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CLEANING Increase cleaning investment and cut infections

FINANCE A new lease of life

INFORMATION DESTRUCTION – Ensuring confidential document disposal PLUS MORE


In an ever more demanding world, Variable Message Signs Limited combines innovation, experience and technology in strategic and urban driver information. Our road traffic product range covers applications in the strategic , urban, and traffic management equipment sectors. We offer a full range of services to suit individual client requirements from design, manufacture, supply, installation and commissioning of LED driver information systems, including fully UTMC compliant systems and all for clients, which include the Highways Agency, Transport for London, Local Authorities, Local Health Authorities, Hospitals and others. We have supplied and installed a number of hospital sites which use our Safewatch range of vehicle activated signs for road & patients safety, by advising and reinforcing the speed limits and other hazards, such as pedestrian crossings, side roads and car park entrances and exits, etc;

Our range of car park guidance and information signs advise drivers where the car parks are on site and the number of spaces left within each, providing information and choice for drivers entering the site, and via our TRAMS car park management software package, the hospital / customer has control over all the listed car parks, the number of displayed / available spaces as well as providing various management reports and helps reduce emissions by keeping traffic moving and avoiding queuing. Variable Message Signs Limited’s full matrix high resolution dual colour range of signs, known as Pegasus, offer the health authorities, individual hospitals etc a flexible solution in three different character heights and in either landscape or portrait mode. The sign is offered in three sizes, with high resolution matrix areas suitable for the display of four lines of text with character heights of 160mm, 100mm, and 50mm. All variants are capable of displaying combined text and pictogram information and employ a dual-coloured, amber and red, matrix. A special feature of the new sign system is the ability to mount it in a landscape or portrait format, with five mounting options for landscape fixing and three for portrait fixing.

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DEAR READER In his quest to reform and modernise the NHS, Andrew Lansley has met further resistance as nurses have passed a motion of no confidence in him. At the recent Royal College of Nursing conference 99 per cent of delegates backed a motion questioning his handling of NHS reforms in England. The health secretary, however, still insists most NHS workers are “keen” on the reforms – are you?

CLEANING

Increase cleaning investment and cut infections

FINANCE A new lease of life

INFORMATION DESTRUCTION – Ensuring confidential document disposal PLUS MORE

These days, many organisations, the health service included, are expected to do better, but on less money. Measures that will help lower spending are therefore of increasing importance. For instance, reducing energy use by minimising waste will lower your bills, something that the Energy Services and Technology Association reminds us of on page 31. A large amount of NHS money, £4.2 billion at present, is spent on obesity and conditions that come with it. How can this escalating expenditure be curbed? Shaw Somers, bariatric surgeon, Portsmouth Hospitals NHS Trust, gives his views on page 49. Enjoy the issue.

Sofie Lidefjard, Editor editorial@psigroupltd.co.uk

P ONLINE P IN PRINT P MOBILE P FACE TO FACE If you would like to receive 12 issues of Health Business magazine for £95 a year, please contact Public Sector Information Limited, 226 High Road, Loughton, Essex IG10 1ET. Tel: 020 8532 0055, Fax: 020 8532 0066, or visit the Health Business website at:

www.healthbusinessuk.com PUBLISHED BY PUBLIC SECTOR INFORMATION LIMITED

226 High Rd, Loughton, Essex IG10 1ET. Tel: 020 8532 0055 Fax: 020 8532 0066 Web: www.psi-media.co.uk EDITOR Sofie Lidefjard ASSISTANT EDITOR Angela Pisanu PRODUCTION EDITOR Karl O’Sullivan PRODUCTION DESIGN Jacqueline Grist PRODUCTION CONTROL Julie White ADVERTISEMENT SALES Jasmina Zaveri, Lucy Rowland, Beverly Sennet, Clive Coleman, Malika Muley SALES ADMINISTRATION Jackie Carnochan, Martine Carnochan ADMINISTRATION Victoria Leftwich, Joanne Mackerness SALES SUPERVISOR Marina Grant PUBLISHER Karen Hopps GROUP PUBLISHER Barry Doyle REPRODUCTION & PRINT Argent Media

© 2011 Public Sector Information Limited. No part of this publication can be reproduced, stored in a retrieval system or transmitted in any form or by any other means (electronic, mechanical, photocopying, recording or otherwise) without the prior written permission of the publisher. Whilst every care has been taken to ensure the accuracy of the editorial content the publisher cannot be held responsible for errors or omissions. The views expressed are not necessarily those of the publisher. ISSN 1362 - 2541

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07 NEWS

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49 OBESITY MANAGEMENT

Is your attitude towards leasing equipment due for a change?

Shaw Somers, bariatric surgeon at Portsmouth Hospitals NHS Trust, investigates the problems that obesity creates for the NHS

15 INFECTION CONTROL

51 CATERING

11 FINANCE

How antimicrobial protection can help against healthcare associated infections

21 CLEANING

Cleaning is crucial in the vital task of preventing infections, writes the Cleaning and Support Services Association

25 FACILITES MANAGEMENT The Healthcare Facilities Consortium’s Keith Sammonds takes a look at what can be done to improve the patient experience through innovative use of art

31 ENERGY

The Energy Services and Technology Association reminds us that cutting carbon will save energy as well as money

35 FIRE SAFETY

The National Security Inspectorate takes a look at some of the complexities that make fire safety in healthcare so demanding

39 SIGNS

New standards for safety signs ensure that only graphical symbols with the highest comprehension credentials are used

41 HEALTHCARE IT

BCS responds to the NHS Information Revolution consultation

45 INFORMATION DESTRUCTION

The Shredding Alliance explains how choosing the right supplier for confidential document disposal can combine the highest level of security with time and cost savings

Contents

THE BUSINESS MAGAZINE FOR HEALTH MANAGEMENT – www.healthbusinessuk.com

Food safety in hospitals and care homes is a top priority for catering managers and correct food temperature plays a key role in risk assessments

53 CONFERENCES & EVENTS Warwick Conferences explores the benefits of using an academic venue for your next event

58 FLEET MANAGEMENT

ACFO’s Stewart Whyte explains how to put in place a more streamlined fleet strategy

61 PARKING

The British Parking Association discusses the emotive issue of car parking provision at hospitals

63 TRAINING

Investing in good quality security training provides healthcare staff with the key skills needed to identify and respond to risks

65 RECRUITMENT

We look at the benefits of using temporary staff to fill the staff and skills shortages caused by squeezed budgets

66 TRANSLATION & INTERPRETING

What problems can arrive when communicating with patients whose first language is not English?

69 CRIME PREVENTION

NHS Protect leads on work to identify and tackle crime across the health service

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CLINICAL TREATMENTS

Reducing low clinical value treatments could save £500m

The Audit Commission has found that the NHS could save up to £500 million a year by carrying out fewer ineffective or inefficient treatments. This money could then be spent on more clinically effective treatments that have better outcomes for patients. In its briefing ‘Reducing expenditure on low clinical value treatments’, the Commission looked at some PCTs’ efforts to decommission treatments of low clinical value. It found that the approaches they took and the list of treatments they targeted varied. A single approach to defining these low value treatments could therefore help to reduce the

duplication of effort between PCTs and help to ensure consistency across the country. The potential for reducing spending varies from PCT to PCT but, based on one of the more widely-used lists, some could save more than £12 million each year by reducing their use of these, or other, treatments. Andy McKeon, MD Health at the Audit Commission, said: “PCTs were keen that the Commission looked into how best to tackle this sensitive issue as they have all been developing their own approaches. We were surprised at the variety of lists used. PCTs across the country are currently paying for treatments that cost the taxpayer money, and according to clinical experts have little or no real value to patients. This needs to change. “Some PCTs have successfully addressed the issue and are now able to spend the money they have saved on more effective treatments. Our report provides practical advice on how best to do this. A single national evidence base would also reduce variation in the treatments available and duplication of effort.”

NHS REFORMS

Four NHS organisations combine to share management costs ‘Business as normal’ – that’s the message as four NHS organisations (NHS Barking and Dagenham, NHS Havering, NHS Redbridge and NHS Waltham Forest) combine to share management costs as NHS outer north east London. The reorganisation is part of the government’s NHS reforms and the result of a restructure across London. The new streamlined NHS team is made up of staff from the four local NHS organisations and they will support GPs preparing to take control of the majority

of the annual NHS budget by 2013. “NHS outer north east London is now responsible for commissioning, or buying, local health services such as GPs, dentists, health clinics, community and hospital services for our residents,” says chief executive, Heather O’Meara. “We are here to make sure that improvements to the health of local people are maintained and built upon, while we work more closely with our GP colleagues to take over the reins more fully by 2013.”

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NEWS IN BRIEF Better urgent care in Croydon Three local services have been redeveloped in Croydon to give people faster access to urgent care. The A&E department at Croydon University Hospital will continue to care for patients who need urgent attention, while a new urgent care centre with x-ray facilities at Purley War Memorial Hospital will give patients access to local urgent care. The Minor Injuries Unit at Parkway Medical Centre in New Addington, has also been refurbished for more space and access.

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New healthcare IT system to improve prison health A new prison healthcare IT system has been installed in all prisons and young offender institutions across England. All clinicians now have ready access to up to date medical information making it less likely that the physical and mental health needs of prisoners and young offenders go undetected. Early intervention and preventative care will improve as healthcare staff have round the clock access to prisoners’ medical histories. TO READ MORE PLEASE VISIT...

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CATERING

Red is the colour for Colchester A new system has been introduced at Colchester General Hospital to ensure all the nutritional requirements of elderly patients are fully met. Patients who need help with eating are served meals on red trays and those who need encouragement with their fluid intake to prevent dehydration are given a water jug with a red lid. Louise Notley, nurse consultant for older people, said the red tray system had been introduced onto the four care of the elderly wards at Colchester General Hospital: “Malnutrition and poor hydration can have serious consequences for patients which is why we have introduced these latest simple steps to ensure they have enough to eat and drink.” “The object of the red trays, an Age UK initiative, and also the red jug lid project is to signal to staff that these particular patients need help with eating and drinking. “It is still relatively early days but I am already

Bariatric surgery reduces type 2 diabetes, study finds

aware that we are receiving fewer complaints about patients not getting enough food.” A red tray must not be taken away from the patient until they have been able to eat what they want to and details of what they have eaten have been recorded. A red jug lid reminds staff to encourage the patient to drink. The patient has their cup and jug, which are kept topped up, and call-bell within easy reach.

The National Bariatric Surgery Registry (NBSR) has said type 2 diabetes fell by 50 per cent and on average patients lost nearly 60 per cent of their excess weight a year after bariatric surgery. The report said there are about one million people in the UK who could benefit from bariatric surgery. Out of 10,000 operations carried out in the UK during the financial years 2008/09 and 2009/10, the audit looked at 7,045. TO READ MORE PLEASE VISIT...

www.healthbusinessuk.net/news3

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THE BUSINESS MAGAZINE FOR HEALTH MANAGEMENT – www.healthbusinessuk.com

Health informatics: an emerging discipline, an emerging profession

Health informatics is a new discipline concerning how ICTs are used within healthcare (Bath, 2008). Several definitions of health informatics have been proposed, including “knowledge, skills and tools which enable information to be collected, managed, used and shared safely to support the delivery of healthcare and promote health” (UK CHIP, 2010) and “the use of information and information and communication technologies (ICTs) to improve the quality of care and health and well-being of patients, their families and carers, and the general public” (Bath 2008, p. 505). These definitions indicate the vital role of health informatics in healthcare. Interest in health informatics within the NHS increased following the publication of ‘Information for Health’ (Burns, 1998); since 2002, the National Programme for IT (NPfIT) has invested over £12 billion in developing new systems to improve patient

care, including the NHS Care Records Service and the Choose and Book Service. Most health professions are involved in, or are affected by, developments in health informatics, as systems are developed and implemented through NPfIT. Health informatics is an emerging multi-disciplinary profession, including those from IT and information specialties, healthcare professionals and managers. The educational and training needs of these groups can be met by post-graduate courses. For example, the MSc in Health Informatics at the University of Sheffield attracts students from a wide range of professions including hospital doctors and GPs, nurses, pharmacists, public health specialists, librarians and IT specialists (Bacigalupo et al., 2002; Booth et al., 2003). This multidisciplinary course emphasises the need for collaboration within health informatics. Health informatics education must

Department of Information Studies

cover not only technical aspects, such as information system design and electronic record development, but also the human and management aspects of developing and implementing ICT solutions within healthcare, e.g. leadership and the management of change. Ensuring that the health informatics training and development needs of these professions are met will be important in the success of health informatics initiatives within the NHS in the 21st century. References: Bacigalupo R, Bath PA, Booth A et al. (2002) Studying Health Informatics from a distance: issues, problems and experiences. Health Informatics Journal. 7.3/7.4:138-145. Bath PA (2008) Health informatics: current issues and challenges. Journal of Information Science, 34 (4): 501–518. Booth A, Levy P, Bath PA et al. (2005). Studying health information from a distance: refining an e-learning case study in the crucible of student evaluation. Health Information and Libraries Journal 22 Suppl 2:8-19. Burns F (1998) Information for health: an information strategy for the modern NHS 1998-2005. A national strategy for local implementation, NHS Executive, Leeds). UK CHIP (2010) Professionalism in Health Informatics. Available at: http:// www.ukchip.org/?q=page/ProfessionalismHealth-Informatics (Accessed March 2010). FOR MORE INFORMATION www.shef.ac.uk/is

MSc in Health Informatics

via distance learning. Study at the cutting edge of healthcare information, with the country’s leading library and information science department. 1st in every Research Assessment Exercise for 24 years 1st in the Complete University Guide 2010 5 Emerald Literati Network awards for Excellence in 2009 This 3 year programme is delivered jointly with the School of Health and Related Research, using state of the art distance learning technology.

For more information about this, or any of our range of programmes, please get in touch or visit our website:

www.shef.ac.uk/is - dis@shef.ac.uk - 0114 222 2660

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CATERING

New hospital crockery improves mealtimes for dementia patients Mealtimes for patients with dementia are being improved at hospitals across County Durham and Darlington thanks to the introduction of new specialist crockery. People suffering from dementia often experience visual problems including not being able to distinguish between different colours. Studies have found that this can compound difficulties at mealtimes. If the crockery is a similar colour to the food being served then a person with dementia may not be able to see the contrast and recognise the food that is there to be eaten. As part of its ‘dignity in care’ campaign, County Durham and Darlington NHS Foundation Trust has introduced new yellow melamine crockery for four elderly care wards across

its hospitals to help improve meal times for those patients suffering from dementia. Eileen Aylott, practice development matron at the trust said: “It has been proven that contrasting crockery enhances the food on the plate, which encourages dementia patients to eat the food which has been served. Alongside the new crockery we have also introduced new signage on one of our elderly care wards which include visual symbols as well as names for different areas such as the bathroom and toilet areas which help those with dementia recognise and identify these different areas. We have also been able to purchase some new red toilet seats for these wards to help patient orientate themselves with more ease.”

NEWS IN BRIEF Doctors and dentists unaware of pension changes New research shows that over a third of dentists and doctors surveyed do not understand how changes to the way in which pensions are taxed will impact on their own pension. From 6 April the annual allowance dropped from £255,000 to £50,000 and from April 2012 the lifetime allowance will reduce from £1.8m to £1.5m. The research by Wesleyan Medical Sickness also shows that almost one in five do not realise these changes could lead to larger tax bills and a similar number aren’t even aware of the new pension rules.

Two trusts are stronger together The Board of Directors at Basingstoke and North Hampshire NHS Foundation Trust (BNHFT) has agreed to move to the next stage of the process to acquire Winchester and Eastleigh Healthcare NHS Trust (WEHCT), after a lengthy due diligence assessment. BNHFT will now produce a detailed business plan, which sets out how the two trusts will work to create a clinically sound and financially sustainable organisation. The board will submit this plan to the regulating body for foundation trusts, Monitor, who will provide a risk rating. The BNHFT Board will then make a final decision by Autumn 2011. If the planned acquisition receives final ratification by the BNHFT Board, the two trusts could become a single foundation trust by April 2012.

Give the one you love a ring

NHS WORKFORCE

17 Equality and Diversity Partners announced 17 NHS Trusts have been awarded Equality and Diversity Partner status for 2011/12, each of whom has exemplary skills that can be used to help develop the wider NHS. The Partners will contribute to the NHS Employers organisation’s programme of equality and diversity work until March 2012 and will share good practice, learning and expertise and help inform public policy. Dean Royles, director of NHS Employers, said: “We are delighted to announce our new partners and look forward to working with them over the coming year. Equality and diversity are already at the heart of the NHS, in the service provided and in the NHS Constitution

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which states the service must be comprehensive and available to all irrespective of gender, race, religion or belief, sexual orientation, disability or age. “We want to continue to provide leadership in this area and support employers to build on good practice and share learning. With support from the Equality and Diversity Partners we want to support employers with knowledge, guidance and leadership so they can realise the many benefits that diversity brings, for patient care and for staff.” TO READ MORE... www.healthbusinessuk.net/ news2

To celebrate the Royal Wedding, all patients at Darent Valley Hospital can make free outgoing calls from 20 April until 4 May (applies to 01, 02 and 03 BT landline numbers). Patients can also watch the Royal Wedding on TV for free, all they need to do is register via their bedside TV screen.

Criteria change for non-emergency ambulance patients in the north west of England Following a review by the North West Ambulance Service, a more standardised method of booking patient transport service (PTS) has been put in place across the north west. This will make sure patients receive the right service and that the same quality of service is available no matter where a patient lives. Graham Atkinson, director of Commissioning at NHS Bolton, said: “Getting to health services can be really difficult for some people. These changes will make sure that patient transport is available to people who need it most.” TO READ MORE... www.healthbusinessuk.net/news1

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Take a closer look

at what equipment efficiency really costs

Leasing new medical equipment can be far more affordable than you might think, and the rewards fast and far reaching. We believe that having the right equipment, in the right place, can help improve efficiency. This results in consistent equipment performance, delivering faster, better results and the very best in patient care. It is a philosophy we have worked to since the inception of operating leasing in 1996 and why over 70% of NHS Trusts lease with Singers.

Our offering includes: • •

To arrange a no-obligation meeting, please contact:

Louise Hamilton or Tina Sander on Freephone

0800 032 3638

Find out more at:

www.singershf.co.uk

A range of finance options to suit your timetable and budget The flexibility to add to, or upgrade, your equipment while still paying a fixed regular amount The support from a team dedicated solely to healthcare finance


CONSIDER YOUR FINANCE OPTIONS Times are changing within the NHS. Could your attitude towards leasing equipment be due for a change too?

It is quite clear that the NHS faces very difficult and extremely challenging financial pressures in the next few years. Hospitals across the country are facing up to a new reality in which they will have to continue to try and deliver an increasing amount, and improving quality of patient care from shrinking resources whilst meeting huge efficiency savings targets. There are likely to be modest or no increases in real-time NHS funding, increasing demand and inflationary cost pressures. Efficiency improvements are targeted to generate £20 billion in savings over four years. Maintaining and improving a high quality healthcare service will depend increasingly on cutting waste and boosting efficiency. According to the NHS Confederation, the quality and efficiency gains are most likely to come from large-scale redesign of clinical services. Not all changes to clinical services will require investment in new equipment, but some undoubtedly will.

CONSIDER THE ALTERNATIVE In today’s NHS some still assume that new equipment has to be purchased. Only if there are no capital funds available do some trusts even consider leasing. When they do there may be ingrained preconceptions that leasing equipment is too expensive or too challenging. In this difficult economic climate, relying on buying equipment outright just isn’t going to be realistic as less capital money is made available for investment So, can leasing be a good option for an NHS trust needing to find ways of getting newer and more equipment into their hospitals? Essentially most equipment used by a hospital, both medical and non-medical can be leased. However, if you are in the fortunate position of having capital available and can choose what to buy and what to lease, assets that have a long life and are not very technical, such as standard beds or surgical instruments, lend themselves well to being bought and

written down over their working life. When advances in technology tend to outpace the effective life of the equipment, leasing can indeed be a sensible and effective choice. The speed at which new technology becomes obsolete is increasing, and at the same time free market thinking is coming into healthcare provision. As outlined in the government’s White Paper on health, quality and patient choice will be key drivers for healthcare provision in the future, as patients will go to where the service is best, and the money will follow the patient. Leasing options can help ensure that trusts have access to the latest, highest performing technology and compete with other providers. To put this in context, consider CT scanners for example: the imaging capabilities have continually been increased and improved. This means faster, more accurate results and, crucially, better patient care. Under a capital purchase equipment programme it can be far harder to find additional funds to benefit from regular technology upgrades. Utilising leasing can build these upgrades into the equipment lifecycle, funded via revenue budgets, thereby avoiding technology obsolescence and service downtime. This, in turn, protects both clinical performance and the vital income that high performing equipment generates. If looked at early enough in the procurement process, as part of a long term business strategy, leasing can indeed be highly beneficial to trusts seeking to procure new equipment. As outlined above, one of the challenges for the NHS will be delivering more for less and the efficiency of their equipment will be key to achieving this. This means having minimal downtime, so that the best clinical outcomes can be achieved, consistently and rapidly.

Written by Louise Hamilton head of NHS Sales and Marketing Singers Healthcare Finance Limited

EQUIPMENT LEASING

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IMPROVING PROCUREMENT PRACTICE The NHS often talks about attaining best value and the cheapest price for goods and services, however, the two are often incompatible. Some trusts have historically opted for the cheapest offering by going with the cheapest price, but this can leave them exposed to greater costs further down the line, when vital equipment fails to perform efficiently. Real value for money comes from adopting a longer-term, planned approach. This embraces the use of leasing, a key benefit of which is the ability to spread the cost of attaining the best equipment. These costs can be repaid over the whole incomegenerating working life of the equipment, funded through revenue budgets rather than trying to carve up limited capital. This is where having knowledge of the true working life of the equipment becomes critical. Strategic procurement planning like this will help trusts to make rational justifications for choosing higher-end, higher value equipment, because it will out-last and out-perform cheaper alternatives. Spending more at the time of purchase E

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EQUIPMENT LEASING E can make a considerable difference, as that additional investment can translate into several years longer working life that the trust will derive genuine benefit from. This is what we refer to as the whole life cost, which is an extremely important factor when choosing both the equipment and the lease finance used to procure it. So here we can say that leasing can directly help trusts to make procurement decisions that deliver best value, help improve efficiency and deliver high quality patient outcomes. It could be argued that some in the NHS may still be unfamiliar with some successful

that year. Working alongside the hospital’s supplier of choice, their leasing partner conducted an audit of the departments revenue budget, and how it was being spent. The department had initially indicated their budget could fund lease repayments for six new endoscopes, but the audit showed they were spending a significant amount of their budget maintaining old scopes. By converting the same revenue spend into lease repayments they were able to procure 22 new endoscopes, which all carried a three-year unconditional warranty. This tri-partite information sharing approach

Leasing can fundamentally improve a trust’s performance across the spectrum, delivering better patient care, improved clinical outcomes, increased income earning potential, all whilst delivering against the savings and efficiency targets. practices used by the private sector to manage financing and procurement of equipment, including leasing. Under the White Paper, changes are being proposed that, if adopted, could potentially force the service to compete with other parties who already embrace this approach. Whilst nobody is suggesting that we directly compare the running of a hospital with a supermarket, there are elements of the approach to procurement used that are equally beneficial in each environment. For example, a leading retailers’ approach to strategic procurement planning could work for the new NHS. The retailer leases most of their equipment ranging from freezers, fridges, tills, cabinets through to transportation trailers, ensuring a consistent delivery of quality service, at a fixed cost. There is no downtime for their equipment: the leasing fee is paid for by the revenues generated from the equipment running efficiently. The retailer can plan ahead; they know exactly how much it will cost each month, how much revenue it will generate and retain the flexibility to upgrade to suit demand. Applying this approach to the NHS could deliver impressive results. INFORMATION SHARING APPROACH Putting this into practice within the NHS is still a new challenge for some who have found themselves taking more of a ‘firefighting’ approach to procurement than utilising strategic planning. An example of how one trust changed their approach was demonstrated when they brought in the equipment supplier and their leasing partner to really get to grips with what the trust needed for the department over the next five years, rather than just issuing a prescriptive tender for the spend available

helped the department to make their existing budget work smarter and harder. In this instance the trust went on to become a regional centre of excellence for Endoscopy. This demonstrates how forward planning incorporating leasing can transform a trust’s service delivery capacity and standard of care. Trusts will often tell you what equipment they can afford, rather than what they need in order to deliver the best clinical services. This is a mindset that needs to change, because if you consider the option of leasing at the outset there can be better outcomes. The trick is not to think in terms of capital outlays, or owning equipment, but of the many benefits both clinical and financial, of replacing an aging inventory with brand new, high-performing leased equipment with consistently high levels of ‘uptime’. TIME TO RECONSIDER Leasing equipment can fundamentally improve a trust’s performance across the spectrum, delivering better patient care, improved clinical outcomes, increased income earning potential, all whilst delivering against the savings and efficiency targets. A well planned equipment procurement programme can help to ensure high service levels, lower running costs and optimum patient care. As the future payment structure currently appears likely to be linked to the quality of service provided by each hospital, better equipment will equal better income. There are strong disagreements with, and passionate arguments for and against, the upcoming Health Bill which have led to the “pause” in the passage of the Bill. No matter what form the proposed new legislation ends up being passed as, one thing all sides agree on is that patient care simply must not suffer as a result. L

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LEASING OPTIONS Trusts have access to two main types of lease agreements, Operating Lease and Finance Lease, although historically by far the most utilised by the NHS has been the Operating Lease option. So what are the key features of both? Operating leases are currently deemed “off balance sheet” and so the Trust will not incur Capital Charges, which are 3.5 per cent per annum of the depreciating value of the asset. A Finance Lease in contrast is “on balance sheet” so capital charges are incurred and it is treated as a form of borrowing. There are a number of aspects that separate an Operating Lease and a Finance Lease. A key difference is with a Finance Lease you repay the whole cost of equipment plus interest. With an Operating Lease you repay the whole cost, minus the residual the lessor takes, plus interest. With both kinds of lease the lessor remains owner of the equipment and would require it to be returned on expiry of the contract unless the trust chooses to exercise an end of term option to extend or upgrade the leased equipment.

LEASING BENEFITS Leasing allows trusts to access the latest, highest performing technology Having the best equipment helps trusts compete with other providers Leasing enables the NHS to meet the challenge of delivering more for less The latest equipment can help trusts avoid technology obsolescence and service downtime Leasing helps avoid costs further down the line Knowing how much the equipment costs each month helps the trust plan ahead and manage budgets Money saved from not having to maintain/repair old equipment can be spent on new medical equipment

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TACKLING HEALTHCARE ASSOCIATED INFECTIONS Is enough being done to prevent deaths and financial implications resulting from health associated infections? A clean and safe environment for patient care is one of the key messages of the Code of Practice for the Prevention and Control of Healthcare associated infections. Whilst a number of implementations have been put in place, such as hand hygiene, improved cleaning practices and re-training of staff, have the problems of healthcare associated infections gone away? Recent news reports of outbreaks point towards the answer: NO. On 19 per cent of death certificates that mentioned MRSA in 2009, this infection was recorded as the underlying cause of death. This figure varied between 17 per cent and 36 per cent over the 1993-2009 period (source: www.statistics.gov.uk). In February 2011, BBC Midlands News reported on a resistant strain of E.coli spreading throughout the region: “New research has been carried out by the Public Health Laboratory at the Heart of England NHS Trust as to events in connection with The Shrewsbury and Telford Hospital NHS Trust. The investigation involved 13 separate hospitals across the West Midlands.” (Source: Linder Myers Solicitors) Are there other solutions that can be added to the package of hand hygiene, good cleaning practices and training of staff? YES. Adopting antimicrobial silver ion technology into the build stage of new and refurbishment healthcare projects would be a major step towards combating deadly microbes like MRSA and E.coli. Dr Richard Hastings, microbiologist at BioCote, explains why. CLEANING COMPLEMENT Innovative technologies that can reduce the risk of bacterial cross contamination within the environment work hand-in-hand with regular cleaning practices. As we are all well aware, it is not possible to wash down or clean surfaces every time a person touches it, whether it is a door handle, cubicle curtain, wall, grab or hospital bed rail or a water jug. The use of silver ion is one such technology that does not replace cleaning but provides protection following recontamination of the product through person contact or

retro contamination until the next cleaning schedule. Barriers such as dirt, grime and dust, prevent silver coming into contact with the bacteria, therefore, treated products are to be cleaned as normal. The abilities of silver to aid preservation have been known for centuries. With its roots in the healthcare industry, it was widely used in

hospitals to combat bacteria before the introduction of antibiotics. Today, it is used in a range of medical products, such as wound dressings and catheters, which have been shown to reduce rates of HCAI. It’s these principles that BioCote has taken for its unique antimicrobial technology. Inorganic silver, in the form of silver ions, is the active ingredient used, allowing silver to be added to everyday products, at the manufacturing stage, that are

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frequently used in the healthcare industry. Silver antimicrobial technology is safe, natural and sustainable. Silver is an ideal antimicrobial agent due to its efficacy against a comprehensive range of micro-organisms and its lack of toxicity to non-target cells. It can be applied to a variety of materials without affecting the performance or aesthetics of that product in any way. Growing in popularity in the healthcare industry, BioCote’s technology is independently tested at UK laboratories, proven to dramatically reduce levels of microbes and fungi by up to 99.99 per cent compared to products that are untreated. To supplement the testing of BioCote treated products, a number of studies have taken place to demonstrate the efficacious nature of the BioCote treated products in real-life environments. IN PRACTICE There are two key ways that healthcare managers should be thinking about utilising antimicrobial technology. Firstly, for those working within existing establishments, if you are looking to replace or buy new equipment for your facilities, you should be insisting products feature it and only work with suppliers that do. Working in tandem with effective hygiene practices, this will go a long way to reduce the risk of cross contamination and consequently, the risk of patients being exposed to bacterial infections. The second, and more effective way, is by adopting antimicrobial solutions into the build stage of new and refurbishment projects. This will ensure a healthcare environment has the maximum protection. Unfortunately, government spending cuts mean the outlook for major capital schemes in the healthcare sector is looking rather bleak. Hospital and healthcare projects have been delayed, with decisions pushed back and contracts taking much longer to reach financial close. Despite these cuts though, there are still projects taking place. In particular, there seems to be a shift from new hospital builds to less costly refurbishment schemes. Whether it’s a new hospital development or the refurbishment of an existing facility, the importance of combating bacterial contamination remains the same and must be a top priority for those involved in the decision making process. Prevention is always better than cure. E

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The best things in life are free‌ Latex-free Powder-free Free from allergic proteins The combination of the Polyisoprene surgical gloves Sempermed Syntegra IR and Syntegra Green provides maximum safety for users and patients.

For further product information please see www.sempermed.com. In order to arrange a meeting to talk specifically about your requirements please contact your Sempermed team. Tel. 01327313140 or E-mail sales@semperit.co.uk


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ANTIMICROBIAL PROTECTION E The good news is, there is a wide range of building solutions on the market that feature BioCote technology. This means antimicrobial products can be built into the planning and specification process of any building project. From paint and furniture, to sanitary ware, hospital equipment and light switches, BioCote protection lasts for the expected lifetime of the product, making it ideal for establishments where hygiene is essential. For example, more than 90 per cent of existing hospital departments are fitted with suspended ceilings. Of these, three quarters have some stains, discolouration or mould visible to the naked eye. Not only does a filthy ceiling affect how patients, staff and visitors perceive a hospital, but this build-up of bacteria can also cause cross contamination, particularly for those suffering with allergies and breathing related illnesses. There are options utilising BioCote technology for both newbuild and renovation. Burgess Architectural Products, one of Europe’s leading designers and producers of metal suspended ceiling systems, provides BioCote treated metal clip-in panels. For existing ceilings the Suspended Ceiling Restoration Company (SCR) can restore to a ‘like new’ appearance with its coating system. EFFICIENT VENTILATION Ventilation is vitally important with the government’s Building Regulations driving an

energy efficient future in the UK as it aims to meet its carbon emissions targets. Whatever ventilation system is specified, its performance and efficiency will depend on the cleanliness of the appliance. Dirty, contaminated units and ductwork are ideal breeding grounds for bacteria and other harmful microbes – a major source of indoor air pollution with dirty systems contributing to 50 per cent of the cases of Sick Building Syndrome. To combat this, leading ventilation manufacturer, EnviroVent, has joined forces

and The London hospitals, one of the largest hospital development projects in the UK. To complement this, a range of antibacterial wallpapers and paint, suitable for rooms exposed to a damp or humid environment such as kitchens and bathrooms, are available from suppliers like Contour and SCR. BioCote’s partnership approach to working with manufacturers in the healthcare sector means there are building solutions featuring antimicrobial technology for virtually any application. In addition to the

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From paint and furniture, to sanitary ware, hospital equipment and light switches, BioCote protection lasts for the expected lifetime of the product, making it ideal for establishments where hygiene is essential. with BioCote to launch the first ever range of ventilation solutions that feature silver ion technology. The BioVent range works to provide continuous protection against a wide range of bacteria, mould and fungi 24 hours a day for the expected life of the product. Innovative antimicrobial cable management systems can also be installed like the ones from REHAU, which were specified for Barts

manufacturers mentioned, we also work with wall cladding suppliers such as Advanced Hygienic Contracting, Mira and Multipanel. One of the main touch components of an architectural nature is the doorset, particularly with the door handles and push plates and around the frame or edge of the door, which tend to come into contact with people. Over 5 years of research, testing E

At the forefront of technology and hygiene

Reduce the risk of cross contamination

Sidhil Ltd is one of Europe’s foremost manufacturer of hospital and community healthcare furniture, with an established reputation for performance and quality based on total commitment to the developing requirements of the healthcare market. Sidhil designs, manufactures and supplies a comprehensive selection of products for the acute sector, nursing homes and community use, including electric profiling beds, dynamic pressure care mattresses and bariatric products. The company runs a modern and efficient manufacturing plant in Halifax, West Yorkshire, equipped with the very latest high technology manufacturing and finishing processes and maintaining a sustained focus on research and development to keep the product range at the forefront of technology. Increasing concern about hospital-acquired infections

Buy a Comark food thermometer and reduce risks from cross contamination. How? Comark thermometers incorporate BioCote® antimicrobial into the instrument cases. To guard against cross contamination, good HACCP practice is essential but as an extra level of defence many Comark instruments come with BioCote® antimicrobial impregnated into instrument surfaces and probe handles. The process uses silver, a natural antimicrobial. When microorganisms come into contact with the silver, their ability to reproduce is inhibited, reducing the risk of cross contamination. Using a Comark thermometer, trials conducted at a restaurant within a leading university showed a massive 92 per cent average reduction in microbe levels on instrument surfaces. Specially designed for food

prompted Sidhil to incorporate BioCote® antibacterial agents into powder coatings used on selected products back in 2002. Today, almost all Sidhil tubular steel products utilise the biocide as a no-cost feature, building in reduced possibility of cross contamination and infection when used in conjunction with good hygiene practices and effective infection control procedures. In addition to the antibacterial properties, the BioCote powder coatings used on these products offer excellent decorative appearance and colour stability, as well as resistance to chipping and scratching. FOR MORE INFORMATION Customer Services Tel: 01422 233000 info@sidhil.com www.sidhil.com

manufacture, processing, catering and foodservice environments, Comark thermometers combine accuracy and reliability with value for money. Thermometers range from pocket digitals and instruments with folding probes, to state of the art hand helds like the compact and economically priced C20 series or the more robust and waterproof N9094 with its 10year battery life and impressive list of functions – both are compatible with an extensive range of Comark probes. Whether you’re storing, displaying, chilling, freezing, cooking or transporting foods, Comark provides everything you need for HACCP food temperature safety. FOR MORE INFORMATION Tel: 0844 8156599 www.comarkltd.com

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ANTIMICROBIAL PROTECTION

Once antimicrobial technology has been adopted into the build process, its uses do not end there. BioCote can be adopted into curtains, bed linen, bedside cabinets, trolleys, seating, desks, crockery and cutlery to name a few. and development has been carried out on Allgood’s ironmongery treated with BioCote and 25 years’ accelerated life cycle testing demonstrated the antimicrobial effectiveness throughout the expected lifetime. FINISHING TOUCHES Once antimicrobial technology has been adopted into the build process, its uses do not end there. BioCote can be adopted into curtains, bed linen, bedside cabinets, trolleys, seating, desks, crockery and cutlery to name a few. Contour Casings offers BioCote treated heating solutions, namely LSTs and radiator guards. Guided by key drivers for the healthcare industry, the design team at Contour Casings, in consultation with industry experts, has developed a new range of low surface temperature radiator products that address all of today’s essential requirements. The Trionic DeepClean LST

Radiator dramatically reduces installation time and making it possible for a cleaning operative to clean the product internally and on their own, saving on both time and cost. An article published on Public Services’ website referencing studies at UCLH, wrote: “Bedding is one subject under investigation. As a patient contact material, the loss of ‘contaminated’ fibres into the environment provides a potential for infection migration and cross-contamination. “The dust that is readily visible, on surfaces and floors, forms only part of the dust loading of the ward environment. Many of the dust particles are of microscopic size, invisible to the eye, and can be suspended indefinitely in the air.” Dust sitting behind radiators is a perfect breeding environment for microbes, which can then be filtered back out into the atmosphere. The same dust gets into other areas, for instance around and behind lockers. Link Lockers

DDC_HealthBus_1-2p_Layout 1 25/05/2010 16:21 Page 1

and Link 51 manufacture a range of storage solutions with BioCote protection. Lockers with BioCote protection have been specified for hospitals, such as Whittington. Specific benefits can be enjoyed through the use of HTM 71 storage and materials management systems, which include reduced stock holding, tailored storage, easily visible stock, more efficient stock rotation, unique stock locations, improved ergonomic design and reduced capital charges. Sidhil, a first customer of BioCote’s at the initial launch of treated products, offers a wide range of BioCote treated products for healthcare, from beds, overbed tables and trolleys to drip stands. More recent developments of BioCote treated products include disposable curtains from Opal and to add to your green credentials they are 100 per cent recyclable. Harfield’s antibacterial range of tableware, including water jugs, tumblers and cutlery, is a step in the right direction to working together with the community to ensure there is a managed environment that minimises the risk of cross contamination. L FOR MORE INFORMATION For more information, including which manufacturers in the healthcare industry work in partnership with BioCote to incorporate its technology, plus how you can become a partner, visit www.biocote.com or call 01902 824450.

Setting new standards in maceration The new improved Pulpmatic+ sets new standards in the maceration of biodegradable pulp product bedpans, bottles, vomit bowls and other similar articles. • Hands Free Operation • Greater Capacity • Reduced Water Consumption • Automatic Disinfection Cycle • Improved Reliability

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Sempermed synthetic surgical gloves – double protection Due to better barrier protection, and thus considerably lower infection risk for user and patient, Sempermed recommends double gloving – especially for high risk patients, vigorous and deep interventions as well as in emergencies and exposure prone procedures (EPPs). Sempermed’s synthetic range provides the optimum solution for double gloving: as a coloured “partner“ for the popular latex- and powder free surgical glove Sempermed Syntegra IR – made of synthetic polyisoprene (IR) – we now offer the new Sempermed Syntegra Green. Sempermed recommends wearing the Syntegra Green as inner glove and the Syntegra IR as outer glove or two pairs Syntegra IR on top of each other. The special polyisoprene formula of the Sempermed Syntegra IR imitates the structural properties of natural latex on the highest level of perfection, so that it excels

by the same material properties as natural latex gloves but without the risk of latex allergies. Therefore the Sempermed Syntegra IR is at least on a par with a natural latex glove regarding its elasticity, suppleness, tear resistance, fit, flexibility, tactile sensitivity and safe (wet) grip. Moreover this synthetic glove made in Austria is absolutely skin friendly and safe, which is due to its innovative accelerator system. Its special weblike lining makes it easy to don and creates a snug feeling on the skin. FOR MORE INFORMATION sempermed@semperit.at www.sempermed.com

A holistic approach to infection control Tristel plc is an infection and contamination control business headquartered in Newmarket, United Kingdom. Its lead technology is a proprietary chlorine dioxide formulation used to disinfect instruments and surfaces and to control legionella in water. Tristel’s products are considered to be amongst the highest performing biocides available to hospitals and industry, killing all organisms, including spores, in short exposure times. Tristel’s chlorine dioxide chemistry is also safe and easy to use. Tristel partners with other infection control technology providers to present a holistic approach to its customers, allowing it to address the five routes of transmission of infection – instruments, surfaces, water, skin and air. Tristel entered the London Stock Exchange AIM market in June 2005. Its stock exchange symbol is TSTL.

Tristel offers dedicated solutions for the decontamination and disinfection needs of its customers. The organisation prides itself in fine-tuning its products to suit the individual challenges of each application and developing easy-to-use delivery formats. Tristel has documentary evidence that its products have a six-log reduction on spores. FOR MORE INFORMATION Polly Oates, director Tristel Solutions Limited Lynx Business Park, Fordham Road, Snailwell Cambridgeshire CB8 7NY Tel: 01638 721500 Fax: 01638 721911 mail@tristel.com www.tristel.com

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Infection control – all wrapped up Infection control is one of the most important issues facing the health delivery services at present. To help in this battle, Sefton Transmail, in partnership with BioCote® silver ion technology, produces anti-microbial products that reduce the numbers of MRSA, E.coli and other dangerous micro-organisms. Sefton Transmail is a UK manufacturer of polythene products and can supply many formats of patient record holders, baby bottle bags, disposal bags, sample bags and others, all made from polythene that incorporates the protective anti-microbial action supplied by a BioCote® additive. This anti-microbial action is crucial where items or information are being passed

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from department to department or ward to theatre within your organisation. The product remains antimicrobial throughout its lifetime; it cannot wear off or be washed off as it is integral to the fabric of the material rather than surface coated. The items can all be individually specified and bespoke manufactured to your requirements. The products can also be made from coloured or 100 per cent recycled polythene (with no effect on the anti-microbial action) or printed in up to eight colours. FOR MORE INFORMATION Tel: 01603 404217 sales@seftontransmail.co.uk www.seftontransmail.co.uk

The latest thinking on general practice Care for the patient is the first priority – after all that is what most doctors trained to provide. But general practice is now a business – and will be even more so under the new NHS structure, whatever its final form. General practitioners will have more opportunities but more risks. A briefing by the Henry Stewart Group, taking place Tuesday 17 May at Mayfair Conference Centre, London, will discuss how to maximise the opportunities and minimise the risks. It covers: • Which services to provide – implications for the bottom line • Containing costs – which staff on what terms • The advantages and disadvantages of outsourcing – what to do in-house • Making the right decisions on property – buy v lease • Sources and terms of finance – set-up and operational • Winning and retaining the franchise • Hedging risk through diversification • Targeting, budgeting and benchmarking

• Marketing and building the practice • The different models of practice and their strengths and vulnerabilities • Understanding the nature and scale of the risks as well as the opportunities Under the new arrangements being a successful business is entirely compatible with, and may be an essential component of, being a successful provider of medical care. Whatever the final form of the changes to the NHS, general practice will be more like a business than ever before – this briefing is about how best to respond to the challenge this change represents. FOR MORE INFORMATION www.hsconferences.com/ page10225371.aspx

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INFECTION CONTROL

Cleaning

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ARM YOURSELF WITH CLEANING IN THE BATTLE AGAINST INFECTION

Cleaning in healthcare premises plays a vital role in the prevention of healthcare associated infections, writes Andrew Large, chief executive of the Cleaning and Support Services Association

The UK medical infrastructure is set for expansion, both as a result of an aging population, but also increased demands for novel treatments. However, this growth may not occur in the classical large scale hospital. The direction of health reforms suggests that more care will be provided in locations such as nursing homes, doctor’s offices, clinics, hospices, and dental practices. All of these are healthcare establishments and all require to be cleaned to the same high standards. At the same time, the growing trend towards outsourcing cleaning services favoured by the coalition government means that the number of contractor opportunities will expand, even if individual contracts may be cut back as a result of budget pressures. Together, these factors mean the potential rewards for cleaning contractors who are willing to invest and commit to cleaning medical facilities are great. HEALTHCARE SPECIFIC CLEANING But what risks should concern contractors when entering the healthcare marketplace? As in all workplaces, a healthy, safe, and aesthetically pleasing environment is reassuring to patients and their families by giving an impression of good quality care while enhancing the reputation of the establishment. Although this is important in all economic sectors, it also serves the healthcare industry in the vital task of the prevention and control of Healthcare Associated Infections (HAI). HAIs are all infections that do not originate from the patient’s original condition that caused them to be admitted to the healthcare establishment. In 2009 in the UK approximately 4,800 people per year died of MRSA or C. diff, and the overall cost of HAIs to the NHS is estimated to be around £1 billion per year – an expense which excludes the indirect costs related to psychological suffering of patients and their family members as well as lost work time spent in the hospital. Managing the risk of HAIs is the single most significant challenge facing cleaning contractors who operate within the healthcare sector. Most infections that become evident after 48 hours of hospitalisation are considered to be healthcare acquired. Infections that occur after the patient’s discharge from hospital could be considered to have originated at the

hospital if the organisms were acquired during the hospital stay. Currently (December 2010), infection levels in the UK for MRSA and C. diff are at just over 5,300 people per quarter. However this data does not include other infections, such as E. Coli or norovirus. CAUSES OF INFECTION HAIs are caused by viral, bacterial and fungal disease causing organisms (pathogens) and it is important to note that not all HAIs are a result of contact with infected surfaces. HAIs of the urinary and respiratory tracts show that many of these originate within the body, and that only a part of the total will have arisen because infection control practices were inadequate. Respiratory infections associated with both surgery and intubations are largely caused by the patient’s own organisms, rather than organisms carried through the air or liquids they have ingested. There is always an element of risk of acquiring HAIs and given colonisation rates in the general population, it is impossible to eradicate all traces of them, so it is the responsibility of those in charge of all aspects of care, from hand hygiene, surgical hygiene, prescribing practice and cleaning, to minimise the risk as much as possible. WHAT TYPES OF HAI ARE THERE? There are a number of different types of infection that can occur in many places in the body, the most common of which occur in hospitals are urinary (23 per cent), lung (22 per cent), wound (nine per cent) and blood (six per cent). The most high-profile type of HAI is Methicillin-Resistant Staphylococcus Aureus, popularly known as the MRSA superbug. MRSA includes several strains or types of staphylococcus aureus that is not killed by ß-lactam antibiotics. Around 30 per cent of the UK population carry the SA germ in their nose or on their skin. In healthy people, this does not pose a risk, nor do any adverse symptoms occur. Another prominent HAI is clostridium difficile (C. diff). Although this is bacteria that is present naturally in the gut of around two-thirds of children and three per cent of the adult population, in some cases it can prove fatal. Older people are most at risk from infection, and most cases occur in people aged over 65.

GOVERNMENT SUPPORT Control of HAIs has been a priority for governments of all political persuasions. With the launch of the NHS Plan in July 2000 came the development of detailed action plans to improve the cleanliness of hospitals. Every NHS trust prepared their own action plan, which focused on the elements that comprise the specific patient environment, including entrances and reception areas, visitor and ward toilets, cleanliness, decoration and quality of hospital food. Then, in a further attempt to tackle the problem, the Patient Environment Action Team (PEAT) was established in 2000 to look at a wide range of cleanliness issues relating to wards, reception and waiting areas. Based on PEAT reports, hospitals are awarded a traffic light colour to denote a good (green), acceptable (amber) or poor (red) performance. Another innovation of the UK government’s health strategy is the establishment of Patient Choice. In December 2005, patients needing elective treatment will be offered a choice of four or five hospitals. These could be NHS trusts, foundation trusts, treatment centres, private hospitals or practitioners with a special interest in operating within primary care. This is called ‘choose and book’. In the meantime, all patients waiting longer than six months for an operation should be offered a choice of an alternative place of treatment. This was called ‘choice at six months’. The most recent high-profile development was in 2008, when the government ordered a £57m deep clean, where hospital walls, ceilings, fittings and ventilation shafts as well as floors and equipment were subject to a thorough clean. The current picture with regard to both MRSA and C. diff in the UK is positive. While the current rate of infection is still too high, it has declined markedly from the peaks of 2007 and 2008. Latest data from the Health Protection Agency suggests a 51 per cent decline in MRSA infections from October – December 2008 to October December 2010 and a 64 per cent decline in C. diff infections over the same time frame. These are good results, but more remains to be done, and the current uncertainty around the NHS risks undoing the good work of the past couple of years. E

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INFECTION CONTROL E UK PERFORMANCE Although Britain has a similar rate of healthcare associated infections as its European neighbours, it has one of the highest MRSA infection rates in northern Europe. In the UK, MRSA makes up 44 per cent of all HAIs, compared to just one per cent in some EU countries. The reasons for this are much debated, but it is not down to a lack of investment; the UK spends approximately the same amount of money on healthcare as other developed nations. Some of the more credible explanations show that it appears that strains of HAI which are more prevalent in the UK spread more easily than the strains in other European countries. Furthermore, so many people in the UK are already carriers of the MRSA infection that on a daily basis many are arriving at hospital. To give another example, in recent months, the appearance in the UK of E. coli bacteria carrying the NDM-1 gene has been associated with travel to India and Pakistan for medical treatment. A further difference between the UK and the rest of Europe is that the UK has comparatively higher bed occupancies, which leads to greater opportunities for disease transmission. Other possible explanations include rapid turnover of patients and hospitals operate under considerable financial pressure. These factors, in addition to increasingly short

inpatient stays, complicate investigations and effective control measures. One of the ways EU countries have addressed the management of MRSA has been to quarantine both areas and workers which are known to carry the superbug. Staff who test positive for the infection are sent home for up to four months and treated with antibiotics. If MRSA is passed on to a hospital ward, the ward is closed, and the whole area is cleaned and disinfected. New disinfection technologies such as peroxide fogging seem to bring benefits, but they require long term logistical planning so that wards can be emptied. The current pressures on the NHS in the UK make it unlikely that this will be achievable in 2011. SOLUTIONS So what is to be done? In the first instance, hand washing is a significant action against the transmission of bacteria. Hand washing rates amongst medical professionals are poor. 2008 Research published in the Nursing Times suggests that between 59 per cent and 79 per cent compliance with hand washing guidelines was achieved in one hospital in Ireland. If compliance rates can be moved closer to the 100 per cent, then this will have a significant impact on the transmission rates of all infections around medical establishments. The second issue concerns cleaning. In early 2011, a number of NHS Trusts are already

Professional, affordable and comprehensive cleaning services AUSSIE is a leading multiservice company offering a range of services to commercial customers throughout the Greater London area. We have many years of experience in the commercial cleaning sector and can provide a comprehensive and affordable professional cleaning service to hospitals, surgeries, medical centres and other healthcare establishments. All our staff are fully trained and we use the latest cleaning materials and equipment to ensure that your premises are thoroughly and hygienically cleaned every single time. We also have state-of-the-art carpet cleaning systems that are designed to produce a deep down clean that cannot be replicated by a vacuum cleaner. We can work with healthcare managers to ensure that all

standards and requirements are rigorously met and that cleaning takes place safely and efficiently, with the greatest consideration for the privacy and needs of patients and healthcare staff. Also, we always consider the environment and use environmentally-friendly materials whenever possible. Aussie also provides a number of other useful services – these include storage, removals, and Man & Van.

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cutting small amounts of money from their cleaning budgets – under the cost pressures imposed by the coalition. This is foolhardy and short sighted. Each HAI costs the NHS upwards of £10,000 in lengthier hospital stays and treatment time (without mentioning the personal costs to the infected individuals and their families). The current costs from MRSA and C. diff are in excess of £20 million per year and this will only increase if cleaning is reduced. It is much better to increase cleaning investment and cut infections as a result. One final thought on the direction of travel for cleaning in the NHS; the localism agenda for the NHS must not be used by either the NHS centrally or the Department of Health as an excuse to walk away from the policy issue of HAIs. The fight against HAIs will continue to require central government intervention and ministers should take the role of setting national baseline standards and ensuring compliance. Otherwise, chaos will reign and patients will be placed in the impossible position of having to interrogate individual hospitals about their cleaning practices rather than being able to rely on a national health service having national cleanliness standards. L FOR MORE INFORMATION Tel: 020 79209632 lcasey@cleaningassoc.org www.cleaningindustry.org

Medical consumables for the health sector Bunzl Healthcare is one of the UK’s largest distributors of leading brand and own brand medical consumables to all areas of the healthcare market. Whether it is supplying examination gloves into acute hospital trusts; vital care home equipment to independent care homes; or personal hygiene products into other healthcare related businesses, Bunzl Healthcare has it covered. A winning combination of tailored supply chain solutions, backed by leading edge technology,

and the most comprehensive product portfolio makes our offer compelling to all of the markets that we serve. FOR MORE INFORMATION For further information about the products and services we offer please contact our customer service team on the below details: Tel: 020 84437800 Fax: 020 84437842 enquiries.healthcare@ bunzl.co.uk www.bunzlhealthcare.co.uk

FOR MORE INFORMATION George Petrou 020 3405 2000 info@aussiecleanteam.co.uk www.aussiegroup.co.uk

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Facilities Management

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ART IN HEALTHCARE

A BETTER PATIENT ENVIRONMENT

How can the patient experience be improved through the innovative use of art? Keith Sammonds, managing director of the Healthcare Facilities Consortium, investigates In reviewing ‘Rewarding Innovation in the Workplace’ in January of last year we closed the article by noting that the facilities team at Wolverhampton City PCT included two arts coordinators, who were working on a job share and doing some very innovative work with what could best be described as tired premises. I promised then to take a deeper look into their work and the impact this has within healthcare premises. Subsequently the topic came up at a local professional meeting with a high level of interest and the trust was highly commended for its work in this area at the 2010 Health Business Awards. Art in hospitals has long been one of those topics that it appears only lip service is paid to. Over the years we have seen, often politically driven, small schemes to place art work (normally pictures) in hospitals to improve the patient environment. The problem is that the funding has only ever been short term and so the pictures become fixed and/or damaged and the impact is severely diminished and often the end result after several months is that they are removed as an eyesore. ART PROJECTS I had the privilege in the 1980s of being involved in two schemes to improve the patient environment by the use of art in a rather

converted into the then new Sainsbury’s store in the town centre. Just inside the ring road the site is still in use by Sainsbury with all the original window openings filled in with matching stone. The windows we retrieved (with support from Sainsbury’s if I remember correctly) were overhauled and resized by Maybury Brothers and then installed into the curtain walling of a reception room at the then two-year old Penn Hospital on the outskirts of the town. The transformation was amazing and the room very well used by patients, visitors and staff alike. The roll of colour into the room was superb and because of the internal glazing also spilled into the main entrance and corridor brightening those two rather utilitarian areas. The second scheme was rather more challenging and sadly the building, and indeed whole site, is now in a massive state of disrepair having been dropped from the local health estate by the Royal Wolverhampton Hospitals NHS Trust. While not wishing to get into the whys and wherefores of the decision making process (and there is much local discontent) I really would love to know if they recovered the stains for onward use elsewhere. The Wolverhampton and Midland Counties Eye Infirmary sits on the western side of the city centre in the fork between two main roads as they diverge to their differing

Art in hospitals has long been one of those topics that it appears only lip service is paid to. Over the years we have seen, often politically driven, small schemes to place art work in hospitals to improve the patient environment. The problem is that the funding has only ever been short term and so the pictures become fixed and/or damaged and the impact is severely diminished. unusual way. While overseeing the maintenance of two local hospitals (one now closed and the other in the care of Wolverhampton City PCT) I was charged with recovering stained glass windows from two churches that were closing and installing them in the hospitals to make chapels for patient and visitor use. The first scheme occurred as one church was being

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HEALTH BUSINESS MAGAZINE Volume | 11.3

locations into Staffordshire. The infirmary was a well loved and respected service provider under the old Wolverhampton Area Health Authority when I worked there from 1979. Just towards the town centre from the infirmary St Marks Church was closed and being converted to offices for a large independent financial advisor who is still there today. We had the

Snow Hill Sexual Health Clinic © Paul Ward

Snow Hill © Paul Ward

opportunity to retrieve some of the stained glass windows and again Maybury Brothers did a superb job of cleaning and refurbishing them ready for our use. A new twin theatre suite was being built behind the main infirmary building and once commissioned I had the unenviable task of overseeing the conversion of the old theatres, including very rusty metal balconies and floor to ceiling metal framed windows, into a chapel. Our in-house carpentry team built an alter rail and other furniture custom to the space and also frames for the stains which were installed with stripped, cleaned and painted metal framing. Just off the main corridor, the new chapel was well used by people of all faiths and as the sun tracked across the beautifully clear glass the colours flooded into the room and to say the least the end result was very pleasing – but I would say that wouldn’t I? I only wish I could find the photos and get them scanned to include here but sadly I cannot. POSITIVE IMPACT So my own personal involvement in these schemes has engrained in me the firm belief that appropriately used art of all kinds can and does have a very positive impact on the E


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About the HFC The Healthcare Facilities Consortium (HFC) is a specialist company that provides information, software, and management support services to professionals working in facilities, estates and related functions in the UK health sector and – increasingly – other business sectors too. To enjoy the HFC’s full range of benefits, organisations become subscribers to our services and play a significant role in shaping and developing the company’s range of services, activities and products. The Healthcare Facilities Consortium works as an information and services ‘hub’, providing a link between a range of carefully chosen FM products, service partners and suppliers, on the one hand, and subscriber organisations and their users on the other. The company also works in close association with a range of other representative and specialist groups involved in the health and FM arena, including HefmA, AHCP, HFS, IHEEM, Welsh and Northern Ireland Health Estates and the NHS Confederation. HFC hosts the longest running Healthcare FM themed conference in the UK. The aim is to provide talks on value for money practices for the current climate and hold topical discussion about the subjects that matter in estates and facilities management. See www.hfc.org.uk for details on next year’s event.

Castlecroft Medical Practice © The Healthcare Facilities Consortium

© Paul Ward

E patient environment as we now call it. The provision of chapels and chaplains is an ongoing debate in healthcare but because of my involvement in local churches these two schemes were of great personal interest and granted me the greatest job satisfaction. However, this only addresses one area of art and it has been thrilling to see and hear of how art is again being used in my home locality for the benefit of patients and their families. Before taking in some of the more recent schemes in the local area there is some guidance and encouragement in the use of art in healthcare premises and this is worth a look. The King’s Fund has been running a programme entitled Enhancing the Healing Environment and between 2003 and 2005 some 23 schemes were undertaken, which are reviewed in a very informative document jointly published in 2006 by King’s Fund and DoH. A series of roadshows were run around the country at the time to propagate the best practice derived from these schemes and some of the outcomes included guidance on colour choices for therapeutic benefit and art involvement for certain classes of patient. At about the same time a report of the Review of Arts and Health Working Group was produced by DH and published in 2007. This

report talks about how art in its various forms can positively contribute to key objectives relating to healthcare provision and health improvement. However, it also points out that although there was much being done, a great deal of innovation being shown and some high quality documents and information available through the web, this was not generally well known, publicised or made use of. With my own passion already declared I find it interesting to note that the report states: “When they (the materials and information) are (known about), they save time and effort and provide sound examples for others to use. Many have commented that they were most inspired and convinced of the need and possibilities by seeing live examples, either within their own organisation or elsewhere.” AWARDING EXCELLENCE Within the Healthcare Facilities Consortium we have long been supporters and propagators of best practice within the facilities arena, effecting this through our workshops, day and conference events and our long established Benchmarking Club. Last year as part of our drive to encourage innovation in the healthcare facilities arena we sponsored a new award in conjunction with Health Business – The Estates and Facilities

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Innovation Award. No doubt more of this later but it is very interesting to note that the report makes the following recommendation: “The Department should establish a national award to promote the use of arts and health.” With all this in my mind I spotted the shortlists for the HefmA Awards being made in May 2010 and noted that it included the very people that had started my ears twitching in late 2009 when I met with their managers to review the impact that winning awards had on the Facilities Team; the arts coordinators, Natalie Jones and Ruth Harvey-Regan at Wolverhampton City PCT. I already had an interview booked with one of them to go through some of their achievements and aspirations. CREATING A BRAND INDENTITY One particular project that caught my eye was: Snow Hill Sexual Health Clinic Refurbishment – Creating a brand identity for Wolverhampton Sexual Health Services. Knowing the building that was being used I knew that this would have been a real challenge and it is fascinating to see what has been achieved, but of course that is going to be very difficult to convey in an article like this. However, some of the branding and photographs of the changes are included here to try and give an impression. E

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Commercial landscape maintenance and enhancement work Avon Landscapes Ltd, established in 1985, undertakes commercial landscape maintenance and enhancement work on numerous sites throughout the south west. Clients currently include both Somerset and Wiltshire Primary Care Trusts. Avon Landscapes Ltd is experienced in all aspects of domestic and commercial landscaping. We also coordinate tree surgery and removal of large trees using qualified tree surgeons. Plant material is sourced from reputable wholesalers, and we are able to implement schemes of any size, using the smallest shrub to large semimature trees imported from the continent when necessary. There is no minimum contract value. We are a proactive company working to maintain both a high standard of workmanship as well as a considerate and cooperative approach to all individuals and organisations with whom we work.

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ART IN HEALTHCARE E Particular points of interest are in the community involvement. Natalie Jones, one of the arts coordinators, told me: “A series of creative consultation sessions with a graphic design company and PCT Consultant in Public Health Medicine enabled young people to participate in developing the ‘Think’ brand. They wanted to create graphic icons to represent each key sexual health service to make it easier to identify what services are available and where. Young people from across the city played a key role in the refurbishment of the Snow Hill Sexual Health Clinic alongside creating a brand identity for Wolverhampton Sexual Health Services.” A multi-agency partnership approach resulted in young people taking ownership of the project from the start and through extensive consultation with different stakeholder groups a youthful new brand identity was created. The brand name ‘Think’ was selected by the Youth Council from shortlisted options. The brand identity aimed to increase awareness of sexual health issues and increase access to NHS services available across the city and bring clarity to what is available and where. For me, apart from the brand which now emblazons the front of the building, one of the most striking

for conversations in relation to reminiscence work with dementia patients, an example being a display on our local football club, Wolverhampton Wanderers – still in the Premiership. The project included a session at Wolverhampton Art Gallery led by a specialist art interpreter, an experienced member of the education team who helped a group of elderly adult inpatients from Penn Hospital to further explore the museums local history collection to encourage communication and sharing of memories – it also provided a day out in a safe environment for everyone involved. IMPROVING BUILDINGS In late 2008 I wrote a Focus on Facilities Management and cited our local GP as an example of the future of healthcare premises. They were moving from a converted detached house into a purpose built medical centre and this has been very well received by their patients and the local community. Just after I took the photograph we used in volume 9.1 a piece of sculpture appeared on the walls of the new building and this to me is a shining example of how art can be used on the external of buildings to improve the impact the buildings have and also shows how the local community

A series of creative consultation sessions with a graphic design company and PCT Consultant in Public Health Medicine enabled young people to participate in developing the ‘Think’ brand. They wanted to create graphic icons to represent each key sexual health service to make it easier to identify what services are available and where. features is the transformation of what I know to have been a dire corridor which was known by staff as “the walk of death”. This has been transformed with the use of light boxes on the walls containing landscape photography created by students Jon Crump and Mairi Turner from the photography department of Wolverhampton University. This gives the impression of windows in the wall and has made the long, narrow corridor bright and airy and far less depressing for staff and those who have to use it on the way to life changing consultations. Away from this particular project the same principles have been applied to the refurbishment of various clinics and health centres showing a marked improvement in the premises. A partnership has been developed with Wolverhampton Arts and Heritage Service to enable the loan of museum objects from their local history collections to Penn Hospital for display in the main reception. The objects have been chosen by the Clinical Lead for Occupational Therapy for over 65s. The museum objects will provide a stimulus

can be actively involved in such projects. The development project was managed by Primary Asset, part of the MedicX group. An interesting aspect of the project was that as part of the planning requirements MedicX was asked to provide a piece of community art. MedicX commissioned experienced community artists, Karl Lewis and Sam Hale of Bostin Arts to develop the artwork with the community. The building is located on Windmill Lane and consequently Sam & Karl identified a broad theme of ‘...on a windy day’ as this provided a wide but interesting concept to develop ideas for the artwork. An initial art workshop was held with the pupils in Years 2 and 6 at Castlecroft Primary School, which is very close to the medical centre. Working with a variety of shapes, objects and books, and using a fan to simulate the wind, the children developed lots of exciting ideas. Drawing them on acetate these were projected onto an image of the building to discuss size and scale. Cutting out shapes and images in metallic plastic generated discussion about the

different materials that could be used and how these would look on the completed building. Sam and Karl spent a long time considering the ideas generated by the school workshop and then from the images generated by the pupils developed seven designs for further consultation. The seven ideas were presented and displayed at the old surgery waiting room, shown to patients and favourites were picked. The dandelion image was very popular, a familiar refrain was ‘However old you are it’s magical to see a dandelion lose its seeds and then watch them blow...’ A further workshop was held at the Windmill Community Centre with the over 50s group showcasing the seven designs and again the dandelion emerged as the most popular. Following the workshops, the Castlecroft Doctors, Primary MedicX and the Architects West Hart considered the designs and after much discussion selected the dandelion which was then manufactured and erected on the building by Rowley Engineering of Stafford.

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A SENSE OF PRIDE The artwork has generated lots of local interest with requests for information at the practice from proud grandparents of children who influenced the design. Craig Lord, development manager at MedicX, commented: “MedicX is very proud to have been part of a project which has enabled the local community to be involved with creating such a tangible and exciting outcome. Not only has everyone come together to provide such a fantastic piece of work, but it will be able to be seen for many years to come and give enjoyment to the local residents.” Sadly for me the senior partner at the practice declined to offer any view on this exciting piece of art on his own place of work. In closing Natalie told me about a creative health education project that they have been running in conjunction with a number of local schools. The interesting thing about this project is that along with promoting exercise and healthy eating in line with the PCT strategic goals, it is also aligned to the ‘Eat 5 a day’ national campaign for healthy eating and so is not just about the look of the facilities. Working within the schools the arts coordinators discovered that the children sometimes lacked enthusiasm for exercise, didn’t eat breakfast or had little understanding of what a portion of fruit really was. A grape was one answer. In helping the children’s understanding about this a series of fruit people were developed, with the children’s involvement, which showed how a handful of a fruit made up a portion. The resulting health promotion artwork has been displayed in the local health centres alongside other improvement works resulting in a much brighter and more welcoming environment. One spin off is that the art work displays draw people into the health centres so that they are now more familiar with the premises and so are more willing to attend when they have medical needs. Art and health in action: I love it! L

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Ariel, Fairy, Lenor – the names of P&G products are well-recognised. But the company covers much more than just cleaning products, with training, technical support and helplines all at your disposal P&G is recognised as a leading global company and a company committed to creating a diverse workplace. Driven by passionate people and a common purpose, P&G brings beloved brands to consumers around the world – including our 50 leadership brands that are among the world’s most well known household names. Companies like P&G are a force in the world. Our market capitalisation is greater than the GDP of many countries, and we serve consumers in more than 180 countries. With this stature comes both responsibility and opportunity. Our responsibility is to be an ethical corporate citizen – but our opportunity is something far greater, and is embodied in our purpose.

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WHO ARE P&G PROFESSIONAL? P&G Professional is the business to business division of Procter & Gamble and is strategically focused on providing high performance branded cleaning and laundry products to the away-from-home-market. Our years of experience in dealing with professional businesses have given us a deep understanding of their needs, allowing our research and development team to specifically tailor products to deliver exceptional performance for professional cleaning. P&G Professional covers an area much broader than just cleaning products, with advice, training, technical support and helplines all at your disposal. So whatever the business, we take pride in creating customer solutions specific to your business needs. Ariel, Fairy, Lenor, Daz, Flash – the names of P&G products are recognised by everybody, and touch over five billion lives each and every year. Because of this, we know the consumer you’re servicing as well as they know our brands, giving us a thorough

Sustainability is embedded deeply into our company’s products, packaging and, importantly, our overall operation and practices. leader for many years in product design, development and manufacture, in collaboration with our consumers and in our work with the communities in which we live and work. For example, since 2002 we’ve reduced greenhouse gas intensity of our operations by more than 30 per cent. And by 2012 we’ll have completed a decade long project to reduce the environmental footprint of our operations by at least 40 per cent. We’ve worked successfully with our consumers to save energy by washing at lower temperatures. Our Live, Learn and Thrive™ campaign seeks to improve the lives of children in need around the world and help them get off to a healthy start.

Sustainability is embedded deeply into our company’s products, packaging and, importantly, our overall operation and practices. It’s an integral part of P&G’s growth, now and for the years to come. PURPOSE, VALUES, PRINCIPLES Taken together, our purpose, values and principles are the foundation for P&G’s unique culture. Throughout our history of over 170 years, our business has grown and changed while these elements have endured, and will continue to be passed down to generations of P&G people to come. Our purpose unifies us in a common cause

and growth strategy of improving more consumers’ lives in small but meaningful ways each day. It inspires P&G people to make a positive contribution every day. Our values reflect the behaviours that shape the tone of how we work with each other and with our partners. And our principles articulate P&G’s unique approach to conducting work every day. L FOR MORE INFORMATION 0800 716854 www.pgprof.com

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EMISSIONS

CUTTING CARBON, SAVING ENERGY AND MONEY Emissions have been rising and the budgets to tackle this are increasingly constrained. Yet it is possible to change this trajectory, argues Alan Aldridge, executive director of ESTA The NHS in England increased its carbon footprint by 40 per cent between 1990 and 2008, according to a study carried out by the Sustainable Development Commission. Indeed, the NHS Sustainable Development Unit reported that emissions rose by a full 20 per cent between 1998 to 2004 – a 3 per cent annual increase. NHS buildings in England consume over £400 million of energy a year and produce 3.7 million tonnes of carbon dioxide. In the wider context, the health service is likely to be disproportionately affected by climate change with increased death rates from higher summer temperatures and new diseases becoming endemic as the climate warms. BEING AWARE The Health Service across the UK is aware of the need to cut both emissions and consumption, though. Published in 2009, the NHS Carbon Reduction Strategy for England says: “Every organisation should review its energy and carbon management at Board level; develop more use of renewable energy where appropriate; measure and monitor on a whole life cycle cost basis; and ensure appropriate behaviours are encouraged in individuals as well as across the organisation.” In 2008, the NHS in England was responsible for 18 million tonnes of carbon dioxide emissions, a quarter of the total for the public sector. The Scottish Sustainable Procurement Action Plan 2009 sets out a series of steps public bodies can follow to make sustainability, including energy efficiency, part of their everyday procurement activity. As an example,

NHS Greater Glasgow and Clyde is working with the Carbon Trust to pilot an asset mapping approach for boiler replacement. This will be extended to other large public sector buildings and further aspects of their energy performance, including lighting, heating and cooling systems, and the building itself. Welsh Health Estates recently published figures that show a 21 per cent improvement in NHS energy efficiency since 1999. So the requirement is there, and some good work has been done. But like all organisations, whether in the private or public sectors, the health service is being expected to do better, but on less money. Energy is an overhead and many see the bill as inevitable and uncontrollable. Yet there are many instances, within the health service and outside, where the estates or facilities departments have been able to make major inroads into consumption and, consequently, bills. IDENTIFYING USE The key to making these changes lies in identifying where energy is being wasted. This has been recognised by the government, which is committed to implementing a programme of installing smart or advanced metering in all domestic and non-domestic locations over the coming decade. Further announcements about how the programme will run were made at the end of March. The government’s belief is that these meters will give consumers the information they need to make “informed decisions” about energy usage. Energy management in non-domestic sites has always depended upon Monitoring & Targeting techniques that measure consumption via meters and then prioritise and target improvement. Organisations with half-hourly metering installed will be given advanced metering by 2014, while smaller sites will be able to opt for smart or advanced metering. In reality, at least for the non-domestic sector, there is not much difference in functionality. If a health service organisation has a mix of half-hourly and non-half-hourly metered sites, it would clearly be sensible to choose the same system for all its properties. In order to do this, though, you have to tell your supplier that this is what you want to do before the

Energy

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2014 cut-off date. Of course, it’s not necessary to wait until 2014 for the new meters, there are good reasons to consider installing them now. As part of an automatic Monitoring & Targeting (aM&T) system, advanced meters can help achieve savings today. With automated data collection and analysis, these speed up the monitoring process and can analyse the information in a number of different ways. Importantly, especially for organisations within the health service, they can help with regulatory compliance too. A number of aM&T systems are approved for production of Display Energy Certificates (DECs). These have to be produced on an annual basis for many of the larger, publicaccess buildings in the health service. However, they will soon have to be produced for virtually all public-access locations – down to 250m2. They will also prove useful in regard to the CRC Energy Efficiency Scheme. CRC ENERGY EFFICIENCY SCHEME The CRC Energy Efficiency Scheme came into effect last April and will soon require all large energy users to purchase allowances for all their carbon emissions. Each organisation will have to account for its energy consumption each year and surrender the corresponding number of allowances. Accurate metered data is therefore essential. There are talks going on between government departments as to whether DECs could be used as a means of meeting CRC EES accounting requirements. This would address some of the issues facing the Department of Communities and Local Government (CLG) E

NHS buildings in England consume over £400 million of energy a year and produce 3.7 million tonnes of carbon dioxide.

LONDON ENERGY SUMMIT The Energy Services and Technology Association (ESTA) is organising a oneday conference for senior managers in both public and private sectors at the Institute of Directors in London on 19 May. The event will explore the contribution of demand management in achieving energy and carbon targets set by government. It will discuss current services and technologies and debate future solutions in establishing the UK at the forefront of the low-carbon energy economy. The strategic response of individual organisations to legal, regulatory and market developments will be crucial to success in both the private and public sectors. The ESTA Energy Summit will help organisations understand and resolve these sometimes complementary and sometimes conflicting issues. Aligning strategic direction in sustainability, energy efficiency and energy management to underlying business and service objectives is vital for success both in delivering public sector services more effectively and in achieving energy and carbon-footprint reductions. FOR MORE DETAILS AND TO BOOK www.esta.org.uk/summit

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Figure 1. Effect of ‘Performance Drift’ due to poor management and maintenance

EMISSIONS E which is faced with a large number of public sector bodies that are not producing DECs on an annual basis. It would also provide the Department for Energy and Climate Change (DECC) with a simple way of verifying returns under CRC EES without imposing any extra costs on participants. No final decision has been reached on this yet, though if was to come about, approved aM&T systems would make the accounting process much simpler. ADDRESSING ISSUES PROMPTLY Regular and consistent monitoring of energy consumption means that sudden changes can be identified and investigated quickly, before they result in significant costs to the organisation. If a control fails or a sensor malfunctions, a piece of equipment may remain permanently on. This should show up as unexpected extra energy demand, compared with the normal usage at that time. So weekend or night time consumption might become consistently higher with no obvious explanation in terms of planned need. Equally, equipment that is just left running – say a heater over an external doorway, or lighting in a storage area – should show up. The weeks around the time when the clocks go forward or back (i.e. late March and October) often cause headaches for energy managers. If timeclocks and other controls do not automatically switch over to the new timings,

then consumption is likely to rise unnecessarily. Heating, lighting, etc, will switch off later than it should but in the early mornings, staff may override the settings when they arrive and the building is still dark and cold. A further aspect of performance that an M&T system should pick up is performance drift. Over time, equipment settings slowly drift away from their original values. Eventually, this can lead to significant wastage (see figure). This may not always be obvious to the user but an effective M&T system should highlight this. Funds are severely constrained for everyone today, for the health service just as much as

others. But energy efficiency projects typically have paybacks of less than two years – sometimes just months. Some actions – like checking timeclocks and correcting for performance drift – actually bring financial benefit for no outlay! And energy savings are permanent, the measures go on saving over time. The Energy Services and Technology Association (ESTA) represents over 100 major providers of energy management equipment and services across the UK. L FOR MORE INFORMATION www.esta.org.uk

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Midas Training Solutions has a proud history of running successful training workshops for NHS staff. Hospital consultants have told us how much they have enjoyed our training and how interesting and useful they found it. We specialise in communication, leadership and management skills. We run tailor made, in-house training, coaching and consultancy for clients in the UK and around the world. Our interactive and practical style of training helps individuals and teams develop and further their skills. We write all our own training ourselves, which means we can create and deliver exactly the right training, coaching and support that you and your team are looking for. Our trainers have practical experience in the areas that they train. Some have worked for the NHS themselves, others have worked in medical

Western Power Distribution’s long established metering business has been refocused to help our customers face the challenges of climate change and increasing productivity. The WPD Smart Metering team provide metering solutions to business customers on a national basis. With a strong reputation for operating HH sites, we now also offer a national solution for NHH sites to deliver to businesses: • automatic remote meter readings and accurate to the minute billing • energy management data and reporting with notification of overconsumption • a consistent national metering service, e.g. to manage the new connection process • integration of remote logging from sub-metering and other utility meters. When you choose the

research and for pharmaceutical companies. If you need media training we have ex BBC and Sky reporters available. We will match your development needs to the right Midas trainer. We enjoy working with diverse groups of participants. Our trainers have worked in over 30 countries, from Afghanistan to Zanzibar. We are experts at involving people from all walks of life in our workshops and helping them achieve success. FOR MORE INFORMATION Tel: 0845 4680235 enquiries@midas-training.co.uk www.midas-training.co.uk

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Western Power Group for your smart metering, you have the confidence of working with a company with many years’ experience of helping UK organisations manage energy more efficiently. As an independent company, WPD Smart Metering works with your supplier on behalf of your business to deliver a firstclass service – from low cost installation of the latest smart meter technologies through to full maintenance and support. FOR MORE INFORMATION Tel: 0870 448900 smartmetering@ westernpower.co.uk www.wpdsmartmetering.co.uk

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R & M Clarkson Ltd, trading as Clarkson Safety Services has been established since 1974. The company has its headquaters in Surrey, with offices nationwide including Scotland and operates a network of engineers to provide a truly nationwide service. Clarkson’s are a versatile company and it’s reputation is second to none holding prestigious accounts in numerous sectors, such as Health Care. One of our main projects of late includes the design, installation and commissioning of a full Fire Alarm system in Great Ormond Street Hospital. We also offer all our clients a helpline manned by engineers to discuss any issue they may have.

Complete Installation service Includes – Design – Installation – commissioning – Maintenance Project Management • Addressable and Conventional Fire Alarms • Emergency Lightling • Fire Extinguishers • Access Control • CCTV • VA / PA • Gaseous Extinguishing Systems • Radio Fire Alarms • Nationwide Service • 24 / 7 – 365 days Call Out • Dedicated Service Desk

R&M Clarkson Limited FIRE AND SAFETY ENGINEERS

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FIRE PREVENTION

PREPARING & PROTECTING

The healthcare environment is so wide and diverse that it can justifiably claim to be one of the most challenging sectors for fire safety. John Davidson, senior inspector, National Security Inspectorate, takes a look at some of the complexities within this area Tap in ‘fire safety and healthcare’ into any search engine and you immediately sense the importance of this subject. The list of websites persuading you to purchase training and reference material is vast. Training courses, books, tuition CD’s, whatever your preferred media, a solution is out there. This is not surprising when one considers the challenges of fire safety in a healthcare environment and the consequences of getting it wrong. Stripped back to basics, a fire cannot start without a source of ignition, fuel and oxygen. If we think of hospitals alone, these three elements are present in abundance. Then there are the less obvious factors that can increase the risk in hospitals. These can include patient groups such as the elderly, those suffering from mental instabilities, or simply those with a desire for arson. Sadly, statistics suggest arson is the basis of a quarter of all fires within healthcare premises. CONSEQUENCES OF FIRE The consequences of inadequate fire prevention and detection in this sector do

not bear thinking about; loss of buildings (many historic), loss of expensive life saving equipment and, of course, the loss of life. Achieving optimum fire safety is a matter for each health authority to consider and is a delicate balance between cost, safety and ensuring the continued core functionality.

readership of this magazine means I don’t have to preach the importance of the Regulatory Reform (Fire Safety Order) 2005 in England and Wales or the Fire Safety (Scotland) Regulations 2006. It is probably a sad reflection of our society that something as important as fire safety needs to be wrapped

Achieving optimum fire safety is a matter for each health authority to consider and is a delicate balance between cost, safety and ensuring the continued core functionality. Each hospital has the potential to adopt every type of fire prevention and detection (and evacuation) solution available in the market; and to install them in large quantities. Unfortunately budgets in the current economic climate, particularly in the public sector, necessitate careful and extensive deliberation. Writing for an audience such as the

up in legislation rather than common sense. Thankfully, healthcare has always realised the importance of fire safety and afforded the subject a priority often not equalled across business or industrial sectors. The healthcare sector, however, is fortunate in that it has comprehensive guidance via the Health Technical Memorandum E

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IF IT IS REQUIRED UNDER FIRE LEGISLATION WE PROVIDE IT Fire Training International Ltd is a UK wide provider of high quality Fire Risk Assessments, Fire Training and Fire Protection Packages designed specifically to move any organisation to full compliance and safety. The fist step to safety is a thorough Risk Assessment and the creation of procedures and policies. Our team of very experienced assessors will not only carry out your risk assessment, write procedures and policies but also work with you to ensure that the systems put in place, will go on year after year protecting the occupants of your workplace. We also train Fire Safety Managers to do this. Services we provide: 3 Fire Risk Assessments 3 Fire Training Courses on Site or at 50 locations around the UK 3 Fire Alarm Maintenance 3 Fire Extinguisher Sales and Service 3 Sales of all Fire Protection Equipment For more information contact: Email: roger@fire-training-int.com Fire Training Division Email: simon.rothwell@fire-training-int.com Fire Servicing Division Tel: 0800 158 4428 Web: www.fire-training-int.com


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FIRE PREVENTION

(HTM); guidance not as readily available within other sectors. Fire safety is often a consideration and responsibility of senior executives who give due priority and attention to fire risks. If other sectors can learn just one thing from healthcare, this latter point should certainly be up there. INVESTING IN SAFETY Healthcare makes significant investment both in the training of highly skilled medical personnel and in life-saving equipment. We are all aware of the expense of this sophisticated equipment and the impact it makes on healthcare budgets. Awareness of this is amplified through direct or sponsorship donations we have all made for new scanners and the like. This expensive equipment makes a great difference to our healthcare, and is one of the reasons that the NHS carries such a wide respect throughout the UK and internationally. Investing in expensive, innovative and life saving equipment commands additional funds for appropriate fire safety measures to avoid that investment, quite literally, going up in smoke. Man and machines have been a productive partnership throughout history. In addition to the challenges of protecting machinery, the challenges of protecting personnel are arguably even greater. In relation to fire safety, people have the ability to cause and prevent fires. The ‘people’ challenge therefore is considerable. For a start, the number and variety of people within a hospital environment is acute – doctors, nurses, surgeons, researchers, security teams, chefs, volunteers, contractors, administration, visitors; the list goes on. The way a given individual will react in any combination of real fire scenarios is a great unknown variable factor. There will be the inevitable ‘have a go hero’; there may also be those whose panic will cause additional hazards or those who react in a violent nature against hospital workers,

patients or visitors, thus hindering the safe evacuation of others. Then there are the patients. It is not only the number of patients but the variety of patients. They will range from those who are independent and mobile, those who are dependent on assisted support such as children and mental health patients, and those with a very high dependency, for example in intensive care units or in the operating theatre where evacuation could prove life-threatening. ASSESSING RISK Fire risk assessment, for each of these classifications, requires careful consideration in any risk assessment both in terms of their safety, and of course, their subsequent safe evacuation. Due to these tremendous variables, fire prevention and detection solutions (and evacuation) will vary from trust to trust, hospital to hospital, department to department, and possibly even ward to ward. It is perfectly feasible that at any given moment, the number of personnel not familiar with the hospital layout, location of the fire exits, fire alarms and/or fire extinguishing equipment, will exceed those who do possess that knowledge. This means the uniquities and complexities of fire safety in a healthcare environment extend beyond fire prevention and detection, and continue into clear and appropriate signage and emergency lighting. Although hospitals are complex in terms of delivering effective fire safety, modern hospitals are possibly some of the ‘easier’ environments for our fire and rescue services. Modern hospitals are designed with fire safety in mind; from access to the hospital itself for fire engines and fire crews, through to isolation areas and venting to reduce the risks and to filter harmful smoke and gases. The proportion of false alarms originating from hospitals is deemed high yet there is some reassurance that the efficiency of the fire crews ‘to the door’ response is testament to

Fire Safety

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considered design and planning. Fire prevention and detection solutions are in abundance and cover a vast spectrum. Many UK fire solution companies offer innovative and internationally renowned solutions. Anyone who has attended an international fire show will have witnessed first-hand the interest shown in UK exhibitors and their wares from a plethora of overseas buyers. The UK fire prevention and detection sector is one that is often taken for granted yet, in reality, is one which we should be justifiably proud of. Many product types have their own bespoke standards and it is worthy of a reminder that standards lay down a ‘minimum’ standard of compliance with numerous products designed and manufactured beyond this ‘minimum’. However, if the equipment is not properly installed, it doesn’t matter how robust the equipment is. If even the best products and solutions are installed incorrectly they may as well not be present at all. Again the fire sector is blessed with comprehensive design, installation, commissioning and maintenance standards. BAFE approval is one reassuring benchmark to establish that the installing company has undergone a thorough inspection from one of four independent third party certification bodies (inspectorates) such as National Security Inspectorate. Fire product installation companies offering BAFE approval have opened themselves up to independent inspection to verify that they work in line with relevant industry standards. Approval, such as with NSI, demonstrates that the installing company complies with industry specific British and European standards that have been drawn up with the input of the fire industry itself, insurers and the fire and rescue services. UNIQUE CHALLENGES We have already stated that hospitals lend themselves to the whole spectrum of fire prevention and detection solutions, yet some of the most staple fire prevention techniques are the basic and everyday actions undertaken by each and every one of us who enter these locations. Complacency, inertia or carelessness can often be the biggest dangers i.e. careless disposal of rubbish, failure to notify staff of a potential hazard, or foolish storage of flammable material, could cause a fire check to become a reality check. Healthcare environments therefore are unquestionably unique environments. Although many industrial and commercial environments can claim to have unique fire risks and safety challenges, very few environments call so many scenarios and hazards into such a concentrated area with the potential to affect so many people. Thankfully fires in hospitals are not commonplace but we should all remember, they do happen. L FOR MORE INFORMATION To find a fire detection and alarm company approved by NSI log on to www.nsi-fire.org.uk or call 01628 637512.

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Signs

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Full sign management service from Whybrow Signing Consultants Whether as a patient or visitor hospitals can stimulate anxiety and stress. This only increases (along with frustration and dismay) when one cannot find a destination or is misled due to absent or inaccurate and ill considered signing. A comprehensive wayfinding scheme will gently guide and answer the visitors’ needs: Where do I park? Where is the reception? Where do I wait? Can I get a coffee? Where are the toilets? Whybrow Signing Consultants provides a full sign management service – wayfinding analysis, scheduling, sign specification, cost planning and project management. Wayfinding analysis deals with the identification of visitor types, their flow routes and needs, not only through signing but lighting, building finishes and even art installations. Following on from this, the development of a sign inventory provides structure and

Direct Signs – 20 years experience in the NHS

a tool for ascertaining costs. Our complete independence allows us free hands to offer impartial advice and specify sign product to match either the aspiration of the client or the constraints of a budget. We are also firm believers in the adage that less is more – the simpler the wayfinding scheme, distilled down to minimum amount of information on the minimum number of signs required, the better.

Direct Signs (northern) Ltd, is a leading supplier and service providers to NHS organisations and healthcare establishments. Our long term expertise in NHS sign making has enabled us to produce a wide range of signs on quality substrates, delivering your corporate identity message on buildings, vehicles and internal signs, from plans to installation. We offer wayfinding signs in varying forms, including wall, suspended, door or post mounted, and modular post and panel sign systems and directories. DDA compliant products, which conform with the technical bulletin 24 issued by the RNIB and Guide Dogs for the Blind, are available to meet the needs

FOR MORE INFORMATION 01325 351092 info@direct-signs.com www.info@direct-signs.com

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of every type of application. Our health and safety supplementary signage including fire safety signage to HTM hospital memorandum 65 Signs Guide 2, and our health and safety general signs conform to BS5499 in accordance with all current UK safety rules. Using the latest technology and equipment available allows us to provide our customers with highquality materials and deliver at the most competitive prices from design to manufacture, from a single sign to a complete project.

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HEALTH & SAFETY

Graphical symbols for safety communication need to comply with the highest comprehension credentials to ensure we are not playing Pictionary with people’s lives ISO 7010 is now finally published and is being implemented as best practice throughout the world. This standard ensures signs communicate the safety message using graphical symbols that transcends the barriers created by different languages and are universally understood. The International Standard Technical Committee (TC145) is responsible for graphical symbols and has worked continuously for over 20 years to develop the very best safety signs to convey critical safety information. The main categories of safety signs are in line with the needs of international requirement for occupational health and safety management and are incorporated in workplace safety legislation. IDENTIFY, LOCATE, INFORM, INSTRUCT Worldwide, safety managers are required by their domestic legislation to ensure that all personnel are aware of hazards, the nature of the hazard and the measures to be taken for the collective protection

including merchant and passenger vessels, will be required to implement and display the new graphical symbols for safety communication. The objective is to ensure that only graphical symbols with the highest comprehension credentials are used and to ensure we are not playing Pictionary with peoples lives. A plethora of graphical symbols are currently being used without these credentials, have little meaning and are untested in accordance with ISO 9186 to ensure comprehension. It is essential that if graphical symbols are to be effective, only standardised symbols should be used. LIFE OR DEATH IMPORTANCE Whilst slight variation in public information symbols may cause, at worst, slight delay in finding a service, or cause embarrassment if you misinterpret the more abstract toilet sign, a mistake in the interpretation of escape route signs causing delay may ultimately lead to death. Considerable confusion has been caused

ISO 7010 is soon to be adopted as a European norm and will be automatically adopted as the domestic standard within all member states of the European Union. All workplaces, including merchant and passenger vessels will be required to implement and display the new graphical symbols for safety communication. of occupants within the working and public environment under their control. Safety procedures, practice and policies will require building managers, property owners and estate managers to identify hazards and mark the location of emergency equipment and life safety appliances. Safety managers have an obligation to inform and educate all occupants about risk control, prohibit certain behaviour and give mandatory instruction to ensure collective protection. EUROPEAN NORM ISO 7010 is soon to be adopted as a European norm and will be automatically adopted as the domestic standard within all member states of the European Union. All workplaces,

by the use of so called Eurosymbols for fire exit signs. Pure illustrations from way back in 1977 have been used, which have no comprehension credentials and fail the basic understanding that is a function of known and effective safety wayguidance convention. Best practice International Standard ISO 7010 graphical symbols for escape route and ISO 16069 safety wayguidance convention ensure that an evacuee is progressed using a known convention through the escape route to place of relative safety. The risk assessment regime required to manage occupational health and safety will determine requirements for safety communication across areas of reflective management.

About the author Jim Creak, editor of the Means of Escape Publication, is an active member of the BSI technical committee and chairman of the Health and Safety Sign Association (HSSA). Jim has over 25 years experience in researching, contributing and participating in task groups on the subject of Safety Wayguidance Systems (SWGS) for marine, industrial and high rise building application.

Written by Jim Creak chairman of the Health and Safety Sign Association

THE COMMON LANGUAGE FOR SAFETY COMMUNICATION

HEALTH AND SAFETY OBLIGATIONS The areas are outlined in international obligations for employers under occupation health and safety legislation. These obligations start with the identification of hazard, the identification of safety equipment, including escape, and the identification of fire fighting equipment including alarms. Employers are further required to locate hazard and safety equipment, including escape route and appropriate fire fighting equipment. Identification and location are the cornerstones of effective safety communication and are specific requirements of workplace legislation. CONTROL OF RISK Following location and identification, a good communication strategy will include measures to reduce and control risk. The control of risk will include the prohibition of behaviour or an activity that is likely to have an adverse effect on the risk matrix or may exacerbate the consequences of an incident. The control of risk and the collective protection of building occupants will require employers, building managers and authority personnel to instigate and enforce mandatory measures to be taken. Finally and probably most important is that safety signs, their meaning and the action to be taken or not taken following them, are part of a formal training, instruction and education process for public buildings, schools, colleges, universities, and the workplace. L FOR MORE INFORMATION www.hssa.co.uk

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INFORMATICS

Healthcare IT

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PREPARING THE NHS FOR AN INFORMATION REVOLUTION

Dr Justin Whatling, vice chair, Strategy & Policy, BCS Health, responds to the NHS Information Revolution consultation with recommendations to shape the forthcoming NHS informatics strategy Health is one of the last major informationintensive sectors awaiting fundamental transformation, and like other sectors before it, this can not be accomplished without using information and technology to reinvent both its internal operational functions and its outward facing business model. An information revolution can support and help drive the changes that are required in the processes and methods of care provision at the start of the 21st century. The Department of Health has now closed its ‘Liberating the NHS: An Information Revolution’ consultation to inform the forthcoming NHS information strategy. In response BCS, The Chartered Institute for IT, has conducted one of the largest engagement exercises that it has ever undertaken, bringing our deep expertise to bear on a holistic approach to the informatics challenges. Our response contained almost 100 recommendations, but a number of themes occurred regularly throughout. USING INFORMATION EFFECTIVELY The scale and pace of the productivity challenge faced by the NHS over the next five years cannot be met without much greater and more effective use of information and IT. The NHS is seeking to deliver 20 per cent productivity improvement over the next five years through better commissioning and more effective provision. This is hugely ambitious and failure will result in reduction of services offered to patients. The NHS must seize the opportunity offered by information and IT. Creating the culture of ‘change at pace’ is vital for a world-class health service. We have recommended that a risk-based approach should be adopted to allow prototyping of new patient-centred technologies and consumer information. It doesn’t have to be right the first time so long as risks are understood and mitigated. We believe that to deliver the impact that information technology has to offer, at pace, IT and QIPP programmes must be integrated and technology used as a method to rapidly spread and enforce good practice. We have recommended that the NHS, with the main software vendors, develops standard implementation of best practice processes and places these in the public domain. For example, the three best ways to run emergency admissions are built into the system, so that a hospital can choose which to

adopt and make the appropriate operational changes, rather than either implementing the technology and worrying about the process change later or behaving as though their A&E requires a total unique solution. IMPLEMENTATION The implementation of information services and IT needs to be viewed as a necessary supporting infrastructure to the redesign of service, not as an end in itself. Successful implementation of the information revolution will involve very substantial behaviour change on the part of clinicians, patients, managers and others. Simply providing the information and IT will not itself guarantee that the information will actually be used – or even collected, analysed and understood in the first place. To meet the massive productivity challenge, the information revolution must start with the design of working practices and cover the whole operating model of care to determine how processes are adapted and how resources are used, prioritised, planned and mobilised as a consequence of better information. The opportunity is to completely rethink the way a service is delivered, whereas implementing modern technology into old processes just makes them more expensive. The electronic patient record (EPR) held by health and care organisations remains a foundation stone, yet these still haven’t been widely adopted in some care settings. Consequently we have recommended that all organisations providing care to the NHS should be given notice that they will be expected to be using an EPR in a meaningful way within five years. Following review of the US criteria for meaningful use, the NHS should create a set that is appropriate to the UK. ENFORCEMENT The rigorous enforcement of standards is not an example of heavy-handed government interference, but a necessary condition to allow a flourishing market of interoperable solutions. Critical to its success, the information revolution requires the creation and nurturing of a viable market for information services, software and transactions to deliver high quality information services to patients, clinicians and organisations. However, for this to happen and for IT suppliers to invest most effectively, the centre should give very clear signals to what it will be doing and what it

will be leaving to others to do. To rapidly innovate solutions, the market requires a quickly established set of minimum standards and guidelines, built on existing good standards, for information collection, production, storage and use by the different actors across health and social care, set against a clear vision for the future. We believe this requires a single overarching approvals and/or assurance body for informatics standards, directed by the Secretary of State for Health, covering health, social care and population health. In some cases standards must be rigorously enforced, for example we recommended that commissioning, regulation and financial penalties for non-use of NHS Number by all care providers should now be applied. At the same time we must make sure that ICT supplier accreditation schemes keep standards high, but also keep barriers to entry low. The NHS Interoperability ToolKit accreditation is a good recent example that has allowed rapid innovation from ICT suppliers – this should be extended as a kite mark for interoperability. COMPETITION The NHS needs to build on the infrastructure of the National Programme for IT, but take rapid steps to reintroduce competition into the NHS supplier market. Whilst the benefits of the National Programme for IT are frequently down-played by people who forget the chaos and lack of progress that preceded it, we are now at a point where the NHS moves to multiple independent care providers, the focus on care pathways rather than institutions and the pressing need for every NHS organisation to be making progress simultaneously. This means that a more dynamic and entrepreneurial supplier market is required. We require a competitive environment, where suppliers will build in the functionality that the market wants to enable them to win the next contract. Additionally the centre will want to maximise the use of legacy investments in information collection, transfer, storage and reporting – vital if the execution of the information strategy is to be affordable. We recommended that existing NHS procurement frameworks such as ASCC should be enhanced so that new vendors can be added to the framework if they meet the national minimum requirements for information governance, functionality, data E

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Healthcare IT

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INFORMATICS E standards and interoperability, or removed if they are subsequently seen to fall below those standards. Equally frameworks should be flexible to allow SMEs to bid for contracts. THE INFORMATICS COMMUNITY The NHS and the informatics community need to win back public and care professional trust through better explanation of the benefits of the information revolution and ensuring that patients are engaged and active in their own health and wellbeing. The transformation of care services needs an improved relationship between the care system and individual patients. This will require a combination of information, education and support. We require patients to take control of managing their own health, choice to liberate patients and incentivise providers, and transparency so the NHS can be held to account. The consultation has not distinguished between these different purposes of the information revolution and must now do so in order that they are individually approached. We have recommended that, where sharing is appropriate, there should be a statutory obligation on healthcare providers to release information as a minimum standard if contracting with the NHS. The NHS Commissioning Board should require

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HEALTH BUSINESS MAGAZINE Volume | 11.3

the publication of meaningful comparative performance data at the level at which patients are being offered choice and that the public will understand and value. To mitigate the risk that, in the early stages of data release, organisations, clinical teams and individuals will be unfairly judged by inappropriate interpretation of data, we recommended that ministers, the Department of Health and commissioners will need to take a mature attitude in responding to data release and be at the forefront of explaining why over-reaction is inappropriate. Many believe that patient groups and others with trusted relationships could step into new key roles as health intermediaries and navigators. But we must recognise that this will not happen of its own accord; they will require help overcoming concerns around liability, skill sets and ability to scale to meet market needs. Technology also has strong potential to engage people in the care system and the NHS should utilise existing technologies that people use on a daily basis, and harness fresh technology, including web 2.0, to meet patients’ desire for better interactions with health and care systems. RESEARCH & DEVELOPMENT England has three of the world’s leading university research establishments in Imperial, Oxford and Cambridge, as well as world-class

pharmaceutical companies. Our integrated health system offers us the opportunity to provide a world-leading environment for clinical research and trials, creating jobs and getting patients early access to groundbreaking treatments. However, the NHS has failed to fully support this opportunity. We have recommended that work is commissioned to develop effective linking systems with medical data and the informatics tools already in use in research institutions, to enable medical data to be used in conjunction with scientific data from pharmaceutical companies and other researchers. These core themes, the information revolution and the awaited information strategy will all falter if we fail to invest in our health informatics workforce capacity and capability. A sustainable health informatics workforce infrastructure is required, spanning health, public health and adult social care, and the public, private and third sectors. Such an approach should be encouraged as a means of improving the quality and professionalism of the health informatics workforce and thereby the quality of data and the management of patient and organisation-critical IT and information systems. L FOR MORE INFORMATION www.bcs.org


Virtual healthcare from Zebra Technologies Zebra printers and supplies are reliable tools to help improve patient safety, manage records securely and efficiently, and track samples and supplies accurately. Medication administration errors cause an estimated 7,000 deaths in the US each year. Bar code identification systems are a proven way of preventing these errors. Zebra wristbands help healthcare professionals identify the right patient every time, and they are a cornerstone of multiple bar code applications that can improve safety, accuracy, and efficiency throughout a hospital. • Accurately and automatically identify patients and staff with accurate, legible, and tamper-proof patient identification wristbands. • Ensure greater security by identifying employees with employee ID cards. • Use lightweight, mobile printers to accurately label specimens at bedside or wherever they are collected, and to provide other documentation at the point of care.

• Track medical records, charts, files, and test results with bar code labels. • Zebra’s extensive range of tag and label supplies includes sterile materials for identifying bandages, kits, instruments, and supplies used in sterile, cleanroom, and laboratory environments, including labels that withstand moisture, frozen storage, heat treatment, and other challenging conditions. • Create RSS or other bar code labels for unit-of-use packaging so medications can be used in automated dispensing machines or scanned as part of a medication administration system. • Improve inventory management by using bar code or Radio Frequency Identification (RFID) smart labels to track medical supplies and equipment.

3M is the trusted UK market leader in clinical coding software, with strong capability in data analysis and document management.

FOR MORE INFORMATION For more information on how Zebra can help improve patient safety and reduce costs, visit www. virtualzebra.com/healthcare

We combine the expertise and security of an innovative global leader in health informatics software solutions, with local and responsive development capability and strong customer service support.

Audio visual and digital signage solutions Charm provides fully tailored and off-the-shelf audio visual, digital signage and content solutions to hospitals, surgeries, schools and businesses throughout the UK. From sophisticated conference hall and training rooms to complex signage network facilities or stand alone information screens, we’re here to help. Digital signage is quickly replacing static signs, notice boards, banners and posters as the most effective method of communicating key information. Used correctly it can help convey detailed messages to almost any audience, anywhere, anytime. Unlike traditional printed signs, digital signage can be updated instantaneously, allowing you to capture current events and suit the demands of the moment. It also eliminates the high ongoing cost of creating and distributing printed ad campaigns. Whether you intend to

3M Health Information Systems

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Driving Health Informatics Improving Patient Care

With a long history of supplying to the NHS and more installations than any other supplier of clinical coding software, 3M is helping health care organisations to manage revenue, and improve the quality of patient care. Ensure that your current and future needs are met by partnering with 3M.

build a brand, influence behaviour or simply provide useful information to visitors, staff or patients, the dynamic visual experience created by digital signage helps get your message across. Our Signage Servers are based on established and extremely stable technologies designed to be active 24/7. They require little or no maintenance once installed – a true “fix and forget” service. To learn more about how Charm can help please get in touch. FOR MORE INFORMATION Tel: 0854 4502012 rod@charmoffice.co.uk www.charmoffice.co.uk

For more information or a demonstration Call: Freephone 0800 626578 E-mail: help.his.uk@3m.com Web: www.3m.co.uk/HIS

3M is a trademark of the 3M Company. ©3M Health Care Limited 2011.

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SECURE DOCUMENT SHREDDING

HEALTHY DISPOSAL OF INEFFICIENCIES

Daniel Hawtin, managing director of The Shredding Alliance, explains how choosing the right supplier for document disposal can combine the highest level of security with time and cost savings Generating cost savings is a key message resonating throughout the health sector and driving efficiencies across vital administration processes will play a pivotal role. With strict policies in place governing record management within the NHS and private healthcare, it is essential that any re-evaluation of operating procedures guarantees compliance with the Data Protection Act, particularly the disposal of confidential information. As all health records are confidential and contain sensitive information about identifiable individuals, it is of the upmost importance that any processing is carried out in accordance with the Data Protection Act (DPA). Processing includes holding, obtaining, recording, using, disclosing, disposal and destruction of records. It is worth noting that the DPA applies to personal information generally, not just to health records, therefore the same principles discussed in this article apply to records of employees held by employers, for example in finance, personnel and occupational health departments within the healthcare sector. RETENTION POLICY Under the freedom of information legislation it is particularly important that the disposal of medical records – defined as the point in their lifecycle when they are either transferred to an archive or destroyed – is undertaken in accordance with established retention policies. Healthcare organisations are responsible for producing their own retention schedules locally, based on internal requirements. However, retention periods should not be shorter than the minimum period set out in the Department of Health’s Records Management Code of Practice. While the destruction of records is an irreversible act, the continuing cost of storage and archiving of records for long periods can be high. Records (including copies) not selected for archiving that have reached the end of their administrative life should be destroyed in a secure manner and in accordance with the DPA. It is the responsibility of the organisation to ensure the method used for the destruction process provides adequate safeguards against accidental loss or disclosure of records. Non-compliance with the DPA heralds serious consequences and can result in criminal prosecution, non-criminal enforcement, audit or

a monetary penalty notice of up to £500,000. It therefore makes sense for healthcare establishments to procure the services of a secure document shredding company. By following straightforward steps in the appointment of the right document shredding supplier, healthcare organisations can not only save money but also have peace of mind that confidential information is securely disposed of. SECURE PROCUREMENT Health records in particular are of a sensitive and confidential nature; subsequently security is the most important consideration during the procurement process. A shredding supplier should operate to ISO9001:2008 incorporating BS EN15713:2009, the European standard for the destruction of confidential information and be prepared to sign any necessary confidentiality contracts. Before appointing a supplier it is crucial to validate these accreditations and confirm how they will keep information secure prior to the shredding process. An accredited supplier will provide locked secure consoles or bins that are strategically located and vary in size according to requirements. In addition, confidential

any formal agreement is entered into, the shredding supplier should offer a free review that includes a full proposal of the current and proposed situation. This should also take into account any regular record appraisal policies, including archive clearances that are in place. To ensure that the shredding service remains competitive and as efficient as possible, it is recommended that regular reviews are undertaken throughout the duration of the service agreement. The single largest cost when using a secure shredding service is the placement of the consoles and frequency with which they are emptied. To ensure the most cost effective service, it is important to find a provider that can offer rapid response times and a degree of flexibility with the methods of confidential document destruction.

Information Destruction

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DESTRUCTION METHODS There are two main methods of document disposal; on-site and off-site. Both of these offer healthcare establishments different benefits. On-site shredding is carried out by mobile shredding trucks that travel to the premises to shred documents. An accredited provider will allow the records manager to witness the shredding process and at the end present a certificate of destruction, which is confirmation that the information has been shredded. The certificate can form part of the necessary information that is maintained and preserved by the records manager about the destruction of records. For these reasons on-site shredding is often the preferred method for health organisations. Once the information has been shredded it is compacted into the back of the truck and the paper is baled and sent for recycling. The main

With strict policies in place governing record management within the NHS and private healthcare, it is essential that any re-evaluation of operating procedures guarantees compliance with the Data Protection Act, particularly the disposal of confidential information. shredding bags need to be supplied, to ensure any additional information is kept secure. These bags should feature a peel and seal lip and have the ability to be shredded and recycled along with confidential information. The customer service operators who handle the confidential information collections must be uniformed, carry identification and have been vetted to BS7858, a ten year background check. Many healthcare organisations operate from multiple locations or sites. When appointing a supplier to drive a reduction in costs, take advantage of buying power by seeking out a shredding partner that can offer a single source agreement for multi-sites. Before

benefit of on-site shredding is that it offers the records manager peace of mind that all confidential documents are destroyed before the operator leaves the premises. Off-site shredding involves a slightly different process and is better suited to larger or oneoff consignments, such as periodical archive clearances. Customer service operators remove the confidential information from the consoles, bags or locked bins into a secure vehicle. Prior to leaving the site, the operator will provide a certificate describing exactly what has been removed. Within 24 hours of collection, the information is shredded via large industrial shredders, baled and dispatched for recycling. E

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data destruction shredding services Compliant to ISO 27001, transportation and destruction of all confidential data. High-quality, security rated containers and sacks. Environmentally friendly disposal (Recycling or Energy-from-Waste). Certificate of Destruction.

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SECURE DOCUMENT SHREDDING E A certificate of destruction is subsequently issued. Regardless of the method put into place, it is important, particularly as healthcare operations are often public sector organisations, that the environmental impact of the shredding service is also taken into consideration. Reducing this impact is not just limited to the recycling of the baled paper but also the delivery of the service. For example, using a supplier that can offer the latest mobile shredding trucks not only ensures fewer vehicle emissions but delivers maximum throughput to reduce the operating time on-site. Remote engine start-stop allows the operator to switch off the truck whilst further collections of information are made from around the site. Furthermore, it is worth identifying a supplier that has off-site plants utilising electric motors because these run at very low amps in comparison to traditional industrial shredders. Industry best practice mandates that all baled paper should be sent to UK or European paper mills for recycling. A reputable supplier should be able to comply with any specific recycling requirement that contributes to an environmental policy. A reputable supplier should also be able to remove and responsibly dispose of any other waste materials, such as surplus cardboard or plastic items, from the

premises. This not only reduces the number of waste management suppliers, but also the vehicle emissions from numerous collections. However, the main driver for procurement in the health sector at the present time will be genuine cost savings. SHREDDING INEFFICIENCY Combining central and local healthcare organisations to source a single agreement that incorporates multi-sites is the most cost effective way of delivering a secure shredding service. Committing to scheduled services offers a stronger negotiation position, as the document shredding supplier will be able to provide cost savings based on regular paper sales. Contracting a supplier that will constantly suggest ways of improving the service is important when driving efficiencies. For example, a supplier whose mobile shredding trucks feature legal for trade scales will be able to monitor the amount of paper each location produces. This information can be used to determine whether the service level is correct or if more consoles are required or collections are too frequent. Whilst cost is always a primary consideration, of equal importance should be the ease of service management. The ability to view service

Nurse call systems from Courtney-Thorne In an environment where product reliability and customer service are paramount, Courtney-Thorne’s 40 years of experience in providing nurse call systems speak volumes for its commitment to both patient safety and customer satisfaction. Established as a family business in 1966, the company has developed into the leading provider of nurse call systems to the UK care industry. From small care homes to numerous hospital trusts and private hospitals, its wireless nurse call systems lead the way in product technology and patient care. A nationwide service team allows for the unique 24 hour a day, 7

days a week and 365 days of the year on-site technical support that Courtney-Thorne provides. This gives total peace of mind to the customer and ensures that patient safety is never compromised. Courtney-Thorne offers the unique and innovative touchscreen nurse call system. Totally user friendly with instant access to on-screen information in one unit, it will no doubt ensure that Courtney-Thorne remains the market leader in wireless nurse call systems. FOR MORE INFORMATION 0800 0687419 sales@courtney-thorne.co.uk www.courtney-thorne.co.uk

About TSA The Shredding Alliance (TSA) was established and is owned by a number of the UK’s leading independent confidential shredding and recycling companies. Offering a secure on-site and off-site document disposal and recycling service, TSA uses a network of local operators to deliver a nationwide service for multi-site customers.

Information Destruction

THE BUSINESS MAGAZINE FOR HEALTH MANAGEMENT – www.healthbusinessuk.com

reports, future schedules, print certificates of destruction and request additional ad-hoc services online undoubtedly saves time. These simple improvements to a secure shredding service can drive significant cost reductions. However, when undertaking such an exercise it is important to remember that using a specialist confidential document destruction company is the simplest way to ensure confidential health records are disposed of in a controlled and compliant manner. L FOR MORE INFORMATION www.theshreddingalliance.co.uk

Secure on site data destruction, IT disposal and WEEE recycling Disk-Demolition.co.uk specialises in secure on site data destruction, IT disposal and Waste Electrical and Electronic Equipment (WEEE) recycling to ensure customers meet their obligations under the Data Protection Act and WEEE Regulations. Our on site data destruction, computer disposal and recycling services are ISO 9001:2008 Quality Management and ISO 27001:2005 Information Security Management certified to ensure confidentiality of sensitive patient and personal data. We are based in Glasgow and there is no minimum number of hard drives for our service. Before leaving customer premises hard drives are removed from computers and processed using UK and US Government approved equipment and methods to securely delete data. Using a two stage process they are first degaussed then physically destroyed by our BS 7858 security vetted staff. This ensures data is destroyed before it leaves

customers’ possession. Optical media (CDs etc.) is processed using a US National Security Agency approved commercial optical media destruction device to remove all information. Before the WEEE is removed from site customers are issued with a Waste Transfer Note to comply with their obligations under the WEEE Regulations. We are a registered Waste Carrier Broker with the Scottish Environment Protection Agency (SEPA) and will remove equipment for reuse or recycling with at least 99.5 per cent recycled. FOR MORE INFORMATION 0845 5197626 info@disk-demolition.co.uk www.disk-demolition.co.uk

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BARIATRIC PATIENTS

THE RISING TIDE OF OBESITY

Obesity Management

THE BUSINESS MAGAZINE FOR HEALTH MANAGEMENT – www.healthbusinessuk.com

Shaw Somers, bariatric surgeon at Portsmouth Hospitals NHS Trust, investigates the problems that obesity creates for the UK health service and what solutions should be exercised Recent figures from a WHO survey have shown that one in ten of the world population is now obese. There is now a greater problem with worldwide obesity than with malnutrition. In England the proportion of men classified as obese increased from 13.2 per cent in 1993 to 23.6 per cent in 2007, and from 16.4 per cent to 24.4 per cent for women over the same timescale. Approximately 1.9 per cent of the population is classed as morbidly obese. That is, obesity severe enough to cause medical co-morbidity. Amongst the Organisation for Economic Cooperation and Development (OECD) nations, the UK ranks as fifth in the league table of obesity prevalence. THE BREAKDOWN IN FOOD BEHAVIOUR The Westernisation and commercialisation of food, coupled with an attitude of ’plenty is better’ has led to a breakdown of the correct relationship between eating behaviour and our body’s capacity to cope with food. Hunger has been successively portrayed as a social evil. Snacking has been invented as an activity to banish hunger. Yet hunger remains a basic physiological function to prepare the body for the next meal. Without hunger, and a suitable gap between meals in which to feel hungry, the body never starts to burn stored fat, and so the pathway to obesity starts. For some the need for food becomes pathological. The term addiction can be appropriate, and the prevalence of disordered eating is more widespread than generally appreciated. MEDICAL AND SOCIAL CONSEQUENCES Obese people are shown to have low quality of life scores when compared to normal weight counterparts. This translates into low self-esteem and decreased effectiveness at work. Many admit to poor home lives and a disinclination to interact socially for fear of ridicule. Unsurprisingly, the rise in obesity prevalence has been mirrored by that of diabetes. The NHS Information Centre estimates that 2.6 million people in the UK have diabetes and this is predicted to reach 4m by 2025. Prevalence between PCTs varies from 2.5 per cent to 5.7 per cent. Approximately one quarter of all diabetics are poorly controlled, and these patients go on to develop costly complications. Other conditions that have a causal link with obesity include hypertension, metabolic syndrome, obstructive sleep apnoea, cancer, degenerative arthritis, intracranial

hypertension and stroke. This poses a significant resource issue for the future NHS. At present the cost of obesity to the NHS is estimated to be £4.2 billion and the cost to the wider economy is £16 billion. These costs are projected to increase to £10 billion per year by 2050, with the wider costs to society and business reaching £49.9 billion per year, at today’s prices. The cost of diabetes to the NHS is £649.2 million (just under ten per cent of the NHS budget for England and Wales), a cost that has risen by 40 per cent over the last five years. There is strong data highlighting the cost effectiveness of metabolic surgery. On the whole, NICE will not recommend any treatment which costs more than £20k-£30k per Quality Adjusted Life Year (QALY). The incremental cost per QALY for metabolic surgery falls well below this. However, many PCTs seem to be turning a blind eye to this evidence. It may be that PCTs recognise the long term cost benefits, but their interest lies in the shorter term and many PCTs find the upfront costs of metabolic surgery prohibitive to their annual budget plans. In order to encourage investment in metabolic surgery across the UK, the NSCG needs to be allocated a budget centrally, which can be distributed to help meet the upfront costs of metabolic surgery. IMPLICATIONS FOR THE NHS The NHS is faced with a number of significant challenges if this rise in obesity related expenditure is to be tackled. Clearly, those in most clinical need require targeted resources and money spent in an effective manner. For those with morbid obesity, metabolic surgery offers the most cost effective solution. Each PCT has a different level of demand for metabolic surgery, as well as different commissioning priorities. Many PCTs are modifying the NICE guidelines, for example by raising the BMI thresholds, in order to ration the numbers of patients they will fund. This is sometimes referred to as the postcode lottery. Again, central planning by the DoH and NSCG should enable strategic allocation of resources to match the expected regional demand. Hospital capacity for offering metabolic surgery is not readily available. With 2.7 acute hospital beds per 1,000 of population, the UK health system is already stretched. Many hospitals simply do not have the available facilities to offer a metabolic surgical service of suitable quality. This includes too few surgeons, of which there are less than 100 in the British Isles. Certainly, the number of hospital beds

occupied by patients suffering from the complications of obesity will increase as obesity prevalence increases. In order to halt this spiral, the UK Government does recognise that obesity management is a health priority. However, funding does not seem to have been targeted successfully. By allocating metabolic surgery centres, the DoH can ensure that the difficult balance of demand, funding and availability is met as efficiently as possible. This would also ensure adequate specialist training and workforce planning. In many quarters, the health and economic benefits of metabolic surgery have yet to be fully understood, even though a large amount of evidence exists. This situation is not unique to the UK. However, with the NHS being funded centrally and to a large extent policy being driven from the centre, it would appear that the devolution of the evidence from the top down should be easier than in more disparate healthcare systems. A coordinated approach between public health, clinicians, medical schools, the NSCG and DoH officials should enable the evidence base to be thoroughly analysed, understood and disseminated to healthcare stakeholders and providers. SOLUTIONS AND STRATEGIES The government’s comprehensive spending review announced the aim that England was to be the first major country “to reverse the rising tide of obesity”. This aspiration was given a strategic framework with the launch of ‘Healthy Weight, Healthy Lives’. Many of the clinical guidelines used to deliver this lofty ambition were summarised in the NICE document: ‘Obesity: the prevention, identification, assessment and management of overweight and obesity in adults and children’. Coercion and ‘nudging’ do not work. People need to be educated regarding diet and lifestyle and rewarded for compliance. Taxes on prepared foods and high calorie foods could also be one disincentive to eat excess. However, we already have a cohort of the population for whom lifestyle change and dietary advice alone is not enough. For those, access to effective treatment must be organised. Medically supervised weight management clinics must be developed as a support for primary care initiatives. These can then identify patients for whom metabolic surgery is the only way to control their morbid obesity. Unless this problem is rapidly acknowledged and tackled sensibly, many of us in this field believe that the obesity epidemic will break the NHS. L

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FOOD SAFETY

Catering

THE BUSINESS MAGAZINE FOR HEALTH MANAGEMENT – www.healthbusinessuk.com

TAKING THE TEMPERATURE Maintaining correct food temperature is an essential requirement for all catering operations – from transport and storage through to preparation and meal delivery. This is increasingly a difficult challenge for the healthcare sector, faced with growing pressures to deliver high standards with evertightening budgets and a shrinking workforce. QUALITY ISSUES Health sector clients are particularly vulnerable to food-borne bacteria, and all catering managers know that even the most basic of thermometers will help them reduce this risk. So a common response is for managers to sacrifice quality for basic budget thermometers of the throw-away kind. What’s wrong with this? Well it could be a risky strategy both for food safety and for economy. Firstly, there is the issue of accuracy. It’s commonly known that ensuring food is piping hot eliminates most bacteria but what do we mean by piping hot – 65°C, 70, 80, or more? The right answer will depend on what is being cooked and for how long it is being kept warm; and this will dictate just how accurate your equipment needs to be. Similarly, the storage temperature of chilled food is especially critical; UK food regulations require an accuracy of +/- 0.5°C. It’s important therefore, to look very closely at the detailed specification of food thermometers and probes when it comes to purchasing if you are to avoid potentially harmful false results. Secondly, there is the issue of value for money – robust, long-life thermometers do what they say on the label and will cost you less in the long run. But that doesn’t mean the purchaser doesn’t have any options – if you know your working environment or methods are likely to result in a high turnover of thermometers, ask the manufacturer about service contracts or pre-negotiated repair charge arrangements, which give you more control over spending. RECORDING ISSUES Another issue to take into consideration is what you do with a temperature once you have taken it. In recent years, European legislation has demanded a belt and braces approach to food temperature recording; taking accurate temperatures alone is not enough – HACCP food safety regulations require enhanced due diligence on the recording of results at every stage of food

storage, preparation and delivery. This can be a logistical nightmare for managers resulting in a more labour intensive operation and a daunting paper mountain, which is why many have turned to paperless systems to reduce the burden and to reduce the risk of human error. An initial enthusiasm for complex wireless monitoring systems to meet this challenge has recently waned – not least because of the significant costs involved for cash-strapped hospitals, care homes and nursing homes, but also due to the persistent need to carry out multiple, hands-on spot checks that can be easily verified. AFFORDABLE SOLUTIONS Thankfully, the design and manufacture of handheld temperature monitoring equipment has evolved quite rapidly in response to these demands. This is particularly true in the UK where there is still considerable expertise in this kind of technology, and experience has shown that it is not always the most expensive or complex systems that are best. Easy to use, affordable equipment is now available for a wide range of temperature applications, commonly required in healthcare catering. For example, waterproof thermometers and dishwasher-safe food probes are not only more practical but also play an important role in supporting infection control. A number of UK manufacturers now build this functionality into their standard designs; keep an eye out for the IP67 label in the detailed specification. Something as simple as hygienic and convenient storage of equipment cannot be overlooked. Considerable time and money can be lost searching for misplaced thermometers and food probes in a busy hospital kitchen; look out for suppliers who offer stainless steel wall mounted storage or handy thermometer holsters to keep equipment in the right place at all times. Even the more innovative solutions are within the grasp of catering managers on a tight budget; there are really useful ideas available, like the cold storage kit that uses an ingenious food simulant probe to mimic the true temperature of stored food in cold cabinets, fridges and freezers – ensuring speedier, more accurate results and reducing the incidence of wastage. THE NEXT GENERATION Maintaining verifiable, interrogative temperature logs at an affordable cost is still one of the most difficult issues for a modern

catering operation. The next generation of thermometers is definitely up to the challenge; thanks to advances in handheld Bluetooth technology, UK temperature experts have developed a new solution to temperature recording, which combines a conventional handheld thermometer with mobile wireless functionality. These revolutionary Bluetooth thermometers also harness barcode technology, combining both functions in a single, handheld unit. The result is a genuine breakthrough in temperature monitoring – a handheld device that records not only temperature, time and date of measurement but also what has been measured. As well as taking temperatures, these newstyle thermometers can scan barcodes to identify and record the unique identity of any location or item that has been measured eg fridge, freezer – or even an individual plated meal. As many as 1,000 readings can be stored on the device which then has the power to download these results direct to PC, mobile phone or PDA. Results can be examined using conventional office-based software, which then allows the setting up of alerts. Results can even be uploaded to a third party website for online monitoring.

Written by Tom Sensier, TM Electronics

Food safety in hospitals and care homes is a top priority for catering managers and correct food temperature plays a key role in risk assessments

SPECIFYING Before you are ready to order new equipment, there are a number of questions to consider. Is your preferred choice sufficiently accurate and robust for the job in hand? How practical and easy to use will it be? How will it fit in with your other operational requirements? A compatible range of thermometers and probes that can be used in all areas is often a wise choice – so is the model you are considering sufficiently versatile? If you are bewildered by the sheer volume of different options on the market, it’s not surprising; many companies can sell you a thermometer but not all have the detailed expertise you need to help you make the right choice. But remember that expertise is not necessarily something you have to pay for; a reputable manufacturer or supplier will be happy to give you advice and their website will offer relevant information and guidance on your application. The main warning note to sound is that a one size fits all approach is one to avoid; make sure your supplier properly understands your particular challenges and the standards you need to meet before committing that hardwon budget. L

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ACADEMIC VENUES

LEARN THE VALUE OF ACADEMIC VENUES

Conferences & Events

THE BUSINESS MAGAZINE FOR HEALTH MANAGEMENT – www.healthbusinessuk.com

The combination of expert staff, the advantages of a university setting, and a core focus on quality content have shown event organisers that academic venues are the ideal solution for their delegates, writes Rachael Bartlett, head of sales and marketing at Warwick Conferences The quality and professionalism of academic venues is a far cry from perceptions of them being ‘fit-for-purpose’ or ‘adequate’ – and conference and event organisers are waking up to that. In the past some have overlooked academic venues, but clients are increasingly recognising the elevated service, technology and flexibility provided. This can be seen in all aspects of the offering, including accommodation, dining and meeting facilities and, most importantly, experienced and passionate people. An event is rarely a success simply because of space, facilities or even because a rock-bottom deal has been negotiated. All are influencing factors, but success is more often a direct result of the skill and passion held by the people that make it happen. Empathy with the event organiser and delegates, attention to detail, focus and experience are the key ingredients academic venues excel at delivering.

UNIVERSITIES Universities are historically attractive employers and retain staff for a number of years, so a problem or request that staff have not handled or catered for is a rarity. Indeed, Warwick Conferences has more than a dozen employees who have been working at one of its venues – Scarman – since it opened in 1991 and many others with similar service records can be found throughout our business. A key offering provided by many academic venues that especially resonates with customers is the appointment of a dedicated event manager to each conference. Giving

organisers a convenient single contact for all queries and requests allows trust and mutual knowledge to build up, so academic venues can tailor the client’s time to perfection. ACADEMIC DISTINCTION Close ties with learning excellence and the ability to link with academic colleagues to enhance events adds further value. For example, a medical conference can enjoy a keynote speech from an esteemed lecturer in the field. Another advantage of academic venues is that they are specifically geared towards earnest conferencing and can provide E

Empathy with the event organiser and delegates, attention to detail, focus and experience are key ingredients academic venues excel at delivering.

John McIntyre Conference Centre

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Hospitality at Senate House at the University of London Outstanding hospitality and service are vital elements in creating a successful event. Our team of experienced staff will take care of the finer details leaving you worry free. Here at Senate House you are in capable hands. We provide a range of hospitality menus to suit any event from a private meeting to a prestigious dinner or reception. We can cater for any group of up to 480 people making Senate House the perfect venue for all your hospitality needs.

Great Times at the Tel: 020 7862 8127 or email us at: enquiries@senatehousevenues.co.uk

We look forward to welcoming you to the University of London in the near future.


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ACADEMIC VENUES E bespoke packages, from luxurious to fundamental. It is the case that many academic venues have built dedicated venues to offer all year round residential facilities. The ethos and dedication this provides is useful for organisations that are required to use their money cost-effectively and transparently. But competitive rates do not mean compromise on standards in facilities, service, accommodation and catering – for example, many venues now boast chefs that have won prestigious culinary awards once seldom found outside the kitchens of 5-star hotels. People shouldn’t assume all academic venues are just student rooms, many now have at least one bespoke high quality conference centre with everything up to bespoke 4-star equivalent as part of their package. Warwick Conferences currently has three – Scarman, Radcliffe and Arden. This flexibility, seldom found elsewhere, means academic venues can handle small events to conferences with 1,500 or more delegates. It is for this reason that conference centres are used by significant organisations, such as blue chip companies, senior policy makers and politicians. FOCUS As university enterprises, academic venues are able to take a long-term view of business because they do not have to respond to the short-term demands of shareholders. This permits an ongoing commitment to quality and service as they have been able to

The question is when does a conference or meeting venue become a hotel or multipurpose facility? The answer is when the customer thinks so. resist any excessive cost-cutting programmes. Renewals and improvement programmes in particular have continued at a high level because there is a belief that delivering high quality, in both service and facilities will mean a stronger business in the long term. Similarly, many academic venues have continued to invest in training people across the board. While venues have considered other potential revenue streams, from Christmas parties to weddings, many academic venues have rejected them due to consideration of appropriate business mix. As soon as you mix a social event with a business meeting the likelihood is that at least one party will end up dissatisfied. The question is when does a conference or meeting venue become a hotel or multi-purpose facility? The answer is when the customer thinks so. Additionally, many academic venues are E

WARWICK CONFERENCES

Conferences & Events

THE BUSINESS MAGAZINE FOR HEALTH MANAGEMENT – www.healthbusinessuk.com

The University of Warwick is one of Britain’s leading Universities. It offers arguably the best University conference facilities in the UK. Branded as Warwick Conferences, it is highly successful with an annual turnover in excess of £20 millionWarwick Conferences consists of three purpose built training and conference centres: Scarman, Radcliffe and Arden, offering dedicated conference facilities all year round and the Conference Park, which utilises the main campus facilities. Over 300 meeting rooms, from boardrooms to tiered auditoria are fully equipped with the latest technology, 600 sq. metres of exhibition space, a 1,200 capacity hall and the largest Arts Centre outside of London. It is considered to house the widest choice of meeting space in the UK – all located on a 700-acre rural setting on the outskirts of Coventry within a few minutes of the motorway network, high speed rail links and Birmingham International Airport.

John McIntyre Conference Centre restaurant

Abden House drawing room

Dining facility at Reading

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London

Training Meetings Conferences KUCEL 86x125mm Advert_Layout 1 28/03/2011 14:53 Page 1

Flexible Event Spaces KUCEL offers flexible, functional, contemporary event spaces in and around Kingston. Our affordable hire rates include room, external space and day delegate rates. Regular clients include film companies, exhibitions, health classes, church groups and adult education. Quite simply whatever your event KUCEL has the space for you! Visit www.KUCEL.co.uk or call 020 8417 5519

T: 020 7631 8306 E: conference@pccc.co.uk W: www.pccc.co.uk

Woburn House Conference Centre is situated at the north end of leafy Tavistock Square in the heart of Bloomsbury. It is conveniently positioned for conference delegates from all over the UK and overseas as it is a short distance from Euston, Kings Cross and St Pancras railway stations. The meeting rooms seat from 10 to 160 people, with full audio visual facilities including video conferencing and technical support. Our Catering service has a variety of menus on offer to suit every taste, dietary requirement and budget. Visit the website at www.woburnhouse.co.uk for further information.


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ACADEMIC VENUES E based within a university campus. As a result they can offer a convenient single location to eliminate the headache of travel between venues, accommodation and social activities. They may also be able to offer a high level of confidentiality, security and privacy and may explain why so many high profile and respected organisations, especially government bodies, select them for their conferencing needs. COST-EFFECTIVE While many venues have clearly had to adjust their pricing strategies as a consequence of the recession, academic venues have largely avoided entering a rate slashing competition. Excessively reducing rates invariably leads to a compromise on standards and investment in areas of the business such as staff, improvements and maintenance. This is a concession it is unwilling to embark upon as it knows customers have come to rely upon and expect high levels of service. That said some clients have been lured away by the prospect of lower rates. However, the majority of these customers have since returned as they recognise that despite a slight differential in a 24-hour rate, the inevitable compromise on aspects like service standards, cleanliness or quality of food, plus the creep of additional costs for extras, has had a

Comments included: “Excellent organisation and communication throughout.” “The facilities at Warwick Conferences are wonderful.” detrimental effect on their event’s objectives. The academic sector now rightfully accounts for a significant percentage of the multi-billion pound events, conferences and meetings sector. The combination of expert staff, the advantages of a university setting, a core focus on quality content and attractive rates have shown organisers that academic venues are the ideal solution for their delegates – whatever the question. CASE STUDY Warwick Conferences was graded highly by the teachers of tomorrow after a major education training event was held there. The Coventry-based collection of training, conference and events venues welcomed more than 1,000 educators for the Teach First National Institute. Over 550 of the participants attended for the full three weeks with more than 400 additional participants arriving for the second week. Teach First is an independent charity with a

Conferences & Events

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mission to address educational disadvantage by transforming exceptional graduates into effective, inspirational teachers and leaders in all fields. Feedback from Teach First revealed that more than 95 per cent were very satisfied or satisfied with their experience at Warwick including the check-in, technology, catering and accommodation. Comments included: “Excellent organisation and communication throughout.” “The facilities at Warwick Conferences are wonderful.” and “The catering has been absolutely amazing.” Teach First director of leadership development Amanda Timberg said: “Warwick Conferences took on the organisational and logistical challenge of Teach First’s biggest ever Summer Institute and delivered beyond our expectations. We are looking forward to returning to the first rate service we received last year.” L FOR MORE INFORMATION www.warwick.ac.uk/conferences

Experience the luxury of organising an conference or event at Imperial College London Consistently rated among the world’s best universities, Imperial College London is a science-based institution with a reputation for excellence in teaching and research. The College is also one of the UK’s largest academic conference venues with three out of nine campuses in and around London offering conference facilities. Imperial offers over 200 event spaces such as meeting rooms, lecture theatres, concourse areas, exhibition spaces, and unique historical town houses, located at its main campus in South Kensington in central London, and at its Hammersmith and Charing Cross campuses in West London. Our South Kensington campus is located just minutes from the Royal Albert Hall, Hyde Park and London’s famous museums, and benefits from a vibrant neighbourhood and excellent transport links. Many of our unique spaces are located on this campus, from the Great Hall, our largest permanent venue which seats up to 740 delegates theatre-style, to the Queen’s Tower Rooms, a modern glass-fronted banqueting and exhibition space which overlooks the Queen’s Lawn, and Imperial’s famous Queen’s Tower, offering guests a unique space balancing

history, quality and the contemporary. At certain times of the year, the Queen’s Lawn, a 1,600 square metre space located in the centre of the campus, houses a marquee suitable for exhibitions, dinners, conferences and much more. It can be used as a standalone venue or as an extension to the Queen’s Tower Rooms a few metres away. Our two historic executive venues, 170 Queen’s Gate and 58 Prince’s Gate, are available all year and are perfect for private dining and more intimate events for up to 120

guests. These two self-contained venues are ideal for really impressing your guests and creating that wow-factor. With its unique design and room layout flexibility, the College has venues to accommodate a wide variety of corporate and private events from high profile conferences to intimate dinners and receptions. Imperial offers more than just space to hire – additional services have been developed to make the organisation of your event smoother and to make you and your guests feel special. Our award-winning in house catering, dedicated events team and excellent on-site technical support mean your event is handled with expert care and attention. During the summer months, accommodation at the South Kensington campus is transformed into 3- to 4-star hotel-style bed and breakfast facilities, and year-round we can help you find the best hotel accommodation at carefully selected local hotels. FOR MORE INFORMATION Tel: 020 75949494 conferenceandevents@imperial.ac.uk www.imperial.ac.uk/conferenceandevents Volume 11.3 | HEALTH BUSINESS MAGAZINE

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Fleet Management

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TRAVEL STRATEGY

REFRESHING YOUR FLEET POLICY

Given the current economic climate, there has never been a better time to put in place a new, streamlined travel strategy to save money. Stewart Whyte, director & membership secretary, ACFO, explains how this can be achieved The conventional view of the fleet market has changed significantly in the last two or three years, with very new options to be considered. One of the biggest changes has been the trend to consider business mobility as an holistic corporate objective, rather than the vehicle-centric ways which used to be the limit of the market. In general, end-user businesses now seek full solutions to the issues of moving employees and goods around, rather than on narrower issues like whether to have petrol or diesel cars. The fleet supply chain has become sophisticated beyond belief with most products and services based wholly or partly on tax issues: in every sense the government’s focus on CO2 from transport has produced quite spectacular results. EXAMINE THE RISKS Many other issues have developed, such as managing road risks, the rising costs of insurance, and the tightening of funding. All of these factors should be examined by all businesses from time to time to ensure that exposure to cost risk as well as on-road risk is minimised. The issue is even more relevant to public sector employers like the NHS. The severe constraints on funding together with the prospect of significant organisational change put even more emphasis on reviewing the options in detail, to maximise value for money and business efficiency. Given the current market and the range of choice, the place to start is not with the vehicles – but with a clear picture of what the demand for business mobility actually is in your operation. Not for other organisations, not your neighbours, but yours. Every organisation has its own pattern of annual mileages, its own mix of long and short journeys, a blend of pure transport fulfilment and remuneration through private use. It is becoming clearer that we are moving away from the onesize-fits-all approach, to something much more sophisticated and efficient. Until recently most change was centred around getting the vehicles cheaper (whether through purchase price or leasing rates). Consortium arrangements such as the recent framework agreements through OGC/ Buying Solutions and others, have

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HEALTH BUSINESS MAGAZINE Volume | 11.3

provided pre-approved and efficient routes to market – but that should now be secondary to reviewing the actual needs now and for the mid-term future, rather than an automatic re-tendering of supply contracts. VIEW THE BIGGER PICTURE In both public and private sectors, smarter fleets are re-examining the wider picture to see where bigger changes and cost savings can be achieved. For example, in some private sector areas there are options to outsource vehicle provision completely to the employees, through cash allowances or highly formulated schemes. Conversely, there is also a move to in-source vehicle provision through salary sacrifice arrangements – often by extending the scheme to all employees and not just those who need a company car. In most cases these are not idealised for the public sector – so should be examined with great care for

at 25 pence per business mile) to be tax and NI free for employer and employee. Many schemes were set up on the assumption that these would continue at these rates for some time to come. However, as we saw, this was not guaranteed at all. The initial rate (for up to 10,000 business miles in the tax year) was increased to 45p/ ml – a 12 per cent increase. How this tax-free rate change interacts with the actual rates paid in many parts of the NHS will need to be assessed by careful analysis of local circumstances; broad-brush simple calculations are unlikely to give a meaningful answer. It should not be assumed that this is the end of the matter. As business mileage patterns have been changing in recent years, there are rumours of HMRC re-evaluating this particular tax-free system more radically. While the recent rise is doubtless good news for employees, it represents an additional cost for employers. With employees’ own budgets under pressure due to inflation and higher monthly food and heating bills, for example, staff may look to subsidise their income by clocking up additional business mileage. It is therefore essential that employers communicate the importance of journey planning and journey management to employees. GREY FLEET The Office of Government Commerce has been aware for some time of the culture within some public sector organisations

The fleet supply chain has become sophisticated beyond belief with most products and services based wholly or partly on tax issues: in every sense the government’s focus on CO2 from transport has produced quite spectacular results. full relevance to the defined requirements. The increase in attention to the grey fleet – employees using their own cars in exchange for a mileage reimbursement – has shown that there is in fact a whole spectrum of potential solutions to meet different requirements. A QUESTION OF TAX There are many opportunities to examine the options as there is now a wide market of tax and fleet consultants offering analysis, industry expertise and outcome comparisons to help the overall optimisation process. One of the problems of many of these comparisons has been the assumptions made about the tax-free mileage allowances – the AMAP scheme – which is often taken as a benchmark level for costing. Until the Budget, this HMRC system allowed tax-free payments of up to 40 pence per business mile (up to 10,000 business miles in the tax year, with any mileage over 10,000 in the year payable

for employees to travel unnecessary miles in their own cars on business. Its report entitled ‘Grey Fleet Best Practice’ (accessible from www.ogc.gov.uk) says: “Often grey fleet is not the most cost effective method of transport available to an employee.” However, the report also confirms the need for management control by going on to say that grey fleet travel maybe preferred by employees for a range of reasons, including: • Employees not being aware of other, more cost-effective, alternative methods of transport that are available which could include car rental, car leasing and public transport • Own car travel being ‘easy’ with effective journey planning probably not undertaken • Mileage rates offered may act as an incentive for employees to drive their own cars, especially where these are


older (and therefore cheaper to run). The report concludes: “Without appropriate demand management measures, this can lead to rising mileage in employee-owned cars, as well as rising mileage costs.” Simultaneously, with keeping costs under control public sector organisations have also been charged by the government with reducing their carbon footprint. Transport is one of the most significant causes of greenhouse gases so journey management not only contributes to cost management but also a reduction in an organisation’s carbon footprint. Government is also looking to encourage car sharing with the little-known allowance for passenger payments currently in place for employees at 5p per passenger per mile being extended to volunteers in a Budget announcement. Too often a number of employees travel individually by car to business meetings or appointments. However, advanced planning could mean that car travel is shared and the drivers can benefit from an additional mileage allowance. FUEL PRICES Of course, all of the above is happening against a background of very significant increases in forecourt prices for petrol and diesel in the last 12 months. Given the current volatility in North Africa/the Middle East there are real concerns about the continuing upward pressure on mainline transport fuels – in fact there are developing concerns about its very availability. Of course the costs of petrol and diesel have been on a relatively consistent upwards trend in recent years and most fleets have recognised the need to look at saving money. But in reality, many have stopped after that first look. Hence it is vital for NHS employers to understand the current profile of demand for business travel before making new decisions about the methods of vehicle provision. An essential journey as defined five years ago may now have to be re-defined as a ‘nice-to-have’ – and vice versa. The realities of the current financial situation, the changing face of NHS service delivery, and the increasingly strident demands for control of climate-change emissions really do justify close scrutiny to ensure the travel policy is fit for purpose. The top levels of management need to accept responsibility for keeping the travel policy in line with function, costs and environmental aspects. Where a business has never had a mileage and/or fuel management policy, it can be a daunting prospect to try to tighten up on expenses claims and look more closely on the amounts being spent – and what mileages are being delivered. In the NHS the common practice is to pay on a rate-per-mile basis and this does reduce administration. But over the last few years, most model ranges have seen a big increase in fuel economy (as a function

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of lower CO2). The approved fuel mileage rates may therefore start to look generous for some quite large model groupings – so the flat-rate reimbursements may be over-generous. 2011 is therefore a year to review the whole picture, and consider how to reduce costs, CO2 and administration. This is never an easy or quick option to undertake carefully, as all the factors of all the valid options need to be assessed as part of the exercise. Failing to make sure that every cost type is included can only give a wrong result – not just for the start, but for the fleet lives of all the cars under the sub-optimal arrangements. ALTERNATIVE POWER The market has continued to focus on petrol and diesel as the main fuels. The big alternative fuels of a few years ago (LPG, CNG, high-concentration bio-fuels) have tended to become niche products with true benefits to fleets limited to specific circumstances. Hybrid power has continued to make penetration into the fleet market, but again needs to be selected where its characteristics suit the operation environment (generally urban/stop-start conditions rather than open-road driving conditions). 2011 will see the arrival on many new allelectric models, range-extended models where the internal combustion engine becomes little more than an on-board generator, and diesel hybrids. These new and developed technologies offer big opportunities – but in their right place. They are not first choice for extensive motorway driving, for example. ADVERSE WEATHER As well as the poor economic outlook, the weather has not been kind to business travellers. Snow in January and December 2010 caused a great deal of disruption to travel plans, and destroyed effective productivity for these periods. One of the big questions to engage the fleet market was the value – or otherwise – of snow tyres, more correctly called cold-weather tyres. Their objective is to provide increased grip on light snow and ice, allowing progress to be maintained when other vehicles are struggling. When the road is blocked by abandoned vehicles, of course, they offer no benefits at all. Some of the suggested solutions include cars and vans being provided with a duplicate set of wheels with the cold weather tyres so that they can be changed on a seasonal basis. That can be expensive and difficult (where do you store the set that’s not in use?) Another solution is to use snow socks – a sort of lightweight version of snow-chains. These are of course much cheaper and require no storage. But why consider a policy on these now? Stocks are not huge and by the time the next major snow-storm or cold weather spell comes along in winter 2011/12, everyone else will be after them. In this area, as in every facet of good

Stewart Whyte

business mobility management, planning ahead really is the key to success. SUMMARY As can be seen, public sector employers and employees face significant increases in their vehicle and car travel costs. Even if low emission, fuel-sipping cars are selected, costs in many cases will rise over the coming years. It is essential that fleet decision makers and HR departments communicate directly with drivers and educate them – not only about the cost increases but, crucially, how that expenditure can be managed downwards. That means producing at-work driving policies that require staff to use the most economic and efficient method of travel, taking into account the cost of travel, environmental impact and journey time. The financial rewards for public sector organisations are huge but it is no good putting in place a new travel strategy if it is not communicated to drivers who, in turn, are also not educated as to how their own costs, particularly in relation to company car benefit-in-kind tax, are likely to rise. Changing established practices is no easy task. But, given the current economic climate, there has never been a better time to put in cost-saving measures that may preserve jobs and boost funding for frontline services. ACFO has long provided a support network for fleet operators in all sectors. Through networking at regional meetings and online, there are many opportunities for knowledge transfer from one level of fleet to another. Experience shows this is irrespective of size: many smaller fleets can teach a few of the big boys a few lessons in improving overall performance through changes in technique, monitoring or communicating with employees who drive on business. L FOR MORE INFORMATION info@acfo.org www.acfo.org

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HOSPITAL PARKING

RAISING PARKING STANDARDS

For many, the car park is both the first and last impression of a healthcare facility. It is therefore imperative to make it an easy and stress-free experience, urges the British Parking Association Parking is now accepted as an important aspect for healthcare facilities to take into consideration when providing the best overall experience for staff, patients and visitors. The British Parking Association (BPA) recognises there are specific and often very emotive issues involved in managing parking in the healthcare sector. We are continuing to develop guidance and networking opportunities for those involved in this sector. CHARTER FOR HOSPITAL PARKING The BPA’s Charter for Hospital Parking, published last year, continues to attract supporting organisations including NHS Trusts, suppliers and car park operators. The BPA believes in raising standards in the parking sector and delivering a professional service to motorists. Both NHS Trusts and car park operators recognise the importance of car parking policy in terms of the wider transport strategy and the need to manage traffic and parking in accordance with demand and environmental concerns. They also recognise the importance of professionalism in carrying out their services and the delivery of customer care. In particular, the delivery of safe car parking for hospital users is paramount. Over 50 organisations have now added their names to the list which is available to view on the BPA website www.britishparking.co.uk MEETING TO DEBATE PARKING The most recent BPA Healthcare Parking Special Interest Group meeting took place at Mid Staffordshire NHS Trust on 20 April. Kelvin Reynolds, BPA director of technical services, opened the meeting by leading a review of the BPA charter. Recommendations for updating and broadening the scope of the charter were made by meeting attendees and continue to be sought. We would welcome your feedback which should be sent to Dave Smith dave.s@britishparking.co.uk. Keith J. Sammonds of the Healthcare Facilities Consortium (HFC) then presented their recently launched ‘Healthcare Parking Good Practice Guide’ and discussed how this closely ties in with the BPA’s Charter for Hospital Parking. Keith explained how the guide is number 11 in the series originally funded by the UK Department of Health to support and develop good practice within the healthcare facilities environment. It has been developed with input from some

two dozen NHS organisations as well as the BPA, NHS Confederation, Which? and the industry, and covers all aspects of parking management for the wide range of healthcare premises from GP practices, through drop in and health centres to the largest of acute hospitals. The guide follows the patient journey from pre-attendance information, access and signage, alternatives to car usage, through charging and concessions, to payment methods and routing off the premises. It also looks forward with note of the need to include provision for electric vehicle charging points in any infrastructure schemes being planned. In line with the other ten guides, checklists are included to assist the premises or facilities manager to review current practice for minimum standards, development towards good practice and suggestions for better practice. The group then took part in an indepth discussion looking at the current benchmarking taking place in healthcare parking and discussed how this might be extended to provide those managing parking with useful reference material and the ability to measure their performance. GETTING THE RIGHT BALANCE A second discussion took place examining the ways in which healthcare sites can predict demand for parking. Methods of managing peak traffic flows were also discussed including how sites calculate the ratio of spaces provided for staff, patients, and visitors and whether they consider the current ratio is balanced. There was also discussion about the way forward for the group and the ongoing support NHS Trusts require to make managing their parking facilities easier and more efficient. The BPA will be implementing resources in conjunction with its NHS members over the coming year. The afternoon session focused on methods and legal issues involved in parking enforcement at healthcare sites. Hosts Mid Staffordshire NHS Trust provided an interesting case study, followed by a private car park operator view from Clare Wood of Vinci Park Services. Roxburghe, a debt collection agent, then provided an insight into the types of technology currently used in parking enforcement. Kelvin Reynolds returned to give an update on the parts of the ‘Protection of Freedoms

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Bill’ which is likely to have a significant impact on healthcare parking. The Bill, which was published by the Home Secretary Theresa May in February 2011, contains provisions to ban clamping and towing away on private land ‘without lawful authority.’ However, the Bill proposes the introduction of keeper liability in respect of ticketing, but only in certain circumstances. It proposes an exception for essential relocation of vehicles but effectively at no charge to the motorist. The police will be given new powers to remove vehicles from private land. The BPA is currently looking at the provisions contained within the Bill and is evaluating their effect on members, motorists, landowners and other stakeholders. The BPA is in close communication with the Home Office and the Department for Transport (DfT) and is examining the various assessments that they have undertaken to determine whether it is considered that they have sufficiently recognised the detrimental impact of the Bill. There was also discussion about the way forward for the group and the ongoing support NHS Trusts require to make managing their parking facilities easier and more efficient. The BPA will be implementing resources in conjunction with its NHS members over the coming year. The BPA will be looking at how to provide this information to its members and those involved in healthcare parking over the coming months. FUTURE DEBATES The next meeting of the Healthcare Parking Special Interest Group will be a joint event with the BPA’s Higher Education Parking Group on 2 June in Birmingham. Provision of disabled parking and gaining a better understanding of the requirements of disabled motorists will be a key agenda topic and Disabled Motoring UK (formerly Mobilise) will attend to give a presentation on behalf of their members. Carbon reduction targets will also be discussed and a presentation on provision of electric vehicle charging points and funding initiatives available for installation will also feature. For further details and to register your interest in this event please visit our website. L FOR MORE INFORMATION www.britishparking.co.uk

About the BPA As the recognised authority for parking and traffic management, the BPA represents, promotes and influences the best interests of those within this sector throughout the UK and Europe. In addition to this work, the BPA provides its members with a range of benefits all aimed at helping the professional in their day to day work.

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SECURITY & RISK TRAINING

Training

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SUPPORT FOR SECURITY PROVISION IN THE NHS

Investing in good quality security and risk training provides healthcare staff with the key skills needed to identify and respond to risks, argues Amy Burrell, training consultant at Perpetuity Training The current economic climate should prompt all sectors to focus on identifying existing and emerging security threats and re-evaluate their strategies to respond to these risks. Healthcare establishments – e.g. hospitals, doctors’ surgeries, and pharmacies – are no exception. In a time of budget cuts, it can be difficult to justify spend on seemingly non-essential work. However, as this article argues, investing time and money in assessing security and developing an effective security strategy is not only imperative but can also save money in the longer term.

of each threat occurring has to be weighed against the scale of the impact (see table). Our role as security professionals, or stakeholders in the healthcare system, is to (a) reduce the likelihood of the risk occurring, and/ or (b) reduce the impact if the risk does occur. For example, if the likelihood of a burglary of a pharmacy is ‘likely’ and the impact is ‘moderate’, the risk of the incident is scored as 12. If the pharmacy is secured with new locks and reinforced doors then burglary may become ‘unlikely’. Although in this case the impact does not change, the likelihood has fallen – halving the risk score to 6. It is important to remember that changes in circumstances can impact on risk assessment affecting likelihood and impact. For example, if funding for security officers is cut but the likelihood of violence remains stable, the potential impact will increase, as it is possible that more injuries will be incurred before the incident is stopped. Thus although likelihood is unchanged, the impact is much greater, increasing the risk score. The implications for accident and emergency (A&E) departments on weekend evenings are clear here. The security strategy is a key step in the process by which management’s expectations for security are translated into specific, measurable, and verifiable goals. In the absence of a security strategy specifying and communicating these expectations, staff will implement their own methods.

SECURITY RISKS Readers will be well aware of the array of risks healthcare professionals face. Suffice to say that traditional security threats to healthcare establishments typically encompass a range of crime types from violence to prescription fraud. It is clear that some traditional crime prevention techniques would not be appropriate in a healthcare environment – for example, access control measures in accident and emergency departments. Therefore, counter measures need to be able to tackle offences without compromising other priorities such as patient care and staff safety. Accurate recording of information on incidents is key to understanding the scale and nature of existing security problems, providing the first step in the problem solving process. This information can be used to inform risk assessments, and then to help form ideas about how to counter future security risks. RISK ASSESSMENT Risk assessment is central to the development of an effective security strategy. Healthcare providers face a range of threats and it is imperative that organisations consider how budget cuts could impact on the risk of crime occurring, as well as their ability to effectively deal with the problem. Once threats have been identified, the likelihood Likelihood

MANAGING RISK The risk management process is cyclical, as illustrated in the Figure. The risk assessment Impact

Insignificant

Minor

Moderate

Major

Catastrophic

Rare

1

2

3

4

5

Unlikely

2

4

6

8

10

Possible

3

6

9

12

15

Likely

4

8

12

16

20

Almost certain

5

10

15

20

25

feeds in at the evaluate risk stage, with the development and implementation of a security strategy feeding into the subsequent two steps. As with all strategies, these need to be reviewed to monitor whether the assets (i.e. what you want to protect) have changed, and whether there are any emerging threats or vulnerabilities. Risk can then be re-evaluated and the security strategy amended accordingly. Changing times signal an appropriate time to review the risks faced, to ensure that emerging risks are identified and suitable counter measures put in place. For example, the risk of property crime increases during a recession, and if budget cuts means that this is combined with reduced spending on physical security measures, it is easy to see how healthcare establishments could face increasing burglary problems. It would therefore be important to consider setting money aside to improve the physical security of vulnerable buildings. INVESTING IN TRAINING Security risk assessment can be a complex process, and there is a wide range of support and training on offer which can help healthcare professionals to implement risk assessments and develop security strategies. Key topics that can be useful include: • Identification of existing and emerging threats • How to measure and record incidents • How to weigh up likelihood and risk • What security measures are available and how and when to use them • Developing innovative methods to improve security • How to plan and implement a security strategy • Targeting spend on security in the most effective way • Communicating the strategy to staff, patients, and visitors Investing in good quality security and risk training provides staff with the key skills needed to identify and respond to risks. This will ensure risks are minimised reducing the likelihood, and potentially the impact, of crime. L FOR MORE INFORMATION 0116 2225550 training@perpetuitygroup.com www.perpetuitytraining.com

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AVAILABLE ON-DEMAND With budgets being slashed and resources stretched, agency staff can help fill the gaps to ensure continued and efficient patient care Despite the government’s promise to protect the NHS frontline and “cut the deficit, not the NHS”, the news headlines are still full of job cuts and stories of services being stretched as money is taken out of budgets. Indeed, a recent Royal College of Nursing (RCN) survey of 777 specialist nurses revealed that 62 per cent are seeing cutbacks in their specialty and 38 per cent are covering staff shortages outside their specialist area. Almost 80 per cent said financial pressures in their workplace have a negative impact on patient care and 11 per cent said they were facing redundancy. Dr Peter Carter, RCN chief executive and general secretary, said about the cutbacks: “Innovative nurse-led schemes, which not only improve patient care but also save money, are the future of the NHS. They provide high quality care and many of them could easily be rolled out across the health service, saving millions of pounds. In many instances, care can be best managed by community-based services, with as little hospital involvement as possible.” Against this backdrop, the ability to call on extra resource from agency and locum staff to fill gaps where necessary is crucial to frontline delivery of services. FILLING THE GAPS Temporary staff allow managers to cover for both planned and unplanned absences, such as filling in for permanent staff who are on holiday or away on maternity leave. Crucially, they can also be called upon at times when there is a peak in demand, say in A&E intakes or childbirths. Working with a specialist healthcare staffing agency to plan ahead where possible and fill these skills gaps as and when they are required is a cost effective solution as it relieves NHS Trusts of the financial burden of providing employee benefits such as pensions and holiday pay. This approach allows trusts to shape the workforce to match their exact needs at any one time. With budgets under huge pressure this is a priority for managers. Specialist healthcare staffing agencies should only take on people that go through a rigorous vetting process to ensure their qualifications and experience are authenticated. This means that managers can rest assured that the temporary staff they employ to cover busy periods are fully qualified and safety checked, freeing up NHS managers to plan their services more effectively. Temporary work is favoured by many healthcare professionals for a variety of reasons. Some may be older workers with a wealth of experience who want to scale

Innovative nurse-led schemes, which not only improve patient care but also save money, are the future of the NHS. They provide high quality care and many of them could easily be rolled out across the health service, saving millions of pounds. down the amount of hours they work. Or they could include established nurses who have chosen to work part-time or who want to get experience in another hospital. What they all have in common is they own invaluable skills and knowledge that are increasingly in demand by trusts. And they will be called upon ever more as managers strive to work through the challenges of the future. POUNDS IN THE HEADLINES The amount of money spent on temporary workers is often criticised in the news headlines as inevitably it costs more to use agency staff than contracted staff. But what is underestimated is the amount of work and administrative requirements that agencies must fulfill when placing staff, such

as the level of data checking and health screening that goes into taking on new recruits. Agency fees include the cost of all overheads such as recruiting fees, training fees, marketing and the cost of compliance checks. And while using an agency is more expensive, trusts can save money by not having to pay out costs associated with permanent staff such as sick pay. With the pressure to save money forcing managers to stretch resources, many trusts have no choice but to rely on agency staff to continue delivering patient care. In this respect, temporary staff should be seen as part of the solution, and not part of the problem. When managed well, agency staff contribute to the efficient and continual delivery of frontline patient services. L

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Translation & Interpreting

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COMMUNICATING WITH PATIENTS

THE RIGHT CHOICES IN MEDICAL TRANSLATION What problems can arise when communicating with patients who do not have English as a first language? Jan Cambridge & Shelley Nix, Institute of Translation & Interpreting members, explain When engaging interpreters, legal imperatives aside, consider the idea that there is no such thing as a routine conversation. The interpreter who is doing the job well is handling medical and vernacular language; idiomatic expressions and jargon; culturally laden references and non-verbal aspects of communication all within a few seconds. A COMPLEX ISSUE Untrained interpreters sound cheap; but when something sounds too good to be true, it is. There is a growing body of research that supports the use of nationally certified ITALS (Interpreting, Translation and Language Support) practitioners. Language is a very complex system and interpreting requires professionally relevant education and skills training along with in-depth knowledge of the subject area. It is dangerous to think that someone whose English is hard to understand has understood you, unless you know what they are saying in the other language. As with doctors, nurses and social workers, interpreters should be able to show they are accredited and registered by a professional body. Risk, endemic in medical consultations, is also present in interpreted ones. STANDARDS Professional structures exist for Public Service Interpreters/Interpreting (PSIs). An interpreter’s commitment to professionalism is evidenced by membership of them. Doctors and nurses base patient protection, their own and the institution’s reputations upon information obtained via bilinguals, many of which are of unknown provenance and competence unless clinicians themselves check their bona fides, say by checking the National Register of Public Service Interpreters (NRPSI) online. Fluency is not a guide unless you speak both the languages. Fluent may only mean being able to describe the route from here to the lavatory without pausing for breath. Nationally benchmarked and accredited exams for interpreters and translators do exist as do national occupational standards. So let us consider María Jesús Fulano Mengano, a recent immigrant who arrived

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HEALTH BUSINESS MAGAZINE Volume | 11.3

in the UK so terrified that for several days she didn’t know which country she was in. María Jesús worked as a senior hospital sister in the capital city. There was a coup d’état. The army took over. At that time she had coincidentally called a meeting of the staff on her unit to discuss government funding cuts. For many weeks she received threatening phone calls in the night; obscene graffiti were painted on her house. She was beaten and raped. She has fled to protect her family and does not know where or how they are. She is not feeling well (not unnaturally). She has never been able to tell any care professional what happened to her because there has been no interpreter who could deal with the language, situations or emotions involved. She is at A&E complaining of weight loss and insomnia. This is her first interpreterassisted conversation with anyone in authority after five months in the country (see box). This is a synthesis of various true stories. We can see several things happening here. Firstly the mediator (used here for an interpreter with some experience but no training) makes a perfectly proper intervention to establish meaning at point four. However he has cut off the word ‘también’ meaning ‘also’ or ‘as well’ because he interrupts to clarify the ‘yes’ response. That little ‘as well’ is not relayed to the doctor and is never returned to. The next five turns at talk are a parallel conversation between him and the patient, asking his own questions. He offers a brief summary of it at point eight, on the basis of his own perception of what ‘eating well’ includes. Any interpreting task is complex, involving listening for meaning, while not locking the doctor out and attending to the little words that ‘dangle’. All of which takes education, training and professionalism. WHAT ABOUT TRANSLATION? The following was overheard in a doctor’s surgery: “Mr. XXXX, do you speak English? Can you understand what I’m saying to you? If you can’t understand my instructions we will need to get a translator to help you.” Translator, interpreter, aren’t they the same thing? The short answer is no, despite suggestions to the contrary you might get from any TV or E

EXTRACT OF INTERVIEW WITH MARÍA JESÚS FULANO MENGANO 1. Doctor: Did you say you were eating alright? You’re eating well? 2. Mediator: ¿Estas comiendo bien, dices? You say you’re eating well? 3. Patient: Sí, también. Yes, I am as well. 4. Mediator: ¿Estás comiendo bien, cosas que te gustan o cosas que no te gustan? Are you eating well, things you like or things you don’t like? 5. Patient: Hombre, lo que no me guste no me lo como. Pero, suelo comer bastante o sea que lo que suelo hacerme. No sé, lo que encuentre que me guste yo puedo comer ¿no? Oh, if I don’t like it I won’t eat it. But, I usually eat enough, I mean I usually make myself... I don’t know, when I find something I like I can eat, you know? 6. Mediator: ¿Buenas cantidades? Good quantities? 7. Patient: Si, pero es eso lo que me extraña porque si fuera que no comiera o que comía solamente algo, pero es que lo que como, lo como en bastante cantidad porque tengo hambre. Yes, but that’s what’s strange because if I weren’t eating or if I only ate a little, but what I eat I eat in fairly big quantities because I’m hungry. 8. Mediator: That is what she’s surprised about. She eats really well, not what she doesn’t like but when she finds something she likes she eats in big quantities. 9. Doctor: Right, so maybe some changes in what you eat, from [the home country] is that right? Some big changes? 10. Mediator: ¿Quizá el cambio de alimentación puede afectar? Aquí se come otras cosas distintas, tú estas acostumbrada a vegetales, frutas...carne. Perhaps the change of food could be affecting you? The food is different here, you’re used to vegetables, fruit...meat 11. Patient: En parte me imagino, no sé, digo yo que pueda ser algo de eso, o sea…, la comida es bastante diferente, ¿no? Partly I suppose, I don’t know, I think it could be something to do with that, I mean the food is pretty different, isn’t it?


E radio broadcaster: “Mr. XXX, talking to us just now from the scene of the accident through his translator.” Translation and interpreting are two sides of the same coin; translation produces what is hopefully the equivalent effect in written form, and interpreting relays information and cultural input orally. Both are similar, but each vastly different in approach, technique, methods and skill sets. An interpreter is the channel through which often culturally loaded oral information is transmitted from one to one or more individuals, frequently in settings of extreme stress. A translator communicates or transfers this information via the written word. Let’s imagine a not-so-uncommon scenario: Mr and Mrs J Bloggs are on holiday in Spain. After a bit too much sun exposure, a rich meal and too much wine, Mr. Bloggs complains of chest pains, discomfort in his legs and a severe headache. He is taken to hospital, where he undergoes various tests and is kept overnight for observation. When he leaves, he is given his hospital discharge summary, the results of his laboratory tests, the ECG report and brain and abdominal CT scan reports – all in Spanish, of course. After returning to the UK, Mr. Bloggs needs to submit the reports to his GP and insurance company – in English, naturally. Mr Bloggs needs a translator, and

one specialising in medical translation. He may require further treatment and even a surgical procedure in the UK, but any future treatments and even the outcome of his condition will be dependent on the information provided by an accurate translation of his medical reports. FINDING A TRANSLATOR So, where does someone like Mr. Bloggs turn for help? Hopefully, not to the relative who did a gap year, worked as an au pair or taught English as a second language in Spain. Not to disparage any of those activities, but to emphasise that translation requires a great deal more than such experiences offer. Both UK professional bodies for translators and interpreters, the Institute of Translation & Interpreting (ITI – www.iti.org.uk) and the Chartered Institute of Linguists (CIoL – www. iol.org.uk), offer directories listing qualified translators in the medical/pharmaceutical and numerous other fields. In addition, the ITI Medical and Pharmaceutical Network provides a website where users can search by language for translators specialising in the medical and pharmaceutical fields (www.itimedical. co.uk). Only qualified ITI Members and Fellows of ITI (MITI, FITI) are listed on the website. Finding a qualified translator experienced in medical/pharmaceutical translation

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is essential for obtaining the potentially crucial information required by the patient’s doctor. The professional translator will be a member of the respective professional body, such as ITI or the CIoL. Membership of such an organisation indicates at the very least that the freelance translator or translation agency/company has met specific admissions criteria and committed to a Code of Professional Conduct. Expect to pay more when using the services of a qualified professional translator: years of experience in a specialised field, membership of a professional organisation, and taking advantage of training opportunities all go into the mix of a highly specialised, qualified translator whose rates should be commensurate with that experience. Obviously, in the current climate of belttightening and cuts, everyone is concerned about how, when and where to economise, but trying to save money by contracting the services of an unqualified translator for medical subject matter is risky business. Mistranslated patient notes or instructions can have devastating consequences regarding patient diagnosis, treatment and future care. This sort of false economy gives new meaning to the old adage of being ‘penny wise and pound foolish’. L

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NHS PROTECT

PREVENT AND DETER CRIME

Crime Prevention

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We all know that the NHS is changing but is the way in which we protect the NHS from crime fit for purpose? Martin Wiles, head of Policy and Standards at the recently launched NHS Protect, explains what makes the new service up to the challenge Since the introduction in 1999 of a small unit with a remit to reduce fraud in the NHS, the health service landscape has changed considerably, and will do so again. There is a clear need for a fresh approach to tackling crime against the NHS and one that adapts and responds to a changing working environment. There is a greater requirement to provide strategic and tactical guidance to those delivering NHS services and to the Department of Health (DH), and to satisfy the needs of an emerging NHS Commissioning Board. Generally, organisations like ours are faced with increased pressure to tackle more high-value and cross-regional issues, while making the most efficient use of resources and ensuring the best possible return on investment. FACING THE CHALLENGE One of our main challenges will be to position ourselves in the best possible place to deal with change, recognise any NHS fraud vulnerabilities and deal with them accordingly. We need to be able to identify any weaknesses in new systems, policies and procedures at an early stage to prevent crime. Meeting these challenges requires a centre

• we will centrally take forward complex and cros-boundary matters that cannot, or will not, be dealt with locally • we will prepare for the unthinkable through emergency and counter terrorism preparedness. LOCAL ACCOUNTABILITY There is now a clear emphasis on local accountability. This approach will enable us to concentrate on coordinating, regulating and maximising the benefit of localised investments made to tackle crime, as well as dealing with those complex and cross-boundary matters that cannot be dealt with locally. To protect the NHS using this new approach, we have adopted five high-level organisational aims. These are: Number one is to provide national leadership for all NHS anti-crime work by applying an approach that is strategic, coordinated, intelligence-led and evidence based. Second to work in partnership with the NHS, DH, NHS Commissioning Board and with our key stakeholders including the police, Crown Prosecution Service and local authorities to coordinate and deliver our work, to take action against criminals.

One of our main challenges will be to position ourselves in the best possible place to deal with change, recognise any NHS fraud vulnerabilities and deal with them accordingly. of excellence, which will support and protect front line services by performing essential tasks that cannot be undertaken by other bodies. So what is the approach? From April 2011: • we will lead on work to protect NHS staff and resources • we will aim to tackle crime in or against the health service • we will gather and develop intelligence using every source available to us, and utilise that intelligence to inform our actions • we will inform and involve NHS staff and the public on the impact of crime in the NHS and how they can do something about it • we will support the local investigators of theft, fraud, bribery or corruption against the NHS wherever it is found and help them to recover sums lost where we can • we will support the prevention and where necessary the prosecution of those who commit violence, abuse or criminal damage against NHS staff or property

Third aim is to lead investigations into serious, organised and/or complex financial risks and losses including fraud, bribery and corruption within a clear professional and ethical framework. Fourth, to establish a safe and secure physical environment that has systems and policies in place to protect NHS staff from violence, harassment and abuse; safeguard NHS property and assets from theft, misappropriation, or criminal damage; and protect resources from fraud, bribery and corruption. And lastly, to quality assure the delivery of anti-crime work with stakeholders to ensure the highest standard is consistently applied. SUPPORT & GUIDANCE We aim to provide increased levels of support, guidance and direction to the NHS through the improved management of information and delivery of criminal intelligence. Greater focus will be placed on targeting and coordinating this work effectively and reflecting wider

NHS PROTECT NHS Protect leads on a wide range of work to protect NHS staff and resources from crime. It has national responsibility for tackling: • bribery • corruption • counter terrorism • criminal damage • fraud • security breaches • theft • violence • other unlawful action The organisation’s work covers three main objectives: • to inform and involve those who work for or use the NHS about crime in the health service and how to tackle it • to prevent and deter crime in the NHS by removing opportunities for it to occur or to re-occur • to hold to account those who have committed crime against the NHS by detecting and prosecuting offenders and seeking redress where viable. NHS Protect also provides NHS anti-fraud services to the Welsh Assembly Government (under section 83 of the Government of Wales Act 2006) as well as leading on: • NHS emergency and counter terrorism preparedness • national data and risk analysis • anti-fraud and pro-security research. government initiatives where appropriate. It will help to ensure that the experiences and best practice of any part of the NHS are appropriately shared throughout the health service, so that wherever possible, crime is prevented. At a local level, the use of an evaluation model will allow assessment of the effectiveness of prevention activity and improved future proactive work. This sharper focus will ensure we are fit to meet the current and emerging challenges facing the NHS. NHS Protect’s ultimate aim is to ensure that funds get to front line services in order to treat patients. L FOR MORE INFORMATION www.nhsprotect.nhs.uk

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Advertisers Index

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ADVERTISERS INDEX

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23

ING Car Leasing

12

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19

Change Works Recycling

46

Jacob UK

26

Select Environmental Services

46

Charm Office Solutions

43

JJ Food Service

50

Sempermed

16

Comark Instruments

17

KAD Environmental Consultancy

26

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32

Kingston University

56

Singers Healthcare Finance

10

DDC Dolphin

18

Language Line Services

67

TM Resource

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Lavazza

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University of Bath

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Ecoblast Supplies

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Logic Manufacturing

26

University of London

54

Excel Parking Services

60

Lowell Group

12

University of Sheffield

8

Eyecote International

46

Midas Training Solutions

33

Variable Message Signs

Fenn Wright

12

Nimans

Fire Training International

36

Nursing Hygiene

Flexible Storage Solutions

44

OKI Printing Solutions

energyhelpline.com

30

P&G Professional

Henry Stewart Conference

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Park Crescent Conference Centre

56

Hosiden Besson

36

Philips

40

6

40, 42 48 4 20, 28

Village Hotels Volvo

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2 52 OBC

Western Power

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Whybrow Signing Consultants

38

Xpert HR

62

Zebra Technologies

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Health Business Magazine issue 11.3