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Protecting healthcare facilities from both common and not so common security threats

HEALTHCARE IT How can open source software benefit the NHS?

CLEANING – PAS 5748: Blueprint for cleanliness or yet more bureaucracy?





Protecting healthcare facilities from both common and not so common security threats

HEALTHCARE IT How can open source software benefit the NHS?

CLEANING – PAS 5748: Blueprint for cleanliness or yet more bureaucracy?



DEAR READER The revamped version of the controversial Health and Social Care Bill to reform the NHS recently passed the commons, clearing its third reading. Health secretary Andew Lansley said the principles of the modernisation plans – patient power, clinical leadership, and a focus on results – will both safeguard the future of the NHS, and move us closer to a health service that puts patients at the heart of everything it does. This proposal has so far spent longer being scrutinised than any Public Bill between 1997 and 2010 – 40 Committee sittings, and over 100 hours of debate. It will now continue the legislative process in the Lords and I guess time will tell whether the government’s ambitions will be realised. Here at Health Business our ambition is to bring healthcare professionals useful and relevant business information. In this issue this comes in the shape of the National Security Inspectorate describing how to get the balance right in protecting healthcare facilities (p. 13), the Association of Healthcare Cleaning Professionals explaining the new BSI specification for hospital cleanliness (p. 23), a look at how open source software can be effectively used within the health industry (p. 39), and much more. Enjoy the issue. Sofie Lidefjard, Editor

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: PUBLISHED BY PUBLIC SECTOR INFORMATION LIMITED

226 High Rd, Loughton, Essex IG10 1ET. Tel: 020 8532 0055 Fax: 020 8532 0066 Web: EDITOR Sofie Lidefjard ASSISTANT EDITOR Angela Pisanu PRODUCTION EDITOR Karl O’Sullivan PRODUCTION DESIGN Jacqueline Grist PRODUCTION CONTROL Julie White ADVERTISEMENT SALES Jasmina Zaveri, Beverley Sennett, Kim Fouracre, Amanda Frodsham, Neil Sharma, Ren Brannigan, Ian Taylor SALES ADMINISTRATION Jackie Carnochan, Martine Carnochan ADMINISTRATION Victoria Leftwich, Alicia Oates 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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CONTENTS 07 NEWS 11 INFECTION CONTROL The Infection Prevention Society has produced a tool that will help enhance the practice of staff working in the field of infection prevention and control

13 SECURITY The National Security Inspectorate describes how to get the balance right in protecting healthcare facilities from different kinds of security threats

18 FINANCE A major debate is going on in the health service over the topical issue of outsourcing

19 FACILITIES MANAGEMENT The sector definition continues to expand to include the management of an increasingly broad range of tangible assets, support services and people skills, says the British Institution of Facilities Management

23 CLEANING The new PAS 5748 provides a valuable additional set of tools to monitor and improve cleanliness and infection control, says the Association of Healthcare Cleaning Professionals

27 DESIGN & BUILD Planning has been approved for a new £7 million state of the art health centre in Knowsley, Merseyside



Taunton and Somerset NHS Foundation Trust has embarked on a pioneering project to reduce Musgrove Park Hospital’s energy consumption by more than 40 per cent

Professor David Haslam, chair of the National Obesity Forum, explains how the increased number of overweight and obese people will affect the NHS

30 FURNITURE Specialist manufacturers have been able to bring furniture collections to market that are designed to meet needs across all areas of hospital life

33 SIGNAGE The ISO 7010 standard helps ensure that safety signs communicate thier messages effectively

34 CONFLICT MANAGEMENT Risk assessments and training can help healthcare organisations ensure their staff are as safe as possible, writes Bob Beal, director, Institute of Conflict Management

36 MEDICAL TECHNOLOGY The Medical Technology Group examines the health of the Payment by Results (PbR) system

39 HEALTHCARE IT How can open source software be effectively used within the health industry? There are steps that can be taken to help NHS departments get more from their IT implementations, advises Information Builders’ John Backhouse

46 OPERATING EQUIPMENT As the incidences of traumatic injuries, cancers and cardiovascular disease continue to rise, the impact of surgical intervention on public health systems will grow, says the Association for Perioperative Practice

49 PARKING An increasing number of hospital premises are moving from traditional methods of parking management to more technologically advanced systems to enable these critical infrastructures to run more effectively

50 CONFERENCES & EVENTS A look at the green venues and conference packages offered under the Green Tourism Business Scheme

52 INDEPENDENT LIVING Naidex South is the disability, homecare and rehabilitation event for London and the South East enabling you to touch, test and compare products to aid independent living

53 PARAMEDIC TRAINING An educational cardiac DVD for ambulance staff can help save lives



FLU Nurses and midwives urged to get the seasonal flu vaccine Hospital nurses and midwives are among the health workers least likely to have the seasonal flu jab, according to new Department of Health data. The latest seasonal flu vaccine uptake reports show, for the first time, those healthcare workers by occupation who accepted the scientific advice and who chose to protect themselves against flu last winter. Uptake was revealed as 30 per cent of nurses, including hospital nurses and midwives; 42.5 per cent of GP practice nurses; 38.2 per cent of GPs; and 37 per cent of doctors excluding GPs. Chief medical officer Dame Sally Davies commented: “NHS staff face increased pressure over winter, especially if there is a severe flu season. They keep the NHS running and it is vital that they protect themselves, their patients and families from the potentially serious effects of flu that they are exposed to over the winter period.” TO READ MORE PLEASE VISIT...

New telephone system to help improve service Milton Keynes Hospital has gone live with a new telephone system to help callers get to the right person straight away. Callers to the main hospital number – 01908 660033 – are now put through to an automated service. With the latest in voice recognition technology, callers simply say the name of the ward, department or individual they would like to speak to and they are put straight through. Callers can also key in the extension number if they know it. Alec Benson, the hospital’s deputy director of facilities, said: “People call us for a huge variety of reasons, and we needed to find a system that works for everyone. “This way, callers who know who they want to speak to can use the system to get straight to the right person, freeing up operators to give the assistance other callers need.” Switchboard operators will continue to take calls, but will have more time to help with more complicated enquiries. Staff feedback has so far been positive.


Recognising excellence in the provision of NHS facilities There is still time to enter the Health Business Awards, an event that celebrates outstanding examples of best practice in healthcare organisations. Held 8 December, the Health Business Awards showcase success stories in the health sector. The event honours the significant contributions made each year by organisations

that work inside and alongside the NHS. There are 17 categories, including telehealth, sustainability, recruitment and procurement. Entry is simple and free for any NHS organisation or public sector body. Entrants must submit a 500-word entry statement online by Friday 14 October. For more information and to enter online please see



NEWS IN BRIEF Grand opening for stateof-the-art GP surgery A new era of healthcare has begun in South Normanton after the opening of a state-of-the-art GP surgery. Known as the Village Surgery, the facility will cater for over 9,000 patients from the South Normanton, Pinxton, Hilcote and Selston areas. It is to be housed in The Hub – the area’s flagship £8 million community building. Boasting six consulting rooms, three large nurse treatment rooms and a spacious reception, patients will benefit from modern couches, the latest in eye and ear diagnostic equipment, and access to a wide range of services housed within the surgery and The Hub community centre. TO READ MORE PLEASE VISIT...

Trust chief executive launches fortnightly blog Chelsea and Westminster Hospital Trust chief executive Heather Lawrence has published the first entry of her new blog. She says: “I hope my blog will offer an interesting insight into life at Chelsea and Westminster and I look forward to using it as a way of keeping staff, patients, members of the public, GPs and others regularly informed and receiving feedback.” TO READ MORE PLEASE VISIT...

Kitchen for carers opens at Ipswich Hospital A beach hut inspired carers’ kitchen has opened at Ipswich Hospital. The area is a comfortable place for carers to take a break or to wait while the people they care for are having scans or tests. The hospital worked with Suffolk Family Carers to provide the bright, welcoming space for carers to relax. There will be free tea and coffee and the chance to socialise with others. There will also be information leaflets for carers about support, issues and rights and volunteers will provide a listening ear and information. Initially, the kitchen will be open Mondays and Wednesdays from 1pm to 4pm but as volunteers come forward, the hours will be extended.






NHS London to drive up quality of adult nurse education and training NHS London has launched innovative plans to improve the quality of pre-registration training for adult nurses to deliver better care for patients. In agreement with NHS employers across the capital, NHS London is introducing new quality standards for the future training of nurses. Healthcare education providers will need to demonstrate how they will meet these standards as part of a competitive tender process. This will raise the quality of training for students by encouraging innovation and competition on quality and value between education providers, ultimately improving care for patients. Professor Trish MorrisThompson, chief nurse at NHS London and a practising midwife at Kingston Hospitals NHS Trust, said: “Our priority is patient care and safety.

Concerns have been raised by NHS directors of nursing about the differences in nurse training across London. We have to raise the quality of nurse education if we want to train and employ nurses of the highest calibre. “By setting new standards for nurse education, we can ensure that nurses in London have the skills and abilities needed to give patients better care. Improved training also means qualified nurses spend less time supporting students, giving them more time to care directly for patients. Health professionals in London are in full support of these improvements and are looking forward to the difference it could make to the quality of patient care.”


Annual review sees more lives saved and improved £5 off the price of each bag of blood, the highest number of organs donated and a major tenyear strategy for stem cells were just three of the achievements delivered by NHS Blood and Transplant (NHSBT) last year. Lynda Hamlyn, chief executive at NHS Blood and Transplant, said: “We are proud of the many successes we achieved in 2010/11. We rely on 1.4 million blood donors to support 52 million potential patients and on those who agree to

donate an organ or tissues or stem cells to help someone else, often a complete stranger. We are so grateful for the dedication of our donors who make it possible for us to save and improve patients’ lives.” The NHSBT annual review 201011 details delivery against four key objectives covering a broad range of activity which all help to save and improve patients’ lives. TO READ MORE...



Homerton leads the way in streamlining hospital discharges with new automated system Homerton Hospital, in the east London borough of Hackney, is leading the NHS in developing a new automated system for recording key information for patients requiring continuing care after hospital. The automated continuing care forms have been developed by the hospital’s discharge planning team as a way to make the whole process more user friendly for staff. Michele Stenning, acute discharge planning service lead, said: “The forms used nationally by the NHS consist of 80 pages of forms. Generally the high level of paperwork required caused apprehension and extra workload pressure for involved clinicians, particularly within the busy ward areas. “We developed an automated system on our computers and piloted its use on a shared folder with the RNRU, Mary Seacole Nursing Home and community health services, beginning the project in August last year. “The system allows for automatic copying of necessary – but repetitive – information throughout the form. It’s simple, user friendly and can be easily adapted for use by other important areas such as social services.” Michele Stenning continued: “At the beginning of the project it was first agreed for set up to be on individual PCs but as the project progressed further,



the trust’s information technology team was able to support the system within the hospital’s shared server. “This allows clinicians to undertake the written element of the submission from any PC within the trust. It also allows the discharge planning team and consultants to check the quality of the submission prior to the administrative process within their own working areas. “Throughout the development, clinicians

were able to trial and test the system and the project gained feedback from early users. This guided the applied fine tuning which consequently made the system in line with the clinician’s computer skills and workloads. “We are now rolling out the pilot across the whole hospital, followed by other London trusts, and are working with NHS London’s Joint Information Sharing Board to create a new paperless discharge system for the NHS,” Stenning concluded.

PATIENT INFORMATION Croydon Health Services NHS Trust website celebrates first birthday Croydon Health Services NHS Trust’s website is celebrating its first birthday this month. Since its launch more than 800,000 pages have been viewed and the site has had more than 140,000 visits. Contact details and how to find the trust’s hospitals and clinics are the most requested items, and information for patients and visitors is the most popular section. Over the past year the trust has developed an online patient information system and library, where patients and the public can quickly access information leaflets on a range of services, and launched a directory of consultants that details which consultant works in which speciality. Furthermore, a secure payment system has been put in place for those wishing to contribute or donate to charitable funds. The trust is also developing an interactive section TO READ MORE PLEASE VISIT... for consultations to gather the views of local people on both existing services and future plans.

DON’T LET YOUR PRIVATE DATA GO PUBLIC. The BlackBerry® Enterprise Solution is the only mobile data solution that’s approved by CESG to handle RESTRICTED data*. It not only gives healthcare professionals access to email, but also lets them view and update patient records at the point of care – ultimately allowing them to provide better care to more patients. All in the knowledge that any data they view or send is secure*.

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The only mobile data solution approved by CESG *Approved versions only, when configured and used in accordance with CESG Security Procedures. Security assured to IL3. Contact or visit for further information. ©2011 Research In Motion Limited. All rights reserved. BlackBerry®, RIM®, Research in Motion® and related trademarks, names and logos are the property of Research In Motion Limited and are registered and/or used in the U.S. and countries around the world. All other trademarks are the property of their respective owners.

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Infection Control


The Infection Prevention Society has produced a set of core competences designed to define and enhance the practice of staff working in the field of infection prevention and control Infection prevention and control is a key aspect of healthcare in the quality improvement and patient safety agendas. Media attention and public awareness of healthcare associated infections has led to a sea change in the perception and expectations of the professionals working in this field. Although traditionally infection prevention and control has been viewed as the responsibility of a small number of designated individuals based in the acute healthcare sector, this is no longer the case. Practitioners in this field now come from a wide range of professions and occupations, bringing skills and knowledge from their own spheres of practice. However, they still require key competences to enable them to practise safely and with clinical credibility in the infection prevention and control arena. CORE COMPETENCES The Infection Prevention Society (IPS) has produced a set of core competences designed to define and enhance the practice

Occupational Standards and the NHS Knowledge and Skills Framework (Skills for Health 2010; Department of Health 2004). The competences may be used in a variety of ways and by a range of professionals, from recently appointed infection prevention and control practitioners, through to managers of healthcare services, educational commissioners and providers as well as practitioners working at or near advanced level of practice. Organisations that are looking to develop staff with the expertise to drive forward the infection prevention and control agenda may also find this document a useful tool. SELF ASSESSMENT Practitioners can undertake a self assessment of their level of competence in any of the competences that relate to their work. This enables them to identify their personal learning needs and develop a strategy to meet them by planning learning and development activities within a defined timescale. The self assessment grid may also

Demonstrating competence in clinical practice is an important aspect of professional development in all fields of nursing practice. This framework provides a tool that enables practitioners to show that they have the skills and ability to practise safely and effectively leading to ever higher standards of care being delivered to patients. of staff working in the field of infection prevention and control. The competences were developed in partnership with all four UK governments, Skills for Health and the Council of Deans, through a national steering group chaired by the chief nursing officer for Scotland, Ros Moore. The competency framework is based on the four domains of: • Clinical practice (six competences) • Education (four competences) • Research (three competences) • Leadership and management (four competences) PROFESSIONAL DEVELOPMENT Each competence comprises a competence statement, and performance indicators aligned to each statement. They also contain generic and specific knowledge understanding and skills needed to meet the competence, and Alignment to Skills for Health, National

be used with managers to inform professional development planning. For example, agreeing on the evidence that would be acceptable to demonstrate competence in an area or discussing the availability of opportunities for particular professional development activities. Demonstrating competence in clinical practice is an important aspect of professional development in all fields of nursing practice. This framework provides a tool that enables practitioners to show that they have the skills and ability to practise safely and effectively leading to ever higher standards of care being delivered to patients. L FOR MORE INFORMATION The competency framework is available in both electronic form and hard copy in the Journal of Infection Prevention. Electronic access is free to all and can be located on the IPS website

Alternatively e-mail or phone 01506 811077.

New educational resource for Scottish care home staff Care home staff throughout Scotland are set to benefit from a free educational resource for prevention and control of infection. Developed by NHS Education for Scotland (NES) and Social Care and Social Work Improvement Scotland (SCSWIS), it comprises a comprehensive DVD learning programme and a CD of additional resources and links to other courses run by NES. The resource, Preventing Infection in Care • enables the consistent application of standard infection control procedures across the highly mobile workforce in the care home sector • helps care home providers meet their responsibility to ensure that staff employed in care homes have the appropriate skills and knowledge to prevent and control infection • is available to anyone providing care, whether care in the community or at home. A key requirement in the development of the reseouce was to address the educational needs of staff providing care in the community and care at home with the goal to deliver an equivalent programme of learning for Healthcare Associated Infection (HAI) to that available in the hospital environment. Commenting on the partnership effort, Malcolm Wright, chief executive, NHS Education for Scotland said: “This project is another example of how we are beginning to work closely with partners in the social care sector. It is our objective to provide integrated education to support models of care which are closer to people in their communities.” David Cumming, director of operations (programming, co-operation and registration) at SCSWIS, added: “We welcome this new educational programme as a practical resource for those working in care homes and the home environment. This important resource will increase their knowledge and skills in infection control with the aim of improving standards of care and support for those who use services.” Preventing Infection in Care was developed in conjunction with the Care Homes for Older People curriculum advisory group.







Chris Pinder, marketing manager of the National Security Inspectorate, describes how to get the balance right in protecting healthcare facilities from common and not so common security threats The recent riots in England illustrate the evolving and sometimes random nature of crime and the way in which organisations’ security practices have to be able to adapt to meet these challenges. Health facilities are certainly not immune from such events; City of London hospitals have experienced damage in anti-capitalism demonstrations and, in the latest incidents, there were reports of a Birmingham hospital being threatened by rioters. Healthcare sites reflect crime conditions in the community – even the most out-of-theordinary – and they have to plan accordingly. However, alongside these threats, they must also deal with specific types and patterns of crime linked to their unique role. NATURE OF THE ENVIRONMENT For example, healthcare facilities experience the same type of one-off thefts and burglaries

as other organisations. However, they are also at significant risk of insidious, ongoing theft of targeted items and equipment, which can result in very significant losses over time. One of the key issues here is the often transient nature of the populations moving through these premises – it is not practical or appropriate to be overly controlling in terms of access to public

areas. One survey has suggested that 80 per cent of thefts in hospitals take place in areas in which members of the public can legitimately be present. This makes the effective integration of security measures in these locations particularly important. Violence against staff is another significant threat for healthcare facilities. There were 56,718 assaults on NHS workers in 2009/10, E

Healthcare facilities experience the same type of one-off thefts and burglaries as other organisations. However, they are also at significant risk of insidious, ongoing theft of targeted items and equipment, which can result in very significant losses over time. Volume 11.8 | HEALTH BUSINESS MAGAZINE





equipment or medication. Alternatively, they can be linked electronically to a number of entrances, often with a computer interface to enable central programming. Large hospitals with complex requirements will need systems with easily adaptable security protocols that recognise staff seniority, areas of practice and likely hours of work. Flexibility is a priority, given that staff may frequently switch between different areas of an organisation. In a large hospital, there could quite easily be over 100 requests for access right changes every day. Systems can be programmed to undertake additional tasks, for example recording who was in a particular zone at a particular time or activating an alarm if the number of staff in a particular area falls below what has been laid down as a safe level. Non-security related features can also be incorporated, for example a time and attendance system. It is common for access control to be used in conjunction with CCTV. For example, on maternity wards visitors will often only be allowed access once their image has been viewed via a security camera. However, full integration of the two technologies is also available. For example, it is possible to set CCTV to start recording if there is an attempt at unauthorised entry. As such systems can link recordings to the access log, it is also easy to find desired footage.

It is important to avoid the public access ethos spreading to places where entry should be restricted to authorised individuals, for example storage areas, pharmacies and office blocks. E which is a 3 per cent increase on the previous period. Recent reports estimate the annual financial cost of violence as being over £60 million – made up of factors such as sickness absence, staff leaving the sector, litigation, conflict resolution training and additional policing. The situation is not surprising given an equation that includes visitors who are distressed, angry, disturbed, or under the influence of drugs or alcohol, but effective management is clearly needed to protect staff and enable them to do their job properly. The NHS strategy document A Professional Approach to Managing Security in the NHS cites this as a priority area for action. INCIDENT HOT SOPTS There will be locations that are particular hot spots in terms of violent incidents, for example A&E and mental health facilities. Others may be more prone to acquisitive crime, such as places where drugs and prescription forms are kept. Others still have specific vulnerabilities that have to be taken into account, even though the risks are low, for example

maternity units in relation to infant abduction. The complexity of the situation means that there has to be a holistic approach to security. On the one hand it should be based on a thorough risk assessment, a comprehensive security plan, appropriate procedures and buy-in from staff. On the other, it requires effective integration of appropriate equipment and security personnel. Every healthcare environment is different, and it is highly likely that a customised solution is going to be necessary, involving consideration of access control, CCTV, intruder alarms and security guards. ACCESS CONTROL It is important to avoid the public access ethos spreading to places where entry should be restricted to authorised individuals, for example storage areas, pharmacies and office blocks. Access control systems typically employ a code or a card. They can be standalone, for example to control access to a particular area containing valuable

CCTV CCTV cameras are used to provide surveillance of key areas within a site. Depending on specific requirements they can be monitored by on-site security staff or remotely via an alarm receiving centre or linked to a recording device to deter and provide evidence for later investigation of events. Cameras can roll continuously in real time, or be activated by access control or alarm equipment. The advent of digital camera technology and delivery of video via internet protocols has brought more competitive prices, a wider range of functionality and the ability of images to travel over much longer distances. Recent feedback from hospitals on the benefits of new CCTV installations includes their role in defusing difficult situations in A&E departments when staff point out that cameras are present. They also make staff feel more secure, particularly those on the front line, and including reception staff who are often the first point of contact. ALARMS In addition to protecting buildings when they are unoccupied, for example, a GP’s surgery or offices during the night, alarms are a valuable way of protecting isolated and high risk locations. They can be linked to a remote alarm receiving centre with priority access to the local police control room or to an in-house control room. Alarms can also be combined with panic button technology to enable a rapid response when someone is threatened. E



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Security teams are a key component of any strategy for protecting premises where there is large-scale public access. They not only deter crime, but also create a more reassuring environment for staff and visitors. E SECURITY PERSONNEL Security teams are a key component of any strategy for protecting premises where there is large-scale public access. They not only deter crime, but also create a more reassuring environment for staff and visitors. In addition, they play a key role in ensuring that security technology achieves its full potential, as there is little point having sophisticated and high-quality equipment in place if security personnel are not going to interact effectively with it, for example by monitoring CCTV and responding appropriately, investigating alarms, responding to panic button alerts, and making the right judgements when dealing with specific incidents. STAFF COMMITMENT Security procedures and technology will fall down if those working in the organisation do not apply them correctly and consistently. One important way of achieving buy-in from staff is ensuring that they feel their views and first-hand knowledge of working in specific environments have been taken into account. Those on the front line are often better placed than managers to identify

where improvements are needed, and reputable security suppliers will welcome this type of involvement at the survey stage of designing installations and services. They will also ensure that staff receive appropriate levels of product-based training so that they can use equipment properly. COST VERSUS QUALITY Keeping costs down is a constant pressure for organisations, and never more so than in the current economic climate. This focus is also evidenced by increased use of e-auctions within the public sector, extending their application from relatively simple products to complex services such as security. It needs to be borne in mind that overemphasis on low price rather than best value (in terms of fitness for purpose, quality and reliability) can bring significant risks ranging from major preventable incidents leading to serious loss and injury (and the potential for legal action and reputation damage); to the type of cumulative losses arising from inadequate security; to having to deal with the fall-out from employing a sub-standard security supplier, in terms of the time and



money required to rectify the situation. A variety of different approaches can be taken to support cost-efficiency without compromising security, for example, maximising the effective integration of security personnel with technology; weighing up how and where monitoring is going to take place; avoiding overspecification; and selecting equipment that can easily be upgraded at a later date with a software change if required. SOUND ADVICE Healthcare facilities need to be sure that suppliers are really capable of giving good advice, delivering quality solutions in line with the organisation’s needs and providing ongoing support. Independent certification by a United Kingdom Accreditation Service (UKAS) approved inspectorate is evidence that the supplier meets standards recognised by the industry and other interested parties such as the police. For example, NSI approved suppliers meet all relevant British and European standards, security screen all relevant staff, provide a high level of staff training and supervision, are comprehensively insured and are inspected every six months by professional auditors. Healthcare security is undoubtedly complex, but a systematic, integrated approach is key to success as is taking professional advice from reputable suppliers who will be just as keen as their client to make security goals a reality. L FOR MORE INFORMATION Tel: 01628 637512






Written by David Martin, general manager, Siemens Financial Services Ltd UK

THE GREAT DEBATE NHS trusts across the country may wish to separate capital equipment acquisition from service outsourcing in order to retain greater transparency of costs associated with outsourcing

Outsource companies do not necessarily have deep capital pockets. They may turn to financiers to help them acquire the equipment needed to fulfil their duties – financiers who themselves will, naturally, charge a margin. So now the NHS trust may potentially pay two profit margins. A major debate is going on in the British National Health Service over the topical issue of outsourcing. Some believe that outsourcing is the single most significant answer to the current financial challenges faced by the NHS. Others believe it would be a sure path to substandard service, destroying the essential founding vision of Aneurin Bevin. These two polarities describe the essential positions of protagonists in the NHS outsourcing argument. BUDGET PRESSURE Certainly, there is financial pressure on the NHS, despite budget protection compared to other government departments. NHS spending as a whole has been ring-fenced, yet this masks the reality that NHS financial managers are having to contend with; £1 billion of the overall budget has been reallocated to social care and over £20 billion of efficiency savings have to be achieved by the middle of the decade. Capital spending is to fall by 17 per cent in the next four years (from £5.1 billion in 2010/11 to £4.4 billion in 2014/15), and even these statistics will only be adhered to if the NHS can deliver huge increases in productivity: four per cent every year until 2015. Overall budget pressure (despite ring-



fencing), along with a particular pressure on capital spending is evident, but why should it be of particular importance? After all, capital equipment investment represents a mere 20th of health spending the NHS. Many studies have, however, shown that access to the most up-to-date healthcare technology often has a disproportionately large and positive impact on the ability to deliver better health outcomes and operating efficiencies. In other words, a relatively small investment in technology can have a large effect on radically improving the cost, efficiency and effectiveness of diagnosis and treatment. As such, the contribution made by technology to those operational efficiencies which the NHS is charged to find, is crucial. MRI SCANS In one example MRI scans can now be completed in a quarter of the time they formerly took, thanks to technological advances achieved since the millennium, according to Siemens’ studies. The scans are also clearer and more accurate. The National Audit Office has pointed out that the number of diagnostic scans carried out on NHS patients using MRI and CT

machines has tripled in the last ten years. In parallel, the number of radiotherapy treatment sessions has increased 2.5 times over the same period. A focus on reducing waiting times and an increasing clinical application of the technologies have largely contributed to their growing demand. THE COSTS The argument for outsourcing is thus put in place: capital budgets are under pressure; trusts want to free capital and devote it to front line services; up-to-date technology plays a very significant part in achieving mandatory efficiencies and improvements; so why not shift both the capital expenditure and the service delivery onto a private sector third party? The response to this argument, however, is “don’t forget about the overall cost”. Private sector organisations do not take on outsource contracts for the public sector without the ability to earn a suitable margin. It is their duty to shareholders to deliver not just revenue, but also earnings. In fact, a little further thought shows that in some respects, a knee-jerk move to wholesale outsourcing may involve several layers of profit margin. Outsource companies do not necessarily have deep capital pockets. They may turn to financiers to help them acquire the equipment needed to fulfil their duties – financiers who themselves will, naturally, charge a margin. So now the NHS trust may potentially pay two profit margins. SPECIALIST SERVICES Of course, the argument for outsourcing certain facilities to the private sector can be strong, in that such organisations are able to deliver economies of scale plus efficiencies of operation that individual trusts would find it difficult or impossible to achieve. This idea of outsourcing specialist services is after all hardwired into the system: the NHS Supply Chain is run by DHL and the Department of Health half-owns NHS Shared Business Services. We are seeing the rise of Diagnosis and Treatment Centres (DTCs) provided by the private sector – an important point in this is the outsourcing of clinical services, not just ancillary blue-collar work. In conclusion then, it is the suggestion of this article, that where outsourcing deals take place, it may be wise for NHS trusts to retain the financing relationships for capital equipment acquisition themselves. In other words, the NHS trust leases the required equipment directly, and the outsourcing company is engaged to concentrate on providing the service. In this way, the trust retains more transparency on the costs involved with its outsource relationships. Outsourcing in the NHS is a trend that appears to be irreversible. However, transparent management of outsourcing relationships is crucial to ensure that they deliver promised efficiencies without a drop in the quality of service to the public. L



Facilities Management


Effective facilities management, combining resources and activities, is vital to the success of any organisation, says the British Institute of Facilities Management “Facilities management is the integration of processes within an organisation to maintain and develop the agreed services which support and improve the effectiveness of its primary activities.” This is the definition of FM provided by CEN, the European Committee for Standardisation and ratified by BSI. Facilities management professionals are responsible for services that support business. Their roles can cover management of a wide range of areas including health and safety, risk management, business continuity, procurement, sustainability, space planning, energy, property and asset management. They are typically responsible for activities such as catering, cleaning, building maintenance, environmental services, security and reception. Facilities management encompasses multi-disciplinary activities within the built environment and the management of their impact upon people and the workplace. THE EVOLUTION OF FM Some key points in the development of facilities management include the cost-cutting initiatives of the 1970s and 1980s under which organisations began to outsource ‘non-core’ services, and also the integration of planning and management of a wide range of services both ‘hard’ (e.g. building fabric) and ‘soft’ (e.g. catering, cleaning, security, mailroom, and health and safety) to achieve better quality and economies of scale. The formation of the British Institute of Facilities Management (BIFM) in 1993, was followed by the development of specialised training and a qualification was also a key point, along with step-change with the Private Finance Initiative (now Public Private Partnerships) becoming an integral part of large-scale projects to manage, replace, and upgrade the country’s infrastructure and public service facilities. This new approach was swiftly followed in the private sector and abroad. EFFECTIVE FM Effective facilities management, combining resources and activities, is vital to the success of any organisation. At a corporate level, it contributes to the delivery of strategic and operational objectives. On a day-to day level, effective facilities management provides a safe and efficient working environment, which is essential to the performance of any business – whatever its size and scope. Within this fast growing professional discipline, facilities managers have extensive responsibilities for providing, maintaining and developing myriad

services. These range from property strategy, space management and communications infrastructure to building maintenance, administration and contract management. Excellent facilities management can, amongst other things: • deliver effective management of an organisation’s assets • enhance the skills of people within the FM sector and provide identifiable and meaningful career options • enable new working styles and processes – vital in this technology-driven age • enhance and project an organisation’s identity and image • help the integration processes associated with change, post-merger or acquisition • deliver business continuity and workforce protection in an era of heightened security threats.

The NHS must achieve up to £20 billion of efficiency savings by 2015, and facilities managers have a substantial role in this target. Strategic Health Authorities (SHA) have been developing integrated QIPP plans that address the quality and productivity challenge. One of these tools is the new ‘Premises Assurances Model’ (PAM). This toolkit has been developed to give trusts a method to provide assurance that space, activity, income and operational costs of the premises meet the requirements of the efficiency programme in the delivery of improved clinical and social outcomes. Efficient use of space is a key priority for successful FM. PAM means looking at the space within buildings, and ensuring that every inch is used in the most cost-effective way to meet the business needs. If the estate is old, delivering effective healthcare is a challenge, especially converting space in older buildings.

The facilities management profession has come of age. Its practitioners require skill and knowledge. The sector definition continues to expand to include the management of an increasingly broad range of tangible assets, support services and people skills. Successful organisations should will approach FM as an integral part of their strategic plan. Those organisations that treat FM as a ‘commodity overhead’ will be at a significant strategic disadvantage. FACILITIES MANAGEMENT TODAY The FM sector is now large and complex, comprising a mix of in-house departments, specialist contractors, large multi-service companies, and consortia delivering the full range of design, build, finance and management. Estimates vary; market research suggests that in the UK alone, the sector is worth between £40bn and £95bn per annum. The facilities management profession has come of age. Its practitioners require skill and knowledge. The sector definition continues to expand to include the management of an increasingly broad range of tangible assets, support services and people skills. FM AND THE NHS The driver for all NHS facilities managers is to meet the government’s Quality, Innovation, Productivity and Prevention (QIPP) initiative.

South London Healthcare NHS Trust has been one of the trusts trialling the beta-test version of the Premises Assurance Model (PAM) for NHS London, and has been piloting new methods of working to maximise the efficient use of space. Depending on the outcome of the trial, PAM could possibly be rolled out nationwide. Here Carolyn Lewis, head of estates performance and governance at the South London Healthcare NHS Trust gives us her take on effective space utilisation. TOP TIPS ON SPACE UTILISATION Trust-wide engagement, working from the top down is critical. Senior managers must be on board. They can set an example of hot-desking for others to follow. Many senior managers can spend more than 50 per cent of their time in meetings if they can give up their offices and share space this sets a great example to everyone else to follow. Clear communication to ensure that everyone feels part of the process. HR can be used to engage all employees. Staff forums should be set up where they can have their say and feedback on big changes E



Facilities Management


INTEGRATED SERVICES E to the workplace. There will have to be compromises from both parties, but the sooner and deeper the engagement the better. Confidentiality – in an open plan office employees discussing patients can be a breach of confidence. There is always a need for break-out spaces for private discussions, such as personal medical matters and there will always be a need for secure space for important records. Make it easy for employees when having to share space. Rather than having multiple systems try and keep it simple, such as room booking via an open access online facility. FINANCE Finance in the NHS is a big concern. Changing the way space is utilised needs an initial financial outlay. For example hot desking requires the right desks, chairs, computers, different terminals and the right telephone system. Budget holders are likely to be sceptical on such items but it is essential that that the right equipment and environment is created to maximise the efficiencies. Some office suppliers will let you try new furniture etc. for free to help you evaluate whether to purchase or not. This improves staff engagement provides essential feedback. It also provides the opportunity to see how the solution will fit the workplace. The supplier also gains a showcase of their products. The NHS has huge ground to make up in utilising space and it is well behind other sectors. In the current climate there is no room for error, the NHS cannot afford to the luxury of “getting it wrong” and must learn from others FM solutions – and mistakes. CASE STUDY – LOST IN SPACE? Take a walk around your estate. How many clinical or therapy rooms are unused at the moment? How many staff work spaces are unused? How many look like they’ve been unused all day? For how much of an average week is your own work space unoccupied?

These were the questions Andrew Lawley, head of estates and facilities at Sandwell Primary Care Trust, was asking himself not too long ago. His perception was of poor utilisation levels yet he continually had to deal with internal customers demanding still more space. Knowing that any additional space, acquired at great expense and effort, would be similarly underused Andrew searched for an alternative way. 18 months later the PCT’s headquarters building in the West Midlands accommodated 25 per cent more staff in the same space but with 10 per cent fewer desks. Apart from meeting rooms, the workplace had previously been wall-to-wall desks save for a small, low quality, staff room. The refurbished workplace returned unused desk space back to staff in the form of high quality break-out areas, quiet rooms and touchdown spaces. The result is an open, spacious look and feel. As a direct result of the increased building capacity achieved through a fully deskshared environment, the PCT has been able to achieve considerable cost savings by terminating a number of building leases. These aren’t what you would consider mobile employees. Andrew Lawley points out: “These space economies were achieved for HQ staff, employed in what you would consider to be desk-based roles – and in an environment where home working is not encouraged.” WORKPLACE UTILISATION STUDY The PCT partnered with workplace consultants, Plan B Solutions Ltd. It was Plan B’s workplace utilisation study that provided the evidence for Andrew Lawley’s perception of poor workplace utilisation. Moreover, the study confirmed the extent and areas of poor utilisation, the exact scale of the opportunity for working differently and provided the undeniable evidence for change to supporters and doubters alike. “There’s nothing unusual about Sandwell PCT’s levels of utilisation” says David Grant

of Plan B Solutions. “We’ve undertaken something approaching half a million utilisation study measurements finding that, even during core working hours, work space utilisation rates average only 50-55 per cent.” Of course, things have changed for the PCT over the last 12 months since the Department of Health’s white paper. Since the headquarters is now a proactively managed workplace – through the use of Gingco, Net New Media’s workplace booking and utilisation tracking system – the PCT has real-time visibility of the building’s head room and is now engaged with a number of agencies in the region to bring multiple services together under one roof. INCREASED PRODUCTIVITY It’s a very productive roof too. The staff benchmarking work which Plan B Solutions undertook with the PCT, examined workplace satisfaction and productivity levels. David Grant says: “The most satisfying result of this project wasn’t actually the 25 per cent reduction in property requirements but the substantial swing in workplace satisfaction levels of staff, and in the significant improvement in productivity indicators achieved at the same time.” It’s interesting to observe the impact that a project of this kind has on carbon reduction. By seeking leading solutions in facilities management an organisation can remove 25 per cent of its property requirements in one fell swoop – and forever. Suddenly, changing a boiler seems a little trivial. The partnership between Sandwell PCT and Plan B Solutions Ltd was recognised at the end of last year when the project won two national awards including the British Institute of Facilities Management’s (BIFM), Impact on Organisation and Workplace 2010 award. L FOR MORE INFORMATION Tel: 0845 0581356

Is your vital information adequately protected? Records management is about more than storing records. It’s about giving clients prompt access and reducing the risk of misplacing critical business information. Crown Records Management protects your files and delivers them as needed, so you can free-up valuable time and space. We specialise in helping our healthcare clients refine their records management policies, enhance their compliance programmes and choose the individual services required to meet their specific needs. Crown Records Management specialises in information management, including the storage of cartons, files, documents, magnetic and digital media, secure and confidential



waste destruction and scanning, imaging and data storage. Whether you require assistance with consultancy and storage solutions, online data hosting or secure destruction, your organisational records

and customised reports will be at your fingertips, so you will always have the information that you’re looking for. Through customised solutions and prompt service, Crown Records Management guides clients every step of the way, helping them choose the best solution to suit the needs of their organisation. Contact us to find out more about how we can help with your information management requirements. FOR MORE INFORMATION Tel: 08457 212177



COMBAT THE SPREAD OF BACTERIA WITH THE DYSON ™ AIRBLADE HAND DRYER A cost efficient, hygienic, environmentally friendly hand dryer for the NHS


The Dyson Airblade™ hand dryer is used by NHS organisations to help combat the spread of bacteria and viruses through effective hand drying, while reducing NHS carbon emissions and driving down running costs. At a time of constrained NHS budgets and difficult spending decisions, the Dyson Airblade™ hand dryer can help reduce NHS running costs and ensure budgets are focused where they belong – on front line services. Based on the restocking price of paper towels alone, the Dyson Airblade™ hand dryer costs 97 per cent less to run per year than paper towels – £78 per year, compared to £2,920 per year. Consequently, if every NHS worker in the UK used a Dyson Airblade™ hand dryer instead of paper towels only once every day, the annual cost saving would pay the salaries of 338 qualified nurses. The Dyson Airblade™ hand dryer is the fastest, most hygienic hand dryer. Conventional warm air dryers take up to 43 seconds to dry hands properly. The Dyson Airblade™ hand dryer takes just ten seconds. It’s as hygienic as paper towels, without the associated drawbacks of high running costs and paper waste. It uses up to 80 per cent less energy than warm air hand dryers and it’s designed and engineered in Britain. HYGIENIC Damp hands can spread up to 1,000 times more bacteria than dry hands. A recent report published in the Journal of Applied Microbiology found that the Dyson Airblade™ hand dryer dries hands effectively, reducing the transfer of bacteria from hands by up to 40 per cent compared to warm air hand dryers tested. Effective hand hygiene routines, with effective hand washing and drying, are essential in

helping prevent the spread of infection in hospitals. The Dyson Airblade™ hand dryer is the most hygienic hand dryer currently available, as hygienic as paper towels to dry your hands, but without the potential for other hygiene hazards such as overflowing bins full of used paper towels. It also never needs restocking. The Dyson Airblade™ hand dryer uses a HEPA filter to filter contaminated air before use; removing 99.9 per cent of bacteria in the air used to dry hands. And an anti-microbial coating kills up to 99.9 per cent of bacteria, including MRSA, MSSA and E.coli. The Dyson Airblade™ hand dryer is also touch-free. The Dyson Airblade™ hand dryer is the only hand dryer certified as hygienic by the independent public health specialists NSF International. No other hand dryer meets every part of the NSF Protocol P335. A study by the Bradford Infection Group, reported in the Journal of Applied Microbiology, found the Dyson Airblade™ hand dryer was the most hygienic of the hand dryers tested – significantly reducing bacteria transfer via hands. ENVIRONMENTALLY FRIENDLY The Dyson Airblade™ hand dryer has a low environmental impact compared to paper towels (3.29g CO2e per dry compared to 12.48g for paper towels). Used paper towels aren’t usually recycled. A total of one billion towels would go into waste every year if every NHS worker dried their hands just once a day using only two paper towels. The Dyson Airblade™ hand dryer also uses up to 80 per cent less energy than warm air hand dryers and has much lower carbon emissions than paper towels. If all NHS employees would dry their hands just once a day with the Airblade™ hand dryer rather than paper towels, this

“We asked for a Dyson Airblade™ hand dryer demonstration. Straight away we saw that it would be ideal in a sterile environment like our hospital. They’re used by everyone – nurses, doctors, patients and their families. Because it works automatically, the risk of spreading infection is greatly reduced – ideal in a modern hospital,” said Stephanie Owen, first impressions manager, The Royal Liverpool University Hospital. “Each Dyson Airblade™ hand dryer represents a saving on waste costs. In addition, public toilet areas are no longer cluttered with paper towels,“ commented Gary Burkill, head of facilities, The Royal Marsden NHS Foundation Trust. “We chose the Dyson Airblade™ hand dryer because it provides an environmentally-friendly, cost-efficient and hygienic means of drying hands. It has proved to be just that, especially when compared with traditional hand drying methods,“ explained Keith Garner, energy manager, Carillion Health.

would reduce annual NHS carbon dioxide emissions by around 4,800 tonnes a year. PROVEN TO WORK Leading NHS hospitals have already recognised the running cost, environmental and hygienic benefits of the Dyson Airblade™ hand dryer. It has a proven track record of delivery in institutions such as the University College London Hospitals, The Royal Marsden, Leicester Royal Infirmary NHS Trust and the Royal Liverpool and Broadgreen University Hospitals. “We asked for a Dyson Airblade™ hand dryer demonstration. Straight away we saw that it would be ideal in a sterile environment like our hospital. They’re used by everyone – nurses, doctors, patients and their families. Because it works automatically, the risk of spreading infection is greatly reduced – ideal in a modern hospital,” said Stephanie Owen, first impressions manager, The Royal Liverpool University Hospital. L FOR MORE INFORMATION



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COMMITTING TO A HIGHER STANDARD Is the new PAS 5748 a blueprint for cleanliness or yet more bureaucracy? It’s a simple and effective code, says Denise Foster, national chair, Association of Healthcare Cleaning Professionals The launch of PAS 5748, the new British Standards Institution (BSI) specification for hospital cleanliness has been broadly welcomed both within the healthcare cleaning and infection control professions and by patients and the public. Sponsored by the Department of Health (DH) and the National Patient Safety Agency (NPSA) the specification has been jointly developed by a range of key organisations in the field including the British Institute of Cleaning Science (BICSc), the Health Estates and Facilities Management Association (HeFMA), the Infection Prevention Society (IPS) and the Association of Healthcare Cleaning Professionals (AHCP). ENSURING A CLEAN ENVIRONMENT A Publically Available Specification or PAS for short, is a collaboratively developed, BSI endorsed specification intended to create management systems, product benchmarks and codes of practice within a specific sector. Developed for use within acute, community and mental health hospitals

across the NHS in England, PAS 5748 is intended to provide assurance to the public that risks associated with hospital cleanliness have been fully assessed and that nationally agreed procedures are in place to ensure hospitals are clean and safe. PAS 5748 aims to achieve these objectives by providing a risk-based system for the planning, application and measurement of cleanliness to ensure that healthcare organisations are able to provide a clean and safe environment for patients, staff and visitors. By introducing a risk assessment approach, PAS 5748 differs from the National Specifications for Cleanliness in the NHS (NSC), the existing ‘gold standard’ of healthcare cleaning. It



is not, however, intended to replace the guidance given within the NSC but, rather, to exist alongside and supplement it. The NSC was developed to define and standardise the healthcare cleaning process and specify the procedures and protocols that should be deployed in all healthcare premises. Published by the DH in 2007, the current NSC was the culmination of the process to define and standardise healthcare cleaning processes, which started a decade ago with the publication of the first National Standards of Cleanliness in 2001 and the first edition of the Healthcare Cleaning Manual in 2003. ASSESSING RISKS Many key features of the NSC, such as the requirement to put structured cleaning plans in place, to analyse performance and report on outcomes, have been incorporated into PAS 5748. However, in a number of important areas PAS 5748 moves into new territory. The first important extension is the use of risk assessment as a tool for monitoring cleanliness. PAS 5748 specifies requirements for assessing the risk of a lack of cleanliness on healthcare acquired infections (HCAIs) and on public, patient and staff confidence. In doing this it aims to take the process E

The NSC was developed to define and standardise the healthcare cleaning process and specify the procedures and protocols that should be deployed in all healthcare premises.





BEST PRACTICE E of embedding a cleanliness culture in our hospitals a step further. It places outcomes – or rather the risk of bad outcomes as seen both by cleaning and infection prevention professionals and by patients, the public and other health staffm – centre stage. The second innovation is that PAS 5748 places responsibility and governance at the highest level within any organisation using it. The intention is for PAS 5748 to be endorsed at board level and implemented by organisation directors whose responsibilities should include the provision of clean safe environments for healthcare. The third important addition is the introduction of visual inspection as a key element of the measurement of cleanliness. POSITIVE EFFECTS AHCP believes all these are valuable additions to the cleaning and infection control process and will have a positive effect on driving up standards of cleanliness. The use of visual inspection has been seen by some as a move away from the use of a science based approach to the measurement of cleanliness in hospitals. However, this is a misunderstanding of the objectives of the PAS. The new specification does not propose abandoning scientific methods of evaluating cleanliness but seeks to build in the additional layer of public, patient and staff observation. In doing this PAS 5748 responds directly to the concerns expressed widely by patients and the public over many years. ADDITIONAL STANDARDS While PAS 5748 has been broadly welcomed questions have been raised about the introduction of an additional set of standards and the bureaucracy that often goes with this, particularly given the challenging economic situation the NHS and the economy as a whole are in at the present time. In this respect it is important to note that use of PAS 5748 is not mandatory and organisations will be free to choose whether they wish to adopt it. The Care Quality Commission (CQC), the body responsible for monitoring compliance, has indicated it will expect healthcare providers to show they have taken note of it as part of their evidence of compliance with the requirements set out in the Health and Social Care Act covering the prevention and control of infections. But CQC has also stated that providers will be able to demonstrate that they meet the requirements on cleanliness and infection control in different ways from that described in PAS 5748, equivalent to or better than the PAS standard. This means that where hospitals and other providers have robust documentation and evidence as to their compliance with standards already in place they will not need to create yet further documents for PAS 5748. However, for organisations that have few or no systems



in place, PAS 5748 will be very useful as it provides clear and concise guidance. NURSING AND CARE HOMES This could be of particular relevance to nursing and care homes, organisations not included in the original remit for PAS 5748. The personal care provider sector is new to Care Quality Commission registration. As a result organisations are much less likely to have systems and may not be used to having to provide information. PAS 5748 provides an opportunity for them to adopt a system which is relatively simple to follow to ensure that evidence of compliance is available. The PAS document notes that it has been developed to enable future revisions to accommodate other types of healthcare

It would, however, also be fair to say that the majority of trusts are probably not meeting the recommended frequencies for cleaning, as specified in the NSC due to funding and operational issues. PAS 5748 can actually assist in demonstrating the decision making processes around these challenges if the risk assessment component is used effectively in operational settings. It even provides a free downloadable set of tools for this and other processes. UPTAKE Initial feedback from AHCP members appears to indicate that uptake of PAS 5748 will not be as widespread as its creators, including the AHCP, might have hoped for. If this is the case it will be because current resources

The new specification does not propose abandoning scientific methods of evaluating cleanliness but seeks to build in the additional layer of public, patient and staff observation. facilities. AHCP does not agree with some of the critics, that the exclusion of care and nursing homes weakens the specification. If PAS 5748 proves to be a useful tool to other sectors they should be free to adopt it and future revisions of the standard should reflect the specific needs of these users. IMPLEMENTING THE SYSTEM While it is AHCP’s view that PAS 5748 need not result in increases in bureaucracy, it is clear that it will create more work during the implementation phase. This would of course be true for any new system or a review of existing systems. NHS hospital trusts up and down the country are now embarking on a review of both the PAS and the NSC to produce a gap analysis that will then enable them to decide on the best way forward. It is how this gap analysis is used that will determine the effectiveness of PAS 5748. One of the key factors trusts will be taking account of is the time and effort that will be required to introduce PAS 5748 and to ensure staff are fully aware of what it entails. Many in the NHS will feel that this time and effort could possibly be better utilised to improve current standards. However, given the current financial climate, the usefulness of PAS 5748 as a public assurance tool needs to be weighted against this. MEASURING CLEANLINESS Another area that AHCP anticipates will prove challenging in the current financial climate will be the measurement of cleanliness. Many organisations will not have the resources to carry out weekly audits in all of the high risk categories, especially so if the trust is spread over a large geographical area.

do not permit it. However, in AHCP’s view it would not be right to postpone the introduction of PAS 5748 and take away the possibility of getting the improvements in cleanliness and infection control it offers because of the current financial situation. Having taken a key role in the consultation and development process, AHCP is fully committed to PAS 5748 and welcomes its introduction as a further step to improving cleanliness standards. The association will support organisations implementing it by gathering feedback, sharing information and participating in reviews. We will also be participating in the review process to ensure any problems which come to light in the future are ironed out. Is PAS 5748 a blueprint for cleanliness or yet more bureaucracy? I hope I have shown that it is very much the former. For organisations new to the regulated cleanliness environment PAS 5748 offers a simple and hopefully effective code to follow. For organisations with a track record of excellence it offers an additional layer of checks and accountabilities to ensure systems are fit for purpose. PAS 5748 provides a valuable additional set of tools to monitor and improve cleanliness and infection control. Notwithstanding the present difficult financial situation, the introduction of risk assessments and visual inspection represents an important step towards meeting patient and public expectations. For these reasons it should be welcomed. L FOR MORE INFORMATION


Cleaning solutions from Rainbow International

Clean up your act with HSS Outsource

Right across the board – hospitals, medical and walk-in centres, dental practices and nursing homes – and across the country, Rainbow International has been supplying the health industry with deep cleaning solutions and disaster recovery and for several years, and in the process become an integral part of many NHS trusts’ and PCTs’ supply chains. Services include steam cleaning, biohazard cleans, blast cleaning, clean room environment, and ductwork cleaning. The company’s ability to clean, sanitise and deodorise, providing minimal disruption to patients and a cost-effective service, ensures its relationship with the health sector provides real benefits for patients and health workers alike – a clean and comfortable environment, with the risk of infections greatly reduced.   With over 80 branches covering the UK, Rainbow ensures the service and commitment to

When it comes to healthcare, you want the reassurance that clean really means clean. Whether you manage it in-house or outsource to an external cleaning provider, you don’t want anything to get in the way of keeping things clean – least of all equipment issues. A recent survey found that facilities managers can “waste” up to a day a week dealing with equipment related issues. HSS Outsource is an insightful new approach to equipment management that lets you focus on more important stuff instead. It’s like hire but even smarter and it makes life simpler, easier and more cost-effective. With access to a massive range of safe, compliant and ready to

its customer meets its own aspirations of quality and reliability, delivering an effective and cost-efficient service, anywhere in the UK, 24-hours a day, seven days a week. There’s a 24-hour helpline and two-hour emergency service. Its innovative approach and on-going investment strategy ensure that Rainbow continues to enhance its service package of specialist cleaning and damage restoration.   FOR MORE INFORMATION Tel: 0800 0430001

Accuro: Understanding the importance of standards Many companies replace their service providers every three to five years. Often the real cause is a lack of standards and specifications being employed by that provider. This constant cycle of retendering services creates an all too often ignored impact on finances, and resources at all levels. Accuro has a record of success that can only be envied by other healthcare FM providers. With contract lengths of 3-30 years, we are proud to not have lost a contract to date, significantly due to adherence, and reviews against, robust quality procedures and industry specifications. Accuro’s record of contract retention demonstrates that the benefits of securing a long term partnership between service provider and client are priceless. True partnerships create a stable

and symbiotic relationship allowing the principals of quality and best practice to take root at the most fundamental levels. This creates benefits that far outweigh the surface savings (often front end only) that retendering can provide. Advice: avoid the largest and the cheapest. Look for a provider who fits your long term view, can genuinely provide needs matching flexibility, demonstrates true client partnering and integrated management, and, above all adheres to and excels in industry specifications, best practices and quality controls. As we at Accuro do.

Imagine being better equipped

use cleaning equipment at the touch of a button; you can flex to demand without the need for hefty CAPEX investment. Costs become variable rather than fixed and you only ever pay for equipment you’re actually using. HSS Outsource is supported by Reintec, a new range of cleaning equipment that takes the best of European cleaning engineering performance and enhances it. Launched earlier this year, HSS Outsource has been described as an “outstandingly good concept”. So what are you waiting for? Let us focus on what we do best so you can too. FOR MORE INFORMATION Tel: 08456 028271

to free yourself from hassle

Facilities managers can spend a day a week managing equipment. Spend your time more constructively. Introducing HSS Outsource – a new way to resource, maintain and manage your cleaning equipment needs. Rather than waste your time sorting out equipment issues, you can set yourself free to do your day job by handing it all over to us. Which sets you free to do more, by giving you more time to do the important stuff.

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The perfect addition to any property Canopies UK are the country’s leading manufacturer of canopy protection systems, having installed thousands to residential properties, businesses and throughout the public sector across the UK. We have a range of innovative products that can be supplied as standard in large volumes or as completely one-off bespoke designs to suit your specific needs.

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We assist our clients in their healthcare delivery through our definitive and diverse service. As a leading property & construction consultancy we work directly for NHS trusts, health authorities, primary care trusts and private healthcare providers. Chartered Surveying

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A new health centre will transform healthcare provision in Kirkby, providing one dental and two GP practices, midwifery clinics, mental health services and much more in an energy efficient building Planning has been approved for a new multi-million pound state of the art health centre in Knowsley, Merseyside, which has involved the local community in every aspect of its development. The centre is to open in the small town of Kirkby, an area that is set to see a significant level of regeneration to revitalise the town centre, and the addition of this centre will bring healthcare services to the centre of the community. IMPROVING COMMUNITY HEALTHCARE Following the announcement of major town centre regeneration, planning permission was granted to build the new Kirkby Health Centre. This has been made possible thanks to a long standing and pioneering partnership between NHS Knowsley and Knowsley Metropolitan Borough Council’s Directorate of Wellbeing Services. The partnership, known as Knowsley Health & Wellbeing, incorporates social care, leisure and culture, and while Knowsley has a range of significant health and social care priorities, the organisation is committed to improving healthcare provision and bringing vital and relevant primary care services closer to local residents. Currently the town’s NHS services are housed in two clinical buildings, St. Chad’s Health Centre and Kirkby Health Suite, in different parts of the town. The new scheme will see the existing centres replaced by one brand new 3,691 square metre centre, serving the community from the heart of the town. The circa £7m health centre development will complement a complete town centre regeneration programme. The wider Kirkby regeneration initiative was given the green light by councillors earlier this year and represents a private investment worth over £200m. A LEGACY IN COMMUNITY HEALTHCARE Knowsley comprises a number of small towns, estates and villages and over the past ten years, Knowsley Health & Wellbeing has focused on improving and modernising community healthcare across the whole of the borough. The new Kirkby Health Centre will be the latest in a string of health resource centres designed to offer easy access to a range of high quality primary care services. Knowsley is already recognising the positive impact of two of its one stop shop style health centre developments that have opened in the

borough over the past two years. The Blue Bell Centre in Huyton – opened in May by Liverpool FC captain Steven Gerrard – and The Halewood Centre, Halewood have both combined energy efficient materials, low energy medical equipment and state of the art construction techniques to bring modern facilities to each of the communities. Both primary care resource centres house a series of services under one roof in addition to boasting energy efficient credentials such as The Blue Bell Centre’s innovative sedum roof, air source heat pumps, rainwater recycling and solar panels, which have helped to reduce running costs and carbon emissions to world class levels. Knowsley Health & Wellbeing was keen to use the models as a blueprint and replicate the success of these developments in Kirkby by once again introducing energy efficient building designs as well as bringing all local NHS services together under one roof, ensuring they are more accessible to all local residents. THE BUILDING The Kirkby Health Centre development is part of the LIFT initiative (Local Improvement Finance Trust), a joint venture between the local public sector and private sector partner, Renova Developments, which funds modern healthcare provision. The health centre building, which has been developed by Taylor Young Architects and TACE Mechanical & Electrical, has been designed with the Kirkby regeneration in mind, in keeping with the look and feel of the other new developments in the town. The large three-storey health centre will be glass fronted to utilise natural light and energy, and feature wooden panelling to complement the local landscape, which will include a new Tesco superstore, retail space, a library and a new bus station. The wood panelling provides effective insulation, which will ensure that running costs are reduced. The building will be constructed to achieve BREEAM excellence standards, similar to the previous resource centres to ensure it meets industry standards in sustainable building, design and construction. CONSTRUCTION IN THE COMMUNITY Construction is set to commence on the building in January 2012 with Knowsley Health & Wellbeing’s newly appointed construction partner Galliford Try

Construction North. Keen to ensure that the local community was involved in the development, Knowsley Health & Wellbeing required that its construction partner uses local skills, expertise and labourers to ensure that the centre really has involved the local community in all stages of development. Not only will the 15-month construction provide access to local jobs and training opportunities, the services which will be contained within the centre have been tailored specifically to meet the needs of the 50,000 residents. HEALTHCARE IN THE COMMUNITY Kirkby Health Centre will provide the people of Kirkby, with two GP practices with a current combined list size of 6,000, community dental services, a Walk-in Centre and a series of rooms that can be used for a range of health and wellbeing services and remain flexible for a range of uses. Out of Hospital services including COPD, CVD and midwifery will also feature in the new centre. It will also receive permission to remain open until as late as 11pm, giving the opportunity to extend opening hours and offer a more convenient and effective service to suit all residents. The car park has been designed to cater for large mobile screening units that can park up and invite local residents to be tested for conditions such as breast cancer and diabetes. INVOLVING RESIDENTS As part of Knowsley Health & Wellbeing’s commitment to keeping local people involved in all stages of the centre’s development, residents will have the opportunity to attend Health Impact Assessment meetings to have their say on the shaping and improvement of services including what is on offer and when services should offer extended opening hours. Ian Davies, Knowsley Health & Wellbeing’s director of strategy and programme coordination, said: “Providing quality, modernised healthcare in the heart of the community is a priority at Knowsley Health & Wellbeing and seeing the success of some of our previous resource centres ensured that we have a robust plan for the Kirkby Health Centre. We have seen an uplift in the use of primary care services when they are housed under one roof so we are always looking at ways to improve access to services for the local community.” L




Ready for the climate change challenge? 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 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: 08457 448900 smartmetering@

The building services and environmental engineering specialists White Associates is a Kent based mechanical and electrical design consultancy who fully appreciate the fact that the detailed M&E design on modern projects is reliant on the outcome of early energy assessment, appraisal of renewable requirements, and predicted CO2 emissions. We apply our extensive M&E knowledge into the energy assessment decision making to ensure that the most practical and cost effective solutions are put forward to comply with all of the requirements imposed under current legislation, whether planning conditions, building regulations,

or CIBSE requirements. As fully qualified BREEAM and SBEM assessors and registered low carbon consultants, we can offer you the most energy efficient, practical, and affordable services design solution for your scheme. Please contact us regardless of your project size as we can provide a solution to any scheme – we have successfully completed works from small low key refurbishments through to new build projects up to £60m in construction value. FOR MORE INFORMATION Tel: 01322 869611

Architecture, space planning and strategic space management The practice has over 13 years’ experience working in-house for large public and private sector institutions across London and the South East. We are equally at home preparing briefs, feasibilities and detailed proposals for any size of project, however large or small, and have the capability to manage complex, multi-sited property portfolios between 500 and 500,000 sq. ft. We pride ourselves in a professional and timely delivery of high quality information in a variety of formats to suit individual organisational technology platforms and communication methods. Benefits to an organisation of this working model can be summarised across rapid response and refinement of proposals, on-call service delivery and economic, high quality delivery.


Turn Costs into Revenue In every organisation there exists the opportunity for accounting errors to occur. We are not talking about major errors of accounting principle but small, seemingly insignificant errors that can accumulate over the years into a substantial amount of unrealised income.

Professional and trade body affilliations include RIBA Chartered Practice Federation of Small Businesses Approved Contractor – Chelmer Housing Partnership and Chelmsford Approved Contractor – St Georges Community Housing, Basildon. FOR MORE INFORMATION Glynn Williams Tel: 01245 222692 Fax: 01245 222692 Mob: 07973 835067


First Pass Ltd has worked with many companies and in every case we were able to recover significant sums for our clients and recommend ways to prevent those errors from happening again. There is no additional cost to the client; First Pass Ltd takes its fee from the additional income generated. It is entirely self-funding. The main reasons for errors are: Duplicate payments - where invoices are paid more than once. Overpayments – e.g. where a supplier has not applied the correct level of discount. VAT - There have been two changes in the VAT rate recently, plenty of opportunity for errors to occur. First Pass Ltd has the expertise to review historic accounting transactions and recover any money due to your business. In some cases it may be possible to go back over six years thereby recovering substantial sums. Call First Pass Ltd on 01600 715508 to find out more about this opportunity. E-mail




AN INNOVATIVE SOLUTION Simon Rigby, director of Clinical Support at Musgrove Park Hospital, explains a new project set to reduce energy consumption by more than 40 per cent and generate savings of £17 million Taunton and Somerset NHS Foundation Trust has embarked on a pioneering project set to reduce Musgrove Park Hospital’s energy consumption by more than 40 per cent, the best of any UK public sector organisation. In addition the project, dubbed the ‘Energy Project’, will also enable Musgrove to generate savings of £17 million, over the next 20 years, which will be directed towards patient care. The government’s comprehensive spending review, the introduction of carbon taxes and mandatory carbon reduction targets have left the NHS facing unprecedented financial pressures. Here at Musgrove Park Hospital we faced a doubling of our annual £1.8m energy bill by 2017 and knew we had to find an innovative way to deliver improvements to our buildings that didn’t have an impact on our operating budget. REDUCING ENERGY USAGE Hospitals are the highest energy users by building type in the UK. The NHS has the largest single estate in Europe and has increased its carbon footprint by 40 per cent since 1990. Collectively we are the largest public sector contributor to climate change, and in England the NHS produces over 18 million tonnes of CO2 per year. The NHS has been set targets to reduce its energy consumption by 34 per cent by 2020. On top of this the NHS has a carbon reduction strategy and is subject to the Carbon Reduction Commitment Energy Efficiency Scheme, which aims to reduce consumption and emissions. To cope with these challenges all parts of the NHS need to make large-scale improvements – and innovative, creative solutions, with assistance from the private sector, can help. Musgrove’s partnership with Schneider Electric highlights how working alongside the private sector can offer great benefits to the NHS and also save energy and money. Together we have come up with a simple solution that will improve our buildings, meet mandatory carbon reduction targets, save money and ultimately, target funds where they matter most – patient care. The project, which is the first of its kind in the UK healthcare sector, will deliver substantial energy efficiency measures at Musgrove Park Hospital. The project is selffunding, and includes the cost of replacing our old energy inefficient infrastructure and equipment as well as essential estate projects financed by the fuel savings achieved, meaning there is zero cost to the tax payer. Some 180 individual solutions are being implemented over the life of the project to

reduce energy consumption, minimise risk and tackle reactive maintenance. These include the installation of a combined heat and power unit linking the low temperature hot water (LTHW) output to plate heat exchangers on several domestic hot water circuits and the addition of new energy efficient boilers to replace existing steam boilers at the end of their usable life. Steam traps will be replaced and general repair and maintenance of the steam distribution system will also take place in addition to the replacement of calorifiers with plate heat exchangers. The project will also encompass a full overhaul of the heating, ventilation, and air conditioning system including variable speed drives and control on air handling units and pumps as well as free cooling alterations to remove mechanical cooling requirements. The benefits of the energy efficiency measures are striking, with Musgrove Park’s average energy consumption set to be reduced by more than 40 per cent, delivering a cut in carbon emissions by 43 per cent – the best of any UK public sector organisation. The guaranteed energy performance project is aimed at minimising energy demand, reducing backlog maintenance and risk while improving Musgrove Park Hospital, Taunton. Following a detailed energy audit in 2010, a refurbishment programme has been developed incorporating the 180 individual improvements across the site. Over £2.5 million of estate backlog maintenance is being tackled, thereby minimising significant operational and financial risks, with carbon emissions being drastically reduced. LONG-TERM PLAN As this partnership was the first of its kind in the UK healthcare sector, we needed a company that could give us the confidence to undertake a project of this nature and Schneider Electric’s skills, knowledge and expertise met the brief. Through the partnership, we will be able to deliver energy savings of 43 per cent by the end of 2012, vastly exceeding those set by central government. The money saved can therefore be ploughed back into patient services, improving the care we offer to our patients, while helping the environment. It is expected to take two years to fully implement, but once completed, Schneider Electric will remain involved for ten years. There is a performance guarantee in place, based on a percentage decrease in energy units (MWh) against fixed targets. Above all, the project will be cash-

flow positive in every year of its 20-year life, being funded by guaranteed energy savings – estimated to be over £750,000 per annum (rising with utility inflation). The project is forecast to generate a net operating cash surplus of £17 million over 20 years, and to free up £2.5 million of budgeted capital expenditure to spend on other trust priorities, such as further improvements to the patient environment and new medical technologies. We’ve started seeing savings from day one. For the first 18 months of the project we keep all the savings from the measures introduced and during that period we will use a percentage of the savings to cover the costs of the installation. Any additional savings are available to be put back into patient care. A HOLISTIC SOLUTION Schneider Electric provided everything from the design to the project management required to ensure that the changes we have implemented are rolled out smoothly. Our role was to support the company in making the improvements. Colin Russell, the company’s healthcare specialist, comments: “When we were considering entering into the partnership, we looked at the trust’s energy reduction targets as well as how long we thought it would take us to achieve these single handedly. We realised that working with a third party would enable us to not only meet targets far more quickly, but also provide us with a pool of resources and knowledge that would be invaluable. “We hope that this project encourages other Trusts to enter into partnerships such as this, helping to reduce energy consumption across the NHS and making vital cost savings.” Initially, an in-depth analysis of the equipment on site would be carried out. If the existing equipment was found to be ageing, inefficient or in need of replacement, the company would opt for the most efficient approach, which might be a combination of traditional equipment and renewable and low-carbon products such as photovoltaic (PV) solar power, solar thermal hot water and CHP (combined heat and power). By using innovative solutions, the NHS infrastructure can be revitalised and huge financial and energy savings can be achieved, while making the care environment more comfortable and safe for patients. We estimate that if similar measures to those discussed in this article were replicated across the entire NHS estate, it could result in energy savings of over £200 million a year. L







A smart, elegant and thoughtfully-presented hospital interior can lift the spirits of both patients and staff, says Knightsbridge Furniture, a member of the British Contract Furnishing Association Furniture (fur¦ni|ture) Noun: The movable articles that are used to make a room or building suitable for living or working in, such as tables, chairs or desks. The lexicon – in this case Oxford Dictionaries Online – makes ‘furniture’ sound so mundane. Yet, as with most aspects of hospital life, reality belies the apparent simplicity. Fitting out a complex environment catering for the 24/7 needs of inpatients and outpatients, staff and visitors is a challenge best left to experts, as those interior designers and buyers charged with the task of furnishing a hospital or other healthcare facility will testify. THE MANUFACTURERS’ ROLE The responsibility for furnishing today’s hospitals no longer lies exclusively with interior designers and purchasing managers. Manufacturers also have an increasingly essential role to play through the development and commercial production of furniture which matches the demands of the healthcare arena – demands which are both precise and manifold. As a result of working closely with customers, specialist manufacturers have been able to bring furniture collections to market that are designed to meet needs across all areas of hospital life, whether catering for defined user groups, answering clinical requirements or actively addressing issues such as infection control, tissue viability or the care of patients with dementia. Standards are high, with all hospital furniture required to conform to BS 7176:2007 ignition test, as well as strength, durability and safety standards BS EN 15373:2007 (chairs) and BS EN 15372:2008 (tables). DESIGNING OUT BUGS Infection control remains at the core of hospital routine and extensive R&D investment amongst key players in the contract furnishing sector has resulted in the introduction of healthcare seating designed specifically to reduce the spread of hospital-acquired infections. For some time, anti-bacterial upholstery fabrics and lacquers applied to exposed timber have been standard weapons in the fight against HAIs. However, fundamental design elements now underpin hospital seating to control contaminant build-up: seat/back hygiene gaps, removable cushions and minimal stitching details in patient contact areas all facilitate access for cleaning and prevent the creation of dirt-traps. Equally specific features have been incorporated into hospital seating to help manage pressure care and tissue viability in long-stay wards. Key pressure-reducing



A diversity of seating and bedroom cabinet furniture has been installed at the Breast Care Unit at Prince Philip Hospital in Llanelli.

Patients at The Christie in Manchester are relaxing in style thanks to its comfortable and supportive Melrose seating.

features include waterfall seats, armpads and weight-distributing cushions. POSTURE AND SEATING Furniture designers and manufacturers have also acknowledged that good posture is crucial: it not only ensures even weight distribution and reduces shearing forces – hence helping in the management of tissue viability – but also encourages movement, social interaction and self-reliance. Enhanced lumbar support built into patient seating will promote good posture even over prolonged periods in the same chair whilst variable seat depths, seat height adjusters and a choice of chair heights and sizes will enable differences in stature to be accommodated without compromising on comfort (see picture

A striking array of armchairs, beam seating and tables at the new Peterborough City Hospital supplied by Knightsbridge Furniture.

courtesy of The Christie, Manchester). Infection control and tissue viability are issues with implications for patients affected by a broad spectrum of conditions. However, seating for defined user groups represents a different sort of challenge for furniture designers. In response to demand from hospitals for more furniture to accommodate the rising number of bariatric users, for instance, specialist seating has been developed for visitors, residents and patients who weigh typically 35-50 stones. Ideally combining style with functionality, such seats should merge comfortably into a mixed setting and complement other seating whilst providing for the special needs of larger users (see image courtesy of Peterborough City Hospital). Armchairs E

E with enhanced size and strength to accommodate bariatric users will feature extra-supportive arms, with handgrips to aid rising and housekeeping wheels to help manual handling. Good posture remains vital: reinforced lumbar support ensures the adoption and maintenance of a correct seating position whilst waterfall seats reduce pressure on the backs of legs. In addition, recent innovations include chairs designed to accept hoists together with the development of upholstered motorised recliners in order to help bariatric users presenting associated health and mobility problems. With patientactivated remote controls, these allow the seat back to be poised at any angle to facilitate a comfortable position. RECLINERS The increasing use of recliners in clinical areas is, however, not restricted to bariatric users. A growing variety of options now includes compact recliners designed for tight spaces, models with a ‘tilt-and-space’ action and recliners providing additional support through a snug containment back. Applications are equally diverse, ranging from counselling suites to maternity departments, where recliners seem to be as useful to expectant fathers as they are to mums-to-be. Several models are also fitted with extra-wide arms

to ease the administration of treatments like blood transfusions or dialysis while the patient remains in a comfortable seated position. Recliners are available with either manual or motorised action: in both cases, the recline position can be stopped at any stage to allow the user to find the most comfortable angle. Other standard features include heavy duty, lockable easy-clean castors to assist mobility. Indeed the day-to-day handling of patients remains a key area of concern to hospital staff, and furniture has been developed with a range of features to ease – and safeguard – the work of healthcare professionals as they move patients around a busy hospital. Specialist patient transfer seating is now available ready-fitted with push handles and castors for easy manoeuvring and adjustable footplates for patient safety, whilst useful options include drop-arms to assist with either bed-to-chair or chair-to-chair patient transfer. DEMENTIA PATIENTS As more hospitals find they have to establish specialist departments to care for patients suffering from varying degrees of dementia, so specialist furniture is being sought with which to furnish them. Here, simple features make a huge difference: highlighted table edges, contrasting carcases/doors and seat arms/cushions all help the visually impaired, whilst upstands on bedside units both contain

Healthcare Equipment

that offer staff, patients and visitors every reassurance in this regard. “Our products aren’t just robust for busy working environments; their advanced protective finish is an important factor in hygiene and infection control in sensitive environments.” Link Lockers and Link 51 provide an extensive range of bespoke storage solutions for all healthcare departments, including its popular Garment Management System, which is used for the controlled issue of work wear, safety equipment or consumable items in the workplace. FOR MORE INFORMATION For more information about Link Lockers and its range of innovative BioCote® protected storage solutions, visit or call the free helpline on 0800 733300.

spills and prevent the loss of personal items. Visual access to cupboard and drawer contents is also vital to preserve a sense of familiarity and encourage ownership. Dipped profiles to drawer fronts allow immediate visual access to the contents, for instance, as do transparent vision panels in wardrobe doors. Throughout, flexibility is essential, with furniture configurations easily adapted if needs change. Yet whether furnishing a dementia ward, a maternity department or a long-stay unit, the importance of style when selecting seating, tables and other furniture essentials should not be overlooked. A smart, elegant and thoughtfully-presented hospital interior will lift the spirits of patients and staff alike, and even give the patient the feeling of being in a hotel rather than in an institutional building. Thanks to the development of versatile modular furniture systems and compact beam seating, even the busiest hospital waiting rooms or the most cramped of transit areas can be imbued with a sense of style and innovation, engendering a positive ambience, spreading a feel-good atmosphere and making a valid – and often under-appreciated – contribution to the healing process. L FOR MORE INFORMATION Tel: 01494 896790

Link Lockers reduces cross-contamination Designing solutions that help healthcare providers maintain a hygienically clean environment is a key priority for Link Lockers when it comes to installing shelving and lockers. Link Lockers, which holds the NHS Supply Chain contract for the supply of shelving and lockers with its sister company Link 51, is the only locker manufacturer that protects its painted steel products with BioCote® protective finish. This silver based anti-microbial technology has been proven in peer-reviewed trials to minimise the risk of bacterial cross-infection such as E. coli and MRSA, and cuts the risk of bacteria and mould growth on surfaces. Andy Millward, Link Lockers sales director, says: “We recognise that everything within a hospital and healthcare setting has to comply with the strictest of standards and we are committed to finding the best solutions



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As one of only a few manufacturers within the Health and Safety Sign Association, we at Lasting Impressions can guarantee that our range of over 2,000 different signs will not only fully comply with all relevant legislation, but will also protect you and your company from any nasty surprises. Lasting Impressions has taken every step to ensure that both your patients and colleagues are protected from unnecessary harm. This includes rounding the corners of every sign to eliminate sharp and dangerous corners which, we feel, also improves the appearance of the sign. Is your signage frequently

ignored? Great signage is noticed, read and understood; Lasting Impressions offers clear, concise lettering on a striking backdrop in order to make sure your message is received loud and clear every time. We believe that our first class service will leave you with a Lasting Impression. FOR MORE INFORMATION To browse our full range of products or request a copy of our 92-page brochure. Please visit www.lastingimpressions or call our sales team today on 01308 456721.


INTRODUCING SAFER SIGNS The understanding of the meaning of fire safety signs is a fundamental requirement of the Health and Safety Regulations The adoption of ISO 7010 as a European norm has finally drawn the end game for fire safety signs that were introduced as a consequence of an EC Directive published in 1977. It is satisfying to know that NHS Estates realised the most important thing about the introduction of graphical symbols to convey safety messages, is that the staff intuitively understand them. The research carried out 20 years ago by NHS Estates gave clear indication that there were risks involved with the introduction of abstract symbols to indicate escape routes. NEW STANDARDS Research and the development of the Health Technical Memorandum 65 Part 2 – Fire Safety Signs, which has been superseded by NHS Wayfinding Document, has stood as a bed rock for the subsequent development by both British Standards and International Standards of comprehension testing and inclusion of

all graphical symbols for safety application. The development of ISO 9816-1: 2007 Graphical Symbols – Test Methods – Part 1: Methods for Testing Comprehensibility, is a testimony for the need to ensure not only the extent of comprehension but also gives indication of the need for supplementary text, training and instruction. The graphical symbol chosen by the NHS enhances the British and International Standard symbol with the use of flames as a determinant, presenting a clear and unequivocal message. Research and tests proved that the NHS symbol increased comprehension and understanding of signs by an amazing 300 per cent. The legislative framework derived from EC Directive 92/58 requires that responsible persons ensure that all building occupants, not only comprehend the meaning of the safety signs, but also understand the action to be taken in conjunction with the signs.



CLEARING THE CONFUSION The changes in fire safety legislation moving from a very prescriptive regime to a risk based engineered solution has highlighted the dangers when using escape route signs that may cause confusion. It has taken 20 years for the rest of the industry to question the validity of using a graphical symbol that is not clearly understood. Using signage that is not clear may have an impact on egress speed and efficient evacuation, which could be fatal. The use of HTM 65 (NHS Wayfinding Document) for escape route signs ensured that a known convention was implemented for safety way guidance. This simple convention was a foundation to BS5499 Part 4 2000 and carried its provenance through to the development internationally of ISO I6069: 2004 – Graphical Symbols – Safety Signs – Safety Way Guidance Systems (SWGS). The understanding of the meaning and actions to be taken in conjunction with safety signs is a fundamental requirement of the Health and Safety (Safety Signs and Signals) Regulations. NHS Estates have to be congratulated for their insight 20 years ago. The NHS Estates will now wait for the rest of the world to catch up and stop playing ‘Pictionary’ with people’s lives. L

A Means of Escape Publication, on behalf of the Health and Safety Sign Association (HSSA). Jim Creak is chairman of the HSSA.



Conflict Management


to suit the specific needs of the various roles at each individual venue. Hospital porters have totally different safety issues from a surgeon, whose safety needs bear no resemblance to the needs of a GP when making home visits. No matter how good the risk assessments have been at identifying the risks, and how robust and tailored the policies and procedures put in place are, it is rarely possible to eliminate all risk. Therefore staff must be given the knowledge and skills that will enable them to deal with the residual risk. It’s important that training is only introduced at this stage and not before. Training should only ever be used as part of an overall personal safety strategy and never in place of one. If the correct risk assessments have not previously been carried out or the previous policies and procedures were not thorough enough, and an incident happens, then the organisation could be at risk of litigation for not accepting that its work systems were inherently unsafe.



For an organisation as enormous, diverse and widespread as the NHS, it can be a challenge to provide personal safety for all staff, writes Bob Beal, director, the Institute of Conflict Management Providing a safe working environment and safe working practices for employees is a relatively complex task for any large organisation. But for an organisation as enormous, diverse and geographically widespread as the NHS, this is a huge undertaking and the complexity of it should never be underestimated. It is an enormous job but essential for both the organisation and its employees that it is done and done well. RISK ASSESSMENTS In order to ensure the safety of staff, there are basic steps management needs to undertake. The first of these is to carry out risk assessments. This means assessing the risks involved with the individual tasks members of staff undertake. These assessments have to be thorough and they have to be targeted. There is no point carrying out risk assessments for hospital porters, for example – and then producing policies and procedures based on this. Each hospital, clinic or surgery has a different layout, location and patient profile. Therefore the safety risks will vary, meaning the safety policies and procedures for each health service venue and its staff, including those that work alone in the community – must be



tailor-made to deal with its specific risks. It is important that those who carry out the risk assessments really know the roles they are assessing. It is pointless to bring in someone from outside the department to assess the risks based on whatever tasks management tell them their staff undertake. For risk assessments to be effective, the assessor must communicate directly with the frontline staff, in order to find out how the jobs are really carried out. Consulting with staff – whether via focus groups, questionnaires or reporting amnesties – will enable management to find out the real issues. POLICIES AND PROCEDURES Once the risks have been identified, this consultation with staff should continue through to the development of relevant policies and procedures. If safety procedures are to work, their input is invaluable. The frontline employees – whether that’s GPs receptionists, ambulance drivers or doctors in A&E – know what really happens on a day-to-day basis, what procedures would be practical for them and, importantly, which procedures they would actually follow. As with risk assessments, generic policies and procedures are pointless. They must be tailored

TRAINING FOR FRONTLINE STAFF Good conflict resolution training for frontline staff should include how to make dynamic risk assessments of the person you are dealing with, the environment in which the situation is taking place and the task that is involved. Is the person they are dealing with under the influence of drugs/drunk/frightened/in pain/ angry? Are there colleagues/security nearby who could come to their assistance if any problems occurred? Do they have to tell the person something that might upset them? Could any of these factors compromise their safety and what should they do about it? Frontline training should also give staff the knowledge and skills to recognise early warning signs of aggression. The earlier they can spot these signs, the easier it will be for them to take action to defuse the situation if possible, or to exit it or call for assistance if necessary. MANAGING BEHAVIOUR How to manage our own behaviour is a vital part of any personal safety training. A crucial element when dealing with others is the awareness of any feelings in ourself – such as anger, disgust, fear or resentment – that could cause aggression in the other person. Good personal safety training should enable staff to act appropriately when dealing with aggression, rather than reacting in a way that could make the situation worse. Employees should be trained in how to judge whether it is safe to stay and attempt to deal with any given situation, and how to defuse that situation if they do decide to stay. Likewise, they need to learn about strategies for exiting a difficult situation safely if they decide that is the safest option. As with risk assessments and policies and procedures, the challenge with training is that it needs to be relevant to the individual. The greater the diversity of jobs within the organisation, the more essential it is that the E

E training is bespoke. You can’t give the same advice on how to exit a situation safely to a nurse who works in A&E as you can to a nurse who makes home visits, for example, or a paramedic who deals with drunks in their ambulance every Saturday night. If, as happens in many cases, training is to be cascaded down from an initial generic system, then it is vital that the ‘trainees’, who are then expected to give the training within their own department, are also taught how to transpose the generic advice to the specifics of their own department. Training the trainers sufficiently is essential if all frontline employees are to be given the necessary targeted knowledge and skills to keep themselves safe in their particular role. ADDITIONAL ELEMENTS Hospitals and other large facilities are using security staff more and more. They play a vital role, however security staff must be registered with the SIA (Security Industry Authority) and have to operate within their remit. This could potentially clash with the NHS safety remit. It can also be tempting for clinical staff, who should be in charge of any conflict management, to hand over the management of aggressive situations to security (this is more likely to happen if they are not sufficiently trained in carrying out dynamic risk assessments). This would be fine if it was just

calming down drunks or exiting them from the building if necessary, as they are trained for this. However it can cause problems if they are asked to manage the aggression coming from a patient whose violence is a result of their clinical condition, for example dementia, certain medications, pain, fear, and so on. Therefore it is essential that the use of security staff is not abused in order to compensate for the lack of relevant conflict management training of clinical staff. Technology can be very useful if its use is clearly defined. Alarms and tracing systems can be extremely effective in summoning help and in warning of possible problems. However, they cannot prevent a violent or aggressive incident from happening nor can they help an employee to deal with such an incident until help reaches them. Technology should never be used in replace of good safety procedures and training. Good reporting systems are essential if an employer is to keep risk assessments and procedures up-to-date. Employees should always be encouraged to report incidents and near misses. They will only do so if the system is simple, non-time consuming and they can see a clear result/benefit of reporting. MANAGEMENT RESPONSIBILITIES Those responsible for staff safety need to ensure that thorough risk assessments

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are carried out and that safety policies and procedures are designed and fully implemented. They need to ensure that employees know about and contribute to the creation of these safety policies and procedures. They should also ensure that frontline employees receive relevant and targeted training and that personal safety is kept on the agenda and integrated into existing structures across the organisation. Finally, they need to create and implement a structured reporting and aftercare process to ensure that victims are supported. There are numerous factors that can adversely affect the personal safety of health care employees – from dealing with people who are frightened, in pain, mentally ill or drunk, to getting home after finishing late or transporting drugs around. The diversity of healthcare roles, the locations where interactions with the public take place and the risk factors involved, make it extremely hard to provide effective personal safety solutions for all those in the health sector. The ICM believes that the only way this can be done is for the training of both frontline staff and management to become less generic and more bespoke in the future. L

Conflict Management



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Medical Technology



CAN PAYMENT BY RESULTS BE REFORMED TO FULFIL THE NEEDS OF THE NHS? When introduced in 2002, PbR was a successful financial tool to increase activity, however, the NHS has since changed and so must this system, argues the Medical Technology Group The Payment by Results (PbR) system, first announced by the Department of Health in 2002, has to date had little to do with outcomes or results. Criticised by the British Medical Association back at its introduction for encouraging unequal competition between the public and private sector, PbR has also faced condemnation for funding arrangements that seemingly incentivise results in terms of quantity, rather than quality, and giving providers a ‘perverse incentive’ to carry out outdated, more invasive treatments that attract higher tariffs. However, it must be recognised that PbR was a successful financial tool to increase activity, which at the time, was much needed to clear the backlog of patients and was arguably instrumental in reducing waiting lists under the previous government’s 18 weeks initiative. CHANGING SYSTEM But the NHS has changed. Speaking to the Nuffield Trust in March 2011, health secretary Andrew Lansley said: “We have a system in the NHS misleadingly called ‘Payment by Results’. But organisations aren’t paid for results. They are paid for activity. They are rewarded for processes and ticking boxes, for doing stuff and not actually for delivering the best possible patient care.” He added further concerns on the limitations of PbR, saying: “Payments based on the historic average cost of a treatment can’t hope to keep up with often fast-paced developments in care.”1 In moves to address this, the government initially proposed a Maximum Price Tariff, which would’ve allowed commissioners and providers to negotiate on the cost of treatments. However, the Medical Technology Group (MTG) voiced concerns about both quality and patient safety under this system. Under the policy, some hospitals would have been able to cut prices to please commissioners, simply by cross-subsidising. However, other hospitals on a less stable financial footing may not have that option – in such cases, they may have been pressed into cutting quality and possibly taking short-cuts on safety. This clause was removed from the Bill during the committee stage as MPs, health organisations and



In a fairly unsophisticated cost-driven culture, there remains a risk that shrinking budgets combined with major structural reorganisation will result in the continued prioritisation of short term, price-based decision making. practitioners raised concerns that the quality of the health service would suffer as commissioners prioritised price over quality. With quality being much harder to measure than price, the MTG also questioned whether the numerous new Clinical Commissioning Groups (CCGs) will have the expertise to identify any decline in quality and react accordingly Sir David Nicholson, NHS chief executive, gave evidence to the House of Commons Public Accounts Committee and expressed similar views. He advised

that without good quality measures or patients not being qualified to judge the quality of their treatment, price competition is “very dangerous”2. ASSESSING CARE In order to ensure the best experiences and outcomes for patients receiving treatment on the NHS, it is vital that all treatments are assessed in terms of their effectiveness, safety and their capacity to deliver good patient outcomes and high quality care – care that will deliver significant cost E

E savings in the future, rather than low-level short term savings. In a fairly unsophisticated cost-driven culture, there remains a risk that shrinking budgets combined with major structural reorganisation will result in the continued prioritisation of short term, price-based decision making. Taking this approach in favour of seeking high quality outcomes for the longer term is likely to be a false economy and moreover jeopardise the future viability of a taxation-based health system such as the NHS. Instead the focus for the service must be provision of services that take account of patient choice and preferences which balance sound long term financials with clinical outcomes befitting a modern NHS. BEST PRACTICE TARIFF One of the proposed antidotes to costly or myopic commissioning could be the new Best Practice Tariff (BPT) programme, of which a small number have already been introduced and more are expected over the next few years. However, the nature of these Best Practice Tariffs vary considerably from additional payments, which are linked to fulfilling aspects of best clinical practice, to an overall reduction in the tariff value to remove the equivalent value of one days stay as an inpatient. An example of the former is the Hip Fracture BPT and the latter is the current BPT for Primary Hip and Knee Replacement. Anecdotally the Best Practice Tariffs work best when they are linked to clinical indicators or aspects of best practice care and really change the way services are delivered. Conversely the impact of a punitive BPT, which simply removes £232 from the tariff value to encourage a reduction in length of stay, remains to be seen but is unlikely to have had the same impact across the country. By extending the BPT further still, the NHS can lay the solid guidelines for commissioners to judge how best clinical practice will play out. The criteria laid out in these tariffs mean that providers are paid according to the costs of excellent care, rather than the average price3. TRUE RESULTS Where Best Practice Tariffs describe the clinical characteristics of best practice and the structure, prices, and arrangements for implementation this is a welcome development in the movement from payment for activity to true “payment by results”. For hip and knee replacements, for example, the pathway includes the pre-operative assessment, care during the hospital admission and immediate post discharge including outreach care. There is an expectation based on a range of publications that utilisation of such pathways should improve the patient experience and satisfaction, reduce lengths of stay and shorten post-operative rehabilitation4. However, the challenge for providers is that in some instances pathway redesign requires investment, particularly for the highly championed enhanced recovery programmes for orthopaedics which utilise community outreach teams that visit patients at home after an early discharge from hospital. Despite the intention to increase the enhanced recovery programmes across the country and reduce length of stay this presents a significant challenge for trusts to deliver when the tariff value is decreasing year on year. Indeed for this approach to best practice tariffs to deliver the necessary change it would need to offer incentives to change which could be used to invest in the programme. STRUCTURED TARIFFS According to the Department for Health: “The aim is to have tariffs that are structured and priced appropriately both to incentivise and adequately reimburse for the costs of high quality care.”5 Whether this is the goal or the reality remains to be seen but it should be the guiding principle for the Best Practice Tariff programme if an erosion of quality is to be averted. Extending clinically-based Best Practice Tariffs to cover a wider range of conditions will ensure care is truly designed around the patient, and focused firmly on the entire patient pathway. It is imperative that Best Practice Tariffs are based on clear clinicallybased indicators of best clinical practice and draw upon relevant national guidelines. The alternative is punitive tariffs that are labelled

About the MTG

Medical Technology


The Medical Technology Group (MTG) is a coalition of patient groups, research charities and medical device manufacturers working to make medical technologies available to everyone who needs them. Uptake of medical technology in the UK is not as good as it should be given its great potential to provide value for money to the NHS, patients and taxpayers. The MTG believes that patients and clinicians need better information about medical technologies so that they can make informed choices about their medical care.

BPTs but which threaten quality of care and patient outcomes. However powerful it is, Payment by Results cannot solve everything. Commissioners around the country are refusing to pay for evidencebased, proven, safe, cost-effective procedures and/or technoogies whether a tariff, or a best-practice tariff is available or not. This shortterm strategy to manage budget constraints is unsustainable and will jeopardise patient access to appropriate treatments and is likely to actually increase the overall cost to the NHS in the coming years. L FOR MORE INFORMATION Notes 1. Nuffield Trust Annual Health Strategy Summit: NHS modernisation and the way we pay for care (2 March 2011) 2. Health Service Journal (p.5, 20 January 2011) 3. Equity and Excellence: Liberating the NHS 4. Department of Health: Payment by Results Guidance 2011 5. Department of Health website

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Healthcare IT


MAKING EFFECTIVE USE OF THE HEALTHCARE INDUSTRY’S IT SPEND Stuart Mackintosh explains the key components of open source software, the government’s attitude towards it and how it can be effectively used within the health industry In comparison to worldwide proprietary software vendors such as Microsoft, Apple and IBM, open source software may not be a term that you recognise. However, the UK Government has been keeping abreast of its development and gradually engaging with OSS over the past decade. This year, strong guidance on how to procure open source software and assess its suitability, plus a catalogue of OSS applications is expected to be pushed through internal government, which confirms its position firmly in the mainstream arena. WHAT IS OPEN SOURCE? The first thing that needs to be explained is what open source actually is – in its simplest form it is software that has been developed in a public and collaborative manner. Unlike proprietary software, OSS has unrestrictive licenses and is generally free to use, giving

Cabinet Office has halted all NHS purchases of Microsoft software whilst it negotiates a central deal. This decision has been made in an attempt to regain control and reduce the overall cost of software to the NHS, and in turn, opens up the playing field to open source suppliers, who are able to build flexible systems that can be adapted for re-use across multiple departments. A similar project is currently being undertaken within the country’s Police force. GOVERNMENT SUPPORT Long-term supporters of open source within the government include Office of the Chief Information Officer, Robin Pape, minister for the Cabinet Office, Francis Maude and advisor to the Efficiency and Reform Group, Liam Maxwell. With his recent appointment to Government Chief Information Officer, the use of OSS throughout

This year, strong guidance on how to procure open source software and assess its suitability, plus a catalogue of applications is expected to be pushed through internal government, which confirms its position in the mainstream arena. consumers the freedom to choose solutions that can be built, tailored and adapted to their specific needs without the fear of prohibitive licenses and vendor lock-in. Its key benefits include robustness, simple implementation and low maintenance. It does not directly attract renewal costs or fees and due to its flexible nature, OSS lends itself well to skunkworks projects. These advantages are key when it comes to the public sector’s current standpoint – it is keen to find ways to reduce costs, whilst providing an increasingly efficient service, with changes in procurement now focused on getting greater value from each purchase made. These changes in procurement also include re-use costs, which have always been an issue with proprietary systems that lock users in, so it comes as no surprise that the

government is sure to gain momentum. Mark O’Neill, leader of the Cabinet Office’s skunkworks team, is currently developing low cost IT applications and advising on the procurement of large projects. Although still early days, he stated in a recent interview: “We are looking at the community aspect as it is intended to provide faster, more agile ways of getting things done and the community aspect is key.” WHO IS MAKING THE TRANSITION? The Department of Health’s vision is to enable greater transparency of information, which includes the ability to access said information from the location it is needed, whilst restricting who can access it. In 2010, the DoH expressed an interest in a number of open source initiatives that were submitted during the Information Revolution consultation. Many government departments are

considering a move from proprietary software to an open source alternative; NHS Scotland is investigating the use of open desktops, which will encourage the use of OSS applications and other programmes that store data in a manner that can be used by other applications. There are numerous open source and free applications that are being specifically developed for the healthcare market, such as DentalOpenERP, which enables dental suppliers throughout the UK and Europe to run more efficiently and covering all operational processes in one open source solution. DentalOpenERP has been designed so that in time, it can be successfully deployed within various other primary care settings. In addition, this July, the government’s technical innovation hub, DotGovLabs, hosted a ‘Dragon’s Den’-style competition to decide on the winner of this year’s Healthcare Challenge prize. The winner was Rob Dyke of Taxtix4, who has assisted the University of York in conjunction with a Knowledge Transfer Partnership (KTP) to develop a healthcare-specific hub for open source software development, in conjunction with BCS, PHCSG and the ehealthopensource ecosystem programme. UNDERSTANDING THE ISSUES Many of the systemisation challenges faced within the healthcare industry are shared with the majority of other industries – projects become too large, objectives are not clearly specified and the people creating the applications are removed from the people using it. Factors such as these can create a product that simply does not fit the use and in some cases, can reduce efficiency rather than enhance it. The case for closed or proprietary software is that the supplier often gains domain experience and is able to spread this learning over multiple sales of the same package. However, larger gains can be made if the lessons learned are shared freely within both the healthcare and technology industries, thereby soliciting greater review and collective benefit. When designing the functional aspect of the system, the focus should be on the process needed, not what the current software does. E



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OPEN SOURCE SOFTWARE E Healthcare was in practice long before IT was introduced; therefore, technology should be used to streamline these established processes with rapid information retrieval, security and efficiencies. Users and their environment need to be taken into account, with adaptations to suit where appropriate. As with any application, professional skills are needed to enable it to be optimally used. Plus, finding the right sized building blocks to build the nation’s healthcare systems is essential – too small and the costs and time are great, too large and they will not allow for the flexibility and fine tuning needed to meet the unique demands of a modern healthcare industry. CREATING THE SOLUTIONS As open source has contributors from across industry, it naturally attracts innovators to create solutions to problems as well as refiners who iron out the finer points and both have the freedom to build and perfect the systems. The Open Health Tools Project supports the Integrating the Healthcare Enterprise (IHE) initiative, which intends to bring together a standard set of information that can be implemented across healthcare systems enabling new products and services to be introduced whilst maintaining compatible information. This project has a community of healthcare and technology industry

professionals working together toward a common goal. This is in contrast to the closed approach, where a system is developed in isolation by a single organisation and sold into the market without the opportunity for the users to affect its design and usability. By building one common system that can be adapted for use across multiple sites and departments, it results in less training and a deeper knowledge of the implemented technology across the organisation. In addition, with an OSS system, there are no ongoing software costs and users have the ability to independently tailor the system to suit their unique requirements, both during the initial build and as business requirements change. Finally, there are the exit and retirement strategies to consider. Proprietary systems ‘lock’ the user in; therefore, in order to retrieve essential data from their system, users may have to engage a consultant to reverse engineer the information schema. Plus, some license restrictions may prevent organisations from using external parties, creating a costly exit strategy and leaving them with no choice but to pay the vendor to export your key data. With OSS, open standard and open data, users enjoy no such restrictions – they are able to view and introspect all components of their systems and the data contained. Therefore, it is a lot easier to access and export business

Healthcare IT


About the author Stuart Mackintosh is the MD of OpusVL. He is a member of the government’s OSS implementation steering group, which governs and monitors the effective adoption and use of open source technologies through government departments.

logic, functions and data from an open system, thereby dramatically reducing the exit cost. LOOKING TO THE FUTURE Once marginalised in favour of proprietary software, open source is finally making waves in the corporate and political worlds. Its philosophy, methodology, flexibility in its usage and modification and obvious cost benefits simply cannot be ignored. No matter how you look at it, OSS has a significant part to play in the future of IT. However, irrespective of the type of system an organisation chooses, technology should not be used to solve process problems and can never be expected to overhaul a organisation’s operations alone – it is only through understanding the issue and resolving it that IT can then be implemented to enhance and streamline the offering. L

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with the Environment Agency for proper disposal. We are registered with the Information Commissioner’s Office and comply with the Data Protection Act. Secure destruction is carried out to BS 15713:2009 Standards as we are members of BSIA. Members of staff are security vetted and CRB checked. We provide secure bins and also lockable consoles in a variety of finishes for office environment. We also supply sacks and ties for your confidential documents for shredding offsite. FOR MORE INFORMATION Tel: 0845 2570022 Fax: 0845 2570033

Founded in 1999 by Stuart Mackintosh, OpusVL has become one of the UK’s leading names in open source software (OSS). OpusVL brings a fresh, innovative and flexible approach to software solutions, utilising best of breed open source and communication technologies, thereby reducing the task of writing software by re-using and assembling modules carefully selected from cutting edge operating software platforms and a library of proven software components. OpusVL can customise a unique solution that will address and resolve a multitude of challenges, such as increasing efficiency, reducing the bottom line and streamlining productivity. One size certainly does not fit all; OpusVL will engage with the client in order to gain a deep understanding of the business processes and challenges

involved, before designing a solution that meets the client’s specific business objectives. OpusVL’s technology is used by a variety of international organisations, such as JP Morgan, RBS and MAN Group, as well as the retail, corporate and government sectors. In addition, MD Stuart Mackintosh is a member of Cabinet Office’s OSS implementation steering group, which will govern and monitor the effective adoption and use of open source technologies through government departments. FOR MORE INFORMATION Tel: 01788 298450 Fax: 01788 298113



Healthcare IT



BEING SMARTER WITH THE DATA WE ALREADY HAVE John Backhouse, Information Builders’ regional programme director for healthcare, explains how to overcome NHS data difficulties and make the most of existing IT implementations After a series of costly contracts, failed deliveries and shifting goal posts, the objective of electronic patient records for everyone in the country looks set to be abandoned. After nine years and £2.7 billion, the National Audit Office has reported that the National Programme for IT has failed. However, the NHS remains tied into contracts whilst hospitals, ambulance crews, mental health units, community care teams and doctors’ surgeries still wait for working computer systems. KEEPING PATIENT DATA SAFE The National Programme for IT was developed in response to concerns about the need to safeguard patient data. But with £4.3bn remaining to be spent by 2015-16, the NHS faces a decision whether to stop development



now or continue with a failing project. The Department of Health has already abandoned the original scheme’s aim of storing all NHS information in a single system, spanning thousands of separate NHS organisations. It has opted instead for one set of common rules so that disparate

systems can share what information they have, a proposal that was originally on the drawing board when the DH first embarked on the National Programme for IT scheme. From a public perspective IT and the NHS have had a rather troubled history, particularly in recent years. E

The National Programme for IT was developed in response to concerns about the need to safeguard patient data. But with £4.3bn remaining to be spent by 2015-16, the NHS faces a decision whether to stop development now or continue with a failing project.

The continued evolution of technology within the healthcare sector is vital to helping overcome the many challenges we face, especially as we continue to live longer. E Analytics in healthcare is currently very poor, and despite the clear and verifiable benefits it can provide, it simply hasn’t been a priority for key decision makers. There are some core processes that are being transferred from manual tasks to automated and algorithmic decision making systems, but for the most part people in this area are just playing catch-up. PREDICTIVE ANALYSIS One of the biggest challenges is building sufficient data for predictive analysis. While there is usually plenty of historical data, in most cases it is tied up in legacy systems – requiring huge, and often error-prone data extraction and migration projects. Furthermore patient data is frequently spread across multiple systems, so even managing to maintain consistency in a local environment can be difficult, never mind trying to migrate or synchronise that information between trusts or different health departments.
 However, it’s not all doom and gloom. There are steps that can be taken to help NHS departments to get more from their IT implementations. As with any significant project, the key is to take a step-by-step approach rather than trying to the tackle such a mammoth task in one fell swoop. First and foremost people should identify the low-hanging fruit – look for the processes that can be easily automated and the data that is the simplest to extract and analyse – and then start looking at more complex additions such as business intelligence, reporting and predictive analysis. This helps to avoid the loss of focus that usually arises when a project becomes too large and unwieldy and also delivers some quick returns-on-investment, which is vital for the continued support of users and management alike. As the NHS remains answerable to the public purse, visible success and fast returns are essential if they are to retain public support.
 SHARING BEST PRACTICE Next, it’s important to remember that healthcare is universal, and so sharing lessons learnt across the sector as a whole is vital. For example, some hospitals in the Netherlands are doing length-of-stay predictions based on the conditions presented by patients. This helps better map and analyse the impact on each ward and improve levels of space and staff utilisation. However, IT personnel within the NHS can also look to other industries for cases of best practice. There are plenty of examples of projects within sectors such as banking or retail that can be adapted to deliver significant improvements to the healthcare industry. Single customer view (SCV) projects share many of the key elements involved with patient data integration programmes. Many SCV projects have been successfully implemented on a vast scale across huge organisations with multiple legacy systems drawing parallels with the size and scope of the NHS.
 The continued evolution of technology within the healthcare sector is vital to helping overcome the many challenges we face, especially as we continue to live longer. Cost is not necessarily the defining factor here. It’s about being smarter with the information we have. If the NHS is to make the most of technology to streamline operations while improving patient care, it needs to break out of the cultural narrow-mindedness that currently plagues it and look outward for examples of best practice and inward for ways of making better use of the data to hand. L

Healthcare IT


INTERNATIONAL SUMMIT 2011 INFORMATION BUILDERS INTERNATIONAL SUMMIT 2011 With any type of navigation, smart decisions are made by combining reliable tools with accurate data. Navigating your business should not be an exception. This year, we’re extending our popular annual Summit event to our international regions. These one-day international events provide a unique opportunity to learn and network on a regional basis with your peers, industry experts, and the Information Builders team. The next event is taking place on the Tuesday 27 September at Mandarin Oriental Hyde Park, London. The events are a great way to sharpen your skills and enhance your knowledge of business analytics, data governance and management, metrics based management, and self-service BI and dashboards. Event highlights: • Learn more about business intelligence (BI) and enterprise information management (EIM) trends and strategies in keynote presentations from industry experts • Find out how your peers and our customers successfully implement BI and/or EIM • Meet with Information Builders executives and product experts to learn more about our solutions and products • Visit demo stands to see the latest applications and solutions from Information Builders and our partners • Network and learn in order to stay sharp on the latest technologies and topics in BI and EIM Featured speakers include Tim Jennings, Ovum’s chief analyst for Enterprise IT, Dave Watson of iWay Software, and Dr Nikki Dowlman.

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Obesity Management Written by professor David Haslam, GP and chair of the National Obesity Forum




The number of overweight and obese people in the UK is on the increase, meaning the financial costs associated with obesity are also on the up, with the NHS paying a heavy price Obesity is wreaking havoc on the UK population’s health, and on its bank balance, yet evidence suggests that it can be managed successfully and cost-effectively. The Public Health White Paper ‘Healthy Lives, Healthy People’ threatens to derail the medical management of obese individuals, by diverting funds from NHS treatment into localised prevention initiatives, despite the fact that a quarter of the adult population already suffer from obesity and for whom prevention has long been irrelevant. GP consortia will have the autonomy to decide whether or not to prioritise the identification, screening and management of obese individuals, or to save money in the short term by ignoring obesity, turning a blind eye to its delayed but expensive complications such as diabetes, heart attack and stroke. IN THE PAPERS “£80m bill for obesity: Benefit claims by those too fat to work have soared under Labour,” reported the Daily Mail.

BMI of 18-25. These diseases can ultimately curtail life expectancy. Some studies have shown that severely obese individuals are likely to die on average 11 years earlier than those with a healthy weight.” PRESCTIPTION COSTS Obesity increases drug prescribing in all the most expensive categories. In a costeconomic analysis by the Counterweight team a higher percentage of patients who were obese, compared with those of normal weight, were prescribed one or more drug in the following disease categories: cardiovascular (36 per cent versus 20 per cent), central nervous system (46 per cent versus 35 per cent), endocrine (26 per cent versus 18 per cent), and musculoskeletal (30 per cent versus 22 per cent). All of these categories had a P-value of <0.001. Other categories, such as gastrointestinal (24 per cent versus 18 per cent), infections (42 per cent versus 35 per cent), skin (24 per cent versus 19 per cent) had a P-value of <0.01,

Obesity is headline news, because of the effect is has on all aspects of life, including the financial costs to the individual and the tax-payer. Obesity prevalence in the United Kingdom has tripled over 25 years, a quarter of UK adults possessing a Body Mass Index (BMI) >30kg/m. “Fat people will cost £75 more to bury than those who are thinner, because they take up more space in a cemetery,” reported the Daily Telegraph. Obesity is headline news, because of the effect is has on all aspects of life, including the financial costs to the individual and the tax-payer. Obesity prevalence in the United Kingdom has tripled over 25 years, a quarter of UK adults possessing a Body Mass Index (BMI) >30kg/m. Official figures from the Department of Health (DH) in 2010 estimate the financial impact of obesity on the NHS at £4.3bn. The DH reported that: “Around ten per cent of all cancer deaths among non-smokers are related to obesity. The risk of coronary artery disease increases 3.6 times for each unit increase in BMI, and the risk of developing type 2 diabetes is about 20 times greater for people who are very obese (BMI >35), compared to individuals with a



while respiratory diseases (18 per cent versus 21 per cent) had a P-value of <0.05. Total prescribing volume was significantly higher for the obese and was increased in the region of two-to-fourfold in a wide range of prescribing categories: ulcer healing agents, lipid regulators, adrenoreceptor drugs, drugs affecting the renin-angiotensin system, calcium channel blockers, antibacterial drugs, sulphonylureas, biguanides, NSAIDs, fibrates, and thyroid drugs. The impact on prescribing volumes in obese patients is from numbers of patients treated, greater dosages and longer duration of treatment in those who are obese. It concluded that obesity more than doubles prescribing costs in most drug categories. PRESSURE ON FACILITIES Counterweight also demonstrated the increasing burden obesity puts upon GP, nurse and hospital time, whether or not

co-morbidities are present in an individual. For every co-morbidity category, and at similar ages, obese patients visit the GP more often than their normal weight counterparts. Even when no co-morbidities are present, the obese make more visits to the GP and PN. Obese individuals make significantly more visits to hospital outpatient units than normal weight patients, and are admitted to hospital more often. So obesity is a major health hazard and a massive expensive to the NHS and wider economy. Even a decade ago the National Audit Office assessed how dire the situation had become: citing 30,000 deaths a year and 18 million sick days attributed to obesity. However in 2001, £480 million was spent on treating the consequences of obesity, but only a paltry £9.5 million was spent on treating obesity. Similarly in Scotland only two per cent of the total obesity-related expenditure is spent on treating obesity and 98 per cent is consumed by the treatment of co-morbidities . Healthcare provision is at a crossroads thanks to the NHS reforms. Although the management of obesity, including identification, screening for co-morbidities, global risk reduction and management of co-morbidities, will be in the hands of GP consortia (and could be transformed for the better and arguably save the NHS from future bankruptcy), funding for interventions is E

and of cardiovascular and microvascular complications such as myocardial infarction, stroke, blindness and amputation. One paper demonstrated cost savings of £1,500 per patient in diabetes management alone after surgical intervention after ten years compared to conventional treatment, a sum which would be much higher if cost savings for other conditions was taken into account.

Obesity Management


OTHER ROUTES Yet PCTs are routinely ignoring NICE guidelines by turning down patients deemed appropriate for surgery by NICE, using their own, arbitrary, non-evidence-based thresholds. Some patients are therefore denied life-saving treatment, others are even being forced to deliberately gain weight to meet strict local criteria. Lifestyle interventions alone for weight loss can achieve impressive results, thereby reducing future costs; the Diabetes Prevention Programme induced only 4kg sustained weight loss at four years, but reduced the cumulative incidence of diabetes by 58 per cent over that period. Mean weight loss in attenders on the Counterweight programme of diet and lifestyle intervention in General Practice, was 3kg and 2kg at 12 and 24 months, both 4kg below expected weight given the normal 1kg/year background weight gain in the general population. Counterweight delivery cost is £59.83 per patient, and therefore costdominant proving that it is cheaper to treat an obese patient than not to. GP consortia will have the power to ensure weight management in obese patients is prioritised, to commission a wide variety of weight management services and to remove the barriers to bariatric surgery. This approach would save a vast amount of money in the long term, but there is a danger that commissioners might be too myopic to appreciate long-term gains. L FOR MORE INFORMATION

E actually at high risk because of the delay in savings appearing on the balance sheet. But the price of doing nothing is far too high. The resulting NHS costs attributable to overweight and obesity are projected to reach £9.7 billion by 2050, with wider costs to society estimated to reach £49.9 billion per year according to the Foresight report. UNDER THE KNIFE Bariatric surgery is a good example of an anti-obesity remedy to demonstrate the financial benefits; weight loss is sufficiently rapid and clinically meaningful for its economic impact to be assessed within a short time span. In its report Shedding The Pounds, the Office of Health Economics looks at wider societal savings, rather than simply health costs taking into account the potential of patients to return to work post-bariatric surgery: “The contribution of additional paid work generated following bariatric surgery offsets the costs of surgery. This is achieved one year after surgery. There are also benefits through reductions in benefits paid and, although the evidence base is limited, savings for the health service that can also be realised. Around one and a quarter billion in savings to the economy could be achieved if 25 per cent of eligible patients received bariatric surgery. In addition, from the government exchequer point of view, around £150m per year in benefits would be saved.” Additionally, although the gastric band and the Roux-en-Y gastric bypass cost around £7,000 and £12,000 respectively, the clinical costs of the reduction of drug prescribing, clinician visits and the reduction of disease and health risks offset the cost of surgery within three and a half years of surgery being undertaken. To understand this it should be considered for example that with the insertion of a gastric band, up to 73 per cent of cases of newly diagnosed type 2 diabetes achieve remission, and around 80 per cent of all cases of type 2 diabetes with gastric bypass thereby avoiding the massive costs of hypoglycaemic agents,



critical need for improved healthcare in a post war Britain. It has been faced with ever increasing costs as a result of advances in medical knowledge, medicines and technology. To the contrary it is faced with financial restrictions that are inevitable in a centrally funded service, with changing management perceptions and political beliefs. I wonder if Mr Bevan in 1948 had been blessed with the power of foresight whether he would have led Britain down the same health pathway.

Written by Dawn Stott, managing director, The Association for Perioperative Practice

Operating Equipment




As the incidences of traumatic injuries, cancers and cardiovascular disease continue to rise, the impact of surgical intervention on public health systems will grow It is often so easy to forget how lucky we are here in the UK and what benefits we, as a nation, enjoy through the NHS service available to us all. Established around an ideal that good healthcare should be available to everyone, regardless of wealth, the NHS was launched 5 July 1948. The government thereby took over responsibility for all medical services with free diagnosis and treatment for all. Having exceeded 60 years of service the NHS, whilst under continual media scrutiny, continues to provide an excellent standard



of care to our population – old or young. When health secretary Mr Aneurin Bevan, the son of a Welsh miner, opened the Park Hospital in Manchester, Britain embarked on a hugely ambitious plan to bring together for the first time hospitals, doctors, nurses, pharmacists, opticians and dentists, as one organisation that would be free for all at the point of delivery. The plan was, and still is, that the service would be financed entirely from taxation. The concept was created to meet the

USING THE SERVICE As a nation we all use the service whether it is through primary care or secondary care intervention and I am sure we can all sight cases of good and bad service. A lot depends on where we are placed geographically in the country and how well or badly the Primary Care Trust is managed in that area. Generally speaking, however, we take for granted that if we need to be seen by a doctor, we are seen at no cost. In an ever-changing healthcare environment it is important that standards are set to meet the changing needs. Innovation in healthcare commissioning means that an increasing diversity of providers will tender to deliver minor and intermediate surgical services. Implementation of government targets requires an ongoing need to assess and improve the efficiency of care and that patients are treated safely by dedicated healthcare professionals motivated to deliver the highest standard of care to everyone. The NHS operating framework 2010/11 confirms that focus remains on stability and improvement in terms of front line services: “We must continue to: • Deliver safe, high quality service with rapid improvement where there are unacceptable levels of variation • Deliver on those priorities that matter most, both nationally and locally, and • Provide cost-effective services to keep people well, alongside delivering appropriate care at the earliest opportunity when it is needed.” INNOVATION IN SURGERY Innovation in surgery has meant that more people’s lives are being changed or indeed saved. During a recent visit to the Thackray Medical Museum in Leeds I was reminded of how far we have come in such a short space of time. Technology has revoluntionised surgical care through advances in monitoring, infection prevention, training, safety standards, less invasive intervention – the list is endless. Technology has also provided our patient population with the wherewithal to understand better the care/interventions required and with this has come high expectations and the knowledge to be able to question and challenge over the care provided. At The Association for Perioperative Practice (AfPP) our aim is to advance health by improving patient care in the perioperative environment. We do this through determining standards and E

E promoting best practice through training and education for our membership which is made up of theatre practitioners working in operating departments, associated areas and sterile services departments. As part of AfPP2010 we challenged our medical device partners to show us their best innovations and we were pleased to see that even in the 21st century there are changes and improvements still being made to ensure safer surgery for patients. Our winning entries ranged from efficiency gains through collaborative working; to a retractor used in gynecological procedures to improve patient safety and reduce needle stick injury; to an infection prevention solution to cut down on surgical site infection; to a single use intubating scope and also a single use tray made from recycled products. The BUPA Foundation recently awarded a grant of over £200,000 over three years to a study that is seeking to develop an endoscopic instrument for keyhole surgery that will give surgeons information they can usually only obtain by touch when performing conventional open surgery. If successful, this will dramatically increase the diagnostic value of keyhole surgery. As I touched upon above information technology is also assisting surgical outcomes and patient efficiencies through the use of SMS messaging surveillance and studies have shown that this has decreased the outpatient waiting times and increased the quality of post surgical care.

when referring to medical innovation and robotic prostatectomy is real procedure for patients with prostate cancer. Robotassisted surgery was developed to overcome limitations of minimally invasive surgery. Instead of directly moving the instruments the surgeon uses a computer console to manipulate the instruments attached to multiple robot arms. The computer translates the surgeon’s movements, which are then carried out on the patient by the robot. Other features of the robotic system include, for example, an integrated tremor filter and the ability for scaling of movements (changing of the ratio between the extent of movements at the master console to the internal movements of the instruments attached to the robot). The console is located in the same operating room as the patient, but physically separated from the operative workspace, or in another place. Since the surgeon does not need to be in the immediate location of the patient while the operation is being performed, it can be possible for specialists to perform remote surgey on patients. We now have the technology to put people back together similar to that which Steve Austin the Bionic Man experienced. I heard an amazing story this week about a woman who lost both her legs in the 7 July 2005 London bombings. In an attempt to bring communities together she walked 200 miles from Leeds to London over a period of a month. Only in my lifetime has healthcare become so advanced. Truly amazing.

ROBOT-ASSISTED SURGERY When I was a girl I watched a TV programme called the ‘The Six Million Dollar Man’, about a man who was rebuilt following an horrific accident – he was said to be ‘bionic’. They used robotic techniques to put him back together which left him with the ability to, amongst other things, leap great heights, run amazingly fast and lift cars at the touch of a button, yes, the touch of a button on the back of his neck. Today we use the word robotic freely

SURGICAL SITE CHECKLIST Often, through adversity good things are achieved and the surgical site checklist is one innovation that was introduced by the World Health Organization (WHO). It identifies three phases of an operation, each corresponding to a specific period in the normal flow of work: • Before induction of anaesthesia • Before the incision • Before the patient leaves the operating room The checklist allows the surgery team to

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complete listed tasks before the operation proceeds, thus ensuring safety to the patient. WHO has undertaken a number of global and regional initiatives to address surgical safety. The Global Initiative for Emergency and Essential Surgical Care and the Guidelines for Essential Trauma Care focused on access and quality. The Second Global Patient Safety Challenge: Safe Surgery Saves Lives addresses the safety of surgical care. The World Alliance for Patient Safety initiated work on the Challenge in January 2007.

Operating Equipment


DEVELOPING THE SERVICE In his latest missive about the NHS reform plans, Andrew Lansley has stated that sticking to the status quo for the NHS is not an option. By 2030, the number of over-85s requiring expensive healthcare is projected to reach 3.5 million, or one in 20 of the UK population, said Mr Lansley in an article for the Daily Telegraph. As a result, the NHS will have to perform an additional two million operations a year and health spending will double to £230 billion – the equivalent of £7,000 a second – in real terms, a figure the UK “simply cannot afford”, he said. These comments only enhance the need for surgical procedures; whether they are interventions, care pathways or processes, to be better and more efficient to ensure that patients are getting the best possible care available. Our invitation to apply for to our Innovation Awards this year will soon be going out to our medical device colleagues and I can’t wait to see what new innovations will be put forward to our panel of experts. The winners will be announced and recognised at AfPP 2011. L FOR MORE INFORMATION For more details about our Innovation Awards and AfPP 2011 please visit

BeaconMedæs – the medical gas pipeline systems (MGPS) specialists BeaconMedæs is the world’s leading supplier of medical gas pipeline equipment (MGPS), including medical air plant, medical vacuum plant, AGS, manifolds and pipeline components to HTM 02-01 standards. We also supply patient environment products including trunking and pendants. Certified ISO-13485 quality management, ISO-14001 environmental management and OHSAS-18001 occupational health and safety management systems, which underline our commitment to high quality services and products, whilst aiming to reduce our environmental impact and maintain a safe and healthy workforce. Our products are CE marked to the MDD, further demonstrating

our commitment to quality and enabling us to stand out from our competitors. With new hospital builds and refurbishments we are involved in the early planning stages, offering advice on the design of new systems. Our installation team is pre-qualified through Safecontractor, CHAS and Constructionline, offering unrivalled expertise with our products. With a proven track record of delivering projects on time we can help you out. Following installation, we can provide preventative maintenance

contracts and emergency repair services. Medical gas service and support is central to everything we offer our customers. Including full mainland coverage and emergency 24hour call-out, seven days a week so we always have your medical gas systems covered. FOR MORE INFORMATION MEDAES Ltd - trading as BeaconMedæs. Part of the Atlas Copco Group. Telford Crescent, Staveley, Derbyshire S43 3PF, UK Tel: 01246 474 242 Fax: 01246 472 982




3 Car Park Management 3 ANPR 3 Car Park Products

At Parking Control Services we understand the needs of Health Services when providing parking for both staff and their patients and visitors. With the latest technology and innovation we take the hassle out of staff parking by introducing automatic number plate recognition systems linked to pay on foot technology which ensures consultants, doctors and staff park with ease. No need for permits or administration our system simply recognises your number plate and simply lets you in the car park. We can also install new pay and display equipment

3 Car Park Wardens 3 Pay & Display 3 Wheel clamping with remote access. Clients may pre-book online as well as receive discounted parking on site through validators at all reception points. Customers can also pay by mobile phone. Special tariffs can be applied at any time to individuals rather than generally. Our on-line systems provide accounts with all the latest revenue and statistical information. Our philosophy is to keep Parking as flexible and adaptable as possible. Our customer focused approach in this very sensitive environment compliments our approach through technology.

Parking Control Services can also provide the necessary resources to help fund such projects. Why not contact our commercial team at or call us on 0800 970 5109.


Many hospital premises are moving from traditional methods of parking management to more technologically advanced systems to enable such critical infrastructures to run more effectively Parking is high on the agenda when it comes to enhancing hospital facilities, developing new initiatives and delivering targets. Yet with government budget cuts and a greater focus on improving standards, there’s increasing pressure on local authorities and commercial organisations to deliver cost-effective and efficient parking solutions that meet the needs of a diverse range of users. Bringing together the interests of hospital car park users including staff, visitors and patients, in addition to those of an NHS trust and its stakeholders, can be extremely challenging yet an increasing number of hospital premises are moving from traditional methods of parking management to more technologically advanced systems. An integrated approach to management is thriving in the healthcare sector, enabling such critical infrastructures to run more effectively. IMPROVED INTEGRATION The trend for Internet Protocol (IP) integrated parking systems started a few years ago and it is fast becoming the set standard within the healthcare sector. Fully IP-based parking systems have set the tone for modern solutions because they allow complete integration of both video and audio, with the facility to utilise cameras, phones, access control readers and intelligent input/output modules. Such products can be easily incorporated into modern parking systems, which creates a user-friendly and cost-effective system for hospitals. The technology also allows authorised users secure remote access from anywhere in the world in order to remotely intervene, update features, access intercom linked to CCTV and monitor alarms by way of e-mail messages for specific requests or maintenance enquiries. For many hospital trusts the need to transfer data is paramount for improving and developing procedures. The electronic exchange of medical, financial and administrative data information across healthcare orientated computers is already promoted by international standards such as Health Level 7 (HL7), so the installation of parking systems with IP technology further enables hospitals to link data with management systems already in place. By utilising links between car park systems and hospital management systems, the control of staff parking is dramatically improved, which also allows better optimisation of visitor parking. In addition, it becomes easier to manage hospital access times as parking requirements can be linked to staff working hours, leaving more spaces available for visitors. FINANCIAL BENEFITS Improving parking is not just about providing better services to staff and visitors, but for many it is considered as financially beneficial. By installing a more advanced system, car park financial data can be passed directly to the hospital’s accounts department, avoiding the costly delays of manual inputting of data and human error. All standard equipment works on the basis of Transmission Control

By utilising links between car park systems and hospital management systems, the control of staff parking is dramatically improved, which allows better optimisation of visitor parking.

Protocol (TCP) and IP by means of LAN/WAN network connected to a server. Separate systems that normally need external connections become redundant and this can also provide large financial advantages with fewer investments necessary in equipment and wiring. The move to video and audio offers added benefits to hospital management and users. The use of intercom and IP cameras for video surveillance can increase the feeling of security and improves the services provided to users of the parking facility. During the day, calls via intercom can be connected to the corresponding camera so that in a simple manner the service can be insured. For night time usage, both the audio and image can be connected through to a guard service, so the same service level can be maintained. ANPR Automatic Number Plate Recognition (ANPR) can also be incorporated directly into the parking system using independent ID cameras. This not only improves the functionality available to the car park manager, including scenarios such as control of lost tickets for visitors with the number plate linked to the ticket, but season card access can also be improved using the number plate as the primary identification. L

Written by Amano UK




Hospital Parking Solutions from RTA Associates Ltd Parking provision at hospital sites is limited due to pressures on land use, cost of provision of maintenance and security and the demand for parking usually exceeds supply. Each site has unique problems that need to be identified and prioritised. Over many years of centralisation and specialisation of types of healthcare provision on a hospital site, parking provision has been low down in a site’s development priorities and in some cases added as an afterthought. Legislative changes to charging for parking has revealed an urgent need for a review of parking stock. Effective remedies are possible to maximise usage of spaces and to prevent unwanted long term parking on and around hospital sites. Specialist independent parking consultant RTA Associates Ltd can help

to design and implement cost effective and efficient solutions in accordance with best practice. Firm but fair management and enforcement is a key factor in producing a blueprint for each site balancing the needs of staff, patients and visitors. With over 20 years advising the parking industry, RTA Associates can draw on its experience to promote options and solutions. FOR MORE INFORMATION



Conferences & Events



ETHICAL EVENTS Corporate responsibility and carbon reduction targets have started to influence purchasing decisions and this is no different for event buyers who demand a more ethical conference package As the climate increasingly hots up so does the activity to cool down meetings. The UK’s national sustainable tourism certification programme, the Green Tourism Business Scheme (GTBS) or Green Tourism for short, has seen interest from the business market grow steadily in 2010 and rise further in 2011. Interestingly the driving forces for these activities are their corporate customers; companies, agencies and public bodies. Sustainability, carbon reduction commitments, and corporate responsibility are all influencing the market and the Green Tourism scheme provides a practical, cost effective framework for conference centres and events venues to deliver what their customers want. The Green Tourism scheme has seen significant interest from these markets over the past two years. Pricing requests and conditions for bookings from public agencies and corporations are requiring not just a commitment to the environment but a nationally recognised third party certification that includes social issues as well as environmental best practice. FACE TO FACE “There will always be a need for face to face meetings,” says Jon Proctor. “We’re a species which thrives on communication, so we’ll always need to get together, no matter how well the internet is able to share information.” Still, Jon believes we can all be more green and responsible while we network. That’s inevitable: he is, after all, technical director of Green Tourism which currently has over 2,400 members, including over 60 conference centres and events venues. In order to pass through the certification programme, sites follow a common framework which considers energy, waste and water monitoring and targeting as well as key performance indicators in social and environmental activities. A sense of place is also important and this is measured through further voluntary indicators. To assess how sustainable a venue is, the Green Tourism auditor on the site visit assesses 145 different criteria – everything from the kind of fish on the menu to proficiency in waste management and the control of heating and cooling. Through this process potential practical improvements are readily identified and these form part of the action plan set for each site in moving forward. “Good advice is an essential part of our certification programme,” said Jon. “The assessment process verifies the actions



undertaken thus far and at the same time points out potential improvements and savings. We provide a range of online tools for members to help manage their venues better, identify potential projects (through case studies and fact sheets) and record and promote achievements.” Businesses and venues are scored and receive a Bronze, Silver, or Gold award, based on their level of achievement. Many of the measures relate to providing a better experience for their customers and ensuring that the venue is reducing the environmental impact of the meeting for their clients. ENERGY SAVINGS In a recession going green with the Green Tourism Business Scheme makes as much sense as during the boom years. As energy prices become a greater proportion of the running costs of leading business venues, innovative and well proven practices need to be established. “Overall businesses in the GTBS have been tracking a 5-40 per cent energy saving based upon our records.” said Jon. “Sites just starting out on this journey often make the biggest savings through acting upon our recommendations and a number of sites seek to receive an advisory visit ahead of the accreditation audit.” “It continually surprises us that there are significant untapped savings available to conference centres, from improvements to air handling systems, maintenance regimes and motor drives to new technologies and management systems,” added Jon. “Over the last three years our Green Tourism assessors have seen our venues respond to this challenge with tremendous enthusiasm and innovation and there are many examples of good practice.” GREEN VENUES Edinburgh International Conference Centre (EICC) has designed a Sustainable Events Programme, Plan-it green™ that helps the business and its clients to minimise emissions across a range of greenhouse gases. A further sequestration option is available employing a carbon sink of native Scottish woodland. EICC’s CEO, Hans H. Rissmann OBE says: “Caring for the environment must become an embedded business process in all companies, irrespective of size, as customers everywhere increasingly demand positive ‘people, planet, profit’ outcomes.” ACC Liverpool, completed in 2005, was

designed to produce half the CO2 emissions it would without any environmentallyfriendly measures, whilst using 20 per cent less electricity – lighting, for instance, is high efficiency and controlled by motion detection. It has been GTBS Gold since 2008. Rainwater is collected on the roof which is used to support flushing toilets, accounting for about 40 per cent of the water used for toilets in the venue; five 20-metre low noise wind turbines on the river side of the venue contribute to the electricity supply. This means that they have a reduced impact per attendee and they continue to develop projects to ensure all events have sustainable features. The Cavendish Conference Centre in London, also GTBS Gold, has a number of green initiatives available to conference organisers including a webinar service for delegates unable to attend in person, a travel survey of delegates, goodie bags of recycled products and use of recycled stationery. They also offer a discount on the room hire if the organisers minimise the amount of waste left at the end of an event/meeting. LOW ENERGY BUILDINGS Recently awarded a GTBS Gold, The Point at the Lancashire County Cricket Club is an excellent example of a low impact building with energy consumption reduced through LED lights, solar hot water, highly efficient appliances and excellent insulation. The recycling system is extensive and very well managed with a 98 per cent diversion rate from landfill, and there is great encouragement for guests to use public transport, which is readily accessible by Manchester’s new tram system. The Point is also very good at promoting the green message to raise awareness of environmental issues, including giving a donation to their chosen charity, MacMillan, on every bottle of fair trade wine purchased. The Best Western Valley Hotel in Ironbridge retained its Gold status recently and offers a sustainable conference package. This includes fresh local food produce, filtered tap water rather than bottled water, fair trade products and recycling options for paper, glass, plastic, cardboard and aluminium. They will also produce a certificate to provide evidence of the clients’ commitment to green objectives. We asked the hotel to comment on the interest in the sustainable conference package. “The Environment Agency has a number of training courses with us, and utilises many aspects of the package as part their own sustainability policy,” said Joanne Boddison, general manger of the hotel. “One of the main strands of the package was to enable companies that part of their green credentials prefer to use more sustainable suppliers, so we provide the green conference package as we know that sustainability continues to be important.” John McIntrye Conference Centre (JMCC) E

E also holds a Gold award. The site in Edinburgh is part of the university and has fair trade status for teas, coffees, sugars, fruit juice, bananas, dried fruit and rice. The sale of fair trade rice is linked to a school project in Malawi and so far over 70 children have been sponsored. The centre uses combined heat and power and has an in-vessel composting system to recycle food waste. All of this helps to demonstrate significant waste and energy savings in comparison to others and also helps them achieve its high rating. GREEN MEETING PACKAGE Queen Anne’s Gate, who recently was upgraded from Bronze to Silver, has established and developed its green meeting package. These conference bookings have doubled over the last year as a result. Clients they have attracted include government agencies, voluntary conservation organisations, renewable technology companies and lobby groups. The green pound now represents 18 per cent of their conference related revenue. “One of the elements in their green package, which includes a range of recycled materials, has been the change from linen table cloths to acrylic coverings saving over £2,500 per annum in laundry costs, never mind associated chemicals and transport,” said Stuart Park, the site assessor. “This goes

to show that it is the combined efforts and achievements over a broad range of measures which ultimately make a difference.” Jon concluded: “It is a most exciting time in our marketplace and we have seen all businesses we deal with really taking note and making significant strides in their eco performance. We can demonstrate that our businesses are achieving significant demonstrable improvements with increased savings as well as securing more bookings through the green pound and we are even seeing evidence that the best employees and graduates preferentially choose green businesses to work for. “However, we also notice that greenwashing is still a problem and unless businesses undertake a more thorough and holistic approach much of the objectives in energy savings, efficiency and CSR will be undermined through other activities. Going forward we see biodiversity and achieving genuine and more significant CO2 savings as growing issues important to both consumers and government which need to be more fully addressed by the sector.” Our GTBS guarantee is that we will continue to recognise the best in the sector through our three tiers (Bronze, Silver, Gold), which will raise the standards further in our next programme revision (version V) to be rolled out before the summer Olympics and

About GTBS

Conferences & Events


• Green Tourism Business Scheme members include hotels, tour operators, conference centres and visitor attractions. • Members need to score 40 per cent to receive a Bronze, 65 per cent for a Silver and 80 per cent for a Gold. • There are over 60 conference centre and events venues all listed on the website 20 of them hold a Gold award • There are nearly 700 hotels with a GTBS grading many of which have conference facilities. ensure that any certified business does not overstate their activities and achievements. It is our intention that the UK becomes and remains the leading destination in sustainable tourism and events and we encourage all readers to become partners with us in this exciting challenge. L FOR MORE INFORMATION Tel: 01738 632162

Perfect Conferences, Perfect Locations

The Birmingham Botanical Gardens

Telephone 0800 389 8950 The Centennial Centre

Telephone 0800 389 8950

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15/8/11 13:29:44



Independent Living




Naidex South, 19-20 October, is the disability, homecare and rehabilitation event for London and the South East enabling you to touch, test and compare products to aid independent living

Building on the successful launch of Naidex South last year, which exceeded all expectations, organisers are busy adding to this year’s show programme to further improve the fantastic London event. The show was launched for people in London and the South East of England and is packed full of interesting and exciting features, drawing in a new audience from this region. Naidex South takes place 19-20 October at ExCeL London, a fully accessible Paralympic venue, and visitors can register for free attendance online. MAJOR ATTRACTION As the only event of its kind in London, Naidex South provides an unmissable opportunity for the estimated 1.4m disabled people living in and around the capital to get first hand advice and guidance on the products and services available to them. With London being such a hub of organisations and institutions, it also attracts an important professional crowd, including local authorities and senior healthcare professionals. This year Naidex South is co-located with the GLA (Greater London Authority) Disability Capital Conference. The conference will take place in the venue’s Platinum Suite on 20 October and adds an even greater sense of occasion to the two-day event, with over 900 high level delegates due to attend. Coliea Bush, a carer who visited Naidex South last year, commented: “I think Naidex South is a great event, the things I have



seen are mind blowing and I came here as there is everything you need and so much modern technology all under just one roof. There is nothing else like this in London – it is fantastic. I work with a lot of disabled children, and I know there has been a real need for an event such as Naidex South.” NEW FEATURES Exciting new features have been added to this year’s Naidex South to ensure there is something for everybody. Visit the Independent Living Show Home and see the best in inclusive design, new technology and products demonstrated by the specialists in a realistic setting. The feature will incorporate living and sleeping areas, interconnected by an inclusivelydesigned bathroom, in order to demonstrate the benefit of state-of-the-art technology for both young and older people alike. In addition to last year’s Meet the OT, the extremely popular feature at all Naidex shows that offers members of the public a chance to speak face-to-face with a qualified occupational therapist, there will also be a Meet the Expert zone at Naidex South, providing a unique service designed to answer your questions and offer invaluable advice via a drop in facility. With top industry experts on hand to offer free 30-minute meetings covering a host of topics, including career options, advice on the psychological effects of disability, up-to-date information regarding the disability allowance and help

concerning your physio needs, come along to be inspired, reassured and educated. Simply make your appointment at the welcome desk. Come October, the 2012 Paralympics will be less than nine months away, so the organisers of Naidex South will be including various features related to this global sporting event. One such feature is the Paralympic Showcase, which will celebrate the talents of disabled athletes and encourage visitors to get involved in sports on the day, also offering information on local clubs they can contact after the show. Naidex South also provides disabled visitors with a great opportunity to test out their route to ExCeL before the 2012 games, ensuring that they are well prepared to travel to the venue when the time comes to cheer on the British athletes. Event director Liz Virgo commented: “We are delighted to be adding the Paralympic Showcase feature to Naidex South and intend to make it a source of inspiration to all our visitors. Not only will it showcase the Paralympic sports that will be seen during the 2012 games but it will do so in the venue where the athletes will actually be competing! The timing is perfect, as it will capture the excitement of London 2012 at a time when tickets for the Paralympics go on sale, so there is sure to be a huge buzz about the Disability Sports Showcase feature. “We are also thrilled and honoured that this year’s Naidex South will be coinciding with the GLA conference. This alongside our repeated association with Primary Care Live means that the show will be bigger and better than ever before, and it is great that so many fantastic organisations will be together under one roof.” EVENT HIGHLIGHTS As well as exciting new features, you will still be able to enjoy Naidex favourites such as the Communication and Learning Village, designed to house the latest technological advancements and supported by Communication Matters, and the Car Zone, which will have many of the UK’s leading vehicle converters, including Brotherwood and Lewis Reed, exhibiting the latest WAV developments. Healthcare professionals are invited to attend the comprehensive free CPD Naidex Conference programme supported by the Health Professions Council. This offers all attendees a CPD certificate for their portfolio. Also returning to Naidex South for a second year is KideQuip, the must see zone dedicated to children with special needs, where visitors and healthcare professionals will be able to meet and discuss individual requirements and products with exhibitors. Naidex South 2011 is shaping up to be an unmissable event for members of the public, trade and healthcare professionals alike, so put 19-20 October in your diaries now to ensure you don’t miss out on this event. Register for free entry at south by quoting priority code EPR1. L

instructor, but most of my knowledge of ECGs has been through self education over the years. In 2002, I wrote a very basic ECG book ‘Let’s Make the ECG Easier To Understand’ (Mallon, 2002) published by Media Publishing Company. This is a sort of ABC of ECGs, which has been quite successful and is still selling, mainly to nurses and ambulance staff nationwide.

Gareth Mallon, Professor Sanjay Sharma and Dr Steve Cox (CRY Deputy CEO) launch the DVD at the 2010 CRY Parliamentary Reception



Time and education could be all that’s needed to reduce unnecessary cardiac ralated deaths, as East Midlands Ambulance Service paramedic Gareth Mallon explains In the UK, 12 apparently fit and healthy people a week die from undiagnosed cardiac conditions. These are the numbers that we do know about, however, the figure could be higher. So what does this mean for ambulance and medical staff? Well, we are in a prime position to be able to reduce that shocking statistic of needless and unnecessary deaths and all it would take is a little bit of time and education. EDUCATION We are led to believe that young people and babies have not yet begun to damage their heart with smoking, long term alcohol use or general lifestyle abuse. Their hearts are under warranty and only fail under extreme and unusual conditions. As a paramedic, I have to admit that this is how things are often perceived and how I used to think myself. This is not due to ignorance but a lack of education. In training school, ambulance staff are taught to deal with many extremes of traumatic situations and medical conditions in a very short space of time. From childbirth to simple or multisystem trauma, to strokes and heart attacks, to psychiatric patients. So, we can be midwives one minute, cardiologists next, then counsellors. Most of what we learn after training school, we do on our own merits and experiences, through necessity of your Personal Development Plan (PDR) or personal interest. We are taught to deal with life-threatening and non life-threatening situations with adults and paediatrics, including the dreaded cardiac arrests. We deal with death, sometimes on a daily basis, but it is the young people who

die that are the hardest for us to cope with, even for seasoned veterans. The hardest part of this is to understand the reason behind the sudden and tragic death, which many staff don’t or, through self preservation and defence, choose not to. RAISING AWARENESS As a result I have worked with the charity Cardiac Risk in the Young ( CRY was founded in 1995 to raise awareness of conditions that can lead to young sudden cardiac death (YSCD), sudden death syndrome (SDS) and SADS. Its founder Alison Cox has worked tirelessly to reduce the statistic of the 12 young deaths a week. Some of the patrons that are associated with CRY are David Walliams, Sir Steve Redgrave, Sir Ian Botham and many other top sports personalities who feel strongly in CRY’s commitment to reducing young cardiac deaths. The latest patron to join CRY is Pixie Lott, a fantastic advocate for young people who are the target audience for the cause. Now about me, I am Gareth Mallon, a community paramedic and developing tutor for the East Midlands Ambulance Service (EMAS) and I am based in Derbyshire at the Swadlincote station. EMAS is an amalgamation of six counties – Derbyshire, Nottinghamshire, Leicestershire, Lincolnshire, Northamptonshire and Rutland – employing over 3,200 people in over 70 locations. I work on both ambulances and response cars and I have been in the ambulance service for 20 years, 16 of those as a paramedic. I have had an interest in ECGs for many years due to a very good and informative training

Paramedic Training


CARDIAC DVD I started with an idea of an educational cardiac DVD purely for ambulance staff. In the past, we have mainly had hand-medown education or non-ambulance specific information. Therefore, the idea of a DVD was for it to be tailored and directed at ambulance staff – making it more personal – with information pitched at the right level for us. The DVD has finally been released as two different versions. The first is the ambulance educational DVD in which there is a mixture of narration by the very eloquent and highly educated professor Sanjay Sharma – one of the leading cardiologists in the UK and consultant cardiologist to the CRY board. It also contains ECG examples to identify common cardiac problems, including cardiomyopathies and long QT syndromes and relevant information about sudden unexplained collapses in conjunction with the NICE transient loss of consciousness (Tloc). The ambulance DVD was so well received when reviewed and tested through various audiences and professions that another version has been produced for medical students. EXTRAS The London Ambulance Service produced a PowerPoint slide set specifically for us following my comments as a stakeholder about the lack of ambulance service representation. This is an excellent supplement to the Tloc guidelines. I also have PowerPoint presentations for both clinical staff and community organisations supplementing the DVD that have been ratified by CRY doctors for use in the health professions and community sports and leisure organisations. I have recently used these presentations for CPD training for EMAS staff. All it would take is a bit of education and something that ambulance staff are good at is listening, researching and implementing new things. Anything that we can use to help improve how we work and gain real results make us feel that we have achieved what we do, help patients and families. There is no greater feeling than that for us. L FOR MORE INFORMATION If anyone would like a copy of the DVD, to know more of what I would like to achieve or has any questions (or even better, some suggestions), then please do not hesitate to contact me and I will do my best to answer them. You can contact me on garethmallon. or on 07854 686192. You can also visit the CRY website on



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Health Business Magazine issue 11.8  
Health Business Magazine issue 11.8  

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