MediLink UK Review - Summer 2008

MEDIC AL TECHNOLOGY I N THE UK

Beat the odds.

The Welsh never say never. Consider, for example, Ruskinn Life Sciences Ltd. They've developed a technology that helps maintain the optimal atmosphere for embryonic incubation. Which means couples trying in-vitro fertilisation have a better chance of success. That’s Wales, where passion and ingenuity combine to overcome the odds and accomplish what was once inconceivable. No wonder 500 companies from around the world have investments here. They know Wales has the right atmosphere for growth. And their chances of success are increased, too.

Gary Knott Group Technical Director Ruskinn Life Sciences Ltd.

SUMMER 2008 ISSUE 1

features Change & Mart Since 2006, MediLink UK has been the umbrella organisation for regional health technology support groups throughout the country. The services of this network are essential in the highly demanding business environment of medical technology, where R&D investment is high, markets are global, and the pace of technological advance is matched by social and political changes in UK healthcare.

It makes for a climate where networking capability is at a premium. Medilink UK co-ordinates the expertise of its members to make a national impact on the political debate and on the quality of shared knowledge and best practice available to the sector. The Medilkink UK Review is written specifically to give this work a national voice.

The Review has been developed in response to demands from within the medical technology sector, and is published and distributed by and for those working in it: it therefore has near-saturation coverage of UK medical technology organisations. In it you will find discussion of the most important issues at stake, along with information about projects and products throughout this diverse and highly active sector.

One of the themes of our next issue will be care of the elderly and the treatment of chronic conditions. We are keen to hear from readers working in this area, and would urge potential contributors to contact the editor. In the meantime we also welcome your comments, queries and ideas.

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products 21

Portable video laryngoscope for intubation

Speeding up the journey of innovative medical technologies into the NHS

22 10 Best in Class Prizewinning products at the Medilink UK National Health Technology Awards

Clearing the airways

Contract & Expand Three companies land key NHS contracts

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A sharp intake of breath Drug delivery through inhalation

12 Breathe Easy Innovative respiratory aid offers hope to chronic lung disease sufferers

projects 17 18

Inventors back inventors

in brief

Medtech company’s new fund for innovators

26

Injecting innovation into healthcare Partnership’s backing for innovative collaborations

biff 35

Coralie Palmer Editor

Development by design… going for growth… going east… living well… agents for innovation…

Great moments in medicine

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Change & Mart

‘Commissioning and procurement have a major impact on innovation adoption’

How can the NHS reap maximum benefit from innovative medical technology? Coralie Palmer looks at the background to this complex issue, and at how efforts to bring medtech users, suppliers and buyers together are now bearing fruit.

Employing some 1.5million people, the National Health Service is one of the biggest organisations in the world. A public body of this kind, with its vast and complex hierarchies, will naturally struggle to accommodate the continuing changes implicit in adopting innovative technologies on a regular basis.

On the other side of the medical technology transaction, some 80% of the companies serving the sector are SMEs: so for the NHS to be receptive to the new products they offer, the cultural and structural differences to be negotiated are that much greater. But the potential benefits are equally great.

Medical devices can not only improve the clinical efficacy of a treatment, or patient safety or quality of life, but also shrink the logistical and financial problems of meeting growing demand throughout the ‘patient pathwayÕ.

Nevertheless the overall medical technology spend in the UK, as a percentage of GDP, is considerably lower than the European average and that of the US.

There is now substantial recognition at national, governmental level of the importance of this issue to the future of the NHS. The Wanless Report of 20021, looking at long-term NHS resource requirements, highlighted shortcomings in NHS technology adoption – a point reinforced by Sir David Cooksey’s review of publiclyfunded health research2, which identified a ‘conservative’ approach to innovation as a weakness in the NHS. In 2005 the Health Industries Task Force (HITF), set up as a focal point for government, industry and the healthcare sector to work together, was specifically requested by Lord Warner to develop routes for promoting the faster adoption of medical technologies in UK healthcare.

From the perspective of medical technology companies, the most visible result of this attention has been an ever-more complex ‘innovation landscape’, inhabited by a plethora of acronyms representing organisations both national and regional. All of these, to varying degrees, aim to offer help or guidance along the innovation route. The emphasis of much of the

MEDICAL TECHNOLOGY IN THE UK

work arising out of the HITF initiative, from web-based portals like those of the Centre for Evidence-based Procurement (CEP) and National Innovation Centre (NIC) to regional networks like the NHS Innovation Hubs, has been on coordinating ‘technology push’ (suppliers with products to offer) with ‘technology pull’ (health professionals with needs to be met).

This focus correlates with the fact that innovative SMEs who successfully work with the NHS tend to be, by design, highly responsive to the clinical needs in their fields. They will typically prioritise the development of trusted working relationships with NHS staff to explore their evolving requirements for medical technology, and to develop appropriate products in consultation with them. Regional networks such as the Medilink organisations and the Innovation Hubs have been particularly successful in consistently bringing the right people together from SMEs and the NHS, promoting just the kind of sustained collaborative dialogues that support innovative products.

or to persist with it in the face of barriers that appear intractable. This is not the least of the factors behind the well-worn observation that in a country famed for its inventiveness, innovative medical technology is the last thing we’re short of: the problem is that so much of it still tends to be sold for the benefit of overseas patients rather than those at home.

Meanwhile the procurement function has been subject to its own share of the sweeping changes designed to improve the NHS. In this regard we are not a United Kingdom: structures and systems are different for England, Scotland, Wales and Northern Ireland.

It is however changes in the English

NHS, as the largest and most influential customer, that will impact the majority of SMEs. The Supply Chain Excellence Programme (SCEP), launched in 2004 with the specific aim of securing the best value for NHS spend on goods and services, brought two particularly significant changes in its wake.

In October 2006 the Purchasing and Supply Agency (PASA) awarded a 10year contract to DHL Novation for the supply of NHS products. Essentially a privatisation of procurement on the American model, this contract enables what is now ‘NHS Supply Chain’ to seek lower prices (and increased margins) through reducing the number and diversity of suppliers. While this

approach may well lower the initial acquisition cost of items to the NHS, it could equally – not least by working against the inclusion of SMEs – both compromise quality and inhibit innovation, with dubious consequences in terms of ultimate value for money.

A more welcome development has been the introduction of Collaborative Procurement Hubs to co-ordinate NHS purchasing on a regional basis, and these now serve a significant majority of English Trusts. While savings through aggregation are key to their strategy, the hubs also employ clinical staff to build links with clinicians in member Trusts, and are required to work with regional agencies in supporting local businesses and innovation as part of their remit. ☞

At the same time, these successes have cast into relief the difficulties that persist with the final hurdle on the journey to NHS adoption: purchase of the product.

Whatever the efforts made elsewhere along the innovation route, they will not end in a new product’s being used by the NHS without – quite literally – buyin from NHS procurement. Equally, this is a part of the NHS that appears resistant to access by innovative SMEs. All too often attempts to take a new product with significant benefits through the procurement stage are defeated by processes commonly experienced as laborious, repetitive, obscure and above all time-consuming.

Hence the reputation of procurement as a bottleneck, and the transactional cost of negotiating it as disproportionately high. For SMEs, this represents a substantial disincentive either to undertake such a transaction, 4

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As the procurement hubs mature, it’s becoming clear that there is widespread recognition at their senior levels of the factors that make innovative medical technologies so ‘disruptive’ in procurement terms.

First and foremost, medical devices do not work in isolation but are intricately bound into a network of interdependent systems. Assessing the true cost implications of an innovative technology demands analysis not only of its clinical capabilities, but its lifetime effect on service delivery, from staff numbers and time to the use of space and the movement of patients and equipment. Companies making a business case need to incorporate the tracking of such costs and benefits, and purchasing departments need to embed them into their decision-making analyses in order properly to judge ultimate value for money.

Here however the enduring syndrome of ‘silo budgeting’ remains a significant problem. Costs relating to an innovative product may be borne by one compartmentalised budget while the savings it brings benefit another – a divergence experienced between, as well as within, organisations. A comparable syndrome arises with the terms on which Primary Care Trusts undertake commissioning for the services they require: the tariffs they set may inhibit the adoption of a beneficial new technology when it fundamentally changes the way a particular service is delivered and by whom - despite the overall savings that may bring.

These conflicts reflect the fact that, as observed by Professor Carl May of Newcastle University’s Centre for Health Services Research, ‘the economics of the National Health Service are really some of the most extraordinarily Byzantine things in the history of humanity.’3 The NHS is not a single homogenous organisation, but a federation of more than 700 Trusts, with differing policies and practices on new technology development, application and purchase. As is indeed the case with their use of new purchasing structures like NHS Supply Chain or the Procurement Hubs, which is not mandated – although of course individual Trusts can choose to establish supply agreements with either that are binding.

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Nevertheless a characteristic shared by the Trusts is that – like all bureaucracies – they are process-driven. For the individuals who administer procurement within them, adherence to an established and familiar procedure simplifies their task. This makes for a culture where the procedural changes demanded by innovative technologies tend to be viewed as a burden rather than an opportunity – in fact, the kind of disruption best postponed or avoided.

The autonomous nature of Trusts makes this cultural slant a powerful influence to be addressed.

The complex interaction of these different factors contributes to the high transactional cost that deters innovative would-be suppliers. To reduce that cost, the managed exchange of key information between multiple stakeholders is at a premium.

Promoting dialogue between users and suppliers is a proven means of easing progress through earlier stages in the innovation route. Increasingly, there is a palpable shift of attention by both national and regional agencies towards bringing NHS purchasers into these collaborative dialogues, so that the journey can be followed through to adoption.

MEDICAL TECHNOLOGY IN THE UK

Margaret Parton, ‘and we need to tackle the practical reality of how these play out. So it became very clear that the most valuable thing we could do was to ask our implementing Trusts to commit to procuring the equipment.’

The NHS National Technology Adoption Hub is the newest of the creatures spawned by the original HITF initiative, and has already demonstrated a refreshingly practical bias.

Its focus is by definition on the end of the innovation cycle: concerned not with R&D, but with products either already on the market, or marketable, that struggle to attain the NHS use they warrant. Its methodology is to select beneficial innovative products that have minimal NHS adoption, source Trusts to implement them, and then track exactly what happens in the course of that implementation – successful or not.

The hub put out a call for its first batch of participants in January: eligible products had to demonstrate both a step change in innovation and a strong evidence base for their benefits, yet still experience NHS resistance to adoption.

The six products chosen were then subjected to rigorous due diligence.

This process not only assessed the companies’ viability but surveyed product issues through dialogue with the company, the relevant clinicians, and the purchasing staff involved in its acquisition. From the outset then, the Hub programme was an integrative one: in a context plagued by

Classic examples have already emerged in this group of projects of how these processes impact adoption. Deltex Medical’s oesophageal Doppler enables better management of the circulating blood volume during operations, which significantly speeds recovery. Despite a strong evidence base and professional endorsement, only 1% of Acute Trusts have taken it up. Silo budgeting is partly to blame: the cost of the device is borne by the anaesthetics department – but the benefit of releasing bed days goes to the Trust. At the same time however, if existing procedures do not allow for early discharge, there’s no direct benefit apparent to the Trust from investing in the device.

Commissioning is an issue for Mediplus’s CT3000, which enables noninvasive diagnosis of bladder outlet obstruction. Its precision means it can reduce the number of patients undergoing prostate resection as well as improving the success rate of that operation. But if a urology department is paid for both the tests and the operations, then while a Trust can make a business case for savings by taking up the device, the urology department will actually lose money. This conundrum simply reflects the fact that the service was commissioned against what was standard at the time. The Hub is currently talking both to PCTs and Acute Trusts’ urology clinics about the possible benefits of siting the CT3000 in a primary care setting.

Mediplus CT300

Deltex Medical CardioQ Oesophageal Doppler

fragmented activity, it combined the input of supplier, user and buyer in framing what the problems might be.

Four products came through this process successfully (two being retained for further review) to become Hub

projects. These then moved to the implementation stage of the programme: for each technology, three Trusts were found who undertook to purchase it. ‘The processes around commissioning and procurement have a major impact,’ said the Hub’s CEO,

In continuing to follow these technologies through the implementation process, the Hub will be seeking and testing practical solutions to the problems raised – problems which make clear the importance of its integrative approach.

Implementation will be pursued until the technology achieves widespread adoption, becoming the standard of care where appropriate. If that’s not accomplished, a clear case will be made either for adoption being unsuitable, or why it’s not yet possible and what has to happen to make it so.

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This leads on to the second part of the Hub’s remit: to translate this experience into generic guides that circulate the collated knowledge nationally. The information will be developed in two forms. ‘Firstly, we’ll produce “how to-why to” guides for specific technologies,’ Margaret explained. ‘These aim to de-risk the process for Trusts.’ The guides will include an expanded business case which looks long-term at the costs and benefits of an innovative technology, and also at the related changes that might have to be made to accommodate it.

The second tool is an ‘Adoption Navigator’ designed to complement the NIC’s web guide to the innovation cycle. ‘The Navigator will be a practical guide,’ Margaret continued, ‘for anyone looking to understand the process of getting a new technology adopted – whether that’s a company, a clinician, or an NHS manager or commissioner. So it will show who does what in the innovation landscape, what information those people need to make an adoption decision, and at what stage in the process you should be talking to them.

‘What we’re hoping to do with the Navigator is get it to the point where companies can define their product by its adoption issues rather than its disease area or its technology. So achieving adoption means asking different questions – “If our product means unbundling the tariff, which route do we take through this landscape?” or, “If our product is higher cost but improves safety, what’s the right path for us?” So that people will be able to take a more informed, strategic approach in their marketing to the NHS.’ After its most recent call for new projects the Hub is currently taking another 12 projects through due diligence: six will be implemented in Trusts, and six will be taken through an adoption review, which assesses the issues but stops short of implementation.

Another call for new projects will go out in January 2009. ‘Essentially, we’ll repeat this cycle,’ said Margaret, ‘until the changes that need to be made have been consolidated – until, ideally, we become redundant.’

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At the regional level, the West Midlands is home to one of the earliest schemes bringing NHS procurement and industry together: following on from that work, specific tools are now being developed to help simplify the tortuous adoption route.

Medilink West Midlands (MedilinkWM) led a group of six organisations in the ‘Single Project’4, designed to support innovative medical technologies from R&D to NHS adoption. Both MidTECH, the region’s NHS innovation hub, and the Healthcare Purchasing Consortium (HPC), its procurement hub, were partners on the Project, which concluded in March after a highly successful two years.

As part of that scheme, three specialists from MedilinkWM were placed inside HPC to work with its clinical engagement teams, facilitating their links with industry. Now the Medilink is working closely with the hub on a new project, developing a web registration portal that links buyers and suppliers across the NHS and the private sector. As MedilinkWM CEO Tony Davis explained, the project is notable in being designed to counter not just practical adoption barriers, but cultural ones.

‘The first stage of the portal is to work jointly with HPC on the listings of buyers’ requirements,’ said Tony.

‘We’ve recruited some 20 Trusts who are HPC members and they will all be trained to use the portal.’ The Medilink already has systems to track supplier opportunities in OJEU, the Official Journal of the European Union where Trusts are obliged to advertise contracts over a certain value threshold.

But on the new portal, Trusts will be registering all their requirements below that threshold, whether tenders or requisitions.

The next stage of the project will be to populate the portal with a suppliers’ list, for which the Medilink will be recruiting members in addition to the existing HPC supplier base. ‘Over the next two years, we’ll be getting companies to register under specific categories,’ Tony explained. This will enable a Trust requirement posted on the portal to be directed immediately to the appropriate companies on the supplier base. The portal will therefore automatically work to increase the

number and diversity of suppliers available to NHS purchasers.

Equally importantly for HPC, this system will help the hub to tackle one of the most intractable barriers to adoption: culturally entrenched buying habits that resist a widening of the supplier base. The hub needs to be able to identify decisions driven by routine procedures, with negative implications for cost, quality and innovation – which is why the technology enables HPC to track the buying activity of purchasing executives, both within the hub and its member Trusts.

‘So if a purchaser continues to use the same suppliers,’ said Tony, ‘while at the same time the system has been providing new, highly suitable supply companies, that will indicate a buying pattern needing attention.’ When looked at more closely, the collated purchasing history and supply opportunities can show what a buyer could or should be changing to offer improved equipment or bring about savings. In this way it’s a practical, evidence-based tool for identifying and amending buying habits that inhibit effective procurement.

Meanwhile existing regional projects at the R&D end of the innovation spectrum are now looking to involve NHS purchasing, to take the process through to adoption.

One of the most interesting models for facilitating direct contact between health professionals and suppliers is the Giebel Round, which was developed in Germany by Professor Gerfried Giebel and is now being applied in North Wales. What’s distinctive about the Giebel Round is that its regular small meetings between equal numbers of clinicians and industrialists are held on active sites, at clinical and company premises alternately. These real-life environments demonstrate the different needs and forces at work in the clinical and commercial worlds, the better to recognise and solve the problems involved.

Professor Giebel’s model was rolled out across upper Austria, and now EU funding has enabled the local County Borough Council to establish Wrexham’s Giebel Round. MediWales

MEDICAL TECHNOLOGY IN THE UK

manager Gwyn Tudor both sits on the project’s Steering Group, and attends the Giebel Rounds themselves. What his experience of those onsite discussions has made clear is the interdependence of medical technologies, service delivery and purchasing. In a clinical setting, these factors are so intricately bound together as to be inseparable.

At one Giebel Round, a dozen clinical and company staff toured both an operating theatre and a critical care unit at Maelor Hospital. Senior nurses raised a significant problem: the difficulty of shifting and cleaning bulky, unwieldy laparoscopic units that need to be moved between theatres – sometimes during surgery. ‘From a purchasing angle,’ Gwyn observed, ‘the hospital could look at the cost of an additional unit offset against savings in staff time. Or a high-tech company might see an opportunity to develop smaller, portable technology. But another option is a customised, efficient laparoscope trolley – a reachable solution that’s in the remit of a good ‘metal-bashing’ SME. ‘So there’s an infinite number of perspectives on any given problem,’ Gwyn continued, ‘and when you walk into that real-time environment, it’s possible to see more of those options and to get at what will actually work best.’ He therefore strongly supports the inclusion of NHS procurement representatives at future Giebel Rounds: by experiencing the full context in which innovative medical devices are developed and applied, procurement staff would be better placed to judge their overall costs and benefits in use and make informed decisions about their purchase.

In Yorkshire, the White Rose Health Innovation Partnership [see p18] was developed in 2006 to promote collaborations between the NHS,

academia and industry. It’s now also supporting the newly-established PCT Strategic Innovation Group, which arose from discussions with Trusts about the lack of infrastructure for innovation. Led by Medilink Yorkshire and Humber, the Group is looking at ways of influencing the culture and processes within PCTs to encourage, rather than deter, the use of innovative devices. Its members include the CEOs of the PCT, regional procurement hub and NHS innovation hub, as well as senior representatives from the Strategic Health Authority, healthcare companies and academia.

With the move towards offering ever more advanced levels of medical attention in a primary care setting, the Group is concentrating on equipment and instrumentation technologies as two key areas for change. The first of its series of specialist focus groups is working on bariatric care, aiming firstly to identify product needs and initiate their development, and then to review and improve procurement of the devices.

Nationally and regionally then, work is under way to get new technologies across the NHS threshold to the patients who need them.

The barriers to NHS adoption – structural, procedural and cultural – represent a formidable challenge.

Nevertheless there is increasing awareness among all the parties concerned as to how these barriers function, and a recognition that sustained collaboration between users, suppliers and buyers is essential to deal with them. This is the strategy being deployed by networks like Medilinks, the innovation hubs and the procurement hubs, in building longterm connections that can dismantle

1 Wanless, D, Securing our Future Health: Taking a Long-term View, April 2002 2 Cooksey, D, A Review of UK Health Research Funding, December 2006 3 House of Commons Health Committee, The Use of New Medical Technologies within the NHS, April 2005 4 HPC, MidTECH, the Centre for Healthcare Innovation and Development (CHID), Business Innovation Centre (BIC) and SetPoint Staffordshire were selected by Advantage West Midlands (the RDA) to channel specialist medtech business support led by Medilink WM.

adoption barriers at a regional level.

Meanwhile the Innovation Adoption Hub is building nationally accessible information routes through the adoption process, with the data from their project implementation feeding into the NIC capacity to supply tools and high-level backing for change at the national level.

Encouragingly, the respective roles taken up by the national and regional groups discussed here play to their particular strengths. The regional collaborations represent activities ideally suited to their agencies, where skilled team members have long-term, in-depth knowledge of their area profile. Equally, there will be other projects like those of the Adoption Hub that demand action at the national level, to generate UK-wide applications which can then be tapped into by the regional groups. For SMEs struggling with the high transactional cost of taking devices into the NHS, these initiatives are developing practical solutions that will help speed the evolution of more responsive innovation routes.

Margaret Parton Chief Executive NHS National Technology Hub Postgraduate Centre Annex Manchester Royal Infirmary Manchester M13 9WL Tel: 0161 276 5263 Web:www.technologyadoptionhub.nhs.uk Tony Davis, CEO Medilink West Midlands 5 Greenfield Crescent Edgbaston Birmingham B15 3BE Tel: 0121 4525630 Fax: 0121 4542325 Web: medilinkwm.co.uk Gwyn Tudor, Forum Manager MediWales 5 Schooner Way Atlantic Wharf Cardiff CF10 4DZ Tel/Fax: 029 2047 3456 Email: gwyn.tudor@mediwales.com Web: www.mediwales.com

Acknowledgements: Thanks to Steve Cook, Research & Innovation Consultant at ABHI, and Sue Dunkerton, Director, Health Technologies KTN, for interviews that informed this article.

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Best in Class The UK’s most innovative healthcare companies had their hard work and outstanding achievements recognised at the Medilink UK National Health Technology Awards.

integrated medical televideo system for healthcare. Providing full collaborative working between clinicians across any distance, Symposia has been installed in the new £220m Bexley Wing of St James’s Institute of Oncology, one of the largest specialist cancer treatment centres in Europe.

Held at the Birmingham NEC on the 13 February this year, the event was the culmination of a year-long process drawing winners from hundreds of applicants from across the UK in the five categories: Innovation, Growth in Sector, Business Start-Up, Export Achievement and Partnership with the NHS. A panel of judges representing each region then selected the best of the Winners in each class.

The Innovation Award, sponsored by The Health Technologies Knowledge Transfer Network, was awarded to medical lighting specialists Brandon Medical. The company has developed Symposia, the world’s first fully

ImmunoDiagnostic Systems (IDS) won the Growth in Sector award sponsored

by Jonathan Lee Recruitment. IDS is a manufacturer of specialist manual healthcare diagnostics kits for bone disease and calcium dysfunction. The company had turnover growth of 49.6% in 2006 and 22.3% in 2007, seeing the business rise to an annual turnover of around £7.13 million. The establishment of new subsidiaries in key global markets drove this outstanding growth.

Hart Biologicals was the winner of the Export Achievement Award sponsored

by UK Trade and Investment.

Hart, a manufacturer of clinical laboratory diagnostic products, have established a new markets in Spain as well as two of the world’s most demanding export markets, USA and Germany, increasing turnover by 47%.

Sleepworks Products picked up the Start-up Award sponsored by The Clinical Services Journal. Sleepworks produce ‘Snorkil’, an over the counter anti-snoring device. In their first year of trading the company has have enjoyed strong UK sales as well as opening up new markets in Europe, Hong Kong, Japan, Singapore and Thailand.

Colin Peacock of Peacocks Medical: “We’re absolutely delighted to receive this recognition which can only work to develop our company further. CELS have been extremely supportive with regards for example, helping us to export.

Without CELS we wouldn’t have been able to take such a large step.”

Peacocks Medical Group was the winner of the Partnership with the NHS Award sponsored by the NHS National Innovation Centre. Their eight years’ work with the Diabetic Clinic in

Newcastle has seen their pressurerelieving diabetic footwear (supported by a multi-disciplinary team) reduce amputations by 45%.

‘This year’s entrants were wide-ranging and of an exceptional quality,’ said Medilink UK Chairman Kevin Kiely, ‘and that reflects the strength and diversity of one of the UK’s most thriving sectors. These awards exemplify the contribution of health technology companies, not only to the regional and national economy, but also to enhancing the quality of patient care.’

Picture: Immuno Diagnostic Systems

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The 2009 Awards are already being planned and a number of ideas to enlarge the profile and the reach of the Awards are being considered.

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Breathe Easy A radically innovative design for an artificial lung offers new hope to the millions of sufferers who currently struggle with, and die from, lung disease or damage.

Lung disease exacts a dismal toll worldwide on human health – both in deaths, and severely compromised quality of life for survivors. The World Health Organisation estimates that Acute Respiratory Infections (ARIs) – diseases such as pneumonia and tuberculosis and newer conditions like avian ‘flu – kill almost four million people a year worldwide.

Chronic lung diseases like emphysema and cystic fibrosis are also widespread: sufferers’ deterioration is slow, distressing and ultimately fatal without a lung transplant.

At present, the standard respiratory aids for these

conditions augment the working of the lungs themselves, through mechanically supported breathing and/or oxygen administration – methods that essentially force damaged lungs to work harder. But the new Haemair device bypasses the lungs altogether, by exchanging oxygen and carbon dioxide directly via the bloodstream. Until now, this method has been limited to ‘extracorporeal life support’ devices that can only be used with anaesthetised or moribund patients.

Haemair’s design is the first to take over “breathing” in this way for conscious and mobile patients, allowing their lungs to rest and recover.

The ubiquity and severity of lung diseases makes such a device desperately needed, and Haemair is now embarking on the development of its first prototype. About the size of a hardback book, this fully external device is connected to the patient’s bloodstream. Within the device, the blood travels through hollow polymer fibres, over which oygen and air are passed. Because the fibres are microporous, the blood can pick up this oxygen and then return to the

patient’s bloodstream as fully oxygenated blood. ‘So in essence, this is a blood/air mass exchanger that imitates how the lungs themselves work,’ said Dr Steve Brown, the project’s Senior Engineer.

Natural healthy lungs, he went on, contain about 700 million alveoli (tiny air sacs at the end of the lung’s airways) where oxygen is exchanged for carbon dioxide. How effectively this exchange works depends on the individual: consistent heavy smoking, for example, can reduce lung capacity to 40%.

Patients in the terminal stages of acute or chronic lung disease may have less than 20% of their original lung capacity, so that adding even another

Haemair’s prototype design for an external device would be applicable to the shorter-term usages. The ultimate aim however is to produce a range of respiratory aids based on this initial design, differing according to the type and duration of treatment. In the longer term, Haemair intend to apply the same concept to a fully implantable device – which could actually represent an alternative to transplantation.

While the principle – direct gas exchange via the bloodstream – might be straightforward, its development as a device presents complex challenges both technically and collaboratively.

Representation of how a fully implanted Haemair device may be situated within the chest cavity

20% radically improves their condition.

The efficiency of the Haemair device is such that it can provide patients with 60-80% lung capacity.

With its ability to replicate and replace lung function, the clinical effect of the Haemair device would be dramatic.

The device could be used for a range of conditions over varying periods of time. This could be a matter of hours in emergencies such as recoverable breathing failure from asthma for example, or trauma where lung function is severely impaired. For patients with ARIs, it would be applied for two or three weeks: allowing lungs to rest in this way maximises both the impact of any drug treatment and the chances of full recovery without lasting lung damage.

Used for more extended periods of months rather than weeks, the device offers both better

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treatment and improved quality of life for sufferers of chronic diseases. For those at home, increased lung capacity through the device would also increase mobility, while doing away with the dead weight of the oxygen cylinder; for those hospitalised, it would reduce the necessity for treatment in Intensive Care Units. Currently, about 50% of the most severely affected patients with emphysema or cystic fibrosis die while waiting for a lung transplant: of those who receive one, 30% die during or soon after the operation. Treated with this device, patients would be in a fitter and stronger state for the operation, and better able to survive it.

The original idea was conceived by Managing Director Bill Johns after his son Graham died of cystic fibrosis at the age of 32 – a premature death sadly typical of this disease. Bill, a chemical engineer by training, worked to develop and refine this idea with his colleague Alan Evans, who also had an engineering background and became a non-executive Director of the company.

Having patented the concept, the fledging company’s first task was to seek the academic input needed to resolve the complex problems of blood flow and biocompatibility. From institutions all over Europe, it was Swansea University, and in particular its Centre for Complex Fluids Processing, that proved best equipped for the task. Led

by Professor Rhodri Williams, the Centre was contracted to provide Haemair with access to its formidable expertise, along with essential equipment, facilities and technical support.

The Haemair display which ran last summer in the British Science Museum’s Antenna science news gallery

As luck would have it, Adrian Evans, consultant in emergency medicine at Swansea’s Morriston Hospital was at that time already working with Prof Williams on the problems of blood flow. He immediately saw the potential of the Haemair device, and now leads the NHS role as the third key partner in the project. With the collaborative team in place and the company firmly established in Swansea, Haemair successfully applied for a Welsh Assembly Government’s Smart Cymru award which helped secure their funding for the next two years of R&D. The project has been notably successful in meeting its developmental targets, now culminating in design of the initial prototype.

For a financially pressured NHS, the potential savings offered by the Haemair device would have a substantial impact. Patients with advanced lung disease may spend months of the year in general wards, and require repeated stays in intensive care at the cost of some £7,000 a week.

The weakness effected by ever-

decreasing lung capacity is a major factor in the deterioration that produces this pattern: annual costs for each such patient can exceed £100,000.

The benefits – clinical, financial and human – of the device, and the achievements Haemair can already demonstrate, have won the company a great deal of professional goodwill.

People are therefore keen to see the project succeed, and this support has become another resource helping the company to meet the technical challenges facing them.

The biggest of these lies in preventing blood forming clots because of its passage through the device. As Steve explained; ‘Blood simply hates being outside a blood vessel – its natural response is to clot. Added to that, different lung diseases cause blood to clot at different rates from healthy people, depending on the disease.’ At Morriston’s Clinical Haemorheology Laboratory, researchers are working on the first studies done anywhere to determine the precise effect of particular diseases on clotting times.

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MEDICAL TECHNOLOGY IN THE UK

A computer generated image of the Haemair artificial lung

A priority therefore is to establish the appropriate means for eliminating this problem. Haemair is currently exploring a number of potential routes to the answer, involving technology from anti-coagulants to cellular coatings that replicate the inside of blood vessels. Liaising with manufacturers, the company is testing a range of biocompatible materials such as the non-thrombogenic (anti-clotting) surface used in stents for treating heart disease. ‘The optimal solution may be down one of these routes, or it might turn out to be a marriage of two or three different technologies,’ said Steve.

The consistently close teamwork between Haemair and Morriston won the company the 2007 MediWales Innovation Award for collaboration with the NHS. As it turned out, the prize of a day’s consultancy with Cardiff product design and development company PDR was perfectly timed to meet Haemair’s advance to the prototype stage. ‘That consultancy is ongoing,’ said Steve.

‘PDR’s brief is not simply to design the exterior but to contribute to a fully functioning device – they have ideas that have developed out of our discussions which will be really useful to us.’

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In developing a prototype the company is embarked on the route to a fully manufactureable device, taking all the project’s work on materials, design and testing to another level – something their strategy has prepared for.

‘The Haemair approach has always been to try and progress all our developmental areas simultaneously, at pretty much the same rate,’ Steve explained, ‘and never to limit our focus in each area to just one option – because if you do that and the option fails, you’re back at square one. So we’ve managed to avoid that.’ This strategy has maintained the company’s developmental momentum, so that the prototype stage finds each of the different contributing factors in the right place at the right time.

One of those areas is of course testing, which will be scaled up for the prototype so as to run larger amounts of blood through a full circuit of the device – and here Morriston’s work is vital. After that, the next stage would be mammalian testing. ‘The phenomenal thing is,’ said Steve, ‘that if you read clinical reports, especially from US physicians, they say they would use an equivalent device after a brief trial in just one mammalian example, because

there’s no alternative. They lose patient after patient after patient. If there’s even a small chance those people could survive, then they’d use it.’

Meanwhile the company has successfully raised further equity to take over from the Smart grant’s expiration in May, and is now in a position to complete in-vivo trials. The company’s long-term goal is to establish – whether through corporate investment, licensing or purchase – a viable high-tech manufacturing facility in South Wales to bring this new respiratory aid to a world-wide market.

Haemair Ltd Unit 212 Digital Technium Swansea University Singleton Park Swansea SA2 8PP Tel: 01792 602466 Email: sbrown@haemair.com wrjohns@haemair.com Web: www.haemair.com

Big,

Bigger, Too

Big?

Medical & Healthcare Industry Confer A MedilinkWM event

Wednesday 4th June 2008 The Hyatt Hotel Birmingham

Does size matter? Eminent professor, Lord Robert Winston, alongside two medtech giants, will offer opinions on company growth and the importance of size.

From SME to global brands, are business development and innovation key to the success of all organisations? This is a great opportunity to network with the cream of the UK medical devices industry, to make new contacts and forge beneficial working relationships.

Delegate Fee @ £50 + VAT per person To view the event programme, speaker information and to book online go to www.MedilinkWM.co.uk/confer If you have any questions please call 0121 452 5630 or visit www.MedilinkWM.co.uk

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PROJECTS

InventorsBack Inventors A new £2 million investment fund is being launched to speed the best British medical inventions and ideas to a worldwide market.

Designed to help surgeons and other medical practitioners develop their concepts into commercial reality, the fund is managed by successful surgical implants and medical devices manufacturer Xiros, a Leeds-based company that has registered numerous patents for new medical components in its 24-year history.

Commercial opportunities in the medical market don’t just happen.

They’re made.

Introducing My M-Link - a brand new member service from supply chain specialists Medilink West Midlands.

My M-Link ‘s highly experienced team of advisors helps to drive businesses forward through networking, market intelligence and commercial ventures.

Instead of basing the fee on the number of full time staff in a company, the new service offers a choice of options, so you can choose the most relevant to your business goals.

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Choose from: • Networking • Market Intelligence • Business Opportunities/Personal Introductions

For more information call 0121 452 5630 or log on to www.MyM-Link.co.uk

‘We are experts in developing surgical procedures and fast-tracking them to market,’ said David Beevers, Business Development Director at Xiros. ‘We will use the fund to invest in the development of product ideas in exchange for a share of the intellectual property rights and potential future profits. In exchange, surgeons, therapists, academics and medical practitioners will gain from cash investment into development facilities, intellectual property protection, legal services and production expenses.’

Commenting on the initiative, Durhambased orthopaedic surgeon Mr Andrews Jennings said: ‘This is a welcome British shot in the arm for the

David Beevers and Managing Director Adrian Howe

cruciate ligament (ACL) repair operations. Both men have since pursued eminent careers to become leaders in the field of Orthopaedics.

With a £3 million turnover, the company exports over 90% of its products and is the only firm in Yorkshire and Humberside to be awarded three stars by the Best Companies Accreditation List. The scheme follows a ‘Michelin style’ star system for rating workplace and leadership excellence as defined by companies’ own employees: one star is first class, two outstanding, and three extraordinary.

Research and development remains at the heart of the Xiros business, with 25% of turnover invested on an ongoing basis.

medical product market, which is invariably led by the USA. Xiros is providing an excellent opportunity for some home-grown product development.’

The development of synthetic replacement ligaments fuelled years of growth until surgical fashions changed: now the evolution of reconstruction techniques continues, with Xiros leading the field in areas such as fixation of tendon grafts to bone.

Xiros was founded when current Chairman Dr Bahaa Seedhom collaborated with Japanese surgeon Professor Fujikawa on the development of artificial ligaments, which eventually led to highly successful techniques and implants still in use today for anterior

‘We have a continuous process of considering literally hundreds of ideas for surgical advancement, with around a dozen projects always in progress,’ said David. ‘Although only a handful of these make it to the marketplace, we are now turning them round from

concept to delivery in a matter of months.’

The company works closely with surgeons to develop solutions in-house and identify the best route to market, either via their Neoligaments branded product range, or through their commercial links with global medical devices companies.

The Neoligaments range includes one of the world’s leading prosthetic ligament products and the portfolio has grown to include ligaments for knee, shoulder and ankle joints, successfully used to restore the movement of over 100,000 patients’ injured joints.

The new Xiros investment fund is being launched with a number of focus events and workshops with key audiences.

Xiros also plans regular attendance at key medical events across the year where it will discuss challenges and opportunities facing surgeons, physiotherapists, academics and other medical professionals to identify potential candidates for funding.

Xiros plc Springfield House Whitehouse Lane Leeds LS19 7UE Tel: 0113 238 7200 Web: www.xiros.eu.com

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Injecting Innovation into Healthcare Revolutionary technology designed to make injecting patients easier is just one of a range of products being developed with the help of the White Rose Health Innovation Partnership.

An augmented reality simulator, developed in a collaboration between Leeds Teaching Hospitals and Leeds University School of Computing, uses virtual reality to train people in the skill of ultrasound-guided needle insertion.

Ultrasound guidance allows clinicians to get an internal view of the body so that they can see exactly where the needle is going.

This process is the first stage in a vast number of medical procedures and a core skill in interventional radiology.

Needles are used in everything from draining blocked kidneys to treating tumours, but none of these things can work without the core skill of putting the needle in the right place. ‘Putting a needle in under image guidance is a

fundamental first step in a huge range of procedures,’ said Dr. David Kessel, Vascular Radiologist from Leeds Teaching Hospital.

With this system, the trainee sees a mannequin and holds a realistic ultrasound probe and needle. As the probe is moved over the mannequin the trainee sees an appropriately oriented computer-generated image. The needle is then aimed towards a virtual target and inserted into the mannequin, with the computer generating a virtual image of the needle as it would be seen on ultrasound - just as it occurs in the real-life procedure.

Tests using the simulator have been carried out at the British Society of Interventional Radiology, where both experienced and novice radiologists performed procedures on a manikin (christened ‘Eugene’) to assess how the simulator could be used for training.

Their feedback confirmed that working

with Eugene was like undertaking the ‘real-world’ task. ‘If we can get people to work in a system where preparing the patient and all of the equipment is second nature to them,’ said Dr Kessell, ‘then the performance of the procedure will be improved when it’s being done for real.’

The simulator is intended to be used in conjunction with an online training curriculum. This will ensure that in addition to learning how to carry out ultrasound-guided needle insertion procedures using the simulator, trainees will also learn about the indications and contraindications for the procedure and when it would be safer to consider alternatives, as well as how to prepare both the equipment and the patient.

The project received essential help from Medipex, the NHS Innovation Hub for Yorkshire, and went on to win its category in the 2007 Medipex NHS Innovation Awards: it then came second

MEDICAL TECHNOLOGY IN THE UK

in its category at the NHS National Technology Awards in London.

Through Medipex, the project was able to access funding from the White Rose Health Innovation Partnership, enabling Dr Kessel to take time out from his day job to work on the simulator.

The Partnership was formed in 2006 following a successful bid by the White Rose University Consortium - Leeds, Sheffield and York - and the University of Bradford to the Higher Education Innovation Fund, which awarded it £4.7 million to provide a framework for accelerating innovations in the healthcare sector. It brings together partners from both sides of the Atlantic, drawing together academic, clinical and industrial expertise in orthopaedics, assistive technologies, dentistry, woundcare, neuroscience and cardiovascular medicine.

The Partnership’s Proof of Concept Fund has made £1.1 million available

to support healthcare projects that are both innovative and collaborative - the Leeds simulator being a prime example.

It’s one of 32 projects that are now well under way courtesy of the Fund, with awards ranging from £12,000 to £45,000. The projects cover a wide spectrum of medical innovation, from rehabilitation monitoring to wound care, brain scanning to pelvic drug delivery. All are unique in their focus, but have one thing in common - each project has a novel element to it and will offer an innovative solution to an identified need.

There are 22 founding partner organisations involved in these projects, many of which have been generated and encouraged through open innovation workshops organised by the Partnership. A group of Health Innovation Fellows offer further support, providing information and focusing on issues such as developmental and assessment methodologies. Additional Fellows have now been appointed for attachment to

specific projects, driving forward their delivery.

Under its current funding the Partnership will run until the end of January 2009. Whilst the projects continue to develop, the Partnership is planning the wider dissemination of its work through a major conference in October 2008, which will bring together all its key activities and provide a detailed overview of progress and future development.

White Rose Health Innovation Partnership Enterprise & Innovation Office Charles Thackrah Building 101 Clarendon Road Leeds LS2 9LJ Tel: 0113 343 0923 Fax: 0113 343 0949 Web: www.wrhip.org

Dr. David Kessel, Consultant Vascular Radiologist, Leeds Teaching Hospitals pictured centre with Derek Magee and Yanong Zhu from the University of Leeds with their invention virtual reality simulator designed to train people the skill of ultrasound-guided needle insertion.

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Clearing the airways The medical device manufacturer Aircraft Medical has transformed a dream of achieving clinical precision into a reality that’s improving patient safety worldwide.

Based in Edinburgh, the company is the producer of the world’s first fully portable video laryngoscope. This stateof-the-art instrument is revolutionizing the common, but often difficult and risky, medical procedure of tracheal intubation, which allows a patient ’s breathing to be controlled artificially during general anaesthesia.

Globally, around 60 million of the 100 million patients undergoing a general anaesthetic need to be intubated, using a laryngoscope to position the tube safely. But intubations are often complicated: damage to the patient’s teeth, tissue or vocal chords can result, as can cross infection. In the worst cases, airway problems can lead to permanent brain damage and even death.

Since its launch in the summer of 2006 the McGRATH Series 5 has attracted a series of distribution contracts running to 2012 with a projected value of £32m.

So far the device has been launched in the United States, Canada, the UK, Ireland and Italy, and the company aims to significantly increase its European coverage in the next 18 months.

Aircraft Medical’s highly sophisticated McGRATH Series 5 Video Laryngoscope has on-board imaging technology that allows tracheal intubation to be performed with a clear view of the larynx. This enables paramedics, anaesthetists and other hospital staff to carry out intubation as accurately and safely as possible with the minimum risk of trauma.

The McGRATH Series 5 features the world’s first variable-length blade, that can quickly adjust to suit different patient anatomies. It’s also the world’s first video laryngoscope blade supplied as guaranteed sterile to help eliminate cross infection. A steel-bodied CameraStick is protected by the disposable blade and a clear image is transferred to the compact LCD mounted at the top of the handle. The novel design uses a single standard or rechargeable AA battery held within the 20

handle to power the device for 20 procedures or more.

This revolutionary device is the result of five years of international research leading from an original award-winning design by chief executive Matt McGrath.

Prior to this, laryngoscopes used in common practice were based on a 1940’s design. Extensive clinical studies have proved the McGRATH 5’s ability to reduce the risks associated with difficult intubations and demonstrated its superior imaging, ease of use and true portability. As a result, it is fast becoming an essential component of operating theatres, critical and intensive care units, and ER or Accident and Emergency services throughout the world.

mechanisms. To control build quality and to gather experience for future products, Aircraft recently took the decision to manage Series 5 production with its own dedicated team at Aircraft NPI in Fife. The company is committed to extending its rapidly growing distribution network, expanding its marketing capacity and further developing its product range. Given its track record, it should be confident of consolidating its position as a leader in the medical devices sector.

Aircraft Medical Ltd 10 St Andrew Square Edinburgh EH2 2AF Tel: 0131 718 6042 Fax: 0131 718 6100 Web: www.aircraftmedical.com

The McGRATH Series 5 is a precision hand-built instrument combining sophisticated electronics with precise 21

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Contract and expand Tendering for major NHS contracts may feel like swimming against a tide in an NHS procurement culture driven by cost cutting, but UK companies are succeeding through combining competitive pricing with the value that specialist knowledge, customer service and innovative solutions can add.

DawMed, 365 Healthcare and Kimel have all recently won major NHS contracts through listening, networking and devising novel solutions to their customers’ needs.

Yorkshire-based DawMed have won a major contract from East Kent Hospitals NHS Trust for a complete ‘turnkey’ project for decontamination equipment.

DawMed will supply, install, test and validate the decontamination equipment, taking total responsibility for carrying out all of the enabling building works and services in each hospitals. The contract covers four hospitals over a wide area of East Kent – Canterbury, Margate, Ashford and Folkestone – and its completion is anticipated for the second quarter of 2008.

The contract represesents the creation of complete decontamination systems for flexible endoscopes used primarily in the endoscopy, urology, theatre and ITU departments. The equipment to be supplied under the contract comprises washer-disinfectors and drying and storage cabinets, all of which have full tracking and traceability systems, and water purification equipment.

DawMed’s Executive Chairman, Kevin Gilmore, described the deal as ‘a ground-breaking turnkey contract, embracing full project management by DawMed International in partnership with the Trust’s Estates Department.’

365 Healthcare have built success on close customer contact as an intrinsic part of their product development process.

The company has been awarded a twoyear contract to supply the NHS with single-use surgical drapes and gowns.

365 Healthcare worked for over a year with partner company Kimal to develop the range of over 62 products of drapes and gowns, ensuring that the materials used outperformed the EN 13795 European standard.

Managing Director Robert Gidley said: ‘The customer provides the vital link in making sure that we can anticipate market developments and have the right product range for them.’ This focus on customer contact is signalled

by Mr Gidley’s maintaining his role as Midlands Regional Sales Manager alongside the team of Territory Sales Managers, all of whom offer on-going product support drawn from their hospital and industry experience.

Based in Droitwich Spa, Kimal has an impressive number of products listed for supply to the NHS, including products used by GP surgeries such as IUCD packs, suture sets, delivery packs and incision sets.

Kimal has now secured an exclusive three-year deal to produce bespoke cardiology procedure packs for the Basildon and Thurrock University Hospitals NHS Foundation Trust.

Thousands of custom-built comprehensive angio procedure packs are already in production and look set

22

to reach the Cardiac Catheter Suite in September.

The contract, worth more than £150,000, marks a significant step forward in Kimal’s development of business in the South East. It was supported by Medilink West Midlands, who gave Kimal the lead to tap into this lucrative region.

‘By being really proactive throughout the tender process,’ said Kimal’s corporate business manager Hamish Macdonald, ‘we were able to demonstrate our expertise, product quality and comittment to customer service.

‘The ability to obtain up to date “live” information about all OJEU adverts is extremely important, and we are indebted to MedilinkWM for providing us with the advance notification of this tender. Without their help, this deal would not have been possible.’

In an environment where, on the face of it, cost is increasingly being heralded as king, these successes go to show that adding value to products and services, listening to customer needs and engaging in networks remain crucial to providing a winning tender.

DawMed International Ltd Eden Close Hellaby, Rotherham South Yorks S66 8RW Tel: 01709 730730 Fax: 01709 730000 E-mail: sales@dawmed.com Web: www. dawmed.com 365 Healthcare Unit 401 Pointon Way Stonebridge Cross Business Park Hampton Lovett, Droitwich Spa Worcs. WR9 0LW Tel: 01905 778365 Fax: 01905 826110 Email: info@365healthcare.com Web: www.365healthcare.com Kimal plc Arundel Road Uxbridge Middlesex UB8 2SA Tel: 01895 270 951 Fax: 01895 274 035 E-mail: ken_findlay@kimal.co.uk Web: www.kimal.co.uk

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A Sharp Intake of Breath Inhalation is now regarded as one of the quickest and most effective ways of administering many different therapeutic drugs. One of the companies leading the world in pulmonary drug development is Vectura Group plc.

Based in the South West of England, the company was founded in the late 1990s to develop emerging technologies in the fast-growing field of drug delivery.

Vectura’s strategy is to take non-novel drugs (i.e. drugs that are off-patent and have already been through regulatory review) and either use them to treat other diseases, or improve the way a drug is administered so as to increase its effectiveness.

In 2000 the Company began working with Arakis Ltd on the co-development of NVA237, a drug to open up the airways of patients suffering with Chronic Obstructive Pulmonary Disease

licensed to a Swiss company, Novartis, which is conducting further clinical trials on NVA237 and also on a combination formulation of NVA237 with one of their own products, Indacaterol.

Vectura is also looking beyond the treatment of respiratory diseases for its next development opportunities.

‘Inhalation is an extremely effective way of delivering drugs into the blood stream,’ Chief Executive Chris Blackwell pointed out. ‘The lung has a huge surface area – equivalent to around two tennis courts – and most substances that dissolve in the lining fluid of the lung, whether it be a gas such as oxygen, or a small molecule drug, pass very quickly into the bloodstream. This means that there are many other therapeutic treatments that could be improved through this method of administration.’

In Parkinson’s disease for example, sufferers sometimes experience hypo-

Migraine is another area where delivery via the lungs could have significant advantages. At present the early symptoms of migraine, which can be severe, largely go untreated as only injected drugs can act quickly enough to treat them. Vectura currently has a product in early-stage development for delivery through the lungs, to bring relief to sufferers in minutes.

Vectura earned a place in the record books in 2006 when it successfully raised $45 million, the biggest biotech sector funding the UK had ever seen.

Some of these funds are being used to co-develop VR315, an inhaled combination asthma therapy that is being developed as a generic product using the Company’s GyroHaler delivery device.

GyroHaler is a dry powder inhaler that can hold up to 60 doses of drug. It is easy for patients to use, cheap to produce and the drug is sealed inside

Making Clinical Research Easier The ACTNoW® online database Is an invaluable clinical research resource for Medical Device and Healthcare Technology companies, Academia and the NHS. It is a web-based tool created to facilitate better and faster site selection for clinical trials, and to improve communication between NHS and Industry.

The total number of registered clinical research experts across the North West and Yorkshire is currently 1200 from 86 registered NHS Trusts. This includes 997 experienced clinical trial investigators.

Database roll-out in new regions

(COPD). The fourth most common cause of death in the world – predicted to become the third by 2020 – COPD is caused, in the developed world, mainly by smoking and its symptoms include irreversible loss of lung function. In Europe alone, the total financial burden of lung disease is nearly 102 billion, with COPD accounting for almost half of this sum.

NVA237 had, historically, been delivered intravenously to treat gastric ulcers, but the companies believed it could block muscarinic receptors in the lung, thereby opening up the airways.

Vectura utilised its PowderHale technology to formulate NVA237, which is inhaled once a day as a fine dry powder. This product has now been 24

mobility episodes, where voluntary movement of the body is very difficult.

Apomorphine, a drug already approved to treat these episodes, is on the market as a subcutaneous injection. Vectura’s aim is to deliver apomorphine through the lungs using its inhaler, Aspirair. This works by using air pressure to break up the drug in powder form into fine particles small enough to travel into the deep lung. The inhaler produces a slowmoving plume of fine powder to ensure that it is inhaled effectively. Clinical development to date shows that the inhaled drug – VR040 – is effective and produces relief in sufferers rapidly after inhalation.

foil blisters to prevent moisture ingress.

In 2006, Vectura signed a deal to license VR315 in Europe and struck a similar deal for the US market nine months later. In the US alone, analysts forecast this treatment could achieve peak sales of around $1 billion a year.

ACTNoW® is hosted by the NHS Innovations hubs in the North of England and is most established in the North West (operated by TrusTECH) but is already live for data from Yorkshire and Humberside (Medipex). Yorkshire data will be completed this year and data for the North East (NHS Innovations North) will go live in summer 2008.

ACTNoW® Key Features: Free online searchable database of trial experienced investigators User friendly interface for identifying Investigators/clinical research resources of interest Single point of contact per NHS Trust – to ease communications and facilitate study start-up

Vectura Group plc One Prospect West Chippenham Wiltshire SN14 6FH Tel: 01249 667700 Fax: 01249 667701 Web: www.vectura.co.uk

Powerful keyword search functions for speciality and subspeciality listings Free Online registration for new Investigators and research staff Export your search results in Adobe Acrobat pdf format Free Online registration for new users – select your own username and password

In the North East please contact Craig at Innovations North : Dr Craig Mackerness E: mackernessconsulting@tiscali.co.uk T: 07939 128 799 W: www.nhsinnovationsnorth.org.uk In Yorkshire/Humberside please contact Liz at Medipex : Liz Maddaford, CEM Data Coordinator E: liz.maddaford@medipex.co.uk T: 0113 344 3855 W: www.medipex.co.uk In the North West please contact Adrian at TrusTECH : Adrian Warner, Business Development Manager, ACTNoW® E: adrianwarner@actnow-database.co.uk T: 0161 901 2511 W: www.actnow-database.co.uk

abase.co.uk t a d w o .actn w w w

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going for growth

development by design Omicron collaborates on new cancer diagnostic Michelson Diagnostics, an optical coherence tomography (OCT) developer, has teamed up with product development consultancy Tactiq on the ‘Omicron’ project, to develop an OCT system for sub-surface imaging of cancerous tissue.

by pathologists when diagnosing, assessing, treating and monitoring cancer. This can be inefficient, expensive and time-consuming: the biopsy may be poorly targeted on the tumour, and results from the analysis can take weeks to come back.

Tactiq focus on embedded electronic systems, and medical imaging systems from gamma ray to visible light represent one area of its specialist knowledge. The company sees the new system as replacing or improving on the current method of taking tissue samples: it will provide real-time images of tissue at near-cellular resolution without the need for tissue removal, a method that the company calls an ‘optical biopsy’.

Omicron started in December last year and has received a £350,000 backing from the Department for Business, Enterprise and Regulatory Reform (DBERR). Led by London-based Michelson, the project also includes the participation of the University of Cardiff, Gloucestershire Hospitals NHS Foundation Trust, the National Physical Laboratory and Scottish semiconductor specialist Kamelian.

Clinicians frequently take biopsy samples of tissue for laboratory analysis

The device will focus on development of an in-vivo imaging probe using OCT, and will operate at a previously untried

wavelength of 1µ, a higher frequency than that used in existing imaging systems. Leading OCT researcher Professor Wolfgang Drexler, Director of Research at the University of Cardiff Dept. of Optometry and Vision Science, said: ‘We believe that images acquired at this wavelength will offer improved contrast and resolution that will help clinicians to distinguish between healthy and cancerous tissue’.

‘OCT scanning has the exciting potential of both guiding and reducing the dependence on biopsies,’ said Dr Nick Stone, Head of Biophotonics at Gloucestershire Hospitals NHS Foundation Trust. ‘This could speed up cancer diagnosis and treatment, reducing the pressure on overloaded pathology departments, and improve outcomes from cancer surgery.’

PRODUCTS - FAST TRACKED Good Products, a leading provider of ECM solutions for the biopharmaceutical Industry, has announced the introduction of a strategically important software product called Innovator.

Multidisciplinary research and development projects are characteristic of the life science sector, along with stringent requirements for reporting and record-keeping driven by regulatory compliance. It is no wonder, under these conditions, that document control is a fundamental competence. As a component of this, Enterprise Content Management (ECM) is the term given to the tools and strategies allowing the management of complex information.

The Good Products solution aims to substantially improve this aspect of the development process for new products. Innovator’s user-friendly 26

software can be readily configured to match any established business process, or used out-of-the-box to instantly improve workflow. The software is built on Microsoft Office SharePoint Server (MOSS) 2007 technology, offering a practical and flexible tool that is intuitive to use and can be integrated seamlessly with other line-of-business applications. As a result, Innovator provides a cost-effective alternative to traditional product development processes, enabling companies to speed the journey of quality products and services to market.

Having built software to meet the rigorous demands of the highly regulated pharmaceutical sector, the company is now in strong position to create solutions for use in other commercial arenas. 'Innovator offers product management professionals an extremely versatile piece of software to drive their development

Axiom invests in medtech services One of Britain’s fastest growing contract electronics manufacturers has invested another £5 million in state-of-the-art production and test technology to enhance its services to the medical equipment industry.

South Wales-based Axiom Manufacturing Services, which provides manufacturing solutions to companies in the medical, industrial, defence and aerospace market sectors, has installed three new pieces of equipment to increase its involvement in the low- to mediumvolume specialist manufacture of hitech medical devices.

The new equipment enables Axiom to fulfil its aim of providing the ‘total solution’ to customers. The investment in a second FUJI AIM SMT line has enabled Axiom to dramatically reduce change-over times, and improve first-time quality yields. The SMT line is capable of picking and placing a 76mm connector down to a 01005 sized component (0.4mm x 0.2mm). The new Laser Etching System eliminates the need for manual labelling, thus reducing cost while providing a permanent ID, which enables full component traceability.

OPTOS GOES NATIONWIDE WITH WAL-MART Optos and Wal-Mart have agreed a deal that will see the Optos P200 device installed in Wal-Mart stores. The Optos devices, most of which are sold in the United States, produce high-resolution image capture of the retina, allowing early identification and prevention of eye disease. Optos retains ownership of the P200 devices and charges for each test under its business model. News of the deal saw the Optos share price rise 8% to 130 pence.

Wal-Mart has in excess of 4,100 US retail unit locations, of which 2,250 in-store sub-leased practices are owned and operated by independent optometrists. As a member of the advanced instrument programme, Optos and its device will be promoted throughout the Wal-Mart network in the United States.

‘Optos’s platform technology provides great clinical benefits for eye care practitioners,’ said Dr Priti Patel, Director of Professional

Relations, Optical Division at WalMart. Dr Kathryn McCullough of Wal-Mart said that her practice was the first in her area to install the technology. ‘The unequalled views of the retina and diagnostic capabilities of the optomap Retinal Exam afford me a great competitive advantage locally,’ she commented. ‘Recently four other local practices have installed it to keep up with our cutting-edge patient services.’

Optos is looking to grow their overall presence in primary care in their core US market. ‘Preventative care allows the practitioner to intervene at an earlier stage in the development of disease – which results in better patient outcomes because irreparable damage can often be averted,’ said Thomas W. Butts, Chief Executive Officer of Optos. ‘Now we’ve been named to the Advanced Instrument Program, we look forward to working closely with the Optical Division to help raise the standard of care within the independent optometric practice locations.’

The investment in a Fixtureless Flying Probe Test System – the Takaya APT 9411CE – has further strengthened Axiom’s overall test offering. The flying probe’s comprehensive test capabilities for prototypes adds a confidence factor which is most important at early stages of product development.

activities,' said Good Products CEO Keith Williams, 'and one that ultimately enables them to get products to market much faster than traditionally possible.'

These increased capabilities will enable Axiom to operate more efficiently by reducing time to market, which in turn will help reduce total acquisition costs for customers.

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IN BRIEF

going east UK & China talk medical devices April saw the 2008 China International Medical Equipment Fair (CMEF) in Shenzhen, which was the venue for the 3rd UK China Forum for the Medical Devices Industry. Its theme, ‘Developing Partnerships to Exploit New Technology and Improve Patient Care’ built on a Memorandum of Understanding for cooperation and exchange in trade, technology transfer and R&D signed by Medilink Yorkshire & Humber and CAMDI last year.

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China’s market for medical devices, which is currently estimated at $13 billion, is growing at an impressive 15% per annum. Market drivers including increasing economic affluence (more than 300,000 Chinese have a net worth over $1 million), a large and ageing population, and a government focused on improving access to healthcare, will ensure continued growth in this sector for the foreseeable future. Indeed, the Chinese government has made the development of a modern medical manufacturing industry a priority.

The Deputy Chief Executive of UKTI, Susan Haird, welcomed a packed audience to the Forum, which saw six UK speakers and four Chinese speakers present on different aspects of technology partnerships. A number of the UK representatives went on to visit Beijing to meet with senior

representatives from the Beijing University of Technology; the Centre of Medical Devices, Institute of the Control of Pharmaceutical and Biological Products (Test House); the Beijing Development Agency; the Chinese Association of Medical Equipment (CAME) and Tsinghua University (ranked No 1 in China).

Photograph from left to right Julian White, CEO White Rose Universities; Peter Vowden, Vascular Consultant, Bradford Royal Infirmary; Sue Dunkerton, Director Health Technologies KTN ; John Wilkinson, Director General, ABHI; Li Ying, General Secretary, CAMDI; Kevin Kiely, Chairman Medilink UK; Michael Etter, Director Medical Affairs, DePuy International Ltd.

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Dubai – a springboard for health technology companies

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The United Arab Emirates (UAE) and its principal city Dubai are featuring ever more prominently in the strategy of British medtech companies. The UAE spends £426 million per year on healthcare, the highest per capita in the Middle East, with demand for medical treatment expected to increase by 240 per cent over the next 20 years.

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The UAE acts as a trading post for medical equipment and supplies to the wider region. The market is valued at £235 million, with imports accounting for some 75 per cent. And demand for diagnostic equipment is also high: £29 million for therapy and rehabilitation equipment, £23 million for monitoring equipment, and £25 million for disposables.

The UAE is also spending very large sums of money building and developing new medical centres of excellence – the largest being Dubai Health Care City, comprising 17 hospitals with a total of

780 beds available, accompanied by state-of-the-art research and education facilities.

Now a new project from the South East Health Technologies Alliance (SEHTA) will be helping companies access this large and hungry market. Using dedicated office space it has established in Dubai, SEHTA will offer a tailored service – which includes a business development director on the ground – to enable companies to meet the right people in the right organisations and develop the essential working relationships.

Fertility Focus is one company that has made the most of the SEHTA offer.

With two unique products, the Fertiloscope and the Advanced Fertility Monitor, the company is bringing a new approach to infertility that’s showing excellent results. ‘The law in the UAE has recently changed,’ explained Commercial Director Robert Milnes,

‘which means that the fertility clinics need to achieve a 15 per cent success rate in order to renew their licenses to practise. Our products can help them achieve this so there’s significant opportunity for us.’ SEHTA’s business development director helped Fertility Focus arrange eight meetings in two days with fertility clinics, so that they could introduce their products to key people. ‘We recognise the opportunities here that are open to companies such as ours,’ Robert said, ‘but we simply cannot afford to do this under our own steam.’

SEHTA is aiming for 20 companies generating $25 million of business in the region by the end of 2008. Support through the Dubai office is available to any health technology company in the UK. To find out more, visit www.sehta.co.uk and www.fertility-focus.com 29

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MEDICAL TECHNOLOGY IN THE UK

living well

living well

Dignity for long-term sufferers

Intelligenthealth care goes home

People with long-term debilitating diseases are set to benefit from the new ‘Devices for Dignity’ project.

London Hospital will lead a team to investigate new technologies to improve bowel function.

Professor Wendy Tindale from Sheffield Teaching Hospitals NHS Foundation Trust (STHFT) will lead the Devices for Dignity Healthcare Technology Co-operative (D4DHTC), looking into new technologies to support stroke survivors, disabled people and a range of debilitating conditions such as incontinence and chronic kidney disease.

The HTCs will bring patients and carers, academics, clinicians, nurses and other healthcare providers together with industry, aiming to catalyse the development of new health care products that will empower people with debilitating conditions and enhance their lives.

The pilots will be used to assess the benefits and effectiveness of this kind of partnership working.

A pioneering scheme to promote assisted living technologies has just launched the UK’s first Intelligent Healthy Home. The iHouse technology demonstrator in West Bromwich, which opened in May, is a traditional Victorian terraced house refurbished to embed intelligent health technology and access-focused building design.

A Department of Health initiative, Devices for Dignity is one of two pilots funded by the Department of Health’s Pilot HTC programme. At the other HTC, Professor Norman Williams at Bart’s and the Royal

STHFT Devices for Dignity will be based at STHFT, and supported by Barnsley Hospital NHS Foundation Trust, Leeds Teaching Hospitals NHS Trust, North Bristol NHS Trust,

Sheffield Children’s NHS Foundation Trust and Sheffield Primary Care Trust.

Mr Christopher Harris, Commercial Director of D4D-HTC said: ‘This clinician-led collaboration between clinicians, patients, academia and industry acts provides a national resource to address areas of unmet clinical need – in turn providing real patient benefit.’

LDA AIDS INDEPENDENCE The London Development Agency (LDA) is funding a new scheme which aims to transform the way assistive technologies are developed to help disabled and older people live independently. ATcare, backed by around £2.35m of LDA funding, was launched at a House of Commons reception in March, and the new ATcare Design and Development Centre is planned to open in the autumn of this year.

Research into assistive technology products is fragmented and it is often difficult to get funding for the development of ideas. ‘There’s a lot of good research taking place in very small assistive technology groups,’ said Dr David Chilvers, Chief Executive NHS Innovations London, ‘but very few of them have the resources or capabilities to get products to the market place.’

ATcare aims to be a catalyst for getting these new technologies to market.

Working with organisations like NHS innovations, it will bridge product development gaps between university research, the NHS, research-based SMEs and the real needs of users. ATcare will

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provide hospitals, universities and inventors with access to core product design, development and testing, regulatory approval (eg CE marking), project management, marketing and business development expertise.

Assistive technology products can make the difference between someone being able to stay in their own home and having to go into hospital or into care. ‘Many innovators have already got the ideas to make that difference,’ said London Development Agency Chair Mary Reilly, ‘but there are real problems turning them into products. ATcare will have the expertise and resources to bring these ideas to life.’

The UK’s demographic of an ageing population makes the development of sophisticated, at-home care a priority: the Department of Health estimates that by 2030 incidences of chronic disease in the over 65’s will more than double. Assisted living technology enables elderly people who are incapacitated to continue to live independent lives in their own homes.

A YouGov survey commissioned by iHealth in June 2007 confirmed that an old age lived at home in the familiar neighbourhood is the future that most of us hope for. Less than 1% of those surveyed wanted to live in a care home: 87% of people said they wanted to remain in their own home after retirement.

With this clear public backing for assisted living, the i-House shows how technology already available can be put to maximum use in real-life housing situations. The environment showcases both telemedicine technology for health monitoring and access, and telecare memory aids and safety devices that will be vital to enable people to stay independent.

Built on the key principles of costefficiency and sustainability, the iHouse includes specialist insulation and ventilation along with automated

lighting and heating to maximise energy efficiency. It also features level, keyless entry with widened doorways to help visually impaired residents to access the house, components such as hands-free and scald-free taps, and a master control computer that can automatically adjust water and heating provision to need, as well as monitor the resident’s mobility and respond to emergencies.

The i-House was created with the help of partners from health and social care, housing associations, industry and people living with physical or sensory impairments.

While helping participating companies to refine, improve and develop their technologies, the scheme will at the same time raise awareness amongst health service providers and create demand from the public to support expansion of this key health provision.

the NHS, local authorities and companies to improve the way such products are commissioned, and users’ access to them.

Given the demographic of Britain’s ageing population, these technologies will become all the more vital in helping increasing numbers of people to live independently for longer.

ATcare will steer the development of products ranging from gadgets that allow people to boil a kettle safely to guidance systems for people with Alzheimer’s disease. It will also work with

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agents for innovation Medtech web collaboration comes of age The online Interwise conferencing system offered by The Health Technologies Knowledge Transfer Network (KTN) at http://www.healthtechktn.com, is now providing members with free systems for multi-site collaboration and online conferencing.

Combining state-of-the-art technology with ease of use, these tools are already proving popular.

The system is widely used by the KTN community for online one-to-one, team and group meetings, sometimes with participants separated around

the world. Software is user-friendly and hardware requirements are modest – unlike other ‘webinar’ systems which may require telephone dial-in (at a cost) to access the audio stream, all Interwise calls for is a standard desktop PC with an internet connection and a headset.

Using Interwise, the Health Technologies KTN has launched a series of virtual seminars by leaders from industry, academia and the healthcare community. January’s inaugural seminar by John Wilkinson, then Director-General of ABHI, on ‘Procurement Challenges for Innovators’ was followed by an extended and vigorous online Q&A

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session. In March, Professor Paul Hatton of Sheffield University presented his work on glass-ionomer biomaterials. Both events attracted a large international audience, and recordings of these events can be accessed on the KTN web portal.

The system is also being adopted to broadcast keynote lectures from KTN Special Interest Group events to a wider audience.

Users of the Collaboration Server can take advantage of a state-of-theart project collaboration space, incorporating a document management repository, on-line editing of content, document versioning, bulletin boards, project calendaring and task management, with secure access and permission control as well as RSS and e-mail notification.

The facility is an excellent resource for multi-site projects where collaborators from different organisations are separated physically, and require a secure server for the storage and maintenance of active as well as archived project documents. There is no restriction on the bona-fide material that can be stored as long as it falls within the remit of health technology, and users can be assured of the confidentiality of data which is uploaded. Currently over a dozen major healthcare collaborations are making use of this facility.

For more information about using the system and future online events, contact Dr Chris Ansell, the KTN Portal Administrator, at administrator@healthtechktn.com

agents for innovation Northern Ireland fills in the health technology picture The medical technology sector is notoriously short of reliable metrics about the companies who serve it. Now BioBusiness NI, which represents the industry in Northern Ireland, has completed a detailed survey of its profile.

The Capability Study for the Life and Health Technologies Sector in Northern Ireland is the most comprehensive study of its kind in the last 30 years, and generated an 80% response from businesses along with 100% support from all key academic, government and clinical personnel.

SMEs make up the majority of life and health technology companies in Northern Ireland, which employ over 4,500 employees and generate over £400 Million in turnover. In terms of innovation, it’s a highly active sector: a sample of 36 of these companies included in the Study recorded 199 new products introduced to the market during 2007, and plans to introduce a further 652 new products in the next five years.

The sector is now set to focus on three key areas over the next two decades: personalised medicine, metabolic syndrome, and connected health. In addition niche priority areas have been identified as genomics (particularly cancer); medical devices; diabetes and obesity; and nutraceuticals.

The January launch of the European Centre for Connected Health (ECCH) has reinforced the importance of collaborative innovation to the sector’s future. This is a central part of BioBusinessNI’s work, delivered through its Academic, Business, Clinical (ABC) collaborations and ☞

BioMedIreland programmes. It also uses national and international programmes such as the Health Technologies KTN and the Innovation Relay Centres, and links with the universities, FE Colleges and HSC to enrol expertise across the sector.

increasingly becoming a recognised need across other regions and at a UKwide level. The Medilink UK network has allowed other organisations to learn from the experiences in Northern Ireland and as a result we can expect to see similar studies emerging in the near future across the country.

The level of research required to produce in-depth sector studies is

ERBI expands into Medical Technology ERBI, the East of England’s biotechnology network, has expanded its scope to include medical technology businesses, building on the growing convergence of the biotech and medical device communities.

ERBI won a competitive tender to take over the Medilink East network with financial support from the East of England Development Agency (EEDA).

Medilink East’s members have been transferred to the new ERBI Medtech, and will benefit from the same level of support enjoyed

by ERBI’s biotech members.

Newly-approinted Medtech Director Barnaby Perks said: ‘We aim to support the growth of globally competitive medtech business in the East of England in the same way that ERBI has supported biotech.’ That means supporting local businesses seeking opportunities to exploit the next generation of medical devices, as well as attracting global operators into the growing cluster of innovative medtech businesses in the region.

EEDA is providing seed funding for ERBI Medtech for three years, after which the network will be

self-sustaining. ERBI already has over 400 members from the biopharma and medtech communities in Cambridge and the East of England, as well as a significant number of overseas members.

‘ERBI has a strong track record of delivering business-led membership services,’ said, EEDA’s Programme Manager for Life Sciences and Healthcare, Mark Wathen, ‘and ERBI Medtech is now well positioned for growth with strong governance as part of the ERBI family.’

For further information contact medtech@erbi.co.uk.

iNet promises innovation boost Medilink East Midlands has been selected by the East Midlands Development Agency (emda) to spearhead iNet, a new innovation network.

‘Sustainable competitive advantage and business growth rely on the continual flow of new ideas’, said Darren Clark, Medilink East Midlands’s Chief Executive. ‘We want to make sure that happens through our work with the iNet. The aim is to co-ordinate support from a variety of key partners to increase the level of innovation within the sector and, in turn, raise competitiveness.

‘We’ll now be able to channel far greater levels of assistance into the sector over the next two years, helping companies tackle a range of issues such as exploiting technology and know-how, overcoming regulatory barriers and making themselves ready for access to the global market place.’

The iNet project has been developed by emda and East Midlands Innovation - the regional Science, Innovation and Industry Council. A total of four separate iNets are to be created serving strategically important sectors and each will bring together partnerships of regional businesses, universities, the public sector and innovative individuals to drive the successful exploitation of new ideas.

Partners in the healthcare and bioscience iNet include BioCity, bioKneX, East Midlands NHS Innovation Hub, Loughborough University, the Nottingham Trent University, the University of Derby, the University of Leicester and the University of Nottingham. The organisation is set officially to roll out a programme in the spring to help companies innovate.

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Working together works

MedilinkUK

working together to raise the profile of the health technology industries in the United Kingdom

Medilink UK Members

Regional Representatives

Medical Devices in Scotland Caledonian House Phoenix Crescent Strathclyde Business Park Lanarkshire ML4 3NJ Tel: 01698 849842 Fax: 01698 849846 Web: www.mdis.org

Medilink North West c/o TrusTech The Innovation Unit 1st Floor, Postgraduate Centre Manchester Royal Infirmary Manchester M13 9WL Tel: 0161 276 5764 Fax: 0161 276 5766 Web: www.medilinknw.co.uk

ERBI Ltd Meditrina Building Babraham Research Campus Cambridge CB22 3AT Tel: 01223 497 410 Fax: 01223 497 415 Email: medtech@erbi.co.uk Web: www.erbi.co.uk/medtech

BioBusinessNI The Innovation Centre Northern Ireland Science Park Queens Road, Queens Ireland Belfast BT3 9TD Tel: 028 9073 7949 Web: www.biobusinessni.org

Cels Ltd Bioscience Centre International Centre for Life Times Square Newcastle upon Tyne NE1 4EP Tel: 0191 211 2626 Fax: 0191 211 2596 Web: www.celsatlife.com

South East Health Technologies Alliance (SEHTA) Suite H2, Leatherhead Enterprise Centre Randalls Road Leatherhead KT22 7RY Tel: 0845 130 8179 Fax: 0845 345 1683Web: www.sehta.co.uk

MediWales 5 Schooner Way Atlantic Wharf Cardiff CF10 4DZ Tel/fax: 029 2047 3456 Web: www.mediwales.com

Medilink West Midlands 5 Greenfield Crescent, Edgbaston, Birmingham West Midlands, UK B15 3BE Tel: 0121 452 5630 Fax: 0121 454 2325 Web: www.medilinkwm.co.uk

Medilink Yorkshire & Humber 301 Glossop Road Sheffield, South Yorkshire S10 2HL Tel 0114 222 7451 / 6317 Fax 0114 273 0058 Web: www.medilink.co.uk

Medilink East Midlands BioCity Nottingham Pennyfoot Street Nottingham NG1 1GF Tel 0115 912 4330 Fax 0115 912 4331 Web: www.medilinkem.com

Health Technologies KTN c/o TWI Ltd Granta Park Great Abington Cambridge United Kingdom CB1 6AL Tel: 01223 891162 Fax: 01223 892588 Web: www.healthtechktn.com

South West of England Regional Development Agency Corporate Headquarters Sterling House Dix's Field Exeter EX1 1QA Tel: 01392 214 747 Fax: 01392 214 848 Email:enquiries@southwestrda.org.uk Web: www.southwestrda.org.uk NHS Innovations London West Wing, 6th Floor 250 Euston Road London NW1 2PQ Tel : 020 7380 1700 Fax: 020 7387 5540 Web: nhsinnovationslondon.com