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SHARING EXPERTISE IN EVERY DEPARTMENT, EVERY DAY.

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B. Braun Medical Ltd B. Braun Medical Ltd is a member of the B. Braun Group, one of the world’s leading healthcare companies. B. Braun manufactures and distributes on a global basis, employing more than 40,000 people worldwide. Our global message - Sharing Expertise - clearly identifies our philosophy of the transfer of knowledge. In 165 years of development, we have acquired a wealth of knowledge that we can share with those who bear the responsibility for healthcare and associated services.

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Community Support Intensive Care Unit MRI Scanner Wards Cath Lab Operating Theatres

7: Recovery Wards 8: Education Centre 9: Consulting Rooms 10: A&E Department 11: Pharmacy 12: Aseptic Pharmacy

B. Braun offers healthcare professionals and hospitals an outstanding range of products, from our world renowned surgical instruments to our innovative implants and therapeutic systems, these are all matched by a comprehensive range of high quality services. Our ability to develop innovative products, services and systems, in partnership with healthcare professionals, hospitals, universities and other specialist bodies reflects on our commitment and promise of Sharing Expertise.

13: Outpatients Department 14: Technical Services 15: Purchasing Department 16: B. Braun Sterilog 17: Community Care 18: B. Braun Avitum Ltd

B. Braun Medical Ltd. Thorncliffe Park, Sheffield S35 2PW. Tel: 0114 225 9000 Fax: 0114 225 9111


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B. Braun Medical Ltd values innovation with NHS partners 8 Sheffield-based B. Braun Medical Ltd is a member of the B. Braun Group, one of the world’s leading healthcare companies. With a focus on innovation in practice and products, the company is delivering real results for the NHS How does NICE promote innovation in healthcare? Getting the most value out of medical technology Jackie Ganley Fielding, Regional Vice President, Medtronic UK

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MATCH Tools Workshops – distilling expertise for health technology innovation 39 Michael Craven, Alan Brown, Elizabeth Deadman, Jennifer Martin, Peter Taylor and Simon J E Taylor University of Brunel Regenerative Medicine, a unique opportunity to transform our national health and wealth, needs capability in manufacturing and supply 42 Accessing the results of remedi, the Innovative Manufacturing Grand Challenge in Regenerative Medicine, and the translational research capability in the new EPSRC Centre for Innovative Manufacturing in Regenerative Medicine and the EPSRC Doctoral Training Centre in Regenerative Medicine

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Loughborough University

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Creating a Culture for Innovation – Together we can 45 Dr. Lynne Maher, NHS Institute for Innovation and Improvement

Technologies to support people with long-term conditions University of Warwick

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Making routine Whole Room Decontamination a reality Chris Lamb, Deployment Manager of Meditrox

Better quality health for more people requires focused innovation Bettina Fitt, General Manager, UK, GE Healthcare

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Empowering innovation in healthcare Mckesson

Getting the best results from your ideas 24 How Beta Technology can help you every step of the way. Beta Technology’s leading health expert, Graham Hughes, explains Find Out More About… 27 The Innovative Technology Adoption Procurement Programme (iTAPP) Health protection and innovation models Health Protection Agency The Safest Suprapubic Catheter in the world? Mediplus Ltd NHS Evidence: Supporting you in your drive to deliver quality now

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Accessible innovation 35 The NHS needs simple, accessible solutions to meet the challenges of the coming years, writes Ian Gillespie, CEO of Vanguard Healthcare Solutions The answer to the NHS’ financial problems? Better value procurement NHS Supply Chain

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NHS Health Informatics A New Approach for Health IT Systems and Information

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Beachcroft Improving Quality and Productivity through Innovation in the NHS 53 Mark Wilkinson, Director Life Sciences Innovation, NHS Sharpsmart Reusable Sharps Containment System an innovation that ticks all the boxes

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A hotbed of innovation 58 With clever use of time, expertise and inspiration, innovation in UK healthcare is going from strength to strength – despite the current economic climate. Kathryn Senior takes a look at the projects that are revolutionising diagnostics, treatment and care within the NHS Building a Healthy Nation through Business Innovation Members of HealthTech and Medicines KTN get an Innovation Boost

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Time for a change? 65 Title: The contingent workforce: safe and cost effective NHS Prossionals

Contents

Innovation in Healthcare Jim Easton “Innovation is the key to high quality care”


Increasing productivity, demanding quality, empowering innovation… be better eQIPPed with McKesson!

“McKesson demonstrated that it has made a major commitment to the NHS and its products and services have made a real difference to healthcare in the UK.“ The British Computer Society (BCS) & Computing UK IT Industry Awards 2010 panel on awarding McKesson WINNERS of “IT Supplier of the Year”.

Trusted. Reliable. Proven.

McKesson UK European Headquarters Warwick Technology Park Warwick CV34 6NZ Tel +44 (0)870 6000 426 Email info@mckesson.co.uk Web www.mckesson.co.uk

Copyright © 2010 McKesson Corporation and/or one of its subsidiaries. All rights reserved. Products or company names mentioned may be trademarks, service marks or registered trademarks of their respective companies.


Innovation in Healthcare Jim Easton

“Innovation is the key to high quality care�

Foreword The plans for the NHS set out in the White Paper Excellence and Equity: Liberating the NHS put our health service on a course of modernisation that is ambitious and far-sighted. We need to develop an NHS that is sustainable and able to meet new demands and introduce new medical technologies. Achieving this requires innovation, and the spread of innovation able to deliver quality and value Such quality and innovation lies on the front line of the NHS. This is where clinicians strive to deliver care that meets all three definitions of quality: effectiveness, patient experience and safety. Innovation is the key to high quality care. Failure to find and implement such innovation is a lost opportunity now, and a threat to the future of sustainable NHS care in the future

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So what’s the evidence?

The NHS is on a path to modernisation which will transform it into a health service with an assured future. We must take this opportunity to secure the financial viability of the NHS so that we can deliver the high quality care we aspire to, focussing on constantly improved health outcomes and with the patient at the centre of all decision making. The Quality, Innovation, Productivity and Prevention (QIPP) programme is aiming to make efficiency savings of up to £20billion over the next four years and, starting in April 2011, this money will be invested in innovative care that results in the outcomes that matter most to patients. Let’s start with the money. When we started this journey we talked to NHS staff and our partners to explain why we needed to start making changes and to find out where the biggest efficiency savings could be made and where, simultaneously, the most effective quality improvements could happen. At the same time we looked for the clinical evidence that these changes would bring about the changes at scale and pace that are necessary for a modernisation programme of this magnitude. Based on the potential savings and the evidence, we supported local planning processes to achieve these changes, and set up national workstreams to concentrate support on these areas, which range from commissioning to medicines-use to end of life care.

Hyper Acute Stroke Units Six months after centralised stroke services were opened in London more people were given life-saving drugs to restore blood flow to the brain after a stroke. This treatment reduces lasting disabilities and could up to 400 lives a year Based on clinical evidence, NHS organisations in London decided to centralise stroke care to provide eight Hyper Acute Stroke Units (HASU) across the capital. Each HASU is staffed by stroke experts 24 hours a day to assess, diagnose with a brain scan and treat patients within a maximum of 30 minutes of arrival often with thrombolysis to clear blood clots.

Meanwhile, we also asked - what are the things that are so big they need central support and how can we use system levers like tariff and pay to make a difference. QIPP is a lens through which we need to look at everything we do if we are to move to better self management of long term conditions, easier access, effective prevention and high value integrated care for people at every stage of their lives. This is an opportunity for savings, yes, but also an opportunity to describe a future model of care for this country. We need to give staff the time to do the things that are important to them and give them the tools to do it. For example, the productive ward series introduced by the NHS Institute frees up on average 35% of staff time by putting in place better systems. Staff can then use this time to improve patient care, including better patient safety.

Latest figures show that 14 per cent of stroke patients taken to London HASU’s were given thrombolysis. This is higher than reported in any other equivalent major city in the UK or Europe. Before opening HASUs, only 3.5 per cent of London patients were given thrombolytic drugs in the equivalent six month period last year. Following treatment in a HASU patients are transferred to one of 24 local stroke units to receive specialist treatment and rehabilitation. The changes have reduced the total time patients spend in hospital from 15 days to 11, which in turn frees up beds and releases significant savings to further improve patient care. Figures show that £3.5million could be saved in six months by reducing the length of time stroke patients need to spend in hospital and by using hospital resources more efficiently.

The efficiency savings identified locally and supported by the workstreams are being reinvested in high value care for patients, treating more patients and enabling new drugs and technologies to be introduced. But, this is more than a simple business transaction. We are using innovation to design the new ways in which patient-centred high value care can be delivered while, at the same time, developing the best of what is already in the system.

Jim Easton 6

INNOVATION IN HEALTHCARE


Better, safer and less expensive angiograms Bexley Care Trust, working in partnership with the European Scanning Centre, piloted the use of advanced CT scanners to take angiograms. They found that it provided better information for cardiologists, was safer and more comfortable for patients, and cost half the price of other more invasive angiogram investigations. The new method is now being used in Bexley on an ongoing basis. The Trust saved a quarter of their £1m cardiology budget by making this change. The other main advantage of using the CT scanner instead of more invasive procedures is that it is safe – no need to have resuscitation teams on standby, and no risk of fatality. It exposes the patient to less radiation, and provides a definitive diagnosis quickly. The vast majority of patients (95%) were very satisfied with the procedure.

anywhere in the home by simply pressing a radio trigger. Sensors that are designed to detect problems can also raise alarm calls automatically. Carers can carry portable receivers that pick up any alarm signals, so they can respond quickly to any problems. Use of this technology allows patients to be more independent and also helps the NHS to save money. NHS Sheffield used systems like these to monitor patients with chronic obstructive pulmonary disease over 5 months, resulting in a 50% reduction in hospital admissions. North Yorkshire County Council saved over £1m on home and residential care costs – an average of about £3,600 per patient.

Clinicians also benefit because the new method reduces the need for multiple time consuming investigations and provides better quality information on the functioning of the heart. There are around 93,000 invasive angiograms carried out nationally each year, and if they were carried out with advanced CT scanners, the service could save around £100m.

Telehealth A number of PCTs around the country use an advanced range of telehealth systems which allow patients to live independently at home, whilst still being in close contact with doctors and carers. The technology means that patients are able manage their own health at home, rather than depend on constant monitoring by health professionals. The fact that patients are able to monitor their own health and quickly call for help also means that PCTs can reduce the number of scheduled home visits, in some cases by as much as 80%.

Innovation competition for quality indicators A key part of the modernised NHS will be the NHS Outcomes Framework. The Secretary of State for Health will use the Framework to hold the new NHS Commissioning Board to account for the health outcomes it secures. The Framework is split into five domains covering the responsibilities of the NHS, consisting of just 51 indicators, developed after a public consultation. There was strong support for three brand new indicators covering improving recovery from stroke, improving recovery from injuries or trauma and improving children’s and young people’s experience of healthcare. The Department of Health is inviting anyone with an interest in improving patient outcomes to suggest new innovative indicators for these three areas. To find out more please go to:

The most simple examples of this technology are lifeline home units that allow patients to raise an alarm call from

INNOVATION IN HEALTHCARE

http://healthandcare.dh.gov.uk/context/ outcomes/ 7


Contact: www.bbraun.co.uk

B. Braun Medical Ltd values innovation with NHS partners Sheffield-based B. Braun Medical Ltd is a member of the B. Braun Group, one of the world’s leading healthcare companies. With a focus on innovation in practice and products, the company is delivering real results for the NHS

There is no doubt that the economic climate continues to present some highly challenging market conditions in the health care sector. There are considerable pressures on costs and increasing competition. The Department of Health has to find £20 billion of cost savings between now and 2014. The drive to reduce costs within the NHS has and will continue to create a very tough environment. There is a danger that the drive to reduce costs within the NHS stifles innovation in care, which benefit patients and delivers real value for money. But, it is important that leading healthcare companies continue to invest in research and development, and to work in partnership with the academic and NHS communities to bring new products and services to the market. B. Braun Medical Ltd has a longstanding commitment to bring new

products and services to the UK market, often working in partnership with NHS Trusts and other providers. Group Chief Executive Officer, Hans Hux, said: “There is rightly a greater emphasis on, and demand for, evidence-based care solutions. “Healthcare companies have to prove new products and services work. We are continuing to work with hospitals to look at new and exciting ways of delivering healthcare.” For example, our revolutionary OrthoPilot computer navigated oper-

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ating technique scooped a global best practice award at the prestigious Frost & Sullivan Growth Excellence Awards 2010. These recognise companies that are making a positive impact with unique and innovative solutions, despite the challenging economic climate. Major policy shifts being introduced over the next couple of years will include the devolution of money and power to GP Commissioning Groups who will be charged with sourcing value for money products and services which will change the way we do business with the NHS.

INNOVATION IN HEALTHCARE


The NHS is continuing to invest but there is rightly a greater emphasis on, and demand for, evidence-based care solutions. Healthcare companies will have to prove new products and services work. There is no doubt that financial constraints and an unprecedented programme of NHS reforms over the next two years will present a challenging market for health care companies in the UK. Healthcare companies need to be ready to adapt to a very different market landscape, working closely with hospitals and general practice to look at new and exciting ways of delivering healthcare. B. Braun Medical Ltd is committed to innovation and partnership, closely linked to the NHS Innovations Agenda of transforming healthcare for patients by developing and spreading new work practices, technology and improved leadership. Recent successes for the company include securing sole distribution rights to the UK market for Quill SRS, a major breakthrough in wound closure technology, which will cut theatre time and reduce the risk of infection. This unique barbed, knotless wound closure device will provide major benefits for surgeons and their patients, particularly in gynaecological, orthopaedic, cosmetic and general surgery. Not only is operating time reduced, but because all the stress is spread evenly across the suture rather than at the knot, there is much less chance that the wound will re-open during or after surgery. A further example of the company’s success in meeting the needs of the NHS is the development of the SeQuent Please angioplasty balloon catheter which has become the subject of the first medical technology guidance issued by the National Institute for Health and Clinical Excellence (NICE).

Advisory Committee (MTAC), which aims to accelerate the adoption of new technologies in the NHS. This commitment to innovation has been recognised with a prestigious national award win for B. Braun’s Introcan Safety® cannula – a safety device which reduces the risk of needle injuries to healthcare workers and cuts the infection risk for patients. Introcan Safety won the IV Therapy category in the national Nursing Times Product Awards 2010, which recognise innovative products that offer the greatest benefits to nurses and patients. The recent trend for moving more care from hospital to the community is one that will increase dramatically over the next decade. B. Braun has developed Transcare, a homecare service which offers NHS Trusts and PCTs high quality hospital to home services in a range of therapy areas, including home nutrition, infection and pain management. B. Braun Avitum UK Ltd provides kidney dialysis treatment and services to hundreds of NHS patients, and is also introducing a home dialysis service in a further reflection of the move to community-based care.

This is the first recommendation by NICE’s new Medical Technologies

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But B. Braun believes that a continued emphasis on innovation and true partnership can and will deliver the evidence-base, value for money products and services for patients. Encouraging staff to innovate and anticipate future requirements is recognised as a key element in B. Braun’s future strategy. To this end the company has set up its own Business School, which has extended the scope of its training for staff at all levels, in recognition that having the right skills is the key to success in a highly competitive health market. Hans Hux added: “Healthcare innovation is at the heart of what B. Braun does and we are constantly trying to increase the effectiveness of our products and services. “Improving the level of care available to patients is at the heart of our development process and in the current climate is more important than ever. “The NHS is continuing to invest but there is rightly a greater emphasis on, and demand for, evidence-based care solutions. We are providing solutions which support the NHS to develop and innovate new services.”


Case study 1 B. Braun spearheads drive for more home dialysis

not everyone will be medically suitable or will want to have their treatment at home.

B. Braun Avitum UK Ltd is spearheading a drive to provide kidney patients with the choice of having life-saving treatment in the comfort of their own homes.

“But for patients who do want to go down this route, home dialysis can give patients far more personal freedom so they can tailor dialysis sessions around their work and family commitments, and can save many additional hours each week in travel time.

The company provides a home-based haemodialysis service working with NHS Trusts, including Bangor, Ipswich, Southend, York & Nottingham hospitals. The development in the B. Braun Avitum UK Ltd home haemodialysis service is aimed at helping NHS Trusts to meet government targets aimed at increasing the number of patients receiving home haemodialysis – a move recommended by NICE, the National Institute of Health and Clinical Excellence. Currently, less than 2% of patients receive home-based care, a figure NICE advises should rise to 10% by 2012. The majority of kidney patients have to travel to hospital units three to four times a week to receive treatment, with each dialysis session typically lasting around four hours. Christine McCabe, Commercial Manager at B. Braun Avitum UK Ltd, said: “The launch of our home-based service is to extend patient choice. We recognise that

“As an experienced partner with the NHS in providing haemodialysis services, we provide the highest standards of clinical and technical support for patients. “The installation, training and support programme is individualised for each patient’s specific requirements. The system is suitable for nocturnal dialysis, tailored to patients’ prescriptions and has a proven reliability record.” B. Braun Avitum UK Ltd is also working with NHS Trusts to help them meet Renal National Service Framework (NSF) recommendations for the provision of home dialysis treatment. The NSF set out a vision for the NHS to improve diagnosis and management of kidney failure in primary care and to reduce the number of late referrals for dialysis and transplants.

Case study 2 B. Braun Medical reducing NHS costs with innovative IV system Patients and NHS Trusts across the UK are benefitting from B. Braun Medical’s innovative intravenous (IV) system, which is proven to eliminate the risk of air embolism. The pioneering SafeSet IV system is saving nurses on average 25 minutes a day because it has been designed to work effectively for 72 hours without air entering the line. A unique airtight filter membrane, AirStop, acts as a barrier preventing air entering and helping to maintain a constant fluid level. A protective cap lined with a special membrane stops fluid leaking and protects against contamination so reducing infection rates. An increasing number of hospitals across the UK are now using the SafeSet system, which ties in to the NHS

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Innovations Agenda of transforming healthcare for patients by developing and spreading new work practices, technology and improved leadership. One Trust which has benefitted from using the SafeSet system is Hull and East Yorkshire Hospitals NHS Trust. Janet Page, Clinical Skills Facilitator at Hull Royal Infirmary, said: “The features of the SafeSet IV system specifically prevent air infusion, help to maintain a constant fluid level and protect against leakage and contamination. The inbuilt air inlet also removes the need for a separate device and therefore reduces the risk of needle stick injuries. “All of these features have made the use of this system both time and cost effective for our Trust. SafeSet has given us a safe product of high quality that we can be confident will help us provide the most efficient care to our patients.”

INNOVATION IN HEALTHCARE


o2health.co.uk

Spend more time with patients. Not paperwork With ø health, community teams can manage diaries and records remotely, freeing up more time to care

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How does NICE promote innovation in healthcare? How does NICE promote innovation in healthcare? Indeed, does NICE promote innovation in healthcare? It might be difficult, if not impossible, to argue that, without NICE, fewer innovative treatments would be made available for use by the NHS in England and Wales. Critics argue that the obverse is true; that NICE has acted as a barrier to innovation, and that without it, drug developers and manufacturers would enjoy a smoother ride in the journey from drug development to reimbursement. Such observers see the root of the problem in the process of health technology assessment that NICE, and other bodies like it, use to examine and quantify the cost effectiveness of innovations. The accusation sometimes levelled at NICE is that the use of health technology assessments stifles innovation and leads to inappropriate or unfair rationing of healthcare. Innovation in healthcare can be a process or a product that has a positive impact on health. An innovation may be incremental, or it may represent a very substantial advance. What health technology assessment seeks to do is answer two very important questions: Does the particular technology offer benefits in comparison with existing forms of treatment? And if so, how great are these benefits? But there is a third question that NICE seeks to answer: Would paying the price for these extra benefits provide value for money? NICE’s cost-effectiveness evaluation therefore considers both the impact and cost of a technology against the impact and cost of current NHS care. In other words, the context in which the innovation is presented is crucial. The NHS, like all healthcare systems, has finite resources, so any money spent on a new intervention is not available to spend on cost-effective care for other people with other conditions. This ‘opportunity cost’ means that if the NHS is considering adopting a new intervention, at a minimum, it generally should be associated with the equivalent health benefits that may be forgone. Decisions on a particular technology for a particular patient group, therefore, need to be made in the context of their impact on the whole healthcare system. The question of a particular healthcare system being able to afford a specific innovation depends on what additional benefit it brings over and above current care, and at what additional cost? Obviously it also rests on how much money a healthcare system has at its disposal. But even for those with the most resources, there is still a limit. ‘Rationing’ therefore is inevitable in every healthcare system that

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operates within finite resources (as most do). The issue is how, not whether, to ration healthcare. Hence there is a need for cost effectiveness analysis in the deployment of healthcare resources. According to Sir Michael Rawlins, Chair of NICE: “To meet the needs of patients and the public, innovators must provide their products at an affordable cost. If they cannot do so, it is a failure of the innovative process rather than a failure of the need to examine the cost effectiveness of innovations themselves. Putting it another way, an unaffordable innovation is not an innovation. “We live at a time of unparalleled knowledge and understanding about the biological basis of many diseases. It is essential these discoveries benefit the entire human race rather than just the rich and the powerful. We need affordable innovation.”

INNOVATION IN HEALTHCARE


Which is where NICE comes in. NICE may not have been universally popular when it was set up in 1999, but few can deny the huge impact it has had on reducing inequality of access to innovative treatments. There is even reason to think that NICE, through its programme of health technology appraisal, is boosting innovation; NICE has pioneered an approach to comparative reviews of drugs’ clinical and cost effectiveness aimed at reimbursing firms for new drugs based on how well they perform – a form of valuebased-pricing. For example, Janssen-Cilag was able to get NICE approval for Velcade, its expensive cancer drug, by offering a money-back guarantee if it did not work as well as promised. In 2009, in response to the newly renegotiated Pharmaceutical Price Regulation Scheme (which sought to put these types of hitherto ad-hoc arrangements on a more formal footing) NICE set up its Patient Access Scheme Liaison Unit. Patient Access Schemes were developed as a way of reducing the cost of a drug to the NHS and improving access to new medicines, by improving their cost-effectiveness. The unit assesses the viability of introducing national patient access schemes, proposed by manufacturers, into the NHS and advises the Department of Health accordingly. This helps the NHS get even better value for the money it spends on many of the newest and most innovative drugs and treatments, as well as enabling patients to access them. Other examples of successful patient access schemes approved as part of a NICE appraisal include: lenalidomide (Revlimid, Celgene) for multiple myeloma, erlotinib (Tarceva, Roche) for non small cell lung cancer, and sunitinib (Sutent, Pfizer) for gastrointestinal stromal tumour and renal cell carcinoma. Recent proposals for a new value-based system of pricing medicines which aims to give NHS patients better access to effective and innovative medicines recognises the need

INNOVATION IN HEALTHCARE

to evaluate new technologies in terms of their clinical and cost effectiveness. Ministers have confirmed that under the new system NICE will continue to undertake an independent and objective assessment of the benefits of new drugs. NICE’s importance was further underlined by the proposal in the Health & Social Care Bill to re-establish NICE as a non-departmental public body in order to guarantee its status and ensure it is fit for purpose. Commenting at the time, Sir Andrew Dillon, NICE Chief Executive, said: “We welcome the opportunity to review and, where appropriate, extend the perspective we use to undertake our assessment of the benefits they bring, to make sure that everything that matters to patients – and the wider NHS – is taken into account. “We also support the general principle that the NHS should pay a price which reflects the additional therapeutic benefit of new drugs. “We share the government’s ambition to ensure that the option exists for all new licensed drugs to be offered to those patients who can benefit from them, provided the price is a fair reflection of their value. “The UK led the world in the appraisal of new health technologies, when it set up NICE in 1999. It can do the same in 2014 with a new approach to managing the entry of effective new treatments into the NHS, in a way which meets the needs and expectations of patients and which uses the health service’s resources effectively.” NICE technology appraisals might be seen as an indirect form of price control — but one that has been, and will remain, consistent with encouraging innovation.

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Contact: www.medtronic.co.uk

Getting the most value out of medical technology Jackie Ganley Fielding, Regional Vice President, Medtronic UK

It is fair to say that we are facing one of the most challenging scenarios we have ever faced in healthcare in the UK. At a time when the NHS is being asked to find up to £20 billion in ‘efficiency savings’ by 2014,1 our ageing population means that the demands made on our health system are bigger than ever.

our ageing population in the future, the immediate question is how can we get the best value from medical technology to meet the current challenges faced in the NHS.

Medical technology – part of the solution, not the problem

While we all hope that the economic situation will improve over time, the challenge of meeting the health needs of an ageing population will continue. Latest figures show that on average a woman born in 2006 is expected to live to 91.5 years and a man born in the same year is expected to live for 88.1 years.2 This means the incidence of chronic disease, which increases with age, is set to rise.

While the cost of pharmaceutical products is spread over the life cycle of disease treatment, medical device therapy is frequently front loaded in cost of care. This distorts the true economic value of medical technologies, resulting in poor uptake which frequently leads to poor healthcare outcomes. The solution is moving to decisions based on value, judged on patient outcomes.

As well as the impact on quality of life, the care of people with chronic conditions consumes a large proportion of health and social care resources. People with chronic illness are significantly more likely to see their GP, accounting for about 80% of all GP consultations.3 The World Health Organization has identified that such conditions will be the leading cause of disability by 2020 and that, if not successfully managed, will become the most expensive problem for health care systems.4 Already, chronic disease costs the NHS about £7 for every £10 spent on patient care.5

The reality is that medical technologies, implemented in the right way, represent smart investments because they keep patients out of hospital and reduce acute care costs, speed up recovery and promote efficient working practices in the NHS whilst providing improved quality of care to patients. However, in order for medical technology to deliver optimum value to the NHS, it is critical that health commissioners fully embrace these interventions and ensure they are implemented in the right way.

While we need to give consideration to how we can meet the demands of

Medtronic’s innovative therapies are making a huge difference to the lives of many patients across the UK, while helping health professionals manage treatment and care costs effectively.

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In this article we give examples of just three of Medtronic’s therapies that are delivering value to patients and the NHS.

Delivering efficiencies through remote monitoring Patients with implantable cardiac devices, including ICDs (implantable cardioverter defibrillators), CRT (Cardiac Resyncronisation Therapy) and pacemakers require regular follow-ups to ensure their devices are running effectively, as well as assessing the patient’s treatments. However, outpatient visits to clinics place a significant burden on hospitals and on patients, for what is often a routine check-up. Medtronic implantable cardiac devices can be monitored remotely using the CareLink system. With CareLink, a small monitor is kept in the patient’s home which receives information transmitted, usually wirelessly, from the implanted device. The monitor sends this data through the phone line directly to the physician where the data are accessed via a secure website. Clinical teams can then review the patient data and if necessary call the patient in to be seen or for the programming of the device to be changed. Beyond routine check-ups, cardiac devices can be programmed to send Care Alerts remotely to the hospital should the device pick

INNOVATION IN HEALTHCARE


up unusual activity in the heart. In these cases, patients can be called in for treatment before their condition becomes critical, thereby avoiding traumatic and costly emergency admissions. As well as demonstrating the reliability of data transmitted remotely, studies have highlighted further benefits of remote follow-up: »» Data from remote transmission is comparable to in-clinic follow-up in 99% of cases »» Studies have shown that remote follow-up can be used to replace 50–63% of in-clinic visits without impacting on patient outcomes, such as CV hospitalisations, ER visits and mortality.6-8 Medtronic’s remote monitoring system, CareLink, is currently used by more than 10,000 people in the UK helping to reduce in-clinic time by up to 80%.9

Taking the pain – Spinal cord stimulation Almost eight million people in the UK suffer ongoing problems with pain, the second most common reason cited by incapacity benefit claimants for not working.10 Prescriptions worth a total of £584 million are written every year for painkillers.10 Chronic pain, notoriously difficult to treat, is a huge burden for patients and a drain on health resources.

Case study – Professor John Morgan, Professor of Cardiac Rhythm Management, Southampton University Hospitals NHS Trust Southampton University Hospitals NHS Trust was faced with the challenge of an increase in the Trust’s implant population, coupled with a shortage of cardiac technicians required to carry out the checks on patients’ implant devices. Back in 2003, the Trust began trialling the CareLink remote monitoring system, with 50 patients already fitted with either an ICD or loop recorder. Following a successful trial period the number of patients using the CareLink monitoring system was rapidly increased. According to Professor John Morgan, “by introducing a remote follow-up strategy, the problems faced by Southampton General Hospital regarding follow-up disappeared in weeks”. Head of Device Follow-Up, Rebecca Gough, agrees: “due to an increase in the hospital’s implant population there wasn’t enough time to see each patient at the required frequency. We can now see 40 patients remotely in the same time it would take to see nine patients in the hospital clinic.” A recent review by the team revealed that without remote monitoring the hospital would have to put on 432 new outpatient clinics every year to meet the demand for follow-up. Professor Morgan believes that changing the ways you do things is how you can get the best value from medical technology: “Innovation doesn’t mean more cost, it means putting the money into different places. By investing in new technology and new ways of doing things it is possible to save money or get more for the same.”

Spinal cord stimulation (SCS) is a treatment option recommended by NICE for adults with neuropathic chronic pain for whom conventional medical management has been ineffective.11 SCS can lead to savings across the NHS as patients reduce their reliance on medication and require fewer consultations with GPs and pain specialists.

Spinal cord stimulators modify the perception of neuropathic pain by stimulating the dorsal column of the spinal cord. The treatment is minimally invasive and reversible. Medtronic’s SCS system comprises an implantable pulse generator which sends mild electrical pulses via leads connected to electrodes, implanted surgically, near the spinal cord. Patients can control the amount of stimulation they receive using a remote control. With the latest spinal cord stimulator, RestoreSensor, motion sensing technology helps the device detect a patient’s position and adapts the stimulation accordingly.

Insulin pumps An insulin pump is a computerised insulin delivery device a little larger than a pager, which delivers insulin into the subcutaneous tissue and provides an alternative to frequent injections for type 1 diabetes patients. Combined with continuous glucose monitoring, where a small monitor ‘talks’ to the insulin pump and provides real-time glucose readings, patients can maintain bet-

Medtronic’s CareLink® monitor

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The long-term costs of diabetes are well documented.12 Reducing the costs to the NHS and improving outcomes for patients are possible by using insulin pumps to decrease the number of hypoglycaemic episodes and other complications. This not only improves outcomes for patients but saves money for the NHS by reducing acute admissions in the short term and prevents costly disease escalation such as retinopathy, dialysis and transplant over the medium and longer term. Medtronic’s RestoreSensor™ - the next generation of neurostimulator for chronic pain

Case Study – Dr Simon Thomson, Consultant in Pain Medicine & Anaesthesia, Basildon and Thurrock University Hospitals NHS Foundation Trust. Dr Thomson established a spinal cord stimulation service at the hospital in 1993 and currently treats 60 new patients a year with the therapy. Patients come from across the eastern region and many of them have suffered from chronic neuropathic pain for many years. The dependency on healthcare by patients living with pain is significant. Of the patients Dr Thomson sees, 87% have tried at least four different modalities of treatment such as neuropathic pain medication, opioids, targeted pain relieving injections, physiotherapy, cognitive therapy, TENS or acupuncture, before they are referred for consideration for SCS. “NICE concluded that SCS was a cost effective treatment option for refractory neuropathic pain in 2008. From a payors perspective, while you pay more in the first year of using the therapy due to cost of the device and procedure, at years 2, 3, 4 and beyond you make savings as patients have a better quality of life and need less medical attention,” says Dr Thomson. Crucially, there is a test phase for patients considered for SCS in which electrodes are implanted and then attached to a test stimulator to measure the patient’s response to the therapy. More than 80% of patients who are trialled go on to have the full implant but this step ensures that payors can be confident that the therapy will work for the patient. For Dr Thomson this is critical: “With SCS, budget holders can be confident they are using the local health resources appropriate to achieve the best results for the patient and reduce overall costs in this relatively neglected population of patients.”

ter control over their diabetes and can significantly reduce dangerous and costly hypoglycaemic episodes. While frequent blood glucose testing remains necessary to optimise therapy, patients on pumps can work, eat or exercise without adhering to a strict schedule of meals and injections.

NICE recommends that insulin pumps be used in children under the age of 12 with type 1 diabetes and in adults who suffer from disabling hypoglycaemia, or when HbA1c levels are high despite the patient trying carefully to manage their condition with adequate healthcare provider support.

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NICE approval and guidance on the use of insulin pumps and the possible savings from their utilisation provide independent endorsement about the effectiveness of this therapy for patients. Today, however, UK patients and NHS organisations lag behind many countries in the benefits they could see by wider adoption of pumps. Less than 4% of patients with type 1 diabetes in the UK use pumps, compared with up to 35% in the US and at least 20% in most EU countries.13

The potential to add much more value The story doesn’t end here. Medical technology goes much further: minimally invasive surgery helps to reduce recovery time and shorten hospital stays; and surgical imaging technology in complex neurological and spinal surgery helps to reduce complications and costly revisions. Currently in the UK, our adoption of medical technology is poor. Only 4.5% of the NHS budget is spent on medical technology compared to the European average of 6.3%.14 Implantation rates for ICDs and pacemakers are up to a third lower than in Europe and as we have already seen, insulin pumps are used by only 4% of people with type 1 diabetes in the UK compared to up to 20% across Europe.13 At a time when budgets are the primary focus there is a danger that too much attention will be made on short-term costs savings even though they could lead to greater costs in the longer term. The challenges we face in the UK boil down to awareness of

INNOVATION IN HEALTHCARE


Case Study – Tara Kadis, Lead Nurse, Diabetes, Mid Yorkshire Hospitals NHS Trust Mid Yorkshire Hospitals NHS Trust introduced an insulin pump service for patients with type 1 diabetes in 2005. At the time the Trust was only permitted to provide 15 pumps a year. The Trust’s excellent relationship with local Commissioners (PCTs) has meant that the number of patients benefiting from pump technology has increased significantly with 54 adults and 52 children currently using an insulin pump. The MYT Trust provides this treatment according to NICE guidance for insulin pump treatment, in a multidisciplinary insulin Pump Clinic. Almost half of all type 1 diabetic children in the region are now managing their diabetes using an insulin pump, in line with NICE guidelines recommending their use for any patient under 12 years of age. According to Tara Kadis, Lead Nurse for the diabetes service, there are several advantages to providing patients with insulin pumps: “many of our patients report an improvement in their quality of life, as their blood glucose is better controlled and the need for hospital visits is reduced. In turn, provision of insulin pumps helps them manage their diabetes better – we have seen many patients becoming further motivated as they learn more about diabetes and take control of their condition to become ‘diabetes specialists’.” In addition to avoiding costly complications later in life, Tara has seen the immediate impact of pump therapy on emergency admissions: “We had one patient who experienced a number of DKA (Diabetic Ketoacidosis) episodes, each requiring emergency admission and occasionally ICU stays. Using an insulin pump the patient has avoided further episodes of DKA, making a huge difference to his quality of life and to the cost reduction associated with multiple admissions.” The savings go further still, according to Tara: “Patients with pumps have greater awareness about their condition, so after the initial time spent to train them on how to use the pump they ultimately require less time during follow-up, saving further costs and resources.”

1. The Spending Review settlement for healthcare. Health Committee Report. The Department of Health. Dec 2010. Accessed online 14 February 2011: http://www.publications.parliament.uk/pa/ cm201011/cmselect/cmhealth/512/51208.htm 2. Population Trends No 134. Winter 2008. Office for National Statistics. Accessed online 14 February 2011: http://www.statistics.gov.uk/downloads/ theme_population/Population-Trends-134.pdf 3. Improving Chronic Disease Management. The Department of Health. 2004. Accessed online 14 February 2011: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/ documents/digitalasset/dh_4075213.pdf 4. Fact sheet: Integrating prevention into healthcare. World Health Organisation. Accessed online 14 February 2011: http://www.who.int/mediacentre/ factsheets/fs172/en/index.html 5. The Crisis in Costs. The College of Medicine. 2011. Accessed online 14 February 2011: http://www. collegeofmedicine.org.uk/crisis-costs 6. Raatikainen MJP et al. Europace 2008;10(10):1145–51 7. Al-Khatib et al. J Cardiovasc Electrophysiol 2009;doi:10.1111/j.1540-8167.2009.01659.x 8. Elsner CH et al. Comput Cardiol 2006;33:241–4 9. CareLink: Major saving in working time. Irish Medical Times. May 2nd 2008. 10. Pain should be viewed as a disease in its own right. BBC News online. 2010. Accessed online 14 February 2011: http://news.bbc.co.uk/1/hi/ health/8543561.stm 11. Pain (chronic neuropathic or ischaemic) – spinal cord stimulation. NICE Guidance. Accessed online 14 February 2011: http://www.nice.org.uk/TA159. 12. A Report from Diabetes UK 2004. Diabetes UK. Accessed online 14 February 2011: www.diabetes. org.uk/Documents/Reports/in_the_UK_2004.doc

Medtronic’s Paradigm® Veo Insulin Pump™

the benefits that medical technology can bring to the NHS and the timely adoption of these therapies. If we can address these challenges then patients will no longer miss out on vital therapies, and the NHS can take advantage of the intrinsic value that medical technology can bring.

Medtronic will be exhibiting at the NHS Innovation Expo – come and see us if you would like to talk about the value of medical technology. For more information on Medtronic and our therapies visit: www.medtronic.co.uk

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13. Good technologies going to waste. The Medical Technology Group. March 2009. Accessed online 14 February 2011: http://www.mtg.org.uk/download/ file/pdf/Briefing-notes-Good-technologies-going-towaste.doc.pdf 14. MTG Policy Statements: The Health Bill – Parliamentary Briefing from the MTG. The Medical Technology Group. Accessed online 14 February 2011: http://www.mtg.org.uk/go.cfm?do=Page. Show&pid=11


Empowering innovation in healthcare The Department of Health’s whitepaper clearly stated that the NHS must make tough cuts - and now! In addition, the coalition government demanded that clinician-led decisions will be an essential requirement to minimise the impact of the cuts on the quality of front-line service delivery. Fundamentally the NHS must ensure high-quality patient care remains whilst simultaneously improving business processes and reducing costs. These challenges are tougher than ever, with the most critical one being how to achieve these goals without impacting on service. Now more than ever, the focus is on spending smarter and investing in technology that supports NHS employees in delivering the best possible outcomes and results. It is critical that the NHS empowers its employees and managers to become innovators in every aspect of their job, from workforce management and education to ensuring ‘right care, right place, right time’ patient-specific care pathways are delivered through a medical evidencebased approach. As operators of the world’s largest integrated HR and Payroll system – the Electronic Staff Record (ESR) – McKesson has set the standard for trusted, reliable and proven national healthcare technology solutions that are making a real difference. ESR is transforming efficiency by streamlining processes, reducing costs and empowering NHS Organisations further to release more time to care and ensure focus remains centred on delivering high-quality healthcare to the patient. Enabling high-quality workforce management At this time NHS Organisations must protect its greatest asset – its people. McKesson supports the NHS with a complete workforce management solution through the delivery of ESR and a shared services approach to improving efficiencies within HR and Payroll. These offerings provide accurate, strategic information and exclusively touch every part of the employee lifecycle. As a central source of all workforce information, ESR enables complete visibility of all NHS employees along with their full employment histories, training records, Occupational Health records, GMC details, identity checks, as well as the ability to transfer the employment history for the 20,000 staff who move within the NHS every year, with ease and minimum disruption. This single system supports streamlining and automation of many HR & payroll functions which can lead to the release of real cash benefits that can be reinvested into front-line resources and patient care.

In addition, the inclusion of self-service technology enables individual employees to ensure personal information is kept up-to-date, make online requests for training and receive online appraisals. Day to day employee management is also transformed as individuals take ownership of their own career progression. This has since enabled the NHS to deliver best practice when it comes to workforce management. This McKesson-powered system is central to the NHS workforce strategy and provides a complete workforce solution for the organisation. Since implementation was completed in April 2008, the project has delivered in excess of £210m in cash and non-cash-releasing benefits (2008 OGC Gateway 5 review). Furthermore, the NHS ESR Central Team have identified in excess of £500m in annual benefit potential across the NHS, if ESR is used to its full capabilities.


Supporting care pathways through evidence When under pressure to cut costs and reduce inefficiencies, knee jerk decisions to slash departmental headcount, beds, even wards can be made. The NHS can avoid this reaction and ensure any decisions about change is supported by evidence and are aligned with local need. Using evidence-based tools enables informed decision-making, whilst maintaining the quality of care provided to patients. Indeed, evidence-based tools that support clinical decision making when determining the appropriate level of care, can not only fulfil the patient’s desire for personalised care that fits their particular condition(s), but they also support the hospital’s need to cut costs as a result of reducing avoidable admissions and unnecessary increased lengths of stay. McKesson’s utilisation management and appropriate level of care solution InterQual®; a clinical decision support tool that provides medical evidence-based guidance, helps ensure that patients receive the right care, in the right place, at the right time. At its heart is a rich repository of the latest clinical evidence, developed over 30 years. McKesson’s highly-trained clinical development team continually assess the evidence with feedback from an InterQual Clinical Panel of 800 experts. As a result, all InterQual criteria have a level of credibility and integrity that cannot be found anywhere else. This can be extremely powerful in identifying areas for service re-design, ensuing less variation amongst clinicians and helping to inform commissioning decisions to benefit a whole local health and social care economy. Implementation of InterQual has assisted in transforming patient flow, it is not prescriptive or actuarial in its approach rather it supports its clinical users while ensuring the patient remains at the centre of care. More trusts are recognising the valuable and powerful insight that InterQual provides and demand is growing steadily for this unique tool.

Transformations through Horizon Enterprise Visibility™ It was recently suggested that better communication between staff and patients could greatly improve the quality and appropriateness of patient care. In 2010, Christine Beasley, Chief Nursing Officer and leader of the Productive Ward Programme, identified “unnecessary administrative tasks” as a major obstacle to caring for patients. One of the main obstacles to improvements in communication is a lack of centralised information regarding every patient and bed on the ward. As a result, bed managers are still walking the floors to gain a true understanding of the availability of beds, and clinicians make multiple phone calls and log into various different systems to try to piece together the full picture of what is going on with each patient. McKesson’s Horizon Enterprise Visibility (HEV) is a state-of-theart, highly intuitive visual control solution that works by taking feeds from a hospital’s existing disparate information systems and provides real-time patient flow information by displaying colour-coded, time-stamped icons against a hospital floor plan. The information is then displayed on large format plasma or LCD screens at ward, bed management and executive level, ensuring a single vision of patients on the ward, across the hospital and even out in the wider community. HEV is highly configurable allowing staff to see “at a glance” when beds are free, who is waiting to be discharged, patient safety attributes as well as when imaging results, lab results and prescriptions are ready.

Designed to make nurses’ lives easier and releasing time to care, HEV allows real-time information about their patients without multiple logins to different systems, having to use pagers or make repetitive phone calls to various departments and staff. This results in the average nurse saving an hour per shift per day, achieved by a saving of up to 7-10 phone calls and 3-4 wasted logins to various information systems per day. An hour a day saving; now that’s ‘releasing time to care’!

Commitment to Child Health In 2003, the Government published ‘Every Child Matters’ – a green paper that prompted an unprecedented debate about services for children, young people and families. Subsequently, in 2004 the Government passed the Children Act, setting out the national framework for local change programmes to build services around the needs of children and young people. McKesson CarePlus Child Health is a browser-based medical information solution that provides a full tool-kit of facilities to control the Child Health programme either within a single Trust, or over a number of Trusts or Strategic Health Authorities (SHAs). The McKesson system is a modular solution with each component supporting a different aspect of the Child Health service. The core modules are Registration, which controls the entry of children into the system, and the Immunisation module; which ensures that children are invited for their correct immunisations at the most efficacious time, to their local PCT. Other modules can track children through their pre-school and school health careers, or support special groups such as Child Protection and Sure Start. CarePlus Child Health achieves 100% compliance with the relevant sections of the Integrated Care Records Service Output Based Specification (ICRS OBS) Version 2, and is kept up-to-date as requirements for system compliance evolve. McKesson’s integration team works with customers and external suppliers to enable interoperability with third party systems for the creation of a comprehensive electronic health record. Customer satisfaction has led to customer retention – 21 NHS Trusts have chosen to remain with CarePlus Child Health as their strategic child health solution.

McKesson’s portfolio of products and services clearly demonstrate how technology can significantly support staff and facilitate a change in approach this is immediately translating into improvements in productivity, patient care and is undoubtedly contributing to cost savings. As healthcare organisations come under increasing pressure, the NHS must empower its talented staff. McKesson’s solutions and services deliver support to NHS employees, helping to ensure best practice and release more time to patient care, when increased efficiencies and rapid cost-savings are required. Through continued product innovation and the proven results their solutions have delivered, McKesson maintains its ongoing commitment to provide trusted technology solutions to the NHS now and long into the future.


The Institute of Digital Healthcare (IDH) is a partnership with NHS West Midlands, WMG and Warwick Medical School (WMS) and is led by two Co-Directors who have a track record of working between informatics, biomedical engineering, computational intelligence, technology assessment, and the health and life sciences sectors.

The IDH aims to improve people’s health and wellbeing through the use of innovative digital technologies. By combining the talents and resources from WMG, WMS, NHS West Midlands, NHS Trusts, private enterprises, charities and other bodies, the IDH will design and deliver appropriate care solutions that will result in real benefits to patients and their care support networks.

For more information please contact: Institute of Digital Healthcare International Digital Laboratory University of Warwick Coventry CV4 7AL Website: www.idh.warwick.ac.uk Email: idh@warwick.ac.uk Twitter: http://twitter.com/IDHwarwick

The new Institute will seek to apply the latest digital technology to assist the training of West Midlands health professionals, and the treatment and support of local patients. This will put the West Midlands at the forefront of many digital health technologies that will attract national interest.

Co-Directors Professor of eHealth Innovation, Professor Jeremy Wyatt Tel: +44 (0)24 7615 1262 Email: j.c.wyatt@warwick.ac.uk Professor of Healthcare Technology, Professor Christopher James Tel: +44 (0)24 7615 1261 Email: c.james@warwick.ac.uk


Contact: Institute of Digital Healthcare, International Digital Laboratory, University of Warwick, CV4 7AL Tel: +44 (0)24 76515 1261 or +44 (0)24 7615 1262 E-mail: idh@warwick.ac.uk  Web: www.idh.warwick.ac.uk

Technologies to support people with long-term conditions The healthcare landscape is changing, with the NHS facing its biggest shake-up since it was founded in 1948. It is no secret that over the years the health service has seen many reforms, but this time it is structural reorganisation that is going to change how and who delivers healthcare to the British public. We are told that this will drive up the quality of health services and improve survival rates in such areas as patients with long-term conditions. Here, Professors Christopher James and Jeremy Wyatt from the Institute of Digital Healthcare discuss how the NHS can continue to provide excellent affordable services for people with long-term conditions alongside having to innovate and improve techniques, and how digital healthcare will help this.

Prof Christopher James

Current issues faced by the NHS This radical shake-up of the NHS will definitely put a strain on finances, on a service where there are constant cuts and freezing of budgets, this at a time when the cost of equipment and resources are increasing. It is a new battle of having to do more for less, whilst at the same time innovating and embracing new practices. We are also seeing higher patient expectations in an age where consumerism is at its highest, so to stand still is no longer good enough. Coupled with this, we have an ageing population and more long-term conditions, and are seeing fewer young people coming into the caring professions. There is no question that the NHS has many challenges ahead in order to ensure service levels are maintained across the board, but especially for those with long-term conditions.

Prof Jeremy Wyatt

The impact on people with long-term conditions There is already a mismatch between the disease burden and the ability of the NHS to cope with long-term conditions. People with long-term conditions want to live their lives as normally as possible, to live at home and go about their daily lives as normally as possible, but with NHS support. If we look at the elderly, they want to live as independently as possible, but some still require a certain intensity of care. This means that the way in which the NHS and people engage together to improve their health needs to be different. To enable independent living to happen, the key is to motivate and support selfmanagement or assisted living. With medical and technological advances, people with long-term conditions can safely live at home for longer through self-management care and with new technological innovations, their life is prolonged greatly, with fewer NHS interactions and a much improved patient experience. However, the technology needs to be seamless and low impact, allowing them to live as normal a life as they wish, but at the same time helping them to manage their disease. Any home-based technology should be useable and understandable and should enhance the individual’s ability to self-care. Of course, there is a cost attached to technology, so it needs to be affordable for all concerned, including the NHS or the individual with a personal health budget.

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patients are asked the same questions several times and duplicate tests are performed. In future, this will only get more complicated with the increase in the number of providers.

Patient records can be merged with the introduction of federated record systems and clinical portals, perhaps controlled by the patient concerned, to allow a unified view of data on systems held by different providers. By coding the data in the records, decision support systems can issue alerts and reminders to health professionals or even the patient themselves.

The challenges ahead The need for supported self-care by people at home with long-term conditions will only increase. Digital technology provides some answers, but needs to be delivered in a scalable way. The reliability, safety, clinical and cost-effectiveness of the self-care technology, and the new care pathways that use it need to be rigorously evaluated before widespread use. Innovative technology could have profound effects on healthcare management. Areas that need continued development include the development of smaller, lighter, lower-powered processing units with longer battery life for data collection and analysis; seamless data communications, where required; guaranteed secure transmission of data; better use of implanted technology; and affordable methods to maintain, upgrade and replace home healthcare devices as dependence on technology increases. The NHS reforms mean that ‘any willing provider’ can provide care for NHS patients. This could lead to fragmentation of patient health records, split between the NHS, third sector and private sector providers. Excessive emphasis on privacy of patient data might mean that GPs, for example, only share a fraction of their records with doctors or clinicians in other organisations who need to see the whole picture. The result is that

convey results to those who need them, be they carers, patient record systems or clinicians. The use of home-based data capture monitoring devices allows information, which once meant a trip to the surgery, can be captured at home and sent to the surgery, allowing people to self-care at home.

Technology advances Technology used properly can be consistent, precise and effective. Small sensors coupled with fit-for-purpose devices can be cost-effective within the home environment. Devices can either monitor the use of medicines and report poor adherence, or even administer drugs under the skin on receipt of signals from a remote computer. Information extraction to help with healthcare management can be through direct (physiological) measurement of data, or by indirect observational data and patient self-entry. Intelligent software algorithms can quickly analyse large datasets and provide predictive information for patients self-caring. Built-in communications if required can seamlessly

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The future for people with long-term conditions The future is looking bright for those with long-term conditions who want to be able to stay living in their own home setting, or in a setting that is closer to home living, as long as effective means can be found to make sense of the data collected at home, share it with those who need to know around the NHS, and respond appropriately using community-based health and social care services. If the NHS develops new care pathways based on these exciting innovations that do indeed deliver safer, more effective and cost releasing healthcare, those with long-term conditions will be in good hands.

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Better quality health for more people requires focused innovation Bettina Fitt, General Manager, UK, GE Healthcare

in quality or access to good healthcare. Focusing spending on early detection of disease, when treatment options are more cost-effective, and viewing healthcare as an investment in the nation’s future well-being, rather than simply a present cost, is imperative in a period of austerity.

Bettina Fitt

GE Healthcare supports the disease-focused and patient pathway approach of the Department of Health and National Health Service as one of the ways to improve patient outcomes. To this end, our teams continuously look for ways to work more closely with the Department of Health to improve patient pathways in cancer, heart and neurological diseases, for example.

Balancing health budgets while improving quality and efficiency of healthcare delivery, and at the same time improving access to care, is increasingly meaning redesigning how a healthcare system addresses particular diseases, or patient pathways. As this magazine highlights, the need for innovation and following through on that innovation has never been greater. GE Healthcare is striving to help the NHS and healthcare systems around the world move towards a model of care focused on earlier disease diagnosis, pre-symptomatic detection and disease prevention. The model is founded on increased scientific and medical knowledge and the use of innovative technology throughout healthcare delivery systems, from research and development, through primary and acute, to tertiary care, including care in the home. If we accept that ‘human capital’ is core to growing GDP, the population’s health is an asset: those who are healthy contribute more to the economy and society. The maxim ‘health is wealth’ is true. If a healthy population is more productive, less of drain on resources, there are economic and social, as well as a moral, imperatives to keep appropriate investment in healthcare at the top of the policy agenda. Having less money means spending it much more wisely. Cost reduction should not mean a halt to improvements

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The Department of Health’s prioritisation of early detection and diagnosis in cancer is to be welcomed. This strategy should improve patient pathways and outcomes and we will continue to support the Department of Health’s agenda to improve cancer diagnosis and treatment. The key questions that need to be considered in developing new policy for the NHS are: »» How can the NHS use digitisation and IT more to make best use of its resources and improve patient outcomes? »» Which of the major disease burdens the NHS faces can best be addressed by earlier detection, intervention and prevention? »» How should budgets be managed effectively to balance patients’ needs with the resources available? »» How can the NHS ensure its procurement encourages innovation in diagnostics, treatment and patient care, including care in the home, and continue to improve the value delivered for patients? Policy guidance is necessary to answer these questions and reduce health inequalities that still affect users across the NHS. As a business, and as genuinely interested individuals, it’s great to see a magazine focused on the importance of real innovation in healthcare. There is an urgent need to discuss in detail current and future innovation, and its subsequent implementation that will support prevention and early diagnosis, as well as long-term care.

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Contact: Beta Technology Ltd, Barclay Court, Doncaster Carr, Doncaster DN4 5HZ, United Kingdom Tel: + 44 (0) 1302 322 633  www.betatechnology.co.uk  Follow Graham on Twitter at: www.twitter.com/ukhealthman

Getting the best results from your ideas How Beta Technology can help you every step of the way. Beta Technology’s leading health expert, Graham Hughes, explains

Graham Hughes

Turning a great idea into a successful result, whether that’s a new product or service or just getting access to new markets, is fraught with problems for those without the money, knowledge and expertise to accomplish it. Beta Technology is a knowledge-based company that has been supporting public and private sector clients through all stages of the innovation journey for over 25 years. Beta has the ability to help you by bringing together its specialist knowledge and extensive networks to create bespoke solutions to the innovation challenges you face. Beta’s expertise in enterprise and innovation covers many areas but we have enjoyed particular success in accessing national and international funding and in providing project management. Our specialist knowledge and successful track record in the health, bioscience and nutrition sectors will help you to find your way through the innovation maze. Whatever your needs, and whenever you need it, we are confident that Beta can provide the support and solutions that you require.

Routes into public funding

Maximising the potential of your funding request

Beta has established a reputation as the expert in public funding schemes, ranging from local and national sources through to the European Commission’s Framework Programme. Our team holds UK National Contact Point positions in the health and biotech fields and is available to provide free and confidential advice on European funding.

Using our extensive knowledge of public funding (regional, national and EU), Beta can help you to take a strategic approach to sourcing appropriate public funds to meet your organisation’s objectives. This can range from identifying suitable funding and partners for specific projects to supporting the development of business plans. We can also work with you to create the best possible application and so maximise your chances of success.

In addition, we can also help you understand the advantages and disadvantages of a wide variety of schemes and programmes, signposting to other sources of support if necessary.

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“Beta Technology has given us very good support throughout the Health 2011 application process, starting with a clear overview of the relevant SME targeted themes, followed by direct and concise responses to specific eligibility and budget questions, and finishing with a very prompt review of our draft application.” “Insightful aid and comment, even to David Blake, Cyclacel naive questions from a newcomer to FP7. Response was timely, comprehensive and accurate, which was welcome in the run-up to the submission deadline.” Grant Cameron, The Automation Partnership

Providing a Complete Solution At Beta we recognise that every client’s needs are different so we prefer a flexible rather than a “one size meets all” approach. We will tailor our service to meet your requirements, whether that is simply advice on how to start, support to prepare a funding bid or providing full project management for the development of your innovative idea. Whatever you chose to do we will make sure that you receive the best advice to deliver the solution that you require.

Collaboration Networks Beta’s long term involvement with European projects, both as participants and providers of official advice means that we have established good relationships with a number of enterprise and innovation agencies throughout the EU. We can also facilitate effective partnerships with research institutions and commercial organisations from our wide network of contacts in the health and bioscience sectors. With this support network to hand you can be assured of the best possible partnership opportunities to develop your ideas.

Project management

Communicating results — maximising success

Beta has a long-standing and excellent track record in the delivery of partnership projects with public sector organisations. We have worked extensively with public sector clients to design, implement and deliver large programmes as well as devising bespoke projects to support enterprise and business innovation.

As experts in dissemination activities, Beta has led communication packages for a number of European scientific projects. We combine scientific knowledge and a range of communication skills to help promote results and successful project outcomes to a wide range of stakeholder groups; tailoring the message to meet the requirements of the public, industry, health professionals and academics.

We can successfully steer you through the intricacies of international technology transfer and advise on the most effective strategies for participation in international collaborative projects.

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We can also help you to find the best way to exploit research results as they emerge. We are currently leading the dissemination work package for the Nutrimenthe project (see next page).

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Case Study: Nutrimenthe Beta Technology is providing specialist communications support to the Nutrimenthe project, an international consortium of scientists undertaking research in the field of childhood nutrition. Beta has many years experience of being a partner in European Framework Programme projects. The current, Seventh Framework Programme began in 2007 and during that year, Beta became involved in the fledgling Nutrimenthe consortium. Beta supported the Coordinator, the University of Granada, and one of the key industrial partners, Unilever, to write the proposal. Subsequently, this led to an invitation to become a full partner. As work package leader for Training, Dissemination and Exploitation, Beta developed and is responsible for implementing the Public Engagement Strategy which aims to: »» raise the profile of the project »» encourage the understanding and public awareness of the critical position that diet plays in the mental performance of children, and »» assist in disseminating the results The project has been running for nearly three of its five years and in that time, Beta has combined its scientific knowledge and communication skills to develop specialist marketing tools and channels to help the consortium reach its target audience (parents, health professionals and other academics) throughout Europe. This includes a website, newsletter, publicity material, articles and a public event. To support the commercial aims of the project, experts from Beta will guide the partners on how to exploit the research results as they emerge.

About Nutrimenthe There is evidence that diet during pregnancy and early childhood, may affect later mental perform-

ance. Studies exist on the potential beneficial effects of omega-3 fatty acids and nutrient supplementation on the mental performance of infants and children; however there is still a lack of clarity and consensus on their actual role in neurodevelopment, mental performance and mental illness. Nutrimenthe aims to address these issues. Nutrimenthe brings together a wide range of research disciplines from 20 organisations around Europe and the US. The specific nutrients being studied include B-vitamins, minerals (iron and zinc), protein (in breast and formula milk) and omega-3 fatty acids. The children addressed by Nutrimenthe range in age from foetal stage (early programming) to early childhood (8-9 years of age) and are drawn from large, well-characterised, population based studies from multiple study centres around Europe.

a battery of neurophyschological tests. These tests are looking in detail at the mental performance of children by measuring motor skills, attention, memory, language and executive functions among others. In addition, Nutrimenthe is addressing parent’s perception of the relationship between children’s diet and mental performance, plus, examining the economic consequences of improving mental performance. Ultimately, Nutrimenthe aims to establish positive dietary recommendations for a number of nutrients, especially Omega 3 fatty acids, to improve public knowledge and lay the basis for appropriate health claims about how diet affects mental performance in children. For further information on Nutrimethe contact Dr Claire Horton: Tel: +44 (0) 1302 322 633 claire.horton@betatechnology. co.uk or visit www.nutrimenthe.eu

A wide range of data is being collected by Nutrimenthe researchers including dietary intake of children and pregnant women, biochemical measurements of fatty acid and micronutrient levels, anthropometric measurements and mental performance measurements, using

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INNOVATION IN HEALTHCARE


Find Out More About… The Innovative Technology Adoption Procurement Programme (iTAPP)

Innovation in medical technologies is vital to ensure further improvements in quality and productivity within the NHS. In the current economic climate, the NHS needs to release unprecedented levels of efficiency savings and one way to do this is by improving quality and productivity through sustained innovation. The Innovative Technology Adoption Procurement Programme (iTAPP) encourages the NHS to adopt high impact innovative medical technologies, which can increase the quality of care provided to patients while at the same time reducing the overall cost of care. iTAPP offers significant benefits to patients, the NHS and UK plc, with potential savings to the NHS estimated to exceed £1 billion. It provides an opportunity to raise quality for patients, while freeing up resources on the front line, creating a win-win situation all round. Increased utilisation of innovative medical technology can: Raise NHS productivity Increase investment in UK businesses Increase exports for UK-based manufacturers

»» »» »»

Process Medical technology manufacturers were invited to submit details of specific medical technologies that can help the NHS improve patient care and reduce costs. Initially, over 100 submissions were received from over 50 companies. The potential scale of the opportunity led to the creation of iTAPP. More submissions are welcome. The successful delivery of iTAPP depends on everyone within the NHS, at a local and regional level, driving the adoption of these innovative medical technologies. The iTAPP team has commissioned the NHS Technology Adoption Centre (NTAC) to provide expert support to providers, commissioners and the Strategic Health Authorities, to help them select technologies that can be quickly adopted in their area. Each of the 10 health regions are initially selecting between one and three technologies and each has either started the implementation process or is in the planning stage to do so. The NHS and the UK have a reputation for being world class at discovery and invention, but questions have been raised about how quickly the NHS is able to adopt innovation. It has long been suggested that there is room for improvement in both the rate and the spread of technol-

INNOVATION IN HEALTHCARE

ogy adoption. This rate can be slow, even when the supporting evidence base is significant, and results in delay or failure to grasp the potential economic, health and social benefits. In the present climate, when the whole of the NHS is looking to make significant improvements through the Quality, Innovation, Productivity and Prevention (QIPP) agenda, it is more important than ever to address this issue. Delayed adoption of innovative technologies leads to loss of health benefits to patients, who might have benefited from earlier access to cost-effective drugs and technologies. There’s a real opportunity to improve patient care and outcomes by increasing the rate at which the NHS implements new technologies. iTAPP has been set up to facilitate this faster implementation of innovative technologies and together we can work towards achieving this. Want to find out more and discuss the opportunities for getting involved? If you are from an NHS organisation: Contact: info@ntac.nhs.uk If you are a medical technology manufacturer Contact: innovation.procurement@dh.gsi.gov.uk

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HEALTH PROTECTION AGENCY David J Rhodes, Head of Business Development, Health Protection Agency, Porton Down, Salisbury SP4 0JG Tel: 01980 612391  Fax: 01980 612242  E-mail: business@hpa.org.uk  Website: www.hpa.org.uk/business

Health protection and innovation models The Health Protection Agency’s role is to provide an integrated approach to protecting UK public health from infectious disease and environmental hazards through the provision of support and advice to the NHS, local authorities and other bodies, and by manufacturing specialist equipment, reagents and standards. Innovative science underpins everything that we do. A growing, ageing population and a faster-moving society require constant innovation in the field of health protection. However, the ways in which innovation comes about and is translated

into improved public health in the UK and elsewhere has changed profoundly, in a way that is not always fully appreciated by those of us who grew up with New Scientist’s “Grimbledon Down” comic strip, in which government boffins worked in secrecy on obscure and mysterious projects. It is now highly unusual for public sector scientists and clinicians to work in isolation; typically our innovations are developed in the context of complex relationships involving the NHS, overseas bodies, industry, the voluntary sector, and others.

Innovation and invention Public sector science does, however, still have a role in developing scientific breakthroughs and innovations, both in fundamental and applied science, typically in areas that are of national importance but where there is no immediate prospect of a commercial return on investment. In HPA we periodically make inventions in the field of molecular biology, not out of academic curiosity, but in response to the need to diagnose threats to public health rapidly and accurately. For example, we recently

Automated microbiology at the Cambridge laboratory

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INNOVATION IN HEALTHCARE


allegedly from polonium 210 poisoning, a substantial exercise of contact tracing and analysis was required in order to assess the potential risks of exposure through contamination of the environment. Urine samples collected from potentially exposed individuals were analysed using radiochemical techniques developed specifically for this purpose and risks associated with exposure were assessed by adapting computational software developed for the routine assessment of occupational exposures. Innovation is also required in challenging areas such as anthrax among injecting drug users, influenza epidemiology, prison health, and promotion of immunisation.

Open innovation

Molecular biological diagnostics

announced the development of a single DNA molecule tuberculosis assay based on real-time polymerase chain reaction, which was driven by the need to obtain rapid diagnosis of tuberculosis cases where appropriate follow-up and treatment may otherwise be difficult. The emergence of oseltamivir resistance has also required us to develop an assay for resistant influenza strains which provides data in a clinically-useful timeframe while meeting strict quality control criteria.

Technology adoption Operating at the forefront of health protection requires HPA to be an ‘early adopter’ of technology where this contributes to speed, accuracy or efficiency. A recent example is the installation of the Kiestra automated microbiology system in our Cambridge laboratory, demonstrated during the recent visit by the Secretary of State, which has reduced the average time to obtain a screening result for MRSA by 20%, providing a critical advantage in supporting clinical decisions.

Translational research and technology transfer In addition to using such inventions within the context of UK health pro-

tection, we seek to maximise the value of such inventions in partnership with industry and others. The process of translational research needs to be managed carefully in order to ensure that inventions are developed in such a way that they can be efficiently transferred to partners and applied in practical settings. This requires effective teamwork by scientists, doctors and clinicians, lawyers, financial specialists and business development professionals. In recent years we have licensed or spun out technologies in the fields of radiation detection, vaccines, diagnostics, therapeutics, software and decontamination, and at any one time we maintain a portfolio of over 60 patent families, which is reviewed on a monthly basis. HPA works together with a number of other UK public sector bodies under the InterAct Partnership, with the support of the Department of Business Innovation and Skills, in order to seek opportunities for commercialisation and collaboration with industry.

Given the breadth of the field of health protection, it is hardly surprising that even a relatively large organisation such as the Health Protection Agency must collaborate with a broad range of partner organisations, each having access to specific facilities or skills. In addition, external bodies are a significant source of funding for our work; in the last financial year approximately 40% of the Agency’s income was generated externally. Partners include UK and global industry, NHS Trusts, UK and overseas government bodies, charities and universities, with a number of collaborations being supported by European Union Framework programmes and the Technology Strategy Board. We also participate in a number of ‘open innovation’ events where diverse partners pool resources towards a common goal. Recent examples have included point-of-care diagnostics and societal changes in healthcare.

Conclusions Innovation in service delivery Much of the work and innovation in the field of health protection takes place both in the laboratory and the front line, through our contact with patients and communities. For example, following the death of Alexander Litvinenko in London in 2006,

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Innovation in health protection has become a complex and highly interactive process. Public sector laboratories still have an important part to play in combating threats to health, but advances are increasingly achieved in the context of ‘open innovation’ models and broad-based partnerships with public and private-sector bodies in the UK and internationally.


Contact: Mediplus Ltd, Unit 7 The Gateway Centre, Coronation Road, High Wycombe, Bucks HP12 3SU Tel: +44 (0)1494 551200   Fax: +44 (0)1494 536333  E-mail: help@mediplus.co.uk  Website: www.mediplus.co.uk

The Safest Suprapubic Catheter in the world? Incorrect insertion of suprapubic catheters can be disastrous, as a recent warning from the National Patient Safety Agency (NPSA) has highlighted. A recent report from NPSA revealed that three people died and seven were severely injured following suprapubic catheter insertion, pointing to an urgent need to minimise the risks associated with this procedure. The report follows an earlier survey of British urologists, carried out by the British Association of Urological Surgeons (BAUS) in 2003, which found that one third of respondents had experienced suprapubic catheter-associated bowel perforation in the past 10 years.

The current technique Conventional suprapubic catheter insertion using kits with a trocar can be daunting to the user, as well as the patient, due to the risks involved in employing a sharp trocar to puncture and push ‘blindly’ through the abdomen to the bladder. Considerable skill (and guesswork) is required to ensure that the trocar finds its target and has not inadvertently punctured the bladder posterior wall (and pierced the bowel) – with dire consequences. Mr Iqbal Shergill, Consultant Urological Surgeon, Wrexham Maleor Hospital states that “Insertion of traditional suprapubic catheters is quite difficult and there can be a high risk of complications – especially if the patient has had previous surgery. Moreover, there isn’t sufficient awareness and understanding of the

procedure, as students are not taught it at medical school”. He further highlighted the difficulties of performing the procedure ‘blind’ – a factor that the NPSA’s Rapid Response Report has addressed. The guidance recommends that clinicians use a number of approaches to improve safety; one of the suggested technology solutions being the Mediplus Seldinger SPC kit, which is designed to help minimise the associated risks of this procedure.

How does the Seldinger technique differ from the ‘Blind’ approach? The Seldinger SPC kit, comprising a long needle, guide-wire, trocar with outer sheath and a silicone catheter, allows controlled entry of the trocar into the bladder and is designed to reduce the potential hazards associated with the blind technique. The guide-wire is the key to its success. Consisting of three parts: the first is the ‘floppy tip’, followed by a more rigid section, with the third part being a solid section with two black reference marks printed on it. When inserted into the bladder the floppy tip protects against posterior bladder wall injury. The second section allows the user to feel resistance on the guide-wire in the bladder – providing a good reference as to how far it has been inserted. The third section features two reference points that are used to identify the location of each section in relation to the patient’s anatomy. The first mark is used with the 18-gauge needle and alerts the user that the solid section is at the

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tip of the needle. The second mark indicates to the user that the solid section is level with the outer sheath of the trocar.

A clinician’s perspective Currently over 40 Trusts and their cohort of patients in the UK are benefiting from using the Mediplus Seldinger SPC kit. Mr Ian Dickinson, Consultant Urological Surgeon at Darent Valley Hospital said: “I was never really satisfied with the previous catheters as we were using them ‘blindly’, and I was attracted to the Seldinger SPC because of the three-stage guide-wire. It allows for controlled entry into the bladder and removes any guesswork. In trials, it was easy to use. Its implementation was unanimously supported by my colleagues as they could be more confident knowing a higher degree of accuracy is involved. I believe patients also benefited from a more comfortable procedure and I would strongly encourage other hospitals to adopt this technique.” Mr Malcolm Crundwell, Consultant Urological Surgeon at Royal Devon

INNOVATION IN HEALTHCARE & MEDICAL TECHNOLOGIES


Table 1: Comparison of conventional SPC with the Mediplus Seldinger Kit Conventional SPC General anaesthetic (%)

Mediplus Seldinger SPC Kit

90

3

2.3 days

28 mins

Insertion in theatre

90

11

Insertion in OP clinic

0

75

Duration of stay

& Exeter NHS Foundation Trust said: “I have found the Mediplus SPC straightforward and safe to insert. In Exeter we usually use cystoscopic guidance for elective SPC insertion and this has remained useful although not essential when using the Mediplus SPC kit. We have had no significant complications relating to SPC insertion using this device.” At Taunton and Somerset NHS Foundation Trust (Musgrove Park), an outpatient SPC clinic has been introduced, which allows patients to have the procedure undertaken under local anaesthetic, thus preventing the risks associated with general anaesthesia, in a relaxed outpatient environment. Mr Ruaraidh MacDonagh, Consultant Urological Surgeon for the Trust, pointed out: “Suprapubic catheterisation using the Seldinger technique offers a safer alternative to the traditional procedure. Instead of a hospital admission and potentially a general anaesthetic and overnight stay, patients could attend for a 30-minute appointment slot in the clinic.” Faith McMeekin of the Musgrove Park team said: “It soon became apparent that, with the Mediplus Seldinger SPC kit, an outpatient setting could be used for its insertion, and that this would be the biggest benefit to patients. This not only reduces the co-morbidity of an anaesthetic but also reduces the amount of time a patient is away from home, making it more convenient for them. Additionally, the risk of infection is reduced as they are attending hospital for a shorter period of time. A clinical audit has confirmed this, showing that there have been no post-operative complications to date following insertion of the Mediplus SPC. It is my opinion that the Mediplus SPC kit should be first choice when deciding to carry out this procedure.

Mr MacDonagh trained our specialist nurse, Angus MacCormick, who is now Lead for training in SPC insertion. One of the other great benefits for this clinic is that it has provided the ideal clinical environment to train all medical staff that require the skill. This then allowed us to put a strong business case forward to the Hospital Board highlighting the multiple areas of improved patient care; for example, reduced time in hospital, no need for general anaesthetic and its associated risks, improved efficiency of service provision and overall cost reduction to the NHS.” A retrospective audit comparing suprapubic catheterisation insertion at the clinic has revealed the extent to which service has improved using the system. General anaesthesia requirements, inpatient admission rates, duration of stay and complication rates one year before establishing the outpatient suprapubic catheterisation clinic using the Mediplus system were compared with those found one year after (Table 1). Angus MacCormick added: “I have been using the Mediplus SPC kit for some time now and would strongly recommend its use to my colleagues within the field of urology. It offers a safer alternative to traditional suprapubic catheter kits. I have been running a specific SPC insertion clinic for the past two years. This clinic has had a huge impact on both the patients and our organisation. Patients are only in the department for approximately 40 minutes, as opposed to two or three days, thus decreasing the risk of hospital acquired infections and also greatly reducing hospital length of stay. This has significant financial benefit to the hospital in these times of austerity.

INNOVATION IN HEALTHCARE & MEDICAL TECHNOLOGIES

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Patient satisfaction rates are good, with 100% reporting they were “highly satisfied” or “satisfied” with Seldinger suprapubic catheterisation and there have been no significant complications following insertion at the clinic to date.” The team continues to audit the performance of the clinic and have reported that the number of patients having an SPC inserted via this clinical pathway has increased, with no post-operative complications to date. The technique has proved so effective that it has been advocated by the NHS Technology Adoption Hub, which strongly recommends adoption of this system. In addition to cost savings and greater patient satisfaction and safety, introducing the suprapubic catheter has provided an additional unforeseen benefit for the clinic by providing a focus for training clinicians from all specialities in this new technique. Following the successful introduction of this clinic in Taunton, the team now recommends that other sites offer a similar outpatient service utilising the system. The team at Musgrove Park were finalists in the Patient Safety category of the 27th International Conference of the International Society for Quality in Healthcare. There had been 1,038 applications from 35 countries, and the Team was asked to present its findings in front of an international audience.

National Guidelines The British Association of Urological Surgeons (BAUS) has recently issued their suprapubic catheter practice guidelines which are aimed at reducing the morbidity associated with suprapubic catheter usage. The guidelines state that “The use of a Seldinger guide-wire may allow a more controlled insertion of a trocar and sleeve than may be achieved using a standard trocar”. The guidelines do not specifically mention the Mediplus SPC but do direct the reader to the NHS National Technology Adoption Centre guide on the Mediplus Seldinger SPC kit, so one could draw a very strong conclusion from this.

References Ahluwalia RS, Johal N, Kouriefs C, Kooiman G, Montgomery BS, Plail RO (2006) The surgical risk of suprapubic catheter isertion and long-term sequelae. Ann R Coll Surg Engl 88: 210–13 Emberton and Fitzpatrick M (2008) The Reten- World survey of the management of acute urinary retention : preliminary results. Br J Urol Int 101(3): 27–32 Horgan AF, Prasad B, Waldron DJ, O’Sullivan DC (1992) Acute urinary retention. Comparison of suprapubic and urethral catheterisation. Br J Urol 70: 149–51 Ischsan J, Hunt D (1987) Suprapubic catheters: A comparison of suprapubic verusus urethral catheters in the treatment of acute urinary retention. Aust NZ J Surg 57: 33–6 Mohammed A, Khan A, Shergill IS, Gurjal SS (2008) A new model for suprapubic catheterization: The MediPlus Seldinger suprapubic catheter. Expert Rev Med Devices 5(6): 705–07 Niel-Weise BS, van den Broek PJ (2005) Urinary catheter policies for short-term bladder drainage in adults. Cochrane database Syst Rev July (3): CD004203 Shapiro J, Hoffmann J, Jersky J (1982) A comparison of suprapubic and transurethral drainage for postoperative urinary retention in general surgical patients. Acta Chir Scand 148: 323–7 British Association of Urological Surgeons’ suprapubic catheter practice guidelines Simon C.W. Harrison*, William T. Lawrence† , Roland Morley ‡ , Ian Pearce § and Joby Taylor BJUI 107 , 7 7 – 8 5 1 Ahluwalia R.S., Johal N., Kouriefs C., Kooiman G., Montgomery B.S., Plail R.O. (2006). The surgical risk of suprapubic catheter insertion and long-term sequelae. Ann R Coll Surg Engl 88: 210–13. 2 Emberton and Fitzpatrick M. (2008). The Reten-World survey of the management of acute urinary retention: preliminary results. Br J Urol Int 101(3): 27–32. 3 Horgan A.F., Prasad B., Waldron D.J., O’Sullivan. Shergill I. S., Shaikh T., Arya M.,Junaid I. A Training Model for Suprapubic Catheter Insertion: The UroEmerge Suprapubic Catheter. Urology, Jul 2008;72(1):196-7. Epub, 2 Jun 2008. Khan A., Abrams P. Bristol Urological Institute, Southmead Hospital, Bristol, UK. Suprapubic catheter insertion is an outpatient procedure: cost savings resultant on closing an audit loop. BJU International, 10 July 2008.


NHS Evidence: Supporting you in your drive to deliver quality now image provided for illustration purposes only

Health and social care is going through a period of significant change to bring about greater choice and control for patients, empowered professionals and increased efficiency. In this period of change, one consistent theme is the need for easy access to quality-assured information. What’s envisaged is an information revolution for health and social care – putting patients first and heralding an information culture change for professionals. NHS Evidence www.evidence.nhs.uk is playing a key part in this information revolution, making quality-assured, best practice information freely and easily accessible. To keep pace with the constantly changing information demands

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of health and social care professionals, NHS Evidence will be improving its service from May 2011 – sign-posting professionals even more clearly to the very best resources to help them make the best care decisions.

Greater choice and control for patients Although NHS Evidence is designed for health and social care professionals it is also accessible to patients, and provides information to aid the doctor/patient interaction. NHS Evidence empowers patients by enabling them to access trusted information to make informed decisions about their care. By using NHS Evidence, patients will be

INNOVATION IN HEALTHCARE


image provided for illustration purposes only

better informed about their condition, the lifestyle options which might improve it, and the treatments available. Patients want to be involved in their care and understand what service they can expect. In May, NICE Quality Standards – showing what high quality care should look like for particular conditions – will be accessible through NHS Evidence.

Better access to specialist information The simple search facility on NHS Evidence provides professionals with access to specialised information, including national collections of evidence in areas such as diabetes, cancer and commissioning. Other specialised content being introduced from May includes a new focus on medicines information. Professionals will be able to search a range of key sources simultaneously – including the British National Formulary, National electronic Library for Medicine (NeLM) and the National Prescribing Centre (NPC) – to quickly and easily access information pertinent to professional practice. It will be possible for professionals to register to get regular updates on changes to guidance and browse new clinical topic areas, which will bring together the latest guidelines, high quality patient information, ongoing trials and other selected information. The way NICE guidance is presented will also be different. From May, NHS Evidence will provide access to NICE pathways, which allow professionals to easily visualise and browse associated NICE products online, guided through supporting documents.

Driving up the quality of information available NHS Evidence carefully selects the information it makes available and, as a result, users can be confident that the information they find is robust.

INNOVATION IN HEALTHCARE

NHS Evidence also wants to make sure that the quality of evidence based information available is as good as it possibly can be. Many guidance producers are improving their methods for guidance production to meet the criteria set in the NHS Evidence Accreditation Scheme. The scope of the scheme will soon be expanded to cover social care and commissioning information.

Supporting the drive to improve efficiency Now more than ever, health and social care staff need to be delivering more for less – demonstrating that NHS money is being spent wisely, to best effect, and with the best possible outcomes. The NHS Evidence QIPP Collection (www.evidence.nhs. uk/qipp) provides quality-assured real life examples of how things can be done differently in the NHS whilst still providing optimal standards of care to patients. This includes evidence based examples that have been shown to improve quality and save money, plus areas of potential disinvestment from NICE guidance and Cochrane reviews. Examples from other QIPP national work streams are also highlighted. By accessing the QIPP Evidence Collection, professionals can find out how their colleagues up and down the country are really taking ownership of the quality agenda, provoking thoughts, ideas and discussions about how changes can be made.

Access NHS Evidence today Hundreds of thousands of professionals use NHS Evidence every month. It is a key resource at a time when NHS health and social care is rapidly changing, to ensure access to the best available evidence, pathways and Quality Standards. To find out more about the developments taking place in May, view the new video on www.evidence.nhs.uk.

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Contact: Telephone: 0845 630 6979  Email: info@vanguardhealthcare.co.uk Website: www.vanguardhealthcare.co.uk

Accessible innovation The NHS needs simple, accessible solutions to meet the challenges of the coming years, writes Ian Gillespie, CEO of Vanguard Healthcare Solutions

high standard of patient care, but the resulting impact on capacity while works are carried out often pose a problem for Trusts. For over a decade, NHS Trusts across the UK have been utilising mobile surgical facilities as a flexible and rapid-fire solution. Favourably priced compared to outsourcing services to a private hospital, temporary mobile units are often brought in to bolster surgical capacity for the duration of the refurbishment or used to respond to emergency situations, providing an instant boost when circumstances compromise an NHS Trust’s surgical capacity.

It is universally agreed that innovation must be the driving force behind the reconfiguration and evolution of the NHS. Innovation and innovative thinking, however, take many forms, and it is important that the pursuit of innovation does not focus solely on that which is new and high tech. In fact, it is often simple and accessible solutions – solutions which have been proven successful in practice – that provide an answer when a new challenge presents itself. The challenge is to reconcile the economics of the restricted financial climate with the desire and need to ensure that the patient experience is not just protected but improved. NHS Chief Executive Sir David Nicholson outlined in the House of Commons last month that around 20% of efficiency savings planned will come from service change. Specifically, it will be achieved by shifting delivery of

services from hospitals to community settings. This is undoubtedly the biggest challenge that has faced the NHS in living memory, and one that will require no small measure of innovative thinking to overcome. The answer, however, will not be found in high tech IT systems, or process management, or any new medical gadgets – these are a given in such a complex sector. In its simplest form, the problem is about being able to provide a suitable clinical environment in a local setting, quickly, safely and cost-effectively. What is needed, therefore, is ‘accessible innovation’ that will enable this to occur.

Tried and tested innovation – the perfect paradox Refurbishment projects, for example, are vital in ensuring a continued

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“Mobile facilities can not only play a vital role in deploying community-focused services quickly and efficiently, but also allow GP consortia to pilot new services with little financial risk.” As a response to capacity issues raised by refurbishments or emergency situations, mobile facilities are a tried and tested solution – the registration of Vanguard’s mobile units with the Care Quality Commission enables a seamless compliant approach to service delivery. Yet in many ways their real potential has been overlooked. In establishing community-focused services, for example – one of the core tenets of the coalition’s NHS reforms – mobile facilities can play a vital role, not only in deploying a suitable clinical environment quickly and efficiently, but in allowing GP consortia to pilot new services without the need to make major financial investments.


The Power of Mobile Healthcare: Artist’s conception of a flexible ‘health port’

Reconfiguration without risk Flexible workflows, temporary office spaces, off-site working – all have been a recurring and growing feature of the business world for many years now. While used widely for refurbishment and emergency capacity, the true potential for mobile facilities and their place in the modern healthcare landscape are yet to be realised – but the success of the model has been proved time and again in other sectors. In healthcare, however, flexible mobile services are still ‘innovative’ and, as the NHS searches for means by which to quickly and cost-effectively move services to a community setting, the case for using a mobile solution grows.

“Flexible working and the use of fluid, temporary services has been a staple feature of the business world for many years but, as of yet, it remains largely ignored in healthcare. To bridge the gap between funding cuts and NHS reform, it may be the only answer.”

The dichotomy facing the NHS is that launching community services would, in normal circumstances require a significant investment, not just in the considerable capital required for the services’ infrastructure but in the investment of time and human resource to ensure the successful deployment of the service and its ongoing management and upkeep – not a decision, as past experience has shown, that has been made lightly.

A great number of factors must be taken into consideration – local requirements, the state of existing facilities, financial influences, political directives, types of procedures, patient demand – all of which will determine what solution will best serve the Trust and the patient. While in some cases capital investment in a permanent facility is the best and only realistic option in developing or improving a service, there are many instances where influencing factors mean that this investment is not a viable option. Mobile healthcare facilities allow the piloting of services rapidly and effectively, and NHS organisations to effectively pre-judge patient flows and responses before investing in the service permanently. Similarly, it allows the reconfiguration of services and gives NHS management teams the ability to juggle workload and redeploy services, without disrupting service delivery.

Bridging the gap Early responses to rhetoric around NHS changes indicate that many are unsure how the shift to community

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services can realistically be achieved without significant financial support – something that is irreconcilable given the cuts in public sector funding that are already heavily impacting on the NHS. What is needed, therefore, is a way to bridge the gap that will allow the long and complex process of implementing localised services to begin without requiring a significant or permanent investment. For both the NHS and private healthcare providers, mobile facilities provide a proven successful vehicle through which to make the vision of ‘Liberating the NHS’ a reality. An ‘accessible innovation’ that has been proven successful in various situations, mobile services now need to be considered in the wider picture of the evolving NHS landscape. In times of continuing frugality, they offer a costeffective, compliant and rapid means of trialling new services and reconfiguring existing ones, while maintaining the standards and patient experience that is expected. They will allow the NHS to do things differently in the future, without risking its future – and isn’t that what the proposed changes are all about?

INNOVATION IN HEALTHCARE


Jayesha Mistry, PR & Public Affairs Officer, NHS Supply Chain, West Way, Cotes Park Industrial Estate, Alfreton, Derbyshire, DE55 4QJ Tel: 07738 071826 E-mail: jayesha.mistry@supplychain.nhs.uk  website www.supplychain.nhs.uk

The answer to the NHS’ financial problems? Better value procurement With tighter budgets and an ageing population, the NHS in England is facing its toughest challenge: to improve the quality of care to patients whilst pushing efficiency hard.

Through the Department of Health’s Quality Innovation and Productivity Programme (QIPP), £20 billion worth of savings need to be delivered by 2015. It is envisaged that £1.2 billion will be delivered through NHS procurement.

One of the immediate ways for NHS trusts to reduce costs is through best value procurement. As a national contract operated on behalf of the Department of Health, NHS Supply Chain is well placed to help NHS trusts realise this ambitious figure. Through using its national catalogue and frameworks set-up to simplify the ordering process, trusts can spend less time on procurement and focus on providing quality frontline patient care and achieving sustainable value. NHS Supply Chain strives hard to develop the most innovative procurement methods. It was recently honoured with a national procurement prize from the Health Service Journal for saving NHS trusts time and money when acquiring large scale medical equipment. Andy Brown, Managing Director of Diagnostics at NHS Supply Chain says: “We aim to make the process of purchasing capital equipment much easier and offer a flexible solution that gives real freedom of choice.”

What is NHS Supply Chain? Formed in 2006 from the NHS Logistics Authority and parts of the NHS Purchasing and Supply Agency (NHS PASA). »» Operated by DHL on behalf of the NHS Business Services Authority. »» Aims to provide over £1 billion of savings to the NHS by 2016. »» Since the start of the contract, it has achieved more than £200 million worth of savings for the NHS. »» Manages the sourcing and delivery of healthcare supplies, including food for over 1,000 NHS trusts and healthcare organisations. »» Provides a single point of access to over 620,000 products ranging from beans to bandages, gloves to implants, and even diagnostic equipment such as MRI scanners.

»»

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Greener procurement saves money, space and waste Recent changes to European Union EN standards for examination gloves enabled suppliers to manufacture thinner gloves which continue to offer adequate protection to clinical users. This gave the additional benefit of including greater product quantities per pack. NHS Supply Chain negotiated with four suppliers to package the new product in quantities of 200, rather than the traditional 100. This reduced cardboard packaging requirements by 50% as well as having a positive impact on product shipping costs. With double the quantity of gloves per pack, ordering and storage requirements have been significantly reduced across the supply chain, from supplier through to customer. Sophie Cros, Sustainable Procurement Manager at NHS Supply Chain says: “This positive result shows how, by working closely with suppliers and gaining a greater understanding of customer needs, we’re able to reduce the impact of the healthcare supply chain on the environment, delivering real benefits to customers at the same time. This is great news all round.” “The comprehensive spending review settlement for the NHS has cut capital expenditure by 17% over the next three years. Whilst the exact details and effects are unknown, it is inevitable that there will be some impact on the budgets for medical and capital equipment. Therefore, it is imperative for NHS trusts that better planning and buying practices prevail.” “There is a fundamental need for hospitals to replace equipment on a year by year basis. The problem is that most hospitals, even in the years when budgets were increasing, have never had enough capital funding available to replace all assets needed.” Explaining how the project was led to success, Andy says: “We started with a national framework contract for imaging in 2007, and have since evolved it to cover over 20 types of equipment categories, including decontamination, patient monitoring and anaesthesia.”

“Our offer is now a full lifecycle management service for capital medical equipment. Over the past few years we have added maintenance contracts, leasing services and equipment disposal. Our planning services have also evolved to cover project management, multi year planning and procurement outsourcing.” Jason Lavery, Trading Manager for Capital Equipment adds: “With DHL’s investment, NHS Supply Chain has been able to commit over £30 million of spend to suppliers on key programs like digital mammography and ultrasound, which has delivered substantial price reductions onto trusts.” From conception to the present day, Jason and his team calculate they have achieved NHS savings of over £60 million, and the initiative has become the method by which over 50% of all capital equipment within the NHS is procured.

Some of the significant benefits the capital initiative has achieved since its inception include: »» Quantifiable savings of over £60 million »» Removal of a trust’s need to tender themselves »» Increased speed of procurement »» Cost effectiveness »» Alignment to Department of Health policies »» Process enhancement »» Access to new technologies. Discussing future plans, Andy Brown says: “Over the next five years our focus will be to address the constraints of capital funds in the NHS by: using alternative funding models; the expansion of capital equipment planning; increased project management for trusts; and driving collaboration between trusts regionally and nationally.

Innovative procurement Innovative techniques that NHS Supply Chain has introduced: Set up ‘Choice for Health’, an own brand range through our Direct from Manufacture programme, which will save hospitals on average 14% on like-for-like products. »» Managed 90 e-auctions over the last two years, which typically deliver around 15% of savings. »» Buying on a national scale, aggregating NHS spend to obtain the best product price through commitment deals and bulk buys, using DHL resources. »» Consolidating product ranges and rationalising suppliers will ensure that the Trusts get better value for their budgets. »» Private sector bringing a more commercial focus to NHS procurement through working with our suppliers to improve efficiencies in their supply chains to achieve best product prices for our NHS customers. »» Working with our customers to manage their stock to avoid costly waste through our managed inventory services.

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Contact: Elizabeth Deadman, Communications Manager (Healthcare) School of Information Systems, Computing and Mathematics, St John’s Building, Brunel University, Uxbridge UB8 3PH Tel: +44 (0) 1895 266050  Fax: +44 (0) 1895 269727  E-mail: elizabeth.deadman@brunel.ac.uk Website: www.match.ac.uk

MATCH Tools Workshops – distilling expertise for health technology innovation Michael Craven, Alan Brown, Elizabeth Deadman, Jennifer Martin, Peter Taylor and Simon J E Taylor The Multidisciplinary Assessment of Technology Centre for Healthcare (MATCH) is a well-established research collaboration between four leading UK universities (Birmingham, Brunel, Nottingham & Ulster) and a cohort of industrial partners, also supported by stakeholders from the NHS and other public sector organisations. MATCH, funded since 2003 by the Engineering and Physical Sciences Research Council and partner subscriptions, provides a critical research mass in the field of health technology assessment (HTA) in its widest sense, bringing together expertise in health economics, engineering and social sciences. Through the translation of its research, MATCH supports both companies across the UK healthcare technology sector and user communities, delivering methods and tools to assess the value of medical devices from concept through to mature product. MATCH aims to transform the medical device sector through improved decision-making, so that companies bring better products to market more quickly and less expensively, whilst healthcare providers are able to adopt products with confidence more rapidly. By engaging with UK advisory bodies MATCH is also influ-

encing policy, and, through its work with procurement organisations, has provided the NHS with better methods for buying technology. The focus is on making good decisions early in product development and improving processes for adoption of innovations. In support of this, over the past seven years MATCH has researched evidence-gathering strategies, early-stage health economics, methods for eliciting the needs of users, the link between clinical demand and business process, and investment decisions.

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Inventing and marketing medical devices has always been a challenge; a challenge now heightened by the credit crunch. There is great pressure on SMEs in terms of market access and finance for both development and day-to-day running, whilst the thirst of purchasers for value for money is unabated. Although there is recognition by the government that the healthcare industry is a plus for the economy, there are fears of cutbacks in expenditure on medical technologies alongside the belt-tightening forecasts for the NHS. All of


and in the UK context resulting from the Healthcare Industries Task Force (HITF) initiative of 2003-7, a strategy to take cost-effectiveness into technology adoption and procurement processes was introduced. This underlined the need to disseminate HTA methods to a wider audience in the medical devices industry and in the NHS.

this points to the case for minimising uncertainty in early stage decisionmaking within development and adoption processes, and MATCH maintains that this can be achieved by addressing uncertainty through the use of formal methods and through mutual understanding of these methods by suppliers and buyers. MATCH has translated the knowledge generated by the research outputs of the first seven years into tools to support health technology assessment and has been organising ‘Tools and Training’ workshops around the UK. During the past two years this has been in collaboration with the regional Medilink organisations, the Association of British Healthcare Industries (ABHI) and the MATCH partner universities. The half-day events are dedicated to interactive tools training and have hosted participants from the NHS, the medical device industry and innovation service providers. Due to attracting a diverse audience, the events have also been excellent cross-sector networking opportunities. We are proud to have received an award in 2008 for industrial collaboration at the Healthcare Business Awards hosted by Medilink East Midlands.

The workshops In the workshops we present participants with an introduction to two of MATCH’s evaluation methods and the accompanying tool or guide. We encourage everyone to work on their own laptop, so that any set-up or software installation queries are

addressed on the day as part of the learning. Questions are encouraged throughout the sessions and time is made available afterwards for a fruitful group discussion. Overall feedback from the workshops has been very positive. Participants leave with a delegate pack, which includes, depending on the combination of sessions: 1. Case Study/Demonstration – highlighting practical applications; 2. a complimentary copy of the HTA tool and training material; 3. an opportunity for further ‘handson’ use of the HTA tool; and 4. a complimentary copy of the MATCH/NPSA User Guide. Currently MATCH has three training sessions: »» ‘How to Demonstrate the Value of your Healthcare Technology’; »» ‘How to Predict Device Pricing According to Sales Volume’; and »» ‘The Benefits of Involving Users and Professionals in Medical Device Development’.

How to Demonstrate the Value of your Healthcare Technology Due to demand from government agencies and from for-profit and not-for-profit private sector healthcare organisations, the importance of HTA has increased considerably in recent years. In response to this, in order to secure reimbursement of a technology, medical device manufacturers more often need to submit strong cost-effectiveness data to demonstrate value for money in addition to evidence of clinical efficacy and safety. In parallel to this,

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MATCH has developed an easy to use Health Economics Evaluator tool that can be deployed at the early stages of the product development lifecycle with minimal input data. This tool is used to demonstrate the value proposition of the innovation in terms of its impact on cost and, especially when the innovation costs more than the existing alternative, to articulate improvements in patient outcomes in terms of QALYs – the essential measure of effectiveness in the NICE ‘reference case’. By speaking the language of HTA, manufacturers are better placed to sell innovative products to the NHS. Likewise, NHS decision-makers are supported in beginning the adoption process for new products, such that improvement in patient outcomes has been articulated as clearly as possible given the available data, and the uncertainties are well understood. The session provides basic training on health economics and use of the MATCH tool – where and how to use it – as well as a chance to get some practical experience using the software.

How to Predict Device Pricing According to Sales Volume This session focuses on how to predict the future pricing of a device against estimated sales volume. The core of this is the MATCH online Experience Curve calculator. This allows medical device manufacturers to quickly assess the price trends for their products and as a result to make a more informed judgement about how fast the prices for current and future products are likely to change, with a view to bringing significant benefits in strategic planning and new product assessment. The session also examines how medical device purchasers can use this webbased tool to track how the prices of

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the product lines change with experience and to make informed decisions in price negotiations. Users are encouraged to contribute to research and future tool development by allowing their own experience curves to be added to the MATCH database and by answering some additional questions about the product and the market. All submitted case studies are treated in confidence.

The Benefits of Involving Users and Professionals in Medical Device Development This session provides help and advice on the issues that should be considered when developing medical devices to ensure that the device meets the criteria of its users. The guide, “Design For Patient Safety – User Testing in the Development of Medical Devices” written in conjunction with, and published by, the National Patient Safety Agency (NPSA) in March 2010, examines each stage of product development and the user issues that should be considered at each of these. The guide describes in detail the process of planning a user requirements study and covers issues of sampling, access to users, applying for ethical approval and the role of user data in medical device standards and regulations. A number of examples of successful user involvement

in medical device development are provided. A glossary is also included that provides information on how research methods can be applied in a medical environment. This is aimed at medical device designers, developers and marketing personnel. It is not prescriptive; rather it provides generic advice which developers can customise to fit the needs of their particular device.

The way ahead The next phase of the workshops has been advanced with the launch of a new partnership between MATCH and Biomaterials and Tissue Engineering Centre of Industrial Collaboration (BITECIC Ltd), an organisation with a respected track record in helping the healthcare industry and commissioners assess the true value of innovative products and services. BITECIC and MATCH have joined forces to bring industry and the NHS easier access to existing and forthcoming tools from the MATCH research programme. MATCH and BITECIC have been working closely for 18 months and will continue to concentrate on support for the UK health sector and user communities initially, and aim to extend into Europe, USA and Asia within two years.

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“There’s a clear synergy in this partnership”, said Professor Terry Young from Brunel University. “MATCH is a successful developer of approaches and tools for assessing value and economic impact, while BITECIC provides ongoing operational support, especially to SMEs in the healthcare sector.” BITECIC Director Dr John Egan agrees. “This is an exciting opportunity for us to lend our experience in reaching out to a wider set of users who really need to understand and benefit from MATCH’s tools and guides as they enter a world that demands cost efficiency from new health technologies.” The partnership has jointly funded a position that will promote MATCH and the MATCH training, with the recruitment of Dr Matthew Allsop. Matthew will be facilitating workshops and seminars around the UK from the autumn. In the meantime, MATCH has a growing range of tools and guides and a pipeline planning to deliver a few new offerings each year. As the level of workshops increases to match the current demand, MATCH aims to work with its partners and the wider base of stakeholders to ensure that delivery of methods and tools are suited to their needs. For information on future events, sessions and tools, check the MATCH website: www.match.ac.uk


Contact: David Williams, Wolfson School, Loughborough University, Loughborough, LE11 3TU

Regenerative Medicine, a unique opportunity to transform our national health and wealth, needs capability in manufacturing and supply Accessing the results of remedi, the Innovative Manufacturing Grand Challenge in Regenerative Medicine, and the translational research capability in the new EPSRC Centre for Innovative Manufacturing in Regenerative Medicine and the EPSRC Doctoral Training Centre in Regenerative Medicine Regenerative Medicine (RM) is widely seen as the next major innovation in healthcare. The ability to repair and replace damaged cells and tissue, using emerging technologies such as stem cells, offers the potential of lifetime cures for unmet medical needs, including conditions such as Alzheimer’s, heart failure, blindness and joint degeneration. The UK has a unique opportunity to build on its strong science lead to create and retain an industrial base in RM that will deliver longterm health, wealth and employment; estimates suggest, within a decade, a million UK patients, £5 billion sales and 15,000 UK jobs in research and high value manufacturing. There are barriers to the emergence of RM in the UK; the industry does not yet have a clear identity and visibility with mostly SME participants, the novel nature of the science and engineering means it is difficult for new companies to attract market investment and the regulatory environment is still evolving. Enabling and trans-

lational science is essential as these emerging therapies progress through clinical trials. The key to RM is that the product is the process. Creation of novel manufacturing and supply technologies and skills gives an opportunity to secure a long-term industrial presence in the UK that captures the entire value stack.

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Background Regenerative medicines replace or regenerate human cells, tissues or organs to restore or establish normal function. They have the potential to revolutionise methods of healthcare treatment and improve the quality of life for many. RM is now established as an important branch of medicine – the industry is starting to enjoy commercial success with annual sales

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of over $1 billion; a large number of products are in clinical development, having real long-term potential for public health benefit. The market shift to commercial products based on stem cells is likely to mature in the next 5-10 years, with a series of therapies for conditions – cancer, arthritis, cardiovascular and trauma – in the pipeline. RM is an emerging industry with the promise to contribute to the health and wealth of the UK. It is a high value science-based manufacturing industry whose products tackle the consequences of ageing and chronic disease. The industry, however, currently still faces a number of critical challenges, including problems of commercial viability and company growth, limited revenue, and

lack of investment. The key issue determining poor sales is the lack of clinical uptake of cell therapy products; this is mainly related to difficulties in establishing clinical utility and cost-effectiveness. Creating an appropriate evidence base is the key to addressing this deficit. Businesses therefore have a primary focus on successfully reaching ‘first in man’ clinical targets; this must be followed by the ‘one-to-many’ translation process, such that effective therapies can be produced at scale, and at a price society can afford. Although effective therapies that demonstrate positive health outcomes are being developed, the key barriers facing firms relate to important aspects of the translation process. These include estab-

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lishing closer collaboration with clinical end-users, greater regulatory certainty, clearer reimbursement policies based on economic evidence of the cost benefit of product solutions in application in the market place, rapid post-approval adoption, and the need to develop enabling technologies that lower manufacturing costs. Recent regulatory decisions also demand more clarity in the criteria that define product performance. Solutions to these problems give significant commercial advantage; dissemination of these solutions to SMEs operating in the correct policy environment gives a unique opportunity for industry growth and retention at regional and national levels.


A new kind of manufacturing industry The emerging regenerative medicine industry is a new kind of manufacturing industry. It will use many biological materials as input and its products will frequently be living materials. Like the medical devices and pharmaceutical industries, it has different customers to those encountered in conventional manufacturing – the regulator, the payer, and the healthcare delivery process – and these create a different value system. The regulator and the choice of regulatory route define the new product introduction process and the cost to market; the payer and the healthcare delivery process define the value in the market. However, unlike the pharmaceutical and the medical device industries, the manufacturing process and the manufacturing and distribution system are complex and cost of goods may be significant. Products when they reach the market may also deliver cures instead of just managing symptoms. The benefit of these cures may transcend the traditional boundaries of acute, primary and social care. The focus of the remedi Grand Challenge was to improve our understanding of how to respond to the challenges of RM, particularly from a manufacturing perspective. Work examined the market, barriers to commercialisation, policy, regulatory and reimbursement issues, created value estimation methods for cost effectiveness, manufacturing and characterisation, and conditions for SME and industry growth. The full results of remedi are available as an accessible monograph seeking to communicate this learning to all stakeholders; see below.

Current initiatives The new EPSRC Centre for Innovative Manufacturing in Regenerative Medicine and the EPSRC Doctoral Training Centre in Regenerative Medicine, are collaborations of Loughborough, Nottingham and Keele universities. They respectively focus on research in innovative manufacturing for Regenerative Medicine and research training at a PhD level in translational

engineering and physical science in Regenerative Medicine. Both are industry and clinically collaborative.

regionally centred initiatives and Loughborough University for its continued strategic support of our work.

Contacts: EPSRC Centre for Innovative Manufacturing in Regenerative Medicine www.epsrc-regen-med.org Director: Prof David J Williams E-mail: D.J.Williams@lboro.ac.uk Tel: 01509 227668 Administrator: Mrs Eleri Bristow E-mail: E.A.Bristow@lboro.ac.uk Tel: 01509 227690 EPSRC Doctoral Training Centre in Regenerative Medicine www.dtcregen-med.com Director: Prof Christopher J Hewitt E-mail: C.J.Hewitt@lboro.ac.uk Tel: 01509 222506 Administrator: Mrs Elizabeth Attenborough E-mail: E.A.Attenborough@lboro.ac.uk Tel: 01509 222511

For a copy of the remedi handbook contact Mrs Eleri Bristow E.A.Bristow@lboro. ac.uk 01509 227690 Acknowledgements The significant funding and support of EPSRC for these initiatives must be acknowledged. This funding was secured from their Innovative Manufacturing and the Life Sciences Interface Programmes both for the remedi Grand Challenge and its successor, the EPSRC Centre for Innovative Manufacturing in Regenerative Medicine. The new Centre, and the EPSRC Doctoral Training Centre in Regenerative Medicine, are collaborations of Loughborough, Nottingham and Keele universities. Remedi was a collaboration of Loughborough, Birmingham, Cambridge, Liverpool, Nottingham and Ulster universities and industry and agency partners. We would also like to acknowledge emda for their support of our more

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Creating a Culture for Innovation – Together we can “Strategies and processes alone are not sufficient to drive the degree of change we are seeking… the NHS should focus on tackling the behaviours and cultures …that stand in the way…” David Nicholson, Chief Executive of the NHS NHS Annual Report 2009

Innovation is something that effective organisations in both public and private sectors strive for. Dr Robert Cooper, senior consultant to Fortune 500 firms and a top scholar in the field of innovation management, suggests that, “Having the right climate, culture, organisation (team-based) and leadership for innovation – the people side is essential”. 3

Dr. Lynne Maher, NHS Institute for Innovation and Improvement

Leaders have a disproportionately large effect on the cultures of organisations and systems. By their behaviours, leaders can create the conditions that either hinder or help innovation.2 Leaders at every level in health care organisations should reflect upon how they are providing support to the 1.3 million people who work in the NHS so they in turn can be innovative. These staff include clinical, administrative, scientific and managerial disciplines, who all provide a wealth of resource, knowledge and skills that can be used to exceed the expectations that are before us.

No one can have failed to realise that health care leaders are being challenged to increase quality, improve patient experience of health services and reduce costs. The ability to innovate is becoming increasingly important in order to meet those challenges. During these extreme times there is often a temptation for senior leaders to rely on and reproduce tried and tested methods that often include traditional cost cutting exercises.

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Healthcare leaders need to explicitly address the organisational culture needed to support innovation. One of the first things leaders can do is to really understand if staff actually think that the culture of the organisation makes them feel they have the support they need to be innovative and make changes. The NHS Institute for Innovation and Improvement has identified seven key dimensions of culture that distinguish highly innovative organisations. These form a framework that leaders can use to assess and strengthen the culture for innovation within and across organisations.

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Rewards for innovation are symbols and rituals whose main purpose is to recognise innovative behaviour and encourage more of this sort of behaviour. The best rewards are those that appeal to people’s intrinsic and individualised motivation.

7 Dimensions of Innovation Culture

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risk taking resources knowledge goals rewards and recognition

In high-performing organisations, innovation is the product of the deliberate use of practical Tools. Leaders need to consider how they build capability and capacity in deliberate methods for creative thinking, idea management and implementation.

tools and methods relationships

NHS Institute for Innovation and Improvement 2009

Risk Taking is about establishing an organisational climate where people can try out new ideas by judging any risks appropriately. Innovative leaders demonstrate that they are more interested in learning from ‘failure’ than in punishing failure. The Resources dimension considers the broadest sense of the word. The climate for innovation is enhanced if people know that they have the ‘resource’ of authority and autonomy to act on innovative ideas, as well as some financial resource to support the new work. 1 NHS Annual Report. HMSO 2009 – I couldn’t find the reference in the text to the annual report. 2 Maher, L. Plsek, P. Bevan, H. (2009) Creating the Culture for Innovation: Guide for Executives. NHS Institute for Innovation and Improvement. 3 Robert Cooper - Innovation Management April 12th 2010 accessed via www. innovationmanagement.se

Broad-based Knowledge is the fuel for innovation. Better conditions are created when information, from both within and outside the organisation or system, is widely gathered, easily accessible, rapidly transmitted, and honestly communicated. Contrary to what some may believe, literature clearly shows that Goals actually support innovation. Organisational and system leaders should signal that innovation is highly desirable by setting aspirational goals in specific areas and challenging teams to find ways to realise the vision.

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The Relationships dimension refers to the patterns of interaction in the organisation or system. Innovative ideas are rarely the product of a lone genius therefore, environments where staff are routinely exposed to a wide range of different thinking, provide rich soil for the growth of innovation.

These seven dimensions of culture provide leaders with a lens that can help them take steps to enhance the conditions for innovation.

Together we can; healthcare staff have a wealth of skills, expertise and resource that can be used to innovate through our biggest challenges. The smart leader makes sure that their most precious resources are supported and enabled to do just that. Do you know if your staff feel able to help you with your biggest challenges? Dr. Lynne Maher NHS Institute for Innovation and Improvement For more information go to www.institute.nhs.uk/innovation

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Tel: 01386 751800  E-mail: sanitise@meditrox.com  Web: www.meditrox.com

Making routine Whole Room Decontamination a reality Chris Lamb, Deployment Manager of Meditrox The Infection Control community is constantly striving to improve hospital hygiene, reduce cross-infection and maintain a high level of patient and staff safety. This, combined with the demands of freeing bed capacity taken with patients carrying HCAIs (Healthcare Associated Infections), proves a constant challenge. While strategies involving traditional surface cleaning and hand washing have proven effective to a degree, there are obvious deficiencies in their efficacy. An integrated approach is required to tackle healthcare related infections. Furthermore, Infection Control professionals are realising that technological innovation is required to overcome the deficiencies of traditional cleaning techniques, with showcase hospitals evaluating a wave of new decontamination technologies. Whole Room Decontamination (WRD) treats all surfaces in a room, typically by emitting a biocidal vapour which permeates all surfaces, however remote. More sophisticated systems, such as those adopted by Meditrox, accurately control vapour concentrations and air distribution to apply a measured dosage to all surfaces, including hidden areas and fabrics. This provides a guaranteed powerful kill against bacteria, yeasts moulds and viruses. Most WRD systems also destroy airborne pathogens, a crucial factor in combating norovirus and influenza. WRD technology is a very powerful tool for infection control, as many of the shortfalls of traditional cleaning techniques can be overcome when it is deployed

effectively. It has been utilised with great effect in outbreak situations by companies such as Meditrox, with proven interventions against infectious outbreaks of varying type and magnitude. Providers of emergency decontamination services have become very adept at responding to outbreak scenarios, but when used in this way, they are only reacting to existing problems rather than tackling root causes. There is much more potential in the use of Whole Room Decontamination that is only just beginning to be unlocked.

The Meditrox approach: routine Whole Room Decontamination If WRD systems are purely used in response to known outbreaks, HCAIs can only ever be contained and thus infection levels are only capped. To truly realise the potential of WRD and make a real impact on HCAI rates, technology must be deployed proactively to tackle the root causes of infections and prevent HCAI carriers from cross-infecting. In providing technology that can be deployed routinely, hospital rooms can be regularly disinfected so that infection can be prevented rather than just contained. This ensures that there is never an environmental build-up of pathogens, keeping infection levels to a minimum. Current Meditrox initiatives with key NHS partners are proving the validity of this type of approach to Whole Room Decontamination, with tangible success.

Traditional surface cleaning

Whole Room Decontamination technology

Labour intensive

Semi-automated process with minimal manual input

Limited efficacy against key bacteria, viruses and fungi1

Proven powerful kills against a range of pathogens

Relies on the diligence and availability of operatives

Controlled, repeatable and uniform application over the whole room on every treatment

Hard to reach areas are often missed

Penetrative vapours attack pathogens on all surfaces, fabrics and crevices not normally reachable

Airborne pathogens are not eradicated

Biocidal vapours destroy airborne pathogens otherwise left untouched

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Benefits of routine WRD: »» Reduced HCAI levels – By regularly treating all surfaces and airborne contaminants, cross-infection is dramatically reduced, making real inroads into infection rates. »» Freed bed capacity – With a hospital stay for a patient with an HCAI being 10 days longer than one without2, the bedblocking effect of infections in the NHS is considerable. By reducing infection levels, bed capacity is freed-up to treat medical priorities and relieve the strain on overcrowded hospitals. »» Cost savings – With the average NHS Trust spending in excess of £5m per year on caring for patients with HCAIs3, the savings made from reducing infection levels vastly outweigh the costs of WRD technology.

Overcoming the barriers to routine Whole Room Decontamination As a relatively new technique in Infection Control, WRD has been limited to deployment in outbreak situations due to technological, logistical and economical constraints. Early systems have had long treatment times, blocking beds longer than is practical for regular use. The specialist nature of the equipment involved has made early systems costly and only operable by highly trained specialists. Additionally, the use of harsh chemicals has made widespread use difficult from a Health and Safety perspective due to the tight controls required. To make routine WRD a reality, technology must be faster, easier to use, safe, greener and more economical than has previously been the case. Recent technological and process breakthroughs at Meditrox have meant that a proactive approach to WRD has been realised. This has been achieved by overcoming the barriers that have previously limited the use of WRD, and by working closely with hospitals to integrate the room treatment process into existing cleaning regimes, providing a complete solution.

1. Journal of Hospital Infection 2007; 67: 182-188 2. Clean Safe Care: Reducing infections and saving lives, Department of Health, 9 January 2008 3. House of Commons Public Accounts, 42nd Report

Meditrox technology uses oxygen and specially prepared water to release a powerful combination of ozone and hydroxyl free radicals to kill contaminants, eliminating the use of harsh chemicals. Technological advances that allow fast removal of biocides, combined with room sealing developments that enable quick and safe deployment, have made regular use possible. Meditrox advantages that enable routine decontamination: Fast – Portable technology capable of eliminating most harmful pathogens in less than one hour is ideal for

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routine decontamination. Even the toughest pathogens, including spore-forming bacteria such as C-difficile, can be treated in less than two hours. Easy to Use – A simple user interface with comprehensive on-screen instructions enables operation by hospital housekeeping personnel without the need for complex set-up and monitoring by highly-trained specialists. Safe and Ecological – Comprehensively risk-assessed process and technology ensures safe operation by Meditrox and hospital personnel alike. With all biocidal ingredients generated and removed in-situ, no harmful chemicals are required and rooms are made immediately safe for reoccupation, without the need for monitoring or ventilation. Economical – Through regular use, costs per treatment become far more favourable than for emergency use. By utilising housekeeping staff to operate machines, operator costs can also be eliminated. Due to the ecological nature of the process, room contents, such as curtains and commodes that often require separate cleaning, can be left in-situ.

The Meditrox approach: complete solution For Infection Control strategies involving WRD technology to be truly successful, a complete solution is required. Furthermore, as with any Infection Control technique or strategy, the process must be time effective and embedded into hospital protocols for it to be truly effective. Meditrox achieves this through: Technological development that overcomes many of the barriers to the proactive use of Whole Room Decontamination strategies. »» Spending longer liaising with hospitals to devise the most effective strategies and integrate the process into hospital cleaning regimes and protocols. »» Providing practical support to overcome any deployment obstacles, maximising the impact of the technology. »» Providing a suite of machine-run data which can be overlaid against microbiological studies and infection data to evaluate and optimise deployment strategies.

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As well as providing innovative technological solutions and robust processes, Meditrox understand that every healthcare provider is different. By working closely with hospitals to meet individual infection control needs and to minimise disruption to day-to-day operations, Meditrox customise their solutions to fully reap the benefits of routine Whole Room Decontamination.

Meditrox is an innovative UK technology and service company specialising in environmental decontamination within medical markets. Meditrox provides long-term routine decontamination as well as fast response emergency decontamination services to NHS and private healthcare facilities.

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NHS Health Informatics – A New Approach for Health IT Systems and Information There are extensive systems and informatics implications of the new commissioning arrangements in the NHS. The Liberating the NHS White Paper implies an extensive re-engineering of the commissioning system in the context of achieving the required efficiency savings and complying with CSR10 spending limits. For commissioners this means: a. a concern for efficiency and quality, with an increasing emphasis on outcomes (results), not inputs or processes (effort); b. a shift of care into more cost effective and value for money settings and plan/deliver ‘decommissioning’ of care services where it is uneconomical to continue them; and c. operation of contracts and supporting processes, like procurement and risk/reward incentives, that are capable of monitoring and delivering the required QIPP (Quality, Innovation, Productivity and Prevention) savings. The best commissioners may also a. analyse the care system as a whole when taking commissioning decisions and determining ‘value’ and seek to manage out inequalities in the care system; b. create and use contract currencies and other results-focused metrics for all areas of care provision, with an emphasis on improving community, mental health and long term condition information; and

We think that: ƒ There is a distinct change in informatics policy. Although the 2008 DH Informatics Review had a chapter on patient and public access to health and service information, its SHA focus and systems-led approach has given way to the much less prescriptive and outcomebased Information Revolution; ƒ The policy drive to make NHS datasets more available and take them out of organisational silos may provide the NHS Commissioning Board and GP commissioners with much better information on which to base decisions, via modern database and analytical systems offered by NHS or private sector providers ƒ There is a major opportunity for information service provision to commissioners which could include or integrate NHS, private, third sector and internationally-sourced information. If the trend of other healthcare information services is followed there will be a separation of the activities of information collation and provision, from its analysis and reporting ƒ There are major opportunities for software vendors and service providers to provide GP commissioners with better analytical, modelling and contract management applications/services

c. overall, and at all times, keep the emphasis on doing what is best for patients, not for organisations, whether commissioner or provider. The Informatics Consultation paper (October 2010), indicates some policy directions, endorses the importance of information to the NHS and the personnel that provide it, sets out a clear direction for the use of information and aims to bring commissioners and clinicians into a new relationship with patients, but leaves out a lot of detail.

Health IT and Information Beachcroft LLP has a well-deserved reputation in advising the health sector in Health Informatics. From EPR and clinical systems, to networks/ infrastructure (advised National Assembly for Wales on the NHS Wales integrated care record), to screening systems (advising on the latest NHS screening programme for AAA), to data extraction/collection and analysis tools to Telemedicine and Telecare & Telehealth. We also routinely advise health sector bodies on Information Governance.


Cost cutting and commercial contracts: how to make it work for you With the NHS under pressure to make cutbacks, a natural reaction for managers is to review current contractual arrangements with a view to renegotiating, exiting early or making savings. However, carrying out such an exercise can prove extremely difficult, not only because both parties may well need to be on board with opening up such discussions, but also because there is likely to be very little incentive on the other contracting party - whether public or private sector – to agree any changes, unless there is a situation where the financial viability of the arrangements as a whole is in question.

The pressure to cut costs particularly exists in an environment where patients and the wider public have been given increased rights to be involved in decisions that may affect the manner in which services are provided. The rights given to patients by the NHS Constitution have been backed up by the mantra in the white paper of ‘no decision about me, without me’ and the pledge to improve progress towards ‘patient-led’ services. If the proposed contractual change has an impact on the manner in which the services are to be delivered, or the range of health services available, then any changes being considered will need to be evaluated first to look at the extent to which there is a legal duty to involve the users of the service in those decisions, whether by way of formal consultation or some other form of patient and public involvement.

In addition to seeking to renegotiate existing contracts, it would also be effective to ensure any contracts that are about to be entered into contain suitable provisions in respect of exit and liability, as well as robust and effective reporting provisions to manage performance. Exercising a decision to renegotiate or terminate an existing contract should be made with caution - it is essential to consider: ƒ the contractual position (what the contract says, or doesn’t say, with regard to early termination); ƒ if the consent of a third party is required, what incentive is there for them to agree a termination or variation to the terms; ƒ the issues of patient and public involvement; and ƒ whether the matter could become contentious if the parties or the wider public do not agree.

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From a contractual perspective, managers looking to renegotiate any legally binding agreements should be aware of and follow the variation or change control procedures contained in those contracts. In particular, where someone wishes to terminate a contract early, they should be fully aware of the consequences of such termination, such as whether early termination can result in compensation being paid to the contractor and how such compensation is calculated. If there are no compensation provisions within the contract, this would not stop a contractor making a claim for wrongful termination and seeking damages (and its legal costs) if appropriate.


The governance challenge for GP Consortia GPs contemplating the establishment of commissioning consortia, need to make sure they quickly get to grips with the concepts of governance, accountability and liability. They need to understand and plan for the very different responsibilities that will rest on their shoulders depending on whether they are sitting on the managing boards of their practice, of the practice cluster, of a PEC, a GP Cabinet, or the consortium itself when they are formally established. Interim arrangements present challenges: GPs will work in partnership with PCTs preparing for the transition to formal commissioning responsibilities. PCTs may create subcommittees and invite GPs to serve on them so GPs need to be alert to the responsibilities and the protection (if any) they will have. PCTs will also need to understand and manage their ongoing statutory accountability during this stage. GPs serving on a variety of boards and committees also need to understand that their status may be different on each. This tricky distinction has caught out directors of a number of private and public sector organisations in the past, and it would be all too easy for GPs to carry across a pattern of behaviour that was right for one organisation but wholly inappropriate for another.

Conflicts In order to have a registered patient list, practices must be members of consortia, while in order to provide a full range of services, consortia will need to contract with GP practices and others for services. They may have to police practices for compliance with national frameworks and locally agreed pathways or other protocols. Consortia may need to apply sanctions or even expel practices. This all provides plenty of potential for conflicts of interest to arise. Governance arrangements will have to allow interests to be identified and declared so GPs can continue to participate in discussions and service provision, whilst providing an audit trail to show that no improper considerations have influenced either contractual or referral decisions. Governance infrastructure – what should it look like? ƒ GPs have little appetite for bureaucracy and the size of the future management allowance will also mean that the governance structure of consortia must be as lean as it is effective. ƒ Governance structures, mechanisms and processes must avoid consortia being immobilised by inertia, support safe and effective management, and allow the organisation to adapt and react quickly to what will inevitably be very fast-changing circumstances in the future. ƒ The management structure must provide for a clear accountability framework in which everything is someone’s responsibility and everyone knows what they are responsible for and the authority they have. ƒ As for governance, any committee must be justified by specifying how it supports its parent body to fulfil its responsibilities, including providing assurance. Terms of reference must be crystal clear.


Private sector opportunities The reforms to be enshrined in the Bill will in due course no doubt usher in significant opportunities for independent providers to work within the NHS. Their initial enthusiasm has, however, been muted by some of the risks posed by the reforms’ implementation.

Key opportunities for the independent sector include: ƒ The opening up of the market for NHS-funded services to “any willing provider”. The Government has made the development of a “fair playing field” a priority. To address market distortions that largely favour the public sector, it is proposing to extend critical provisions of the Competition Act 1998 to the NHS as well as adjust tariff structures and will also give Monitor extensive new competition powers. ƒ The need for commissioning consortia to draw on the expertise of consultants, as well as Primary Care Trust staff, to ensure best practice in governance, commissioning and procurement of services and achieve economies of scale. Our report Driving Change: Steering Commissioning Consortia from A to Z reveals a widespread view that GP leads need to buy in these skills quickly. ƒ The increased scope for innovative partnership arrangements between the independent sector and Foundation Trusts which the abolition of the private patient income (PPI) cap will allow. The need for new skills and capital to develop NHS estates, particularly those previously owned by PCTs, will give this trend further impetus. ƒ The scope for commercial lending to the FT market. The proposed extension of corporate insolvency rules to FTs, the dilution of the restrictions in relation to the disposal (and therefore charging as collateral) of NHS assets and the removal of the ability for FTs to be financed other than through loans represent a critical development in this respect.

The independent sector remains cautious, however. Particular risks include: ƒ The multitude of complex (and in some cases, it has been argued, flawed) procurement processes that PCTs have initiated in relation to the new Any Willing Provider (AWP) contracts, which has made the task of tendering for these contracts unexpectedly onerous and makes it likely that the deadline for putting in place AWP contracts will need to be extended beyond 1 April. ƒ The very limited budgets which consortia will have to procure external expertise, making the investment required to provide such support a credible proposition for only a small number of private sector providers. ƒ The scope that the abolition of the PPI cap may give to unfair competition from private patient units cross-subsidised from Foundation Trusts’ other operations. ƒ The protection of “designated services” (those that cannot easily be provided by other providers) from creditors through the health special administration regime and concerns that the enforcement of lenders’ security generally will be hampered by public opinion.

To find out more about us please call: Nigel Montgomery, Partner and Sector Head of Health, on +44 (0) 117 918 2321 or nmontgomery@beachcroft.com


Improving Quality and Productivity through Innovation in the NHS These objectives support the key priorities of putting patients first; improving healthcare outcomes and empowering professionals and providers, as set out in the White Paper ‘Equity and Excellence: Liberating the NHS’.

Mark Wilkinson Director Life Sciences Innovation, NHS

Innovation in using drugs and medical technologies is vital to ensure further improvements in quality and productivity within the NHS. In the current economic climate, the NHS needs to release unprecedented levels of efficiency savings and the best way to do this lies in improving quality and productivity through sustained innovation. Central to this role will be encouraging more NHS and industry joint working, to develop and facilitate the uptake of new innovative medicines and technologies to deliver improved patient outcomes. The benefits are potentially immense. The NHS Life Sciences Innovation Delivery Board (NLSIDB) has been set up to: »» Increase the uptake of cost effective medicines and medical/diagnostic technologies. »» Increase the attractiveness of the NHS as a site for research and development. »» Increase the spread of innovative practice and uptake in support of improving NHS quality, productivity and efficiency. »» Improve the strategic relationship between the NHS and the life sciences industries.

INNOVATION IN HEALTHCARE

Positioned at the heart of the NHS, the NLSIDB is a unique partnership that brings together senior NHS leaders, expert advisors (e.g. National Institute for Health and Clinical Excellence), senior policy makers and industry leaders from across the life sciences sector to work in collaboration for the benefit of patients. The UK life sciences industry includes pharmaceuticals, medical technology and diagnostics. A world-leading, high-tech industry, it employs over 120,000 people and invests around £5 billion in R&D in the UK. We are developing an effective partnership between the NHS and industry, to help the NHS increase quality and productivity and make it easier for the life sciences industry to collaborate and work jointly with the NHS. This will help industry focus on the development of new medicines and medical devices, which are designed to meet the needs of the NHS and its patients. This collaboration is vital for innovation so the NLSIDB is working hard to help overcome the barriers that may currently be experienced when the NHS and industry clearly want, and need, to work in partnership. The NHS and the UK have a reputation for being worldclass at discovery and invention, but questions have been raised about how quickly the NHS is able to adopt innovation. It has long been suggested that there is room for improvement in both the rate and the spread of technology adoption. This rate can be slow, even when the supporting evidence base is significant, and it results in delay or failure to grasp the potential economic, health and social benefits. In the present climate, when the whole of the NHS is looking to make significant improvements to Quality, Innovation, Productivity and Prevention (QIPP), it is more important than ever to address this issue. Delayed adoption leads to loss of health benefits to patients who might have benefited from earlier access to cost-effective drugs and technologies, so there is a real opportunity to improve patient care and outcomes. There may be a perception that when it comes to working with the private sector, the NHS is ‘culturally resistant’ and mistrusting. Yet in the work we have undertaken, we have found a significant number of creative, mutually beneficial partnerships where people have told us that trust is the

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crucial first step. We know that many of the examples cited by the Department of Health and the Association of British Pharmaceutical Industry (ABPI), in their Joint Working Toolkit, are the result of this trust. Fortunately, there are a number of steps NHS staff can take to develop greater knowledge and trust. A better exchange of information between partners will lead to greater knowledge, insight and ultimately the kind of deep levels of trust needed if we are to really maximise the benefits from this joint working. Clearly there is much that can be done nationally but the best and most important trust is built, or lost, at a local level. The NLSIDB is working to embed a culture of innovation and ensure innovative medicines, treatments and technologies are taken up. This will be done through: »» Specific projects, for example to encourage the uptake of cost effective medicines and medical technologies. »» Actions that will support system-wide reform to ensure that the NHS, in all its component parts, operates quickly and efficiently to embrace innovative medicines and technologies. »» Securing proactive support from leaders of NHS organisations and industry in ensuring adoption of best practice in the initiation and delivery of clinical trials identified via the National Institute of Health Research (NIHR) Clinical Research Network Exemplar Programme. »» Developing a leadership programme to develop a business to business relationship between the NHS and life sciences industries. There are various initiatives already in place to encourage quality and productivity improvements within the NHS. The Commissioning for Quality and Innovation (CQUIN) payment framework was introduced in 2009 to make a proportion of providers’ income conditional on demonstrating improvements in quality and innovation in specified areas of care. This framework helps make quality an intrinsic part of commissioner-provider discussions and encourages a culture of continuous quality improvement across all providers. In essence, it is a way to give rewards and incentives for excellent performance. The CQUIN framework is important for the implementation of the National Institute for Health and Clinical Excellence (NICE) quality standards and improving patient experience and patient-reported outcomes. The NLSIDB is currently working with organisations throughout the NHS to produce a set of Exemplar CQUIN goals, building on the model of illustrative example schemes that were developed last year. We are seeking Exemplar goals to which the CQUIN framework could apply. The first CQUIN indicator that we are looking for NHS commissioners to implement is the increased use of Oesophageal Doppler Monitoring (ODM), as an alternative to invasive monitoring, in patients undergoing highrisk or major surgery or high-risk patients undergoing any surgery. The ‘high-risk’ benefiting group for ODM has been estimated as comprising 11% of all surgical procedures per annum, which could be approximately 330,000 cases. The

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NHS Innovation Technologies Adoption & Procurement Programme (iTAPP) Board recently identified ODM as one of the technologies, which could make a contribution to savings in the region of £1billion across the NHS. The ODM assesses the cardiac output of a patient, to guide appropriate administration of fluid and drugs during surgery. It is typically used in perioperative management of patients undergoing major high-risk surgery, highrisk patients undergoing any surgery, or in intensive care for critically ill patients being treated with invasive ventilation. It is intended to be less invasive than some other options for cardiac output monitoring and involves the use of a monitor and a single-use disposable probe, which is placed into the patient’s oesophagus through either the mouth or nose. A low frequency ultrasound signal, generated by the monitor, is reflected by red blood cells as they travel down the aorta, and the Doppler principle is used to determine the velocity of the travelling blood cells. ODM technology has been available to the NHS for a number of years and is routinely used in some hospitals, but there is potential for more widespread use. There is evidence that the use of the ODM in the perioperative care of patients undergoing major or high-risk surgery may reduce the length of stay in hospital and complications. NICE is due to publish medical technologies guidance related to Cardio-Q ODM in January 2011. The National Technology Adoption Centre (NTAC) has produced a ‘How to Why to’ guide to support the implementation of Doppler-guided intra-operative fluid management into routine clinical and operational practice across the NHS. The implementation project worked with three NHS Trusts so that there is real-life expertise available to others. Individualised goal-directed fluid therapy is also described in the Department of Health (2010) guidance ‘Delivering enhanced recovery: helping patients to get better sooner after surgery’ as follows: “New monitors (such as the oesophageal Doppler) allow just enough intravenous fluid to be given to maximise the amount of blood ejected by the heart each heartbeat, without giving excess fluid, which can accumulate in the tissues and slow recovery from surgery.” Projects like these provide the foundation for delivering a more efficient and effective NHS. By working in partnership, both the NHS and industry will gain and ultimately patient services will improve. Effective innovations, which are widely adopted, will lead to improvements in quality, productivity, and patient outcomes, as well as the wider potential benefits to the nation’s health, social and economic status.

INNOVATION IN HEALTHCARE


For more information, call the Sharpsmart UK head office on 01388 810310 E-mail: info@sharpsmart.co.uk or visit www.sharpsmart.co.uk

Sharpsmart Reusable Sharps Containment System - an innovation that ticks all the boxes Cost savings, environmental sustainability, regulatory compliance and the safety of staff and patients are the main reasons NHS institutions are selecting the innovative Sharpsmart Reusable Sharps Containment System.

»»

Very rarely is an innovation introduced to the NHS that has been proven to provide so many inherent benefits, such as: »» 33% reduction in sharps injuries »» 32% reduction in sharps waste volumes »» 91% reduction in lifecycle CO2 emissions »» 10% cost savings »» Guaranteed compliance with waste regulations.

The outcome of the Sharpsmart design project was an outstanding product that has exceeded all expectations. The product has quickly become the system of choice for healthcare organisations who’s targets include cost saving, waste and CO2 reduction and Health & Safety improvements.

The Sharpsmart System was developed in conjunction with healthcare professionals across the world. The key design criteria identified during a three year long development study were: »» Develop a sharps containment system that includes passive inbuilt safety systems to reduce needlestick injuries to staff, patients and the general public »» Produce a reusable product that will eliminate the need to incinerate the sharps container to provide reduction in waste volumes and CO2 emissions.

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Improve infection prevention procedures at point of generation to final disposal of the sharps. Reduce costs associated with the procurement of the sharps container and the disposal of the sharps waste stream.

Unique design features of the system include: »» Impenetrable ABS plastic construction »» Automatic closure when full »» Fill level viewing window »» Hand entry prevention »» Air and liquid tight seal. These inherent safety features have contributed to a typical 33% reduction in needlestick injuries for Sharpsmart customers following the first year of installation. Container related and other injuries caused by inappropriate sharps disposal are a major contributory factor to the UK’s higher than average needlestick injury rate, which is estimated at 14.8 injuries per 100 beds per annum.

INNOVATION IN HEALTHCARE

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It was reported by the Royal College of Nursing in 2008 that 1 in 10 nurses receive a needlestick injury every year in the UK, and sharps injuries cost the average NHS Trust approximately £500k per annum. Sharpsmart has been proven in global studies to be the safest method of sharps disposal available. Catherine Stokoe, Specialist Infection Control Nurse, Northumbria NHS Foundation Trust comments: “A review of needlestick injuries across the seven hospitals established that the after-use injury rate was reduced by one-third. I am pleased to confirm that the introduction of Sharpsmart has contributed to a verifiable reduction in needlestick injuries.”

Treatment The seamless disposal service offered by Sharpsmart includes the delivery of the clean ‘ready to use’ containers and collection of the full ‘used units’. The used units are returned to the nearest Sharpsmart reprocessing facility where a robotic system (Washsmart) performs the opening, decanting and the validated cleaning processes. All containers are quality checked prior to being returned to the Health-


single use polypropylene or polyethylene containers which, when full, are incinerated along with the disposed sharps.

care facility in a clean ‘like new’ condition. Tests have proven that the Sharpsmart containers are capable of 500 uses before they require replacement. The typical lifecycle of a Sharpsmart container is 10 years. Traditionally, healthcare generated sharps have been disposed of within

The NHS Carbon Reduction Strategy for England (CRS) sets out an ambition for the NHS to help drive change towards a low-carbon society. The government has committed to take action now and has introduced the Climate Change Act with a target to cut carbon emissions by at least 80% by 2050, with a minimum reduction of 26% by 2020 across the UK. Waste reduction continues to be a major focus for all NHS institutions and, apart from efficient waste segregation, a reusable sharps container is currently the only measurable and

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validatable method of significantly reducing clinical waste volumes within the healthcare environment. A recent clinical study performed across 10 hospital sites in the UK has proved that, on average, the implementation of Sharpsmart system contributed to a reduction in the sharps waste volumes by 32%. This reduced volume represents the elimination of the single use container from the waste stream. The 10-site study was commissioned as a joint venture between the participating hospitals, Sharpsmart Ltd and Waterman Environmental as part of a barrier constrained lifecycle assessment study to determine the CO2 emissions generated throughout the manufacturing, transportation, cleaning (Sharpsmart only) and disposal phases.

INNOVATION IN HEALTHCARE


To support their customers in their drive for compliance with European Waste Regulations and HTM 07-01 Safe Management of Healthcare Waste, Sharpsmart has introduced its unique complimentary auditing service, Auditsmart.

The year-long study determined that the Sharpsmart system contributed to a 91% reduction in lifecycle CO2 emissions when compared to prior year use of single use sharps containers. The conclusion of this lifecycle assessment study was that the CO2 reductions experienced during the first year of implementation of the Sharpsmart Reusable System exceeded the targets laid out in the Climate Change Act. It also determined that the CO2 generated to manufacture, transport and dispose of the containers generated more CO2 than is generated during the disposal process of the sharps themselves. The NHS is undertaking a number of sustainability, procurement and waste reduction initiatives focusing on CO2 reduction, and Sharpsmart Ltd is proving to be a key contributor to the attainment of the targets set out in these initiatives. Rob Nash, environmental risk manager at Chesterfield Royal Hospital, comments: “The introduction of Sharpsmart has proven that, not only have we significantly reduced the weight and the cost of our clinical waste disposal but, in relation to the packaging of the sharps waste stream, we now have validatable

proof of life-cycle CO2 reductions which exceed the targets set out in the Climate Change Act.”

The Auditsmart product includes a comprehensive compendium of reporting, analysis and corrective action planning related to all critical procedures throughout the sharps generation and disposal processes, including monthly waste composition analysis with pictorial evidence of non-compliance.

Clinical waste volumes are increasing rapidly, as are the costs of disposal, which typically exceeds £700 for the incineration of 1 tonne of sharps waste.

The introduction of the Auditsmart procedures has provided Sharpsmart customers with an added compliance guarantee, which is unique throughout the clinical waste industry.

The 32% reduction in waste volumes (experienced when introducing the Sharpsmart system) has resulted in hospital cost savings of around 10-15% during the first year of introduction (when comparing the Sharpsmart service with the purchase and disposal of single use containers).

The NHS procurement toolkit ‘Procuring for Carbon Reduction’ sets out a hierarchy of interventions that should be considered when purchasing all goods and supplies. The Sharpsmart Reusable System is proven to reflect this commitment towards the environment by meeting these procurement interventions at every stage and will provide an immediate attainment of the targets set out in the Climate Change Act (2008) related to the disposal of sharps.

The correct segregation and consignment of clinical waste is a major concern within many healthcare institutions across the UK. Incorrect segregation constitutes a real danger to the environment, hospital staff, waste treatment facility staff and the general public, and carries stiff legal and financial penalties for non-compliance.

Sharpsmart is continually providing support of the NHS initiatives related to safety, sustainability, value, quality care and regulatory compliance.

Detailed below are the annual benefits experienced by a typical 500 bed hospital in England: Waste Reduction

9.08 tonnes

-32%

CO2 Reduction

66 tonnes

-91%

Needlestick Injury Reduction

24

-33%

Cost Reduction

£10,000

-12%

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A hotbed of innovation With clever use of time, expertise and inspiration, innovation in UK healthcare is going from strength to strength – despite the current economic climate. Kathryn Senior takes a look at the projects that are revolutionising diagnostics, treatment and care within the NHS

In today’s economic climate, it would be no surprise if the UK’s healthcare system had battened down the hatches and was opting for a more cautious approach to new ideas. Fortunately, nothing could be further from the truth. Funding is being spent carefully and wisely but clever use of time, expertise and, above all, inspiration is still proving to be a good investment. The result is a series of innovations that have the potential to improve both the efficiency and the effectiveness of our services. This article presents just a few examples of excellence in innovation, introducing new projects that may ultimately revolutionise the way people in the UK are treated and cared for within the National Health Service (NHS). Technology continues to advance at an ever-increasing rate and healthcare innovations continue to make good use of hi-tech developments. The most useful innovations, however, are those that resist the urge to use technology for technology’s sake, and instead combine state-of-theart automation with practical application, simplicity and people-friendly usability.

DIAGNOSTIC INNOVATIONS Diagnosis and ongoing monitoring of disease states are the springboards from which all healthcare decisions are made. Treatment choices, rehabilitation and self-help advice among other topics are all based on the findings of diagnostics. The challenges faced in this field of medicine are numerous; the need for invasive testing and the time required for complex analysis creates long waiting times for both clinicians and their patients because of the inevitable burden on resources. To be truly successful, innovations in this area must simplify and reduce this burden, as well as providing superior diagnostic information.

Biosensors for predicting flares in respiratory disease Chronic Obstructive Pulmonary Disease (COPD) is the second most common cause of emergency admission to hospital, and unexpected flare-ups can cause havoc to someone with the disease. Currently, the only methods of monitoring the progress of COPD involve spirometry – which uses machines that measure the speed and volume of expelled air – or monitoring the composition of exhaled

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Vanessa Raw, Neil Frame and Alistair Campbell

breath. While effective at diagnosing and assessing the stage of disease, these tests alone are generally not sensitive enough to predict flare-ups before they happen. With this in mind, Monica Spiteri, Professor within the Directorate of Respiratory Medicine at the University Hospital of North Staffordshire NHS Trust (UHNS), has developed a method of testing saliva for the acute monitoring of serious lung conditions: “Saliva analysis is currently used in other fields, such as testing for alcohol and drug levels. Using saliva is far more convenient and less invasive for the patient than having to give a blood sample,” says Spiteri. Collaboration between clinicians from UHNS and scientists from the international technology giant, QinetiQ – a partnership facilitated by MidTECH, the West Midlands NHS innovations hub – has resulted in a new saliva test for patients with respiratory diseases. This measures

INNOVATION IN HEALTHCARE


biomarkers – proteins whose concentrations fluctuate according to the severity or presence of disease – to give accurate early warning of flare-ups. Mary Haigh, QinetiQ’s exploitation manager for the project, said that the biosensor “incorporates leading edge chip-based technology and optical sensors, and anything else for the diagnosis and detection of bio-markers associated with respiratory disease”. Tests are currently underway to refine the device prior to beginning clinical trials, and future aims of the project include the development of hand-held devices that allow patients to monitor their own condition from the comfort of their home. “The arrival of our prototype respiratory biosensor is a landmark step in the development of future near-patient technology that could make a big difference for monitoring patients with lung disease,” says Spiteri. Speaking of the success of this collaboration between industry and the NHS, Rebecca Garrod-Waters, director of innovation at Advantage West Midlands, said: “This project again highlights the technology strengths and innovation of West Midlands businesses – capabilities which will help them to grow in difficult economic conditions.”

Taking the ‘I’ out of eye observations The Regional Medical Physics Department at Freeman Hospital, Newcastle upon Tyne, have developed an automated, hand-held instrument that can objectively measure and record pupil size and reactivity in both conscious and unconscious patients. This simple, portable device allows staff to perform this type of observation easily and under varied conditions, enabling the objective measurement of pupil state throughout the patient’s stay in hospital. The way that the pupils react to light provides the most insight into the neurological status of patients who are critically ill. It can also indicate responsiveness of the autonomous nervous system, and can indicate the presence of pharmaceutical agents and recreational drugs. The new automated system should be useful in many hospitals all over the UK by replacing the currently used subjective method for assessing pupil responsiveness – a simple viewing of the pupil’s reaction to a beam of light. Current practice inevitably leads to considerable inter-observer variability, making small changes in patients’ status difficult to detect. Use of the automated device will mean that a second opinion could no longer be required before any change in status can be confirmed, so reducing the current relatively large burden on NHS resources.

Revolutionising lower-limb rehabilitation For the past decade, Neil Frame, NHS Specialist Podiatrist in Biomechanics, has been working on a unique platform to overcome the problems faced by physiotherapists when prescribing and monitoring an exercise regime for lower leg rehabilitation. The RehabAngel® – developed by MDTi from within the NHS, with funds and assistance from TrusTECH the NW NHS innovation hub, to provide improved patient care, safety and greater cost savings to Allied Healthcare services – is a unique variable incline device that has a flat and 5 degree inverting wedged surface, allowing patients requiring lower limb rehabilitation to perform a prescribed set of lower-limb exercises with enhanced control and safety. The angled platform – which meets all health and safety and ‘best infection control’ protocols – reduces the level of stress placed on the ankle joints while squatting and stretching, offering reduced risk of injury and providing a controlled, graduated rehabilitation environment. The RehabAngel® is convenient to use and to store, and is suitable for use in both sports and community health environments, making it a valuable and cost-effective tool whenever and wherever lower-limb rehabilitation is needed. Mike Farrar, chief executive of NHS North West and sports tsar to the Department of Health, said: “The RehabAngel® is a great example of the NHS working successfully in partnership with industry to offer great benefits to patients recovering from sports-related injuries, knee surgeries and those whose health is impacted by long-term conditions.”

INNOVATIONS THAT PROVIDE A LITTLE EXTRA HELP Some recent innovations within the health service are the result of a patient, health worker or bystander daring to look again at something that wasn’t working and striving to find a new approach that just might.

Recycling body heat for easier breathing Cold snaps, which seem to be increasingly common in the UK, can exacerbate existing breathing difficulties caused by respiratory conditions like COPD. This can significantly affect the patient’s mobility and their quality of life. This was the experience of retired judge, Ian Morris. He had personal experience of breathing difficulties in cold weather following an operation. Thinking about his problems, he came up with the idea of the Warmamask – an innovative idea for a facial mask designed to allow people with COPD to inhale warm air in cold conditions by recycling air that has been pre-heated by the body.

INNOVATIONS FOR REHABILITATION Following injury or surgery, rehabilitation is the long, sometimes painful and often costly road to recovery that is experienced by patients but also shared by their careworkers. Innovations that can reduce the length of this phase of patients’ recovery, reduce the chance of relapse or new injury, and lessen the strain that rehabilitation puts on the health service are particularly welcomed.

INNOVATION IN HEALTHCARE

After discussing Morris’s ideas during his visit to their stand at the MDT Medtech Exhibition in February 2007, Medilink West Midlands brought the project to the attention of MidTECH, who met with the inventor and his business partner to guide them through the processes involved in the development and commercialisation of such an innovation with the assistance of the NHS.

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GraftBolt® Case study Although they are relatively rare and tend to affect mostly athletes, awareness about anterior cruciate ligament (ACL) injuries has increased dramatically in recent years, with Michael Owen famously sustaining his in the 2006 World Cup, and Tiger Woods experiencing an ACL injury of his own during the 2008 US Open. As one of the most serious injuries in sport, a torn ACL often requires surgery and a lengthy rehabilitation period, placing a significant burden on patients caused by reduced mobility for prolonged periods. By being one of the most commonly performed types of knee surgery, ACL reconstruction also places a considerable burden on health services.

The problem Surgery for ACL injuries usually involves the use of a graft taken from another site, usually the tendons of the kneecap (patella tendon) or hamstrings, or from a donor. This graft is then used to reconstruct the ACL, and is held in place with a fixation device. Rigid fixation of the graft is essential to facilitate timely rehabilitation and prevent failure of the reconstructed ACL before it has been accepted by the surrounding tissue. Typically, fixation of the graft is seen as the weak link in the chain of ACL reconstruction. Consequently, research and development of numerous different fixation methods are continually evolving. Historically, fixation methods have included polyethylene anchors, the ‘EndoButton’, bone grafts, washers, pins/staples/screws and many more.

The solution Now, five years after its initial development, GraftBolt® – an innovative device used for tibial fixation of softtissue grafts during ACL reconstruction that has demonstrated better performance than other devices on the market – has been launched in the UK and USA.

How does GraftBolt® work? The GraftBolt® employs a system of a PEEK optima screw and tapered sheath with circumferential, deployable tabs to create a solid fixation environment for soft-

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tissue grafts during surgical treatment of ACL injuries. The screw is used to expand the sleeve, which can fixate two or four-strand grafts, allowing them to be separated and separately tensioned. By providing superior fixation of grafts, GraftBolt® has the potential to increase surgery success rates and reduce patients’ rehabilitation time.

How did TrusTECH help? GraftBolt® is the brain-child of Martyn Snow, then a specialist registrar in orthopaedics based at University Hospital of South Manchester NHS Foundation Trust (UHSM), and Dr Bin Wang, lecturer in engineering at the University of Manchester, who approached TrusTECH, the NW NHS innovation hub, for advice and funding. After being successfully awarded a TrusTECH Pathfinder Development Fund grant, Snow and Wang’s team – led by then PhD student, Mahmoud Chizari – carried out further research into the performance of the device that showed GraftBolt® to be a superior alternative to existing fixation devices on the market. Following these positive findings, the team used some of the development funding provided by TrusTECH to file a UK patent application. TrusTECH subsequently provided further support by negotiating a licence with Arthrex Inc, who expressed an interest after being approached with GraftBolt’s® credentials. Once the licence was agreed, Arthrex undertook some further design refinements, following which GraftBolt® was eventually launched in 2010, five years after its initial inception, with patent protection now underway in Europe, the US, Australia and Canada. Richard Deed, unit manager of TrusTECH commented that recent research carried out by Arthrex has shown that GraftBolt® results in significantly less displacement of the ACL in the tibia than the leading competitor. “GraftBolt® went from initial concept to available in the UK and USA within five years, which is impressive and demonstrates the value of cross-disciplinary working. The long-term impact will be that fewer patients will need repeat surgery and this will reduce costs for healthcare providers.”

INNOVATION IN HEALTHCARE


control of the environment that surrounds the product, in particular temperature, pH and air quality, which can be easily contaminated by organic compounds and micro-organisms that can be particularly harmful to the products in question.

The solution

Case study: Vitro Safe Systems Limited The problem In vitro fertilisation (IVF) is a sensitive subject on a number of levels. It is an emotional rollercoaster of highs and lows for patients, and a highly sensitive and costly procedure combined with high failure rates, resulting in relatively low cost-effectiveness for the NHS. Stem-cell procedures are also often victim to similar challenges and failures.

A new technology that addresses this issue of controlling environmental factors during sensitive procedures such as these has recently been developed by the Newcastle Upon Tyne Hospitals NHS, and is being patented on their behalf by NHS Innovations North. The Vitro Safe Systems, an IVF isolation cabinet system launched at the European Society of Human Reproduction and Embryology Annual Conference in 2008, uses a linked series of enclosed isolators and incubators to create the world’s first completely enclosed bio-processing system for reproductive technology. The system allows, for the first time, the entire IVF procedure from oocyte retrieval to embryo transfer to be conducted in a totally closed environment. Using HEPA and activated carbon filters, the internal environment can be continually maintained to provide a controlled and stable environment, thereby reducing the environmental stress placed on samples and increasing the viability of the resulting embryos.

The result One reason for the failure rates seen with IVF and stemcell procedures is the potential for significant fluctuations in the environmental conditions under which these procedures are carried out. Both are typically conducted within open-fronted laminar flow cabinets, which are designed to create a clean environment by drawing air away from the product, but which in turn offer poor

Warmamask has already gained the support of Jean Emberlin, professor at the National Pollen and Aerobiology Unit at Worcester University, and has attracted significant clinical interest and support from Richard Lewis, consultant physician at Worcestershire Acute Hospitals NHS Trust, who is helping to assess the mask’s effectiveness. Warmamask also has potential to be adapted for use in the event of a viral pandemic, as well as for sport, leisure and military uses.

Child-friendly help for physiotherapists Monitoring range of movement is a key aspect of managing hip problems in children with cerebral palsy, a condition that affects around one in 500 children in the UK. Tra-

INNOVATION IN HEALTHCARE

Preliminary clinical data with the system demonstrate increased embryo viability and significant improvements in pregnancy rates, both clear benefits to patients and the NHS. Further, the easing of time constraints and added control over working environment are of considerable benefit to the staff and trainee embryologists working with the system on a daily basis.

ditional methods for measuring range of movement in the hips of children with cerebral palsy – typically done using a hand-held goniometer – are fraught with problems, including difficulty of use and poor reproducibility. A new measurement tool, the Proximat®, for assessing range of movement in children’s hips has recently been devised by Manchester PCT physiotherapists, Patsy Pott and Andrea Selley, who were inspired to try a new way of doing things after seeing a typical patient assessment. Proximat® is a simple, child-friendly tool for measuring range of hip movement that is easy to use and has demonstrated its accuracy and usefulness in studies as well as in several UK physiotherapy practices.

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Proximat®

In a reliability study, the Proximat® was found to be a responsive and acceptable method of measuring passive hip movements in children with cerebral palsy that was quick and easy to use in day-to-day clinical practice and, importantly, acceptable to the children. When compared with existing studies with goniometers, the Proximat® was also found to be simpler to use and with greater reproducibility, making it more effective in identifying problems. With the help of TrusTECH, Manchester PCT has been able to register the design of Proximat®, and it is now widely available for use across the country from JCM Seating Ltd.

mist of water into the patient’s mouth via the soft bristles. It has an angled and flexible neck and a hygienic cover to protect it. All of this leads to better health and comfort for patients, making the whole experience more pleasant for all concerned.”

A clean sweep for new toothbrush

INNOVATIONS FOR THE COMMUNITY

An innovative aid for hospital patients unable to clean their own teeth was awarded the top prize of £4,000 at the 2010 MidTECH NHS Innovation Awards, held on 25 November 2010 at Birmingham’s Botanical Gardens.

Certain challenges transcend the world of healthcare in which they originate, and infiltrate the whole of society. Innovations that are aimed at the wider community need a personal touch from someone with their feet firmly on common ground.

The ‘Teggy’ toothbrush was devised by staff members at University Hospitals Coventry and Warwickshire NHS Trust, led by Natasha Wileman, research and development business manager, and Margaret Goodman, research facilitator. Development of the Teggy was inspired by the thoughts of the hospital’s chaplain, Reverend Kirsteen Macaulay, who thought there must be a better way after watching nurses and hospital support workers struggling to clean patients’ teeth with ordinary toothbrushes. “Normal toothbrushes can be hard, inflexible and dry quickly inside the mouth, especially in patients who are already debilitated by their illness. This makes it more difficult for staff to help patients, making their mouths painful and uncomfortable,” explains Goodman. “That’s why we developed the Teggy, which incorporates a water reservoir in the base, which when squeezed emits a thin

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The £4,000 prize will allow the Hospital Trust to continue development of the Teggy, enabling the developers to turn the prototype device into a marketable product with practical application across many aspects of health and social care throughout the country.

Saggy boobs and other breastfeeding myths Few topics cause more controversy among parents, women and society as a whole than that of breastfeeding, and the pressure often felt by new mothers on how best to feed their baby is only magnified by the number of myths and misconceptions that surround this delicate subject. Saggy Boobs and Other Breastfeeding Myths is a new book by Val Finigan, midwife and infant feeding co-ordinator at Pennine Acute Hospitals NHS Trust. With the help of funding from the National Lottery ‘Awards for All’ scheme, Val instigated and ran a project within her local community designed to engage with mothers and stimulate discussion around some of the myths associated with breastfeeding, with the aim of encouraging mothers to give it a try.

INNOVATION IN HEALTHCARE


Acting as a central hub of communication, the database contains listings for clinical expertise and trial-experienced NHS investigators (consultants, GPs, research nurses), non-clinical research support, and a single point of contact for each NHS Trust. In this way, ACTNoW® is designed to ease communications, facilitate site selection and aid the support of research and development from the early stages. In addition, other research networks such as NIHR Clinical Research Networks, Biomedical Research Centres/Units, and Research Design Services are fully acknowledged and signposted. Saggy Boobs and Other Breastfeeding Myths is a new book by Val Finigan

Val captured the information gathered during the project in a creative way that could then be used to encourage women on a wider scale to breastfeed. Val worked with Lou Gardiner, a specialist embroidery artist commissioned by the hospital arts organisation LIME to produce an illustrated compilation of the common myths about breastfeeding and the facts that dispel them. The result was a colourful, creative and humorous book, designed by LIME arts coordinator for the Trust, Rob Vale, which was produced in a limited print run of 1,000 copies given out to mothers and clinics in the local community. The commendation received at the All-Party Parliamentary Group on Maternity (APPGM) awards in 2008, prompted the team to take it to the next level. Thanks to the help of TrusTECH, the book has since reached the bookshelves of mainstream outlets, with all royalties going to the Trust.

INNOVATIONS FOR THE FUTURE OF MEDICINE None of the progress in healthcare that we have seen to date would be possible or even worthwhile without clinical studies and trials to demonstrate the world of benefits that innovations such as those presented here have the potential to provide. The future development of medicine relies on the continued support of and participation in all aspects of clinical research by the NHS and its associated clinical research partners.

Forging research links between the NHS, pharmaceutical industry and patients The ACTNoW® (Accelerating Clinical Trials across the Northern Way) online database is a web-based tool designed to assist in the placement of clinical trials in the NHS by facilitating the identification of key clinical expertise and trial-experienced NHS investigators. The aim of the database is to promote research within the NHS across the North of England by actively encouraging participation in clinical trials, with the ultimate goal of increasing the number of clinical trials hosted in this part of the country.

INNOVATION IN HEALTHCARE

Initially developed for the Northwest the database is currently being expanded to include more allied health professionals with research experience, as well as a wider range of clinical expertise to cover devices as well as pharmaceuticals. For further information see www.actnow-database.co.uk A small selection of the best of the rest ... »» First step leg bath: portable leg bath for the treatment of ulcerated leg wounds, the idea of community care nurse Maureen Scott at the North Tyneside Primary Care Trust. »» EPAQ® systems: electronic personal assessment questionnaire software, developed by Dr Stephen Radley of Sheffield Teaching Hospitals NHS Foundation Trust in conjunction with Illuminaries Ltd. »» mIPS: new mains isolated power socket, developed for healthcare use, by Dr Fares Mayia, a consultant clinical scientist working in the Medical Physics Department of the Oxford Radcliffe Hospitals NHS Trust. »» OCT and lung cancer: optical coherence tomography (OCT) technology to obtain sub-surface images of lung tissue at more than five times the resolution of state-of-the-art ultrasound systems, the brainchild of Professor Monica Spiteri, of the Directorate of Respiratory Medicine at the University Hospital of North Staffordshire NHS Trust. »» Managing acute pain in children: CD-based educational package created by Vivien Maiden, a child health lecturer practitioner at Poole Hospital NHS Foundation Trust. »» CSA Assessment Training Aid: Child sexual abuse assessment training aid comprising a DVD and anatomical model, developed by Dr Sue King, an associate specialist in community paediatrics at the Oxford Children’s Hospital. A professional science writer, medical writer and journalist, Kathryn Senior supplies regular features to international journals such as The Lancet Infectious Diseases, The Lancet Oncology and acts as a consultant to several medical communications organisations. Director of Freelance Copy, she is a specialist in medical SEO writing, producing targeted and informative copy for healthcare websites.

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Knowledge Transfer Network HealthTech and Medicines

Building a Healthy Nation through Business Innovation

Members of HealthTech and Medicines KTN get an Innovation Boost The HealthTech and Medicines KTN supports business innovation through partnerships, funding and knowledge transfer: l Connecting partners:

Bringing together and facilitating collaborations with a common goal

l Access to funding:

Identify and influence new and existing sources of funding

l Knowledge transfer:

Opening doors to wider networks of people, organisations

Innovation depends on an intimate knowledge of a technology and close relationships with subject experts on one hand, and a breadth of contacts and an overview of the supply chain on the other. The HealthTech and Medicines Knowledge Transfer Network is a single front door through which members can find all the expertise and support they need across the innovation chain, from first idea, to patenting and packaging intellectual property, finding academic and industrial partners for product development and manufacturing scaleup, meeting regulatory standards, and getting access to market. The HealthTech and Medicines KTN also help members to access funding from the Technology Strategy Board for prototype development and proof of concept work. Membership of the KTN provides access to a dynamic, UKwide knowledge transfer network covering all aspects of medical devices, diagnostics, and medicines. In addition, the KTN works with these communities, actively promoting sharing of knowledge, building value chains and suggesting possible collaborations and partnerships. It is also involved in developing international networks, supporting business engagement in the US, China, Japan and Europe. The KTN has set up specialist groups in areas including Advanced Wound Management, Assisted Living, Clinical Trials, Regenerative Medicines, Healthcare-Associated Infections and Stratified Medicines to help companies home in on the particular resources they need to address any of these areas.

www.innovateuk.org/healthktn

Membership of the KTN provides access to: l Potential practitioner network into industry and industry friendly academia l Technology Strategy Board, National and EU funding competitions l Impartial advice and access to the full KTN team l Key individuals within the community – putting you in touch with the right partners for forming collaborations l Networking opportunities and event

Led by key opinion leaders, these specialist groups bring researchers, entrepreneurs, companies, clinical and regulatory experts together to identify opportunities, flag up potential roadblocks and foster new partnerships. Backing up these meetings, the KTN’s innovation platform features online tools that enable partners to explore projects and issues they are working on together.

For more information and how to engage with the HealthTech and Medicines KTN community visit:

www.innovateuk.org/healthktn

Technology Strategy Board Driving Innovation


Contact: NHS Professionals Business Development Team: 01923 690 565

Time for a change? Title: The contingent workforce: safe and cost effective

A workforce strategy should accommodate seasonal demand changes. But demand fluctuations require a combination of substantive staff, working flexible shifts, and a contingent workforce comprised of reliable flexible workers, ready to provide support to maintain standards of care. A bank operated as a managed service provides both financial and continuity of care benefits compared to an in-house bank or even a shared-service bank operating between Trusts. NHSP tunic at work; relative pay rates; key quotes from Trusts.

Seasonal trends Almost all businesses have a seasonal cycle, though perhaps not all as polarised as the perfume industry, where 80% of the annual sales are recorded in December! Wherever you look – construction, tourism and retail – all have a seasonal business cycle that demands flexible working. In fact, according to the Confederation of Private Employment Agencies (CIETT), the UK has the highest number of temporary work¬ers in Europe, with over 1.3 million temps – around 5% of the UK workforce. Farming alone has a seasonal workforce of 62,000 workers, 11.5% of the total workforce. Healthcare is no exception. Seasonal pressures can dramatically increase demands on the entire system, often resulting in the need to open additional wards to accommodate the influx of patients. Yet there seems some reluctance to acknowledge this reality, with limited

evidence of budgeting to accommodate the increased demand on the workforce, particularly the contingent workforce. Undoubtedly, the drivers of shift demand are complex, but annual trends clearly demonstrate a regular annual cycle of increased activity. The effect is well known at ward level, where matrons are used to ramping up activity, but their extraordinary effort to make it all happen does not always appear to be supported.

ice reconfiguration to be able to deliver a range of services to match their core capabilities. Centralisation of business processes is quite normal in industry and commerce, where production is regularly concentrated into specialised units to maximise performance and minimise cost, but it’s a relatively new phenomenon in the NHS. Patients have come to expect a certain level of care, which their local Trust simply may no longer be able to deliver economically.

Uncertain future

Industry responds to uncertain income streams by minimising fixed cost and maximising variable cost. This allows the business to be more agile, to ‘flex’ more quickly to meet rapidly changing patterns in demand.

The NHS is far from a static economic environment. Changes in income tariffs for different types of care are putting additional pressure on already stretched Trust finances. Many will be forced to consider serv-

And yet Trusts are encouraged by some to reduce expenditure on the flexible contingent workforce, even while many have all but ceased recruitment to substantive posts.

But what is the right mix of permanent and temporary staff in any given care scenario?

INNOVATION IN HEALTHCARE

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Comparative Day Shift Costs Qualified

Unqualified

£212.04

Buying Soluons agency median

£126.27 £207.23

Typical Trust Substanve + O/Time

£144.49 £155.88

Typical Trust Substanve

£108.68 £155.88

Typical Trust Mul Post Holder

£108.68 £138.91

Typical Trust Internal Bank Only

£101.35 £134.21

NHS Professionals

£99.19 £ per nine hour shiŒ

1. 2. 3. 4. 5. 6.

Assume an employee working full time, 37.5 hours per week on AfC SP 9/20 with 50% overtime premium plus allowance for typical NHS employment costs (NI) Assume an employee working full time, 37.5 hours per week on AfC SP 9/20 plus allowance for typical NHS employment costs (NI, Pension) Assume an employee working part-time, zero-hours contract, on AfC SP 9/20 plus allowance for typical NHS employment costs (NI, Pension) Assume an employee working part-time, zero-hours contract, on AfC SP 8/18 plus allowance for typical NHS employment costs (NI, Pension) Agenda for Change’ (AfC typically point 8/18), plus an allowance of 12% to cover employment costs, and 2.5% NHSP transaction fee

Quality of care could easily be the first casualty of expenditure cuts, but it needn’t be.

is managed by an external service provider, additional savings can be made beyond the obvious economies of scale.

Best value

The first £110 of any individual’s earnings is free from Employers’ National Insurance contributions (ERS NIC). That also applies to any second or subsequent employment, provided the employers are separate legal entities*.

Flexible working arrangements may help cyclic demand trends but is it a cost effective solution? The answer depends on how that demand is managed and serviced. Uncontrolled, random use of expensive agency staff is unlikely to be cost effective. But what about a flexible worker bank? Flexible workers on the bank can be employed on set rates for the role, rather than for the individual fulfilling the role. Overtime can also be arranged via the bank to minimise cost. All of this contributes to a lower cost per shift than a comparative substantive role.

Employment on-costs But there are other factors to consider. Who manages and maintains the bank? How can employment oncosts be minimised? Where a bank

The net result is a saving to the Trust in ERS NIC of around £14 per week for every person working regularly through the bank, including substantive staff working overtime through the bank. In addition, people who work only via the bank may be entitled to an employer supported stakeholder pension at a substantial saving to the Trust, compared to the NHS pension provision. These two items alone can make a substantial difference. In fact, they make a flexible worker shift more cost-effective than a full-time substantive shift.

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Is it safe? Flexible working may be cost effective but is it safe? Yet again, the answer depends on the specific situation and how it is managed. Random use of expensive agency staff provides little in the way of reassurance on continuity of care for patients. It can also put extra pressure on full-time staff to maintain a safe environment.

Safe contingent workforce In times of need, the ideal solution is to deploy a contingent workforce: flexible workers familiar with the Trust, the ward and its procedures; people who know what is expected of them and how to operate effectively with minimal supervision. The mix of substantive and flexible workers on the ward depends on the area where the care is delivered. However, from NHS Professionals’ experience, a typical bank mix includes around 50-60% substantive staff working as multi-post holders (MPH) and 40-50% ‘bank only’. This

INNOVATION IN HEALTHCARE

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provides an optimal combination to ensure continuity of care.

WTD compliance In fact, NHSP can evidence that its flexible workers regularly operate on the same wards (93% of shifts). Flexible workers’ hours are also automatically monitored to ensure compliance with the Working Time Regulations; particularly important for staff who already have a substantive role.

hared service

Careful recruitment

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Bank only flexible workers are recruited following a stringent recruitment process that ensures a match of flexible worker experience and grade to the specific requirements of the assignment.

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the other hand, regular incentives encourage flexible workers to work specific shifts that can be otherwise hard to fill.

Carrot and stick But continuity of care is not in itself sufficient. One of the most disruptive situations any matron faces is where people simply don’t show up (DNA) or cancel a shift at short notice. That creates a gap on a busy ward, forcing the ward manager to shuffle staff between wards or hire expensive agency staff at short notice to maintain a safe environment. NHSP tackles this through a combination of carrot and stick. Short notice cancellations and DNAs are closely monitored, ultimately resulting in persistent offenders being deregistered after three warnings. On

An online learning portal allows flexible workers to keep their skills up to date.

Innovative? NHS Professionals continues to make significant investments in technology to drive down the cost of managing flexible workers. Online recruitment and shift booking portals allow people to access the NHSP system 24 hours a day. Streamlined recruitment processes are all managed through an online portal to ensure that NHS Employment Check Standards are satisfied. Practical innovation End-to-end online recruitment process »» Online knowledge-based assessment »» Voice recognition telephone booking systems »» Online learning and development portal »» Online shift booking »» Electronic timesheets »» Automated management information »» Integrated online electronic rostering platform

»»

There are processes that help NHSP, the largest employer in the NHS, to filter out the 450 ‘bank only’ flexible workers recruited each month from around 4,000 applications received. That includes full governance compli-

INNOVATION IN HEALTHCARE

ance, including occupational health checks, right-to-work and enhanced CRB checks processed in bulk.

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Matrons and ward managers from 80 client Trusts place their shift demand through the NHSP:Online portal or via a voice recognition telephone system, where an army of around 50,000 flexible workers comprising doctors, nurses, healthcare support workers, AHP and A&C can book assignments from the comfort of their own home. Management Information is automatically generated for every ward to help ward managers, matrons and Trust executives manage and control the demand for flexible working across each Trust. Together these investments in technology have allowed NHSP to reduce its corporate workforce dramatically from over 900 staff based in six regional centres to just 200 based in one centre, supporting a field team of approximately 80 staff based in and around client Trusts. A true technology success story. Technology-based innovation has allowed NHSP to become entirely self-supporting from its operations, whilst saving millions of pounds every year for its client Trusts.

Now that’s progress!


Specialist Microbiology

Assay Development & Evaluation

Diagnostics

Immunology Serological measurements

Biosafety testing High Containment Consultancy

Research, Development & Testing

www.hpa.org.uk/business business@hpa.org.uk Tel +44 (0) 1980 612100 fax +44 (0) 1980 612241


The bank you can trust. APPLIED INNOVATION NHS Professionals applies technology to recruit and manage flexible workers, helping them to operate effectively across multiple NHS Trusts. • ‘End-to-end’ online recruitment process • Online pre-employment checks • Bulk CRB checking • Governance processes • Online shift booking • Electronic timesheets Across the country, assignments are being offered by Trusts and booked by flexible workers via the NHSP:Online platform or through our integrated voice recognition telephone system, 24 hours a day, every day of the year.

NHS PROFESSIONALS APPLYING TECHNOLOGY TO DRIVE DOWN THE COST OF FLEXIBLE WORKING

WWW.NHSP.CO.UK | 01923 690 565


We are your national service, delivering cash releasing savings to the NHS. Offering you... • transformational procurement processes driving down product price • back office savings • innovative solutions in products and service • sustainability

For further information, please contact us on enquiries@supplychain.nhs.uk

T: 01773 724000 www.supplychain.nhs.uk

Gateway Ref. no: 1473


Innovation In Healthcare