised the tech company in paid-for newspaper articles. Not only was Hancock’s relationship with George Osbourne questioned, with the former Chancellor now editor of the Evening Standard, but he also faced accusations of breaking the ministerial code. Shadow Health Secretary Justin Madders wrote to the Prime Minister accusing Hancock of repeatedly

Having achieved 100,000 whole genomes from NHS patients, Hancock has set his sights on sequencing five million genomes in the UK over the next five years, aided by the NHS Genomic Medicine Service endorsing the products of a company that receives NHS funds for every patient it treats.

Manifesto for Matt At the end of November, techUK launched its ‘Manifesto for Matt’ – a report highlighting priorities for digitising the health and social care sector, aimed at Hancock. It sets out priorities for fast-tracking the long overdue digitisation of health and care, focusing on three main areas: empowering the public; enabling a world-class workforce; and making the UK the destination of choice for health tech innovators. In part it was in reaction to Hancock sharing his three early priorities for being Health Secretary after his appointment: workforce, technology; and prevention.

Looking at promoting public-powered prevention, techUK stresses that to make person-centred care a reality, the NHS needs to make it easier for citizens to access their health and care data and play a greater role in publicising how they can do so, also touching upon the role of the NHS App in acting as a springboard for better access to digital health tools.

Concerning workforce, the paper said that NHS trusts need to be benchmarked and supported to implement what staff see as the digital basics, including fast and secure single sign-on, reliable Wi-Fi, secure peer-to-peer communication tools and sufficient handheld devices to allow contemporaneous work. Furthermore, digital leaders should be represented on the board of trusts to enable an understanding

and ownership of digital transformation at the highest levels. This appears to be an ambition shared by Hancock who has overseen the first meeting of the Healthtech Advisory board, which will advise him on his technology vision for health and social care. techUK also suggested that NHS Digital should work collaboratively with the Academic Health Science Networks to provide a local ‘one stop shop’ where innovators can simply, safely and securely access health and care data. Much of this will rely upon the success of initiatives like the #NHS70Innovations campaign, led by NHS Digital and the AHSN Network, which shined a spotlight on some of the latest healthcare solutions and technologies making a positive difference to NHS organisations, staff and patients.

Perhaps in part to the funding boost made just before his appointment, the first five months of Hancock’s holding office at the Department of Health and Social Care have been without too much criticism or controversy. There have been no junior doctor strikes, no closures and no NHS weekend cover issues. However, there have been some ambitious aims and, if the period between July and December is a sign of what may come in 2019, digital should remain high on the agenda and we can expect to see more efficient systems of working being implemented across the NHS. L FURTHER INFORMATION www.techuk.org

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Digitising the NHS – streamlined data, reducing medical errors and safer care Embrace Digital highlights the benefits of paperless technology to streamline file processing and data handling

As the NHS celebrates its 70th birthday this year, we thought it would be the perfect mile marker to look back and see how the NHS’s vision to become paperless is progressing.

In 2013, the then health secretary Jeremy Hunt stated that ‘the NHS cannot be the last man standing as the rest of the economy embraces the technology revolution’ and set out a plan for the NHS to be fully digital by 2018. Now that date has all but passed and the new deadline of 2020 is looming.

One of the major focus areas of this mammoth digitisation project is the conversion of paper patient files to electronic notes allowing secure sharing of information with patients and clinicians. As a result, the vision is to help doctors more effectively diagnose patients, reduce medical errors, and provide safer care, not to mention better use of expensive NHS real estate and redeployment of records management staff to assist an already stretched labour force. With these clear tangible benefits, it’s surprising to see that a lot of trusts are still yet to commit to digitisation. Perhaps a combination of positive tales from digital exemplars versus negative disaster stories from failed projects make it difficult to see how and where to start the digitisation of patient notes.

Complex logistics In theory, this is one of the simplest projects for an IT project team to pick up but with huge volumes requiring capturing in a time critical

manner, a massive peak at the very start of the project, ongoing complex logistics, significant increase in administrative staff, processing rules and compliance it soon becomes a much larger and complex challenge. Add in to the equation additional real estate and procurement of technology to deliver the project and you can start to understand where the nervousness to commit is coming from.

Previous approaches Looking at previous projects and the differing approaches, many different methodologies have been used with the NHS. A common approach has been to look to ‘fully outsource’ the scanning of patient records. This allows the risk to sit with the service provider but comes at a price. In addition to the cost model, there is also a level of loss of control as a trust has to allow one of its most important assets to go off site to an external party.

Another common approach is to take on the scanning ‘in-house’. Here the risk sits firmly with the trust and many have attempted this approach without understanding the sheer scale of the ‘production line’ involved in capturing the number of records required in the early stages of such projects.

trust from a potentially huge investment in scanning hardware, software, recruitment, training and infrastructure that will become obsolete within the first year. The internal records management team can then take over the longer-term ‘thin file’ processing that may continue for several years. This both avoids a large short-term influx of staff and also assists with job security for the current records management staff. The onus is then on the outsource provider to re-use the infrastructure for another client, hence no one trust has to bear the cost of the infrastructure that they required for only a short time period.

At the start of investigating a trust’s path into a paperless environment, it is key to work with a provider who can be flexible and also seek guidance from others who have already undergone this journey.

A final thought…If you walked into your bank to ask for a loan (presuming for a second you don’t have a phone application and your branch wasn’t long since closed) and the bank clerk walked into the back office, retrieved a paper based file and started to asses this file to ascertain if your request could be approved, would you be impressed?

The reason the NHS gets away with working in this historic manner in many cases is simple - because it’s so good at how it copes with the demands and limited resources it has to deal with and is the pride of the nation.

Surely though, it can only improve with more digitisation helping to make the task easier and the process more efficient? L FURTHER INFORMATION www.embrace-digital.co.uk

External outsourcing An approach that has been successful is a hybrid of the above approaches whereby an external outsource company takes on the initial peak of the project. This saves a

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Cyber threats top ECRI Institute’s 2019 Health Technology Hazards ECRI Institute, one of the leading patient safety and medical technology research organizations, places health technology cybersecurity at the top of its just-released 2019 Top 10 Health Technology Hazards. This was also the case for ECRI’s 2018’s list, demonstrating the ongoing significance of cybersecurity as an issue Vulnerable networks Attackers take advantage of unmaintained and vulnerable remote access systems to infiltrate an organization’s network. Once they gain access – whether through medical or nonmedical assets – attackers can move to other connected devices or systems, installing ransomware or other malware, stealing data or rendering it unusable, hijacking computing resources for other purposes such as to generate cryptocurrency.

ECRI Institute report ECRI Institute is providing an abridged version of its 2019 Top 10 list of health technology hazards as a free public service to inform healthcare facilities about important safety issues involving the use of medical devices and systems. The new report identifies safety issues and action steps for 10 dangerous and preventable hazards The report highlights the potential for hackers to exploit remote access systems to gain unauthorized entry to a healthcare organization’s networked devices and systems. Such attacks can disrupt healthcare operations, hindering the delivery of care and putting patients at risk.

Cybersecurity Cybersecurity is clearly a growing concern. ECRI Institute published 50 cybersecurity‑related alerts and problem reports in the last 18 months alone, a significant increase over the prior period.

Cybersecurity attacks that infiltrate a network by exploiting remote access functionality on connected devices and systems can render them inoperative, degrade their performance, or expose or compromise the data they hold, all of which can severely hinder the delivery of patient care and put patients at risk.

Remote access systems Remote access systems are a common target because they are, by nature, publicly accessible. Intended to meet legitimate business needs, such as allowing off‑site clinicians to access clinical data or vendors to troubleshoot systems installed at the facility, remote access systems can be exploited for illegitimate purposes.

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Safeguarding Safeguarding assets requires identifying, protecting and monitoring all remote access points as well as adhering to recommended cybersecurity practices such as instituting a strong password policy, maintaining and patching systems and logging system access.

Ransomware attacks and prevention Ransomware and other types of malicious software programs (malware) can disrupt healthcare delivery operations, hindering the delivery of care and putting patients at risk.

These programs infiltrate a network, propagate through connected devices and systems and encrypt data, disabling user access, software and IT assets. Multiple variants of ransomware and other malware have infected healthcare facilities and other organizations throughout the world. In a healthcare environment, a malware attack can significantly impact care delivery by rendering health IT systems unusable by preventing access to patient data and records and by affecting the functionality of networked medical devices. Further, such attacks can disable third‑party services, disrupt the supply chain for drugs and supplies, and affect building and infrastructure systems.

Such disruptions can lead to cancelled procedures and altered workflows (e.g. reverting to paper records). They can also damage equipment and systems, expose sensitive data and force closures of entire care units. Ultimately, they can compromise or delay patient care leading to patient harm. Safeguarding against malware attacks requires a proactive approach involving senior management, clinical engineering, IT and other individuals throughout the organization.

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS | www.healthbusinessuk.net

The 2019 Top 10 Health Technology Hazards executive brief is available for complimentary download at www.ecri.org.uk/resource-category/ articles/ or www.ecri.org/2​019hazards.

Also available for free download is ECRI’s article: Ransomware Attacks: How to Protect Your Medical Device Systems ECRI Institute ECRI Institute’s engineers, scientists, clinicians, and other patient safety analysts select topics based on insights gained during incident investigations, medical device testing, and reviews of problem reporting databases. They weigh factors such as the severity, frequency, breadth, insidiousness, and profile of the hazards.

The annual list defines the top health technology hazards that ECRI Institute believes warrant priority attention by healthcare leaders. It serves as a starting point for discussions, helping healthcare organizations plan and prioritize their patient safety efforts.

The annual report includes practical solutions that can help prevent patient harm.

Other topics on the list include contaminated mattresses, retained surgical sponges, improperly set alarms on ventilators and physiologic monitors, recontaminated endoscopes, infusion pump errors, mechanical failures with overhead patient lifts, damage to electrical equipment from cleaning fluids, and battery charging errors.

For more information on questions such as what do cyberattackers want? Where are the vulnerabilities? Where to begin?

And how to protect your hospital with a cybersecurity gap-analysis? Please contact the ECRI Institute and also download your free copy of the 2019 Top 10 Healthcare Technology Hazards executive brief. L FURTHER INFORMATION www.ecri.org.uk/resourcecategory/articles

Cyber security Written by Shalen Sehgal, managing director, Crises Control

Preparing to handle the next WannaCry type incident Shalen Sehgal explains how healthcare providers can prepare to handle the next WannaCry type incident, the GDPR implications and what steps can be taken to mitigate business disruption events The WannaCry attack which took place in Although there was no evidence that any May 2017 was a global event, hitting 150 NHS trust paid a ransom to the creators of the countries worldwide. But it was a particularly virus, and NHS England claims that no patient significant event for UK healthcare providers, data was stolen, the total financial cost of the with more than a third of NHS trusts in incident is unknown. The hit to reputation and England disrupted by the ransomware virus the disruption to normal business was certainly which encrypted data on infected computers significant and the cost is likely to have run and demanded a ransom to release it. into several millions of pounds across the NHS. According to a National Audit Office (NAO) In its response to the NAO, the NHS has report into the NHS handling of the event, already accepted that there are lessons to learn almost 7,000 patient appointments were from WannaCry and it has promised to develop cancelled because of the attack, which a response plan. The NHS will was entirely preventable. The NAO now ensure that critical cyber found that NHS trusts had not security updates, such as T he NHS acted on critical alerts from applying security patches, has alre NHS Digital and a warning are implemented a dy accepte from the Department promptly by IT staff. of Health and the And it is probably are less d that there o n Cabinet Office in 2014 reasonable to s t o from W to patch or migrate assume that the NHS annaCr learn y and it has p away from vulnerable defences against romised older software. An this type of low-level t o develop assessment of 88 trusts attack will be much

by NHS Digital before more robust than respons a e the attack found that they were previously. plan none passed the required But the problem cyber security standards. going forward is twofold.

The first is that the NHS and its associated agencies comprise such a vast and disparate network, including thousands of hospitals, GP surgeries, dental practices and care homes, that rolling out administrative directives from the centre is always going to be almost impossible to police effectively.

The second is that the threat from cyber attack is a constantly evolving one and if a relatively low-level attack such as WannaCry could get through so easily, then more sophisticated attacks will pose an even greater risk. When well-funded commercial organisations like banks and telecoms companies fall to the cyber hackers then underfunded organisations in the public sector, over reliant on legacy IT systems, will remain at significant risk whatever steps they take. The only safe working assumption is that at some point your network is very likely to suffer a breach. This might be large or small but it will take place.

Sir Amyas Morse, NAO comptroller and auditor-general, said: “WannaCry was a relatively unsophisticated attack and could have been prevented by the NHS following basic IT security best practice. There are more sophisticated cyber threats out there than E Volume 18.6 | HEALTH BUSINESS MAGAZINE

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What steps can be taken to mitigate business disruption events?

There are several steps that every organisation can take to prepare themselves for the kind of unexpected disruption that

the WannaCry virus caused within the NHS. This way you can be ready for the event, even if you don’t know what it is going to be or when it is going to strike.

Make sure that you have a business continuity (BC) plan which is fit for purpose: The health care sector is ahead of many other industries in having BC plans in place across the board, because of the demands of the regulatory authorities.

This does means that the process is in danger of becoming something of a tick box exercise. Make sure that your plan is fit for use when an event strikes by creating a series of shorter action plans to fit each of your major threat scenarios. This will make it much more likely than it will be useful in real time when disaster strikes.

Make sure that your BC plan, and action plans, will be available to you under all circumstances: Having a well written plan in place is absolutely no use to you if you cannot access it in an emergency because your IT servers have been taken out by the flood, fire or power failure. This is easily achieved by making sure that your plan is remotely hosted in the cloud on secure servers and can be accessed from anywhere on mobile devices.

Review your risk register to make sure that it covers all your possible threats: Many risk registers are based entirely on

past experience and cover only events that have already happened to an organisation.

This is likely to leave you vulnerable to more unpredictable events. In addition to power outages, severe weather and pandemic, you should also consider the impact of a more unpredictable event such as a fire or a security incident.

Cyber security

 WannaCry, so the Department and the NHS need to get their act together to ensure the NHS is better protected against future attacks.”

Given the highly sensitive nature of personal data held by health care providers, and the additional reporting requirements imposed by the GDPR in the event of a data breach since May 2018, then every health care agency must now raise their game in this crucial area and put in place incident response plans. A notifiable breach must be reported to the Information Commissioners Office within 72 hours of the organisation becoming aware of it. If the breach is sufficiently serious to warrant notification to the public, the organisation responsible must do so without undue delay.

Of course, cyber attacks are only one of a range of business disruption incidents to which health care providers are vulnerable.

In fact, you might be surprised to learn that even though cyber attack is the top-rated risk for health and social care providers, it does not feature in the top three of actual events. According to the Business Continuity Institute Horizon Scan 2018, the top three actual business disruption events in the health and social care sector are unplanned IT and telecoms outages, adverse weather and interruption to utility supply.

Consider the benefits of a cloud based multi-channel communications platform: An emergency communications platform is essential to successful incident management, but it is only useful if it is always available. This means that it needs to be cloud hosted. In addition, having a multi-channel system, with phone, e-mail, SMS and push notifications, means that stakeholders can choose which channels they prefer to use, and the message is guaranteed to get through to them somehow.

Make sure that you have a testing and exercising programme in place: This should include a mixture of virtual, desktop and live tests and exercises. Having such a programme in place is standard BC good practice, is an emergency planning requirement for many NHS agencies, and greatly increases the chances of an effective incident response. L FURTHER INFORMATION www.crises-control.com/healthcare

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Leading from the front and delivering strategy with teams who know how to succeed ‘Learning and innovation go hand in hand. The arrogance of success is to think that what you did yesterday will be sufficient for tomorrow’. William Pollard Discidium believes that businesses need to create space for their greatest asset, their people, in order to flourish and grow to high levels of efficiency and effectiveness by working together as part of a collaborative team.

Good leaders champion diversity, learning and capability development to build potential and create a safe space in which innovation can flourish. Your business cannot stand still, it has to evolve and adapt to an ever-changing climate driven by customer expectations or regulation.

To manage changes in a controlled, sustainable way, and to keep staff engaged, a business must have a clear vision and strategy. It must understand the difference between operational effectiveness and business transformation. Discidium can help you define your vision, values, strategy and objectives and help you map out the journey. Importantly, we will then

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roll up our sleeves and help you deliver it in a practical way with Structure & Rigour and Focus & Pace to deliver real results rapidly.

For you, our client, the story is simple.

If you work with Discidium we will help enable your people to meet future challenges, developing individual team knowledge, skills and experience, using a variety of methods for individual and organisational learning. We will drive measurable sustained improvement in effectiveness, efficiency, engagement or delivery and we will do so, without quibbles,

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS | www.healthbusinessuk.net

focusing on delivery not just advice.

Discidium can help you learn how to change and adapt and make it part of your business DNA. Discidium is a Crown Commercial Services Supplier on the Management Consulting Framework (MCF2).

FURTHER INFORMATION Tel: 01732 752030 information@discidium.co.uk www.discidium.co.uk

Digital Health Rewired

Disruptive technologies to change healthcare How might digitisation release cash and bolster care integration? A former life sciences minister and several NHS chief executives are among those who will discuss this important question at a brand new industry-leading event Digital Health Rewired takes place on 25-26 March 2019 at London Olympia. Open to all those with an interest in healthcare digitisation – and free to attend for anyone working for an NHS commissioning or provider organisation – it will connect health leaders with the latest innovations.

Curated by Digital Health, the programme brings together leaders and experts from all areas of digital health. Delegates will see first-hand how technology can drive patient safety and offer efficiency savings, while at the same time bridge the gap between health and other public sector services.

Among those already confirmed to speak over the course of the two-day event are former life sciences minister George Freeman; national chief clinical information officer for health and care Simon Eccles; Babylon Health chief executive Ali Parsa; and clinician, journalist and bestselling author Ben Goldacre.

Leadership Summit on day one: addressing current challenges Day one of Rewired is specifically tailored to board-level NHS executives. The Digital Health Leadership Summit brings together C-suite executives to address the leadership challenges of digital transformation. Attendees will include chief executives and directors of finance from both commissioners and providers, as well as chief information officers (CIOs) and chief clinical information officers (CCIOs).

Among those due to address the Summit are former life sciences minister George Freeman. He will share his unique perspective on the recent past and present of digital health, as well as on its post-Brexit future.

He is joined by Simon Eccles, who will share key insights from his first year as national CCIO for health and care in England.

Rewired Expo on day two: trailblazers and new tech For those in search of inspiration or guidance on the next chapter of the digital journey in health and care, there is the Digital Health Rewired Expo. The brand-new conference and exhibition will showcase some of the very best local and national work of digital trailblazers in health and care, with a particular focus on integration and interoperability.

Packed with with provocative keynote speakers at the cutting edge of the digital revolution, the Rewired Expo will demonstrate how to harness the full potential of digital to better integrate and deliver health services.

Already confirmed to speak is clinician, academic, author and journalist Dr Ben Goldacre. Chair of the national HealthTech Advisory Board, created by Health and Social Care Secretary Matt Hancock, Goldacre will give his view on the next steps for NHS digitisation.

A pioneer who is challenging traditional models of health in the UK and internationally with his

company’s innovative AI-powered digital health services will keynote the afternoon programme. Ali Parsa, the chief executive of Babylon Health, will share his thoughts on how digital is now creating radical disruption and detail Babylon’s aim to make digital health services available to all.

Further groundbreaking speakers from local NHS providers, innovative start-ups and NHS England will feature across five dedicated zones and theatres – AI and Analytics; Clinical Software; Cloud and Mobile; Cyber Security; and Digital Imaging.

Each has a dedicated programme exploring benefits achieved and the lessons learned.

Hack Day: bigger and better at Rewired Building on the successful Hack Days run as part of the 2017 and 2018 Digital Health Summer Schools, the Rewired Hack Day will run across both days of the event. The diverse digital health community, including healthcare leaders, will come together to create prototype solutions, presenting their joint work and taking part in a community vote for the winning project.

While it is now widely accepted that SMEs are a rich source of ideas to meet today’s integrated care challenges, there are still limited opportunities to adopt new forward-thinking technology in the NHS – but the Digital Health Rewired Pitchfest changes the landscape.

Digital health innovators, inside and outside of the NHS, will now have the opportunity to pitch Delega their disruptive ideas and at Digit tes a prototypes to a judging panel l H e a lth Rewired made up of digital health experts and investors, and first-ha will see an audience packed with techno nd how logy ca members of the UK’s largest n drive patient NHS IT community – the s Digital Health Networks. offer efafety and ficie Applications are open savings ncy until 22 February 2019.

With its complementary but diverse elements, Digital Health Rewired represents a mustattend event for anyone interested in healthcare digitisation. L

FURTHER INFORMATION https://digitalhealthrewired.com

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Let’s speed up the transformation of NHS services At a time when demand is increasing, and budgets are under pressure, digital transformation can help NHS services get ahead.

But we need clear IT strategy if it is going to succeed

Over the last 70 years, the National Health Service (NHS) has transformed the wellbeing of the nation. It has eradicated diseases like polio and diphtheria while pioneering the world’s first liver, heart and lung transplants.

And it continues to innovate. Mechanical thrombectomy is improving stroke survival.

Bionic eyes are restoring vision. Surgeons can now transplant hands. But the NHS is also facing challenges to its financial sustainability and the quality of care it can provide.

Partly due to its own success, average life expectancy has risen by over 13 years since the NHS’s founding in 1948. Infant mortality rates have slashed, going from 34 per 1,000 live births in England and Wales, to 3.8. But a population boom and living longer has created new challenges for the health service. A 65-year-old costs over twice as much as the average 30-year-old. And by 2044, 16.5 million people will be over 65 – that’s three million more than today.

While budgets are being stretched, the public expect more from the NHS. They ask, ‘why can I only book GP appointments over the phone, and during set hours?’

‘Does it really take that long to get my test results?’ Used to always-on and instant service in the private sector, patients find the NHS’s slow processes frustrating.

It’s clear that NHS services needs to adapt.

As NHS England chairman, Sir Malcolm Grant, said: “We are at a tipping point of how we provide care.” And changes are being made, but they’re not happening fast enough. To succeed in the long term, Chris

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Hopson, chief executive of NHS Providers, says the organisation needs a clearer plan to deliver digital transformation.

Hopson has highlighted the need to move to integrated care systems, which is a crucial first step. But digital transformation could be revolutionary for the NHS. It could be the biggest shakeup for healthcare since doctors, nurses, pharmacists, opticians and dentists were first brought together under one umbrella.

Health services are holding back Almost seven out of ten NHS trusts plan to integrate their IT with other local health and care systems within the next two years.

While they know they will move to the new Health and Social Care Network (HSCN), few have a plan for managing this. 75 per cent of people believe that one of the top three benefits of HSCN is greater collaboration.

But under half are still at the ‘scoping’ stage and haven’t moved their plans forward.

The picture looks better for mobile. Twothirds of NHS trusts have a mobile strategy. 84 per cent expect mobile adoption to increase within the next two years. NHS executives also identify their main reason for going mobile is to empower frontline staff. But while ambitions are big, progress remains slow.

Part of the reason for this hold up, NHS executives have said, is that their focus was often on operational matters. They didn’t spend much time looking at new ways of working. Even though they acknowledged that this could boost operational efficiencies.

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Our research into broader local service transformation shows it reduces administration, makes it easier to access vital information, and improves community collaboration. In health and social care, it could mean seeing more patients or making critical decisions faster.

The only way this technological revolution is going to work is if you embrace the opportunities. Keep your eye on the long-term goals and commit to transformational change.

Because the technology is already here to help you achieve that vision. So why not use it?

Breeding a tech focused culture in the NHS Currently, IT managers are mostly spearheading digital transformation projects.

But to have a meaningful effect, your digital future should involve every level of health professional and the patients they care for.

Organisations must consider the people, culture and process elements of a successful strategy. They must make sure appropriate training, knowledge and processes are in place. What is it that they want to achieve, or need to do differently? How could new digital initiatives, including more flexible and intelligent connectivity, make it easier for them to work more efficiently?

Rather than developing in isolation, a successful transformation strategy embraces the cultural aspects of the NHS. It’s also adopted by every member of staff, including those working on the frontlines. This will unlock the powerful potential of empowering the NHS. Better connections improve everything If you don’t know where to start, look at the quality of your networks. Make sure that you have broadband that’s robust – able to cope with hundreds of people using it, without a drop in speed. And mobile networks must offer reliable coverage, wherever you go.

Running a fragmented system, made up of islands of technology, applications that are inaccessible or slow, connectivity that is expensive and can’t always keep up with the spiralling demand for bandwidth, is also inefficient. Running a singular, shared system streamlines processes, giving you greater data insight and control. Better connections make it easier for everyone to be flexible, efficient and productive.

Embracing the cloud Compared to other services, the NHS’s take-up of the cloud has been slow. Part of the reason for this low adoption is that NHS executives place emphasis on capital budgets, and the need to get the most out of legacy systems.

But at a time when care is moving beyond the traditional settings of hospital and GP surgeries, this is short sighted. As NHS staff increasing work in the community – at drop-in centres, pharmacies and in people’s homes – the flexibility and collaboration cloud services offers can’t be ignored.

Cloud services allow anyone to access information wherever and whenever they need to. Allowing busy staff to check medical notes

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subjects are enjoying more reliable and responsive mobile internet, as well as augmented reality apps and services.

As well as will supercharging our existing mobility solutions, 5G will open new opportunities. Providing smart devices with added bandwidth, 5G could allow health teams to monitor patients at home, rather than in hospital. They could even administer medicine remotely.

Get a single, simple way to save on IT services with frameworks Before upgrading your infrastructure, consider boosting the power of your organisation by joining a framework. Simply put, frameworks are a public sector contract for buying products and services. They help eligible public organisations evaluate suppliers based on suitability, capabilities and value.

There are hundreds of frameworks across the country, helping organisations to buy anything from office supplies to cloud services.

For instance, by working with the London ICT Framework and UniCORN Partnership you could save up to 25 per cent. We provide support from these frameworks, so you’ll also get our best UK fixed and mobile networks, smart security and 24/7 support. and more on go, saves them having to return to the office. It also makes it easier to share info with others, so multi-disciplinary teams can offer a more joined-up patient experience.

Many worry also about how safe it is to store sensitive data like medical records in the cloud. But cloud services have security protection, which is automatically updated to address the latest threats. Last October’s WannaCry ransomware attack, which disrupted so many NHS appointments and operations, is a sobering reminder that internal systems are vulnerable to attack if they’re not maintained regularly.

5G will fuel the tech revolution The increase of phones, tablets, laptops and smart devices will put new strains on the system. Mobile data usage is set to rise by 50 per cent by 2020. Recognising 3G and 4G networks aren’t going to cut it for much longer, we’re already testing the solution: 5G. It can handle a higher volume of devices, transfer data faster and support larger file sizes.

Since October, five homes and five businesses in East London have been trialling our next-generation network. Aiming to achieve live speeds over 1Gbps, our test

Start your future now Health Secretary Matt Hancock recently said that ‘the biggest risk is not doing digital transformation’. So don’t wait any longer.

Empower your frontline staff. Improve your patient care. Maintain your financial stability. And reach your smarter digital future sooner rather than later. If you need help taking those steps, speak to us. We’re already working with NHS services just like yours. L FURTHER INFORMATION business.bt.com/public-sector/health

Empowering patients with smart sensors Connected medical devices are at the forefront of tech transforming the NHS. This mobility solution captures care information and shares it with patients and health professionals in real time.

This can take the form of wearable tech, such as the flash glucose monitor, most notably worn by Prime Minister Theresa May. Resembling a patch on her arm, this device is less demanding than carrying out regular finger-prick checks. It provides a constant stream of data to her smartphone, allowing Mrs May and other diabetics like her to track trends in their blood sugar and take action sooner. It empowers patients to better manage their condition while easing the burden on frontline services.

Similar devices can track blood pressure, sleep patterns, and even the taking of prescribed medicines. Working with the NHS, we recently identified individuals with undetected heart conditions using a smartphone attachment. It scanned patients with an ECG and provided real-time data to specialists.

Volume 18.6 | HEALTH BUSINESS MAGAZINE

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How can hospital buildings plan and build structures intended to slow or prevent the spread of fire, and will this promote a better fire safety culture in at-risk buildings? Using advice from the Fire Industry Association, we look at the current laws and legislation around fire safety

The £335 million Royal Liverpool Hospital was reportedly built with unsafe cladding that does not meet fire safety regulations.

Replacing the cladding not only incurs extra costs for the trust, but again raises the question of building protection after the Grenfell Tower fire which took 72 lives.

You would think that given the devastation in west London, with local authorities issued a list of instructions that must be taken if insulation within cladding ‘is unlikely to be compliant with the requirements’ of current building regulations, that the issue would be top of every organisations to-do list, especially given the large estates and multiple buildings that NHS trusts operate.

Hospitals can be very large and complex buildings. The main risks for fire in a hospital are the main risks of fire everywhere, but with hospitals there are more risks. There’s the risk of patients with limited mobility as well as all the flammable substances that most buildings do not contain, such as chemicals and oxygen supplies, and all the flammable materials within a pharmacy or an operating theatre. Even if one simply considers the sheer volume of curtains and bedding within a hospital, that presents a risk too, because naturally cloth is flammable.

Patient safety Of course, a great consideration is the patients themselves and the danger present to them in the event of a fire. Due to limited mobility, a plan should be drawn up for progressive

Fire safety

Exploring the current fire safety landscape

Additionally, hospital trolleys banging into manual call points (the button that activates the fire alarm) is one of the prime causes of false alarms in hospitals. Research sponsored by the FIA entitled ‘Investigations into the causes of false fire alarms’, highlighted that despite this problem being exceptionally common, it is something that can easily be remedied. The solution is to ask a specialist fire alarm company to install a special plastic cover to go over the call point, which should protect the it from getting banged or knocked by busy staff with trolleys.

Not only do false alarms cause time to be lost investigating the cause, they also cause distress to patients who may be worried that there is a real fire on the premises.

It is therefore recommended that alarms have a delay before sounding. During this time, a team should investigate the cause of the alarm – and confirm if the fire is real or false. If a fire is confirmed, the evacuation plan including progressive horizontal evacuation should be followed.

Fire safety laws Let’s take stock for one moment and sort out the mess of confusion that surrounds fire safety legislation and what it actually says. 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 Passive same thing. For the sake of fire pro accuracy and preventing horizontal evacuation, t e c tion is vital as any confusion, here is whereby each floor or the full list: Regulatory section of the hospital from tr it blocks fire a v e Reform (Fire Safety) acts as a different l l i n g from one com Order 2005 – applicable ‘compartment’ for p a area of rtmented in England and a fire. When the ah Wales; Fire (Scotland) fire approaches a to anot ospital Act 2005; Fire Safety nearby compartment, her (Scotland) Regulations staff and patients 2006; The Fire and Rescue should evacuate that Services (Northern Ireland) compartment, rather than Order 2006; and The Fire Safety evacuating everybody from Regulations (Northern Ireland) 2010. the whole building at once. This is why Fire safety legislation applies to all nonpassive fire protection, insulation from fire domestic properties such as businesses, shops, within the walls, doors, and windows, is schools, hospitals, church buildings, festival vital as it blocks fires from travelling from halls, and leisure centres, for example. But one compartmented area to another. it can also apply to housing associations, This is the reason that fire doors are such landlords, student halls of residence, and an important part of trying to contain the fire care homes. This is not an exhaustive list in the room behind the doors. Fire doors are but it gives an idea of the scale of the designed to help stop the spread of fire beyond need for everyone to understand, apply, the doors; it helps in the event of an evacuation and comply with fire safety regulations. situation to keep the fire contained within Each piece of legislation refers to either the designed ‘compartment’ of the building. a ‘duty holder’, ‘appropriate person’ or a However, in a hospital, fire doors are often ‘responsible person’ but they mean the same propped open or bashed into by hospital thing. This is the person who will be held liable trolleys. But this can be exceptionally if there are any failings in the fire safety of dangerous as it increases the risk of fires the building, and the person who ultimately spreading through the building. Keeping the makes the decisions about the requirements for doors closed keeps the fire safely behind the building. This could be the employer of a the door, allowing for a greater escape time. business, or a landlord, or the appropriate body Therefore, it is vital not to prop fire doors responsible for managing a house of multiple open with hospital trolleys or cause damage occupation (HMO). E to them as this reduces their effectiveness.

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Knowing when the legislation applies Knowing and understanding what fire safety legislation means for businesses and the

Fire safety

 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).

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 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

Due to limited mobility, a plan should be drawn up for progressive horizontal evacuation, whereby each floor or section of the hospital acts as a different ‘compartment’ for a fire

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.

It is important that the local authority adheres to the need to consult the enforcing authority before any changes are made.

The dangers of fire extinguishers Fire extinguishers play a very important role in first aid fire-fighting. They can mean the difference between a small localised incident that is quickly put out, or the fire and rescue service arriving to find a raging inferno which is putting life, property and environment at risk.

Hopefully there would never be the need to use a fire extinguisher, but if there was, you’d certainly want the extinguisher to work as E

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• 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

Volume 18.6 | HEALTH BUSINESS MAGAZINE

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Advertisment Feature

Fire resisting doors in healthcare premises: essential to fire safety but difficult to manage?

Ensuring the maintenance and standards of healthcare premises is imperative to patient safety. Fire Doors Complete Limited offers inspection, consultancy and training services

The greatest consideration regarding fire safety in healthcare premises is clearly patient safety.

In the event of a fire, progressive evacuation in stages to safe places is necessary in keeping patients away from the effects of fire and smoke. Therefore the buildings fire and smoke compartmentation is relied upon to restrict the spread of fire and smoke from one part of the building to another.

It is the walls, floors, ceilings and doors that compartmentalise the hospital buildings into a series of compartments to keep the fire in the room or compartment where it started thus maintaining safety for people elsewhere and allowing the fire and rescue service to reach the fire and deal with it.

The difficulty with fire doors is that although, just like the walls, they restrict fire and smoke spread they also have to function as doors in busy areas, opening and closing possibly thousands of times each day. Add to that the likelihood of damage from wheeled trollies and the sheer number of doors at the hospital, it is easy to see how managing maintenance to a standard where older doors will meet their required fire and smoke ratings can be so challenging for estates departments.

Fire door strategy At any large and complex building it will be necessary to have an efficient inspection and maintenance regime for fire doors.

None more so that at a hospital due to the inherent difficulties of evacuating patients.

Maintaining fire doors could be seen as something akin to the painting of the Forth Bridge so first it is necessary examine the fire strategy to see which fire doors are

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most critical in providing protection to enable safe progressive evacuation.

Having inspected thousands of doors, I have found that one common denominator is that estates departments are not always aware which fire doors are particularly necessary to safe evacuation. Maintaining fire doors can be a drain on resources so it is vital that the efficient working order of the fire doors lines up with the fire evacuation requirements. The fire doors that must protect escape routes and protect areas providing refuge from the fire are the most critical, the planned preventative maintenance regime must take account of that. In other words there should be a fire door hierarchy starting with doors critical to the escape and refuge strategy all the way down to doors that although marked with the blue signs may not when compared to the evacuation strategy be so necessary to safety. Dealing with fire safety is ‘risk-based’ so the fire risk assessment must identify escape strategy and therefore identify the compartmentation vital to safe evacuation.

Fire door maintenance The majority of fire doors are made from timber therefore repairs and maintenance can be carried out by competent carpenters and joiners. However, fire doors are different from ordinary doors especially regarding working tolerances, seals and door hardware so maintenance teams should be aware that work must be carried out in accordance with the relevant standards.

BS 8214: 2016 is the code of practice for timber based fire doors so installers and maintenance teams should adhere to such guidance along with other documents such as code of practices and guidance for hardware, seals and glazing.

Healthcare Technical Memoranda also provide guidance on specification and design to building components specific to healthcare, including doors in HTM58.

Estates departments should therefore ensure that repairs, maintenance and new door installation work complies with necessary standards.

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS | www.healthbusinessuk.net

Specifications for new doors Where a fire door must be replaced due to severe damage or as part of refurbishment works the opportunity arises to ensure new doors will meet the necessary durability requirements as well as the correct fire rating. There are many types of fire doors, impact protection products and hardware that can extend the life of fire doors so where doors are likely to be subject to heavy use, the specification must meet the demands of the door’s location.

It is worth consulting fire door specialists to ensure the doors are suitable for the intended application. In many instances, doors are too easily damaged and fail to provide sufficient resistance to heavy use, soon becoming unsightly and compromising fire and smoke protection.

Fire performance of the new door must be considered. There may be a requirement for large sized door leaves to provide access for specialist equipment or security hardware for sensitive areas. In those cases it is wise to consult fire door specialists otherwise fire certification can all to easily become void and fire performance jeopardised by incorrect specification, non-fire rated hardware and incorrect installation.

In summary Valuable resources can be better targeted by ensuring that maintenance addresses the fire doors most vital to fire safety at the buildings.

Update fire risk assessments to take account of changes of use to rooms at the building and to help identify the critical fire door locations.

Ensure the fire door maintenance teams or contractors are suitably qualified in terms of experience and training and that specifications for new doors take full account of durability requirements as well as the door’s fire rating and spread of cold smoke performance.

Neil Ashdown is managing director of Fire Doors Complete Limited, he provides fire door inspection, consultancy and training services. He holds certificated fire door inspector and fire stopping inspection qualifications. L FURTHER INFORMATION www.firedoorscomplete.com 07970201231

including any enactment repealed or revoked by this Order (RRO) are subject to a suitable system of maintenance and are maintained in an efficient state, in efficient working order and in good repair.” In Scotland and Northern Ireland other fire safety legislation applies, but the message is broadly the same: maintenance of fire protection equipment is paramount.

Due to the complex nature of the legislation, the Chief Fire Officers Association produced a guidance document for enforcing authorities.

Within this document, section 17 maintenance states that where equipment is ‘provided and installed to a British Standard; it is reasonable to expect that the standard be met by the responsible person in terms of maintenance and recording systems’.

Protection from risks An employee who has been instructed to check the gauge, or gauges on a fire extinguisher annually is not a competent person for the purposes of maintaining life safety equipment. The annual attendance of a professionally trained and competent fire extinguisher technician to inspect and maintain your equipment, will ensure each extinguisher is in good working order, ensuring you have the appropriate number and types of extinguishers to protect you from the risks present, and should you need the extinguisher it will work and keep you safe.

You also rely quite heavily on the organisation behind the technician. For your own protection, they should be third‑party assessed, carry the right liability

insurances, and provide the technician with tools, the correct spares and refills for your extinguishers. They should also be members of a recognised Trade Association (such as The Fire Industry Association) who alert their members to extinguisher‑manufacturer safety notices and recalls.

Third Party Certification means that an independent body has inspected the company and assessed them thoroughly. It is designed to give consumers peace of mind when selecting a fire protection company as those with Third Party Certification are more likely to have the demonstrable skills, knowledge, experience, and competence to do the necessary works in your premises and to provide you with recommendations should any changes be required (for example if you have had any recent building work or an extension to the building – this would likely affect your fire protection).

Third Party Certification is obtained on a company basis, not to individuals – so you can rest assured that once you a have selected a certified company, that the individual that arrives on site should be compliant with the relevant British Standards and legislation. However, the easiest and simplest way to check if a fire protection company has been certified is just to look for the Fire Industry Association logo on the company website. L

Fire safety

 expected. As such, there is a need for proper maintenance. For example, if the safety pin in the extinguisher has corroded, it will mean that the pin cannot be removed, rendering the fire extinguisher inoperable.

Annual checks by a competent fire extinguisher technician, who has the relevant training, qualifications, experience, tools, equipment, and access to refills and components, would identify and rectify this type of issue, cleaning and lubricating, or replacing the pin if necessary. When a fire extinguisher technician visits, each extinguisher is subject to a stringent 20point check before it can be signed off as safe to use. They will be able to identify any extinguisher which has reached end‑of‑life before you end up with an extinguisher that won’t work or, worse, becomes a danger to your or your employees.

When selecting a service provider to inspect and maintain your extinguishers it is essential to ensure the competence of the company and/or individual being employed to carry out inspection and maintenance, as not all service providers will be the level of competency you’d expect and hope for. This means that you could have extinguishers that may have been ‘serviced’ but may still not operate correctly.

In Article 17 of the Regulatory Reform (Fire Safety) Order (Maintenance section), which is the relevant fire safety legislation for England and Wales, it states: “Equipment and devices provided in respect of the premises under this Order or, subject to paragraph 6 (General Fire Precautions) under any other enactment,

FURTHER INFORMATION www.fia.uk.com

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Volume 18.6 | HEALTH BUSINESS MAGAZINE

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Hospitals face challenges in evacuation with compartmentation playing a crucial role. Checkmate Fire Solutions Limited have a wealth of experience facilitating the NHS with fire stopping solutions and compliance services

During the NHS’s 70-year history the UK’s hospitals and healthcare facilities have evolved and expanded, presenting estate managers with a unique set of fire safety challenges. Checkmate Fire is proud to have worked with many NHS trusts over the last 20 years, providing fire stopping solutions and compliance services to help them meet all their legal requirements and, more importantly, to protect patients, staff, expensive equipment and buildings. This work has enabled us to develop significant knowledge of the passive fire protection challenges faced by hospitals and expertise in minimising the disruption to services caused when working in live healthcare environments.

Our services for NHS trusts include: Fire doors and compartmentation Hospitals commonly face challenges in regards to evacuation, with patient needs often making immediate or total evacuation not appropriate or possible. Because of this, fire-resistant compartment lines and doors are critical aspects of the property’s fire protection strategy, restricting the spread of fire and smoke, and allowing time for the site’s progressive horizontal evacuation strategy to be implemented.

Compartmentation plays a crucial role in containing fire and is achieved by dividing the building into ‘fire compartments’ through the use of fire-resistant flooring, walls and cavity barriers within roof voids.

Having the right fire-rated doors is another essential part of this compartmentation.

Typically, the fire doors used in the NHS are designed to offer 30 minutes of protection – although doors that prevent fire spread for longer periods are available for locations

where evacuation may be a slower process.

Checkmate’s specialist teams can both specify and install the most suitable fire stopping and fire doors to achieve the required compartmentation in any new hospital building, or to bring an older property up to standard.

Third-party accreditation In theory, there are lots of contractors who can hang a door or plug gaps in walls, but whether their work will be of the standard required to achieve the compartmentation needed to prevent fire spreading is another matter.

Checkmate Fire’s installation, remediation and compliance inspection work is third‑party accredited to a standard trusted by the UK’s largest insurers. This gives all our NHS customers the confidence that not only do they meet the requirements of RRO and Building Regulations, but that they have the necessary protection in place to give them time to implement their progressive horizontal evacuation plan in the event of a fire.

Checkmate also have a long track record of the successful delivery of projects for NHS Trusts, including installations for new builds, remediation work identified in Fire Risk Assessments (FRA), surveys and ongoing fire door maintenance contracts. This experience has given our specialist surveyors and engineers an in-depth understanding of healthcare construction and how to minimise disruption to patients and staff while working in a live hospital environment.

Advertisment Feature

Delivering fire safety protection across UK’s hospitals effectively in the event of a blaze. As many of the hundreds of fire doors in a hospital are used on a daily basis, they are at risk of damage from trolleys, wheelchairs and people.

And damaged doors can mean drastically reduced periods of protection from fire, smoke and heat. To prevent this scenario, Checkmate Fire offer a professional, independent fire door survey service; carried out by our BRE/LPCB certified inspectors. We provide a full report on the fire doors on your premises and outline any restoration or replacement works that are required to ensure compliance.

Fire door restoration To ensure that your fire doors are fit for purpose, we also offer a full restoration and remediation service. Checkmate Fire are fully qualified and third party accredited to carry out repairs that will not compromise the fire separation properties of the door, using suitable fire rated components.

Once doors have been restored, we can then put into action an annual inspection and maintenance programme to ensure that all doors remain fully functional, fire compliant and legal – working either directly for the NHS Trust or through a contract with your facilities manager.

Checkmate Fire have extensive experience working in open environments and on sensitive wards and sites across multiple locations, keeping staff, patients and assets safe, while providing critical fire safety works.

Having worked in everything from small health centres to major multi-building hospital estates, our unrivalled knowledge of the healthcare sector enables us to effectively deliver our third party accredited passive fire protection services on time and within budget.

To find out about some of our past work for NHS properties across the UK, see our case studies at CheckmateFire.com, or to discuss your passive fire protection requirements, get in touch at 01422 376436 and our expert team will be happy to help. L FURTHER INFORMATION CheckmateFire.com info@checkmatefire.com

Fire door surveys Installing the right type of fire door is only part of the solution though, as they also need to be in the right condition to work

Volume 18.6 | HEALTH BUSINESS MAGAZINE

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Global Leader in Quality, Safety, Compliance and Data Solutions

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Let the professionals look after your water hygiene We provide microbacterial sampling in the South for Poole Hospital NHS Foundation Trust.

“Aquacare are a key partner in providing us with solutions to improving our water hygiene services at the Trust.”

Domestic Contract and Compliance Manager Poole Hospital NHS Foundation Trust

We’ve also had success in the South East, by achieving very high compliance in the water systems of QEQM hospital in Margate, via innovation and customisation of the electronic logbook system.

To find out how our business can help you, simply contact us.

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BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS | www.healthbusinessuk.net

0330 041 5566 info@aquacarewms.co.uk

www.aquacarewms.co.uk 22/11/2018 08:16:23

Estates Written by Claire Tew and John Wingfield-Hill, PA Consulting

How can we fix NHS estates?

Take the opportunity to ‘right-size’ your estate In an era of multispecialty providers and integrated care systems, commissioning will increasingly focus on population outcomes rather than inputs. This means a fundamental shift for provider estates and provider property will need ‘right-sizing’ to meet the need.

In turn this means being able to manage a How can the NHS modernise its estate to deliver world-class property portfolio strategically rather than care, while using tax payers’ funds efficiently? Claire Tew and deploying tactical service moves around John Wingfield-Hill explore the annual contracting cycle. Contracts are increasingly being let in this way around the The Naylor review set the tone for change But, the world is changing and country and we expect the estate and the government, nearly a year later, commissioners are now beginning to be a major focus within has pledged to invest in the NHS estate and to procure ‘multi-specialty’ new contracts being let.

Provide set the challenge to find creative ways in (MCP) and ‘integrated care With a recent survey of which to modernise it at the same time system’ (ICS) provider GPs showing that four must m rs a In July this year, each of England’s 44 contracts. These give more in every 10 feels that n a g e their es Sustainability and Transformation Partnerships power to providers to they are practicing in t a strateg (STPs) submitted five-year estates strategies deliver services based on premises that are not ically, dtes evelop to NHS Improvement – setting out for the population outcomes, adequate for patient building s b first time a comprehensive national picture integrate along care, there is certainly a s ed clinical of local estates priorities, covering primary pathways and release an opportunity to need, a on nd care through to specialist and ambulance economies of scope as consolidate services, move t o services. Breaking it down, the £2.6 billion well as scale. With this rationalise the estate digital a the pledged STP estates funding means around comes an opportunity to and improve what is left. ge £59 million contribution from the centre use new powers to be more per STP area over the next five years. creative in using the estate.

Minimise property Based on PA Consulting analysis of average MCP and ICS providers will be able overheads by utilising costs of NHS community schemes, this equates to turn around some of the misaligned buildings better to building around four new 2,000m2 health incentives in the NHS property market.

Our work shows that many community centres per STP area over a five-year period – There are three key steps for providers, buildings are only 60 per cent utilised in core clearly other sources of financing will still be who find themselves entering into new hours on average (which varies by type of required. Add to this a complex picture where single provider contracts in 2018, to take. room and time of day and can be as low as commissioners do not own their own buildings To use taxpayers’ funds efficiently, providers 30 per cent in some properties), when a target and providers are not incentivised or supported must manage their estates strategically, of 80 per cent utilisation should be achievable. to rationalise estates and the offer from develop buildings based on clinical In contrast, bed space in acute hospitals is government doesn’t look quite so compelling. need, and move to the digital age. often at least 95 per cent utilised, which E Volume 18.6 | HEALTH BUSINESS MAGAZINE

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Rinnai, specialists in the development of commercial and multi-point water heaters ‘walks in’ to help the NHS Rinnai hot water heating units have been installed in a series of five NHS ‘walk in’ centres in the North of England. The walk-in centres are part of a plan to modernise and improve NHS services, offering greater access, convenience and choice. Staffed

by NHS nurses and health professionals each centre provides healthcare advice, information and treatment to residents, shoppers, commuters and visitors.

After looking at different hot water delivery systems the Rinnai Infinity HDC1500 and HDC1200 internal continuous flow water heaters were specified and installed.

The Rinnai heavy duty condensing range uses two heat exchangers to capture residual heat from flue gases to pre-heat incoming water, with the HDC1200i offering 107 per cent net efficiency and the larger HDC1500i turning in 104.5 per cent net efficiency.

These figures point to considerable ongoing energy savings when compared with noncondensing continuous flow water heaters and alternative water heating systems.

Rinnai is the only manufacturer that can supply a complete range of condensing, LOW NOx water heaters. The Rinnai Infinity range also regulates water temperature to within +/- 1ºC via a ‘smart’ digital control

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system ensuring there is never any variation of temperature at the outlet even when water is drawn off elsewhere. The units have full electronic ignition, no pilot light and operate on demand only, so there is no gas consumption when the unit is idle.

The units are also easily configured in a manifold arrangement, ensuring there will never be a shortfall of instant hot

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS | www.healthbusinessuk.net

water whatever the demand. As long as electricity, water, and gas supplies are connected, hot water is available when the hot water taps are opened.

FURTHER INFORMATION Tel: 01928 531870 www.rinnaiuk.com

 makes it difficult to manage services effectively, but also summarises the opportunity for providers in creating a shift from acute to local care models.

NHS Property Services estimates that maintaining void space in its own estate alone costs more than £10 million per annum. Managing the cost base effectively will be crucial in a world where the risk on tight budgets is handed over to providers.

For shared community estates, commissioners are often in a difficult position: they hold the risk on utilisation (having to pay for property voids) but often lack the ability to fill sites as it is up to providers as to where services are located.

Integrated providers should now be able to release savings from managing services delivered over several sites, contributing to a more efficient NHS estate overall.

Go agile Building a property based on how many rooms a GP or nurse needs is no longer an option. The luxury of having a room per practitioner (which stays empty when there is no clinic or when the individual is not there) is no longer viable – there simply isn’t enough capital in the system. NHS property must go ‘agile’.

Around the country, public and private sector office-based workforces have been meeting via video or teleconference and hot-desking for years. District nursing hotdesking areas, smaller consultation rooms

for telephone or video appointments and self-check-in at a single reception desk – there are many ways in which community health centres can move into the digital age.

Recent PA work sizing community health centres (working closely with clinicians and estates professionals) found that phone appointments could be delivered for between 20-50 per cent of GP appointments, and the room used only needed to be half the size of a standard GP consultation room (following DH Health Building Notes guidelines). Some practices have reduced the proportion of face-to-face appointments from around 70 per cent to around 30 per cent by using technology. If this could be released as a cashable benefit, the savings could be considerable in a health centre where primary care activity may be between 40-50 per cent of the total footprint. Going back to a typical 2,000m2 health centre, that’s a not negligible benefit of up to £1 million to the NHS on a new-build (and could contribute to efficiency savings on an already operational site).

Providers adopting new models of care have an opportunity to seize Naylor and the government’s ‘call to action’ – because the taxpayer has too long lived with an NHS estate that is inefficient, under-utilised and has been slow to move to the digital age. L FURTHER INFORMATION

Estates

Breaking it down, the £2.6 billion pledged STP estates funding means around £59 million contribution from the centre per STP area over the next five years

Asbestos in nine out of 10 hospitals The BBC has found that nine out of 10 NHS trusts responding to an inquiry report that they have hospitals containing asbestos.

Having sent Freedom of Information requests to all 243 NHS trusts in Britain, receiving 211 responses, the findings indicate that 198 trusts run hospitals containing the material, once widely used in construction between the 1950s and 1970s.

Since then it has become clear that the presence of asbestos can be dangerous when inhaled and may give rise to asbestos-related diseases such as mesothelioma, which causes more than 5,000 deaths in the UK each year.

The BBC also discovered that 352 claims were made against trusts between January 2013 and December 2017 by people who had developed asbestosrelated diseases in NHS buildings, resulting in payouts totalling £6.8 million. However, three legal firms have told the BBC that they had won compensation claims totalling more than £16.4 million in the same period.

In light of the findings, Jo Stevens, chair of the All Party Parliamentary Group for Occupational Health and Safety, has urged the government to conduct an audit to ‘ensure every trust knows the extent of asbestos on their premises and has a plan for dealing with it’.

Mesothelioma UK is set to launch a research project into the impact on hospital workers.

www.paconsulting.com/healthcare

Volume 18.6 | HEALTH BUSINESS MAGAZINE

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Modular buildings

Modular buildings as the solution to providing better hospital facilities How do manufacturers and installers of volumetric offsite construction ensure sustainability and compliance when the key priority is time? Jackie Maginnis, CEO of the Modular and Portable Building Association, shows how the industry has been leading the way longer than you think Volumetric or modular has been successfully supplying education, health and commercial businesses with their much needed facilities without many end users realising that they are in this type of building, thus showing the standards and quality that are produced today for many years.

Not only do suppliers provide permanent buildings, they also supply much needed temporary facilities at a far greater speed than traditional construction with a quality to match.

Offsite construction has become a hot topic in the last few years, and sustainability has been the buzzword of the decade (other than fake news of course) but there is still an element of ‘catch all’ with both words. Offsite simply means built in the factory and transported to the final destination site where it will be assembled for final occupation. Built, and in most cases, fit out is completed in the factory where a high standard of quality can be achieved.

Manufacturers drive quality in the product through ISO9001 accreditation and BBA approvals, and its due to these high standards that when it comes to thermal bridging and

air permeability tests show that on average a factory built modular/volumetric buildings achieves better than traditional construction, good reason for hospitals to be built in this way. There are many examples of where exemplar quality increases carbon performance, leading to a more sustainable building – ticking all the boxes for the future.

It ta up to 6kes cent les 7 per produc s energy to buildinge a modular with a compared trad built pr itionallyoject

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Leading sustainably That brings us nicely to sustainability, where volumetric construction has long since led the charge. Back in 2006 as an association we introduced communities and local government to the embodied energy, particularly within the hire and refurbishment markets.

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When a modular building is constructed as an alternative to traditional methods to be a permanent building it is built to the same standards required for all construction, and with the added benefit that the built performance will match the as designed performance. The speed of manufacture and construction is so impressive it can even keep up with the demands of the modern designs and requirements of end users today.

It is important that procurement departments and buyers realise that modular buildings have the potential to be more cost-effective than conventionally built projects. Because the structures are made to the highest standards off-site, modular buildings can and are frequently installed causing minimal disruption to staff and the existing patients.

Still today there is a reluctance to not to make the industry sector the first port of call. In doing this it eliminates an expensive part of a project by not going through a third party.

Modular building companies specialise in providing a ‘complete service’ to hospitals and a variety of medical facilities from undertaking the initial design and carrying out all necessary groundwork to construction and final fit out.

Modular buildings

Standalone structures, single-storey ‘cluster’ departments, two-storey schemes or whole hospital configurations to name but a few of what can be provided by the industry. In addition to being fitted-out for wards, theatres, general offices, kitchen and dining purposes, the expertise also exists to design, create and subsequently install more ‘specialist’ accommodation required by the clients.

By placing a contract with a volumetric/modular building company they know that the date they are given for occupation is the date that they can use the building to admit patients.

Off-site manufacturing Modular buildings are built in controlled, energy-efficient environments.

From initial works to completion, it takes up to 67 per cent less energy to produce a modular building compared with a traditionally-built project.

Whilst initial, onsite ground works are being completed; modules – which make up a modular building – are manufactured offsite, in a controlled, factory environment.

Pre-fitted with electrics, plumbing, heating, doors, windows and internal finishes before they are taken to site, modular buildings can also be installed with energy-efficient systems such as PIR sensors, enhanced ‘U’ values and solar panels. Not only is the offsite manufacture greener, buildings are also designed to be energy-efficient for their entire life cycle, all within the NHS requirements.

Modular buildings now come with a range of external options to cater for nearly every look, including brickwork and tiled roofs to give a traditional appearance if that’s what’s required.

When you build offsite, you plan and construct with meticulous precision.

It takes strategic thinking and rigorous co-ordination, but modular construction allows for minimal disruption to staff and patients which is particularly key in the acute care environment. Offsite construction also allows for a 90 per cent reduction of the total number of deliveries to site as well as reducing up to 90 per cent of waste generated as the structure is recyclable.

Companies have been providing volumetric buildings for hospital facilities for many years and there are many examples of existing hospital today built by the industry and fully compliant with NHS requirements, as an association we would suggest that if there is any doubt to look at whatis already out there.

There are now volumetric/modular frameworks in place for the health sector which enables facilities to be supplied by companies that have been vetted and meet the requirements – using this will give buyers confidence in the knowledge that these companies can supply their needs. L FURTHER INFORMATION

Modular buildings now come with a range of external options to cater for nearly every look, including brickwork and tiled roofs to give a traditional appearance if that’s what’s required

Offering you a Modular solution to your building project Committed to be with you from conception to completion of your project Offering a full turnkey package with bespoke designs to your Modular Building project: • Design • Groundworks • Manufacture • Delivery and Installation

Over 30 year’s experience in the design and build of Modular and Portable buildings for various sectors

E: info@envirobsl.co.uk | T: 01422 647610

www.envirobuildingsolutionsltd.co.uk

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Volume 18.6 | HEALTH BUSINESS MAGAZINE

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Advertisment Feature

Understanding your customer – the ISS way ISS Healthcare are keen to be part of the modern NHS, delivering patient care and providing great services in a collaborative and coordinated way

When, in 1984, the Thatcher Government demanded that Public Services like the National Health Service were market tested a new company was formed to meet the challenge. Although founded by Michael Ashcroft, now Lord Ashcroft, the fledgling company was soon acquired by the Danish ISS group. Writing at the millennium the former CEO of ISS A/S, Waldemar Schmidt said that buying Mediclean was the best investment the company had made in the 20th Century. Instinctively Schmidt knew that this company, specifically created to operate within the NHS would grow successfully as the foundation of the entire business was based on hiring professionals directly from the service, who fundamentally understood the ethos of the business they were supporting.

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Some 35 years later those same traits are being demonstrated as ISS Healthcare are keen to play their part in the modern NHS. No two NHS Trusts are the same, most of them are designed to help the local community they serve, whilst others provide world class, cutting edge treatment. Each will have their own demands and a successful contractor needs to understand those differences and build their service offering around it. This empathy for the customers’ own needs has recently seen ISS Healthcare add another four new contracts to its already impressive portfolio.

Financial constraints Every NHS Trust across the country is under pressure to live within its financial constraints and whilst market testing has been around for

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decades it is estimated that some 60 percent of services are still operated by inhouse teams, many of whom have never been subjected to competitive scrutiny; so when a Trust takes that step for the first time, they have to be certain that it is for the right reasons.

Contract awards In a recent spate of contract awards, the first to sign up ISS was the Kent and Medway NHS and Social Care Partnership Trust (KMPT), one of the largest mental health trusts in England and provides mental health, learning disability, substance misuse and forensic services across the area of Kent and Medway to a population of 1.7 million people. The new service will cover locations in Canterbury, Dartford, Maidstone, Margate and Sittingbourne. This was a bold step by the Trust as they had not outsourced the services before. Their particular focus was on food, an essential part of the wellbeing of both patients and staff. All sites will move towards a consistent delivered meal service using the latest cook freeze technology, using menus that have been jointly developed and subject to review twice a year. Collaborative working at ward level will ensure that the service user experience is enhanced. Speaking at the time of the award, Chris Ash, managing director of ISS Healthcare said how pleased he was that the Trust had selected ISS as their first commercial partner. He added: “This exercise was particularly heart-warming as the trust has clearly embraced the thoughts and opinions of their stakeholders.”

This was confirmed by Teresa Barker, deputy director of nursing & practice, KMPT said, “KMPT set out to appoint a catering service partner that listened clearly to our requirements, quickly understood the importance we place on providing our patients, staff, carers and visitors with good quality food options, and present this in a way that offers flexibility in menus, sustainability, and efficiency. We look forward to working together.”

Shortly afterwards Camden and Islington NHS Foundation Trust, invited ISS to provide services at the mental health trust’s two main sites, St. Pancras Hospital and Highgate Mental Health Centre, with a mobile estates team looking after about 30 further community sites across the Trust. Here the main focus for the customer was finding a company that would be happy to work in partnership as a true TFM (Total Facilities Management) partner (including both hard and soft FM) across a large and varied portfolio of properties.

Phil Wisson, associate director estates and facilities at Camden and Islington NHS Foundation Trust, said: “We are very much looking forward to ISS starting with us and bringing their expertise and approach to

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enhance the delivery of key services. They will play a fundamental role in ensuring the smooth and effective operation of the Trust, and one which our staff rely on for significant support as they focus on providing high quality mental health care.”

The best way any company can prove that they know what they are doing is to demonstrate their skills over a lengthy period.

ISS has been working for a neighbouring trust of Birmingham Community Healthcare NHS Foundation Trust (BCHC) for many years, so when BCHC, a large community Trust created in 2010 to provide services across the City of Birmingham and the wider West Midlands, they looked carefully at what was being provided next door. After a full market test ISS was able to demonstrate effectively that they understood the nuances of such a wide reaching organisation and came up with a number of initiatives which reflected that deep understanding; including principles of ligature safe equipment.

At the same time and after an extended period of competitive dialogue with a number of potential partners, Oxleas NHS Foundation Trust awarded ISS Healthcare a five-year contract to provide a wide range of soft facility services, including: Cleaning, catering, housekeeping, security and associated services.

This is the first time that the Trust has been able to take the opportunity of testing the services across their whole estate, following historic mergers and contract awards to different providers. At the time of the award the trust said “We are excited about merging all these services into one single contract.

There are many benefits, but the best is that now everyone, across all the sites, can feel as if they are one team, providing great services to a coordinated way.”

Playing our part – a contractors perspective Operating in a coordinated way is being part of the same team; all striving to achieve the similar aim. In this case we are talking about

patient care and the professional delivery to those patients, their visitors and the staff that provide the essential clinical and support services that is the National Health Service.

The NHS Improvement (NHSI), Estates and Facilities Division has been working hard this year to pull together a consensus across soft FM services and providers and has taken the opportunity of reviewing some key standards that reflect the cleaning, catering and retail offered across the entire estate.

ISS, along with other key providers to the NHS, including the Royal Voluntary Services and high street operations like W H Smith, have all joined in to share their best practice and to review the current standards.

The National Standards for Cleanliness was first published by NHS Estates in 2001 and has been revised several times since then. They provide a comparative framework within which hospitals and trusts in England can set out details for providing cleaning services and assessing ‘technical’ cleanliness.

As ISS is the market leader in the provision of professional healthcare cleaning they readily put forward two of their senior team to work on the review: Collette Sweeney, Head of Healthcare Cleaning at ISS, has over 40 years of experience, having worked in acute, mental health and community trusts.

Her technical expertise is second to none, whilst Donna Brown, Divisional Director, has almost 30 years of operational experience, starting out as a Domestic Assistant herself.

Both have extensive experience of visiting healthcare establishments in other parts of the world, and developing improvements based upon those visits. Such experiences helped introduce microfiber cleaning into the NHS originally and now they are harnessing the Internet of Things (IoT), calling upon the work that ISS is doing with IBM in this field.

At the same time NHSI has also convened a healthcare food strategy and quality group to create a set of Food Standards for Healthcare establishments following on from the 2014 report commissioned by the Department of

Health (DH) that will help ensure, among other things, that quality, sustainability and costs are reviewed, monitored and maintained.

This root and branch review covers patients, staff and all retail establishments, so again they have turned to inhouse teams and commercial professionals to help. In this case ISS put forward Lauren Bowen, head of patient services, a qualified Dietitian who has been instrumental in the publication of the second edition of the BDA’s Nutrition and Hydration Digest, she is also joined on this large workforce by Andrew Gipson, service performance director and Tom Barter, head of retail and food service, whose extensive experience is being tapped along with high street giants such as Costa, Boots and M&S. ISS has also put forward their head of corporate affairs, Craig Smith, who has been working in, or for, the NHS for 40 years. Smith is also the national vice chair of the Hospital Caterers Association, and is also there to share the views of their wide membership.

This represents a huge commitment by ISS in terms of manpower but as Chris Ash concludes: “ISS sees this as part of our responsibility. We are there to help support the NHS in any way that we can, and sharing our experience and best practice from across the globe is something that we are proud to do. It is also a clear demonstration that we take our role in the development and improvement of the NHS very seriously and work hard to understand the needs of our differing customers and we expect to be doing exactly that when we celebrate the NHS’ centenary in 2048, when we shall still be playing our part in this world class institution.” L FURTHER INFORMATION ISS Facility Services Healthcare Velocity 1, Brooklands Drive, Weybridge, KT13 0SL - Phone: +44 845 057 6300 E: enquiries@uk.issworld.com W www.uk.issworld.com

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Recruitment Written by Damon Culbert, political commentator for the Immigration Advice Service

Is Brexit set to worsen the strain on the NHS? Access to EU doctors and nurses is integral to the survival of UK healthcare says Damon Culbert, who argues for an immigration plan fit for this purpose Since the UK voted to leave the EU in 2016, there have been growing concerns about the future of the NHS. Over the past year, almost 4,000 EEA nurses left and only 800 joined the NHS in the only notable ‘Brexodus’ in any industry since the vote. Despite the promises of the Vote Leave campaign of an extra £350 million a week for our healthcare services, the NHS continues to tighten its belt.

The Confederation of British Industry released a report earlier this year in an appeal to the government to consider every aspect of British industry before outlining its post-Brexit immigration policy. The report notes that EU nationals make up 17 per cent of dentists and 10 per cent of doctors. While EU nationals have been assured that they can remain in the UK after we leave, the current social, political and economic climates provide a variety of

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reasons for why they may consider taking their expertise elsewhere. From unworkable migration targets to an unwilling resident labour market, Brexit instability could be about to topple our healthcare system.

Office’s stringent limitations. Following this, doctors and nurses were removed from the cap and we have since seen our first month this year (August) where the cap wasn’t met.

While this may have relieved the struggling visa system, the cap still applies to many other healthcare professionals, including healthcare scientists. Considering the decision of the European Medicines Agency to leave London, and the no-deal possibility of leaving this organisation altogether, Britain’s healthcare science needs will only increase post-Brexit.

To maintain the visa cap would put many industries at risk, but with healthcare that risk could also be passed on to patients, as denying visas to scientists could mean our technology falls behind and the development of new medicines slows down dramatically. The Home Secretary Sajid Javid has stated that he will be reviewing this cap but the CBI suggests that the only way to ensure our businesses are protected is to remove it entirely.

They also suggest that the process in which companies apply for a Sponsor Licence be reviewed or removed completely to allow small businesses to easily access the workers they need.

The Home Office has made no indication that this will be the case and have stated that lower-skilled workers will not be eligible to enter the UK post-Brexit.

Ov past ye er the 4,000 Ear, almost left and EA nurses joined t only 800 only no he NHS in th ta e in any i ble ‘Brexodus ndust ’ the vot ry since e

The Tier 2 Visa issue Earlier this year, it was reported that, due to the Tier 2 Work Visa cap of 20,700 per year, several prominent doctors were denied entry to the country, meaning those in need of their expertise were put in jeopardy by the Home

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vacancies. The UK’s ageing population will continue to stress the sector as demand increases and, with a further restricted immigration system, workers decline.

The economic issues Boris Johnson and his big red Brexit bus were quick to assure voters that, once on our own, the money we send to Europe would be ours to support the NHS. Since the vote, Theresa May has also claimed that a ‘Brexit dividend’ has been used to increase funding to our health service but the Institute for Fiscal Studies quickly responded to this.

They claim that after the Brexit divorce bill, post-Brexit payments to the EU and a reduction in the economy, this money will all be taken up before the NHS sees any of it.

Chancellor Philip Hammond also recently backed the International Monetary Fund’s belief that a no-deal Brexit would have ‘dire consequences’, stating that a ‘no-deal Brexit would risk substantial progress’ of the last 10 years. One of the most likely areas to be affected is adult social care, which is made up of seven per cent EEA staff and 90,000

The social climate As immigration is still held to be the most significant factor in the Brexit vote, the social terrain of the UK has undoubtedly affected by it. Immediately after the referendum, reports of hate crimes increased and many European migrants claimed that they now felt unwelcome in the country. As our immigration system is set to become even more closed off, the picture of an open, welcoming Britain of the future seems to be a fantasy. The CBI report makes several suggestions which could maintain the UK as an attractive destination, but the government doesn’t seem to be interested.

With 12.5 per cent of NHS staff coming from overseas, the UK health service is dependent on migrant labour at every skill level and in every department. Since its creation, the NHS has relied on migrants, as has been recognised this year on the 70th anniversary of the docking

The countless lower-skilled roles that support the NHS will then have to be filled by domestic workers should EU workers in these roles decide to leave after Brexit day

of the Windrush ship. Caribbean migrants came to the UK on this ship, invited by the UK government to come and help rebuild post-war Britain, with many taking up jobs in healthcare.

This legacy was soured this year, however, as accounts from former Windrush migrants and their families facing deportation after a lifetime in the UK filled the news. At a time when the government had eyes on an agreement with Jamaica to invite nurses to Britain to train, our Commonwealth relationships were put under serious strain.

Any trust that former colonies may have had in preferential treatment in the ‘Motherland’ may be difficult to restore following this scandal.

Recruitment

The countless lower-skilled roles that support the NHS will then have to be filled by domestic workers should EU workers in these roles decide to leave after Brexit day.

Domestic labour A UCAS report in October last year observed a 17.6 per cent drop in applications to nursing courses. This is just one symptom of a domestic workforce that is less than willing to enter the healthcare industry. Despite a pay rise for a great deal of NHS workers earlier this year, the view is still that the healthcare industry is filled with overworked and underpaid workers. The government will need to change this view if it intends to fill the growing vacancies over the next few years.

Schemes such as Physician Associate Programmes may be useful in shoring up numbers of doctors and surgeons, as these schemes allow students of other scientific disciplines to train at a similar level as doctors. However, this is more likely to work best in the long-term if information on the courses is circulated more freely but may not be able to fill all the vacancies of the NHS in the immediate aftermath of Brexit.

CBI suggestions Some of the CBI report’s 14 recommendations include dropping the net migration and simplifying the visa process. These two steps would work to mitigate the problems that could follow immediately after Brexit as our economy is so reliant on migrant labour from the EU. They have also stated that the government should devise a new system for EU migrants as the current system is completely unworkable for most businesses.

In his latest announcement on post-Brexit migration, the Home Secretary has stated that there will be no preferential treatment for EU citizens and they will be maintaining the current work visa system. These comments show that the government has completely ignored the recommendations of prominent groups such as the CBI which puts a number of industries in danger. While the government believes that keeping our borders closed to unskilled workers may be what the British people want, its effect on the UK economy may outweigh the political significance.

While the government insists that they are still working to get the best deal for Britain out of the negotiations, it seems that we are hurtling towards a Brexit which, deal or no-deal, could mean further difficulty ahead for the UK’s healthcare sector. L FURTHER INFORMATION https://iasservices.org.uk

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Defeating winter bugs – the power is in your hands Chris Wakefield, Vice President, European Marketing & Product Development, GOJO Industries-Europe Ltd explains how improving hand hygiene practice can make a huge difference to health for example, can live on surfaces for up to 12 days, and C.Diff spores, up to five months!

Furthermore, worrying research has shown that fourteen people can be contaminated by touching the same object one after the other.

Each winter, infection rates rise as millions of people contract influenza (‘flu’), norovirus, and other common colds and viruses – in fact, last winter, the ‘flu’ reached epidemic levels in some parts of the UK, and the season was declared the worst for seven years.

The colder months are rife with germs which cause frustrating and unpleasant symptoms for the sufferer, from coughs, sneezes and sniffles to infections that can have more serious, implications.

The ‘common’ cold is very much the ‘entry level’ infection, with coughs and sneezes that are usually short-lived. Influenza, on the other hand is much more severe and debilitating, often leaving people bed-ridden and unable to work. It is a highly infectious, and potentially deadly infection. Last year, three times as many people died of the flu, compared to 2016, and GPs also saw a major rise in patients suffering from flu-like symptoms.

Another common winter infection is norovirus, often referred to as the winter vomiting bug. It can be very unpleasant, causing violent episodes of vomiting and diarrhoea, but usually goes away after two days. It can strike people of all ages, and poses a risk of dehydration, particularly dangerous for the vulnerable people in society, such as the elderly or the very young. It is also highly contagious and has wide-ranging implications, from putting the lives of patients already in vulnerable positions at risk, to the cost and disruption of services – including the enforced closure of hospital wards.

Viruses such as these spread easily through direct and indirect contact with others via the hands and surfaces. Did you know that these dangerous pathogens can live on surfaces for days, weeks and even months? Norovirus,

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The power is in your hands This chain of infection needs to be broken in order to minimise the spread of winter infections – and hand washing is the first line of defence to help achieve this.

Many studies published in the last 20 years have proven that this simple act can make a huge difference to health, helping to prevent the spread of germs, and can reduce Healthcare Associated Infections by between 25 per cent and 50 per cent.

However, whilst more than 80% of illnesses can be transmitted by the hands, research shows that 25 per cent of people don’t wash their hands after using the washroom, while a further 46 per cent don’t wash long enough to be effective. Clearly, there is still a real need for education and awareness on both the benefits and the best technique of handwashing to influence and change behaviour. This is important, not only for staff, who already make this part of their daily lives, but, also for visitors and patients themselves.

Influencing good hand hygiene habits As a founder member of the Private Organizations for Patient Safety group, GOJO Industries-Europe advocates a ‘total solution’ approach to making hand hygiene second nature to everyone in a healthcare setting.

The PURELL SOLUTION™ from GOJO combines

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scientific expertise, effective formulations and state-of-the-art technology to promote hygienic and compliant hand hygiene behaviour, which helps prevent infection and keep both people and places healthy.

Their total solution approach recognises and combines three key strategies to influence behaviour: Accessibility; Formulations; and Signage. Handwashing facilities must be accessible and dispensers easy to use. The WHO recommends that an adequate number of appropriately positioned hand hygiene facilities should be readily available at the point of care.

The high frequency with which healthcare workers wash or sanitise their hands means that the formulations must be gentle yet effective against germs, complying with key hospital norms EN 1500, EN 14476 and EN 12791. If using hygienic hand rubs, a popular choice in many healthcare settings, ensure you choose one which is at least 70 per cent ethyl-alcohol which has been clinically proven to kill germs within seconds.

Finally, eye-catching signage is very effective as a prompt, especially at key germ hot-spots such as washrooms and waiting areas.

By having these effective hand hygiene systems in place, and actively promoting and reminding health care workers, visitors and patients alike to use them, we can lessen the impact of the seasonal viruses this winter. L FURTHER INFORMATION Tel: 01908 588444 www.gojo.com

Infection control Written by Pat Cattini, president, Infection Prevention Society

Every infection prevented helps us combat antimicrobial resistance Infection prevention must be the cornerstone of our approach to tackling antimicrobial resistance, says Pat Cattini who looks at the reasons why effective infection prevention is a crucial part of the fight against AMR The threat of antimicrobial resistance (AMR) prevention. Every infection results in an is widely publicised. As highlighted by a report increased demand for antibiotics, and failure from the Health and Social Care Committee, to control antibiotic use provides opportunities AMR could result in the death of 10 million for resistance to emerge. With further lapses people per year by 2050 if we don’t take in infection prevention, these resistant action. The second year of Public Health organisms will continue to spread and thrive England’s national ‘Keep Antibiotics in our healthcare environments, Working’ campaign is also well posing a significant threat to underway. But are we taking our ability to deliver modern action on this major public healthcare including We mu health threat where surgery, transplants ensure st it’s needed most? and cancer care. that healthc are wo Awareness campaigns We are unlikely rkers on the to educate the to find a solution public and health by looking to the are wel front line professionals on the development of new tackle t l armed to correct administration antimicrobials. There he chal lenges of antim of antibiotics are an have been no new ic important way to help classes of antimicrobials resistanrobial the over prescription and for decades, and those c e incorrect use of antibiotics. which are brought to But first and foremost, we market through re-engineering must prioritise effective infection of old antibiotics are expensive

and often redundant within a short time. Big pharmaceutical companies generally do not see a good return on the massive investments needed to produce antimicrobials and are more likely to focus on producing drugs which appeal to a wider, more long-term market.

Controlling resistance This situation is unlikely to change within the next five years - the lifetime of the government’s new AMR strategy. It is therefore vital to focus on looking after the effectiveness of existing antimicrobials by reducing their use. Infection prevention is key, because every infection prevented means we don’t have to administer antibiotics. Infection prevention must be the foundation of preserving antimicrobial treatment and controlling resistance.

A vital element of the infection prevention armamentarium is the use of vaccination to prevent disease circulating within our communities. Encouraging vaccination is E Volume 18.6 | HEALTH BUSINESS MAGAZINE

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 particularly important given recent figures showing that take-up of MMR vaccine has fallen for the fourth year in a row, while measles outbreaks are increasing in the UK and across Europe. Vaccination is probably a victim of its own success: with a lack of visibility of many conditions within the general public over recent decades, people have forgotten the very real risks that they pose and may not appreciate how devastating conditions like measles can be.

Simple and inexpensive practices such as hand hygiene can significantly reduce rates of infections in health and care settings, reducing the need for antibiotics to be used.

However, there is more to infection prevention and control. It is vital that we build and maintain the right environment to deliver care, that we ensure the procurement of clinical devices and equipment which best enhance patient safety, and that we ensure a clean environment and clinical equipment. The robust education of staff and patients is also crucial.

The role our the health workforce Although infection prevention is one of the most simple and effective ways to tackle the root of AMR, the last few years has seen reduced investment in the infection prevention and control workforce, resulting in a loss of experience and leadership. For example, a survey of the Infection Prevention Society’s members carried out last year showed that almost a third (30 per cent) have seen a reduction in the IPC services where they work. This is particularly true in primary and community care settings, where community infection control services have been significantly depleted. Some services are dependent on a single IPC professional.

We must ensure that healthcare workers on the front line are well armed to tackle the challenges. This means investing in the development of a specialist infection prevention workforce across the health and social care sector. Healthcare providers need to have access to competent infection

prevention teams – and infection prevention behaviours must become ingrained.

Infection prevention and control is a constantly changing field, with healthcare professionals required to deal with various new and emerging threats. Infection prevention staff need to have access to best practice guidance and be assured that they have robust governance on infection prevention.

To help ensure this, the Infection Prevention Society has developed a set of professional competencies that provide healthcare leaders with assurance of the professional development of their infection prevention staff. They allow infection prevention professionals to assess their skills and knowledge, further their understanding and identify development needs.

Every time we prevent an infection we go some way to reducing the use of antibiotics.

Ensuring well-equipped, well-resourced and well-educated infection prevention teams will help deliver effective infection prevention and must be the cornerstone of our approach to tackling AMR. Effective infection prevention also

NHS England is urging people aged 65 and over to take advantage of the NHS’s biggest ever flu vaccination programme, providing a record 8.5 million doses, free of charge.

Infection control

Although infection prevention is one of the most simple and effective ways to tackle the root of AMR, the last few years has seen reduced investment in the infection prevention and control workforce, resulting in a loss of experience and leadership

Winter flu vaccination

Health chiefs are highlighting the importance of the campaign to promote flu vaccines to the over 65s, as part of the annual campaign to encourage the public to stay well before and during the winter period, with NHS leaders reassuring the public that there is sufficient supply of the vaccine in stock for everyone to get protected this year.

Seqirus, the sole supplier of the new, more effective vaccine for over 65s, have phased deliveries to cope with global demand. GPs and pharmacies have been setting up special vaccination clinics.

There are also local helplines for GPs and pharmacies if they have any problems so they are able to ensure all patients have the appropriate advice and information about their flu jab.

Alongside the elderly, NHS England is also providing vaccines for other at-risk groups such as pregnant women and people with long terms conditions, as well as for NHS and care staff. There is also a nasal spray, which works better in younger people, and is free of charge for children.

limits illnesses and saves lives. It saves on length of stay in hospital and costly consumables.

Successful infection prevention is a win-win for patients, staff and healthcare providers. L FURTHER INFORMATION www.ips.uk.net

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Wherever you look in hospitals there are signs. They tell you what you can and cannot do. They inform you of hygiene requirements. They show you which way you need to go to the department you require. Signs come in all different styles and formats, with some printed and some handmade. It cannot be disputed that signs are necessary in a hospital environment.

They are a great way to warn the many thousands of people who go through the doors of hospitals every day of some of the risks and specific precautions that need to be taken.

However it is important that there are not too many signs as this can lead to ‘sign blindness’.

By this, I mean too many signs mean people switch off and walk by, ignoring them and potentially missing important information.

When thinking about signs in a hospital one of the most important factors in getting messages across is to have a joined-up approach between departments, including infection control, health and safety, communications, specialist and other departments, charities, volunteer organisations, and so on. All of these departments want to get their message across to the right people. But without a joined-up approach they can tend to use different methods and styles, which can result in a lack of control and standardisation of signs.

This in turn leads to ‘sign blindness’. If signs are not used properly it can cause problems for patients and visitors, which in turn can lead to frustrations being taken out on staff.

used to warn people how long they may have to wait depending on their injury and how it was sustained. For a sports injury, the wait may be as much as three-and‑a‑half to four hours – essentially the end of the queue as the injury is viewed as self-inflicted.

If the patients are warned that they must expect such a long wait this reduces the chances of them getting annoyed.

As technology has moved on, we now find in most A&E departments the use of TV screens to keep patients informed of waiting times.

This has been shown to reduce the amount of aggressive incidents towards members of staff. As referred to earlier, another group of signs which are relevant from a health and safety point of view are those warning of the dangers of the One different types of waste and of the m ost wet floors. Positioning is importa crucial with these. They are in getti nt factors there to serve a purpose n g across i messages but if they are left where people only see them at Health is to ha n a hospital ve a joi the last minute, there is and safety n approa a risk of a slip or a trip.

From a health and ch betwed-up If used and positioned safety perspective een departm correctly these signs do serve there are obvious ents a purpose. Hospital floors, requirements for signs. for infection control purposes, For example, they can tend to be mainly vinyl. However be used to warn of dangers when wet can they can become slippery, such as nearby X-Ray equipment, especially with the wrong footwear. So or they can be used to warn of potential signs need to be displayed to warn patients, hazards such as wet and slippery floors. All visitors and staff and must be displayed of these signs are off the shelf and come in well in advance of the area in question. either the mandatory or advisory colours.

We must also not forget hygiene signs in key There are, however, many more signs than locations. This includes those in toilets which those which warn of hazards to patients and have information about good hand-washing visitors. Among them are those which inform techniques and the use of hand gels. They can patients how long they may have to wait also include when to stay away from visiting, to see a medical professional. These can, in such as if you have the winter bug, which turn, be used to protect staff. When people can create the risk of infecting others, but visit a hospital they will expect to queue these signs must be clear and on their own but if they feel they are waiting too long and not swallowed up among many others. they may start to get annoyed and agitated, which can lead to aggression towards Directions staff – something which is unacceptable.

Good signage is also useful for directional Hospital staff are there to do a job. As with purposes, both inside and outside of the people in all other industries they should building. For patients, arriving at hospital be covered by a culture of care, something can be an anxious time. Hospitals can be the Institution of Occupational Safety and big and scary places with lots of buildings, Health’s (IOSH) Health and Social Care group departments and people. Once inside a – and the Institution as a whole – strongly hospital, there must be clear signs to different believes in. This includes preventing them departments. Generally outpatients areas are being the target of aggression from the split into various specifics like fracture clinics public. Signs play an important part in this. and the common approach for directional If you take accident and emergency signs is to colour code them. This means it E departments as an example, signs can be Volume 18.6 | HEALTH BUSINESS MAGAZINE

Written by Mark Hughes, Institution of Occupational Safety and Health

Signage should be a major consideration for hospitals, especially from a health and safety perspective. Mark Hughes, from the Health and Social Care group at the Institution of Occupational Safety and Health, looks at the importance of the correct use of signage in hospitals

Wayfinding

First time to a hospital?

Do you know where to go?

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Standardising signage Standardisation of signage and ensuring they are controlled is key. A successful way of doing this is nominating someone within each department and Trust wide to be responsible for monitoring the amount of signs and their clarity. Those nominated must ensure that the important messages carried in signs are not lost among too many trivial signs.

Wayfinding

 is a case of following the red or green lines along the wall or floor to the relevant clinic.

Such signs can also be handy for patients who have to make their way to and from different departments, for example if they need to have their bloods taken.

It isn’t just patients who signs play an important part for. They are also important for visitors such as patients’ relatives and patient transport like taxis, ambulances and volunteer drivers. Clear signs are needed for drop-off and pick-up points and car parking. The same is the case for the relevant wards and clinics as well as coffee shops and restaurants.

The need for signs begins from the moment people arrive at a hospital. Car parking arrangements must be displayed. There should be clear signs taking you to the right car park for the specific department or ward you are visiting, including clear car parking fees and how to get a reimbursement if applicable.

If hospitals don’t get these signs right it can cause numerous problems. As with waiting time information, directional signs are important in preventing patients and visitors from becoming frustrated and taking this out on staff.

The use of technology like TVs to generate messages and keep people informed is a move in the right direction, but we must not stick with the same message over and over again The use of technology like TVs to generate messages and keep people informed is a move in the right direction, but we must not stick with the same message over and over again; there needs to be a program in place to continually update and remove unwanted and old messages.

Even when a sign is temporary it should still be made to a specific standard and it must be removed when it becomes out-of-date. An example of this is in infection control isolation areas. It is crucial that once the problem has been removed so should the sign. The responsibility of those nominated people can also include ensuring hospitals make use of the information that they have, for example which languages they need signs to be in.

Hospitals gather huge amounts of information about people’s nationality, so they must use this to work out who use their services. By doing so means that in the most important cases they can have signs printed in the key languages for the demographics of the area. This again can help staff avoid potentially confrontational situations.

Having signs printed in relevant languages significantly reduces the chances of having people getting lost in a hospital because they don’t understand the signs. So, signs are more than useful in hospitals, vital even. But it is important to remember that having too many signs can actually have a detrimental effect when it comes to health and safety as people can become oblivious to them.

Signs should be used only when necessary and should be clear and readable. If this is the case, staff in hospitals are able to get on with their job without the risk of coming into contact with agitated patients

and visitors. This is one way in which hospitals can meet the culture of care which staff should be covered by. L FURTHER INFORMATION www.iosh.co.uk

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How ‘low’ is low enough to protect patients from falls from the bed?

The UK’s ageing population will continue to add further pressure to the NHS in the coming decades. An ageing hospital population presents associated challenges in terms of patient safety The overall cost of falls in acute settings is estimated to be £506 million per annum and those aged 65 and above are at a greater risk of harm from a fall, accounting for 87 per cent the overall cost.

22 per cent of all falls occur from the bed, meaning a preventative solution will reduce the amount of avoidable harm and the associated higher risk of mortality, along with lowering incremental treatment costs.

Low beds are widely used to prevent falls and reduce harm by lowering the potential height a patient falls.

How do we define a ‘true’ low bed?

A ‘true’ low bed should offer two key benefits: It should offer a height that is low enough to allow shorter patients to mobilise safely from the bed; it should have a minimum height that is low enough to significantly reduce the risk of fall-related injury.

Manufacturers often use terms such as ‘High-Low’, ‘Low Entry’, ‘Low’, ‘Extra Low’ and ‘Ultra Low’, but do these terms actually describe low beds?

How low is low enough?

The optimum position to promote safe mobilisation from the bed is that which achieves a 90° angle at both the knee and hip. This is equivalent to a patient’s popliteal measurement, which is the height from the bottom of the heel to the back of the knee whilst the patient is sitting. Therefore we can conclude that the distribution of popliteal heights of the elderly population should dictate the minimum height required of a bed and mattress combination in order to enable safe mobilisation.

Analysis of popliteal heights in an elderly population to determine the ideal low bed height Analysis of popliteal data from a recent study of ergonomics using anthropometric data can be used to suggest the ideal minimum height of a low bed, in order to provide protection for the widest range of patients.

The study detailed the popliteal heights of a defined population age 65 years and above. This data set was compared to the lowest height that can be achieved

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by combining a range of minimum bed heights with a 14cm foam mattress in order to determine the per cent of this population that would have the potential to achieve the safe mobilisation position.

Based on the data set, a platform height of 21cm combined with a foam mattress of 14cm provides an optimal mobilisation height for over 99 per cent of males and 84 per cent of females.

In comparison, a platform height of 32cm combined with a foam mattress of 14cm provides an optimal mobilisation height for six per cent of males and less than one per cent of females.

Reducing the impact force on falling We can determine the relative risk of injury from a fall from the bed by using a simple physics equation to predict the relationship between bed height and harm.

Gravitational potential energy (GPE) is defined as the energy an object possesses due to its position in a gravitational field and is directly proportionate to the height from which an object falls. The higher the height, the greater the GPE. Can we conclude that GPE can provide an indication of impact force which in turn could be an

indication of the level of potential harm?

The relative increase in GPE based on bed height has been calculated: a bed with a height of 32cm increases GPE by 31 per cent versus a bed height of 21cm; a bed with a height of 38cm would increase GPE by 49 per cent versus a bed height of 21cm.

The Medstrom Range of Ultra-Low Beds The Medstrom range of ultra-low acute beds offers a minimum height of just 21cm. This is low enough for the safe mobilisation of 99 per cent of males and 84 per cent of females aged 65 and above.

Uniquely, the Medstrom ultra-low beds offer the ability to programme a customised height setting for each patient to ensure the safe mobilisation height is achieved consistently.

A low height of 21cm results in a GPE that is significantly lower than a bed that is 32cm+.

Conclusion With 40 per cent of the acute patient population being 65 years and above, a percentage that is growing year on year, there is a strong argument for institutions to consider a bed fleet that offers true, proactive protection from falls by selecting a ‘true’ low bed. L FURTHER INFORMATION www.medstrom.com info@medstrom.com

The graph shows that a fall from a bed height of 32cm creates 31 per cent more GPE than a fall from a bed height of 21cm.

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS | www.healthbusinessuk.net

Obesity

Targeting healthier lifestyles to reduce obesity levels The NHS has prioritised funding prevention as a key part of lowering the NHS budget and helping people better manage their health. With the Health Secretary urging the public to take greater responsibility for its health, what is in place to lessen the burden of obesity on our hospitals?

When setting out his long-term vision for in the country to adopt a daily ‘active mile’ the NHS last month, Health Secretary Matt initiative, part-funded by Living Street’s Walk Hancock urged the public to take greater to School project, as well as the launch of a responsibility for their own health to tackle three-year programme for the government to the rising toll of obesity and cancer. Speaking work alongside local authority partners to find at the International Association of National and highlight areas of best practice and show Public Health Institutes, Hancock called for what can be achieved within existing powers. a big increase in people making healthier lifestyle choices, such as reducing the amount The diabetes link of alcohol and junk food they consume.

Figures released by NHS Digital this month Rebalancing the way which the NHS have shown that children of obese parents currently spends its funding is one of are more likely to be obese themselves Hancock’s target areas as Health Secretary, compared with children whose parents are not seeking to prioritise prevention as a way of overweight or obese. Monitoring trends in the improving health, freeing up hospital space nation’s health, the Health Survey for England and helping the elderly stay active 2017 surveyed 8,000 adults and for longer. While much of this 2,000 children about a variety conversation has taken the of topics including obesity, form of social prescribing, smoking, and drinking, Matt often encouraging patients with a particular focus H ancock to take part in sports on the association has urged t and social activities between parent h rather than prescribing and child weight, to take e public greater drugs, it is also about looking at those respons i b lifestyle changes who are overweight i l i t y for th own he at an earlier age. and obese. e i r a l With the Department The data reveals the risinth to tackle g toll o of Health and Social that 28 per cent of f obesity Care currently spending children of an obese £97 billion of public money mother were also obese, on treating disease and only compared with eight per cent £8 billion preventing it, plans to of children whose mother was halve childhood obesity by 2030 really not overweight or obese. Likewise, 24 need to begin seeing some substance. Former per cent of children of an obese father were Health Secretary Jeremy Hunt announced also obese, compared with nine per cent of this aim in June, pledging to introduce clear children where the father was not overweight and consistent calorie labelling on menus in or obese. In total, 30 per cent of food outlets, such as restaurants, cafes and children aged two to 15 takeaways, to help parents make informed in England were choices about the foods their children are overweight or eating, as well as preventing stores from obese in displaying unhealthy food at checkouts 2017.

- thereby contesting ‘pester power’ on last-minute, buy-one-get-one-free offers.

There are nearly 7,000 children and young adults under 25 with type 2 diabetes in England and Wales, with the Obesity Health Alliance saying that the government should act now to implement proposals to cut childhood obesity. The latest National Diabetes Audit for 2016-2017, which contains information on cases of type 2 from 95 per cent of GP practices in England and Wales, finds that a total of 6,836 children and young people aged under 25 were being treated for the condition, mainly made up of 20 to 24 year-olds.

The measures from earlier this year also outlined ambitions for every secondary school

Aside from direct investigations into childhood obesity and the rising numbers of pupils leaving primary school overweight or obese, there has also been much discussion of type 2 diabetes circulating the headlines, with Simon Stevens, chief executive of NHS England, announcing a few weeks ago that hundreds of thousands of people will receive NHS help to battle obesity and Type 2 diabetes under radical action.

A trial at the end of last year of the 800-calorie a day diet helped almost half of those involved to reverse the condition of type 2 diabetes. Using liquid meals and shakes will be prescribed for three months, initially to 5,000 people, and follow-up support given.

NHS England has announced that wearable glucose monitors will be made available to tens of thousands more people with type 1 diabetes from April 2019. With nine out of 10 people with diabetes in the UK having type 2, which is strongly linked to diet and lifestyle, NHS England’s decision will not just improve the health of patients but also save the NHS money that can be reinvested in frontline care, with the NHS currently spending around 10 per cent of its budget on treating diabetes.

Recent projections show that the growing number of people with diabetes could result in nearly 39,000 people living with diabetes suffering a heart attack in 2035 and over 50,000 people suffering a stroke. Furthermore, Diabetes UK has revealed that 169 people a week are having to undergo amputations as a result of diabetes. According to the charity, 26,378 people had lower limb amputations E

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Here at PS24 we believe in raising standards in the parking sector and in delivering a more professional service to our customers. Both NHS Trusts and car park operators must recognise the importance of car parking policies, both in terms of the wider transport strategy and the need to manage traffic and parking in line with demand and environmental needs. Some hospitals have lost Accident and Emergency status on parking issues alone!

Our free of set up charge and easy to manage parking solutions include ANPR, Permits, Virtual Permit Schemes, cashless systems, Pay and Display, Mobile Self Ticketing systems and more. We provide the best solution that meets your parking space needs from a shopping centre to some spare land at the back of your offices through to hospitals, colleges and Universities. We can take care of everything from installation of signage and machines, maintenance, cash collections, enforcement, line marking and can even arrange CEOs (Car park Enforcement Officer) nationwide who will patrol your premises to British Parking Association standards. With a percentage of enforcement monies being paid back to the landowner, which generates another source of income whilst creating a safer environment for all and less disruption.

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www.ps24.co.uk

Obesity

 linked to diabetes between 2014 and 2017, marking a 19.4 per cent increase on the three years previous, with unhealed ulcers and foot infections widely mooted as the main cause of diabetes-related amputations.

Dan Howarth, head of care at Diabetes UK, said: “The shocking number of lower limb amputations related to diabetes grows year on year. An amputation, regardless of whether it’s defined as minor or major, is devastating and life-changing. A minor amputation can still involve losing a whole foot. Many diabetes amputations are avoidable, but the quality of foot care for people living with diabetes varies significantly across England.

Transformation funding since 2017 is working and will help to reduce these variations, but much work still needs to be done.”

An expensive issue Projections in the Foresight Report a few years ago suggested that 50 per cent of adults will be classified as obese by Body Mass Index (BMI) by 2050, with direct and indirect costs of obesity costing the NHS an estimated £49.9 billion per year. We currently have approximately one in four adults that are classified obese by BMI and approximately two thirds of the adult population are at an unhealthy weight, meaning more of us are at an unhealthy weight than a healthy one.

So what can we do to slow down or reverse this crisis? Unfortunately, treatment and care of obesity is still not consistent across the UK with some areas having these services in place with other having very little obesity care. Lucy Turnbull, chair of the Obesity Specialist Group at the British Dietetic Association, says that no single solution creates sufficient impact to reverse obesity. Education and personal responsibility are critical elements of any program to reduce obesity, but they are not

According to the charity Diabetes UK, 26,378 people had lower limb amputations linked to diabetes between 2014 and 2017, marking a 19.4 per cent increase on the three years previous enough on their own - only a comprehensive, systemic program of multiple interventions is likely to be effective. These include: national and local governments; retailers; consumer-goods companies; restaurants; employers; media organisations; educators; health-care providers; and individuals.

Restructuring the context that shapes physical activity and nutritional behaviour is also going to be a vital part of reversing the obesity trend. Thus, public health strategies such as town planning, convenience store planning, school food and exercise programmes and good information campaigns are needed. Other identified examples include reducing portion sizes of packaged foods and fast food, changing marketing practices, and changing physical activity curricula in schools.

Such interventions rely less on individual willpower, but make healthy lifestyles easier to achieve. The National Obesity Observatory was set up in an effort to collate the research information and to provide a single point of contact for wide-ranging authoritative information on data and evidence relating to obesity, overweight, underweight and their causes, in order to support policy makers.

A future action plan In 2013 doctors of the United Kingdom united to form what they call a ‘prescription’ for the UK’s obesity epidemic. The report presents an

action plan for future campaigning activity, setting out 10 recommendations for healthcare professionals, local and national government, industry and schools which it believes will help tackle the nation’s obesity crisis.

Recommendations include: food-based standards to be mandatory in all UK hospitals; a ban on new fast food outlets being located close to schools and colleges; a duty on all sugary soft drinks, increasing the price by at least 20 per cent, to be piloted; traffic light food labelling to include calorie information for children and adolescents – with visible calorie indicators for restaurants, especially fast food outlets; £100 million in each of the next three years to be spent on increasing provision of weight management services across the country; a ban on advertising of foods high in saturated fats, sugar and salt before 9pm; and existing mandatory foodand nutrient-based standards in England to be statutory in free schools and academies.

Additional interventions need to rely less on conscious choices by individuals and individual responsibility, and more on changes to the environment and societal norms. These interventions reset the default and make healthy behaviour easier and more normal. It reports that ‘as many interventions as possible must be delivered to have significant impact.

A holistic approach by the public, private, and third sectors is the best way forward’. L Volume 18.6 | HEALTH BUSINESS MAGAZINE

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Advertisment Feature

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

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Advertisment Feature

Utilising innovative storage solutions to increase security While personal storage in hospitals isn’t a new concept, the demand for such facilities is higher than ever before, primarily due the influx of hospital staff that increased by 1.8 per cent in 2017 and is forecast to continue

Providing personal lockers for new and existing employees, is one of many areas where storage solutions can be utilised to help increase the security within each location.

Garran, a company that has worked closely with hospitals across the UK, has developed several innovative solutions that can be implemented to not only provide increased security, but can also be integrated with an advanced system to monitor usage, provide multi-level access control, and even offer remote security notifications as part of its many features.

These developments combined with a variety of locker specifications can be used in several instances around each facility to directly benefit staff, visitors, and companies.

Personal Staff Lockers Developments within the storage industry in general, have a direct correlation to the specification required by hospitals for their staff lockers, with new designs always focusing on a combination of three key elements – security, function, and ergonomics.

The functionality of a locker is increasingly dependent on the type of lock integrated into the design. Incorporating technology into storage systems is enhancing the transition from traditional, generic key locks to more sophisticated methods such as mechanical, and digital combination locks, and RFID locking systems. The use of more advanced locking features provides a longer-term return on investment by limiting maintenance costs associated with lost keys, and time spent by staff designated to managing the locker rooms.

Patient Storage Solutions Unlike staff lockers that are confined to specific changing room locations within the facility, patient lockers can be located more freely, utilising space on wards and in patient bed areas to provide a secure place for patients to store personal items and valuables.

This much needed storage solution helps to directly reduce incidences of lost and stolen property, and the cost implications associated with thousands of claims filed each year by patients.

Garran can provide self-managed and keyless lockers that can further benefit hospitals and their staff by reducing instances of items being misplaced, or stolen, therefore decreasing the associated time used to investigate such incidents.

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Secure Visitor Charging Facility With over 65,000 people visiting accident and emergency departments across England and Wales each day, a facility to allow visitors to charge their mobile devices in a safe location is of great benefit to visitors.

Paired with a locking system that can collect a small fee for the use of the charging facility, this system could provide an additional revenue stream thus paying for the initial investment and over time, becoming a source of direct income for the hospital, whilst providing peace of mind for its visitors.

This system can also be utilised in patient areas allowing them to charge mobile phones and devices throughout the duration of their stay.

Medical Supplies and Equipment Storage In addition to the lockers which have been designed with the user in mind, additional storage solutions are available which provide added security to the storage of medical equipment and medical supplies.

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS | www.healthbusinessuk.net

Increasingly, the term ‘asset management’ is becoming more ubiquitous in the storage industry and this term is particularly relevant to medical supplies and equipment.

All our multi-faceted storage solutions can be used by multiple departments and across multiple sites. For more information or to speak to a member of our team call 02920 859 600 today and we will work with you to create the best possible solution. L FURTHER INFORMATION www.garran-lockers.co.uk

Secure storage

Making sure your hospital baggage is safe A survey suggests that 80 per cent of thefts in hospitals take place in areas in which members of the public can legitimately be present. Therefore, what roles does access control and secure storage facilities play in keeping patients and their belongings safe?

Despite the inherently busy and unpredictable has to be avoided at any cost. Nowadays, nature of hospitals wherein members of the many suppliers of security and storage public often come and go freely, restricting equipment deliver products with a special access to specific areas is vitally important. anti-bacterial powder coating to remove Access control cards that use radio frequency any traces of bacteria that can potentially identification (RFID) chips provide a cause disease and infection. Additionally, convenient tool for proximity reading of card locker doors are often manufactured with details and the activation of gates, turnstiles ‘logo vents’ to assist air circulation in each and vehicle barriers. The system has a wide compartment, similar to those used in range of applications from controlling a single gyms and leisure place changing rooms. entrance door to a large integrated security However, with hospitals stays often a network, and can prove invaluable when stressful experience for patients, again protecting restricted areas. Other identification noticeably for those on labour wards, hospitals devices which can be used to identify users have a duty to ensure that any belongings before granting access include: smart that arrive in a hospital room with a cards and readers; swipe cards patient are able to be securely and readers; PIN pads; and stored and kept away from Lockers finally biometric equipment, the threat of theft as best provide such as fingerprint as possible. As digital s and iris scanning. advances continue to regardl ecurity Healthcare facilities fasten, the range and whethe ess of r the fa experience the same quantity of belongings cility assigns type of one-off thefts that patients bring t and burglaries as with them to a hospital simply hem or m other organisations. has meant that secure a k e s them a However, they are storage is even more vailable also at significant risk important. Phones, t o staff of insidious, ongoing iPods, laptops, chargers, theft of targeted items as well as wallets, purses and equipment, which can and keys need to be kept off of result in very significant losses surfaces and away from passers-by. over time. One of the key issues here is the often transient nature of the populations Staff storage moving through these premises – it is Those working in hospitals fully understand not practical or appropriate to be overly the importance of custom lockers when it controlling in terms of access to public comes to keeping their personal belongings areas. One survey has suggested that 80 per cent of thefts in hospitals take place in areas in which members of the public can legitimately be present. This makes the effective integration of security measures in these locations particularly important.

safe and secure during long shifts. Working in such a high-traffic environment demands a specific type of secured storage solution in order to prevent theft or loss - some nurses and doctors may not revisit their belongings throughout their shift, missing breaks or sleeping through time off ready to return again for the next slog.

As mentioned above for patients, custom employee lockers fulfil these requirements as well, often maintaining cleanliness, convenience and style as the same time.

Perhaps more so than any other job or work location, hospitals are open and busy 24 hours a day, seven days a week. Regularly reflecting airport passengers rushing to their just-announced terminal to catch their flight, the high traffic nature of corridors and waiting rooms means that finding the right place to secure personal belongings can be challenging. Therefore, lockers provide security regardless of whether the facility assigns them or simply makes them available to staff.

Where possible, it can also help staff to be able to keep their belongings organised in one place. With crowded hallways, break rooms, and locker rooms, providing employees with spacious custom lockers that suit their needs eliminates the issues that come with space constraints in a busy location. This also increases a degree of privacy that may not be found in any other aspect of the job. L FURTHER INFORMATION www.bsia.co.uk

The patient environment Much of the design work that goes into the hospital setting rightly focuses upon hygiene and comfort. That means that the furniture chosen for hospitals wards, especially where patients are more likely to have longer stays, such as maternity and elderly wards, prioritises a sense of cleanliness and relaxation. Therefore, the bedside environment is designed to be easily cleaned and to influence patient and staff behaviour to reduce the likelihood of exposure to HCAIs. Lockers, a key part of storage needs, are often required to be used in very clean and ‘high risk’ areas where risk of contamination

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SECURITY

Security bollards to protect people and places

The most innovative equipment in the world

Macs Automated Bollard Systems Ltd specialises in the nationwide supply of security bollards, automatic barriers, traffic calming and vehicle restriction solutions, and retractable power units.

With over 20 years’ experience in the industry, the company has worked successfully with numerous large contractors and local authorities, installing automatic security bollards in towns and city centres all over the UK. Macs Automated Bollard Systems Ltd supplies a variety or semi-automatic and automatic bollards for applications ranging from urban regeneration, vehicle restriction, and traffic calming projects, to PAS 68 and IWA 14 crash rated systems for counter terror projects.

Customer satisfaction is the organisation’s number one goal, and its team will thoroughly discuss and assess your specific needs, and work to deliver a

Innova Care Concepts has teamed up with the University of Huddersfield to research and improve the effectiveness of pressure care equipment in healthcare.

Extensive pressure mapping and panel discussions have taken place to assess each item. This included Innova’s sales director and pressure care specialist Joe Hulbert laying on mattresses for a long time to measure body weight redistribution. The researchers also carried out a sound test on the pump to make sure it would not disrupt the patient, and they tested the stretchiness and durability of the mattress covers.

Joe Hulbert said: “It’s been a real privilege to work with Huddersfield University with their studies. Not only has this given us as equipment suppliers actual evidence that our products are at the cutting-edge of research and technology, but it’s also allowed us to further improve

solution to fit. The company only works with manufacturers that it believes offers the most reliable and highest quality products, and Macs also offers a full technical support and aftercare service, always having someone at the end of the phone or email when you need.

FURTHER INFORMATION Tel: 0161 320 6462 enquiries@macsbollards.com www.macs-bollards.com

ADVERTISERS INDEX

The publishers accept no responsibility for errors or omissions in this free service Agenzia O UK

IBC

Fujitsu 14,16

AFGA Healthcare UK

10

Fire Doors Complete

44

Amity International

66

Gojo Industries-Europe

58

Aquarius Water Solutions

60

Hardy Signs

62

Arcanum Information Security

35

Ice Locker Group

76

Assistive Partner

24

Illumino Ignis

40

Awesome Technology Blue Sky Hosting British Parking Association

22,23

Innova Care Concepts

78

26

ISS Mediclean

54,55

14

KHIPU OBC

BT Plc

38,39

LS Fire Solutions

43

Checkmate Fire Solutions

46,47

Macs Automated Bollard

78

Coopers Fire

45

Medstrom 74,75

Demoed 60

Optus Conferencing

17

diabolo 50

PCH Manufacturing

64

Diesel Thistle Generators

14

Pennon Water Services

48

Digital Health Intelligence

37

Philips IFC

Discidium 36

PS24 72

ECA UK

12

Renray Healthcare

50

ECRI Institute

32

Riannai UK

50

EDSB Fire & Security

42

Safety Technology

26

Sign Direct

64

Embrace Digital Enviro Building Solutions Evac Chair International

74

DESIGN & BUILD

30,31 53

Sign-It 64

14,70

Total Intelligence

18

Evaccess 4

Wardray Premise

60

Fire Class UK

Zetasafe 48

78

our mattresses and carry-out continuous product development with expert opinions and input.”

The studies have included rigorous testing and product developments to ensure that patients are getting the best care possible. It is estimated that pressure ulcers cost the NHS over £3.8 million every year in the United Kingdom.

FURTHER INFORMATION Tel: 0345 034 1450 enquiries@innova.uk.com www.innovacareconcepts.com

FIRE SAFETY

Fire rated glass is a crucial element in building safety Fire protection strategies have dramatically advanced from fire glass technology, where once, fire escape routes were standard steel or wooden fire doors and walls.

Fire glass testing and performance allows these out-dated methods to be modernised in any building or development. Fire rated glass can be a more aesthetically pleasing alternative and can contribute to safety, as the the glass allows fire and smoke to be detected more easily, allowing for a more effective escape plan. Risk assessments can help you identify any potential issues that you may have.

Glass fire screens and doors can provide performance of up to 120 minutes integrity and insulation, depending on the glass and application used. It is vital that any fire rated glass is installed correctly and to FIRAS standards and must only be fitted as part of an appropriately approved glazing system.

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS | www.healthbusinessuk.net

Fire Glass UK understand how confusing this can be and that is why the company has a dedicated technical help team to help with any specifications and issues that may arise. All of Fire Glass UK’s glass is rigorously tested and the organisation can advise if the glass your choose is suitable for your location – helping you to meet Building Regulations.

FURTHER INFORMATION Tel: 0121 521 2180 info@fireglassuk.com www.fireglassuk.com

When was the last time you ran a health check on your print costs?

As a Director, Manager or Administrator of a department, clinic or surgery, within the Health Sector, managing your budgets can often give you quite a headache.

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The report you receive from the Print Audit will provide a CLEAR DIAGNOSIS of which machines are costing you the most, which ones are not being utilised to their full potential or if any are being abused and GIVES YOU THE CHOICE to manage your print and CONTROL YOUR PRINT COSTS. (*Usually worth ÂŁ600.00)

Olivetti UK Agency

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01933 420565

or email: admin@olivettiagency.uk

www.olivetti.com

PRINT MANAGEMENT SOLUTION