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prevention.

RCN general secretary and chief executive Professor Nicola Ranger said: “Moving care into the community and supporting people to live healthier lives is key to repairing our health service, taking that pressure and congestion off the hospital and even more importantly improving population health...

NHS reveals winter plans

The NHS has announced its plans to prepare for what is expected to be a busy winter.

The health service will upgrade its 24-hour live data centres to manage demand, strengthen same-day emergency care and offer more falls services for older people.

NHS leaders have cautioned that urgent and emergency care services are likely to come under “significant pressure”.

NHS England has sent a letter to providers, asking systems to ensure all services work together to ensure patients are cared for in the safest possible place, and treated as quickly as possible.

This includes having front door assessments for patients to make sure they are signposted to the right place for their needs.

Trusts have been asked to focus on patient safety and experience, while maintaining consistent high standards of care, and only using temporary escalation spaces in periods of elevated pressure.

Before winter, NHS England will be carrying out reviews of each of the 42 integrated care systems to support them to deliver the actions necessary to cut waiting times and improve patient safety and experience.

Sarah-Jane Marsh, national director of urgent and emergency care and deputy chief operating officer for NHS England, said: “Winter is always a challenging time for the NHS and social care system – and despite extensive preparation our clinical and operational teams are braced for the expected surges in demand, alongside usual seasonal pressure...

WINTER

But did you know… ‘ ’

Survey highlights NHS financial pressures

A new survey from NHS Providers has highlighted the financial pressures facing the NHS.

The results came ahead of the review of the health service by Lord Darzi.

The survey of NHS trust leaders highlighted financial pressures due to issues like industrial action, erosion due to inflation, eye-watering efficiency demands, and relentless operational pressure.

51 per cent of respondents were extremely concerned about delivering operational priorities within their organisation’s 2024/25 financial budget.

92 per cent of those surveyed felt that the scale of the efficiency challenge in 2024/25 is more challenging than 2023/24.

44 per cent forecast their trust’s financial position for 2024/25 as a deficit, 45 per cent forecast their position as breakeven and 11 per cent forecast their position as a surplus.

Only 32 per cent were confident that their system will deliver its recovery targets to reduce waits for physical health services in 2024/25 and only 8 per cent said they were confident about recovery targets to reduce long waits in mental health services.

Chief executive of NHS Providers, Sir Julian Hartley said: “The Prime Minister’s comments today echo what trust leaders have been telling us – the shockwaves of the longest and deepest squeeze in NHS financial history, a growing mismatch between capacity and demand, major workforce challenges and the aftereffects of the Covid-19 pandemic are still being felt throughout the health service...

Strategy for Improving Safety

Communications launched PATIENT SAFETY

The Medicines and Healthcare products Regulatory Agency (MHRA) has launched a new three-year Strategy for Improving Safety Communications.

Launched on World Patient Safety Day, 17 September 2024, the strategy aimed to transform the way information is provided about the risks and safety of medicines, medical devices and healthcare products in the UK to support effective implementation of new safety measures.

MHRA points out that effective communication is essential so that patients are informed of and understand the benefits and risks of medicines and devices they are using, to assist healthcare professionals in best protecting their patients, and to maintain confidence in medical products, the broader health system, and the MHRA.

MHRA has engaged with healthcare professionals and listened to their feedback on bringing improvements to communications and systems. The strategy is underpinned by the findings of a recent consultation with healthcare professionals and healthcare organisations.

The strategy aims to deliver to patients and healthcare professionals more co-ordinated, targeted, and impactful safety communications, when they need it, using the best possible communication channels. It aims to build on the MHRA’s transformed approach to safety following the 2020 Independent Medicines and Medical Devices Safety Review...

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NHS England publishes guidance on corridor care

NHS England has published principles for providing safe and good quality care in temporary escalation spaces.

NHS England believes the delivery of care in temporary escalation spaces (TES) in departments experiencing patient crowding (including beds and chairs) is not acceptable and should not be considered as standard.

The announcement comes after a survey and report by the Royal College of Nursing (RCN) which showed that this has a detrimental impact of this type of care setting on patients and staff.

TES does not refer to spaces that are opened as part of winter pressure planning but does include care given in any unplanned settings (such as corridors).

The principles have been developed to support point-of-care staff provide the safest, most effective and highest quality care possible when TES care has been deemed necessary. They should be applied alongside any local standard operating procedures and arrangements governing flow pathways and safe staffing.

The six core principles are assessment of risk; escalation; quality of care; raising concerns and reporting incidents; data collection and measuring harms; and de-escalation.

In response, Patricia Marquis, executive director for RCN England, said: “Nursing staff raised the alarm over treating patients in corridors and the system is beginning to respond...

CYBERSECURITY

NHS England announces change to cyber security strategy

The National Data Guardian (NDG) and NHS England have announced a significant update to how health and social care organisations measure and self-report their data security capabilities.

This change, part of the Department of Health and Social Care’s cybersecurity strategy for health and social care: 2023 to 2030, aims to align health and care with cyber resilience standards across other sectors.

Starting from 2 September 2024, the NHS Data Security and Protection Toolkit (DSPT) will gradually transition from using the NDG’s 10 data security standards to the National Cyber Security Centre’s Cyber Assessment Framework (CAF) as its underpinning assessment mechanism.

DSPT is an online self-assessment tool health and care organisations use to demonstrate compliance with data security standards.

NHS England will notify organisations when it is their turn to transition and guide them through the process.

Introduced in the National Data Guardian’s 2016 review of data security, consent, and optouts, the 10 data security standards have been essential in protecting patient information by encouraging a focus on three key areas: people, process and technology.

NHS England and NDG said that keeping data safe is a “continually evolving challenge as it adapts to new threats and innovations”...

£400 million investment for clinical trials

The government has launched a joint publicprivate investment programme worth up to £400 million for cutting-edge health research.

The Voluntary Scheme for Branded Medicine Pricing, Access and Growth (VPAG) Investment Programme will channel investment into the UK’s health and life sciences sector over the next five years, with an aim to boost economic growth and the global competitiveness of the UK’s life sciences sector.

It is said to be the first major public-private collaboration of this scale in the world.

The money will be used to increase opportunities for patients to participate in commercial clinical trials. 75 per cent of the investment will be used to expand the UK’s capacity and capability for commercial clinical trials. 18 new clinical trial hubs will be created to fast-track the development of new medicines to patients.

Around 20 per cent of the funding will be directed towards sustainable manufacturing initiatives, promoting efficiency and reducing waste and emissions within the pharmaceutical sector.

The remaining 5 per cent will focus on modernising HTA processes - a way to assess the cost and clinical effectiveness of new treatments. This includes support for the National Institute for Health and Care Excellence (NICE) HTA Innovation Laboratory...

NHS data centres to receive increased protection from IT blackouts: READ MORE

Taskforce addresses diversity in NHS communications: READ MORE

Importance of organ donation promoted by NHS: READ MORE

NHS cancer site sees surge in visits after announcement: READ MORE

Health and social care has highest need for jobs and skills: READ MORE

GOVERNMENT

Paul Corrigan appointed to shape government health plans

Paul Corrigan has accepted a direct ministerial appointment to the Department of Health and Social Care.

He will work closely with secretary of state for health and social care, Wes Streeting, to shape the government’s 10-year health plan and “provide independent scrutiny of its structure and implementation.”

The government has committed to three strategic shifts in its mission for health: from hospital to community, from analogue to digital, and from treatment to prevention.

These ambitions have been long held in the health and care sector but have not, as yet, been successfully delivered.

Streeting is bringing in additional experience to support the government to turn visions for better health services into successful delivery.

Corrigan has previously worked as a government adviser, and has undertaken several executive and non-executive roles across the health and care sector, including positions held at NHS London Strategic Health Authority, Care Quality Commission and Care City.

He joins the department to work on emerging policy and delivery issues.

The appointment is a paid role, which began on 11 July 2024 and is for a 12-month period with the possibility of extension. It is not a Civil Service appointment.

Virtual wards: are they here to stay?

Virtual wards, also known as Hospital at Home, provide numerous positives and allow patients to be cared for in their own space. But how much of a part will they continue to play in NHS treatment?

Virtual wards offer numerous benefits, including increased access to medical services, especially for remote or underserved areas, reduced travel time and costs, enhanced convenience and flexibility for patients, and the ability to monitor chronic conditions effectively.

While some patients and staff think they are being introduced at the risk of removing the human element of healthcare, others see it as a stepping stone to the positive benefits of technology in healthcare.

But let’s go back to the beginning: what actually are virtual wards?

Virtual wards (also known as hospital at home ) allow patients to get hospital-level care at home safely and in familiar surroundings, helping speed up their recovery while freeing up hospital beds.

Patients on a virtual ward are cared for by a multidisciplinary team who can provide a range of tests and treatments. This could include blood tests, prescribing medication or administering fluids through an intravenous drip.

The use of virtual wards was introduced into everyday use by the NHS during the pandemic. This helped to avoid unnecessary face-to-face meetings, especially in medical settings.

What are the benefits?

There are several ways that virtual wards can make the lives of patients and staff easier. For example, they allow patients to stay in their own space without having to receive all of their treatment in hospital. This means they can spend essential time with family and friends E

Some people on virtual wards may avoid a lengthy hospital stay

F in the comfort of their home, instead of adhering to visiting hours and often feeling isolated from their loved ones.

Patients on virtual wards wear sensors which update clinicians in real time, helping the remote management team to intervene sooner and ensure the patient receives the same quality of care as they would in hospital.

As well as this, virtual wards free up hospital beds across the NHS to ease the worrying issue of bed occupancy.

Some people on virtual wards may avoid a lengthy hospital stay, which means higher priority admissions can be prioritised and waiting times can be reduced.

Manchester University NHS Foundation Trust and Manchester Local Care Organisation is one of the hospitals who have said virtual wards have been a success.

Between April 2023 and March 2024, 3,849 people in Manchester and Trafford were helped by the service.

Mark Cubbon, group chief executive of Manchester University NHS Foundation Trust, said: “Hospital at Home is changing people’s lives, providing them with better access to care in the comfort of their own home.

“It helps people avoid admission to A&E and makes safe discharge back to the patient’s home easier. We are committed to deliver care closer to home, when it is possible to do so. We’re incredibly proud of its success so far and the lives it has changed.

“Hospital at Home is a collaboration between our hospital and community teams working closely with GPs and our primary care teams. Our teams across Manchester and Trafford have made it their mission to improve the care and experience for our patients, something we are, and will continue to, achieve.”

What are the challenges?

While there are numerous pros that are attributed to virtual wards, there is also a negative side to the service.

One of the biggest issues with the Hospital At Home scheme is that not everyone has access to the right technologies or is digitally literate enough to use it efficiently. While the number of internet non-users has declined over time, in 2018, 10 per cent of the adult UK population were described as ‘internet non-users .’

Even though the majority of people do use the internet for essential tasks, many people in the UK do not have a stable internet connection or do not feel confident at operating smart devices on their own.

As well as this, the number of staff available for the service has caused challenges for virtual wards.

New healthcare ventures often need new staff, so that’s not too problematic, but the NHS has been facing a staff shortage.

NHS England admitted that in the case of Frimley Health NHS Foundation Trust there were issues of care coverage. This resulted in out-of-hours patients being managed by the existing healthcare pathways.

Do patients and staff like it?

In March 2023, the Health Foundation commissioned a survey of 7,100 nationally representative members of the public (aged 16 years and older) and over 1,200 NHS staff members to explore what people think about virtual wards and what factors will be important for making sure they work well.

Support for virtual wards is higher among disabled people and those with a carer

They found that the UK public is, overall, supportive of virtual wards (by 45 per cent to 36 per cent). But this support is finely balanced –with a further 19 per cent unsure whether they are supportive or not.

Support for virtual wards is higher among disabled people and those with a carer – groups that typically have greater health needs and who might therefore be expected to be more intensive users of virtual wards.

Nearly three-quarters of the UK public are open to being treated through a virtual ward under the right circumstances, while 27 per cent said they would not be – suggesting that, if implemented well, virtual wards should be acceptable to a large majority of service users. L

What does physical records management cost the NHS?

EDM Healthcare Consulting looks at the impact of introducing digital transformation strategies for records to the NHS

Working in the NHS, we often hear comments from patients and the general public about their surprise that NHS Trusts are still heavily reliant on paper. In contrast, many who work in the NHS remain hesitant to state with any form of confidence that the NHS will ever be fully paperless.

Some will even mock and scorn at the idea of a truly paperless NHS. Regardless of view point though, most will be taken aback at the idea that most NHS Trusts will operate or outsource the management of warehouses full of paper records.

But how about the idea that over the last five years, NHS Trusts in England alone have spent over £1.163 billion on physical records management.

The NHS England ERIC Report provides information on 200 NHS Trusts Estates Returns Information for organisations located in England. This excludes Ambulance Trusts, ICBs and GP practices. At EDM Healthcare Consulting, we’re asking NHS organisations “what impact are physical records having of your digital

transformation strategy?” and using the ERIC report data to increase awareness around the impact physical records are having on digital transformation strategies and revenue expenditure profiles.

The total expenditure on Health Records estate over five years between FY2018/19 - FY2022/23 was reported at almost £1.163 billion with £884 million spent on on-site Health Records storage and £278 million spent on off-site Health Records storage. Twenty four per cent of the total cost incurred relates to off-site storage and 76 per cent of the total cost incurred relates to on-site storage.

So that means costs are going down?

Not quite. Over the last five years, despite an increase in many NHS organisations digital maturity, the spend on Health Records estate has had a net increase of £6 million (£6,116,991), 0.5 per cent driven by an increase in off-site storage of £16 million (£16,159,928) but a welcomed reduction of on-site costs by £10 million.

What about Electronic Document Management Systems (EDMS)?

Of the 200 NHS Trusts, 65 are still reporting no Electronic Document Management system has been implemented to facilitate the digitisation of Health Records. These organisations represent £259 million (£259,951,323) of the £1.163 billion, 22 per cent of the total spend.

Which Trust represent the majority of the spend?

40 of the 200 NHS Trusts have reported a spend of £10m or more, per Trust, over the same five year period, with costs for just these Trusts totalling £600 million. While this only represents 20 per cent of NHS Trusts in England, their expenditure represents more than 50 per cent of total spend.

Furthermore, five NHS Trusts (2.5 per cent of NHS Trusts in England) have each reported a spend of £20 million or more over the five years reported, with costs totalling in excess of £143 million representing 12 per cent of total expenditure.

How does the spend compare across different regions?

When we look regionally, the spend of the 33 NHS Trusts located within the London Commissioning Region equated to £235 million over the last five years representing 20 per cent of the total five year spend across England (20 per cent). Of the 33 Trusts in the region, 11 do not have an EDMS.

In contrast, 55 NHS Trusts located in Midlands and East of England incurred costs of £300 million over the last five years (£300,296,873), 26per cent of the total five year spend across England (25.827per cent). Of the 55 Trusts, 21 do not have an EDMS.

Of the 63 NHS Trusts in the North of England their combined spend over the last five years was £337 million (£337,115,020), forming almost 30 per cent of the total five year spend. Of these, 17 Trusts reported they are yet to implement an EDMS (26 per cent).

The remaining 46 NHS Trusts located in the South of England also spent £289 million (£289,879,103), representing 25 per cent of the national spend over the last five years. Fourteen of these are without an EDMS currently (30 per cent).

What EDMS solutions currently make-up the market?

While not reported within the ERIC report, responses to Freedom of Information requests have highlighted that of the 200 NHS Trusts in England, 135 have reported an EDMS (Electronic Document Management System) is in place.

Of these 135 Trusts, 110 use one of seven vendor applications. The remaining 25, representing around 19 per cent of the market used a variety of MS Office, Inhouse Developed applications, VNAs and ‘other’ EDMS solutions.

How do we address this?

At EDM Healthcare Consulting, we’re committed to working with the NHS to reduce this spend. We believe that outsourced storage, scanning and digitisation all play their role when used correctly. No single NHS Trust is the same and as a result, careful analysis of the specific Business Drivers for each Trust should be undertaken to inform the Investment Objectives for any Health Records Management project. M

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Is VR the answer to patient care?

Virtual reality may be thought of as an immersive way to play your favourite games, but it also has an increasingly important role in providing support for patients and staff

Virtual reality, or VR, has increasingly become a part of people’s lives in the last decade. While it was first created in the late sixties, it was not until 2014 that huge tech companies invested in the idea.

Samsung announced the Samsung Gear VR, a headset that uses a Samsung Galaxy smartphone as a viewer. As well as this, Sony announced that they were working on a VR headset for the PlayStation 4 (PS4).

By 2017, many companies were developing their own VR headsets, including HTC, Google, Amazon, and Microsoft.

More recently, the Apple Vision Pro brought VR into our private and public spaces even more.

Users can watch videos, make calls, and play games on multiple windows at once (for the hefty price of up to £4,000).

VR was first used for training back when it was created for military trials, and has been utilised in other sectors like healthcare since the eighties for medical trials.

But how can we continue to use these innovative technologies for healthcare? There are various ways that VR is already being utilised as a tool to improve patient care, recruitment and training.

VR as a distraction

One way VR can help to enhance the healthcare sphere is to support patients throughout their treatment.

At Medway Maritime Hospital, the tech is helping to keep patients calm and alleviate their pain while they have image-guided procedures carried out under local anaesthetic.

It is believed to be the only NHS hospital in the country to offer therapeutic VR to patients undergoing Interventional Radiology (IR) procedures such as angioplasty, stent changes and inserting feeding tubes.

Andrea Hattabi, senior sister for interventional radiology at the hospital, said: “Every IR procedure is carried out under local E

F anaesthetic, meaning the patient is awake. Using the headset helps block pain receptors and helps them to take their mind off of what is happening. You can see that it works because the machines show their vital signs stabilise during the procedure while wearing the headset.”

She added: “We’re already talking to other teams across the hospital who are interested in using TVR in their service, so the hope for the future is to be able to offer TVR in other areas so even more patients, including children, can benefit.”

At the Christie NHS Foundation Trust, a specialist cancer centre in Manchester, VR is used as a distraction therapy for children and young people having radiotherapy.

The headset is specially designed for children aged between seven and 16 years-old.

The team use the headset with patients when they’re having clinical procedures including cannulation, injections, blood tests and dressing changes, as well as with those having radiotherapy or proton beam therapy treatment for cancers other than brain tumours (as these patients have to wear a mask over their faces).

The technology can be used to allow patients to overcome extreme fears in a safe environment

Patients can choose what scenarios the VR will show, with choices such as a theme of ‘Under the Sea.’

VR as a type of therapy

This leads us to another way VR can help patients. In the mental health sector on the NHS, the technology can be used to allow patients to overcome extreme fears in a safe environment.

One example of this comes from the VR company gameChange.

They provide psychological therapy for people with psychosis, aiming to reduce anxiety around daily activities.

For people living with psychosis, everyday tasks – such as getting on a bus, going shopping, speaking to other people – can be a challenge.

Players can get a taste of life as a pharmacist by racing against the clock to get virtual patients the medication they have been prescribed by the doctor

At Greater Manchester Mental Health NHS Foundation Trust, gameChange was piloted and received positive feedback from patients and staff.

The VR therapy programme allows a person to practise, at their own pace, being in virtual simulations of everyday situations. The therapy is provided in around six 30-minute sessions.

Agoraphobia, a type of anxiety disorder where someone is afraid to leave environments they know, is often untreated or undertreated in adults who present with a range of mental health conditions.

The VR therapy uses cognitive behavioural therapy (CBT) techniques supported by mental health professionals, requiring less time for delivery and easier access to treatment for patients.

VR as training

Virtual reality tech is not only useful for patients in healthcare, but also for providing training to NHS staff.

The South Western Ambulance Service NHS Foundation Trust is using it to provide its incident commanders with an immersive training experience to test their knowledge, skills and decision making in a realistic environment. It is especially useful for incidents such as multi-vehicle road traffic collisions, flooding and terrorist attacks.

During the training, virtual reality headsets are worn giving a three-dimensional moving image with realistic sound effects and voice injects, which replicates a live incident.

Although this is the first ambulance trust to provide this kind of VR training, this could be the start of more NHS organisations using the technology to support their staff.

The video game to recruit pharmacists

Who said gaming is never useful? Earlier this year, Rachel Craven, pharmacy business, service and performance manager at Northern Lincolnshire and Goole NHS Foundation Trust, wanted to find a way of inspiring more people to join the team.

The result was a video game where players can get a taste of life as a pharmacist by racing against the clock to get virtual patients the medication they have been prescribed by the doctor.

It can be played on a computer, mobile phone or tablet, making it ideal to take out to careers events at local schools and colleges.

You can play it here L

What is ‘smart’ data?

With the government’s new Digital Verification and Smart Data Bill announced in the King’s Speech, many are wondering what Smart Data is and how it affects them

Data itself can never be ‘smart’. However, the way we access and share data can be. David Crack, chairperson of the Association of Document Validation Professionals and CDD Services, explores how ‘smart’ data can change the delivery of services so we can work together as one.

Why do we need smart data?

I like to think of ‘smart’ data in the same way project managers define ‘SMART’ tasks. If we define goal-driven tasks that are Specific, Measurable, Achievable, Relevant, and Timebound, then the data we need to perform those tasks will inevitably become ‘smart’. Smart data is about accessing data from an authoritative source at the time you need it. For data to be ‘smart,’ it must be actionable, relevant, and useful for decision-making. This is not new. We use ‘smart’ data daily, like checking venue times for a show or upto-date travel and weather information. This real-time information affects our decisions.

However, the long-standing culture in organisations is to create multiple database silos that hold extensive information about customers, staff, and suppliers. This culture stems from when only large organisations had the computing power to digitise data. Not only is this model now maintenance-intensive and costly, it’s also highly inefficient compared to the alternative methods available today. This is why smart data is becoming so topical. To become more agile, make better informed decisions, and improve efficiency, organisations need to start using data like we do. They need to become SMART in how and when they access data.

What are the benefits for individuals?

As individuals we have more access to agile technology, high-speed communications, and extensive data sources than most organisations. Consequently, when we do engage with organisations our interactions are bogged down by outdated processes, bureaucracy, and delays.

A similar position existed in retail banking before the introduction of smart data within Open Banking. Now we can pay for things without cash, verify who we are going to pay before we pay them, and can seamlessly switch banks with minimal disruption.

The question is: why can’t we do the same with the rest of our data?

This is the motivation behind the Government’s Digital Information and Smart Data Bill (DISD Bill). It aims to create a regulated market of ‘Holder Service Providers’ offering such things as personal data stores and digital wallets. These will enable our interactions with organisations to become simpler, as with contactless payments. The regulation will also enable central and local government to share information with regulated providers so that we can all begin to control and manage our data more easily. And, to avoid getting locked in with a single provider, we will all be able to move our data around in a similar way to how we move our money between banks and bank accounts.

What are the benefits for organisations?

To appreciate the impact of smart data, consider the effort of changing your address. Individuals must separately update every organisation they deal with, while each organisation must disseminate the change across all their databases. By contrast, in a smart data world, individuals update their address only once in a personal data store; organisations only access that data when it is needed. This simplicity and cost saving is transformational.

With this in mind, the DISD Bill builds on the Government’s digital trust framework used for Right to Work, Right to Rent, and DBS. After the pandemic, organisations did not want to return to pre-pandemic, in-person paperbased regulation. Instead, the trust framework enabled immigration verification to take place remotely using digital technology, eVisas, and smart data to help prevent fraud. Similarly, the PASS Age Verification Scheme will help organisations meet their obligations within the Online Safety Act though digital PASS cards issued by multiple providers. Individuals have the choice of which card provider they want to use.

Another example is CDD’s SafeGuarden. This allows individuals to reuse verified digital credentials across multiple organisations to remove unnecessary friction and share the cost of compliance. SafeGuarden’s inspiration is Singapore’s Singpass, which, since the pandemic, has enabled individuals

David Crack, CDD Services

David Crack has over 40 years’ experience designing customer systems in retail banking and is chairperson of the Association of Document Validation Professionals and CDD Services.

to share their data with over 700 government agencies and private sector services.

What are the barriers to the introduction of smart data?

Getting market regulation and data regulation right is critical to win trust, achieve industry adoption, and public acceptance. It is important to recognise that the UK’s trust framework is NOT a national ID scheme. Similarly, commercial models for new data institutions, cybersecurity, and national fraud prevention are also required to protect the public from abuse, and enhance productivity, competitiveness, and innovation.

If these barriers can be overcome, technology push will turn into market pull as organisations look to offload sprawling and unwieldy data management overheads. They will naturally focus AI decision-making on Specific, Measurable, Achievable, Relevant, and Time-bound data.

In the meantime, if you’re investing in new systems for the next five years, ensure they are adaptable and future proofed to thrive in the smart data world. M

FURTHER INFORMATION

Want more information? Click below cdd.services/smart-data

How switching to re-useable devices can make healthcare better, cheaper and greener

Mels

Arnoldy, MSc graduate of Rotterdam School of Management Erasmus University investigates the benefits of sustainable devices

Over the past 30 years, hospitals have become reliant on single-use medical devices. Born out of the need to keep clinical settings sterile and the ability of manufacturers to produce tools at mass.

Their continued use is problematic for a number of reasons, but two stand out above others. The first is the paradox that relying on such tools causes harm to global health, which is at odds with what hospitals are set up to protect. The environmental pollution caused by the high levels of waste and the difficulty of disposing of the complicated compositions they’re made of leaves a significant footprint on the earth.

Costs are also a key concern. Devices are made in large supply and operate in linear value chains, which start at manufacture and end with disposal. Money is lost once each item is consigned to waste. Devices are also vulnerable to supply chain disruptions, which can be disastrous for hospitals and their patients if supplies run low.

A solution can be found in establishing circular hospitals, where clinicians shift away from

single-use medical devices towards reusable tools which, as well as only needing to be produced at a lower volume, can be easily reprocessed, repaired and recycled, often in a more localised capacity. This could reduce costs, decrease wastage, ease supply chain reliance and make hospitals far more efficient. However, to achieve this, the material logistics infrastructure of hospitals needs to be adapted. My research undertaken during my time at Rotterdam School of Management Erasmus University set out to provide a step forward. The first phase was problem definition. There are over 500,000 types of medical devices in use on the European market. To understand where the key challenges lie, a typology that sets out the many different varieties and how the requirements on the material logistics infrastructure changes when moving from a single use to a reusable version was developed. This was created through a structured examination of all medical devices that have a Life Cycle Analysis and Life Cycle Costing, comparing single-use tools with their E

F reusable versions. These studies measure the environmental impact and costs over the full life cycle of each device.

In the second phase, the typology was used to investigate how circular the material logistics infrastructure of hospitals currently is. Consulting with Erasmus University Medical Centre and Leiden University Medical Centre in the Netherlands, the study identified both common problems and the effectiveness of their existing solutions through analysing data retrieved from discussions with senior hospital staff, and reviewing archive documents. This made clear where practices can be adapted.

The third phase was solution design, consulting with businesses offering new ways forward to the medical sector, and experts with experience of their implementation.

The result of these explorations is establishing a series of pathways that can assist hospitals in finding their way to operating in a more circular fashion.

Each hospital may operate in its own style, but common problems exist across the board

Reducing financial and global costs

The structured analyses of Life Cycle

Analyses and Life Cycle Costing studies data gathered on each reprocessing type provides comprehensive evidence for the theory that reusable medical devices have a lower environmental impact and lower costs than single-use medical devices.

Such findings can help decision makers to identify the specific types of medical devices that have the lowest environmental impact and/ or costs and choose to invest in them. This can help to change both mindsets and practices.

On an industry-wide scale, such decisions taking place will also highlight exact areas where circular innovation is most needed, spurring action.

Tracking and streamlining logistics

Beyond device make-up, the study provides a breakdown of how the requirements of material logistics infrastructure elements can change when devices are swapped from a single use to a reusable version. These elements include transport, tracking and tracing, storage space, reprocessing, repair and point-of-collection space, so the wider impact of their continued use can be fully understood.

There is a financial element to this too, as monetising this aspect of a device’s

environmental and social impact can help to illustrate which options for device production and disposal are more sustainable, and smarter choices can be made.

Challenging processes

Each hospital may operate in its own style, but common problems exist across the board. The studies’ investigations revealed 70 common problems.

For some, solutions have already been developed providing others with a blueprint to follow. For all other common problems, the data enabled the production of a solutions flowchart, setting each out in a step-by-step order to be followed and also showing where the same solution can be used to solve multiple issues.

Doing this also highlighted where the most important and necessary solutions are needed, helping to direct hospital decision makers in their investment decisions and actions.

Track and trace

One such area is tracking and tracing, as many solutions to problems generated by single-use medical device supply, use and disposal can be found through monitoring. The study data indicates that hospitals should invest in better ways to track everything that happens with a unique medical device, including identifying where it will eventually end up as waste inside the hospital.

Those hospitals which accomplish this can eventually identify how much of an environmental impact they are making, and which costs can then be reduced when switching from a single use to a reusable version, backed up by data from LCA and LCC studies.

However, in order to change to reusables, investments in the material logistics infrastructure are required, which can sometimes present a hurdle for those wanting to see a swift return. The costs of the required investments should be, at least, offset by the potential gains from switching to reusables.

Investment in the material logistics infrastructure are required in many ways. Storage space can be optimised with a Warehouse Management System, and supply chains can be stabilised through automated order systems, whilst adding RFID technology to each device can enable these innovations to become possible as well as boosting

In order to change to reusables, investments in the material logistics infrastructure are required

traceability, providing details of devise history as well as adding information on correct disposal.

Doing this could help hospitals recycle and sell some of their waste streams, including plastics and expanded polystyrene, or let suppliers or service providers pick up some waste streams for reprocessing, repair and recycling, enabling them to recover some costs.

Future investments

The solutions flowchart also provides further practical implications for external stakeholders. Businesses can identify new business opportunities, healthcare insurances and banks can allocate their innovation budgets accordingly, and lastly governments and policymakers can adapt laws and regulations accordingly.

The result? A greener, more innovative and financially efficient system which protects global health in more ways than one, rather than damaging it.

Mels Arnoldy, MSc graduate of Rotterdam School of Management Erasmus University

https://www.moorhouseconsulting.com/sectors/health-care/

https://www.moorhouseconsulting.com/ mailto:HineshPatel@moorhouseconsulting.com

Frameworks 101: what you need to know

Frameworks are often an invaluable way to improve healthcare, but can seem hard to grasp to newcomers. We have laid out the basics of how to use them, and why you might want to

What is a framework?

A framework often refers to agreements, systems, or plans used to provide healthcare services, manage staff, and buy products.

They help ensure that everyone is following the same approach, making things work smoothly and efficiently.

There are different types of framework that are, as you probably guessed, used for different purposes.

To buy from a framework, you can start by searching for the framework that offers what you are looking for.

They are usually offered by organisations such as the NHS, Crown Commercial Service (CCS)

and NHS SBS. You can find out what each of them offer online.

There are different ways to buy, but the services are usually separated into Lots.

What are the benefits?

The main benefit of using a framework is efficiency. Instead of searching online yourself for a specific system or agreement, users can find things in one place.

This means much of the heavy lifting is already done, and often makes the process a lot smoother.

For some frameworks, there is also a cost benefit. For example, you can buy a selection E

A specific benefit to this framework is that the framework supports the NHS in reaching its Net Zero target

F of frameworks in a package which could be cheaper overall instead of buying individually.

What are some examples?

Let’s take a look at a couple of frameworks to put this into practice.

The RM6331 framework from Crown Commercial Service is for soft facilities management, and there are a variety of services that trusts and GPs can buy.

These include linen and laundry including the collection, wash and return of laundry and specialist laundry services, waste services including the collection, storage and removal of general, recycled, classified, clinical and medical waste.

As well as this, they can buy security including guarding services such as alarm response, access control, passes and perimeter guarding.

Visitor support services such as reception duties and telephony service and grounds maintenance (including soft landscaping, tree surgery, snow and ice clearance and planting) are also available.

Porterage services are purchasable, which includes transporting patients, stores, and equipment.

Trusts and GPs can also buy catering such as patient feeding, meeting hospitality, event catering, full restaurant services and vending services.

Finally, cleaning such as routine and reactive cleaning services, including pest control and ambulance vehicle decontamination is available.

This is a framework that encompasses a lot of different aspects of healthcare.

A specific benefit to this framework is that the framework supports the NHS in reaching its Net Zero target. This is something to look out for when researching frameworks, as it can support the NHS’ goal of reaching net zero by 2040. M

FURTHER INFORMATION

In Health Business, we often break down frameworks into easy terms. You can find out more here.

A framework solution to provide quicker diagnosis

NHS Shared Business Services (NHS SBS) has recently released the ‘Elective Recovery Combined Framework Agreement Solution’, which groups four framework agreements

The framework provides additional capacity to help see more patients, more quickly within a trust, with the option of utilising out of hours care providers. It includes artificial intelligence imaging and teleradiology services too, helping to speed up diagnosis and release resources to focus on patient care.

The framework solution includes artificial intelligence imaging and teleradiology services too, helping to speed up diagnosis and release resources to focus on patient care.

We have outlined the framework agreements below so you can decide what works best for your trust:

Insourcing

clinical services

First up, this framework focuses on growing patient backlogs, elective recovery budgets being cut, lack of resources and an aging population is putting increased strain on NHS services.

The ‘ Insourcing of Clinical Services

Framework Agreement ’ enables the use of insourcing support services across the NHS, securing additional clinical capacity to help meet increased demand.

It is active from 1 July 2023 to 2 July 2027, and all NHS organisations can use it.

Users can bring in a third-party provider who utilises a trust’s premises out of hours, during the weekend and in the evening, and uses equipment that would normally be dormant.

For the patient, there is no difference – they are still seen at their hospital, and they receive quicker care. In most cases, insourcing simply extends the trust’s existing clinical service. Insourcing is a short to medium term solution that allows you to retain capacity planning in-house, ensuring that patients can be seen within the trust. E

Delivering clinical excellence for over 20 years

As the UK’s foremost and longest-standing provider of additional elective care services we take pride in being elective pathway experts, dedicated to delivering safe, high-quality, cost-effective, and patient-centric care across all elective specialties.

>2 million Patients Treated Community Care Outsourcing throughout local facilities, private hospitals and GP providers. Advanced Modular Units Secondary Care Insourcing

F The ‘Insourcing of Clinical Services Framework Agreement’ forms a wider solution designed to support elective recovery within the NHS.

One benefit of this framework is that providers can bring forward new services throughout the duration of the agreement.

It also features an approved list of providers who have been evaluated on quality and price.

Clinical managed services

Also included is the ‘Clinical Managed Services including Managed Maintenance Services Framework Agreement .’

It offers a wide range of clinical services, and runs from 8 January 2024 to 7 January 2028.

It can provide managed services that will include products, maintenance, supporting services, and staff to operate devices to help increase the volume of patients that can be seen.

For example, diagnostic imaging including devices, training, maintenance, and other services and resources that can lead procedures.

The framework agreement can help with updating the equipment and includes product refresh options as part of the managed service. It is a comprehensive framework agreement with a choice of suppliers across a range of key clinical spend areas, including those referenced in the Lord Carter of Coles’ 2016 report.

The ‘Clinical Managed Services Framework Agreement’ forms a wider solution designed to support elective recovery within the NHS.

Lot 1 includes a range of specialities and areas of expertise and will be delivered across a range of healthcare settings.

The framework agreement can help with updating the equipment and includes product refresh options as part of the managed service

This is including but not limited to: pathology; diagnostic imaging, interventional radiology, cath labs, cardiology and radiotherapy (including mobile imaging); endoscopy –flexible and rigid including decontamination equipment; renal – continuous renal replacement therapy including outsourcing and home dialysis; operating theatres – including all equipment and furniture (operating tables), pre op and post op rooms; ward and clinical departments.

This lot offers managed service solutions from OEM, vendor neutral (VN) suppliers.

Lot 2 is for managed maintenance services, and provides services ranging from maintenance of specified manufacturers’ equipment to a fully outsourced medical engineering (EBME) function.

Reporting services teleradiology

The ‘ Reporting Services: Teleradiology’ framework means suppliers can aid in reducing reliance on overnight shifts within teleradiology, helping reduce stresses placed on departments, safeguarding clinician wellbeing and improving patient care.

It runs from 18 August 2023 to 17 August 2027, and all public sector bodies can use it. E

F The framework covers the provision of emergency, routine, specialist and backlog teleradiology reporting. It also covers service provision 24 hours a day, 7 days a week, 365 days a year, the provision of both insourced on-site services and outsourced reporting services.

Reporting on CT, MRI and Plain film reporting services are also included.

One of the main benefits of this framework is the wide coverage, as it offers both insourced and outsourced teleradiology services. It also enables approved organisations to increase capacity to meet increased national and local demands.

AI, imaging and radiotherapy equipment

This final framework supports the development of AI to transform the NHS’ ability to prevent, diagnose, treat, and manage disease in order to support a shift towards better prevention, health and wellbeing.

Using AI is an enabler for rapid diagnosis via technology, which results in improved diagnosis, frees up resources, and is more efficient in both cost and resource, which leads to better patient outcomes and helps with Elective Recovery.

It runs from 14 September 2021 to 13 September 2025, and any NHS and public sector organisation can use it. There are 18 Lots included.

Using AI is an enabler for rapid diagnosis via technology

Via the ‘ AI, Imaging and Radiotherapy Equipment, Associated Products and Diagnostic Imaging Framework Agreement’ , AI looks to capture methods and processes that can improve diagnostics, assist, and relieve workloads for a wide range of clinical staff.

AI software allows radiology to carry on out of hours without the radiologist being on site, reducing the burden. It also covers full body scanning, with a focus on chest and head.

The demand for diagnostic imaging is expected to increase by 10 per cent to 12 per cent year on year, linked to improving outcomes and increasing demands on the health service. The requirement to deliver better and faster diagnosis in an environment of increasing demand will require the NHS to increase capacity whilst working against financial constraints – this framework agreement can help you to achieve this.

One of the benefits of this agreement is that the solutions are cloud hardware and software compatible.

Also, there is a minimum year-long warranty. L

Industry Insight: CCS breaks down aggregation

How health authorities can take advantage of the public sector’s national buying power

With budgets and resources more squeezed than ever, public procurement is no easy task for the health sector. Unsurprisingly, many health authorities are turning to aggregated buying solutions to help take the pressure off. Crown Commercial Service (CCS) has seen an increase in demand for aggregation services from the health sector. Between April 2023 and March 2024, the CCS aggregation team supported 230 customers, of which over 40 per cent were from the health sector. This is more than double the number that participated in aggregations the previous year.

What is aggregation and how can it help health authorities?

Aggregation really just means ‘collective buying’. It usually involves bringing together more than one organisation with similar

needs to buy common goods and services from suppliers. It helps public sector organisations to achieve savings that would not be possible through individual buying. For example, a health authority looking to save costs on software packages and office solutions, could benefit from competitive prices, discounts and favourable terms from suppliers by taking part in a technology software licensing aggregation. Recently, 58 NHS trusts saved £3.2 million in our latest Microsoft aggregation, covering all Microsoft licensing products.

How does it work?

Suppliers on suitable commercial agreements are given the opportunity to take part in the aggregation, offering their best price for goods and services collectively identified by the group

of customers. Any organisation that is eligible to buy through CCS can join an aggregation.

CCS organises regular aggregations for common technology solutions such as software licences, mobile voice and data connections, and IT hardware. Customers can also suggest other potential areas for aggregation. We recognise that health authorities often have similar needs when it comes to procurement and can develop aggregated competitions solely for their use.

What kinds of goods and services can be bought?

Aggregations work best with common goods or services that will attract more than one customer and supplier.

When customers with similar needs aggregate their buying power, it encourages a wide range of suppliers to take part, reducing the cost of goods and services that do not require complex, bespoke solutions. There are also time and cost savings for buyers as the aggregation is managed, free of charge, by CCS.

For example, we run quarterly aggregations for water and wastewater services. They are open to all public sector, non-residential premises in England, Wales and Northern Ireland. Hundreds of customers take part and have benefited from savings of up to 10 per cent on their water bills.

We also run regular aggregations for technology goods and services. For example, five health customers saved £500,000 or 73 per cent on average on their mobile voice and data services.

More complex requirements, such as a contract for architectural services, may not be suitable for aggregation, since each customer will have distinct needs that are unlikely to be the same as other customers. In that situation, it makes more sense for customers to set out their individual needs to a range of suppliers on a framework.

How can health authorities get the most out of aggregation?

Early engagement is key. The earlier health authorities contact us the better. Our teams can then conduct market research and engage with suppliers to ensure that requirements can be met. We will also engage with other health organisations and customers with the same or similar needs to increase volume, which will benefit all those participating. Aggregation usually works best when there is no urgent procurement need and timescales are flexible, as it can take some time to get enough

Roberts is category lead for aggregation at Crown Commercial Service. Her current role focuses on engaging with stakeholders to understand their needs, combining requirements to build competitions that leverage volume, to deliver greater value for all Crown Commercial Service aggregation customers.

customers together to maximise collective buying power. Health authorities should plan ahead and allow themselves plenty of time to get the goods and services they need.

Our aggregation programme

It isn’t just about saving time and money. It’s about helping our customers to achieve efficiency through aggregated buying and build an NHS that is fit for the future. We run dozens of complimentary aggregations every year for customers. Visit our website for details of our upcoming aggregations

To find out more about our upcoming aggregation opportunities, contact our customer services team on 0345 410 2222, or email info@crowncommercial.gov.uk. M

FURTHER INFORMATION

Download our latest digital brochure for more information on our agreements and how we can help you add power to your procurement.

Viv

Viv Roberts, category lead for aggregation, Crown Commercial Service

How to reduce stress for children in hospital

Long hospital stays for children and young people are often daunting for patients and their guardians. What can be done to make their experience a little less stressful?

Hospitals can be lonely and daunting places, especially for young people. Painful treatments, time away from loved ones and uncertainty can impact anyone’s mental health.

Sometimes patients won’t have the energy to engage in anything too taxing but, if they are well enough, there are some small touches that can make a big difference to a young person’s stay in hospital.

From cinema rooms to animal therapy, we have highlighted charities and organisations working hard to ease stress and anxiety for young people spending time in healthcare settings.

Movies as medicine

Films provide an escape for many people. They can be a way to forget about your situation for a couple of hours.

It therefore makes sense that there is a demand for movies to be shown on large accessible screens in hospitals across the UK.

MediCinema is a charity that creates and operates cinemas inside hospitals, specially designed to accommodate beds, wheelchairs and medical equipment.

They show the latest films free of charge to patients and guardians at six cinemas in healthcare centres across the UK.

“For patients in hospital for long-term care, the cinemas help to change the perception of healthcare environments”

In a recent survey from the charity, they found that 95 per cent of patients, their guests and hospital staff agreed that going to a MediCinema screening made them feel better. It also suggested that attending the screenings reduced pain (55 per cent), reduced isolation (94 per cent) and supported people’s mental health (91 per cent).

Colin Lawrence, CEO of MediCinema, said the cinemas can mean the difference between surviving and thriving for patients.

“If you’ve got a sick kid,” he said, “that impacts the whole family.” With MediCinema, the whole family is able to enjoy the film and forget about their hospital surroundings.

Lawrence added that one of the biggest impacts on younger patients is on their mental health, as it can help them forget the medical interventions they are living with.

“For patients in hospital for long-term care, the cinemas help to change the perception of healthcare environments,” the CEO said.

He added that another “important” benefit of the cinemas is their inclusivity, as children with disabilities or who are immuno-compromised are not always able to attend public cinemas.

Lawrence recalled a young boy in hospital who insisted on walking into the cinema, something that his parents had never seen him do.

According to Lawrence, some of the most popular recent screenings for younger patients are ‘Despicable Me 4’, ‘The Garfield Movie’ and ‘Inside Out 2’. E

Image

©MediCinema

Image ©MediCinema

F MediCinema also has shows specifically for staff, dubbed ‘Thank You’ screenings.

“I’m excited to say that we are in the process of building a new cinema in Alder Hey Children’s Hospital,” added Lawrence. The cinema will be converted from a lecture theatre and is expected to impact thousands of young people.

Paw-sitive visitors

Great Ormond Street Hospital (GOSH) said on their website that it is “well proven that animals can reduce the stress of being in hospital.”

They have dog volunteers who visit the hospital regularly and go to most wards and departments.

“The main aim of our therapy dogs,” they said, “is to cheer up children and young people who might be missing their pet at home”.

The dogs also help with clinical work by encouraging patients to carry out their exercise programmes, often by joining in or acting as a reward for getting up and about.

The pups can visit patients before a test, operation, or procedure to reduce a patient’s anxiety and calm them down, as well as distract patients from any pain or discomfort by giving them something else to focus on.

Tina Jullings, chair and founder of Essex Therapy Dogs , said the feedback she gets from patients is “always positive.”

“We now have over 300 members with around 280 dogs”

She said: “I founded Essex Therapy Dogs after spotting a need in the local area for therapy dogs to visit local hospitals, care homes, nursing homes etc after Covid. There were so many people who were struggling with mental health issues, and the charity I was with previously weren’t ready to restart visits.

“I arranged a dog walk with some of my friends and put forward the idea and they were very supportive. So we originally launched Essex Therapy Dogs on 21st November 2021 with just five members with 10 dogs. We now have over 300 members with around 280 dogs.”

The charity visits nine hospitals across Essex, including 22 wards at Broomfield Hospital and nine mental health units and hubs.

Jullings recalled a new patient in one of the mental health wards who had been noncommunicative since his admittance.

“He hadn’t spoken a single word until one of our dogs walked through the door,” she said.

“Suddenly he broke out into a huge smile and rushed over to say hello and started to talk to the dog.”

The founder added: “All the staff became very emotional at the impact the dog had on that patient as they had been unable to break through his wall of silence.”

Jullings said she often get patients talking about how the dogs have made or brightened their day.

“For a few minutes someone is transported to a different place,” she said, “and the effects stay with them long after I’ve left.”

Jullings said some of the benefits she has seen included helping patients remain calm, decreasing aggressive behaviour, and encouraging communication.

A creative outlet

Another way to help young people manage their anxiety levels in hospitals is to engage in artistic activities. This can cover a whole range of events, from clay modelling workshops to spoken word poetry groups.

There are a whole host of charities and organisations that offer these kinds of activities.

The National Portrait Gallery, for example, runs a programme working with London children’s hospitals to promote health and wellbeing through creative arts programming.

The partners they are working with currently are Chelsea and Westminster Hospital, Evelina London Children’s Hospital, Great Ormond

The National Portrait Gallery runs a programme working with London children’s hospitals to promote health and wellbeing through creative arts programming

Street Hospital for Children, Newham University Hospital and The Royal London Hospital.

Children taking part in the programme can create art inspired by ‘healthcare heroes’ like Dame Sally Davies (former Chief Medical Officer for England) and Mary Seacole. They can participate in a toy hospital and a board game making workshop, where kids can even create their own board game inspired by the healthcare heroes.

Research conducted by the Centre for Cultural Value found that half of the studies referenced the idea that cultural experiences provided a ‘safe space’ for younger people, and they were proud of their creations.

As hospitals are often daunting and lonely spaces for children, it could be suggested that the impact of these creative sessions is even more pronounced than for children not in hospital. L

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NHS catering: healthy and sustainable?

With meals in hospitals forming a key part of an individual’s hospital stay, the NHS is on the road to making sure it is both nutritious and playing a part in their journey to net-zero

When you’re cooped up in hospital away from much-needed home comforts, one of the main aspects patients miss is good quality food.

In August, a survey from the charity Eating Better found that 78 per cent of respondents want healthier food in hospitals, and that public sector procurement can help achieve ‘better’ meat and dairy being served.

The survey revealed that 65 per cent agreed that ingredients known to cause health problems, such as processed meat, should not be served in schools and hospitals.

Additionally, 84 per cent think that sourcing UK-grown food for schools and hospitals is a good way to support our farmers.

The NHS has introduced plenty of guidelines for hospitals and healthcare settings to implement tasty and nutritious food for patients.

In 2020, the NHS became the world’s first national health system to commit to becoming net zero carbon, this was in response to the threat to health posed by climate change.

It is estimated that food and catering services in the NHS produce 1,543 ktCO2e each year, equating to approximately six per cent of total emissions. This places a huge responsibility on the hospital caterer to look at ways of reducing that footprint.

There have been efforts to bring hospital catering back in-house to make sustainable E

F and financial gains. This includes reducing transport costs, lessening the carbon footprint and environmental impact, as well as improving quality and minimising costly waste.

At Imperial College Healthcare NHS Trust for example, they have introduced more sustainable catering at their hospital sites through a food and retail transformation programme which maps sustainability from farm-to-plate.

Like most initiatives, there is a catchy alliterative list of words to summarise the best ways to create sustainable and healthy food in healthcare:

Reduce

Covered under this first topic is maximising resource efficiency and reducing consumption. There are several aspects that need to be considered for this, such as economic and environmental.

Food miles are a big factor to consider. The term refers to the distance food is transported from the time it is made to the time it reaches the consumer. Typically the further food travels, the worse its carbon footprint.

To avoid transporting food huge distances to different hospitals, trusts sometimes have the option to find local suppliers.

Reuse

Switching to reusable cutlery rather than single use is a great way to reduce the carbon footprint of catering in healthcare.

The NHS is the largest user of single-use plastics in Europe

A lot of industries have been taking these steps, and the NHS can certainly learn from the wider catering industry.

The NHS is the largest user of single-use plastics in Europe, with services across the NHS in England using more than 600 million disposable cups and millions of disposable cutlery pieces as well as other avoidable singleuse clinical and non-clinical plastic items between 2013-2018.

In 2020, almost one quarter of the NHS’s waste in England and Wales was plastic. In April 2021, the NHS could no longer purchase single-use plastic cutlery, plates or single-use cups made of expanded polystyrene or oxo-degradable plastics.

Continuing to push for banning single use plastics in hospitals is a great step to make catering in hospitals more sustainable.

Remanufacture

Waste generation is closely tied to consumption and production patterns. Shifting from a

linear model of production, consumption, and disposal to sustainable practices supports remanufacture and recycling.

Disposing of products at their end of life isn’t just an environmental issue; it’s also economic. Waste contributes to the NHS carbon footprint and poor waste management affects climate change and air quality. In a circular economy, waste becomes a resource. Recovered and recycled materials re-enter the supply chain, reducing the need for new resource extraction.

Adopting circular economy principles in our frameworks supports the journey to net zero. Infrastructure, partner collaboration, behaviour change, and recognising waste as a resource are essential.

Introducing more plant-based meals

Moving on from the trusty alliterative list, introducing plant-based meals is another way to reduce the NHS’ carbon footprint and make tasty food.

The Vegetarian Society estimates that 4.5 per cent of the UK population have a vegan or vegetarian diet.

This means that many people in hospitals are looking for plant-based meals during their stay. According to Plant Based Healthcare

An additional source of stress for vegans and those following a plant-based diet can be accessing appropriate meals

Professionals UK, an additional source of stress for vegans and those following a plant-based diet can be accessing appropriate meals.

Not eating animal products means healthcare settings can decrease their carbon footprint, minimise land use, and mitigate environmental degradation associated with livestock farming.   Under the Equality Rights Act 2010, hospitals have to provide vegan meal options as it would otherwise be considered discrimination.

However, the quality of these meals has often been put under scrutiny.

The Vegan Society said on their website: “It’s important for public institutions like hospitals to cater for vegan patients, but vegan food can be enjoyed by most people so let’s get more of it on hospital menus. Great vegan food can promote inclusivity, sustainability and good nutrition.” L

Understanding the impact of backlog maintenance on NHS infrastructure, patient safety, and operations

David Jones, director of estates, facilities & capital development, University Hospital Southampton NHS Foundation Trust & PhD research student University of Southampton investigates the impact of hospital maintenance backlog

Backlog maintenance in the NHS has been a growing issue for years, posing serious risks to patient safety, staff efficiency, and financial performance. Two years ago, an article in HEJ titled “Badly maintained buildings can be a risk for all” 1 highlighted the escalating problem. At that time, backlog maintenance costs stood at £9.2 billion, with £1.6 billion classified as Critical Infrastructure Risk (CIR)2. As of 2023, these

numbers have risen sharply to £11.6 billion in backlog and £2.4 billion in CIR.

The increase in backlog maintenance has affected the physical state of buildings, the functionality of equipment, and overall infrastructure. Projections suggest that by 2028/29, backlog maintenance could reach £25 billion, with over one-third categorised as CIR, a situation that threatens to impact patient care, E

F operational efficiency, and financial sustainability.

Financial impact

The financial implications of backlog maintenance extend far beyond repair costs. Every time an operating theatre or ward is closed due to infrastructure failures, trusts lose thousands of pounds in revenue and

The risks associated with backlog maintenance are most starkly reflected in patient safety

valuable staff time. In addition, hospital bed closures, caused by estate issues, exacerbate system-wide pressures, resulting in delays in patient admissions and ambulance handovers. Cumulatively, these disruptions cost the NHS tens of millions of pounds annually.

Several factors are driving the growing financial strain. Deferred maintenance accelerates asset deterioration, turning minor repairs into costly replacements. The faster increase in the Critical Infrastructure Risk (CIR) compared to the overall backlog – rising from 13 per cent in 2019 to 23 per cent today – illustrates this trend. While inflation has pushed up costs, if inflation were the sole factor, the backlog would have only reached £5.33 billion. The larger increase stems from neglecting essential repairs. Over the past decade, many NHS trusts have faced shrinking estates budgets, forcing them to focus on urgent, reactive fixes instead of planned maintenance.

Impact on patient safety

The risks associated with backlog maintenance are most starkly reflected in patient safety. As healthcare facilities age, incidents linked to infrastructure failure have doubled since E

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Addressing backlog maintenance requires a multifaceted approach

F 2011/12, amounting to over 115,000 reported incidents in 2019/203. These risks include both active failures, such as a patient tripping due to environmental hazards, and latent risks, such as poor ventilation contributing to hospitalacquired infections.

A 2022 report from the British Medical Association (BMA) found that 43 per cent of doctors believed poor workplace conditions were negatively affecting patient care, while 38 per cent rated their facilities as poor or very poor 4. Recent ERIC data also revealed that over 2,600 patient treatments were delayed or cancelled due to infrastructure issues.

Operational and staff implications

Backlog maintenance also impacts staff morale and retention. NHS staff already face immense pressures, and working in poorly maintained environments further diminishes job satisfaction. Issues like faulty equipment, leaks, and inadequate heating not only frustrate staff but also affect their ability to provide highquality care. This results in higher staff turnover, which further strains an already stretched workforce.

Beyond morale, operational disruptions caused by infrastructure failures – such as ward closures – result in cancelled procedures, contributing to longer waiting lists and delayed care. These disruptions ripple through the system, causing inefficiencies and increasing patient wait times.

Environmental and public perception

Outdated infrastructure also hampers the NHS’s ability to reduce its carbon footprint. Aging facilities tend to be less energy-efficient, and frequent short-term repairs hinder the implementation of sustainable, long-term solutions. Moreover, the poor condition of NHS estates damages public perception, creating a narrative of neglect that can undermine confidence in the system. This is borne from recent reports stating that the public’s confidence in the NHS is at an all-time low.

Research and academic perspectives

Studies show that good Evidence-Based Design (EBD) improves patient outcomes5 but has limited impact due to long implementation cycles in the NHS… in other words, we are rarely able to put theory into practice as we seldom build new facilities. Therefore, maintaining what we have is crucial, and the failure of the infrastructure can have significant impacts on the system.

The author is undertaking research studies to understand the broader impact of backlog maintenance. One study is using AI and large language models like Google’s “BERT” to analyse over 4.8 million patient safety incidents to identify the role infrastructure failures play in patient harm. Another study applies Operations Research methodologies to map out the causal relationships between infrastructure failures, patient harm, trust finances, and staff morale. E

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F This study invites directors and senior leaders of acute trusts in estates, finance, HR and nursing to contribute to this research (details below).

Addressing the backlog: future steps

Addressing backlog maintenance requires a multifaceted approach. Research into infrastructure failures must be expanded, and decision-makers need access to better data to understand the long-term costs of deferred maintenance. Current studies are focusing on how backlog maintenance impacts patients and staff, aiming to provide actionable insights. In addition, investment in proactive rather than reactive maintenance is crucial. Waiting for central government to inject funds will not suffice. The NHS needs a more strategic, long-term plan that incorporates modern data analytics and A.I. application to identify and address critical infrastructure risks before they escalate further.

Conclusion

Backlog maintenance in the NHS poses a significant risk to patient safety, financial health, operational efficiency, and staff wellbeing. If left unaddressed, these issues

In addition, investment in proactive rather than reactive maintenance is crucial

will only worsen, leading to higher costs and declining care quality. A comprehensive, data-driven approach to maintenance and infrastructure management is essential for ensuring the long-term sustainability of the NHS. By investing in the infrastructure that supports healthcare delivery, the NHS can not only improve patient outcomes but also secure its future in an increasingly complex and demanding healthcare landscape. M

FURTHER INFORMATION

References:

If you would like to get involved in the study, visit www.dpjones.uk/s2 or scan the QR code

1. Badly maintained buildings can be a risk for all. Health Estates Journal, 2022

2. NHS Digital Estates Returns Information Collection, Summary page and dataset for ERIC 2022/23

3. NHS England NRLS Reports. www.england.nhs.uk/patientsafety/organisation-patient-safety-incident-reports/

4. BMA. Building the Future. Brick by Brick. 2022

5. View through a window may influence recovery, Ulrich, R, 1984

Servicing and maintenance: The key to safe and trusted healthcare water delivery

The breakdown or failure of equipment can often have a significant impact on the provision of trusted and reliable healthcare. Matt Whiting at Rada Controls reveals the importance of servicing and maintenance, especially in the ever-evolving world of healthcare

The average UK hospital features thousands of taps and showers. The impact of just one of these breaking down or failing to work efficiently can lead to water stagnation and the potential growth of bacteria.

This is highlighted in a report from the World Health Organisation (WHO) that revealed around 20 per cent of patients in acute-care hospitals will acquire at least one healthcareassociated infection during their stay. Rada Controls’ preventative maintenance and regular servicing will go a long way towards preventing tap and showers downtime and reducing the associated risks.

Improved infection control

The loss of water and downtime of taps and showers can have a major impact on the control of bacteria as well as the operational functions of the hospital.

Through regular maintenance and servicing, healthcare providers can minimise this risk, utilising technology to accurately monitor the performance of their systems and identify potential issues or faults early.

Preventative maintenance reduces downtime

Taps and showers installed in hospitals and healthcare facilities are subject to heavy usage all year round. This can often increase the chance of breakdowns or failures.

Regular servicing and maintenance will ensure downtime is kept to an absolute minimum, reducing the chance of a poor user experience and preventing the potential spread of bacteria.

A more cost-efficient solution

Typically extending the lifespan of taps and showers through regular service and maintenance is a more cost-effective solution than repairs.

Not only does it reduce downtime, it is also more cost effective than the potentially expensive reactive repair costs in the future.

Full compliance with regulations

With healthcare providers and decision-makers responsible for compliance with all current and upcoming regulations, it is imperative that not only are the correct approved products used, they also need to be properly maintained and serviced.

As the healthcare environment is changing all the time, further regulation changes are expected in the coming years. With that in mind, Rada Controls is constantly researching and investing in the latest technologies to support healthcare providers, with new innovative products expected soon. M

FURTHER INFORMATION

www.radacontrols.com

design build facades work closely with the client team and stakeholders from the very outset, through the design and build to ensure smooth delivery of the specialist envelope package. This results in a quality project delivered on time, within budget and with minimal disruption. NHS projects completed whilst the hospital remains 100% operational with minimal disruption to clinical services & normal day to day use.

Healthcare EFM sector gears up for Healthcare Estates

Thousands of healthcare engineering and estates and facilities professionals will come together in Manchester on 8-9 October this year for IHEEM’s flagship annual event, Healthcare Estates

Taking place at the Manchester Central convention complex in the heart of the city, and this year organised around the theme of “Embracing the Challenges”, the two-day Conference and Exhibition provides learning, engagement and networking opportunities for professionals of all levels in every estates and facilities profession.

To help make Healthcare Estates as accessible as possible, IHEEM offers a choice of attendance options to suit different budgets and availability.

The Conference and Exhibition (Delegate) Pass gives access to everything on offer at Manchester Central, with a choice of one-day or two-day attendance. That includes all keynotes, conference sessions, workshops (subject to availability), exhibition seminars, and the exhibition itself.

The Exhibition-only (Visitor) Pass is free of charge and gives access to the Exhibition, including keynotes and technical seminars taking place in the Exhibition Hall theatres. E

F Interact with top decision-makers

All attendees to the event are entitled to attend the Keynote sessions, which take place on the main stage in the Exhibition Hall. IHEEM has once again recruited an impressive line-up of top name Keynote speakers , with addresses, panel discussions and live Q and As on subjects mirroring the five key themes of the Conference programme, which are: Strategic Health and Social Care Planning; Governance; Assurance and Compliance; Digital Technology and Innovation; Medical Engineering and Healthcare Engineering and Estates and Facilities Services.

Conference Programme: engage with leaders and peers on the major challenges in healthcare estates management

The multi-stream, CPD-certified Conference addresses in detail the critical subjects affecting the healthcare engineering and estates management sector today, and those shaping

its future, with the aim of providing ideas, inspiration and answers for tackling those challenges. Curated by the IHEEM Conference Committee, the broad programme features 25 hours of CPD-accredited content across two days including presentations and interactive workshops.

The full programme can be found on the event website at www.healthcare-estates.com.

IHEEM members can add Conference sessions attended at Healthcare Estates to their CPD record via the MyIHEEM CPD platform.

The Exhibition Hall: 200+ exhibitors plus a full programme of seminars

The Exhibition at Healthcare Estates is the UK’s largest showcase of products, services and information for the healthcare engineering and estates management sector.

Here you can meet over 200 exhibitors and discover the latest products and specialist services for every type of project in healthcare E

F engineering, estates and facilities. The 2024 Exhibition is expected to be the largest in the event’s history, with a number of new exhibitors alongside the many top companies who support the event year after year.

To help visitors navigate the huge number of exhibitors in the Exhibition Hall, the Healthcare Estates floorplan is organised into industry ‘zones’. The zones have been refreshed and expanded for 2024 to provide visitors with the most comprehensive coverage possible for equipment, products and services to meet current and future challenges.

The Exhibition Zones for 2024 are: Design and Construction; Energy and Sustainability; Facilities Management; HVAC and Engineering; Software and Smart Hospitals; and Water and Infection Control.

Each zone features a theatre with a full programme of free-to-attend seminars, providing vital information and insights on key topics.

Visitors can pre-plan their time in the Exhibition by exploring the interactive Exhibitor List on the event website. This online tool includes exhibitor profiles, contact details and additional media, and the list can be filtered by E

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F supplier category or searched alphabetically to identify the suppliers, products, equipment and services you are looking for.

At the end of the first day of the Exhibition, all visitors to the event are invited to the complimentary networking drinks, kindly sponsored by Currie and Brown. Served in the Delegate Catering area, this is an informal networking opportunity and a chance to catch up with colleagues after a busy day at the event.

The Awards: winners to be announced in 12 categories

The shortlists for the 2024 Healthcare Estates Awards have been revealed and the winners will be announced at the annual Healthcare Estates Awards Dinner, taking place on the evening of 8 October at the nearby Kimpton Clocktower Hotel.

The Awards are the centrepiece of the annual IHEEM Dinner (8 October 2024), a popular evening providing an excellent opportunity to network with peers from across the healthcare engineering and EFM professions.

The dinner features pre-dinner drinks, a sumptuous three course meal with coffee, a prize draw (courtesy of sponsor Troup Bywaters

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+ Anders) and entertainment from an afterdinner speaker, which this year comes from footballing legend and renowned public speaker, Kevin Keegan OBE. M

FURTHER INFORMATION

Passes for the Conference and Exhibition, and tickets to the Awards Dinner, are available via www.healthcare-estates.com

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Can we power hospitals sustainably?

We explore how improving energy efficiency can positively affect hospital operations, including cost savings, improved patient comfort, and reduced environmental impact

Every sector has had to consider measures to maximise energy efficiency, and healthcare is certainly no exception.

Healthcare buildings contribute 15 per cent of the total NHS carbon footprint, according to NHS England.

As well as this, electricity already accounts for over 50 per cent of a hospital’s energy costs. However, the NHS was the first health service in the world to imbed net zero into legislation with a goal of reaching net zero for emissions it directly controls.

At the end of last year, the NHS announced the rollout of a new centralised approach to buying energy which was estimated to slash its energy bill nationally by up to £100 million a year.

NHS Trusts across the country are also developing decarbonisation strategies with a keen focus on energy efficiency.

The Public Sector Decarbonisation Scheme has played a big part in this mission, which has implemented a range of different initiatives.

We have detailed a few ways that healthcare buildings across the NHS are hoping to increase their energy efficiency while improving patient comfort and reducing their environmental impact.

Solar energy

One way to reduce energy consumption in hospitals is to use more sustainable generation methods.

Solar panels, for example, capture the sun’s energy and convert it into electricity.

The cells don’t need direct sunlight to work and can even work on cloudy days but the stronger the sunshine, the more electricity generated. E

At Southmead Hospital in Bristol, they have been able to install solar panels that will produce 255,000kWh of electricity each year

F The average hospital electric bill in 2021 came to £279,895, according to Light Up Energy. That of course equates to a lot of energy, but solar panels are proven to be able to generate enough to at least power part of a hospital building.

Hull University Teaching Hospitals, for example, installed solar panels in 2022 to generate enough electricity to meet the hospital’s entire daytime running needs during the summer months, supporting the wider NHS’s plan to become carbon net zero.

The 11,000-panel solar farm – funded through a grant of £4.2 million – means that during the summer, the organisation saves about £250,000 a month in energy bills.

At Southmead Hospital in Bristol, they have been able to install solar panels that will produce 255,000kWh of electricity each year, which will reduce their carbon emissions by 54 tonnes of CO2 and save £80,000 per year.

Matt Gitsham, carbon and energy manager of North Bristol NHS Trust, said in 2023 when the panels were installed: “This is another great step in helping reach our net-zero goal, and we are hoping to install a further 450 panels across the Southmead site in a few months.”

He added: “Together with help from staff in reducing their energy consumption, we can create a healthier, cleanlier, and brighter future for everyone.”

Lighting

Hospitals are more reliant on lighting than a lot of public sector buildings as it is essential for surgeries and other procedures. However, there are ways to reduce energy consumption from lights.

LED lighting in hospitals is not only proven to reduce stress for patients, but it also reduces lighting energy usage.

Being aware of a hospital’s energy consumption is one of the first steps to reducing its carbon footprint

At East Surrey Hospital operated by the NHS Surrey and Sussex Healthcare Trust, 720 LED fittings replaced old fluorescent tubes with LED light bulbs which are longer lasting.

Out of over 170 bids, the Trust was one of the 48 successful applicants to secure this transformative NHS grant of £100,000.

The Trust said that the LED lights will create savings of nearly £35,000 a year, alongside a remarkable reduction of 41 tonnes of carbon dioxide emissions – the equivalent of just over 70 passengers’ roundtrip flights to Munich.

As well as saving energy, LED lights can create a relaxing and welcoming environment in reception, consultation and patient rooms.

LED lights are also often preferred in hospitals because they have very little UV radiation compared to other bulbs.

Energy monitoring systems

Being aware of a hospital’s energy consumption is one of the first steps to reducing its carbon footprint.

That’s where energy monitoring systems come in. They provide users with data about the building’s consumption patterns so they can make informed energy management decisions.

Using smart technology, the systems can even look at individual rooms to determine how much energy it is using.

While being aware of inefficient energy use is only part of the solution, it is a great way to see where changes can be made within the hospital.

There are many other methods to reduce energy usage in healthcare buildings, and you can find out more via the Greener NHS page below. M

www.england.nhs.uk/greenernhs

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Digital realities in fire safety

Aisha Farooq, from the FPA, takes a look at how virtual, augmented, and mixed reality technologies are changing the fire safety landscape

The advent of digital realities has transformed understanding of how technology can be utilised in the real world. With a rise in the number of new technologies and capabilities emerging across diverse sectors, the fire safety industry is recognising the impact that immersive tools can have on its products, services, and practices.

The advantages from using these emerging technologies have uncovered a whole new world of possibilities of what could be achieved in terms of mitigating risks from fire and increasing life safety. The scope of digital realities is also expanding with augmented reality (AR), virtual reality (VR), mixed reality (MR), and some elements of extended reality (XR) now weaving their way into our daily lives.

Much literature has already been published about the use of both AR and VR in the context of fire safety. Take, for instance, the installation of sprinklers in a care home. With AR technology, computer-generated elements are superimposed onto a real-world

view, allowing the user to benefit from digital markers or guides in a physical environment. Thus, a fire engineer or inspector can use an AR headset to provide a virtual overlay of how a fire suppression system will appear in an existing structure. Visualising this can help installers measure and align materials to fit correctly and follow step-by-step instructions throughout the process of installation, thereby flagging any potential for errors or damage.

Fire safety inspectors can also take advantage of this capability by viewing a digitised form of maintenance records for fire safety equipment that includes dates of installation, most recent tests, and recorded repair work.

A 2019 research study 1 led by Yi-Jao Chen considered the feasibility of integrating a building information modelling (BIM) system with AR to aid in the inspection of fire safety equipment of a virtually designed building. It did so by creating a cloud database of fire safety equipment information that could then be accessed by the user through AR to carry E

F out maintenance and inspection via a mobile device. Of the various benefits summarised, the study highlighted its convenience, efficiency, and accuracy.

Fire safety education

Perhaps one of the most obvious applications of VR technology is through training simulations for fire safety professionals. VR offers a simulated three-dimensional environment that an individual can interact with. Common examples of VR technology include flight simulators for pilots or combat scenarios for military training. In such cases, users can immerse themselves in dangerous environments without the risk of harm.

One Florida-based company, TargetSolutions, created a ‘Smoke reading in virtual reality’ training course after filming firefighters training in a real-life two-storey building fire. Launched in 2018, subject matter expert, Paul Costello said one of the several benefits of using VR as a training tool was that firefighters had the opportunity to run the simulation again and again, which was useful for “recognition prime decision making” and to build muscle memory. During a Q&A session in 2018, Paul said: “Smoke reading techniques have been around for a while, but this activity brings this training to the masses with unfettered access to it to get it right. So when firefighters arrive on scene, see high volumes of smoke, it tells them what they’re going into – what tactics to use, resources needed, whether to attack or go on the defensive. This VR activity allows you to get in, test the environment and start working on core concepts before going into an immediate dangerous to life or health (IDLH) environment.”

Another company leading the way on this is the Australian-based FLAIM, which “intersects technology and science to create real-world immersive learning solutions, in safe virtual environments”. Trainee firefighters can take advantage of fire proximity heat suit technology, a thermal imaging camera, and self-contained breathing apparatus to practice across multiple fire scenarios including residential buildings and high-rises.

Case study: Innovation at the FSC

A leading organisation for fire prevention and protection, the Fire Service College (FSC) has also been making use of the capabilities that AR and VR can offer. Based in Moreton-in-Marsh, Gloucestershire, it has been delivering fire and resilience training since the 1950s.

In the summer of 2023, FSC unveiled its first foray into AR technologies by designing a virtual building for its fire risk assessments. Speaking to F&RM about the launch, Pippa Steele, head of teaching, learning, and digital innovation at the Fire Service College says: “We have designed virtual, 3D buildings for students to navigate as an integral part of our fire risk assessment and fire safety courses.

“Previously, students would complete their training course with the FSC and then assess real buildings. Our research found that the consistency of assessment could be improved, given that learners encountered real buildings of differing complexity. Now learners can carry out a virtual fire safety audit where we have designed the buildings from scratch and set up different scenarios that deliberately don’t meet regulations. This approach is both authentic and consistent, and has further enhanced the quality of our assessment.”

The virtual assessment involves the user walking through the building on screen and addressing fire safety hazards. “The

Perhaps one of the most obvious applications of VR technology is through training simulations for fire safety professionals

assessments are getting hugely positive feedback because those being assessed feel as if they are getting the support they need. The other brilliant thing is that we can give detailed and meaningful feedback on their behaviours. Before, when a student went to assess a building they would provide a portfolio of documents, but we were not able to assess how they approached the interviews with the owners of the building to gain the required information. The AR tool that we developed allows us to look at this, and provide constructive feedback on how the student could have prompted this in a better way or could have explained the legislation and requirements as clearly as possible.”

The advantages of being able to use AR in such a way have been transformative for the college’s teaching practices, especially regarding firefighter development. “AR supports the learner by allowing them to consolidate their learning and broaden their experiences to best prepare them to tackle a fire when the need arises.

“At the FSC we have introduced technology that simulates a fire demo box for the learner, so they can focus on the fire’s behaviour without their responses being impacted by heat and noise – shaping a rounded learning experience. The instructors are able to pause the simulation and discuss it. From a learning experience, that’s incredibly important – we can teach firefighters about the principles of the fire, then

VR-led

fire extinguisher training is also available for workplaces and businesses

get them to see what it is like to be in a real fire when they have embedded those principles and theories – rather than having to do everything in one go.

“Safety is another aspect to consider. By using an AR environment during parts of the training, we’re reducing the number of unnecessary contaminants that we’re exposing instructors and learners to.

“Ultimately, the learner is at the centre of what we do. We want to further improve the quality of the learning experience to robustly prepare firefighters for when encounter a fire. Using technology in this way offers a chance to pause, discuss, and debrief a lot easier.”

FSC is currently scoping a dedicated virtual reality suite that is due to open in autumn 2024 as part of the college’s 50th anniversary year. Once launched, it will cement the FSC’s commitment to utilising innovative techniques as part of its teaching, training, and assessment procedures.

Fire safety education

A 2021 paper by Haosen Chen et al. presented a proof of concept that considered how building information modelling (BIM) and AR/VR E

F could increase situational awareness for firefighters during a fire incident. It states that the 3D architectural layout from BIM could be “integrated with other technologies to perceive and present more fire-related information”, helping inform evacuation strategies.

Training simulations are not just limited to fire safety professionals. VR-led fire extinguisher training is also available for workplaces and businesses, where users can use an industrystandard fire extinguisher and practise different types of fire behaviours and extinguishing agents.

Elsewhere, in 2021, the not-for-profit housing association Orbit teamed up with Firemark Education to launch a digital safety tour through a virtual home using augmented reality. The tool offers fire safety tips to customers by highlighting fire hazards and safety features with links to links. Aimed at a mass audience, the tool was designed to be ‘user-friendly’ and ‘easy to understand’ .

In 2023, the Virtual Reality in Medicine and Surgery (VRiMS) project launched an app that could provide mandatory fire safety training for NHS staff using XR. Users wear VR headsets to interact with the simulated environment of an existing hospital – a digital twin – and tackle scenarios where fire hazards are present. They can pick up and interact with objects in the digital environment and the technology also enables many staff to undergo their mandatory training whilst staying safe from risk.

Importance of data collection

The use of technology to aid fire safety work has been vital for the improvement of compliance and competency across the board. For example, in late 2023, insurers AXA UK announced it would be issuing body cameras to its contractors while they carried out work to remove flammable cladding and insulation from buildings. Its purpose was to “protect our customers and ensure the work is carried out to the required standard using the correct materials”. Additionally, the recordings would offer “evidence of how protection systems such as sprinklers and alarms are installed”.

At the time, the director of customer risk management at AXA Commercial, Dougie Barnett said that it “should result in the remediated buildings being an improved risk, which will have a positive impact on policy premiums”.

Arguably, when it comes to the practical use of AR and VR tools, there is a huge reliance on robust systems of data already being in place. For example, a fire inspector using AR to access fire safety equipment information for a building will rely on that information being stored digitally where it can be made accessible when required. In line with the Building Safety Act 2022, the government has made known the need for a Golden Thread of building information to be accurately recorded and digitally safeguarded as a single source of truth. Added to that is the Building Safety Regulator’s recent mandate for

key building information to be submitted by the principal accountable person of high-rise residential buildings. In the long run, these rigorous procedures for data collection and the digitisation of building information can only support the shift towards digital realities and fire safety and make it the norm.

For now, though, expansion into this area is limited by the data we have available. When it comes to building design and construction, architects and building designers have already been using digital reality tools to their advantage, with MR (combining elements of AR and VR) having a transformative effect on how an architect or designer understands their building. A 2020 study2 by James Garbett et al. examined whether BIM systems could encourage collaborative working in an AR environment to support design and construction. Thus, combining two-dimensional and threedimensional data from BIM, which can then be shared with other parties through AR, suggests that data integrity can be effectively maintained throughout a building’s lifecycle.

Generative AI: the next step in AR and VR?

In the recently published Fire Industry Association’s Fire Future Today anthology, Dr Chris Xiaoxuan Lu, Assistant Professor at the School of Informatics at the University of Edinburgh, wrote about how generative AI would be a game changer in fire safety in

The opportunities in fire safety made feasible by the use of digital reality tools cannot be underestimated

2024. Teaming up with the Scottish Fire and Rescue Service, his team have successfully trialled firefighter helmets with embedded AI technologies “designed to revolutionise the way firefighters navigate and respond to fire incidents”. The technology enables a firefighter tackling a fire to be equipped with a ‘carry-on AI brain’ that can send informative texts to the fire commander in real time, updating them on what is happening inside.

For Lu, generative AI “stands as a beacon of innovation in fire safety” and its “ability to transform and relay information across various formats revolutionises how we approach firefighting and prevention”.

The opportunities in fire safety made feasible by the use of digital reality tools cannot be underestimated. Such scenarios demonstrate how digital realities can offer safer alternatives to otherwise high-risk environments, and our growing dependence on mobile and smartphone technology has opened a whole world of possibilities when it comes to utilising digital tools not only in our daily lives but also across industry. From making the most of the digitisation of building documentation and offering viable solutions to mitigate fire risk, the use of AR and VR in the fire safety sector is nothing short of transformative. M

About the Author:

Aisha Farooq, F&RM deputy editor at the FPA

Aisha is the Deputy Editor of Fire & Risk Management, having joined the FPA in 2022. She is a key member of the editorial team, helping produce both the journal and news content for our website, to keep members and clients abreast of key industry developments.

www.thefpa.co.uk

References:

1. Yi-Jao Chen, Yong-Shan Lai, Yen-Han Lin, ‘BIM-based augmented reality inspection and maintenance of fire safety equipment’, Automation in Construction, Volume 110, 2020

2. James Garbett, Thomas Hartley, David Heesom, ‘A multiuser collaborative BIM-AR system to support design and construction’, Automation in Construction, Volume 122, 2021

The independent water safety audit

The Water Hygiene Centre looks at the importance of an independent water safety audit

Before we can discuss the uses and benefits of an independent water safety audit, it’s important to understand what one is and what it entails. An independent water safety audit completed by an Authorising Engineer (Water) is not to be feared but to be welcomed as a measure to promote compliance within an organisation.

Whether water systems are being managed within a healthcare setting or non-healthcare setting, there are legal (absolute) requirements

detailed within health and safety law which underpin our approach to safe water management.

Water safety guidance

Guidance is available in the form of BS 8680:2020, which will aid you in developing and implementing a written control scheme or ‘water safety plan’ and demonstrating an ongoing review of the scheme to ensure it remains effective and relevant. An annual

independent audit is one such method of review. Moreover, we must first understand and invest in our written scheme of control to understand how an independent audit is structured and delivered.

We can section the written scheme of control or ‘water safety plan’ into four core areas: Water Management Policy; Legionella Risk Assessment & Schematics; Operational Procedures; and Legionella Log books (reporting and recording evidence).

We will look at auditing each of these four areas in more detail below.

Water management policy

Therefore, the annual audit will typically start with a review of the water management policy. It makes sense to first understand the management strategy and arrangements that underpin the organisational processes for the safe management of water systems.

As a rule, if concerns arise relating to compliance, then it’s prudent to revisit the supporting processes. Conversely, should an organisation not have confidence in their

The annual audit will typically start with a review of the water management policy

policy and process because it’s demonstrably flawed then it’s unreasonable to expect an improvement in compliance. Following a review of this area of compliance, the audit may be used to do the following.

One - highlight inaccuracies within the management structure of an organisation, such as the need to formally capture roles and responsibilities within the organisational water safety policy, as well as to formally appoint persons with a water management responsibility in writing; especially the Responsible Person (RP) for water.

Two - identify Legionella training requirements for all persons with responsibility for the safety of the water systems – delineating between management and operational responsibilities.

Three - identify the requirement for further measures of competency such as the completion of suitable appraisals by the Authorising Engineer (Water), of the Responsible Person, and the Authorised Persons. Such appraisals typically look for evidence of qualifications, experience, and knowledge appropriate to the site, role & responsibilities, and applicable legislation and guidance. Organisations should ensure that competency appraisals are completed for all persons with a water management responsibility.

Four - assess an organisation’s ‘attitude’ towards water safety and whether a pragmatic or reactive approach has been adopted to protect staff, occupiers, service users, and others from harmful waterborne contaminants such as Pseudomonas aeruginosa and Legionella. A pragmatic approach to water management may be evidenced by the formation of a water safety group or in the way that an organisation manages risk once it’s been highlighted.

This leads nicely onto the next stage of the water safety audit which is reviewing legionella risk assessments and schematics. The review will determine how risk assessment recommendations may be used to inform the written scheme of control and organisational action plans. A review of how much risk can be accepted and tolerated by an organisation (known as risk appetite) will help to determine organisational priorities amongst these recommendations. E

F Legionella risk assessments & schematics

The completion of site-specific legionella risk assessments is another ‘absolute requirement’ under health and safety law and should be completed to current standards.

Moreover, the water safety audit will identify whether assessments have been completed following the requirements of the HSE’s ACOP L8 and British Standard 8580-1 2019 Water Quality, Risk Assessment for Legionella control, and whether the process was UKAS accredited and completed by a competent Legionella Risk Assessor.

Quality Risk assessment providers should also be able to demonstrate up-to-date professional membership/registration to relevant bodies (e.g. Legionella Control Association, UKAS). The quality of the risk assessment is of paramount importance as the information contained within it will inform the control scheme and action plans and shape how water safety is managed.

If the water safety audit identifies irregularities or doubts over the accuracy of the risk assessments or the associated schematic drawings, then this could undermine confidence in the control regime. If potential shortfalls are identified within the assessment, consideration should be given to reviewing the current assessment, or better still, carrying out a new assessment in line with current guidance to give assurance that the assessment and resultant recommendations and control regime derived from it are suitable and sufficient to manage or mitigate any risk as far as is reasonably practicable.

If we can demonstrate and accept that legionella risk assessments & schematics have been completed with accuracy and to the desired standard, then we can review recommendations that have been made and devise an action plan that supports a ‘proportionate’ approach to risk management. That isn’t to say that we simply accept certain risks as derogations, but we must adopt a measured approach to managing risk. This means an approach that is underpinned by the principle of ‘as low as reasonably practicable’

and that action priorities are calculated based on the associated risk, cost, and difficulty – which the annual audit supports.

Moreover, if our approach is to be truly measured we must acknowledge the difference between inherent and residual risk, whilst evidencing the rationale for adopting either conventional, good, or best practice. In short, service users and their vulnerability always need to be considered as this will inevitably determine when conventional, good, or best practice are suitable. For example, only ‘best practice’ would be considered suitable for managing areas occupied by high-risk patient groups.

Operational procedures

Moving on to ‘operational procedures’, the annual audit will also appraise ‘control strategy’ using the concept of monitoring to establish control and Legionella sampling for a particular reason. The traditional primary method of control is temperature for the good reason that if cold water remains cold (<20˚C) and hot water is kept hot (50˚C to 60˚C) throughout the system then it is unusual to have an issue with waterborne bacteria.

The guidance in HSG 274 Parts 1, 2 and 3 details how to safely manage water systems, with Part 2 focusing on the management of hot and cold-water systems and identifying suitable monitoring frequencies. Careful application of this guidance can ensure that such waters do not become a reservoir

If potential shortfalls are identified within the assessment, consideration should be given to reviewing the current assessment

If cold water remains cold and hot water is kept hot throughout the system then it is unusual to have an issue with waterborne bacteria

for bacterial contamination. The audit will examine compliance with these monitoring frequencies, and it will also interrogate and appraise other precautions taken to minimise the growth of waterborne contaminants, such as: procedures to ensure the normal daily use of all outlets and for flushing programmes where outlets are found to be infrequently used; the identification and possible removal of flexible hoses; the completion of scald risk assessment to substantiate the number of TMVs in situ etc; and any supplementary control strategies used (e.g. chemical dosing systems). In addition, the audit will review microbiological sampling practices to ensure that; the sampling strategy is supported by the legionella risk assessment (i.e. sampling for a particular reason) and that samples are taken following the approved technique with a chain of custody that ensures samples are processed by a UKAS accredited laboratory and remain within the required stability parameters (i.e. samples are representative of the system sampled). BS7592-2022. Sampling for Legionella bacteria in water systems code of practice details this protocol.

Legionella logbooks

The annual audit will typically conclude with a review of how all this data is recorded. The suitability of the records management system will be defined by the completeness and accuracy of the data held on such systems at the time of audit.

Conclusion

The annual water safety audit is not a piece of work to be feared but it is an invaluable tool to identify and correct inaccuracies within management and operational strategy. The audit may be seen as a ‘strategic health check’ for estates/organisations providing a means of demonstrating compliance with water safety requirements and associated health and safety laws. M

www.waterhygienecentre.com

Managing infection over winter

As flu season approaches and Covid still present, we look at infection control measures for healthcare premises

People visiting medical facilities, whether it be the hospital, GP or another location, are likely already ill or injured and therefore are more susceptible to infection. For this reason, it is important that healthcare facilities meet the highest standards of cleanliness and infection control. Infections can increase the amount of time it takes for a patient to recover, or worse, and therefore increases pressure on the NHS.

Of course, regulations are in place on the prevention and control of infection. The Care Quality Commission states that all providers of healthcare and adult social care should meet or exceed the Code of Practice on the prevention and control of infections and related guidance.

The Code states: “Good infection prevention (including cleanliness) is essential to ensure that people who use health and social care services receive safe and effective care. Effective prevention and control of infection must be part of everyday practice and be applied consistently by everyone.

“Good management and organisational processes are crucial to make sure that high standards of infection prevention (including cleanliness) are developed and maintained”.

Policy

First and foremost, all providers of healthcare should have an effective Infection Prevention and Control (IPC) policy, which is relevant to the location/specialism etc. The IPC policy should be regularly updated and available to all staff.

Cleaning contractors should have a general cleaning schedule, which includes the frequency of cleaning specific areas, fixtures and fittings. Of particular note here are items that are touched frequently, such as keyboards, telephones, door handles and light switches.

The policy should also include the use of, training in and disposal of PPE. PPE is essential to prevent the spread of infection to protect patients, staff and visitors. It is also necessary to prevent to spread to the wider community. It is important that the PPE meets regulations and is in good condition. There also needs to be enough to meed operational needs.

What can staff do?

Disposal of clinical waste is an important area to consider. Bins should be easily accessible to staff and operated with a foot pedal. Waste should be assessed and separated properly. E

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F Medicine waste should also be stored in a designated bin and collected by an appropriate waste contractor and staff need to know which medicines to dispose of in each bin.

Hand washing is highly important. Handwashing facilities must be available for all staff to adequately wash their hands in hot water using the correct technique. Liquid soap, paper towels and alcohol gel should be available.

It is important that staff are properly trained on infection control, this includes handwashing technique, use of disposable aprons and gloves, and recognising signs of infection.

Visitors

It is important for visitors to also contribute to infection prevention. Healthcare staff and cleaning teams can do everything right, but remember that visitors can bring in infection too and they are unlikely to know as much about it as those working in the environment. Educating visitors is very important and can help protect your patients and reduce infection in your area.

Clear signage should be displayed reminding people to wash their hands or use alcohol gel. In high-risk areas, for example, those visiting vulnerable patients, verbal instruction can be used to ensure every precaution is taken to reduce spread of infection. People may not be admitted to a high-risk area if they do not take infection control measures.

Hand washing facilities and alcohol gel should be provided for visitors, whether patients coming in for an outpatient or other appointment or relatives visiting someone on

Disposal of clinical waste is an important area to consider

a ward. Everyone in a healthcare facility (staff, patients and visitors) should wash their hands when they are visibly dirty, after using the toilet, after sneezing, after contact with body fluid, before and after handling food and when visiting patients with diarrhoea.

Masks can also be provided and encouraged for visitors to reduce the spread of air-borne infections.

Patients in hospital can also be encouraged to remind their visitors to help prevent infection, for example, asking people not to visit if they are unwell, asking them not to sit on the bed and trying not to have too many visitors.

When inviting patients for outpatient appointments, include details of your infection control measures. For example, you can remind people not to attend the appointment if they are showing signs of sickness that are not related to the reason they are attending. Relatives should not visit if they are ill – particularly if they are showing signs of diarrhoea and vomiting or flu.

Patients, visitors and staff can also make a report if they notice an area that is dirty.

Everyone is responsible for infection control in healthcare facilities to reduce the risk to patients and reduce pressure on the NHS. Therefore it is important that everyone has the education, training and means to be able to effectively act on infection prevention and control and ensure effective measures are taken and are in place. L

gaz@ecogrit.co.uk

ecogrit.co.uk

EcoGrit supplies a granular deicer which is safe to use around plants, children and animals. It is effective to below -20C and isn’t corrosive like rock salt. EcoGrit Concentrate is used by emergency services, wildlife trusts, English Heritage, National Trust, vets, councils and maintenance contractors to name just a few.

BLE Lighting & Power Ltd specialises in safety solutions, offering a comprehensive range of emergency lighting products and central back-up power solutions. With a focus on innovation, reliability and compliance, BLE ensures that businesses meet safety standards while delivering high-quality products designed to protect lives in critical situations.

HC Legionella Ltd offer services focusing on the control and prevention of legionella bacteria in water systems. ‘Managing through to resolution’ means that we will provide whatever is necessary to make sure you as our customer have the best advice, service, and a resolution to meet your

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