Health Business 20.1 by PSI Media

ISSUE 20.1 www.healthbusinessuk.net

RECRUITMENT

CYBER SECURITY

GS1 STANDARDS

FIRE SAFETY

PARKING

PROVIDING IMPROVED CARE

FAIR FOR ALL? HOSPITAL PARKING

Analysing the potential of Global Location Numbers to drive transformational change in our hospitals

Our panel of experts assess the latest changes in hospital parking, including free parking for the patients most at need

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ISSUE 20.1 www.healthbusinessuk.net

RECRUITMENT

CYBER SECURITY

FIRE SAFETY

PARKING

GS1 STANDARDS

PROVIDING IMPROVED CARE

FAIR FOR ALL? HOSPITAL PARKING

Analysing the potential of Global Location Numbers to drive transformational change in our hospitals

Our panel of experts assess the latest changes in hospital parking, including free parking for the patients most at need

Does free parking mean fair parking? At the start of the year, Health Secretary Matt Hancock announced that thousands of NHS patients and visitors in England will soon be able to access free hospital car parking under a new DHSC approach.

PLUS: CLOUD TECHNOLOGY | DIGITAL HEALTH | FACILITIES MANAGEMENT

From April, all 206 hospital trusts in England will be expected to provide free car parking to disabled people, frequent outpatient attenders, parents of sick children staying overnight and staff working night shifts. The issue of free parking has been a constant one for decades, with NHS trusts in England responsible for making their own car parking arrangements, including setting any charges. But it is by no means the only issue facing the industry. Our Expert Panel, comprising of Dave Smith, Stewart Clure, Grahame Rose and Simon Jarvis, discuss the Queen’s Speech announcement and the other problems with hospital parking in our piece on page 24. Additionally, Kelvin Reynolds writes on page 31 about why fair for all, but not free for all, may be the best solution to hospital parking.

Follow and interact with us on Twitter: @HealthBusiness_

Elsewhere, Cancer Research UK has warned that the 2030 smoke-free target is set to be missed by at least seven years. Surely Hancock must make changes to public health funding before ambitious targets become completely unachievable. Michael Lyons, editor

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Issue 20.1 | HEALTH BUSINESS MAGAZINE

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Contents

Contents Health Business 20.1 07 News

47 GS1 standards

All adults to be automatically enrolled as organ donors; expensive visa fees could deter NHS staff; and service cuts prompting worries for health visitors

Glen Hodgson, head of Healthcare at GS1 UK, looks at the current state of the eProcurement strategy and asks where the GLN sector is heading over the next few years

15 Facilities management 31 41

On behalf of the Institute of Workplace and Facilities Management (IWFM), Preston Gan asks whether the current state of facilities management in the NHS is ready for the investment of IoT, Big Data and AI

19 Fire safety Dr David Gold and Neil Vincer, from IOSH, discuss how organisations can ensure that a sustainable workplace fire safety culture is incorporated to all staff in a hospital setting

24 Expert panel: Parking

In our second Health Business Panel of Experts on parking we are joined by representatives from Debt Recovery Plus, GroupNexus, WPS Parking and the British Parking Association to discuss the ongoing issues relating to hospital parking

31 Parking Kelvin Reynolds, director of Corporate and Public Affairs for the British Parking Association, explains why fair for all, but not free for all, may be the best solution to hospital parking

36 Recruitment 56

Neal Suchak, policy advisor at the Recruitment and Employment Confederation, analyses the importance of a healthy, transparent recruitment supply chain and the benefits of co-operation in NHS recruitment

41 Catering

Over the last few years, Food for Life has researched intergenerational activity and support for care settings for the elderly. Here, Florence Todd Fordham shares some of the findings

Health Business magazine

53 Technology Barbara Harpham, chair of the Medical Technology Group, considers the mechanisms designed to promote the adoption of innovation by the NHS, and asks whether - at last - we may be making some progress

56 Cyber security Sascha Giese, Head Geekâ&#x201E;˘ at SolarWinds, discusses the failings of legacy NHS technology and how cyber security is vital for the well-being of the health service

61 Digital Health Rewired

READ MORE https://tinyurl.com/r3v5sxg

Issue 20.1 | HEALTH BUSINESS MAGAZINE

Putting the Patient Front and Centre

ISS Healthcare is fully supporting the current NHS Food Review and has recently published its fully updated ‘Great Food & Beverage Services Guide’ designed specifically around the patient, reflecting the current advice on allergens, the new modified texture diet standards and why nutrition and hydration is so important when staying in hospital. When it comes to putting the patient first, you can depend upon ISS. ISS - the First in Innovation

Enquiries@uk.issworld.com

Facilities management

Facilities management and increasing IoT investment On behalf of the Institute of Workplace and Facilities Management (IWFM), Preston Gan asks whether the current state of facilities management in the NHS is ready for the investment of IoT, Big Data and AI

Whether as a patient or as an individual helping our loved ones, families and friends, most of our real-life experience with the current use of technology and information systems used in health and care is not always as positive. As an example, the lack of information about a person residing in a particular region or area is not available because their records are stored somewhere else in the country. Or a person with multiple complex problems often has to repeat the same information many times to different people, as every organisation and professional works with a different system, and a different record. Or, elsewhere, existing systems having multiple logins often creating frustration for staff to do their jobs, leaving people confused and disappointed. Digital technology should be one of the key enablers, rather than a barrier, to delivering excellent care. The role of technology today has fundamentally changed the way we live and manage our daily lives. Increased technological advances has provided us with greater choices and more control than ever before; whether from how we communicate with each other, the way we travel, shop

To gain a basic understanding of the three elements, IoT is the idea of connecting any physical devices or objects to the internet and to other connected devices. This could mean an extraordinary number of ‘things’ of all shapes and sizes that allow us to connect, collect critical data, analyse and then react to data based on real-time information to enhance performance and prevent losses - most without any type of human input. To explain the relationship between IoT, Big Data and AI, these connected devices trigger a massive inflow of the different types of ‘Big Data’. Three classifications of data are normally associated with Big Data. Structured data, often categorised as quantitative data, is what most of us are used to working with, data that fits neatly into fixed fields and columns such as databases, spreadsheets CRM or ERP systems, that is often the easiest to search and organise. A much bigger percentage of all data in our world is unstructured data. Unstructured data that is Is facilit ies most often categorised as manag e qualitative data, which m e nt in the NH cannot be processed S r e the inve ady for and analysed using conventional such as IoT, Big stment of text, audio, video, photos, D a AI in its ta and social media content, and and pay for things, the curr satellite imagery, which way we bank, how we state? ent is difficult to deconstruct. manage our well-being The third classification of ‘on the move’ to how data beyond structured and healthcare is delivered and unstructured is semi-structured how we access healthcare services. data which is a mix of both that contains There is certainly recognition that digital metadata, making it easier to organise. But technology is critical to transforming health there is still flexibility in the data such as and social care services so that care can email messages or a digital photograph. become more person-centred, creating There is no doubt that it will be immensely a positive impact on patient outcomes difficult to comprehend the vast amount and patients can be more empowered to of unstructured data gathered from the participate more fully in their own care. millions of sensors via IoT devices and the complexity to process on a real time basis. Relationship between IoT, Big However, once the raw input is cleaned, Data and artificial intelligence structured and integrated well enough to The growth and the convergence of the become useful, artificial intelligence will use ‘Internet of Things’ (IoT) with ‘Big Data’ that processed data to build its intelligence and artificial intelligence has opened with the necessary learning algorithms to up a world of possibilities in medicine produce your desired output. In essence, you that will help healthcare professionals can say that IoT is the senses, Big Data is the realise the anticipated benefits that fuel and artificial intelligence is the brain to enhances the workplace to manage and realise the future of a smart connected world. alleviate the clinical burnout that affects As an example for patients, devices in the a significant proportion of clinicians, form of wearables, like fitness bands and allowing them to focus on the core other wirelessly connected devices like blood tasks, giving them more time to care for pressure and heart rate monitoring cuffs, E patients and improve clinical outcomes. Issue 20.1 | HEALTH BUSINESS MAGAZINE

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Utilising the benefits of technology How do facilities managers working within the healthcare built environment utilise the benefits of IoT to enhance the workplace and support our health professionals in providing the best care possible to our patients? It needs to be understood that real estate for most organisations represents the second highest expense after human resources. Therefore, facilities managers have a direct impact on the productivity on any organisation’s most important asset, their employees. The acceleration of IoT is certainly creating new possibilities for FM by allowing the evolution of intelligent and integrated buildings. IoT data and analytics allow facilities managers to understand what is happening within every aspect of a building, understand how people are using it and oversee the operations undergoing in an automated building environment which will help facilities managers meet demands and drive efficiencies. The combination of information technology (IT) and operational technology (OT), such as Building Management Systems (BMS), lighting controls, energy monitoring, security and safety systems, transportation for the built environment will provide a digital health care infrastructure with the required connectivity and intelligence, smart controls with the ability to manage, automate and optimise resources and equipment effectively along with the capability to utilise cloud-based digital services. Patient experience and satisfaction is paramount within healthcare facilities and will only grow in its importance as patients are offered more choices. For example, by using an app installed on their smartphone via environmental sensors, patients can create their own optimal healing environment through individual control over their room temperature, humidity levels and lighting rather than calling on nurses to perform these basic tasks. In turn, this frees nurses up to spend more time on clinical tasks that will improve patient care. Patient safety presents another top concern. Uninterrupted access to power can mean the difference between life and death. Hospitals

need constant, reliable power to feed medical devices. IoT-enabled power management solutions such as electrical panels, connected power meters and power monitoring software can ensure reliable electrical power to critical areas, identify potential issues before a failure occurs, reduce operating theatre downtime and automatically test emergency power supply systems. IoT across the NHS estate Apart from monitoring patient health, there are many other areas where IoT devices are very useful in hospitals. IoT devices tagged with sensors are used for tracking real time location of medical equipment like wheelchairs, defibrillators, nebulisers, oxygen pumps and other monitoring equipment. Deployment of medical staff at different locations can also be analysed real time. As an example, NHS Highland’s Caithness General Hospital in Wick began a trial system to automate the process of bed maintenance through the use of sensors to monitor the status of medical beds and improve access to maintenance data. Keeping tracks of beds which require monthly maintenance checks creates significant administrative burden on staff. The Bluetooth tags and centralised dashboard with real time data make it easy to find the beds and access up-to-date maintenance records, enabling smarter, more informed decisions to be made. Another example is the transition from Planned Preventative Maintenance (PPM) to Predictive Maintenance where current practices in preventative maintenance seeks to decrease the likelihood of an asset‘s failure through the performance of regular maintenance. Predictive maintenance relies on data to determine an asset’s likelihood of failure before that failure occurs based on condition of the asset and reasonable estimates about how it is used (such as expected operating times). This allow facilities managers to move from a repair to replace model to a predict and fix maintenance model using analysis which relies on data, statistics, machine learning, and AI modelling to make future predictions to improve maintenance and production efficiency. Moving with the times Is facilities management in the NHS ready for the investment of IoT, Big Data and AI in its current state? And how can we move ahead with the times? The facts are clear. The majority of the NHS estate has passed its ‘sell-by’ date with ageing infrastructure, facilities and equipment that are no longer compliant with statutory safety standards. The total NHS’s backlog maintenance bill is estimated at around £6.5 billion. In my view, I believe this presents a significant opportunity for facilities managers within healthcare across the country to make a difference. Within individual NHS organisations, there could be multiple existing systems associated with facilities management to manage. Perhaps the first initial step is to review and consider which systems or applications are the most essential to retain, which of

these are core that is required across the FM environment or specialist, only across a number of FM functions which tend to be single purpose use. Conduct a mapping exercise and cross examine your systems to identify whether there are opportunities for integration, maintain and optimise or potential elimination of others. Do your systems have open protocol?; are they scalable and flexible enough to incorporate the implementation of IoT without the need for further investment of ‘another’ system? and do we have the right digital infrastructure and governance to support the rollout? If there is an appetite to consider the investment of IoT, we need to understand what problems we are trying to solve. Understanding your final goal before you start is perhaps the most critical. Identify the quick wins to get the tangible return on investment; will it save on labour costs, resources, increased energy efficiency which you can trade off with the savings made to implement IoT? Perhaps an initial IoT project that could be as small as a wireless device added to an existing meter to collect data, makes it easier for facilities staff to get used to understanding data and make informed decisions based on that data. Or pilot an office space that has minimal impact and risks to patients and office staff by installing environmental sensors with an aim to improve indoor environmental monitoring to improve employee well-being and productivity. L

Facilities management

 glucometer, healthcare apps etc. give patients access to personalised attention and real time health data. These devices can be tuned to remind calorie count, exercise check, appointments, blood pressure variations and much more providing patients with actionable insights that will eventually improve the quality and health care they experience. For clinicians, using wearables and other remote home monitoring equipment embedded with IoT, allows them to keep track of patients’ health more effectively, reducing the length of hospital stay and prevents readmissions, monitor patients’ adherence to treatment plans or any need for immediate medical attention. IoT enables healthcare professionals to be more watchful and connect with the patients proactively, thereby increased satisfaction due to enhanced patient experience and engagement.

Preston Gan is head of Business Services and Performance at NHS Grampian. He is charged with driving transformational change through the delivery of strategic and operational facilities management. He develops the ‘Informed Client Function’ to enable FM alignment and meet organisation’s business strategy and performance goals. With over 11 years of FM experience in healthcare, Preston has won multiple industry awards with the most recent ‘FM Professional of the Year’ by IWFM. FURTHER INFORMATION www.iwfm.org.uk

Preston Gan, Head of Business Services and Performance, NHS Grampian

Issue 20.1 | HEALTH BUSINESS MAGAZINE

Advertisement Feature Written by Neil Ashdown CertFDI, FSIDip

Fire resisting doors in healthcare premises: Essential to fire safety but difficult to manage? The greatest consideration regarding fire safety in healthcare premises is clearly safety of relevant persons. In the event of a serious fire, progressive evacuation in stages to safe places would be necessary in keeping people away from the effects of fire and smoke. Therefore the building’s 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 fire doors that divide the building into a series of compartments to keep the fire in the room or compartment where it started thus maintaining safety for occupants 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 wall, they restrict fire and smoke spreading they also have to function in spite of heavy use and in communal areas, opening and closing possibly hundreds of times each day. Add to that the likelihood of damage and the sheer number of them, it is easy to see how managing maintenance to a standard where older doors can meet the required fire and smoke ratings can be so challenging. Fire door strategy At any large or complex building it will be necessary to have an efficient inspection and maintenance regime for fire doors. None more so than in high rise residential buildings. Maintaining fire doors could be seen as something akin to painting the Forth Bridge so first it is necessary examine the fire strategy to see which fire doors are most critical in providing protection to enable safe progressive 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 building’s fire safety requirements. The

entrance doors to individual flats and those that protect escape routes and protect areas providing refuge are the most critical, the maintenance regime should take account of that. In other words there should be a fire door hierarchy starting with doors critical to the fire strategy all the way down to doors that although marked with the blue signs may not when aligned to the fire strategy be as necessary to safety. Dealing with fire safety is ‘risk-based’ so the fire risk assessment should identify fire doors that are vital. Fire door maintenance Fire doors should be inspected at suitable intervals and maintained in efficient working order. The majority of fire doors are made from timber therefore repairs and maintenance can be carried out by competent carpenters. However, fire doors are different from ordinary doors especially regarding working tolerances, glazing, seals and ironmongery 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 codes of practices and guidance for hardware, seals and glazing. Housing maintenance departments should therefore ensure that repairs, maintenance and new fire door installation work complies with necessary standards. Training for fire door installation and maintenance teams Those carrying out installation and maintenance works should have the necessary skills and competence. Dedicated fire door installation and maintenance training can help operatives and their managers to understand the

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS | www.healthbusinessuk.net

requirements for timber based fire doors so that maintenance work and new installations can be carried out to meet the relevant standards. Fire Doors Complete Limited provides training courses both at its fire door training centre in Queniborough, near Leicester, and via remote learning courses. We can also provide the training at the clients own premises, so long as suitable facilities are available. Delegates can benefit by understanding more about the legislative requirements and standards that cover installation and maintenance. They can also find out how to access many useful fire door resources that will help them to select suitable products that can help maintain the service life of fire doors and help to protect doors from damage. 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 should meet the demands of the door’s location. Maintenance teams that have the knowledge and resources to procure the most suitable products will be able to reduce costs in the long run. In summary Valuable resources can be better targeted by ensuring that maintenance addresses those 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 skills and training and that specifications for new doors take full account of durability requirements as well as the fire and cold smoke performance.

Neil Ashdown is managing director of Fire Doors Complete Limited, providers of fire door inspection, training and consultancy services. L FURTHER INFORMATION www.firedoorscomplete.com

Fire safety

Building a fire safety culture in health facilities Dr David Gold and Neil Vincer, from IOSH, discuss how organisations can ensure that a sustainable workplace fire safety culture is incorporated to all staff in a hospital setting Health care workers play a vital role in todayâ&#x20AC;&#x2122;s society, especially considering the ageing populations in many countries that need or will need care either in health care facilities or at home. All members of the health care profession should continually work in a safe and healthy environment carrying out practices that do not put them at risk of injury or ill health. A previous article in this journal examined several of the risks health care professionals face and described measure to eliminate or mitigate those risks. Occupational safety and health promotes the concept of a safety culture. A safety culture exists when workers throughout an organisation not only continually look out for their personal safety and health, but also look out for the safety and health of others including their co-workers. The concept of a safety culture embraces positive values, including attitudes and knowledge. Professionals working in the health care field, by the nature of their profession and their duty of care, extend the safety

culture to protect their patients, some of whom cannot look after themselves, especially during an emergency situation. The American Bureau of Shipping (ABS) proposes eight categories of leading indicators of a safety culture. The following are leading indicators, adapted from the ABS publication, that fall under the eight categories: A Communication about fire safety The organisation: develops means of communication including the provision of information sheets, newsletters, and toolbox talks, in local languages regarding incidents and

lessons learned about fire safety; includes adequate fire safety information as part of new employee induction providing; and shares with employees, contractors and visitors policies, goals, directives and standards addressing fire safety.

Empowerment The organisation: involves all workers and contractors in fire s culture afety safety; and develops and exists w promotes for all workers hen worker means to bring fire s n o t only continu safety to their home. a

for their lly look out p and he ersonal safety look ou alth, but also t for th and he e safety alt of othe h rs

Feedback The organisation: documents the presence and use of a fire safety worker feedback mechanism; and ensures that information about fire-related risks, incidents, and near misses are communicated to workers. E

Issue 20.1 | HEALTH BUSINESS MAGAZINE

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î &#x2020; Mutual trust The organisation establishes a fair system for fire-related incident investigation. Problem identification The organisation: puts in place and maintains a policy mandating fire safety procedures and instructions with specific information on job-specific fire safety; establishes and maintains a policy and procedures for reporting unsafe fire-related conditions and actions; and ensures that fire safetyrelated checklists are regularly updated. Promotion of safety The organisation: has fire safety-related safety goals and objectives; has a procedure making all fire-related incident investigation findings available to workers; and requires senior management attend meetings related to fire safety. Responsiveness The organisation: regularly implements fire training programmes for different category of emergencies; puts in place and maintains an organisational-wide effort to continually promote fire safety awareness; and puts in place and maintains training programmes for assessing risks related to fire. Safety awareness The organisation provides fire safety awareness training and puts in place procedures to document the training. Management of health care facilities, whether public or private, has an upstream responsibility, a duty of care, to ensure all aspects of safety, health and fire safety are addressed and reinforced for health care professionals, patients, visitors, contractors and others visiting the facility.

For example, bedding is common in a health care environment, and is a source of fuel. Oxygen is ever present, and may be more concentrated around some patients, but the risk of fire is minimal if there are no sources of heat. Therefore bedding, either laundered or soiled, should always be stored away from sources of heat. In health care facilities areas, such as laundries, laboratories, pharmacies, heating plants and waste disposal areas may have elevated fire risks as the potential for the combination of fuel and heath may be elevated. Even health care facilities that may be designated smoke free campuses may be at risk from ignition from open flames such as cigarette lighters, matches or discarded cigarettes due to a perceived urgent need to smoke by staff, patients, visitors or contractors who will try to find an area where they can smoke unobserved. Health care facilities may also have flammable and combustible liquids or gases in different areas of the facility. Laboratories, operating theatres and casualty, maintenance areas, pharmacies as well as supply areas may stock certain products that when exposed to heat may ignite. Also shipping and receiving areas may have combustible waste that needs to be disposed of. The basic philosophy which needs to be vigilantly followed is to keep heat, fuel and oxygen apart.

Fire protection Fire protection in health care facilities includes what is needed to protect the patient, workers, visitors and others from the danger of fire. This includes, but is not limited to: the preparation and keeping upto-date a number of required and essential documents; systems to detect smoke or heat; automatic fire suppression systems such as automatic sprinkler systems; mechanisms to notify the local emergency services that an alarm has been activated; systems to notify staff, patients, visitors and others to evacuate; a system of designated primary and secondary emergency escape routes from all areas of the building; designated external emergency assembly areas; a system to account for evacuated patients, staff, visitors and others; mechanisms to provide continuity of care during an evacuation including agreements with other facilities to provide shelter as necessary; staff training on evacuating patients; regular drills and exercises involving the local emergency services; fire related doors including selfclosing mechanisms to limit the spread of smoke and fire by-products; stairways that are protected from smoke; and a compilation of safety data sheets that is readily available and describes the properties of hazardous substances used in the facility. Although the 14 above-mentioned points are examples of essential fire protection elements, it would take more than a journal article to provide detailed information on each one. We would, however, like to call your attention to a few.

Fire safety

Management of health care facilities has an upstream responsibility, a duty of care, to ensure all aspects of safety, health and fire safety are addressed and reinforced for health care professionals, patients, visitors, contractors and others visiting the facility

Evacuation It is essential that there are designated emergency escape routes from all areas of the facility to a place of safety. These routes need to be clearly marked, continually unobstructed, well lit, and unlocked. E

Fire prevention What managers need to consider about fire prevention is keeping apart the three elements that when combined in the right proportions can create fire or explosions. The three elements are heat (also known as source of ignition), fuel (also known as combustible or flammable materials in solid, liquid or gas form) and oxygen (bearing in mind the level of oxygen we need to breathe is the same level that supports fire). An essential element of fire risk assessment, if properly done by an appropriately trained competent person identifies, assesses and proposes control measures to either eliminate or control the risk and follows up where and when these elements, in combination, may increase the risk of fire.

Issue 20.1 | HEALTH BUSINESS MAGAZINE

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Audit Trail

î &#x2020; In consultation with the local fire service, the emergency action plan may call for a phased evacuation, not evacuating all patients and staff at once. In some facilities there are designated areas of refuge (with specific engineering criteria) where evacuees wait for assistance from the emergency services. An emergency escape route may be part of a normal passageway. Often times the secondary emergency escape routes may be passageways and doors that are not in constant use. In some locations, during the winter season, the doors leading outside may be obstructed by snow. It is essential that all designated escape routes are regularly inspected by a designated person and are continually unobstructed. Evacuation in a health care facility includes both ambulatory and non-ambulatory patients, although during a fire emergency, ambulatory patients may become non-ambulatory due to fear or stress. Moving non-ambulatory patients in beds may not be feasible. In a number of facilities an evacuation sheet is used. It is essential, however, that health care facility staff are trained in how to evacuate a patient using a drag sheet or other evacuation mechanisms that the facility uses. Accountability Patients, staff, visitors and others need to be accounted for once outside of the building. A means of accounting for who is missing needs to be set up and described in the emergency action plan. There also needs to be a means of rapidly informing the responding emergency service who is not accounted for and where and when they were last seen. This will greatly influence the search and rescue strategy of the emergency service. Planning Planning for fires and other emergencies needs to be done in advance. As essential documents are drafted, proposed measures need to be tested and revisited as necessary. When new procedures are designed and implemented and new equipment, materials and products are brought into the facility, plans need to be re-examined and adjusted as necessary. Desk top exercises and evacuation drills are essential means for determining whether plans are effective.

Key to successful emergency planning is the training and education of all staff including hands-on practical training so that their respective roles in a fire and evacuation become second nature. It is also a good practice to provide all staff, during induction, a thorough briefing on fire safety and regular refresher training. Visitors, contractors and others should also be provided information about fire safety when they work in or visit the facility. Essential documents This article suggest three essential documents that should be continually reviewed and updated as necessary. The three documents are the fire risk assessment, the emergency action plan and the fire prevention plan. All documents should be drafted in concert with the local emergency services and should be reviewed with these services before finalised. The fire risk assessment According to the publication Fire Safety Risk Assessment: Health care premises and the (UK) Health and Safety Executive, there are five steps for carrying out a risk assessment: identify fire hazards; identify people at risk; evaluate, remove, reduce and protect from risk; record, plan, inform, instruct and train; and review. The Fire Safety Risk Assessment: Health care premises publication goes into further guidance of what needs to be considered on the following topics: fire risks and preventative measures; fire-detection and warning systems; firefighting equipment and facilities; escape routes and strategies; emergency escape lighting; signs and notices; recording, planning, informing; and instructing and training. Strong consideration should also be given to who is carrying out the risk assessment for the facility. Criteria for the competencies of fire risk assessors can be found in the following document: https://www.london-fire. gov.uk/media/1106/guidance-choosinga-competent-fire-risk-assessor-2.pdf. The emergency action plan An emergency action plan is based on a risk assessment, carried out by a competent risk assessor. Partially based on a document from

Fire safety

the (US) Occupational Safety and Health Administration (OSHA) an Emergency Action Plan must contain the following elements: a description of types of emergencies that could occur to the facility; means of reporting fires and other emergencies; levels of emergencies and criteria for escalation; evacuation procedures and emergency escape route assignments; procedures for staff who remain in order to assist patients and others or shut down critical functions before they evacuate; procedures for accounting for all patients, employees and visitors after an emergency evacuation has been completed; rescue and medical duties for employees performing them; names or job titles of persons who can be contacted; agreements with emergency services; agreements with other facilities to accept evacuated patients; and timing for the regular review of the emergency action plan. The Fire Prevention Plan A number of organisations also publish a fire prevention plan. It is based on the fire risk assessment and includes a description of sources of fuel and sources of ignition at the facility that could cause or contribute to the spread of fire. The plan also describes alarm systems and fire extinguishing systems. The plan should also describe protection dealing with the detection, the outbreak and the spread of fire. Based on HSE guidance the plan should also provide clear instructions on eliminating or controlling sources of heat, diminish the amount of combustible or flammable materials. The plan should describe measures to: avoid or control sources of ignition; eliminate or minimise combustible or flammable materials; separate sources of heat from fuel; detect fires and raise the alarm; minimise the spread of fire, smoke, or bi-products of fire; and take action on discovering a fire or when a fire alarm is activated. Even in the most up-to-date health care facility with the most modern fire safety equipment, fires can and do occur. It is essential that fires are prevented and that we do everything that is reasonably practicable to protect ourselves, workers, patients, visitors, contractors and others from the dangers of fire. Empowering the health care professional and other staff with information and training on preventing fires and procedures should a fire occur will help build a culture of fire safety in the organisation. A clearly demonstrated commitment by senior management has also been proven to further strengthen this culture. Everyone needs to understand the risks of fire and the means to either eliminate the risk or mitigate it to an acceptable level. L

Dr David Gold, CFIOSH, is vice president of the Institution of Occupational Safety and Health (IOSH) and former chair of the IOSH Fire Risk Management Group. Neil Vincer, CMIOSH is the current chair. FURTHER INFORMATION www.iosh.com

Issue 20.1 | HEALTH BUSINESS MAGAZINE

Panel of Experts

EXPERT PANEL PARKING In our second Health Business Expert Panel on parking we are joined by representatives from Debt Recovery Plus, GroupNexus, WPS Parking and the British Parking Association to discuss the ongoing issues relating to hospital parking

Dave Smith, BPA

Stewart Clure, Debt Recovery Plus

Grahame Rose, GroupNexus

Simon Jarvis, WPS

Dave leads the Public Affairs and Communications Team at the British Parking Association to promote, develop and maintain relationships with politicians, stakeholders and the media. Dave developed the BPA’s current communications strategy, to help raise the profile of the association with all key audiences including members, stakeholders, media and public.

Stewart joined Debt Recovery Plus in 2015, having previously spent five years working in the private parking sector. Through his experience of working with clients on retail, commercial, NHS and various other sites, Stewart was able to bring his knowledge of the industry to DRP. Since graduating from Leeds University with a 2:1 in Maths, Stewart worked on the Barclays Graduate Scheme before ending up at Savills.

Grahame joined CP Plus in 1995. Coming from a small business background his ‘hands on’, service orientated approach fitted in perfectly with the business outlook. He has been instrumental in the creation of GroupNexus, from a company that managed 28 sites when he joined to its current portfolio of over 1,200. Grahame is a Board Member of the BPA, regularly speaking at industry events.

Simon Jarvis is the UK Managing Director for WPS, a global leader in parking systems for over 25 years, with a long-held reputation for engineering excellence and providing the industry’s most reliable solutions. It is part of Dynniq, a dynamic, high-tech and innovative company with a comprehensive knowledge of managing mobility, parking and energy using advanced systems engineering.

At the start of December last year, data from the Press Association revealed that a third of hospitals in England put up car parking charges in the previous 12 months, with total income rising by 10 per cent. Freedom of information data from more than 140 NHS trusts showed that £254 million had been raised during 2018-19, an increase from £232 million the year before, with hourly charges varying between £4 and £1 for an hour. As well as highlighting fee increases, the Press Association survey also indicated dissatisfaction with hospital parking charges, with the poll of more than 7,800 people finding that 86 per cent

of respondents felt that parking added to the stress of their hospital visit. Free hospital parking In the same month, the Queen’s Speech announced that hospital car parking charges would be removed for those in greatest need, benefiting thousands of patients up and down the country. Health Secretary Matt Hancock said that disabled people, frequent outpatient attenders, parents of sick children staying overnight and staff working night shifts will not have to pay for NHS car parking from April 2020. Furthermore, the government will also consider car parking

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capacity across the country, and how improved technology will reduce burdens for hospitals and take away stress for visitors. It means that all 206 hospital trusts in England will be expected to provide free car parking to groups that may be frequent hospital visitors, or those disproportionately impacted by daily or hourly charges for parking. As before, any profits from remaining car parking charges must be reinvested into frontline care. The British Parking Association is supporting the government in developing the proposals, reiterating their desire to help them devise and deliver a solution which helps to make

WPS were recently criticised by the Green Party for helping a local authority customer to realise a free parking validation scheme to support local retailers because they believed it would encourage people to drive into town. Supply versus demand We all know that parking space availability is limited – if parking is free, it is likely that demand will increase which is likely to increase congestion and make finding a space far more difficult. How do we control this if parking becomes free to all or many? Using Scotland as an example, Jarvis claims that free hospital parking is attractive to shoppers and commuters, with cases documented of people leaving their cars in hospital car parks while they fly off on holiday! On the issue of demand, there is no denying that hospitals are always over-subscribed in terms of their parking capacity, and also worth noting that the NHS has more special requirements and considerations than most organisations offering car parking facilities. However, the problem of abuse by motorists that have no business at a hospital has largely been solved by the introduction of parking systems, whether this is barriers or enforcement via ANPR. Demand will always outweigh supply in terms of spaces, because hospital parking is not an unlimited resource and users are continuing to grow. Stewart Clure says that there are various ways to manage the

The Speech d ’s n e e e Qu nnounc r a y l t n e a rec spital c that ho harges will c parking moved for be re greatest those ineed n

staff usage and control dwell times and through close management and flexibility, issues and errors can be controlled. Dave Smith highlights the statistic that approximately 64 per cent of all journeys involve a car at some point and an average of 39 million parking acts every day. It is widely considered that promoting sustainable travel will contribute to reducing demand. Choosing an appropriate management system is important too. Proper and effective parking management is essential in our modern society - without it, we all suffer. Grahame Rose says that GroupNexus works with clients across the UK to bring innovation to this problem, from intuitive, flexible car sharing apps to offsite parking, with car share or shuttles.

Panel of Experts

hospital parking better for everyone. The association’s Dave Smith says that, whilst he believes it is wrong that healthcare budgets should be used to provide parking facilities for those who choose to drive to hospital, the BPA also thinks there should be exceptions, particularly where there is no alternative and especially where long term or vulnerable patients are concerned. That is a viewpoint shared by our panellists, with Stewart Clure saying that the move is a ‘much needed boost to hospital visitors’. However, the age-old argument remains, with the opinion of our experts all leaning towards there being no such thing as free parking. The NHS receives a steady revenue stream from their parking provisions which helps to support other NHS funded services. Without this income, says Clure, other services would inevitably have to be sacrificed. Grahame Rose agrees, stating that if there were no charges, the costs of car park maintenance, equipment and management would all have to be taken from the healthcare budget. There are numerous estimates but it’s sometimes quoted at £2 million/annum. Rose also highlights that, when it comes to free parking, people who use public transport or taxis don’t get their fares paid. Aside from the cost argument, Simon Jarvis of WPS points to the environmental and demand issues. In all other forms of parking, charging forms part of a green transport plan which discourages people seeing cars as the default mode of transport. Indeed,

Recent parking measures and future plans The Conservative success in December’s General Election means that the country is now likely to face another five years of Tory-rule. Given the Queen’s Speech announcement, the way in which parking has become and emotive issue and the prominence of parking in party manifestos, it is important to question how the parking landscape in hospitals has changed since 2010. We have seen more NHS sites implement parking enforcement during the last 10 years, which is now seen as a necessary evil. Stewart Clure, of Debt Recovery Plus, says that whilst some NHS trusts used to think of enforcement as a dirty word, it is now often one of the most talked about hot topics at any NHS site. The reason for more trusts taking up operator services is simply because the industry has strengthened during the last 10 years, with the introduction of POFA, E

Issue 20.1 | HEALTH BUSINESS MAGAZINE

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Debt recovery services for the private parking industry Debt Recovery Plus (DRP) is the leading provider of debt recovery services to the private parking industry, providing debt recovery and back office solutions to 90 per cent of the industry, handling over 120,000 unpaid parking charges each month

Based in a call centre environment we have a core telephony team who can handle incoming and outgoing calls to motorists to help resolve any issues, answer questions and ultimately settle any unpaid parking charges. We can handle client payments 24/7 via our web/automated services along with our dedicated team of advisers. Debt Recovery Plus have been the chosen provider of debt recovery services to the leading parking operators for over 10 years, helping our clients to grow along the way. By working closely with the operators, we have helped to strengthen the parking industry through educating and challenging each other with new ideas.

Delivering a one stop enforcement solution Recently Debt Recovery Plus became part of the Bristow & Sutor Group, who are one of the largest providers of debt recovery to the public parking sector. Together with B&S our aim is to deliver a one stop enforcement solution to all our clients. With over 40 years of enforcement experience within the group we can offer our clients advice based upon our knowledge of both industries along with tried and tested solutions to help our clients maximise revenue recovery whilst protecting their data. Data reports At DRP we know how important each and everyone of our clientâ&#x20AC;&#x2122;s parking charge notices are, which is why we employ client specific teams to analyse the data and report back on any trends, unfamiliar patterns and unusual cases. This helps our clients and landowners to identify persistent offenders and review their parking management strategy to ensure that they are offering their client a suitable solution.

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At DRP we create bespoke recovery strategies for all our clients, which helps them to deliver an educated recovery model designed specifically for the industry which they are working. We can provide recovery for clients on Commercial, Residential, Retail, Rail, Airport and NHS sites. Our aim is to deliver an ethical approach to debt recovery to help our clients capture any unpaid parking charges whilst at the same time allowing the motorist an opportunity to discuss their case. Within our group our priority is our clientâ&#x20AC;&#x2122;s data, when making any decisions on strategy, reporting or collecting on a case Compliance is our first thought. When GDPR was introduced we decided as a group to implement a GDPR team at both of our offices. Our GDPR teams implement compliant processes and practices at each office along with helping our clients with any GDPR questions which they may encounter along the way. L FURTHER INFORMATION www.debtrecoveryplus.co.uk

When people do not pay Debt Recovery Plus is the leading provider of debt recovery services for the private parking sector in the country, and knows better than most the need to ensure debts are paid and issues resolved as quickly, and with as little disruption to the hospital, as possible. Through close reporting, management and direct relationships between the company and the NHS, Stewart Clure says they can help to identify any issues that may occur and help to work out new ways to improve services. In most situations, whether that be a staff member who has a permit issue or a family member who is visiting a sick relative each day who simply can not afford their parking, it is important to ensure an amicable solution is reached - often helping the motorist to

Panel of Experts

 banning of clamping and towingwhich means that the only legal way to protect their land is to introduce a robust parking management system. In terms of the two largest political parties, the Labour Party has a long standing pledge to remove parking fees altogether in England, following on from the abolishment of parking fees at most NHS hospitals in Scotland and Wales in 2008. The Conservatives meanwhile have more recently launched their car parking pledge to introduce free car parking at hospitals for the two million ‘blue badge’ disabled drivers and passengers, as well as frequent outpatients, gravely ill patients, visitors to relatives in hospital for extended periods, and staff on night shifts who cannot use public transport. Speaking in terms of policy, the Parking (Code of Practice) Act came onto the statute books in March 2019. It’s an enabling Act that provides for the creation of a single Code of Practice regulating private parking firms, and provides for the creation of a single independent appeals service for challenging parking charges. Simon Jarvis says that the real change we are seeing is hospitals’ ability to fund the right approaches to parking. This is impacting their ability to invest in parking solutions which: are simple and stress free for all to use; are considered fair; are efficient to operate; effectively control demand and space occupation; offer very easy ways to apply concessions (which is even more important now); and avoid possible punitive fines wherever possible. This is echoed by Grahame Rose, our representative from CP Plus, who points to the British Parking Association’s Code of Practice, which has been in circulation for many years. Bringing this into legislation – it will be compiled by the British Standards Institute – will change the landscape for parking operators. He says that a single appeals service will also take away any confusion and anomalies that sometimes occur under the current two appeals services (the other is run by the International Parking Community). However, with the free parking for specific groups announcement fresh in the mind, there is no doubt that change over the next ten years may be more dynamic than the ten years just passed.

We all know that parking space availability is limited – if parking is free, it is likely that demand will increase which is likely to increase congestion and make finding a space far more difficult understand the reason for issuing the charge and the consequences of not paying. Dave Smith says that it is important to consider the outcome hospitals wish to achieve, stressing that a good working relationship between hospital, parking operators and debt recovery companies is crucial to ensure that parking enforcement is undertaken fairly and responsibly. Furthermore, every effort should be made to reduce the number of parking charges notices that need to be issued, by ensuring the rules are clear, simple to understand, easy to comply with and, above all, fit for purpose. As Grahame Rose suggests, an appeals decision tree should also be agreed so that appeals are dealt with consistently and fairly. How to help NHS staff It is clear that staff parking continues to be a difficult task, especially for NHS organisations. So, aside from the fair/unfair argument, how can the issue best be solved? Inevitably there will be peak demands and conflicting demands between the priorities of administrators, clinicians, consultants, and facilities teams to name a few. Just how do you determine the priorities? Dave Smith says that the overarching consideration for us all is climate change and the NHS has been vocal about the role it wants to play in helping to reduce emissions. He says that staff parking requires the same solutions as patient and visitor parking. For staff this means being part of a sustainable travel plan, establishing priorities when and where space is insufficient to meet demand and incentives to reduce the

need to travel by car. It’s also sensible to consider working arrangements and shift patterns to determine optimum occupancy. The solution is not necessarily immediately agreeable. Simon Jarvis points to the very innovative work from some of WPS’ healthcare customers in increasing the price of staff parking, making investments in additional capacity and making offsite parking far more practical and financially attractive. On the other hand, GroupNexus argues that it is not sustainable, nor in many cases environmentally acceptable, to keep building spaces sufficient to satisfy the demand for staff parking. The real solution, as suggested by Grahame Rose, is to encourage staff to use other forms of transport, car sharing and park and ride. He does concede, however, that encouraging staff to use other ways of commuting needs to be compelling, perhaps including financial incentives, more flexible working practices and better public transport. Equally, Stewart Clure says that, instead of increasing prices to encourage other modes of transport, NHS staff should receive a discounted rate for parking, often with a designated area for staff only. Alternatively, some operators can subsidise discounts at local contract parking sites for staff in return for a long term contracts. Ultimately, the BPA says that the answer lies in a good working relationship with the NHS trust working in partnership to deliver the outcome they would like to see. L FURTHER INFORMATION www.healthbusinessuk.net

Issue 20.1 | HEALTH BUSINESS MAGAZINE

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Torbay puts trust in WPS’ parking solutions The issue of parking within hospitals is constantly in the news and evokes strong emotions from all sides of the debate. Finding the balance between meeting the cost of delivering a service with providing a customer experience that is sensitive to the environment is no easy task. Convincing employees that parking is not a right, but a privilege, is also a challenge

In the vanguard of industry thinking is Joanne Brimblecombe, the Sustainability and Site Services Lead within the Estates and Facilities Management Division of Torbay Hospital, part of the Torbay & South Devon NHS Foundation Trust. And supporting Joanne and her team in delivering their vision is parking technology specialists, WPS. Jo explains: “Parking should be fair for all not free for all, and we support concessionary parking on our trust site.” Complex site The Torbay Hospital site, while not especially large, is still noticeably complex. The diverse nature of the portfolio required a mix of solutions to be delivered: for the larger car parks, and staff car parks, a Pay on Foot solution is preferred, with barrier controls; for the smaller car parks, typically with a capacity of 20 vehicles or less, Jo has opted for Pay and Display. Jo says: “Department of Health guidance recommends that ‘NHS organisations should consider Pay-on-Exit systems’. This is considered best practice and will improve the patient and visitor experience. Our site does not lend itself to only being able to offer one solution due to car park sizes so an option of both Pay on Foot and Pay and Display has been adopted and WPS has been able to offer Pay-on‑Exit and Pay and Display solutions.” Alongside managing a portfolio of approximately 650 visitor parking spaces, it also had to accommodate large volumes (up to 1,100 spaces) of staff parking. It had to achieve all of this while ensuring vital highways (i.e ‘the blue routes’) were kept clear, so that emergency vehicles would not be held up by vehicles queuing on the surrounding roads.

having reliable systems that are easy to use, and easy to configure to manage concessions and other specific requirements.” The staff parking experience is similarly important: “At Torbay, we provide staff parking, and staff have to pay. They can do so either on a monthly basis, or pay as you go, but in both cases they use their NHS smart card that acts as an ID badge, a payment card, and a card to operate the barrier.” In terms of visitor concessions, Torbay has adopted an innovative approach that gives them total discretion and control. Thanks to the full TCP IP architecture of the WPS ParkAdvance systems installed, concessions can be easily accommodated. Jo explains: “We have three scanners at various reception desks connected over our local network and several hand-held USB devices in the wards simply connected to ward PC’s.” Discretion and control This level of control helps to avoid one of the biggest challenges every hospital faces. On the one hand, revenues are important to meet the cost of managing the parking estate; on the other, a recently bereaved visitor or patient just diagnosed with a serious illness does not need the additional stress of a Penalty Charge Notice.

Customer experience Jo explains: “Parking is the first experience our patients and visitors have of our hospital. It needs to be as smooth, hassle-free and as comfortable as possible, and that means

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Unauthorised and unwanted parking also has to be managed, and abuses minimised. Torbay Hospital manages to achieve the balance it needs, thanks in no small way to the flexibility of the WPS technology. Jo concedes: “WPS technology was not the cheapest solution but offers the right level of technology, reliability, and ease of use. Its Pay on Foot systems have undoubtedly helped us to maximise our parking revenues.” In selecting a parking solution, and an equipment provider, Jo considered various options and suppliers. Among them was a system based on Automatic Number Plate Recognition (ANPR): “We did consider ANPR and there is a place for ANPR in hospital parking, perhaps in the future. But operators who install systems that rely on enforcement and PCNs for their revenues can sit very uncomfortably in a hospital scenario.” Another option considered, was one centred around chip coins: “We looked at chip coins but they are very expensive to replace and easily lost,” she says. “They also need to be hygienically cleaned to prevent the spread of infections.” Jo is excited by what the future holds. She says: “The principal advantage of the WPS technology is that it is effectively future proof. That enables us to think freely and differently about what we want to achieve to enhance the customer experience, knowing that whatever we do, the WPS technology will enable us to do it.” L FURTHER INFORMATION Tel: 0845 094 1543 www.wpsparking.com

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Complete and effective hospital car park management solutions GroupNexus is committed to providing effective hospital car park management while remaining sensitive to patients and visitor’s needs GroupNexus (formerly CP Plus & Ranger Services) provides complete hospital car park management solutions. With over 25 years’ experience, we have a deep knowledge of the healthcare industry, with an excellent track record in delivering high quality parking services to hospitals across the UK. We provide parking expertise with the sensitive approach that is needed at hospital parking locations, working with over 20 NHS trusts at over 40 hospital sites. Parking enforcement is needed to help manage the car parks and prevent abuse but not at the distress of patients or relatives. Therefore, we train our staff to encompass a range of skills suitable for working at our NHS hospital car parks, as well as providing security management and tailor-made CCTV and control centre systems. With the implementation of more advanced technology at our NHS sites, we can expect to see further enhanced security and safety for patients and visitors.

We understand the importance of keeping vital roadways clear, so that emergency vehicles have immediate access when on call, and the need to be aware that users of the car parks may have an emergency or be in a distressed state. Our unrivalled experience brings sector wide knowledge that allows us to advise on concessions, staff permit parking, green transport schemes and more. Our end-to-end services: GroupNexus offers an end-to-end service, from technology that allows you to track, monitor and gather data on car park usage, to setting the standard for the provision of management services. GroupNexus handles installation of ANPR linked car park management systems, barriers, parking permit applications, paid for parking services including machine, cashless and online, concessions, vehicle alerting, user intelligence and on the ground facilities management, parking assistants,

enforcement, security and maintenance. NexusInsights: NexusInsights has a complete range of insight services that can benefit your trust. We get under the skin of each of our client’s sites enabling us to build a bespoke package that provides real and valuable insights into how each facility is being used. The aim of our parking services is to help hospital car parks function in a more logical manner, with patient and visitor needs taken into consideration, enabling the smooth running of vital services. L FURTHER INFORMATION www.groupnexus.co.uk info@groupnexus.co.uk

Issue 20.1 | HEALTH BUSINESS MAGAZINE

Parking

Changes are afoot in parking across trusts in England Kelvin Reynolds, director of Corporate and Public Affairs for the British Parking Association, explains why fair for all, but not free for all, may be the best solution to hospital parking For years newspapers, politicians and parking in hospitals in England: disabled campaigners have told us that paying people; frequent out-patient attenders; for parking at hospitals is a tax on the parents of sick children staying overnight; sick. There have been many attempts and staff working night shifts. to scrap healthcare parking charges in We welcome this more measured England including campaigns by MP’s, approach by government for England, Private Members Bills, charities and which is so much better than the free-forof course trade unions. We absolutely all that has been created in Scotland and understand why, but is it that simple? Wales, and we now sit on the Department Parking facilities at hospitals are usually of Health and Social Care Hospital Car oversubscribed and demand often outstrips Parking Programme Board to support supply. Free parking usually increases them in developing the proposals. This demand too. We have always encouraged Manifesto commitment is easy to say hospitals to consider the outcome they but more challenging to achieve, without wish to achieve when many unintended consequences. Our aim planning their parking is simple: to help the government provision to ensure devise and deliver a solution it is managed which helps to make hospital The NH S for the benefit parking better for everyone. has mo r e of everyone, We know when parking s p e r c equirem ial whether they’re charges were abolished in conside ents and a patient, r visitor or staff. most o ations than Additional offeringrganisations hospitals and car par k their parking f a c i lities ing operators must work together to ensure parking is used properly by those it is intended for and not misused. This all costs money. Where does that come from?

hospitals in Scotland and Wales, patient accessibility didn’t improve; instead spaces were taken by commuters and staff to the detriment of visitors and patients. And where parking isn’t managed properly it spills onto yellow lines, grass verges and nearby residential streets. In some cases, bus companies refused to offer a service because they couldn’t get through. The NHS has more special requirements and considerations than most organisations offering car parking facilities. Besides the obvious emergency services and A&E access, hospitals have the unenviable task of juggling the interests of patients and visitors with the needs of healthcare professionals, who understandably want convenient, safe and affordable parking when they come to work. Keith Fowler, chair of the BPA Healthcare E

Recent exemptions The UK government announced recently that from April 2020 four groups of people will no longer be charged for

Issue 20.1 | HEALTH BUSINESS MAGAZINE

E Q U I P M E N T A N D S O L U T I O N S M A N A G E M E N T, PA R K I N G

All aspects of parking control and enforcement using the latest technology and software on the market Warden Patrol Ticketing Parking Charge Notices have been widely used throughout the UK for many years by local authorities and now, housing associations, managing agents and private land owners can also benefit from this enforcement system.

Pay and Display Machines

(no mains power supply required)

We can supply and install pay and display machines, which take cash or credit card payments. These are battery operated machines with integrated solar panels, therefore no mains power supply is required.

ANPR Ticketing ANPR (Automatic Number Plate Recognition) uses hi-tech CCTV cameras that are monitored using wireless GPRS to automatically issue Parking Charge Notices.

DIY Ticketing This is the enforcement method that puts you in total control and can be tailored to any clients needs, from single to multiple spaces.

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Parking

 Special Interest Group, and head of facilities services at an English NHS trust, said: “Parking is always at a premium. Staff parking is often a cause of anxiety with colleagues wishing to park on site and arrive at work, on time. Clinical services cannot be delayed, and patients must be ready at stated times for appointments. The juggling of priorities is therefore a skill the team responsible for parking must apply when deciding how best to manage parking at healthcare locations.”.” Free at the point of use Like most NHS medical services, some car parks may be free at the point of use but someone, somewhere is paying for their upkeep and maintenance. If they are patrolled to keep them safe someone is paying for that too. This so-called free parking is always paid for - by someone else. Additionally, is free parking fair on those who travel to hospital using public transport and continue to pay? Far from being a tax on the sick, it could be argued that free parking is a subsidy for the motorist… It is imperative the proposal being developed by the government to implement its manifesto commitment of ‘free parking’ is well designed and easy to understand; each of the four key groups, namely, disabled people, parents sick children, frequent outpatients and night-shift staff, need to be well-defined in simple and straightforward

We strongly advise that all hospitals in England who are planning, or about to introduce new ways of controlling parking or new charges, to consider how they manage it for these four groups of people currently language and clearly understood, to minimise confusion and ambiguity. People need to know whether they are included in

the scheme of concessions or not, otherwise complaints and calls for clarity will outweigh any praise precipitating from this policy. We should be learning from the experience of hospitals where some of these concessions already exit and good local implementation plans need to be devised by hospitals and their parking operators to provide solutions that meet local needs. And of course, paramount is a clear public awareness communicated at a national level across England and providing information on who qualifies and what the ‘offer’ is. Additionally, today we strongly advise that all hospitals in England who are planning, or about to introduce new ways of controlling parking or new charges, to consider how they manage it for these four groups of people currently. In a world focused rightly on climate change we also advocate that this ‘Free Parking’ strategy be considered as part of hospitals’ Sustainable Travel Plan. This will demonstrate a commitment to reducing congestion and pollution near hospitals and promote sustainable travel. The government has also said it will consider hospital car parking capacity across the country and how improved technology will reduce burdens for hospitals. This is a much bigger challenge especially as hospital trusts have been under pressure to release surplus land for much needed housing in recent years. Either way, we remain ready to aid and assist government to achieve an outcome that works for everyone. Fair for all, but not free for all. L FURTHER INFORMATION www.britishparking.co.uk

Issue 20.1 | HEALTH BUSINESS MAGAZINE

What happened to Axe the Fax in the NHS? The deadline for Axe the Fax has passed. Health secretary, Matt Hancock has officially banned the NHS from buying fax machines and April 2020 is the deadline for the phasing out of all fax machines throughout the NHS. Matt commented that “because I love the NHS, I want to bring it into the 21st century and use the very best technology available. We’ve got to get the basics right, like having computers that work and getting rid of the archaic fax machines still used across the NHS when everywhere else got rid of them years ago.”

Why is the NHS still using the fax machine? With almost 9,000 fax machines owned by NHS hospital trusts, transitioning away from them is a monumental task. However, it looks like the April deadline will not be met by a large number of NHS Trusts, with research suggesting that just 42% of the fax machines had been removed according to September 2019 figures. The problem with change is that without a suitable replacement process or transition plan, the easiest thing to do is continue as you were. Fax has become an integral part of the healthcare process for decades now, and the move to digital, needs care, planning and training to make the transition effective, whilst delivering the raft of benefits promised by the new technologies. The fax machine has been around for many decades and relies on the conversion of a scanned document into an audio tone which can be transmitted by a phoneline, converted back into a document and then printed out. It is slow, inefficient, wasteful, offering no audit trail and making document sharing difficult.

Why is there so much paperwork in the NHS? Healthcare generates many sources of paper-based information, including documents, x-rays, medical notes and records for patients, as well as policies, reports and regulatory documents. Storing and managing all of this paper based information takes a lot of energy and space, not to mention the time taken to archive and retrieve these documents. Data security is also a great concern, with significant penalties for violation or loss of information, which could result in impacted patient care.

How can we transition away from the use of the fax machine? The implementation of document scanning could help NHS Trusts achieve significant cost savings and improved business processes whilst improving the quality of patient care. Through the scanning and digitisation of documents, paper based information can be converted into a digital system accessed via computers, tablets and even mobile phones. With appropriate document management software, processes can be automated and accelerated, and access to data can be controlled and tracked to ensure the privacy of patient information and to produce more accurate audit trails for compliance. This digital data can be stored off-site in the cloud protected from fire, flood

and theft. Through a document management system, data can be shared and sent instantly saving money and time on faxes, couriers and photocopying whilst reducing the chance of loss and damage.

Key benefits of digitisation include: ■ Centralised storage for documents with enhanced security, access control and instant retrieval. ■ Business process agility leading to productivity gains and cost savings. ■ Enhanced compliance with regulatory guidelines throughout all departments. ■ Faster access to patient information, potentially leading to improved patient outcomes, better patient engagement, and better access to critical information across the care continuum.

How do we digitise paperwork? Fujitsu have a range of scanners, designed with the healthcare industry in mind to aid the transition to digital. Highlight models with their range include the numberone selling fi-7160; a best-in-class scanner designed for high quantity batch scanning and reliable performance. The Fujitsu fi-800R is a perfect desktop solution for GP and hospital reception desks, with a footprint smaller than the size of an A4 sheet of paper and the ability to scan ID and everyday documents. The intuitive ScanSnap iX1500 is an easy to use scanner for improving admin processes and the ScanSnap iX100 ideal for capture in the community. At the higher end of the range are models such as the fi-7900 capable of scanning and processing thousands of patient records a day.

Use of new technology in the NHS is advocated by the UK Government The UK government are now offering support for modernisation in the NHS. Matt Hancock, has announced a new digital aspirant programme, to encourage the whole of the NHS to make use of the latest technology. Matt stated that “We’re going to use digital technology to ease the burden on staff, give people the tools and information to manage their own healthcare, and make sure that patient data can be safely accessed wherever and whenever it’s needed across the system.” “It’s quite simple: better tech means better health and social care.”

Next steps To find out more about Fujitsu scanners and document management systems, please visit http://emea.fujitsu. com/scanners or call 020 8573 4444. The money saved through the investment in improved efficiencies and processes may mean the new investment costs are recouped within a much shorter timeframe than you imagine!

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Recruitment

NHS recruitment: joining the dots Neal Suchak, policy advisor at the Recruitment and Employment Confederation, analyses the importance of a healthy, transparent recruitment supply chain and the benefits of co-operation in NHS recruitment The UK has now left the EU – so what does this mean for the future of the NHS workforce? How can the NHS best recruit, train and retain its workforce, and what role does the recruitment industry have to play in supporting the NHS through these unchartered waters?

Although the UK has officially left the EU and become a ‘third country’, we are currently in a transition period in preparation for the 31 December, where on-the-ground changes will be evident, including a new immigration system. Nevertheless, even From before these changes Septem Where are the numbers? occur more than Latest NHS figures show that 10,000 EU all nurs ber 2020 most staff are British – but nationals have will rec ing students eive a p a sizeable minority are not. left the NHS ayment of at le Around 153,000 out of 1.2 since the Brexit year, w ast £5,000 a million staff report their referendum, ith up t nationality as non-British. This including o £3,00 further is around 13 per cent of all almost 5,000 f u n ding 0 nurses; and availab staff for whom a nationality le for e is known, with around 65,000 on top of that, s tudents ligible (5.5 per cent) being EU nationals; fewer nurses the figures are much higher are arriving. in London and the South East. Recent figures

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS | www.healthbusinessuk.net

from the Nursing and Midwifery Council show that the number of nurses arriving from the EU dropped by 87 per cent from 6,382 in 2016-17 to 805 in 2017-18. To address these challenges, the Conservative Party has pledged to add 50,000 nurses to the workforce in England by 2024-25. How realistic is this target, particularly given that nurse numbers have gone up by only about 5,000 since 2010? Early steps With more than 40,000 nursing vacancies, workforce is the main concern for NHS leaders. The current government have said that 14,000 more nurses will be trained with extra placements funded in the NHS. Another 5,000 more nursing staff will come from apprenticeships - which are designed to allow recruits to be trained in the workplace without the need to pay tuition fees and study at university. However, the Nuffield Trust notes that the nurse apprenticeship scheme is relatively new and by the middle of 2018, only 300 people had started. The government also wants to see 12,500 more nurses recruited from overseas, arguing that halving the cost of the NHS visas will help attract more staff from outside the UK. Will better retention help? The government says that 18,500 extra nurses can be found by using policies to ensure fewer leave the NHS. NHS England is already addressing this issue by promoting more flexible working, enhancing continuing professional development and encouraging highly qualified staff who have left in

What do health experts think? Both inside the NHS and among independent health commentators there is agreement that 50,000 more nurses than now will need to be working in the service in five years’ time. The Health Foundation, Nuffield Trust and King’s Fund think tanks, in a joint report, argued that 5,000 nurses will have to be recruited annually from overseas over four years to avoid staff shortages, even if other initiatives are pursued to boost the workforce. That would mean 20,000 more internationally recruited nurses by 2023, considerably more than the Conservative plan. The Year of the Nurse and Midwife As we enter the Year of the Nurse and Midwife, the Department of Health and Social Care have at least put measures in place. From September 2020 all nursing students will receive a payment of at least £5,000 a year which they will not need to pay back, with up to £3,000 further funding available for eligible students, including for: specialist disciplines that struggle to recruit, including mental health; an additional childcare allowance, on top of the £1,000 already on offer; and areas of the country which have seen a decrease in people accepted on some nursing, midwifery and allied health courses over the past year. The funding will be given to all new and continuing degree-level nursing, midwifery and many allied health students, and it is expected to benefit more than 35,000 students every year.

Given the increased administrative burden for many NHS workers in recent years, it would be better to think of how automation could potentially complement human capacity rather than replace it Taking a joined-up approach Agency staff have provided a vital lifeline to the NHS for decades. They continue to provide the NHS with the extra support that it needs in times of increased demand, and are crucial in ensuring patient safety. Agency staff have the same skills as substantive staff, often with many years of experience. It is essential that these staff are recognised for their professionalism and contribution, are treated fairly and are valued. Furthermore, specialist healthcare recruiters are experts in workforce planning, and see first-hand the shortages that it has to contend with. Recruiters are perfectly placed to identify where problems lie and able to offer immediate solutions. They can supply staff up and down the country, often to regions that are less appealing to other workers, as well as offering immediate help in critical situations. What about AI? Automation has potential to help fill the skills gaps. However, how far this will go is debatable. It’s difficult to believe that most people will be eager to lose their GP, nurse or care worker to automation. These are roles where the human skills of

Recruitment

recent years to return. Projections suggest that as many as 20,000 nursing staff who might have otherwise quit could still be working for the NHS in five years’ time.

compassion and empathy are so important. Looking beyond front-line services, the RSA point out that outsourcing decisionmaking in the public sector to computers is also a risk, as it is important that the decisions taken on the services that people rely on maintain a human element. Given the increased administrative burden for many NHS workers in recent years, it would be better to think of how automation could potentially complement human capacity rather than replace it. There is huge potential for it to minimise administrative elements of the roles. Looking forward To attract more people into the NHS, it’s important to think of what new generations of workers will be looking for in their jobs. ‘Purpose’ is often cited as having increasing importance in why people choose their career paths. This is something that the NHS has lots of, and playing on this strength makes sense. Something else frequently cited as increasing in importance in career choices is having more job flexibility. Workers are increasingly expecting to see flexible working patterns offered as the norm. There are challenges with increasing flexibility for some healthcare jobs, but finding solutions to achieving this is important if the NHS is going to compete with the private sector on modern working practices. With the decline of ‘jobs for life’ and more people leaving the health sector early in their career, it’s also important to think of ways to attract people from the private sector. The NHS ‘We Are the NHS, We Are Nurses’ campaign, backed by the Health Secretary, targets teenagers who are about to choose their degrees as well as career switchers considering going into nursing. The measures are part of the NHS People Plan, which will set out work to reduce vacancies across the NHS and secure the staff needed for the future. Recruit, train and retain Deep problems remain within NHS recruitment and there are no quick fixes, but consistent and determined action from the government and employers can deliver results. Government needs to work hard at retaining its existing workforce, as well as adopting a joined-up approach to workforce planning with specialist recruitment agencies. Patient safety always has to come first, and getting the workforce right is the single biggest factor that policy makers and NHS leaders need to be focussing on to achieve that. L FURTHER INFORMATION www.rec.uk.com

Issue 20.1 | HEALTH BUSINESS MAGAZINE

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The NHS is the UK’s biggest employer, with 1.5 million employees, and is one of the largest employers globally, ranking fifth behind McDonalds, Walmart, the People’s Liberation Army China, and the US Department of Defense Even with its 1.5 million strong workforce, the NHS does not have enough staff to meet demand. The majority of NHS staff work in ‘hospital and community services’ (HCHS) as direct employees of NHS trusts; providing ambulance, mental health, and community and hospital services. The NHS workforce is made up of direct and indirect employees. Direct employees count for 319,740 staff members in support to clinical staff, 306,996 nurses and midwives, 171,282 working in NHS infrastructure support, 139,241 scientific, therapeutic, and technical staff, 111,247 HCHS doctors, 78,684 in GP support and admin roles, 34,534 GPs, 20,951 ambulance staff, 16,276 practice nurses, and 4,752 counting for other staff, as of September 2018. In addition to direct staff, NHS organisations have indirectly employed staff through a paying company to provide services such as laundry, cleaning and catering, corporate function and estate management. Current hiring demands In NHS hospitals, community, and primary care settings, there are approximately 150,000 doctors and over 320,000 nurses and midwives. These two groups make up just over one third of the total workforce.

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Given the multidisciplinary nature of the NHS, finding staff that meet hiring demands is always going to be tough. Between July and September 2018, there were almost 94,000 full-time equivalent advertised vacancies in hospital and community services alone, equating to an estimated shortfall of eight per cent. These shortages were unevenly distributed across the country. The lowest were found in the North East & Yorkshire and Humber areas, at 4.5% and 5.6% respectively. Further South, at 9.9% and 11.5%, Kent, Surrey & Sussex and Thames Valley were the highest in the country. The lowest staff shortages within hospitals and community health services were healthcare scientists, estates and ancillary staffing groups. In a 3 month period both were around 2,500. This is particularly concerning since the latter group are often responsible for ensuring that hospitals are maintained and fit for purpose. When it comes to recruitment, the first port of call is usually advertising vacancies through different platforms, or internally within NHS organisations. In the short term, this approach to recruitment is cost effective, and makes sense considering current financial constraints. A permanent recruitment cycle takes on average 47 days. However, when you factor in time to short list candidates and submit applications this process can be pushed past ten weeks. If unsuccessful the clock resets. The impact of this challenging recruitment process is that jobs are left vacant, or unqualified staff are taken on. This is a risky approach to take as a lack of resources often means that there is not enough oversight of under-skilled staff, so problems may often go unnoticed or ignored until they pose a serious risk. For existing staff, this can result in elevated stress levels and ultimately lead to burnout. Some organisations look at solutions that rely on support from service providers and consultancies to fulfil a client side role. The cost of these services is often magnitudes higher than it would be for internal staff, creating a false economy, and these service providers do not always necessarily represent the trust’s best interests.

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Meeting hiring demands Apprenticeships are a great tool to add to your succession planning. Any method that helps unskilled workers gain valuable experience within the sector should be paramount for any staffing strategy. It has been troubling to see that UK trusts are sitting on £200 million of unused funds for apprentices. These funds collected though the apprenticeship levy, will be clawed back by the government if unused. However, according to a government spokesperson speaking in October 2019, new flexibilities have been introduced, ‘to help employers spend their levy funds. It means employers now have 24 months to spend their levy funds and large employers are able to transfer up to 25 per cent of their funds to other businesses’. Hopefully this initiative will enable employers to use their money to invest properly and ensure that apprenticeships play a role in solving the staffing crisis. Organisations could do well in identifying weaknesses within their departments, for example, which areas are under-resourced, or failing to recruit? Develop your strategy to address these weaknesses. When it comes to a hiring strategy, organisations need to be flexible and not follow a rigid process. Be clear with deadliness and interview dates. Applications should be monitored two‑three times a week and not left for a hiring manager to sift through after a closing date. Too often candidates slip through the net because there is already a rigid interview process in place that doesn’t accommodate their needs. In a market with a shortage of candidates, it needs to be a two way street, and organisations need to actively promote themselves throughout the hiring process. A personal touch makes all the difference, and any contact should be made over the phone as opposed to via email. It would be of benefit to an organisation to engage with fewer agencies, rather than more. Crown Commercial Service (CCS), for example, enables you to identify specialist agencies for critical posts. More time could be invested in speaking with fewer agencies about where a shortfall might exist within a resourcing team, ultimately resulting in a higher quality of candidate and service. Specialist agencies tend to have a greater understanding of the market and will take the time to filter suitable candidates rather than bombarding clients with CV’s with the hope that something will stick. This might mean that some positions will cost more in the short term, but the long-term savings, such as time, overall cost and staff retention will certainly outweigh this initial cost. Recruiting for the NHS will likely continue to be tough for the foreseeable future and the best solution is one that encourages trusts to diversify their hiring strategy and leverage key relationships internally and externally. L FURTHER INFORMATION oysterpartnership.com

Issue 20.1 | HEALTH BUSINESS MAGAZINE

Advertisement Feature

A healthy approach to building design The rapid growth in smart technology means building engineers can now deliver far more sophisticated HVAC solutions, according to Daikin Applied UK Wireless systems and greater connectivity in buildings means it is now much easier to accurately match system performance to user requirements and optimise energy efficiency. It also gives engineers a route to tackling the individual pieces of equipment that consume the most energy, such as fans and chillers. This is an increasingly important consideration for NHS estates procurers, who are under pressure to reduce running costs and increase efficiency, while also maintaining good quality indoor environments. It also means Building Services Designers have more tools available to address one of the biggest challenges of our age - the issue of poor indoor air quality (IAQ). Air pollution is a huge problem and has been labelled a ‘public health emergency’ by World Health Organisation (WHO). The British Lung Foundation identified a particular threat to hospitals and healthcare facilities in its 2018 report entitled Toxic Air at the Door of the NHS. This revealed that more than 2,000 GP surgeries and 248 hospitals in the UK are in locations where air pollution is above WHO recommended contamination limits. The WHO is also concerned that outdoor air continues to be used as supply air for ventilation systems despite heavy contamination by particulates and other outdoor pollutants. It has called for much more effective use of air filters and room air purifiers, particularly in buildings with vulnerable occupants like care homes and hospitals. Protection Healthcare facilities pose a unique design challenge for heating, ventilation, and air conditioning system engineers. These systems fulfil a broad range of ventilation requirements and provide protection from

airborne hazards, but controlling HVAC systems can be complex, particularly in a highly mixed use environment like a hospital. However, these challenges can often be overcome if good control logic and optimum system sizing based on closely matching demand to the system’s capacity and performance are used. It is also important to use the technology to continuously monitor critical plant remotely once it is installed and up and running. This will prove increasingly valuable for the NHS because – with summer temperatures staying higher for longer in the UK – continuous monitoring allows facilities managers to spot early warnings. They can see if the cooling system is not achieving its design capacity or efficiency, which could be due to low refrigerant charge or high operating pressures. This allows potential breakdowns to be avoided and any drop in performance to be addressed before it causes serious problems. At Daikin Applied (DAPUK), we focus on providing a fully integrated HVAC solution. We have worked on 311 UK hospitals since 2002, delivering solutions worth more than £43 million. This extensive experience has allowed us to build up a team of highly trained mechanical engineers who understand the particular requirements of a healthcare environment. Our engineering team focuses on the full lifecycle operation of our solutions, which means we have a good handle on operating costs and will always argue for a long-term focus that will deliver a good return on investment – in terms of both finance and human health. Dainkin Applied’s HTM compliant service and maintenance packages include continuous remote monitoring of site conditions and

can be tailored precisely for the healthcare facility in question combined with excellent air filter technology produced by our sister company AAF, which provides clean air solutions for patient rooms, medical procedure areas, operating rooms, dentist offices, research centres, morgues, and cafeterias. When it comes to air filtration, the control of viable and non-viable particles is crucial in many process applications in the life science industry. Protection of people from hazardous or potent compounds is equally important and there is a wide variety of supply, exhaust and recirculated air housings and filter types to address each application. AAF offers a wide range of solutions including HEPA (High-Efficiency Particulate Air), ULPA (Ultra Low Particulate Air) filters and chemical gas-phase filtration. HEPA and ULPA filters are used in isolation rooms, protective environment rooms, organ transplant areas, and other applications requiring ultra-clean air. This allows DAPUK to deliver high care/clean room technology solutions with the necessary sterile environment and our full system approach includes delivering solutions to control air pressure, temperature and moisture. It is an important consideration for any HVAC specialist supplier to understand both the operational parameters of the equipment it supplies and the impact of its designs on indoor operating environments. The extra bonus we now have, thanks to the growing sophistication of digital systems, is that we can continue to monitor and adjust those systems throughout their operating life on behalf of our clients. L FURTHER INFORMATION www.daikinapplied.co.uk

Catering

Supporting the elderly to eat and enjoy food together care Over the last few years, Food for Life has researched intergenerational activity and support for care settings for the elderly. Here, Florence Todd Fordham shares some of the findings Malnutrition presents a significant health threat to older people and care home residents. In the UK, over one-third of care home residents have been found to be malnourished and require treatment (BAPEN, 2015). This has major impacts on their quality of life, with additional consequences such as social isolation and loneliness. Through the Food for Life Better Care programme we have aimed to positively impact on the lives of older people and care home residents. What is Food for Life Better Care? Food for Life Better Care was a two year programme to promote good food for older people and included a focus on care homes and intergenerational work in Edinburgh, Calderdale, Kirklees, Leicester, Leicestershire and Rutland. The team used innovative techniques, based on ethnography and codesign, to identify opportunities for change. Food for Life Better Care sought to be both comprehensive â&#x20AC;&#x201C; with a whole settings approach to multiple aspects of food â&#x20AC;&#x201C; and developmental â&#x20AC;&#x201C; to test out and reflect on what worked and what might be enhanced. While each area shared a common overarching framework and approach towards engaging partners, it was anticipated from the outset that the team would adapt the delivery of the intervention to fit local circumstances. The programme has consisted of networking, training, support, development and delivery for a wide range of care homes.

This has included creating opportunities to Here is an independent endorsement, backed partner with nurseries and schools, some of by annual inspections, for food providers which are active in the Food for Life schools who are taking steps to improve the food and Early Years national programmes. Food they serve, for climate, nature and health. for Life Served Here, an accreditation from The aim of the scheme is to encourage and the Soil Association that awards sustainable reward caterers who serve fresh food, source and healthy catering, was used as a platform environmentally sustainable and ethical food, for promoting nutrition, hydration and make healthy eating easy, and champion local sustainability standards in care homes. food producers. Food for Life Served Here Key goals of the Food for Life Better Care accreditation is available for all organisations programme were to prevent malnutrition who serve food. The fixed bronze and loneliness, to enhance the standards apply to all caterers wellbeing of people in later life, while silver and gold to build capacity within the are assessed using a Therap care sector around food, points-based system. e u t i c food ac and to bring communities Points are achieved t together through food. at silver and gold dining ivities, r o for sourcing o m experie FFLSH and environmentally n c e s and nutritio sustainability of friendly and activitie n training food provided ethical food, steps A key aspect of Food taken towards benefic s are greatly ia for Life Better Care making healthy care ho l to residents was supporting better eating easy and , m access to nutritious food. championing local cateringe staff and Through our work in other food producers. teams settings, such as schools and If you see a Food for early years, Food for Life has a Life Served Here logo you wealth of experience in improving know that the majority of food the food provision, procurement of on the menu will be freshly prepared, ingredients and the overall dining experience. it will always be free from undesirable trans To help caterers make good changes, Food for fats, sweeteners and additives, be cooked Life supports food providers to meet Food for by trained chefs, and use ingredients from Life Served Here criteria. Food for Life Served sustainable and ethical sources. E Issue 20.1 | HEALTH BUSINESS MAGAZINE

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 What did we find? The evaluation of Food for Life Better Care was led by the University of the West of England, collaborating widely and building on related research to ensure relevance across the UK. Through the evaluation we were ultimately testing a hypothesis: if older people have better access to nutritious food, therapeutic food activities and shared mealtimes across care homes, community care services and hospitals, will they be less susceptible to malnutrition and loneliness and enjoy enhanced health and well-being. The programme introduced individuals and organisations to the methods and benefits of co-design and whole settings approaches. Greater collaboration helped move beyond the fragmented and isolating working practices that often feature in adult social care. The programme therefore illustrated an approach that holds the prospect of being transferable and scaleable. Overall, the Food for Life Better Care activities were linked to promising evidence of benefits for care home residents in terms of positive social interactions, mood and mental well-being, improved diet and enjoyment of meals and eating. Case study In November 2017, the Food for Life Better Care team collaborated with staff and residents at Summerfield House Care and Nursing Home, a large privatelyowned care home in Calderdale, to test a whole settings approach to food using a co-design test-and-learn approach. Over an 18-month period, the Food for Life Better Care team collaborated with staff and residents at Summerfield House Care and Nursing Home to focus on food and foodrelated activities as a social experience and a bridge to the surrounding community. Food for Life Better Care sought a comprehensive approach, in that the programme was informed by a whole settings approach to consider multiple aspects of food. The

Food for Life Better Care was a two year programme to promote good food for older people and included a focus on care homes and intergenerational work in Edinburgh, Calderdale, Kirklees, Leicester, Leicestershire and Rutland team adopted a ‘test and learn’ approach to the programme. This involved consulting with residents, care home staff and others on types of activities to run, testing them out, and reflecting upon the learning. There were several benefits of the programme to residents, staff, residents’ relatives, schools and the care home itself. The analysis led by the University of West England showed that residents derived social, affective, nutritional and general wellbeing benefits from the programme. Staff who engaged in the programme were noted to feel valued, supported and developed a higher sense of morale in the care home. Communication between staff and residents were observed to have improved during the implementation of the programme. There were testimonies from staff about residents’ relatives’ satisfaction of care due to residents’ exposure and engagement in the Food for Life Better Care activities. The activities had a positive impact on school pupils who visited Summerfield House Care and Nursing Home to undertake intergenerational growing, gardening and other food-related activities with residents. There were observed and reported increase in empathy for older people; counterstereotypical behaviour towards older people; and development of friendships with residents through the intergenerational work. The quality of food was noted to improve during implementation of the Food for Life Better Care programme in

Summerfield House Care and Nursing Home and management had realised savings on food cost and reduction of plate waste. The future of Food for Life Better Care Because of the experience of successfully delivering Food for Life Better Care, we have learned that therapeutic food activities, dining room experiences and nutrition training activities are greatly beneficial to residents, care home staff and catering teams. This experience and the expertise we have built around improving the health and well-being of older people through food related activities, means we know how to support care homes to develop an outstanding food culture and service. We can offer tailored support to you if you’re a local authority, care home company, caterer. We can provide help by delivering consultancy, staff training and activities for nutrition and dining experience, and for our Food for Life Served Here accreditation scheme. L

If you are interested in developing a Food for Life Better Care programme where you work, please get in touch with Florence Todd Fordham on ftoddfordham@soilassociation.org and we would be happy to build a programme that would best support your needs. FURTHER INFORMATION www.soilassociation.org

Issue 20.1 | HEALTH BUSINESS MAGAZINE

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Transforming mobile working in healthcare Nick Offin, head of Sales, Marketing and Operations at dynabook UK, explores the challenges and opportunities presented by mobile working in 2019, and how the latest solutions – from mobile zero clients to wearables – can help healthcare organisations ensure security, productivity and mobility are achieved in equal measure Technology is continually transforming the way people work across a diverse range of industries, with the number of mobile workers predicted to climb from 1.45 billion in 2016 to 1.87 billion by 2022 – accounting for 42.5 per cent of the global workforce. Healthcare is no exception to this, with the global healthcare mobility solutions market predicted to experience an annual growth rate of 28.3 per cent by 2022. The majority of organisations today already have a mobility strategy in place given the widespread nature of mobile working, and the numerous advantages it can bring. According to an EY study, over 50 per cent of companies have deployed a strategy whereby mobile working is implemented every day. Yet the fast-paced nature of technological innovation, coupled with rapid data explosion driven by the Internet of Things (IoT), mean that such strategies constantly need to be reviewed and refreshed to meet the latest demands. Unrelenting threats to security in healthcare Remote working and the ever-multiplying swathes of data which are so integral to operations today create increasing opportunity for cyber criminals to strike. The average annual cost of such attacks on healthcare organisations is $12.87 million (£9.26 million) – the fifth most expensive of all industries, given the immense value

attached to sensitive patient data. The more data available to mine, and the more entry points there are providing access to the network, the bigger the risk. Proof of this within an increasingly data-centric healthcare sector is the 211 per cent increase in disclosed security incidents in 2017 when compared with the previous year, according to McAfee. The edge and data proliferation While security may be the most pressing IT and mobility-related concern for healthcare organisations right now, ensuring efficient and productive working while on the move is also becoming increasingly important. 5G is set to instigate a further boom in the IoT, meaning this ongoing data rush of unprecedented levels is certain to continue and healthcare must be primed to take advantage of this. In order to relieve the strain this data will place on cloud services, a growing number of organisations are integrating an edge-focused element to their mobility infrastructure. Organisations can provide an enhanced quality of service by processing data at the edge of the network, thus reducing the likelihood of data overloads while also helping mobile workers such as GPs to meet compliance regulations, for example by recording consultation notes in a timely manner.

Paving the way for wearables As edge computing develops, so too will the solutions used to collect and manage this data. Global wearable device shipments will rise to 154 million in the enterprise by 2021, according to ABI Research, as sectors including healthcare recognise how they can utilise such technology to enhance mobile productivity. Accenture claims that, by 2020, 91 per cent of healthcare solutions providers will include wearables in their IoT offerings to clients. This includes the adoption of long-mooted solutions such as Assisted Reality (AR) smart glasses, which can for example be used by medical workers in the field to record patient information in real‑time during an examination. What is clear is that, while most organisations have already embraced mobile working, whether they are executing such a strategy effectively varies from one to the next. Verizon’s Mobile Security Index 2018 found that 35 per cent of healthcare organisations reported data loss or downtime from a mobile device security incident in the past year, while 41 per cent admit to purposefully putting themselves at risk of a security breach for the sake of expediency or business performance. Building, managing and maintaining a secure and agile IT strategy is more complex now than ever before, from choosing trusted devices to integrating bespoke security solutions at a network level. It is, therefore paramount for CIOs to constantly assess their architecture and integrate the right solutions to ensure security, productivity and mobility in equal measure. L FURTHER INFORMATION www.dynabook.com

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Parallels Remote Application Server

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GS1 standards

A simple approach to providing improved patient care Glen Hodgson, head of Healthcare at GS1 UK, looks at the current state of the eProcurement strategy and asks where the GLN sector is heading over the next few years Trading beyond borders is often a challenge for suppliers. And that’s not just with reference to supply-chain efficiency and traceability that can also be extended to order processing, invoicing and payment management too. However, when you compound these seemingly simple tasks with the intricacies of a country’s healthcare framework, an already complicated system becomes even more difficult to navigate. As a result, the Department of Health and Social Care (DHSC) introduced the NHS eProcurement strategy1 in 2014 – designed to help improve procurement efficiencies across the NHS, and enable organisations to provide better value and better care for patients. After all, irrespective of being an NHS trust, or a supplier, distributor or manufacturer, the main aim is to make sure the patient has the right product or device, available in the right place and at the right time, every time. With the eProcurement strategy in place, products can be traced to their point of origin, through to their point of issue/delivery. This enables any defective products to be identified and removed from circulation quickly – a significant patient safety advantage.

This depends on the inputting of accurate product data to the GDSN, which can then be attributed back to any individual organisation on the supplyside using their unique organisation identification number – their legal GLN. For NHS trusts, this information feeds directly into their product catalogues. Once an order is placed, suppliers then send the order directly to the trust’s unique delivery How does this work? location, also identified using a GLN. Delivering the aims of the eProcurement The trust is also identified with a legal strategy relies on two central components GLN, so it’s not mistaken any of the other to support the transition to e-trading 153 acute trusts across England. Adding and e-invoicing. Firstly, the use of GS1 further granularity to the process, the trust standards for the unique identification can also use a separate GLN to ensure of products, using Global Trade Item the delivery goes directly to a designated Numbers (GTINs) and of locations, using point such as a department, ward or even Global Location Numbers (GLNs). This a specific shelf or patient’s bedside. feeds into the efficient synchronisation of All GLNs used across the system are held in data across a central network – the Global one central repository – LocationManager3. Data Synchronisation Network (GDSN). So, any time a shipping location is modified, Secondly, the use of PEPPOL messaging billing information is updated, or a delivery standards for the electronic exchange point is changed, the amendments of transaction information are available in real time, so such as purchase orders, suppliers have access to delivery details and the D eliverin everything they need, exchange of invoices. the aim g whenever they need it. s of the ePr Without accurate location information strategy ocurement in place, products are central relies on tw susceptible to being o c o m ponent suppor lost and deliveries are s to t the tra at risk of being E ns t Take the example of the Poly Implant Prostheses (PIP) breast implant scandal of 20102. To this day, there are tens of thousands of women still living with these implants a decade after their surgery. Apply this same methodology to anti-counterfeiting and medicines traceability, and there are some clear translatable benefits here too.

o e-trad ition in e-invoic g and ing

Issue 20.1 | HEALTH BUSINESS MAGAZINE

Introducing the PURELL® ES8 Dispensing System Hand hygiene that’s always ready When you choose new PURELL ES8 hand hygiene dispensers, you’re not only getting trusted hand hygiene products, you’re also getting a revolutionary dispenser design that addresses the two most common service issues – empty dispensers and worn out batteries. AT-A-GLANCE™ Refill Design We make it easy to monitor product levels with one quick look, saving time and labour, and eliminating complaints about empty dispensers. Breakthrough Energy-on-the-Refill Technology Each reﬁll comes with a coin cell battery that's integrated into the reﬁll. Touch-free dispensing without the hassle of battery change outs.

GS1 standards

 missed, resulting in unwarranted delays to vital patient care. Without accurate billing information, trusts and suppliers can easily end up with troublesome invoice queries and delayed payments. All-in-all, this serves to create an efficient procurement system, which is set in place to streamline business transactions across the NHS, improving the purchaseto-pay process for all stakeholders.

Over the next few years, the value of GLNs and effective location management will have real potential to drive even more transformative change beyond the realms of efficient procurement and supply chains

Where are we now? Fast-forward to 2020, and the adoption of GLNs continues to play a fundamental role in the current healthcare landscape. Forming part of key mandates and recommendations, the value of GLNs and effective location management has become paramount, with benefits being realised beyond procurement, having demonstrated advantages within clinical settings as well. The use of GLNs underpins a significant part of the NHS Framework Agreement for the Supply of Goods into the NHS4, and several suppliers are already on the journey, having barcoded their products, and begun to trade messages via PEPPOL. But more recently though, the Medicines and Healthcare products Regulatory Agency (MHRA) has also recommended the use of GLNs in Field Safety Notifications (FSNs) and Medical Device Alerts (MDAs). Due to the critical nature of product recalls, it is essential for manufacturers, distributors, suppliers and NHS providers to be able to establish where any remaining inventory is located as quickly as possible, in order to limit potential harm to patients. Therefore, on both of these counts, the use of the legal GLN will feature as a requirement – which in turn supports one of the core aims of the EU device regulations for medical devices (EU MDR) and in-vitro diagnostic medical devices (IVDR). This particular regulatory update comes into force from May 2020, and will place greater emphasis on the post-market surveillance of products, including the proactive monitoring of device performance

for recertification, annual safety updates for higher-risk class devices, and rapid reporting of safety incidents. Crucially, these changes will impact trusts and wider healthcare organisations that are integral to the supply of products into the NHS. What next? Over the next few years, the value of GLNs and effective location management will have real potential to drive even more transformative change beyond the realms of efficient procurement and supply chains. There’s no escaping the ‘digital first’ messaging emanating from government, and the drive to go paperless is still at the heart of the agenda, along with the clear focus on interoperability. And that’s not to disregard the overarching sentiment – to improve patient safety across the board: these changes are all steps in the right direction towards achieving a much needed seamless healthcare system. Envisage the bigger picture of being able to track each touchpoint of a patient’s journey from community and primary care through to secondary care anywhere across England – or around the world for that matter. It’s a long road to get to that point, but it’s not as unachievable as it might have appeared to be some decades ago. In reality, there are already some areas of excellence that exist, and trusts and their suppliers across England are making headway. They are beginning to reap the benefits that effective location management has to offer – enabling them to collectively provide better value and, ultimately, a better patient-care experience. L

For more information on GS1 standards and location management, or to start your GLN adoption journey, contact the GS1 UK healthcare team at healthcare@gs1uk.org. Glen Hodgson is head of Healthcare at GS1 UK. He is charged with supporting the NHS and the healthcare industry to deliver greater efficiency and a more robust approach to patient safety. With over 20 years of national and international experience, Glen has served at board level in a variety of operational and commercial roles within complex organisational structures inside the pharmaceutical/healthcare arena. 1.

https://assets.publishing.service.gov.uk/ government/uploads/system/uploads/ attachment_data/file/344574/NHS_ eProcurement_Strategy.pdf

https://www.nhs.uk/conditions/pipimplants/

https://www.gs1uk.org/our-industries/ healthcare/locationmanager

https://assets.publishing.service. gov.uk/government/uploads/system/ uploads/attachment_data/file/681448/ Guidance_on_NHS_Terms_and_ Conditions_for_the_Supply_of_Goods_ and_the_Provision_of_Services__ 2018_.pdf

FURTHER INFORMATION www.gs1.org/industries/healthcare

Issue 20.1 | HEALTH BUSINESS MAGAZINE

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New report looks at how we can optimise the path to innovation in digital health The healthcare industry is an ever-evolving space and there is a need to consistently reassess the pathways for innovation so as not to hinder new and exciting developments from reaching the market. For this reason, in 2019, EIT Health hosted a series of round tables across Europe, attended by key stakeholders, to examine the areas of the innovation pathway where improvements can be made In recent years, there has been rapid growth in the field of medical and health technology. Not only has the number of players in this sector increased, but the diversity of products and services has evolved exponentially. While there are clear benefits in this change in dynamic, we must consider the impact this has in terms of how adequately innovators (those developing products and services) are able to navigate the path to market in a field that is highly regulated and often complex and slow to evolve in line with new technologies. This is particularly relevant when we consider that we are seeing more and more solutions being developed by innovators who are not sector specific, and therefore may lack relevant experience and understanding of the specificities of the healthcare market. The regulatory and reimbursement landscapes are also ever-changing, posing new challenges in terms of development, testing, implementation, usability and adoption of new healthcare solutions. As a result, innovators and other stakeholders can face further hurdles in simply keeping abreast of how to access the healthcare market. In light of this environment, the EIT Health Think Tank selected the topic ‘Optimising Innovation Pathways: Future Proofing for Success’ for consideration and debate in its 2019 Round Table Series. The UK Round Table focused on the digital health market as the introduction and evolution of mHealth applications has seen this market grow rapidly over the past few years. According to a study from Deloitte, the UK market rose from £2bn to £2.9bn between 2014 and 2018. This trend shows the long-established structure of the healthcare industry, where

the pharmaceutical sector has traditionally stood at the forefront, is beginning to shift towards digitalisation – opening the path for new entrants and for giants such as Google, Apple and Amazon to diversify into the healthcare space. In fact, only 32 per cent of mHealth developers come from traditional healthcare stakeholders such as hospitals, health insurers and Pharma companies. The current situation: a focus on today’s innovation pathway The innovation pathway, or route to market for new products and services, is comparable in the UK to the rest of Europe. It is a continuous and modular pathway whereby all parts are interconnected and reliant on each other. Regulatory and reimbursement stages of the pathway were historically developed to support the introductions of more traditional treatments such as pharmaceutical medicines or medical devices. This has led to a pathway that may be considered to favour more traditional innovation, and in need of reform in order to address emerging technologies such as digital health in all its many forms. This is particularly relevant when assessing the regulatory processes, which is struggling to keep pace with the rapid introduction of new technologies. In the current landscape, where new technological discoveries are constantly being made, there is increasing need for a more agile regulatory framework. Such reform of the regulatory pathway in Europe, and consequently, the UK, has indeed been addressed recently, as evidenced by the European Medicines Agency, with the proposed introduction of new guidance for medical devices and in-vitro diagnostics which are planned to be introduced in

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2020. These new guidelines have been developed in response to the increasing pace of innovation and evolution of the types of products and services requiring assessment. Regulatory capacity to assess innovations based on the introduction of these guidelines, however, is expected to be challenging. Currently, regulators have the capacity to evaluate approximately 600 products per year; whereas approximately 6,000 are expected to be impacted by the new MDR. This will create a backlog of solutions both new and already on the market that require review via the new guidance and may interrupt and slow access for patients and citizens. Pathway optimisation is profoundly important for health innovation, as it will in turn ensure that patients and citizens benefit from access to promising solutions as quickly as possible. Conclusions and recommendations for optimising the path to market The body of evidence collected during the Round Table Series, demonstrated that there are a number of key stages within the innovation pathway where improvements could be made to aid and speed up the route to market for promising innovative solutions. Participants of the UK Round Table Meeting were asked to agree on a set of recommendations that, if implemented, could help to optimise the pathway for digital health solutions. Where possible, they also identified potential stakeholders who would need to be engaged for further discussion. Bolstering the ideation stage Ideation marks the beginning of an innovation’s life cycle, and if errors are made

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at this early phase, the future success of the innovation may be severely hampered. Through the Think Tank activity, it is clear that a number of activities could be optimised to support innovators at this stage with regards to digital health solutions: Develop a systematic process for needs identification and assessment to provide better guidance on the evaluation of solutions Digital health solutions should consider both the ‘clinical need’ and the ‘system need’. While the underlying need may be similar for the two, the environment and context can be vastly different. Therefore, innovators should be encouraged to place greater emphasis on the broader ‘problem identification and mapping’ and this process should be structured and standardised to offer clarity. HealthTech Connect, provided by NICE, offers a service that presents a centralised repository of granular needs, and EIT Health should consider consulting and promoting this service to ensure innovators are effectively engaging with this resource. Additionally, the needs of the end user (i.e. patient or citizen) should be fundamental to this process, and a cocreation strategy should be at the forefront throughout the innovation pathway. Map incubators and accelerators available in the UK and promote engagement amongst innovators Many impactful incubators and accelerators are in existence across the UK, however they are often accessed locally and awareness may be low amongst the wider context of the innovation community. EIT Health should consider conducting a mapping exercise of quality health incubators and accelerators in the countries and regions and promoting this as resource to the EIT Health network. Further discussions should also take place with Academic Health Science Networks,

the National Institute of Health and Care Excellences’ HealthTech Connect or the NHS innovation accelerator to capitalise on existing resources and add value where necessary. Improving the development phase Embrace failure as part of the innovation process – be prepared to ‘fail fast’ – and systematise learnings. There is great value in failing within the innovation process – failure allows us to learn and strengthen our ability to innovate. Failing fast also allows for time, cost and resource efficiency. However, culturally, we are still fearful of admitting failure which hampers our ability to learn. EIT Health can help in changing attitudes to failure and promoting positive sharing of learnings within health innovation. EIT Health should consider sharing results and learnings from funded innovation projects that have failed or not continued. Clarify the evidence generation requirements for digital health solutions to demonstrate true value and facilitate conversation between innovators and regulatory and reimbursement bodies. The generation of evidence occurs too late in the pathway; it is needed throughout the process. There should also be clarity around the appropriate body of evidence required for regulatory and reimbursement bodies for digital health solutions as a distinct methodology in contrast to evidential requirements for medicines and medical devices. Innovators should be supported by early access to, and dialogue with, such stakeholders (HTA bodies, commissioners, trust executive teams, etc.) to develop and sustain a strong value proposition. There are a number of resources in existence in the UK which may help including the NICE MedTech Early Technical Assessment (META). Additionally, open-access databases that can be used for testing, such as from NHS Digital. EIT Health can help to

facilitate such a relationship, connecting innovators with decision making authorities to clarify data collection requirements, as well as signposting innovators within the network to existing resources in the UK. Market entry – navigating the changing regulatory landscape Assess the impact of the new medical device regulation on the access to digital health solutions. The introduction of the medical device regulation in 2020 is expected to slow access to digital health solutions due to changing guidance as well as regulatory capacity. While estimations have been calculated, it is not clear what the full impact will be on digital health solutions, and guidance is lacking for innovators in approaching the new regulation. ORCHA has developed a briefing on this for Digital Health Apps Adoption Promote incentives and a value‑based approach to the provision of new digital health technologies. The current reimbursement system is heavily focussed on cost, which presents a challenge for digital health solutions which aim to improve more long‑term outcomes such as adherence or care quality. EIT Health should consider assessing the value-based healthcare procurement landscape for digital health solutions in Europe specifically, and discuss potential reform with policy makers and reimbursement bodies. L

Find out more about how EIT Health it is enabling innovation in healthcare throughout Europe and access the full report at www.eithealth.eu/think-tank-topic FURTHER INFORMATION www.eithealth.eu/think-tank-topic

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Digital transformation in NHS trusts

Written by James Adie, Vice President EMEA Sales, Ephesoft

Over the last 20 years, new technology, and the changes this technology has had on general workplace practices, has slowly eroded the paper-based past

We mostly send our invoices in PDF form rather than in the post, and we sign our signatures digitally as opposed to printing out documents and putting pen to paper. But in the NHS, paperwork is still very much alive. From lab results to surgery notes, no sector encounters more paperwork than healthcare. This is still a consistent hindrance to NHS staff, who are required to carry out extensive admin in order to do their jobs. Looking to a paperless future The integration of smart document capture technology – and the bypassing of excessive admin – is an important step towards delivering a paper-free health service – an objective that many NHS trusts are hoping to achieve by the end of the decade. More and more trusts are beginning to use scanning platforms to cut down the reliance on paper, but this doesn’t solve the whole problem. We’ve spoken to trusts who have scanned documents into old systems, only for the system to generate one massive file which then needed to be manually searched to pinpoint the information needed.

Beyond scanning platforms, the NHS requires intelligent systems – perhaps the product of multiple vendors’ technology – that not only scans a document, but is then able to identify exactly what each document is and store it in a fully-integrated digital platform. In a fit-for-purpose modern-day health system, access to an intelligent, central patient platform is essential to help alleviate some of the administrative strain – one that removes the need for labour-intensive filing and the organising of physical records. By using sophisticated data capture technology, hospital staff can collate and access patient records from a wide variety of sources all in one place, giving them greater visibility into patient history and affording them quick and easy retrieval of information. This technology can change the functionality of the NHS. From the patient’s perspective, clever, integrated digital systems can connect them to care more efficiently and effectively than ever before. And for staff continuously weighed down by administrative tasks, these new technologies will allow them to focus their efforts on the more pressing and personal aspects of care. Technology in healthcare today At first glance, data capture initiatives may not seem the most glamorous examples of new technology in healthcare today – particularly when compared with robot brain surgeons in Canada, and the developments in 5G and extended reality that are creating new possibilities in simulation training and remote patient treatment. But the conversion of outdated healthcare systems into modern, streamlined and highly effective ones will underpin the continued success of health services across the world. In the future, further improvements to machine learning and artificial intelligence technologies will radically improve our ability to identify illnesses and diagnose patients. These technologies feed off massive sets of data, and there is an obvious abundance of this in the NHS. But in order to utilise these developments properly, our health services must first

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organise the way they store, use and access the extensive and ever-increasing patient information that staff encounter every day. Ephesoft in the NHS In recent years, a number of NHS trusts across the UK have selected Ephesoft’s technology – together with specialised healthcare technology partners – to transform their working processes. This partner ecosystem can offer complete data capture solutions to NHS trusts that organises, processes and extracts data from a wide variety of clinical documents – from referral notes to discharge summaries and everything in between. By scanning stickers containing a patient’s date of birth, NHS number and case note number, for example, each record can be clearly identified, ensuring that staff can always access the relevant documents. The technology also has the ability to develop itself over time by learning the layouts of different document types as it comes into contact with them. Given the sheer number of clinical records at play in the NHS, this function ensures that no time is lost when document layouts change – the system learns to recognise the record type and remembers it for next time. The benefits of an NHS without paper records are numerous and include reduced storage costs; the elimination of lost case notes; eradicating the need for manual entry of patient data; efficient and remote access to extensive patient information all in one place; and digitally secured records protected by rolebased access, safeguarding any sensitive data. But most importantly, the time saved on filing, preparing, auditing and locating patient records – combined with removing the need to ferry documents across wards – will free up the time of hospital staff that can be better spent in patient-facing care. To find out more about how Ephesoft can help increase efficiency in your NHS trust, visit the website below.. L FURTHER INFORMATION www.ephesoft.com

Technology

The innovation buck stops with you, Mr Hancock Barbara Harpham, chair of the Medical Technology Group, considers the mechanisms designed to promote the adoption of innovation by the NHS, and asks whether - at last we may be making some progress For over 18 years, successive Secretaries of State have championed the importance of innovation and the adoption of new medical technology by the NHS. In that time there have been over 20 reviews, reports, recommendations and initiatives designed to achieve this goal. But how successful have these steps been in ensuring the NHS takes full advantage of the technology on offer and what needs to be done next to make a significant impact? Fifteen years of frustration When we first reported on efforts to promote the adoption of innovative medical technology back in 2016, we branded our report Déjà Review. The title reflected the frustration we felt from what we perceived as a distinct lack of progress, despite countless hours of civil servant time being poured in to solve fundamental issues. That was before the publication of the Accelerated Access Review. Déjà Review set out nine recommendations for the Accelerated Access Collaborative (AAC).

The AAC is providing leadership and guidance for development of innovation across the health service. It also appears to be gaining the prominence and leadership needed to ensure it makes a significant impact on the innovation landscape. Its remit has expanded from identifying specific products that it supports through accelerated regulatory Checking the pulse of approval to addressing the more fundamental innovation in the NHS challenges to the uptake of new technology. Four years on from the Déjà Review report, It now functions as a ‘single front door’ to the we decided the time was ripe to take innovation ecosystem, horizon scanning for another look at the health of the NHS’s the best new innovations so we know what’s innovation systems. Our latest report: coming down the track, and developing Our NHS: A spotlight on the Innovation a local and national approach to Landscape does just that. Launched demand signalling to send a at a roundtable event in clear message to the market Westminster hosted by Chris about what the NHS needs. Green MP in January, the The go o Similarly, the AHSNs, report makes for more d work d established in 2013 to positive reading. In o n e by one AH spread innovation at fact, we conclude that always SN is not pace and scale across the NHS system for regions and improve innovation adoption well in replicated anothe health and economic is healthier than r while collabo growth, provide a E it’s ever been. ra These included a long-term commitment to the AAR by government, and a central role for Academic Health Science Networks (AHSNs) in supporting the spread of innovative technologies. I am glad to say that much of this advice was heeded.

tion industr with y

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Technology

 vital vehicle for interactions between industry and the NHS, while connecting the academic organisations and the third sector. This role as ‘catalysts and connectors’ has been enormously successful, and the 15 AHSNs have together helped introduce over 330 technologies which have benefited over 20 million patients. With their licence and funding renewed until 2023, they are well placed to continue to deliver results and build on their crucial regional links. The vital signs are good, but there’s room for improvement Of course, there is always more to be done. The good work done by one AHSN is not always replicated well in another while collaboration with industry, essential to ensure that device manufacturers tailor their innovation to the NHS landscape and source of demand, could be improved. Meanwhile, the AAC has focussed on a limited number of technologies and, although this has produced impressive results in certain fields, the process is unlikely to solve the fundamental issues that slow down the rapid uptake of technology across the wider healthcare system. In our view the AAC needs greater prominence within the NHS architecture. It needs support, as the key organisation focussed on the adoption and use of innovative technology, so that it can continue to assist in the development of NHS practices that are fit for patient demand. Furthermore, it needs a more formal role in all aspects of innovation, most notably NHS Business Services Authority and procurement. With a clear function, it can ensure innovation is the absolute priority when procurement decisions are made. Our report explores the six steps set out by the Accelerated Access Review, from horizon scanning to uptake support, and makes suggestions for enhancing them. It also examines the role and performance of the NHS Innovation Accelerator, NHSX, and HealthTech Connect, all of which have the potential to contribute to ensuring the right technology gets into NHS clinicians’ hands. However, we believe there are broader issues to be addressed to reform the system:

Many government initiatives, including Getting It Right First Time, are aimed at reducing the demand on NHS services by removing treatments. This sends the wrong signals to policy makers Five ways to further boost NHS innovation adoption 1. Early Access to Medical Technology The NHS still struggles to support and incentivise early access to medical technology. The Medicines and Healthcare products Regulatory Agency (MHRA) already has an ‘Early Access to Medicines Scheme’, alongside the Cancer Drugs fund as a way of allowing early access to medicines. No such scheme exists for medical devices. NHS England should establish an Early Access to Medical Technology scheme that provides funding and support for NHS organisations to give patients early access to medical technology. 2. Joining up the system The NHS needs to look at the vital elements of the system that impact the use of medical technology and ensure they are joined up. This would require a seamless process that supports all technology through the evaluation, commissioning, reimbursement and procurement challenges. All evidence, data and information on technology gathered during the evaluation phase should also support the latter elements. Doing this more effectively would allow for a reduction in the amount of duplication. 3. Funding mandate The proposals for a medical technology funding mandate will help support the uptake of proven, cost effective medical

technology. The criteria for technologies achieving mandatory funding is initially very narrow, and focused on in year savings. We would like to see this extended, with a funding mandate similar in operation to that of the system for pharmaceuticals. 4. Change ‘less is better’ mind-set Many government initiatives are aimed at reducing the demand on NHS services by removing treatments. Both Getting It Right First Time (GIRFT) and the Evidence Based Interventions programme are focused on reducing activity. This sends the wrong signals to policy makers. The drive to reduce demand should aim to get people back to full health as quickly as possible. The most effective way of achieving this is through access to effective diagnostic and subsequent treatment for all patients. 5. Creating a culture of innovation More needs to be done to create a ‘culture of innovation’. A challenge given the NHS employs 1.5 million people. Nevertheless, this needs to come from the very top and the buck stops with Secretary of State for the Department of Health and Social Care, Matt Hancock. Mr Hancock’s commitment to technology has been welcomed, but he needs to look at how he can go beyond the implementation of exciting initiatives to embed a change of culture within the UK health system. L FURTHER INFORMATION www.mtg.org.uk

Issue 20.1 | HEALTH BUSINESS MAGAZINE

Cyber security

How technology can help ease NHS winter pressures Sascha Giese, Head Geek™ at SolarWinds, discusses the failings of legacy NHS technology and how cyber security is vital for the well-being of the health service Winter brings challenging circumstances for the NHS, with the impact of seasonal bugs and flu, among other cold-weather conditions, and places an increased burden on services and resources. Indeed, as recently reported by The King’s Fund, back in the winter of 2018/19, nearly all NHS beds were occupied due to 18,000 patients a day arriving as emergency admissions during February 2019. Peaks in demand such as this will test the resources of any organisation, even one as big as the NHS, and it is perhaps no surprise important stakeholders such as the British Medical Association (BMA) have previously characterised the winter situation as a ‘crisis’. The reasons behind the challenges faced by the NHS during winter are extremely diverse, but there can be no doubt the reliability, resilience, and security of IT infrastructure is fundamental to the ability of any healthcare organisation to meet major spikes in demand—seasonal or otherwise. At any time of year, a security breach or any serious system downtime can cause huge problems for the delivery and efficiency of healthcare services. Add the extra pressure common

at this time of year, and an inconvenient IT problem can quickly evolve into a wider crisis.

A current example is the recent arrival of the end of support for Microsoft® Windows® 7 – an operating system widely used across The failings of old technology the NHS. Going forward, Microsoft has It’s inevitable in a public sector organisation now stopped providing security updates with over 70 years of history, the NHS will and support for the product and users always feel the impact of ageing IT. Even have a choice of paying for extended when the technology continues to do the job support, upgrading to the current version it was built for without obvious problems, this of Windows, or sticking with what they’ve ‘legacy’ can bring with it an unwanted got in the hope they remain secure. collection of deeply embedded This is no small problem. problems, from reliability, According to information from the collaboration, and Department of Health, there It’s inev performance issues are still ‘approximately 1.05 in a pu itable to an inability to million NHS computers scale when demand using Windows 7 from a organis blic sector ation w rises. When older 1.37 million’. Aside ith over total 70 year hardware and from the difficulties of the NH s of history, software is in daily, upgrading that number S mission-critical use of computers to Windows feel the will always within organisations 10 in the short term, it impact as large and complex shows the sheer size of of ageing as the NHS, the the task facing the NHS for IT technical and financial any wholesale technology issues associated with change. And the process can replacing it are intimidating. take years –indeed, five years

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Cyber security – Vital to the well-being of the NHS Building a strong cyber security strategy focusing on the key requirements of detection and prevention requires a co-ordinated approach from the top down. At a leadership level, efforts should include improving security best practices. For example, because the NHS employs around 1.7 million people, the risks presented by insider threats, whether unintended or malicious, are considerable. Indeed, the security risks from insiders can often be more numerous and acute than those coming from external criminal hackers or foreign governments. As a result, end-user security awareness training, network access control, and effective patching are among the best routes

to improving insider threat detection and prevention. In general, organisations investing in best practice often see an improvement in security effectiveness, and processes such as employee background checks can play an important role in controlling the risks presented by malicious insider threats. These should form part of ‘basic security hygiene’ for the NHS and will prove of immense benefit under almost all circumstances. But this only represents part of the challenge. In their attacks against hospitals, cyber criminals probe a variety of apps, systems, and environments, trying to find critical servers where Personally Identifiable Information (PII) resides. These tactics make multi-layered defences essential to augment hospital network security with intelligent threat monitoring, triggering alerts, and automated incident response software to quickly remediate cyber security issues. Ultimately, the perennial challenge for the NHS is one of funding. In the case of more advanced and sophisticated security tools, for example, the shopping list can be long. However, to help mitigate the risks of security problems exacerbating the wider winter pressures, intrusion detection and prevention tools, endpoint and mobile security, web application firewalls and encryption technologies are now ‘must-haves’.

Ultimately, the perennial challenge for the NHS is one of funding. In the case of more advanced and sophisticated security tools, for example, the shopping list can be long

It would be foolish to suggest technology alone can take away the challenges brought to the door of the NHS every winter. But it can certainly play a significant role in helping the organisation deliver infrastructure that is reliable, secure and can flex effectively whenever demand dictates. L

Cyber security

after Windows XP went ‘end of life’, the NHS still has some 2,300 computers using XP. There are always going to be challenges with using legacy technology. Despite this risk, the key to keeping systems going is to make the risk as small as possible, through implementing the necessary technology and training to primarily stop cyber threats in their tracks, but also to reduce the negative impact of a potential failure. Every organisation will face these issues; what’s important is how well they cope with them.

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Cyber incidents in last year for two thirds of organisations New research has revealed that 67 per cent of healthcare organisations have experienced a cyber security incident in the past year. Highlighting the serious threat that data breaches and malicious attacks pose to the UK’s health-related data, the Clearswift analysis also found that 48 per cent of incidents within the health sector occurred as a result of introduction of viruses or malware from third-party devices – including IoT devices and USB sticks. The survey found that further causes of cyber security incidents within the healthcare sector included employees sharing information with unauthorised recipients (39 per cent), users not following protocol/data protection policies (37 per cent), and malicious links in emails and on social media (28 per cent). The number of security incidents are in stark contrast with further findings from the survey which revealed that 24 per cent of respondents had an adequate level of budget allocated to cyber security. Alyn Hockey, VP of Product Management, Clearswift, said: “The healthcare sector holds important patient data, so it is alarming to see such high numbers of security incidents occurring in the industry. The healthcare sector needs to securely share data across departments and organisations in order to facilitate excellent patient care. With the proliferation of third-party devices in this process, it’s more important than ever that the industry bolsters its cyber security efforts to reduce the risk of everything from unwanted data loss to malicious attacks and focusses on keeping patient data safe and secure.” tinyurl.com/vhalzpk

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