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FRANCIS ENQUIRY Ofsted-style ratings planned

Who or what is protecting those under secrutiny? AMBULANCES


Keeping the blues and twos green









Sir David Nicholson has agreed to step down from his £210,000-a-year job in March next year, but is coming under increasing pressure to step down sooner after figures disclosed that hospitals have spent £2million on 50 ‘secret gagging orders’. BACKGROUND CHECKS


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FRANCIS ENQUIRY Ofsted-style rratings a tings planned



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The figures, obtained under the Freedom of Information Act, show that over 50 staff have been ‘silenced’ since 2008, some of which cost as much as £500,000. All are thought to contain confidentiality clauses.


The NHS chief has been heavily criticised for his role in the scandal at Stafford hospital between 2005 and 2008, when patients died after being routinely neglected. Sir David was head of the West Midlands Strategic Health Authority, which supervised the trust at the centre of the scandal, before becoming chief executive of the NHS in 2007. A criminal inquiry into Mid Staffs is under way. Health Secretary Jeremy Hunt told Parliament that “no one is above the law of the land”, and Staffordshire Police have since revealed that up to 300 cases could constitute criminal neglect. Inquiry chairman Robert Francis QC, said the failings went right to the top of the health service. Read about the findings of the Francis Report on page 33. Danny Wright

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226 High Rd, Loughton, Essex IG10 1ET. Tel: 020 8532 0055 Fax: 020 8532 0066 Web: EDITORIAL DIRECTOR Danny Wright ASSISTANT EDITOR Angela Pisanu PRODUCTION EDITOR Richard Gooding PRODUCTION CONTROLLER Jacqueline Lawford PRODUCTION ASSISTANT Jo Golding WEBSITE PRODUCTION Reiss Malone ADVERTISEMENT SALES Jeremy Cox, Lorena Ward, AJ Baker ADMINISTRATION Victoria Leftwich, Hannah Beak PUBLISHER Karen Hopps REPRODUCTION & PRINT Argent Media

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NHS continues to spend on CSC’s Lorenzo; NHS Charter of Rights planned by CQC; self-help books on prescription; Trusts need a dedicated CPO says expert


Balancing the needs of hospital patients and visitors, staff and healthcare professionals is the challenge faced by parking managers at healthcare sites every day, writes the BPA’s Dave Smith



Whilst background checks are undoubtably vital, employers and applicants should be aware of their potential pitfalls, writes Michael Boyd

Terry Barker, CEO of UK Asbestos Training Association, sums up the latest position on the safe removal of the lethal substance



‘Leadership’ has become the recent buzz word in business. So, is the NHS simply a victim of this latest trend, or does effective leadership really matter in healthcare? The NHS Leadership Academy’s Alan Nobbs finds out

The new Professional Record Standards Body (PRSB) is tasked with ensuring professionally endorsed standards are adopted to enable safe information sharing




Health Business talks to South Central Ambulance Service’s head of fleet Rick Stillman about the challenge of running an emergency response fleet

Eddie McCabe explains how agile working has helped North East Lincolnshire Clinical Commissioning Group (CCG) adapt to its new responsibilities



A look into the report ‘NHS Hospitals and the Energy Hike’ which examines the possible impact of energy inflation on NHS hospitals




Mike Sinclair reflects on this year’s leading event for informatics, clinicians and senior managers



What does the government’s initial response to the Francis report mean for the future of patient care?

Phil Lewis-Farrell discusses fire safety and training in a hospital setting


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NHS continues to spend on CSC’s Lorenzo patient record systems

The NHS is set to spend nearly £600 million on Lorenzo patient record systems provided by CSC, despite the failure of the government’s National Programme for IT (NPfIT), to which CSC was a major contributor. Senior executives from the NHS were grilled by the parliamentary Public Accounts Committee, where chair Margaret Hodge called CSC a “rotten company” and said the Lorenzo system was “hopeless”. She and other members of the committee expressed disbelief at the mismanagement of the CSC contract, where it is still dishing out hundreds of millions of pounds to the company despite it having failed to deliver on a number of key targets over a ten year period. Hodge said that when the NHS declared that the NPfIT had been cancelled in 2010, this was nothing more than a “PR exercise”, as taxpayers are still spending money on purchasing CSC’s systems. So far the government has spent £1.1 billion on the CSC part of NPfIT, but this is set to increase to £2.2 billion over the lifetime of the contract. Some £600 million of this additional anticipated spend is to go on CSC’s Lorenzo systems, thanks to the renegotiated deal the NHS struck with the supplier last August. The rest is set to go on a system that has been subcontracted out by CSC. Tim Donohoe, Senior Responsible Officer for Local Service Provider Programmes

(LSPs), insisted that the NHS had “got a good deal for the taxpayer”. The £600 million is being given to up to 22 NHS Trusts that may choose to implement CSC’s Lorenzo system. Although this number has decreased from over 160 Trusts, thanks to the renegotiated deal, and although the Trusts are free to choose other system providers if they wish – they will only receive central funding from the NHS if they opt for CSC. Donohoe said: “We are not forcing Trusts to take the software”. The NHS also had to pay CSC £100 million to renegotiate the original deal – despite it having not achieved many of its previous objectives and failed to implement systems across the NHS. On  op of this the government also paid CSC £10 million for changes to the software, which it has requested. Outgoing NHS chief executive Sir David Nicholson told the committee that he had worked with the Cabinet Office, the Major Projects Authority and the Treasury on the deal and had been advised that it was the best outcome the National Health READ MORE: Service could achieve.


NHS Charter of Rights planned by CQC Hospitals, care homes and GPs could be judged against a new set of patient rights following a radical overhaul of standards to be announced by the Care Quality Commission (CQC). The new charter of rights could see hospitals taken over by external experts, bosses dismissed and units closed if standards were continuously breached. According to the Times, the new minimum standards would be displayed in hospital wards in full view of patients and staff.

The plans must first go out to consultation. David Prior, CQC chairman, said: “For patients and their families these fundamental standards will be an unambiguous baseline: if they see or receive care that falls below that line, they should report it at once. We will give people who lead hospitals clear guidelines about what good care looks like so they know that patients READ MORE: know what to expect.”


Leeds finds interim appointment solution A husband-and-wife team of former primary care trust leaders have been appointed as interim chief executive and turnaround director of the huge and troubled Leeds Teaching Hospitals Trust. This follows the announcement last month that Maggie Boyle, its chief executive for more than five years, was leaving.

Chris Reed, who was chief executive of the NHS North of Tyne PCT cluster until it was abolished in March, will be interim chief executive. Karen Straughair, Chris Reed’s wife and chief of South of Tyne and Wear PCT cluster until March, has been appointed as Leeds recovery director. Read more at


HB News


Royal College of Nursing welcomes NHS England review The Royal College of Nursing has welcomed the publication of the first draft of the National Review of Urgent and Emergency Care by NHS England. Dr Peter Carter, RCN chief executive & general secretary, said: “This review is very positive news and we fully support its principles of providing consistently high quality patient care in the appropriate location. We are also pleased to see recognition of the important role nursing staff will play in improving urgent and emergency care. The report rightly highlights the potential for greater use of community and specialist nursing to provide care out of hospitals.” Read more at

UCLH nurse consultants gets MBE UCLH nurse consultant Bernadette Porter has been awarded an MBE for her trailblazing work for patients with multiple sclerosis. Bernadette was the first nurse in the NHS to be appointed a multiple sclerosis nurse consultant in 2003, and has pioneered projects to help thousands of patients at The National Hospital for Neurology and Neurosurgery. Bernadette, who has worked at the NHNN for nearly 25 years, said: “It was such a surprise for me to receive an award – and such an honour.” Read more at

Nuffield Hospital scraps aftercare time limits The Nuffield Hospital is set to launch a unique service to those requiring common surgical procedures. For the first time, patients choosing to have their care outside of the NHS will have no time limits placed on their aftercare following procedures such as hip replacements or hernia repair. The Hereford hospital, part of the Nuffield Health Charity, says the move is significant as currently providers of private healthcare offer only short-term guarantees of up to 28 days to patients following surgical procedures. READ MORE:



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Self-help books on prescription A new scheme has been launched which will allow GPs to direct people with conditions such as depression and phobias to self-help books that will be stocked in their local library. The Reading Well: Books on prescription scheme will supply books based on cognitive behavioural therapy (CBT) which will help people understand and self-manage common mental health conditions. Dr James Kingsland, the national clinical lead for NHS clinical commissioning, said: “The Reading Well: Books on prescription scheme is brilliant. It will enable me and my fellow GPs to recommend book-based CBT from libraries. This can be a stand‑alone treatment or alongside medication and other psychological

interventions.” Evidence from the National Institute of Clinical Excellence (NICE) has shown that self-help reading can help people with conditions, such as anxiety and depression.


Trusts need dedicated CPO, says expert undervalued and underdeveloped in terms of training,” the consultant stated. In light of this, Loseby advised all NHS Trusts to appoint a chief procurement officer (CPO), who would report directly to the chief executive or chief financial officer. This would mean all procurement activity comes under one experienced professional’s attention. Loseby recently spent a year at Brighton & Sussex University Hospitals NHS Trust and the organisation has now appointed a CPO and plans to use his white paper READ MORE: as a guide for its operations.


CQC wasn’t set up to examine hospitals in any meaningful way, says new chairman The Care Quality Commission, England’s healthcare watchdog, had failed to ‘get under the skin’ of the organisations it inspected and had given the public false reassurances on how good they were, the new chairman David Prior admitted at a seminar in London. Speaking just a few days before the CQC’s proposed regulatory model was due to be published for consultation, Prior was scathing about the failings of the organisation he now chairs, saying that it “wasn’t set up to inspect hospitals in any meaningful way” and that

Moonlighting fraud surgeon and team appear in court A heart specialist and five of his staff have appeared in court accused of defrauding the NHS out of £1million for work that never even took place. Internationally‑renowned specialist John Mulholland is alleged to have billed for work he did not do, as part of a so-called moonlighting fraud. Mulholland, 40, worked at Basildon Hospital’s specialist Essex Cardiothoracic Centre as a perfusionist, which involves operating a specialist heart and lung machine during surgery.


The NHS needs to develop its procurement skills, according to an industry expert. Procurement consultant David Loseby recently published a white paper, in which he analysed some of the mistakes made at the scandal-hit Mid Staffordshire NHS Foundation Trust. He found that high-value and complex contracts were often handled by procurement professionals without the necessary experience or by individuals from outside the industry, Supply Management reports. “If you look at the way the NHS is structured and the lack of training and development it’s not surprising that [procurement officers are] underperforming. They’re both


credit for drawing attention to the failures at Mid Staffordshire NHS Foundation Trust had been primarily due to the campaigner Julie Bailey and nine others who met in a cafe in Stafford, not to the regulators, the medical royal colleges, NHS managers, or the clinicians or nurses at the trust. Bailey, whose mother died at Stafford Hospital, set up the group Cure the NHS to draw attention to the poor READ MORE: care at the trust.

HB News



Breast cancer screening showing ‘no effect’ on mortality rates

New research analysing breast cancer mortality data spanning almost 40 years concludes that breast cancer screening does not yet show an effect on mortality statistics. The research, published in the Journal of the Royal Society of Medicine, analysed mortality trends before and after the introduction of the National Health Service Breast Screening Programme in 1988. The research was based on an analysis of mortality statistics in the Oxford region because, unlike the rest of England, all causes of death on the death certificate, not just the underlying cause, are available prior to the commencement of the National Health Service breast cancer screening programme. In addition, mortality statistics for the whole of England, where death is recorded as an underlying cause, were analysed. Lead researcher, Ms Toqir Mukhtar, says that while the new results do not rule out a benefit of breast cancer screening at the level of individual women, “the effects are not large enough to be detected at the population level”. READ MORE:



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Whilst criminal background checks on healthcare workers are vital, recently the relevance of some of the information revealed by these checks has been called into question. Michael Boyd looks at the effectiveness of checks and asks, what is protecting those under scrutiny? By providing a safeguard for the more vulnerable members of society, including children, older people and those in hospital care, criminal background checks are seen as vital to protect those who could be the targets of wrongdoing. However, in recent months, the relevance of some of the information revealed by these checks has been called into question. THE FIRST LINE OF DEFENCE Due to the one-to-one nature of some of the work carried out by the medical profession, and the large number of vulnerable adults and children coming into contact with staff, it is crucial that all relevant precautions are taken to ensure their safety. The importance of this is highlighted in the NHS guide to Criminal Record Checks, published in January 2011, which states: “Failure to comply with these standards could put the safety and even the lives of patients, staff and the public at risk.” A major trigger for the tightening of background checks was the 2002 case of Ian Huntley. He was appointed as a school caretaker in Soham, Cambridgeshire, and was later found guilty of the murder of two of the school’s young pupils. Due to a failure by the school to carry out

relevant criminal background checks, as well as the local police authority’s uncertainty that checks had been carried out against the Child Protection Database, Huntley was allowed to start working with children without suspicions being raised, despite him being linked to numerous past sexual offences. SPENT CONVICTIONS AND EXCEPTIONS Under the British criminal justice system, some convictions and cautions become “spent” after a prescribed period of time, as the offender is deemed to have been rehabilitated and, as such, will no longer appear on a “basic” Disclosure and Barring Service (DBS) (formerly known as a Criminal Records Bureau or CRB) check. Sexual and violent offences, however, can never be deemed as “spent” and so must be disclosed following a DBS check, regardless

Written by Michael Boyd, Partner and Head of Healthcare Group at business law firm DWF


Background Checks


of the position applied for. DBS checks are available at three levels: “basic” disclosure, which only includes unspent convictions; “standard” disclosure, for individuals who will have regular contact with children or vulnerable adults; and “enhanced” disclosure, which is used in professions where the applicant will regularly care for or supervise children or vulnerable adults. Under the (Exceptions) Order 1975, certain occupations, such as medical and teaching positions, are deemed to be “excepted circumstances” and, as such, require enhanced disclosure, irrespective of how much contact the individual will actually have with children or vulnerable adults. INITIAL MEASURES Following the events in Soham, the Bichard Inquiry recommended a number of measures E

Surprisingly, perhaps, children’s hospitals are no longer a “specified place” where checks are to be carried out. Employers are now being tasked with assessing candidates and identifying those who may pose a security risk Volume 13.3 | HEALTH BUSINESS MAGAZINE


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SECURITY  be put in place, to make background checks more comprehensive. This culminated in the introduction of the Safeguarding Vulnerable Groups Act (2006) (SVGA), which provides protection for children and vulnerable adults through the use of a vetting procedure, which is still in place today. The Act included the introduction of children’s and adults’ “barred lists”, to which an offender can be added to prevent them from working with vulnerable groups. Since 2010, in addition to the SVGA provisions, all NHS employees have been required to register with the Care Quality Commission (CQC). This registration places the responsibility on the NHS to provide evidence of compliance with NHS Employment Check Standards. A recent amendment of the SVGA by the Protection of Freedoms Act (PFA) (2012) brought in further changes; introducing a list of regulated high-risk activities, including the provision of personal care, social work, health care and the conveying of vulnerable individuals. These are all subject to the more stringent enhanced disclosure tests. By directly referencing healthcare providers, and those who are responsible for the safe transport of patients, the Act takes into account the importance of background checks in the healthcare industry. In addition to the provisions of the SVGA, there are also designated “specified places”. These are workplaces which are deemed to be “high risk”, in which all staff must undergo criminal background checks. Surprisingly, perhaps, children’s hospitals are no longer a “specified place” where checks are to be carried out. Employers are now tasked with assessing candidates and identifying those who may pose a security risk, for instance, if the role involves unsupervised activities with children.

on a sports studies course at university. As both positions involved working with children, T’s warnings were disclosed. Claiming the disclosure conflicted with his right to respect for a private and family life under Article 8 of the European Convention on Human Rights (ECHR), T issued judicial review proceedings. The case was dismissed by the High Court. T then took his case to the Court of Appeal, resulting in the proposal of changes to the disclosure process. This included the need to consider the relevance of: the seriousness of past

of old and minor convictions, although draft legislation has not yet been published. Through this more personalised approach, DBS checks will ensure the highest possible level of protection is provided for the vulnerable, without excluding potential care providers due to prior incidents that have no bearing on their character or likelihood of reoffending. Further, the removal of details from the DBS certificate should not be seen as a weakening of the system. An adult’s details are only removed in the event that: it has

Background Checks


By keeping track of the changes made to criminal background checks and being aware of the potential pitfalls that can be faced by both employers and applicants, the industry can ensure it is meeting legislative standards offences; the sentence imposed; the time elapsed since prior offences; the nature of the work sought by the individual, and whether they had subsequently reoffended. This “filtering” system was designed to preserve an individual’s right to a private life under Article 8 of the ECHR, rather than issuing a blanket ban preventing all offenders from working in excepted circumstances. The removal of irrelevant information also ensured that employers could not interpret the disclosure of unrelated offences incorrectly when carrying out background checks. PUTTING PROPOSALS INTO ACTION Three months after T was successful in the Court of Appeal, it was announced that the Home Office would start the legislative process to improve the filtering

CHANGES AND LIMITATIONS Although the measures put in place by the Bichard Inquiry and the resulting legislation have greatly increased the protection available for children and vulnerable adults, in recent years there have been disputes raised over how relevant spent and unspent offences are to potential employers and the decisions they make. One case in particular – R (T and others) v Chief Constable of Greater Manchester and others [2013] EWCA Civ 25, which concerns a claimant referred to as “T” – was instrumental in bringing changes to the system and the perceptions of spent convictions, warnings and cautions in high-risk occupations. At the age of 11, T received two “warnings” from the police, both in connection with stolen bicycles. Due to the nature of the offence, and T’s age, these cautions were immediately considered to be “spent” under the Rehabilitation of Offenders Act 1974. Some years later T applied for both a part‑time job at a football club and enrolled

been 11 years since the offence; it was the only offence committed by the individual, and no custodial sentence was imposed. Even if all of these criteria are met, those who have committed “specified” offences, such as those involving sex or violence, will never have these details removed from their background checks. Following these changes, it was also announced that additional amendments would be made to the system, with “Spring 2013” given as an estimated date, though this has yet to happen. The latest alterations will see only one DBS certificate being produced, in place of the previous two, which will be issued directly to the applicant. This will give them the best possible chance of reviewing and appealing against the information before a potential employer sees it and draws any conclusions. WHAT DOES THIS MEAN FOR THE HEALTHCARE INDUSTRY? By keeping track of the changes made to criminal background checks and being aware of the potential pitfalls that can be faced by both employers and applicants, the industry can ensure it is meeting legislative standards, while putting the safety of patients and staff first. With recent changes placing more power in the hands of HR departments, the responsibility now lies squarely on the employer. By providing recruiters with the tools to carry out rigorous criminal background checks, while allowing applicants to query disclosed information, the current system offers a fair approach as well as providing the greatest possible protection for both children and vulnerable adults – provided HR scrutiny is maintained. L FURTHER INFORMATION

Michael Boyd: “By providing a safeguard for the more vulnerable members of society, criminal background checks are seen as vital to protect those who could be the targets of wrongdoing.“




In order to promote positive behaviours and create a healthier climate, effective leadership for staff and patients of the healthcare system really matters – both now and in the future Leadership and the lure of the panacea of cultural change that it promises, is undoubtedly currently in vogue. It is widely espoused to be the key to successfully helping us address the many complex challenges that we face in health care today; continuing financial pressures, changing demography, increased expectations from patients and the public, remarkable advances in patient treatment and leaps in scientific knowledge. Therefore, as the NHS Leadership Academy is currently embarked upon researching and developing a new model for leadership in our health care service – a leadership model that we believe will meet the demands, expectations and pressures that our NHS faces, not just now but into the future – it seems timely to consider this question. Not least perhaps because, as Hartley and Benington posit in Leadership for Healthcare (2011), it could be considered that the language of “leadership” has simply replaced that of “management” as the “fashionable” language of business, suggesting perhaps that there is little substance behind the rhetoric. And, as we look around the NHS and listen to the many interested commentators, it is immediately apparent that the language

of “leadership” certainly is flourishing and, as is so often the case, “buzz word” fatigue and cynicism are biting at its heels. PATIENT SAFETY Perhaps more importantly, the time is right because the need to focus on patient safety and to understand the needs of users in shaping the development of health services, a central theme in Liberating the NHS (2011), was brought sharply back into focus following the publication of the Francis Report (2013). This clearly emphasised the role that effective leadership has to play in our future: a role in listening to and learning from patients and in ensuring that patient safety is prioritised. The significance of which is supported by a growing body of more recent research on “effectiveness” in many kinds of service sectors – healthcare included. So, is the NHS a victim of this latest trend? Is the notion of “leadership” as a “cure-all” for the challenges we face in our health care system today simply a fad, the latest fashionable language of our particular kind of business? Or does effective leadership really matter for us,

for health care, for our patients? We believe the answer to be a resounding yes. Leadership practice, at its most effective, actively promotes positive behaviours in individuals and creates healthy and enabling climates in which to work. These, in turn, lead to the delivery of truly effective, even outstanding, organisational performance. RESPECT, CARE AND COMPASSION But what drives our belief? That would depend upon how we might choose to frame our understanding or concept of leadership; where we might choose to shine a light. However, Professor Michael West (Lancaster University Management School) in a blog for NHS Employers (May 2013) usefully helps us to frame this quite simply. He said: “If we want staff to treat patients with respect, care and compassion, we must treat staff with respect, care and compassion. If we don’t want staff to treat patients rudely, brusquely, aggressively or as onerous tasks rather than as vulnerable and often anxious human beings, we should not manage them [staff] rudely and aggressively.” This is easy to say, and the sentiment may reek of platitude: the stuff of headlines and Twitter conversation, but this is far from being the case.

Written by Alan Nobbs, senior programme lead, Delivery & Frameworks, NHS Leadership Academy




hip Leadersce practi s e promotaviours, beh positivees enabling creat mates and i work cl s effective r delive rmance perfo

CUSTOMER SATISFACTION Indeed, there is a growing body of evidence that demonstrates this link. Drawn, in large part, from evidence in retail and other competitive settings, where leadership has been demonstrated to be an effective means to driving customer satisfaction and loyalty, there is now a growing body of evidence in health care settings, specifically. West, et al (2012) root their work firmly in NHS healthcare. They evidence links between staff experience and patient outcomes, and staff experience and their leadership climate. Analysing data from the NHS staff survey and related sources, between E



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Wendy Fisher of Wendy Fisher Consulting explains why managers have to be the driving force behind research and innovation in today’s NHS Research was seen, at the inception of the NHS, as integral to ensuring the best treatments were developed and available for patients. Now, however, research is often seen as a “nice-to-have extra” and not as being at the heart of what we do. We must ask ourselves how we can improve our ways of working, our treatments and patient care, unless research is embedded into the core business of NHS Trusts. In today’s NHS, research should be firmly embedded in the patient pathway. At each contact point we should be offering our patients a research study to be part of and, if we don’t have any research available, we should be asking what research is needed to improve our patient’s care. Even the simplest research can have positive effects on the way we work and stimulate further exploration or audits or service evaluations that can improve our understanding, and prevent us from doing harm, unwittingly. Once conducted, however, research findings often sit on the shelf gathering dust and are not published. Quite rightly, Ben Goldacre is taking researchers and, in particular, commercial organisations to task for not publishing all findings, especially any negative results. How can clinicians make judgements about treatments without access to the whole picture? It is our duty to ask questions about treatments we provide but it is also the duty of the research organisation to provide us with the information needed to make an informed decision. LEGISLATION AND BUREAUCRACY Staff are often suspicious of getting involved in research, thinking of it as difficult or the business of academics. But we all conduct research every day: looking at data on electrical goods before we make choices is as much research as trialling new patient pathways. Research managers often struggle with successfully bringing the concept of research to the forefront of a Trust’s agenda. To be successful in convincing strategic planners and the government that the research department is essential and not just an attractive optional add-on of a modern NHS Trust, it becomes more and more important for research leaders to prove that they can run a streamlined, effective and prestigious research and development (R&D) division that is not only cost-effective but income generating.



One of the issues often cited for research being difficult and slow are the systems and processes around starting research. In the NHS these hurdles have grown exponentially over the last ten years. One aspect of research that seems to mystify managers and prevent Trusts from using the full potential of their R&D teams is the legislation and bureaucracy surrounding much of the research process. It will come as no surprise to anyone that all parts of health care management have increasingly been subjected to a wealth of new legislation over the last few years. I have experienced brilliant teams virtually paralysed by the uncertainty and constant changes that current legislation and national systems can present. But this is not an insurmountable obstacle. RECOMMENDATIONS Often, alongside training for the entire team, it will help to have an experienced individual offering management support while working directly with the team. Legislation is nothing to be afraid of once you understand why it’s there and how to work effectively within it. The R&D world does need to scale back on the layer upon layer of bureaucracy, however, the Health Research Authority, formed in 2011, is tackling just this issue in response to The Academy of Medical Sciences’ review of research in the NHS and will soon be making recommendations to the Department of Health on how research can

be streamlined while retaining the quality that the UK is internationally renowned for. LEADERSHIP SKILLS Many R&D departments have embraced the Toyota Lean philosophy which, while stripping out unnecessary steps in a process, recognises that experience and leadership is an essential part of any process. Good leaders need to be able to see further and wider than their teams and bring their experience and stability to the workforce. Gaining respect for your knowledge, understanding and leadership skills will not only enable you to lead the team, but motivate and support them. These are key leadership qualities that many strive for but few achieve. Both training and interim support can help to really assess the skills and competencies of a team and help work on those areas that are not yet optimally developed. From personal experience, I find developing and monitoring an action plan that management and team members have developed together is an ideal way of ensuring that everyone is onboard for the journey. This, of course, means that everyone needs to be willing to think creatively and challenge possible preconceptions about what it means to work in research and development. To discuss your research and development needs, see L FURTHER INFORMATION



 2004 and the present day, they demonstrate that high levels of staff engagement directly correlate with lower standardised mortality rates, reduced absenteeism and a positive association with both quality and financial performance of the organisation. QUALITY OF CARE And they go on to demonstrate that patient satisfaction is highest in organisations where staff report clear goals at every level, staff views of leaders are strongly related to patients’ perceptions of the quality of care, and the more positive staff are about their work generally, the more positive patients are about their care. But, leadership is not such a new kid on the NHS block, The NHS Plan (2000) first signalled the shift when it made the case for greater focus to be paid to leadership and the development of leaders, stating that: “A new Leadership Centre will be set up to develop a new generation of managerial and clinical leaders.” From this time, the NHS has given clear focus to leadership. The NHS Leadership Framework (2011), building from its origins in the Leadership Qualities Framework (2002), originally developed for senior leaders, has actively engaged many of us with the importance of leadership as a central tenet that underpins the delivery of great NHS health care. Indeed, it has been used as the foundation underpinning the development of the Medical Leadership Competency Framework (2008) and the Clinical Leadership Competency Framework (2010). GOOD LEADERSHIP BEHAVIOUR So why are we still discussing leadership? The Framework has served us well; it is a great descriptor of our current model of leadership. It has done a great deal to help shape our thinking about what good



The Framework has served us well; it is a great descriptor of our current model of leadership and has done a great deal to shape our thinking and challenged us to focus on the benefits of more collaborative, distributed leadership approaches leadership behaviour should look like. And the Framework has challenged us to focus on the benefits of more collaborative, distributed leadership approaches. But the service has been challenged by significant change. Unprecedented change, driven by both our successes and our failures. Change that we will continue to see, and change that has manifested an increasingly command and control culture; a culture that has refocused our attention on the disconnect that can so easily exist between the manner in which we each practice our leadership, day to day, and that which we espouse. PRIMARY RESEARCH However, such change does not simply provide us with significant challenges, it also presents us with huge opportunities, and the NHS Leadership Academy is seizing one such opportunity. Against the backdrop of a desired shift in emphasis towards greater autonomy, responsibility and accountability, and with a strong orientation towards patient care, compassion and safety, the Academy is working to develop a new model for leadership in our health service. Working closely with its partners, and the wider NHS, the Academy is reviewing the current evidence on leadership, drawn from health care in the UK and beyond, as well as across wider public and commercial sectors. It is undertaking primary research in order to better understand “what is the

difference that really makes the difference?” in the leadership practice of some of our highest performing leaders. The aim of the Academy is simple: a new Leadership Model. One that will meet the demands, expectations and pressures that our “new” NHS faces, and will be as effective at helping create a new vision for leadership that reflects the best in care and compassion as equally as it does for excellence in strategy, vision, direction and engagement. This will not be easy or straightforward as effective leadership is learned, nurtured and developed in organisations. ACTIVELY ENGAGE Therefore, if we are to ensure that our desired culture of care and compassion reaches all corners of the organisation, we must provide an unquestionable example to our staff. We must engage in using the new leadership model in our efforts to guide and develop the behaviours we seek of our leaders. It will require each of us to actively engage in understanding ourselves as leaders through this new lens. And for our leaders to provide the time, support and access to world‑class leadership development that is necessary if we are to grow the capacity we need to achieve “better leaders, better care, brighter future”. L FURTHER INFORMATION

Kruger Associates: specialist training consultants who know what really matters Kruger Associates is a family of social care and health learning specialists who come from all kinds of backgrounds, including social work, care management and nursing. When it comes to knowing the pressures you face, Kruger Associates are here to help: the staff have all been there themselves. The company also knows a thing or two about funding, and partners are often amazed at what Kruger Associates can find funding for. It can be everything from leadership and management training to QCF diplomas and short courses. The company is even helping individual employers access funding to train their PAs in massage.

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The emergency team at Mülheim’s Protestant Hospital requires immediate access at any time and this is made possible with a control system, giving them priority entry to a number of areas at any time The scope of the Nedap software also reaches the catering service. The central food supply service functions in the Mülheim hospital in that the food is delivered to the kitchen frozen, divided into portions and stacked in the canteen trolleys. It is then thawed and warmed up on the wards, so that it doesn‘t arrive on the plates lukewarm or cold, because of the long transport distances. Each of these canteen trolleys has a transponder that automatically opens the door in front of it as it passes over the inductive loop in the floor directly below. In this way, it is not necessary for staff to manually open a door with their card each time and the kitchen remains accessible to authorised persons.

The Protestant hospital in Mülheim an der Ruhr has 602 beds and around 1,250 staff, and it is also an academic college hospital of the University of Düsseldorf. The clinic uses the AEOS security management platform from Nedap and the offline lock system from Salto. When the quick-response emergency team, known as “Christoph 7” after the most‑famous rescue helicopter in Germany, rushes to a crisis (such as a heart attack or a stroke somewhere within the hospital), there is no time to lose. In the most serious cases, it can even be a matter of life or death. Saving lives has absolute priority, of course, and requires unhindered access. The access control management system must therefore be prepared for this eventuality. So the team has its own special Christoph 7 cards which, when held in front of any card reader, initiate elevator priority control. The elevator that is specially reserved for the emergency team is then ordered to the appropriate floor. Only when a Christoph 7 card is used in the elevator will it then go with priority to the selected floor. The elevator is then released for normal operation again by the team using the card. This is just one of many features that  the new access control system provides. PAVING THE WAY FOR FLEXIBILITY The foundation of the access control management system goes back to an investment decision made in 2008. As

well as access control, this includes the identity and authorisation management, IP video management and intrusion alarms. Other features include supervision and reporting with web-based alarm administration via a web-based, operating system independent graphic interface. The Salto offline system has been fully integrated into the AEOS security management platform and thereby enables the homogeneous administration of all components, people and functions. AEOS manages a total of 1,580 offline lock systems, including all online doors and functions, the access doors, the offline lock system, room doors, patient cabinets and containers and employee cupboards, as well as mobile care and food trolleys. EMERGENCY DOOR MONITORING Applications of the security management system can be found everywhere. For example, all escape doors (those that are on escape and rescue routes within the hospital) are connected to AEOS. Whereas alarms could only previously be raised by pressing an emergency button, they can now also be alerted at a central point and forwarded. The connection also serves to prevent doors being opened without permission. If this happens, an alarm is raised in AEOS so it can be closed again. An additional connection to the video surveillance system is also planned.

PARKING AUTHORISATION It may seem practical for members of staff to use the car park of the centrally located hospital, but some employees were using their ID cards outside normal working hours. This has now prevented by a connection to the AEOS software. Dietmar Vetten of GST explains: “The installation specialist has fitted a card reader to the parking lot barrier which is connected to the AEOS system. This has saved having three separate proprietary parking management systems.” The parking spaces can be of “mixed” use by the public/visitors and staff, according to an algorithm. The software shows the current occupancy status of each. If a staff member parks for too long, an email is sent to the facility management personnel. Parking authorisation for various stand-by services is organised so that just one person from each stand-by team on duty can park there during the appropriate shift, even though all the staff that provide stand-by cover have authorisation for the various parking lots. L FURTHER INFORMATION



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Fleet Management


With a fleet of 960 vehicles and attending over 400,000 incidents in 2011/12, South Central Ambulance Service has a tough job. Health Business talks to head-of-fleet Rick Stillman about the Service’s challenging fleet operation and how it came to win Large Public Sector Fleet of the Year at the Fleet News Fleet Van Awards 2012 DESCRIBE YOUR FLEET AND ITS OPERATION. South Central Ambulance Service (SCAS) has a total fleet of around 960, of which 200 are front line ambulances and about 120 are marked-up response cars. The rest are staff cars, covert response cars, Patient Transport Service (PTS) buses and commercial vehicles. The Service provides patient care to a resident population of more than four million and the millions more visitors we receive every year. The Service’s primary purpose is to respond to 999 emergency calls and to get the right treatment to patients with life-threatening conditions, serious injury or illnesses, as quickly as possible. In addition, we provide pre‑arranged transport for our patients, with medical needs, to and from the treatment centres via our Patient Transport Service.   WHAT’S THE HISTORY BEHIND HOW SCAS WAS FORMED?   South Central Ambulance Service was established on the 1 July 2006 following the merger of four ambulance trusts in the counties of Berkshire, Buckinghamshire, Hampshire and Oxfordshire. This area covers approximately 3,554 square miles with a residential population of over four million.  

ng Followi l, a tria onse d resp 36 rapi been fitted ve cars ha solar panels with y power to l YOU WON LARGE to suppmergency PUBLIC SECTOR e the t n FLEET OF THE YEAR e m p i equ AT THE FLEET NEWS FLEET VAN AWARDS battery

Rick Stillman, SCAS head of fleet

2012. EXPLAIN WHY YOU WON THE AWARD. The fleet award goes to those van operators that are committed to keeping their drivers safe and their vehicles accident-free. In our case the award was in recognition for our systems and processes which have enabled us to achieve van excellence status from the Freight Transport Association (to date the only ambulance trust to be accredited), low accident rate, and reductions in CO2. WHAT WAS INVOLVED IN GAINING VAN EXCELLENCE STATUS FROM THE FTA? We appointed Julie Larner as project manager to oversee the Van Excellence process and she tirelessly spent two months in the build up to the inspection documenting and auditing every process and working practice. She created a spreadsheet that mirrored the Van Excellence inspection sheets to ensure every element of the audit had

SCAS provides patient care to a resident population of more than four million

been covered. We challenged some areas, such as licence checks, and put processes in place to prove they had been done. Documentation was also tightened up, particularly logging the emergency equipment on the ambulances.   WHAT IS YOUR CARBON REDUCTION STRATEGY?   We introduced a 120g/km CO2 cap on car emissions for non-emergency response cars and speed limiters on all commercials and operational vehicles (but these switched off when on blue lights). What’s more, South Central Ambulance Service NHS Foundation Trust (SCAS) is the first ambulance service in England to introduce solar panels on to its Rapid Response Vehicles (RRV). Following a successful trial of the solar panels in January 2012, 36 of the Trust’s RRVs have now been installed with solar panels to supply power to the secondary battery system that powers all emergency equipment on these vehicles. WHAT BENEFITS DO THE SOLAR PANELS BRING? The introduction of solar panels E



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Fleet Management


Solar panels enable the Rapid Response Vehicles to be fully mobile at all times as they no longer need to recharge essential battery systems with their engnes

South Central Ambulance Service has a total fleet of around 960, of which 200 are front line ambulances and around 120 marked-up response cars. The rest are staff cars, covert response cars, Patient Transport Service buses and CVs  means that vehicles no longer need to standby with their engines running to recharge essential battery systems, or to return to base to recharge vehicle battery systems. This means that the vehicles are unable to respond to emergencies whilst batteries are being charged. The solar panels enable the RRVs to be fully mobile at all times and effectively means we have more vehicles able to respond to more incidents, more often. SCAS will now be trialling solar panels on Front Line Double Crewed ambulances.

which replaced 4 legacy systems, bringing the whole trust onto a single platform. We wanted a standard fleet management software system across the whole of the service so that we could accurately gauge fleet costs and manage workshop parts much more effectively to reduce vehicle downtime. We wanted complete visibility across all parts of the fleet for all vehicle and workshop administrators. We are now delivering significantly improved vehicle operating efficiencies and reducing operating costs.



take 1030 emergency calls a day, 300 of which are potentially life-threatening. In 2011/12 we took 510425 emergency and urgent calls and attended 411303 incidents. This huge demand on the service can be a challenge with diminishing financial resources. WHAT ADVICE WOULD YOU GIVE TO OTHER FLEET MANAGERS ABOUT RUNNING AN EFFICIENT HEALTHCARE FLEET?  Getting buy-in and support from all areas of the organisation is essential and removing surplus vehicles from fleet helps. L FURTHER INFORMATION



Business Mobility on the Move. At Alphabet we’re always developing new, more efficient ways of moving employees from A to B. It’s all part of our vision for the future of mobility. Existing forms of fleet management underpin this vision. But there’s certainly more to come. Take AlphaCity for example. As ingenious as it is simple, it’s a corporate car sharing scheme set to change the way we finance, manage and use company vehicles. It’s yet another step forward in clever fleet thinking from Alphabet.

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Clive Buhagiar, head of public sector at business mobility provider Alphabet, explains why making sure the mileage adds up can help keep the pennies focused on frontline services

There are not many people who would say analysing business mileage is the highlight of their day. Indeed, for most organisations, it is enough of a struggle to ensure their expenses paperwork is kept up to date for HMRC. However, whether travelled in company cars or private vehicles, mileage represents a big opportunity to generate cost savings; especially when most research shows organisations typically pay out almost 25 per cent more in fuel and mileage expenses than they need to. MILEAGE MIX Perhaps the simplest and often misunderstood element of the mileage mix revolves around what is actually defined as business mileage. For example, journeys you have to make to do your job (such as delivering goods or meeting with patients) are considered to be business travel. However, commuting journeys (like travelling to and from your place of work, even if you call in at a patient or supplier en route) are considered to be non-work journeys. For many organisations, there can be perceived grey areas where an employee may claim business mileage but, under strict HMRC application of the rules, a commuting journey is considered to be unrelated to work. There is also a legacy belief across much of the public sector that mileage payments should make up a part of your remuneration package. Historically, there have been

organisations that have balanced out lower-than-average salaries with higherthan-average mileage payments, sometimes reaching 80p per mile. While recent years have seen a real push to manage the headline rates being paid, there has also been a corresponding rise in the amount of private mileage put through as business travel on expenses forms. As a result, the expected cost savings have not necessarily materialised, leaving fleet managers and finance teams scratching their heads. ALLOWANCE PAYMENTS In reality, there are two big challenges when it comes to managing fuel and mileage payments. The first looks at the comparison between declared business mileage and actual travel on behalf of the organisation; the second takes into account the fuel-efficiency and economy of the vehicle. For example, if an employee completes 600 actual business miles per year, but claims for 800. On a manual, often paper-based, system this is likely to get missed, leaving the organisation a potential £90 worse-off at the end of the year, based on a standard approved mileage allowance payment rate of 45p per mile and excluding tax implications. However, if two employees make the same claims and receive the same payments but one has a more fuel-efficient car, then the potential disparity is

even higher, as the fuel-efficient employee is spending less per mile on actual fuel costs. There are a number of factors combining to push mileage higher up the agenda: HMRC has undertaken more record-checking visits over the past 12 months, the price of fuel continues to rise, and technology has developed so it is easier to monitor, analyse and verify mileage and fuel data.

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INCORRECT CLAIMING When it comes to HMRC audits, some of the anomalies that tend to stand out on claim forms, and those that can be identified and minimised through automated mileage capture, include “rounding up” distances (often identified when more than 16 per cent of trip mileages end in a zero) and low private mileages (HMRC expects most company-car drivers will cover 30-40 per cent of total mileage on private journeys). In addition, cars whose total odometer readings don’t tally with fuel purchases can signify incorrect claiming, while fuel purchases on both a Friday and a Monday point to something being amiss. Essentially, it is all about making the process as easy and transparent as possible. For the driver, a system which calculates business travel expenses based on information uploaded online or via a mobile app at the end of each journey is easier than manually completing paper-based forms or spreadsheets. Likewise, software that automatically collates actual mileage completed, fuel expenses (from scanned receipts or fuel cards) and the fuel economy of the individual vehicles will deliver valuable information to the employer, ensuring the expenses paid out reflect the reality of the business mileage being completed. An added benefit of this method can be the identification of drivers who may need to go on training courses to improve their fuel economy. CAPTURE AND AUDIT PROCESS It doesn’t matter how much data you collect if you are not making use of it. The most important aspect of any mileage audit is the actions that are taken as a result. Often, it is the simplest changes that can make the biggest difference, such as re-educating employees on the definition of business mileage and checking that vehicles are appropriate. Any customer going through the Alphabet mileage capture and audit process could save in the region of 18-22 per cent of their annual fuel bill. Mileage audits are just one part of the bigger “fleet management” picture for the health sector. Alphabet is taking a broader, more consultative approach to the challenge of “business mobility”. This ethos has led to the company offering a broader-based travel audit to the public sector, as well as innovations such as AlphaCity, the cost-effective, sustainable alternative to the traditional carpool. L FURTHER INFORMATION




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Facilities Management


According to the Estates Return Information Collection (ERIC) data produced for the Department of Health, NHS hospitals in England currently face a collective energy bill of around £550 million per annum. Based on Power Efficiency’s price forecasts for the next decade, this figure is likely to be in the region of £995 million per annum by 2021. If unaddressed, the rise in energy costs is going to have a severe impact on hospital budgets. ‘NHS Hospitals and the Energy Hike’ looks at the impact of energy inflation on NHS Hospitals and outlines some of the steps to address and combat energy inflation over the next decade Hospitals face particular energy challenges unique to their environment. The list of high energy consuming functions is long, and goes well beyond the immediate and obvious needs of heating, lighting and a reliable hot water supply. The demands on ventilation, air quality and air conditioning, as well as process energy consumptions on tasks such as imaging, radiology and sterilisation, create an energy-intensive environment. Add to this the need for environmental control, catering, laundry, theatre, etc. and it becomes clear why energy efficiency is such a challenge. The clinical benefits of good environmental service provision in combating airborne bacteria and infection are well known and understood. The challenge is to meet all these energy demands consistently and effectively within the financially constrained world of modern healthcare provision. REVIEW AND AUDIT ENERGY USE The starting point of any energy saving drive should be to get a clear picture of

where you are now in terms of energy consumption. Good quality data analysis is fundamental in identifying the steps the trust / hospital will need to take to reach achievable project savings and performance outcomes. From our experience, we believe that most hospitals can realistically target savings of between 20-30 per cent by integrating all activities. DEVELOP A ROBUST ENERGY MANAGEMENT STRATEGY The key priority for any trust is to create a clear energy management strategy which addresses in detail how it will manage and mitigate rising energy costs. The strategy will need to address the varied and complex energy needs of a hospital, which typically include: heating, air conditioning and ventilation, hot water, lighting, imaging suites, office and admin (computing, photocopying, printing etc), catering, and specialist equipment such as X-Ray machines, mortuary and pharmacy cool rooms etc.

SET INVESTMENT LEVELS Against a backdrop of public sector spending cuts, setting the capital investment levels the trust will need to reduce its energy cost, s is going to be hard. However, money spent now will provide increasing rates of return over the next ten years as energy costs escalate. If budgets are too tight to make any sort of capital investment, then the trust should look at alternative solutions such as an Energy Performance Contract. LINK PROCUREMENT TO DEMAND-SIDE RESPONSE Review how the trust currently procures its energy and establish what the basis is of its current energy supply contracts (fixed price or flexible) and, if the latter, look at robustness of the risk management strategy. Buying energy is a highly complex activity. The market is volatile, and purchasers must balance the desire to minimise the price paid with the appropriate level of risk. But poor E




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ENERGY  energy procurement decisions can prove costly. The constant fluctuation of energy prices can significantly affect energy bills. Given that hospital trusts are public sector bodies and that government procurement policy will not give hospitals much room to manoeuvre in this area, it is important to understand where procurement sits in the overall energy management picture and how it needs to be integrated with demand-side management and the optimisation of on‑site generation through CHP and Biomass. OPTIMISE OPERATIONS AND MAINTENANCE REGIME Understanding the pros and cons of the various O&M programmes available to a hospital is critical to success. For example, reactive maintenance can be expensive, typically requiring approximately 10 per cent of the asset replacement cost each year to maintain performance and availability. The fixed schedules for Planned Preventative Maintenance (PPM) might not be cost-effective either, as they can treat all plant maintained under the plan the same with no allowance for the environment in which the plant operates, the length of time it operates per day or the criticality of the equipment under consideration. For a more flexible approach, it may be worth considering a Conditioned Based Maintenance (CBM) programme or a tailored Intelligent Asset Management (i-AM) programme. This will ensure that all statutory maintenance obligations are met and that critical assets are maintained to a higher standard ensuring continuity. The initial set up costs might be higher with CBM (typically 5-10 per cent higher than PPM), but over the lifetime of your asset CBM can deliver considerable ROI – as much as 30 per cent of asset cost – and can significantly reduce operational costs.

y Standb on i generatte an a can cre l income na additio m and/or strea he cost t reduce energy of the ement p ro c u r

ESTABLISH MONITORING AND MEASUREMENT SYSTEMS Cost and carbon reduction targets require on‑going vigilance throughout any organisation, triggering remedial action if progress falters. Until now, energy monitoring has been regarded as primarily a Corporate Social Responsibility (CSR) task that is linked to regulatory reporting. Yet carbon compliance represents a significant opportunity – and intelligent asset management will depend on dynamic reporting. TURN COMPLIANCE INTO AN OPPORTUNITY The installation of measurement and monitoring systems will all help with, and simplify, CRC reporting for the trust,

helping to turn a ‘tick box’ obligation into something which can work to a real advantage for the organisation.

CONSIDER BIOMASS AND CHP Biomass and Combined Heat & Power (CHP) plants on large hospital estates make sense. They can help in terms of security of supply and may be configured and sized to earn revenue by feeding excess power into the grid. However, we have seen many oversized Biomass and CHP plants installed, particularly in public sector premises, as the first step in an energy-efficiency drive. This can prove to be a bad investment and a false economy, resulting in plants which are underused and which therefore fail to provide a ROI for the trust. Power Efficiency’s advice is that Biomass and CHP should be a much later step in an energy-efficiency drive, installed after other energy reductions are delivered. A hospital which spends £1 million per annum on energy which installs a CHP to support that level of consumption will have a unit which invariably produces too much heat leading to a waste of consumed gas. If however, the unit is installed after the trust has reduced downstream electrical consumption by 20 per cent and gas consumption by 10 per cent (both eminently achievable), so its energy spend is now under £800,000 per annum, a Biomass or CHP plant can be installed with a much lower electrical capacity (relative to the heat demand), thus maximising performance efficiency and shortening the delivery of a real ROI for the trust. Additionally, a ‘good’ CHP is relatively simple to fund externally and maximises the potential for grant and subsidy support. DEMAND MANAGEMENT ON THE AGENDA Standby generation can create an additional income stream and/or reduce the cost of the

Facilities Management


energy procurement. It might not be obvious, but diesel generators designed originally for emergency use actually have a role to play in the UK’s low carbon future. There are currently six separate industry pricing mechanisms you can potentially exploit: 1. National Grid’s “Triad” mechanism; 2. National Grid’s “STOR” market; 3. National Grid’s “Frequency Response” market; 4.Supplier’s ‘time of day’ tariffs; 5. Distribution networks’ ‘red time band’ tariffs; 6. Distribution networks ‘Low Carbon Network’ schemes. A seventh mechanism is being introduced in the government’s Electricity Market Reforms. LOOK AT NEW SOLUTIONS Is energy management something the trust can outsource or risk transfer? There are new models for this market which provide such a solution. For example, look at the Energy Service Company (ESCO) model and establish if this model could work for your trust. The ESCO supplier will develop a tailored energy management strategy and plan specific to the client’s needs and which will work towards achieving set targets in energy savings and carbon reduction over an agreed timeframe. It will make its return by using its experience and knowledge to develop the best integrated energy solution, investing in new and upgraded technologies and by sharing further financial benefits accrued from savings. The guarantee is based upon achieving a minimum pre‑agreed percentage reduction in energy costs, but typically ESCOs will be looking to exceed energy‑saving targets of more than 20 per cent. L FURTHER INFORMATION Power Efficiency is a leading UK energy procurement and carbon reduction consultancy – part of the multinational infrastructure group Balfour Beatty. For further information visit





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connections, meter installations, AMR, data collection and meter operator agreements. As well as water surveys and audits. Managing utilities is difficult and time-consuming. STC’s services take away the burden and reduce utility costs to a minimum. Other benefits are reduced costs in the accounts payable department and efficiency gains through accurate energy and financial data. FURTHER INFORMATION brendan.ocallaghan@

Critical buildings and facilities are challenged with constantly evolving demands on their energy performance. Optimising a site’s resource cost and capacity are at the heart of Socomec’s energy efficient management systems. An efficient, flexible and accurate measurement system is now an essential requirement in any network infrastructure. With numerous regulations, standards and taxes concerning energy consumption and carbon emissions evolving, it is becoming a necessity for organisations to demonstrate a proactive energy management process. Efficient management of energy costs starts with accurate measurement and centralised monitoring of all the energy used. Socomec has now expanded its offering with VERTELIS, a software package designed using the latest web technologies. The result is an intuitive, scalable solution,

tailored to the needs of managers, users, building occupants, industrial sites, infrastructures and local authorities. VERTELIS allows you to reduce energy consumption, cost and carbon emissions. With accurate consumption measurement, centralised data and analysis and results that are easily shared, managers are able to implement steps to optimise energy consumption. FURTHER INFORMATION Tel: 01462 440 033

Specialist consultants to unlock your building’s saving potential

Energy-display systems bringing consumption data into the sight of all users

There are very few ways to release cash for further investment without affecting patient services, but saving energy is one such way. Hospital estates budgets have suffered in rounds of funding cuts and investing to save energy has also declined. Ecoteric uses over 30 years of experience to unlock the saving potential of healthcare estates, whilst maintaining quality, resilience and safety of healthcare facilities. The first stage is to identify where energy can be saved. This may be obvious, and may have been identified in the past, but technology becomes more affordable and energy prices have risen, making viability better in many cases. An audit every few years is worthwhile. The next stage is to put together a business case for improvement. This identifies solutions, looks at the

Cut your energy spend by more than ten percent with a payback in just nine months by using the unique Ewgeco system. Healthcare is facing higher energy bills at a time when we can least afford it, enabling Ewgeco reduces such bills. Voted “innovation of the 21st century” by The British Library, Ewgeco is a unique device that non-technical users can readily understand with a userfriendly traffic-light (red, amber and green) display, showing real-time energy consumption at any given moment. Simply by keeping the bars “in the green”, you will save money that could be better spent elsewhere on healthcare. Knowing how much energy is being used and the true cost, people alter their behaviour on consumption. Ewgeco’s data can also be accessed on the internet. A nursing home owner who benefitted from the system said:

technical challenges and, most importantly in the current economic climate, looks at the potential sources of funding. Funding sources are still available. Salix, Siemens Financing via the Carbon Trust, and the Green Investment Bank will all lend to public sector clients. There are also revenue incentives such as the Renewable Heat Incentive. Ecoteric works with clients through these stages with new and existing buildings towards a sustainable and low-carbon future. FURTHER INFORMATION


“We were told reducing usage by just 12p per hour with a Ewgeco display would save £1,050 a year. When we installed it, we were using £2.91 per hour and we realised 42p of savings within 10 minutes. The system had paid for itself within four months.” FURTHER INFORMATION Tel: 0131 331 5445

Solutions for energy Efficient electricity and cost-cutting by investing in hot water with EZsolar low-carbon technologies EZsolar is leading the way Eco Heat & Power is a well-established company specialising in the installation of renewable and low-carbon technologies for commercial and domestic buildings. It provides solar power, solar heat and biomass heat. Eco Heat & Power can also provide energy audits to identify the most appropriate measures for your facility. It offers competitively priced, highquality installations, with clients including: Kier Building Services, T Clarke (North West), National Trust and several local authorities. The company can assist you with financial support, from debt finance with Siemens Financial Services in conjunction with the Carbon Trust, to a full Energy Supply Company (ESCO) with Morri Consult. A company spokesperson said: “Siemens has arranged finance for more than 50 per cent of NHS trust and local authorities.”

Eco Heat & Power is an experienced MCS registered installer of photovoltaic, solar hot water and biomass systems, giving access to the government’s feed-in tariff and renewable heat incentive, both provide a revenue stream and this can produce a ROI of between 8-12 per cent. The company uses Romag (made in the UK) and REC PV modules (Tier 1 manufacturer), SMA inverters and Fröling boilers. FURTHER INFORMATION Tel: 01422 843414

Environmental noise and air quality consultancy from ACCON UK ACCON UK is a specialist multi‑disciplinary environmental consultancy with particular skills in noise, vibration, air quality, daylight/sunlight studies and flood risk assessment etc. The company has carried out a wide variety of work related to new hospital proposals, health care facilities, care homes and the impacts of other new developments on health care facilities. ACCON’s work on noise and vibration has included the design of noise reduced glazing systems, compliance with planning conditions and specifications for mechanical

plant and extraction systems. Air quality is a particularly important issue where peoples health may be compromised. The company can provide specific advice in respect of air quality issues and prediction of pollutant concentrations. ACCON works across the UK and Europe, but is still able to offer a personal service where its directors lead on projects and provide on‑going support to clients. FURTHER INFORMATION Tel: 0118 9710000

in innovation through the installation of a new type of solar panel, designed to efficiently produce both electricity and hot water within the same module. The new Photovoltaic Thermal panels (PV-T) is a cut above the standard PV panels and sees efficiency levels drop the hotter they become. The new panels are instead cooled, making them more efficient and increasing electrical production by as much as 20 per cent. This new technology means the PV-T system lends itself perfectly to situations that require large volumes of hot water and electricity all-year round, such as sanitary or heating systems and even swimming pools. With EZsolar’s expertise, customers can rest assured the installation is in safe hands. With a range of financial benefits, it’s a great time to look at renewable energy alternatives. Following installation, EZsolar’s customers not only enjoy



“free” heat and electricity but also benefit from additional payouts every year, for up to 20 years, through governmentbacked Feed-in Tariff and Renewable Heat Incentive (RHI) schemes. A recent announcement has seen commercial RHI rates double in some cases, meaning there has never been a better time to “go green”. Call EZsolar on 01299 270011 for a free, no-obligation assessment to see how much energy and money you could save. FURTHER INFORMATION Tel: 01299 270011

Energy efficiency working with your interests in mind GES Environmental – Aberdeen has worked with Carbon Trust for over ten years to promote energy efficiency, aimed primarily at the public sector, health care and commercial consumers. Site surveys have been completed for organisations, with energy bills from £30,000 to £5 million. There have been many examples where implementation has followed the energy survey and feedback results confirm average overall energy savings of up to 25 per cent. GES Environmental carries out a full inspection of facilities in order to compile an energy audit, with a view to assessing overall energy consumption and looking for opportunities to reduce this expense by improving energy monitoring or investment in more efficient equipment.

M&E inspections include: conventional lighting (fluorescent, halogen), compressed air and vacuum systems, steam and hot water infrastructure, ventilation and air handling, refrigeration and water chillers, generators and multi-fuel CHP feasibility. GES Environmental is independent of equipment manufacturers and pursues a rigorous policy of impartial advice that guarantees it works entirely in the client’s interests. Monitoring and inspection is supported by: colour and thermal image reports, electrical load data logging, light meter reading and data logging and building energy performance certificates. FURTHER INFORMATION Tel: 01224 791596



A 41% reduction in surgical site infections1 isn’t just statistically significant

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Setting a new standard in operating procedures Prescribing Information ChloraPrep® (PL31760/0004) & ChloraPrep with Tint (PL31760-0001) 2% chlorhexidine gluconate w/v / 70% isopropyl alcohol v/v cutaneous solution. Indication: Disinfection of skin prior to invasive medical procedures. Dosage & administration: ChloraPrep – 0.67ml, 1.5ml, 3ml, 10.5ml, 26ml ; ChloraPrep with Tint – 3ml, 10.5ml, 26ml. Volume dependent on invasive procedure being undertaken. Applicator squeezed to break ampoule and release antiseptic solution onto sponge. Solution applied by gently pressing sponge against skin and moving back and forth for 30 seconds. The area covered should be allowed to air dry. Side effects, precautions & contraindications: Very rarely allergic or skin reactions reported with chlorhexidine, isopropyl alcohol and Sunset Yellow. Contra-indicated for patients with known hypersensitivity to these constituents. For external use only on intact skin. Avoid contact with eyes, mucous membranes, middle ear and neural tissue. Should not be used in children under 2 months of age. Solution is flammable. Do not use with ignition sources until dry, do not allow to pool, and remove soaked materials before use. Over-vigorous use on fragile or sensitive skin or repeated use may lead to local skin reactions. At the first sign of local skin reaction, application should be stopped.

Per applicator costs (ex VAT): ChloraPrep: 0.67ml (SEPP) - 30p; 1.5ml (FREPP) - 55p; 1.5ml – 78p; 3ml – 85p; 10.5ml - £2.92; 26ml - £6.50 ChloraPrep with Tint: 3ml – 89p; 10.5ml £3.07; 26ml - £6.83 Legal category: GSL Marketing Authorisation Holder: CareFusion UK 244 Ltd, The Crescent, Jays Close, Basingstoke, Hampshire, RG22 4BS Date of preparation: January 2013 Adverse events should be reported. Reporting forms and information can be found at Adverse events should be reported to CareFusion Freephone number: 0800 0437 546 or email: © 2013 CareFusion Corporation or one of its subsidiaries. All rights reserved. Reference: 1. Darouiche R et al. N Engl J Med 2010; 362: 18–26. Date of preparation: February 2013

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0000CF01522 Issue 1



Ofsted-style ratings for hospitals, a statutory duty of candour, and one-year frontline training for nurses make up part of the government’s plans to overhaul the health system following the Francis inquiry into the care failings in Mid Staffordshire

Patient Safety


The final report into the failings of Mid Staffordshire NHS Foundation Trust by Robert Francis QC concluded that patients were routinely neglected by a Trust that was preoccupied with cost cutting, targets and processes and which lost sight of its fundamental responsibility to provide safe care. In the report, Francis made recommendations for both the Trust and government on how to improve patient care and prevent such failings in the future. The government has now responded to the report, pledging to overhaul of the health and care system so the quality of patient care will be put at the heart of the NHS. On release of the government’s initial response to the report, ‘Patients First and Foremost’, Health Secretary Jeremy Hunt said: “The events at Stafford Hospital were a betrayal of the worst kind. A betrayal of the patients, of the families, and of the vast majority of NHS staff who do everything in their power to give their patients the high quality, compassionate care they deserve. “The health and care system must change. We cannot merely tinker around the edges – we need a radical overhaul with high quality care and compassion at its heart. I am setting out an initial response to Robert Francis’ recommendations. But this is just the start of a fundamental change to the system. “I can pledge that every patient will be treated in a hospital judged on the quality of its care and the experience of its patients. They will be cared for in a place with a culture of zero harm, by highly trained staff with the right values and skills. And if something should go wrong, then those mistakes will be admitted, the patient told about them and steps taken to rectify them with proper accountability.” SHOCKING EVIDENCE Robert Francis’ final report is based on evidence from over 900 patients and families who contacted the Inquiry with their views. It clearly shows that for many patients the most basic elements of care were neglected. Calls for help to use the bathroom were ignored and patients were left lying in soiled sheeting and sitting on commodes for hours, often feeling ashamed and afraid. Patients were left unwashed, at times for up to a month. Food and drinks were left out of the reach of patients and many were forced to rely on family members for help with feeding. Staff failed to make basic observations and pain relief was provided late or in some cases not at all. Patients were too often discharged before it was appropriate, only to have to be re-admitted shortly afterwards. The standards of hygiene were at times awful, with families forced to remove used bandages and dressings from public areas and clean toilets themselves for fear of catching infections. Speaking at the publication of his final report, Robert Francis QC said: “I heard so many stories of shocking care. These E



Patient Safety • 8 million admissions each year, 850,000 result in patient safety incidents Cost : £2 billion. • 10,000 patients seriously harmed each year due to misidentification, misprescribing or wrong surgery Cost : Incalculable. • Time wasted each year looking for assets, records and results Cost : £900 million. Statistics presented at a recent Healthcare conference

Rivendale can help increase patient safety • Print Anywhere is a GS1 certified solution that prints wristbands and other patient documents on standard networked laser printers. It can be integrated with most patient administration systems.

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Patient Safety


 patients were not simply numbers they were husbands, wives, sons, daughters, fathers, mothers, grandparents. They were people who entered Stafford Hospital and rightly expected to be well cared for and treated. Instead, many suffered horrific experiences that will haunt them and their loved ones for the rest of their lives.” The Inquiry found that a chronic shortage of staff, particularly nursing staff, was largely responsible for the substandard care. Morale at the Trust was low, and while many staff did their best in difficult circumstances, others showed a disturbing lack of compassion towards their patients. Staff who spoke out felt ignored and there is strong evidence that many were deterred from doing so through fear and bullying. Robert Francis QC added: “It is now clear that some staff did express concern about the standard of care being provided to patients. The tragedy was that they were ignored and worse still others were discouraged from speaking out.” DISCONNECTED The Inquiry concluded that a number of the deficiencies at the Trust had existed for a long time. Whilst the executive and non-executive Board members recognised the problems, the action taken by the board was inadequate and lacked an appropriate sense of urgency. The Trust’s board was found to be disconnected from what was actually happening in the hospital and chose to rely on apparently favourable performance reports by outside bodies such as the Healthcare Commission, rather than effective internal

The Francis nd fou Report ronic that ch staff was Robert Francis QC has e of recommended, given the shortagy responsible lack of understanding l d e r larg substanda surrounding mortality e statistics and their use, for th vels of le that the Department of Health set up an care

assessment and feedback from staff and patients. The Trust failed to listen to patients’ concerns, the Board did not review the substance of complaints and incident reports were not given the necessary attention. Problems at the Trust were exacerbated at the end of 2006/07 when it was required to make a £10 million saving. The Board decided this saving could only be achieved through cutting staffing levels, which were already insufficient. The evidence shows that the Board’s focus on financial savings was a factor leading it to reconfigure its wards in an essentially experimental and untested scheme, whilst continuing to ignore the concerns of staff.

NO MORE EXCUSES Announcing the Inquiry findings, Mr Francis told staff and patients: “A number of staff and managers at the hospital, rather than reflecting on their role and responsibility, have attempted to minimise the significance of the Healthcare Commission’s findings. The evidence gathered by this Inquiry means there can no longer be any excuses for denying the scale of failure. If anything, it is greater than has been revealed to date. The deficiencies at the Trust were systemic, deep-rooted and too fundamental to brush off as isolated incidents.” The Inquiry concluded that it would be unsafe to put a figure on the number of avoidable or unnecessary deaths at the Trust.

independent working group to urgently review the gathering and use of mortality data in the NHS. Over the course of the Inquiry, many people expressed alarm at the apparent failure of external organisations to detect any problems with the Trust’s performance. Robert Francis QC has recommended that the Department of Health commission an independent examination of these bodies in order to restore public confidence in the system. Despite the findings of the Inquiry, Robert Francis QC has concluded that Stafford Hospital should not be closed. He believes that whilst there is still much work required at the Trust, the new Executive team has made a successful start in improving the safety and quality of care it provides. To assist the Trust in this process 15 recommendations for the Trust have been made and he has recommended that the Secretary of State for Health reviews the Trust’s status as a Foundation Trust. REGAINING CONFIDENCE Speaking in Stafford Mr Francis said: “I have been struck by the commitment of the local community to its hospital. So many people who gave evidence were motivated because they care deeply about the hospital and want to see it improve. I hope that the Trust will soon be able to E



Swallow EMP Ltd is the largest solution provider in Europe, who provides fire evacuation, access/egress in the event of lift breakdown with the new 230kg capacity Super Trac. Integral ramp and option of a winch to allow easy access and also Swallow EMP was also the first company to offer solutions for access and egress by having a range of powered units so that you can go both up and down stairs. Your staff should not be transferring anybody over 25kg. Your staff should not be sliding people out of buildings on their backs. Horizontal evacuation can only work for a short-time; it is your responsibility to evacuate eventually, not the fire service. Most people in the health sector will have seen pictures of a wheelchair user at the top of a staircase. “What now? How will you evacuate safely” Well guess what! The moment you can’t use a normal evacuation chair because the wheelchair user is bariatric or can’t be transferred, then you need to be looking for the most appropriate solution. We are the only company that can truly offer evacuation access for Bariatric people, wheelchair users and the less abled. The article on page 7 of the ROSPA Occupational Safety & Health Journal June 2012 discusses days lost through sickness absence in 2011 and out of around 131 million days lost through sickness absence 34.4 million were due to musculoskeletal problems. The new 230kg Super Trac completely eliminates the above problems and negates manual handling. From Swallow Evacuation & Mobility Products Ltd – The world leader in evacuation chairs.

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FRANCIS REPORT  regain the confidence of its local community which it will achieve, not through words, but demonstrable actions and results.” The presentation of his report was concluded with a message for all concerned with the management of NHS hospital services that: “People must always come before numbers. Individual patients and their treatment are what really matters. Statistics, benchmarks and action plans are tools not ends in themselves. They should not come before patients and their experiences. This is what must be remembered by all those who design and implement policy for the NHS.” GOVERNMENT’S RESPONSE In the government’s initial response to the Francis inquiry, it pledges that quality of patient care will be put at the heart of the NHS and that a culture of compassion will be a key marker of success, ending the negative impact of targets and box ticking which led to the failings at Stafford Hospital. Radical new measures will be introduced to achieve this including Ofsted-style ratings for hospitals and care homes, a statutory duty of candour for organisations which provide care and are registered with the Care Quality Commission, and a pilot programme which will see nurses working for up to a year as a healthcare assistant as a prerequisite for receiving funding for their degree. The response is accompanied by a statement of common purpose signed by the chairs of key organisations across the health and care system. It renews and reaffirms the commitment to the values of the NHS, as set out in its Constitution, and includes pledges to work together for patients, always treat patients and their families with compassion, dignity and respect, to listen to patients and to act on feedback.

peer-review. Assessments will include judgements about hospitals’ overall performance including whether patients are listened to and treated with dignity and respect, the safety of services, responsiveness, clinical standards and governance. A new Chief Inspector of Social Care will ensure the same rigour is applied across the health and care system. The merits of having a Chief Inspector of Primary Care are also being explored What’s more, the NHS Confederation will review how to reduce the bureaucratic burden on frontline staff and NHS providers by a third. DETECT PROBLEMS QUICKLY A new set of fundamental standards will be introduced to make explicit the basic rights that anyone should expect of the NHS. They will be produced by the Chief Inspector of Hospitals, working with NICE, patients and the public. Where these standards are breached, a new failure regime will ensure that firm action is taken swiftly. If it is not, the failure regime could lead to special administration with the automatic suspension of the Board A new statutory duty of candour will ensure honesty and transparency are the norm in every organisation overseen by the CQC. To help detect problems quicker, the new Chief Inspector of Hospitals will be the nation’s whistleblower‑in‑chief. And as publishing survival results improves standards, as has been shown in heart surgery, survival rates for a further 10 disciplines, including cardiology, vascular and orthopaedic surgery, will now be published.

In l its initiao the et respons Report, Francis ment says ern the govtient care will that pa the heart of be at e NHS th

MOVING FORWARDS In order to put in place a culture of zero-harm and compassionate car, the government says there will be a new regulatory model under a strong, independent Chief Inspector of Hospitals. The Chief Inspector will introduce single aggregated ratings. The Nuffield Trust rightly said that in organisations as large and complex as hospitals a single rating on its own could be misleading. The Chief Inspector therefore develop ratings of hospital performance at department level. This will mean that cancer patients will be told of the quality of cancer services, and prospective mothers the quality of maternity services. The Chief Inspector of Hospitals will also assess hospital complaints procedures. The CQC will move to a new specialist model based on rigorous and challenging

ACCOUNTABILITY FOR WRONGDOERS Health and social care professionals will now be held more accountable. The government is considering the introduction of legal sanctions at a corporate level for providers who knowingly generate misleading information or withhold information from patients or relatives. The General Medical Council, the Nursing and Midwifery Council and the other professional regulators have been asked to tighten and speed up their procedures for breaches of professional standards. The Chief Inspector of Hospitals will also ensure that hospitals are meeting their existing legal obligations to ensure that unsuitable healthcare assistants are barred LEADERSHIP AND MOTIVATION NHS-funded student nurses will spend up to a year working on the frontline as healthcare assistants, as a prerequisite for receiving

Patient Safety


funding for their degree. This will ensure the people who become nurses have the right values and understand their role. Nurses’ skills will then be revalidated, as doctors’ are now, to ensure their skills remain up to date and fit for purpose. Healthcare support workers and adult social care workers will now have a code of conduct and minimum training standards, both of which are published at The Chief Inspector will ensure that hospitals are properly recruiting, training and supporting healthcare assistants. The Department of Health will become the first department where every civil servant will gain real and extensive experience of the frontline. The Government is also publishing a revised NHS Constitution following a recent public consultation. It incorporates many of the changes that were consulted on and, where possible, further changes resulting from additional suggestions heard through consultation. A copy can be found on the Department of Health website. It is likely there will be a further consultation later in the year on further changes to the NHS Constitution, with the aim of incorporating further recommendations made by Robert Francis QC. REACTIONS FROM THE INDUSTRY Commenting on the government’s response to Robert Francis’s report, Chris Ham, Chief Executive of The King’s Fund said: “We broadly welcome the government’s general approach. Quality of care should be a guiding principle for the NHS, and it is for the Secretary of State to make this clear. He cannot legislate for compassion but he can create a more stable environment, in which NHS organisations focus on improving quality of care. “Effective regulation has an important role to play as a ‘backstop’ against failure, but it is only actions on the ward and board that will deliver compassionate care for patients. This will require leaders, from chief executive to frontline clinicians, to start developing a culture of care as a matter of urgency. But we recognise this is not without its challenges, especially in the current financial climate where time and resources are under pressure. “The value of aggregated ratings for hospitals is highly questionable; these are complex organisations with different services and specialisms that may vary in quality so an overall rating can hide significant failings within a trust. We welcome the proposal for ratings for specific services, which we think will be of much greater value.” Robert Francis QC, who chaired the public inquiry, said of the government’s response: “Even though it is clear that it does not accept all my recommendations, the government’s statement indicates its determination to make positive changes to the culture of the NHS.” L FURTHER INFORMATION




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Chris Mallett, client manager at Aon UK writes an easy to understand guide on care home insurance to help you understand what each insurance covers and why you might need it One of my main concerns is that care homes may not have the necessary type of cover in place to ensure that in the event of any unforeseen circumstance that their care business is adequately protected. If you manage a care business, you need to be sure that the reputation and financial success of your business, which you have worked hard for, are insured. This has prompted me to write the easy to understand guide below to help you understand what each insurance covers and why you might need them. KEY INSURANCES So what are the key insurances and what they are designed to cover? Here are the typical types of insurance you would expect to be offered alongside an easy to understand statement describing the cover.

When you see ‘property’, this generally means building and contents insurance, similar to the type you would purchase on your own property. ‘Legal liabilities’ would typically include employers’ and public liability insurance, potentially including care and treatment. ‘Employers’ liability’ is protection for you as an employer in the eventuality of a claim against you from a member of staff for issues such as negligence in the event of an accident. The same would be the case for public liability but obviously for visiting members of public. ‘Business interruption’ covers you in the event that your business can no longer function, ensuring that your business does not miss out financially and in turn help to avoid closure of your care home. Engineering insurance – the main purpose

Employers’ liability is protection for you as an employer in the eventuality of a claim against you from a member of staff for issues such as negligence in the event of an accident

of this part of the policy is to carry out the statutory inspections of the homes twice yearly. The insurance element is for all risks including breakdown (as long as not down to wear & tear) as part of these inspections. ‘Legal expenses’, as you would expect, covers legal costs incurred when defending actions against your business such as employment disputes.

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OPTIONAL COVER Alongside the above typical insurances you may also be offered optional cover options such as private and commercial motor – this would provide cover for any motor vehicles associated with the care business including minibuses. Optional cover could also include employee dishonesty which can be costly for any business and this cover provides insurance for loss of money/stock as a result of theft or dishonesty by an employee. The option of directors & officer cover protects the directors & officers of the company in relation to allegations of wrongful acts in their capacity. What’s more, charity & charity trustees cover protects the charity & its directors & officers against alleged wrongful acts committed by the charity and directors & officers. I hope that the information I have provided above has helped you with the maze of jargon and information that exists in the world of insurance but if it hasn’t then please do not hesitate to contact me. L FURTHER INFORMATION Tel: 0845 485 3222 Fax: 020 7621 1511




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In a bid to get NHS patient-related data digitilised and for Trusts to embrace a culture of compliant information management practice, Jeremy Hunt’s aim is for this to be carried out by 2018 Health secretary Jeremy Hunt wants the NHS to be paperless by 2018. In a directive, issued this year, Hunt wants patients to have digital records so their information can follow them. But, unlike previous large-scale, top-down directives, he wants this driven bottom-up and by 2018 any crucial health information should be available to staff at the touch of a button. Most NHS sites hold patient-related data on a variety of different media, such as paper, microfilm and digital. It is currently difficult to identify exactly what information may be held on a given patient. This has resulted in falling standards for maintaining the patient’s acute medical record; increasing risk and leaving patients and clinicians at a disadvantage. COMMON SENSE APPROACH To address this, cost-effective solutions based on established electronic document and records management (EDRM) technologies offer the chance for Trusts to embrace a culture of compliant information management practice to deliver paperlite health care, if not paperless! There is no magic bullet solution, just a common sense approach that focuses the available technologies on specific processes to ensure that the solution delivers what is expected of it. The core technology has been around for over 35 years and is in use across many industry sectors. Lessons have been learnt through careful application of EDRM technologies. Systems have become more affordable and are delivering real and measurable benefits. KEY POINTS There are key points to keep in mind: it is vital to understand that simply digitising paper records is not enough, the solution must offer facilities to stop producing new paper through generation, management, and integration of electronic records. Patient information resides on many disparate systems within Trusts. The electronic medical record cannot sit in a document management system that remains unconnected with other hospital systems and processes: information must be exchangeable and shareable amongst all practitioners. To be optimally effective the electronic record has to be delivered to key users when and where they need it. A solution that

offers a standard interface for all users will provide limited functionality to most users. UNDERLYING PROCESSES A number of Trusts took the bold step towards paperless health care some years ago and achieved paper-lite health care using EDRM, by paying great attention to the underlying processes. So, what have they achieved? Savings gained through process efficiencies achieved by minimising dependencies on paper, by delivering the electronic patient record to those who provide care, at the right time, and by guaranteeing the accuracy and quality of information delivered. St Helens & Knowsley NHS Trust already has all of its patient records accessible online for doctors, nurses, GPs and community services Savings gained through realisation of real estate to provide more treatment facilities and better quality of care. The recently launched e-LGs managed service (digitisation of Lloyd George records) is a great example of how a “low-tech” service is helping GP practices to release much‑needed space in the surgery for clinical activities without breaking the bank. Digitising patient records makes it easier to control access and sharing. The Hunt directive of “…information following the patient…” is both practical and readily manageable. One step leads to the next: innovation is within reach instead of being unreachable. Advances in IT and its consumerisation means rapid progress towards the wider digital revolution can be made within

the NHS IT, to help deliver timely and accurate information. Use of electronic forms, for example, to capture, store, manage and deliver information electronically. ACTIONABLE DATA Similarly, the vast amount of information locked in paper records is now being transformed into actionable data: systems that can understand content and deliver it to those who need it, when and where they need it. These are no longer predictions. We have access to real data complied over the last few years – data that makes the case for going digital compelling. So, why isn’t everyone doing it? Given the bad press about large-scale IT implementations, two valuable lessons must be learnt: not all Trusts are ready for the top-end solutions. Each must accommodate the technology and its implementation gradually to suit a number of local conditions, including budgets, IT infrastructure and user training. A core application cannot be driven top-down without involving the people who will actually use it and who will be held accountable. While it is good to see that the Hunt directive is accompanied by a financial commitment (£260 million), each Trust must make its case for improvement and demonstrate willingness to change. Simply throwing money at a problem will lead to yet another IT failure. The bottom-up approach means that the digital revolution in the NHS is achievable, gradually and over time, rather than committing astronomical sums on large scale IT projects. L

A number of Trusts took the bold step towards paperless health care some years ago and achieved paper-lite health care using EDRM Volume 13.3 | HEALTH BUSINESS MAGAZINE


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Productive Primary Care is an NHS-focused organisation that provides innovative systems, training and expertise to clinical commissioning groups in order to improve efficiency, patient experience and clinical outcomes. In a traditional GP appointment system, at 8am patients would nervously contact their GP practice in the hope of securing a face-to-face appointment, often redialling or left “on-hold” as the phone lines see a surge. Once connected, patients have the perceived barrier of a receptionist to overcome. If there are no appointments left, then let battle commence for that emergency slot. This pattern all too often is what stops doctors seeing patients who actually need to be seen, encouraging them to go elsewhere in the system, such as walk-in centres and A&E. The Doctor First system is an efficient method for managing

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The BPA has a role in raising parking standards to promote innovation, technology and sustainability will develop and move the sector forward and continue to make parking a recognised profession. And nowhere is this more apparent than in the healthcare environment. Balancing the needs of hospital patients and visitors, staff and healthcare professionals to ensure that access to healthcare is fair and cost-effective, requires courage and determination. Parking managers at healthcare sites across the UK face these challenges every day. Working alone, they seek to resolve their problems locally, often challenged by local media and, indeed, their own colleagues. BENCHMARKING OF DATA The health of the nation depends upon the NHS, and the NHS depends upon the parking profession to help ensure that access to its facilities is fair and appropriate, properly managed and adequately funded. The BPA has initiated a Healthcare Parking Special Interest Group, bringing together those in NHS facilities with parking operators

Written by Dave Smith of the BPA

The health of the nation depends on the NHS, which itself depends on the parking profession to help ensure access to its facilities is fair and appropriate, properly managed and adequately funded. With this in mind, the British Parking Association (BPA) has initiated a Special Interest Group to support its work in raising parking standards – whilst always putting the customer first

A large ce differenrking at n pa betwee are facilities healthc arking for and p and leisure s businesat there is is th oice little ch

and service providers to share knowledge and experience. It is the BPA’s role to educate and inform people about the best practice that is already out there. At a recent BPA meeting in Sheffield, where the group welcomed a new chair (Jug Johal, hotel services general manager at Northern Lincolnshire and Goole Hospitals NHS Foundation Trust), one of the main topics on the agenda was the benchmarking of parking data; an area that has recently been developed by the Higher and Further Education Special Interest Group. Around 30 Higher and Further Education facilities took part in a benchmarking survey, answering questions and providing specific data about different criteria at their own facility and campus, including number of spaces; number of sites; charging mechanism and tariffs; whether concessions are offered and the type of concessions; payment control systems; details of travel schemes and so on. The resulting data was shared between each facility, allowing them to benchmark themselves against each other in terms of the criteria surveyed.

CAPTURE ANY TRENDS In total, around 80 questions were asked and the data, which was fed back to the participants, is now being analysed further and developed into a full report that will capture any trends and also inform further research in this area. The healthcare group is extremely keen to develop this process for its sector and further meetings of the group will explore how best to facilitate this. The BPA’s Healthcare Special Interest Group next meet on 11 July at the Northern General Hospital in Sheffield. For further information if you would like to attend, visit www. Working together through the BPA Healthcare Parking Special Interest Group, we can all share knowledge and best practice, as well as campaign for better recognition of the services provided and the need for them to be properly funded. STRONG OPINION If truth be told, many people who attend healthcare facilities, either as patients E



A BRIGHT FUTURE FOR YOUR HEALTH CARE ENVIRONMENTS Working collaboratively with clients, medical staff and service users has enabled us to develop a service that respects the sensitive, critical nature of health care environments. We understand the complex nature of working in live clinical and health care environments and have developed protocol for working around vulnerable patients, upholding confidentiality and security at all times, whilst delivering a seamless service to patients, visitors and medical teams. Our expert teams have been specifically selected for their experience of successfully delivering health care projects and have an exemplary track record for delivering clinical refurbishment schemes, adopting the highest standards of quality and control in sterile environments and embedding that into our working procedures.

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FACILITIES MANAGEMENT  or visitors, expect car parking to be free. But given the sheer number of people who use these types of facilities, the costs involved and the demand for spaces, it is clear that there is a real need for car parking to be managed properly. Often the most effective way to do this is by charging for parking. This recognises a number of factors, namely the value of a car parking space, the needs of other users of the facility, the environmental impact of driving and the need to maintain and improve car parks by reinvesting income. Parking at hospitals and healthcare services is always going to be a soft target for the media to create sensational stories about how the National Health Service can do no right. Healthcare and parking as individual issues are emotive and inflame passions, with most people holding a strong opinion. Taken in combination, they provide ample opportunity for populist headlines. FREE PARKING As we have seen in Scotland and Wales, free parking has consequences: it is now virtually impossible for visitors and patients to find somewhere to park. This is because commuters and non-hospital users take all the spaces very early in the day and remain all day. The big difference between parking at hospitals and other healthcare facilities and parking for business and leisure is that often there is little choice. Few people choose to go to hospital and even fewer have a choice of which hospital. These are facilities used most when we are unwell or seeking medical advice or obtaining treatment for long-term conditions. At best, we are visiting someone who is unwell. The BPA strongly believes in raising standards in the parking sector and in delivering a more professional service to the public. Providing, managing and paying for parking at healthcare facilities needs to be seen in the context of delivering a better and fairer service to those who use such facilities.

The British Parking Association Wales and Scotland as governments seemingly pander to the popular demand. Increasingly, there is a demand for England to follow suit. None of this is without consequences and it is only too apparent in Scotland and Wales that there is no such thing as a free parking space. Someone is paying for it. The BPA does not feel it’s right that dwindling healthcare budgets should be used to provide parking facilities for those who choose to drive to hospital, whilst there are those who arrive by public transport and continue to pay. We strongly believe that healthcare budgets be used to provide healthcare. RATIONED AND MANAGED In 2010, the British Parking Association first published its Healthcare Parking Charter, aiming to strike the right balance between being fair to patients and others, including staff, and making sure that facilities are managed effectively for the good of everyone. Now, nearly three years on, the BPA has revisited the Charter and, with the help of those working in both the parking and healthcare sectors, has republished its guidance. Like so many other places, the demand for parking spaces at hospitals exceeds the supply and therefore it needs to be rationed and managed. Parking charges can help to pay for maintenance and management services, and prevent these from becoming a drain on healthcare budgets. Therefore, BPA encourages healthcare facilities and those that manage parking at these facilities to sign up to its Charter and to abide by its letter and spirit. Over 65 organisations have now signed up to the Charter, including both the NHS Confederation and Healthcare Facilities Consortium. Some 30 car park operators managing parking at healthcare facilities have also agreed to abide by the terms of the Charter and are committed to providing excellence in parking management. A full roll call of signatories, along with a downloadable version of the Charter and

Demand for spaces at hospitals exceeds the supply, so it needs to be rationed and managed. Parking charges can help to pay for maintenance and management services and prevent these from becoming a drain on healthcare budgets Those who manage healthcare facilities and car park operators recognise the importance of car parking policy, both in terms of the wider transport strategy and the need to manage traffic and parking in line with demand and environmental needs. They also recognise the importance of professionalism in delivering their services and providing a high standard of customer care. Free parking at hospitals is the norm in

details of how you can add your name to the list, can be found at www.britishparking. Following the success of the Healthcare Charter, the BPA has developed a Charter for Higher & Further Education. This new initiative was recently launched at Parkex, the biggest event for those working in parking and traffic management, which took place at Birmingham’s NEC.



The BPA is dedicated to promoting and improving knowledge and standards in every type of parking facility, both on-street and off-street. It is also committed to bringing together the interests of users, government, local authorities and commercial organisations; providing a forum for the exchange of information and ideas concerning parking. Already, a number of Trusts that are also teaching hospitals have added their names to the list, including: George Eliot Hospital NHS Trust, Lancashire Teaching Hospitals NHS Foundation Trust, University Hospitals of Leicester NHS Trust, and York Teaching Hospital NHS Foundation Trust. A full list can be found at charter-for-higher-education-parking. One of BPA’s main aims is to encourage members to raise standards so they provide a better, fairer service to their clients and to all car park users. BPA members recognise the value of maintaining high standards, and becoming a member enables them to do this. DETERRING CRIMINAL ACTIVITY Reducing crime and the fear of crime is a key initiative of the BPA and the Safer Parking Scheme does just that. It is owned by the Association of Chief Police Officers (ACPO), but operated and managed by the BPA on its behalf. The UK government recognises the benefits of this Scheme. Safer Parking status (or Park Mark®, as it is known by the public) is awarded to parking facilities that have met the requirements of a risk assessment conducted by the police. These requirements mean the parking operator has put in place measures that help deter criminal activity and antisocial behaviour, thereby doing everything they can to prevent crime and reduce the fear of crime in their parking facility. For customers, using a Park Mark®Safer Parking facility means that the area has been vetted by the police and has measures in place to create a safer environment. Through the planning processes, BPA’s aim is for all new car parks to be required to achieve a Park Mark® award and it would like to see wider public awareness of the Scheme. BPA is asking government, police organisations and other agencies involved in the regeneration and creation of safer communities to become more proactive in promoting the benefits of the Scheme. Better promotion and public awareness will increase its popularity. L FURTHER INFORMATION




Written by Terry Barker, ceo, UKATA

Asbestos Management



Following the discovery of asbestos in various hospitals, Terry Barker, ceo of UK Asbestos Training Association (UKATA), sums up the latest position on the safe removal of the lethal substance

There have been many cases in the news recently of asbestos being discovered in public buildings and while this is not a surprise to UKATA, when it started to be found in hospital buildings throughout the country, the public as a whole started to take a little more notice. City Hospitals Sunderland NHS Foundation Trust, NHS Foundation Trust in Sandwell, West Birmingham Hospitals Trust, over 20 hospitals in Northern Ireland… The list goes on, and these examples will not be the last. Rather than being rooted in the past as so many mistakenly believe, the problems of asbestos remain with us, but by following the regulations and taking sound advice on asbestos training and removal, these problems can be safely overcome. HIDDEN KILLER Despite being one of the biggest single causes of fatalities in the UK today, asbestos remains a hidden killer, with the wider public and indeed some contractors ignorant of its risks and dangers. Those with responsibility for building maintenance should be well aware of the risks, but with the legal requirements recently changing, it is important to remain abreast of the latest legislation pertaining to such a serious issue. The fears over the health risks associated



with asbestos led to its use being banned, much later than many realise. While people tend to think asbestos was outlawed decades ago, incredibly it was only banned outright in the UK in all its forms in late 1999. Increasing health fears surrounding asbestos led to a steep decline in its use from the mid-1980s, but the damage was already done. Materials containing asbestos were widely used from 1930 to 1980, so many buildings, including hospitals constructed and or refurbished at this time, may well contain asbestos, particularly where it was used as a fire retardant. Estimates suggest over 1.5 million buildings in the UK may still contain asbestos, nationwide. A real headache for those charged with managing and maintaining buildings saddled with this unwanted 100-year legacy; the majority of which are still in regular use. The case of hospitals poses particular problems at a time when NHS budgets are under pressure and now have this legacy problem to confront. REGULATED BY LAW Many of the hospitals involved in the most recent cases have been found to contain what is referred to as crocidolite, or “blue asbestos”, and it is fair to say this is the most lethal form of the material. Leaving it is not an option.

A health trust in Northern Ireland was fined £10,000 over asbestos-related safety breaches, so the problem must be tackled by those qualified and trained to deal with the material. Belfast City Hospital was known to contain the material, but this information was not passed to contractors working at the site, potentially putting them at great risk. Breathing in asbestos fibres can cause a variety of fatal illnesses, from mesothelioma to asbestosis. Those diagnosed with mesothelioma have a life expectancy of just 9-12 months and there is no cure. When you understand that it is not always easy to tell whether a product contains asbestos, it is not hard to see why it remains at the root of so many deaths, over a decade after its use was discontinued. The most common products to watch out for are asbestos insulating board (AIB), lagging and sprayed coatings. Lagging has been used for the thermal insulation of pipes and boilers and was widely used throughout the 1960s and 1970s. Cement products were the most common, being used in many building applications, from room partitions to walls and ceilings. AIB was also heavily used in similar applications. The danger is unwittingly drilling into it or otherwise causing fibres to be released in the form of dust, putting contractors at risk of inhaling asbestos fibres.

Contact with asbestos and its removal is heavily regulated by law. If you own, occupy, manage or have responsibilities for premises that may contain asbestos, as Belfast City Hospital discovered, you have a legal duty to manage the risk from the material. The key legislation known as the “Duty to Manage” asbestos (Regulation 4) was originally enshrined in the Control of Asbestos at Work Regulations 2002. This legislation applies to all non-domestic buildings and includes commercial, public and industrial premises, applying also to the common parts of domestic locations. This might include lift shafts, stairwells and corridors in blocks of flats, to give just a few examples. SAFE REMOVAL These asbestos regulations were significantly updated again only last year and are currently provided for by the Control of Asbestos Regulations 2012. Coming into force on 6 April 2012, these modified the 2006 regulations in several ways in response to European Commission reasoned opinion. The Commission felt the 2006 regulations omitted certain key terms from the European Directive for the protection of workers from the risk of being exposed to asbestos and demanded the UK fully implement the Directive, which led to the update. A new asbestos Approved Code of Practice (ACoP) consultation is also on the horizon. The public consultation is scheduled for July-September 2013 and, once a redrafted ACoP is complete, it is anticipated it will clarify certain aspects of legal duty and focus on easy‑to-understand language, so duty holders can easier make sense of their key duties. Managers should make themselves fully conversant with the full regulations, but the most significant changes affected non-licensable work on asbestos,

which entails the majority of work carried out on asbestos within the UK. This is where UKATA has a significant input in ensuring that its members provide the training necessary to ensure the safe removal of asbestos in line with UK regulation and laws. From the 6 April 2012, some “nonlicensed work” needs to be notified to the relevant enforcing authority (see HSE: www. but the requirements in respect of licensable work are ostensibly unchanged. These changes come at a time when the pressure on the public sector to work collaboratively is greater than ever as a means to cut costs. The coalition government has been pushing for such partnerships almost since taking office, and asbestos control and removal is an obvious place this can be achieved. With pressure on budgets greater than for a generation, the collective procurement of asbestos management services can be a tempting carrot for the sector to avoid the stick of not doing enough to cut costs, particularly in an area requiring a high level of training and specialisation.

ng Breathi tos s in asbe can fibres riety va cause allnesses – i of fatal lioma gives e SUBMITTED mesoth expectancy TENDERS a life 9-12 Although UKATA fully of supports the concept of collaboration of this type in months principle, profit must never be

put before safety. While tenders that have reached the public domain are often being assessed on quality first and price second, those in public sector procurement need to ensure tenders submitted are compliant with the 2012 regulations. For procurement managers, bid writers and specialist asbestos companies alike, compliance will need to be fully demonstrated when completing a pre‑qualification questionnaire or when writing a contract tender. If the latest discovery of asbestos in hospitals tells us

About UKATA UKATA (UK Asbestos Training Association) exists to set and verify standards and to emphasis the importance of best practice in training when it comes to the safe handling, removal and disposal of asbestos. Public sector managers should ensure asbestos is only handled by trained professionals. Tasked by the HSE in 2008 to take on, manage and develop the list of training providers for licensed asbestos work in the UK, UKATA is now the leading authority in all levels of asbestos training.

Asbestos Managaement


anything, it is that strict compliance with the new regulations is vital. Those failing to abide by the current regulation run the risk of potentially large fines and criminal conviction. Looking to the future, the 2012 regulations are unlikely to be the end of the matter. If tenders have been approved for companies without the necessary training and ability to adapt to what remains a fluid legislative environment, this could be storing problems for the future of an effective collaborative/partnership approach to UK asbestos removal and management. FURTHER EU DIRECTIVES Members of the European Parliament are already pushing for further asbestos regulation. If this happens, it will inevitably impact on future asbestos regulation in the UK. Draft concepts are already under investigation and with reports filtering through of over 125 possible amendments, everyone needs to be ready to tighten up yet further on asbestos regulation in the near future. Ensuring you use fully trained and registered compliant companiesis good advice indeed. FURTHER INFORMATION

Asbestos training: compliance is law, trade membership is not It is compliance with regulations that is mandatory, not trade association membership. There is so much misguided and conflicting information in the asbestos training market that it is no wonder so many employers and duty-holders are confused. If you take the adverts and editorials at face value, you could be forgiven for believing that there is only a limited source of asbestos training sanctioned by HSE. The reality is that the law requires employers to ensure that asbestos training is suitable and sufficient for the work being undertaken. It does not require you to use trainers who are members of any

particular trade association or organisation. At the end of the day, if asbestos training (or any other occupational training) is found to be wanting and non-compliant, the buck

stops with the employer, not the trainer. Granted, some trade associations do have entry requirements and “auditing”, which can be cited by an accused employer as grounds for due diligence but, in reality, how useful is a prearranged audit? The search for suitable training providers should involve several checks, not just whether they are members of a trade association. After all, that is all they are, “trade” associations. FURTHER INFORMATION



Healthcare IT


Take control, improve services and reduce costs: making IT happen now

Helping you achieve a realistic return and deliver superior customer service

The Industrial Revolution was driven by standardisation and mass manufacture of components. In the 18th and 19th centuries it was mechanical components like nuts and bolts; now, in the 21st century, the same is happening with software. Powerful, tailored and flexible, business solutions can be built and configured using inexpensive standard software components. Leaders need to change the way they think about IT. They need to see it as a service, take control of it as a business tool and spend their limited budgets in smarter ways. Facing constant change, business managers need tools that allow them to respond quickly and inexpensively, using strategic solutions. Using “enAct”, enCircle’s business process automation platform, one public-sector organisation realised returns on its investment of up to eight

Netcall’s dedicated solutions help organisations manage the ever-changing demands of their customers efficiently and cost-effectively, to increase customer/patient satisfaction. The company offers a platform with a range of innovative market specific solutions for end-to-end customer engagement; incorporating intelligent contact handling, workforce optimisation, business process management and enterprise content management. The solutions available are scalable and can be delivered on-premise or in the cloud. The government says “the patient experience” is a crucial part of quality healthcare provision while the NHS constitution reinforces the need for patient-centred care. Therefore, healthcare organisations must seek new ways to maximise their resources and reduce costs while

times the initial outlay, and still growing. A spokesperson for the organisation said: “The benefit of having non-technical team members able to develop screens and processes for us in-house is invaluable. They are able to enhance or develop the system to support process evolution. An exceptional selling point of the enAct system and enCircle.” FURTHER INFORMATION Tel: 0844 9910109

Scalable, highly available, database Riak is the database chosen by the NHS, the Danish national health authority, Comcast and other organisations with critical big data problems. Created by Basho, Riak is linearly scalable, highly available, fault tolerant and ops-friendly.

meeting these demands for an improved service to patients. Working in partnership with healthcare customers helps provide the feedback needed to create solutions to help them achieve savings and improve patient contact and experience. Netcall’s customer base has over 750 organisations in the public and private sectors, including NHS Acute Trusts, London borough councils, BT, University of Cambridge, Prudential, Spire Healthcare and Thames Water. FURTHER INFORMATION Tel: 0330 333 6100

Primary objectives for estates staff is PATIENT SAFETY. MGS Ltd. have developed and produced our Medical Gas Isolation Kits to enable safe shutdowns of wards and departments and single terminal unit isolation. PLEASE CONTACT US FOR FURTHER INFORMATION.

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The new Professional Record Standards Body (PRSB) is a major step forward in ensuring professionally endorsed standards are adopted to enable safe and effective information sharing, writes Dr Philip Scott, BCS Health representative for PRSB and Dr Justin Whatling, chair BCS Health All too often, stories about information in the NHS and social care are about failure. Not just the failure of massive government IT projects but the tragic cases of personal harm and loss of life caused by the absence of proper knowledge sharing between care professionals and providers. Inadequate records management and information sharing were identified as contributory factors in the deaths of Victoria Climbié in 2000, Penny Campbell in 2005 and Baby P in 2007.The Laming report into the death of Victoria Climbié concluded that: “Improvements to the way information is exchanged within and between agencies are imperative if children are to be adequately safeguarded.” In some cases, information sharing has been unduly inhibited by misperceptions about data protection requirements – this was highlighted by Lord Laming and other reports since, even in the recent Caldicott2 report on information governance. Yet each day there are hundreds of thousands of successful information transactions that support the routine business of health and social care: GP referrals to hospitals, social care or therapists;

laboratory and diagnostic imaging reports to GPs; intra‑hospital test requests and results; referrals from independent sector treatment centres to NHS care providers; emergency department attendance notifications, to name but a few. A COMPLEX TASK However, practice is highly variable both between and within care provider organisations. Academic research has demonstrated that the NHS is unacceptably tolerant of unsafe processes. Media reports have claimed that over a million NHS outpatient consultations are held each year without access to the patient’s medical notes. Software solutions for many of the routine information flows are often local to a community or service and incompatible with other software. Many high volume processes are still paper-based – hence the Secretary of State’s ambition for a paperless NHS by 2018.

How can information sharing in health and social care be made safe? The problem is multi-faceted and includes complex factors such as organisational policy, culture and leadership; adequate resources and training; appropriate data quality controls and well-aligned financial incentives. One vital component is professionally‑endorsed information standards for care services.

Written by Dr Philip Scott, BCS Health representative for PRSB and Dr Justin Whatling, chair BCS Health


Healthcare IT


THE NEED FOR STANDARDS The NICE clinical guideline for improving the patient experience (guideline 138) specifies the requirement for “coordinated care with clear and accurate information exchange between relevant health and social care professionals.” This implies the needs for information standards to enable the clear, accurate and safe exchange of knowledge. There has been substantial progress in the technical standards for IT systems to exchange data and meaning. International standards development organisations such as ISO, HL7 and IHTSDO have produced widely used protocols for messaging, clinical document representation and coded vocabularies to precisely express clinical facts and opinions. These standards provide compatible ways to share information without constraining E

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PATIENT INFORMATION  commercial software innovation. They also act as a form of ‘corporate memory’, distilling the collective experience of information specialists from multiple international health IT projects into usable best practice. However, what has been missing until now is an authoritative voice to state the professional requirements for document structure, content and process that can then be implemented in the technical solutions. What has typically happened is that the user group for a particular IT system or a clinical advisory group for a specific project will articulate the requirements. In some cases, professional societies have defined clinical requirements for records or processes. But professional requirements for information standards have remained piecemeal. Given the government’s policy aim of opening up patient access to their electronic records, the need for standardised, organised and comprehensible records is even more pressing. BCS, The Chartered Institute for IT, stated in 2011 that it is a priority to address the weakness in data quality at the point of collection through data standards, validation and enforcement. It recommended a multipronged approach including defining a minimum set of information, clarifying professional obligations and monitoring, clarifying legal obligations of organisations, greater audit scrutiny, and imposing standards in contracts. BCS recommended the creation and enforcement of clinical standards for record keeping, data recording and sharing, with intercollegiate standardisation across professional societies to ensure that information is comparable and terminology consistent. DEVELOPMENT OF THE PRSB In 2010, the Department of Health commissioned a joint working group to recommend how professional requirements and leadership could best support the development of electronic health records in line with national policy. This group built on earlier work led by the Royal College of Physicians of London and the Academy of Medical Royal Colleges that in 2008 had produced national standard headings and definitions for hospital admission records and handover and discharge communications. The working group recommended the creation of an independent body to lead the development and professional assurance of clinical record standards across all specialties and clinical disciplines. The Professional Records Standards Body for health and social care (PRSB) was

formally launched at the BCS Healthcare Computing congress on 17 April 2013. The founder members were the patient representative group National Voices, the Royal College of Physicians, the Allied Health Professions Federation, the Royal College of Nursing, the Association of Directors of Adult Social Services, the Royal College of General Practitioners, the Academy of Medical Royal Colleges, the Royal College of Pathologists, the Royal College of Psychiatrists, the Royal College of Surgeons of England, the Royal College of Paediatrics and Child Health and BCS, The Chartered Institute for IT. Professor Iain Carpenter, the Deputy Director of the RCP’s Health Informatics Unit who will be the first chair of the PRSB, says it will help organise the structure and content of health and care records around the needs of patients and the health and care sectors: “Acting as a partnership, PRSB will have direct links to the NHS in England, Scotland, Wales and Northern Ireland, thus ensuring a joined-up approach to record standards development. By uniting the development of both health and social care records, it will underpin and support the new commissioning structures and aim to ensure that patients no longer fall between the gaps created by separate record systems.” AN INDUSTRY WELCOME The creation of PRSB has been widely welcomed by clinical informatics leaders. Dr Mark Davies, Clinical and Public Assurance Director of the Health and Social Care Information Centre, stated that: “the professional standards for electronic record keeping are a fundamental element of successful IT enabled care... we need to ensure good outcomes are supported by good records.” Dr Justin Whatling, Chair of BCS Health, said: “This is a major step forward in ensuring market‑driven standards exist for the way in which information is stored, retrieved and used to improve and integrated healthcare provision. As the professional body for IT and informatics, we’re delighted to be one of the founding members and actively contribute our experience and knowledge.” A particular contribution of BCS is to help ensure alignment and mutual learning between the professional and the technical standards worlds. PRSB is now in the process of finalising its governance structure and planning its priority work programme for the next year of activity. BCS believes that the UK can set a powerful example within Europe and beyond by demonstrating the importance of clinicians and end users setting and

PRSB will not he ll t solve a faced in s problem social care d NHS an , but it does sharing potentially offer a ormative transf tunity oppor

What will the PRSB do?

Healthcare IT


Provide overall governance of the professional structure and content standards for health and social care records, including their maintenance Provide assurance of standards proposed for implementation in information systems Advise statutory and professional bodies and associations on record structure and content Provide avenues for professional bodies and associations to contribute to the work of the PRSB Act as a broker for record content standards development work required, undertaken and funded by statutory and professional bodies and associations Be a first point of call for professionals, professional organisations, service providers and commissioners and policy makers for expertise and all matters relating to the structure and content of electronic care records agreeing the standards that are used to record and share information. ENFORCEMENT OF STANDARDS Under the Health & Social Care Act 2012, the Secretary of State and the NHS Commissioning Board (NHS England) have the powers to publish information standards for the NHS and adult social care. The Act requires that providers of care “give due regard” to these published standards – legislative code words for the standards becoming mandatory. The professional assurance of information standards that PRSB now offers will give credibility to such a political enforcement if these powers are invoked. However, the 2012 information strategy, The Power of Information, argued that a new approach is required to the adoption of standards: an approach that has “clinical and professional buy-in” and that “promotes adoption by the market.” The role of PRSB is entirely compatible with this ambition. PRSB will not solve all the problems faced in NHS and social care information sharing, but it does offer a substantial and potentially transformative opportunity to get record keeping right. The mission of BCS is to enable the information society – supporting health and social care is central to this purpose. ‘To care appropriately, you must share appropriately’ (Caldicott2 Report). L FURTHER INFORMATION




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Healthcare IT


Following recent changes to the way NHS services are commissioned, agile working has helped North East Lincolnshire Clinical Commissioning Group (CCG) adapt to its new responsibilities

THE BUSINESS CASE When agile working was first introduced, our vision was for it to support the Trust’s strategic goals by delivering three main ‘cashable’ benefits: estate rationalisation; personal productivity improvement; and travel cost reduction. By equipping our staff with laptops and mobile

time. The development of paperless systems has enabled staff to work collaboratively on projects. The new working practices have created a culture where senior managers are more visible and more accessible. No one in the organisation has their own desk and only the accountable officer has an office. Additionally the organisation has a flatter structure. Combined with giving staff the ability to work from home and reducing stress caused by unnecessary travel, this has contributed to a 30 per cent fall in absenteeism since 2011. SUPPORT FOR COMMISSIONING Following the government’s recent structural reforms and changes to the way NHS services are commissioned, the technology put in place to create a flexible workforce is now helping us transition to new structures and making it easier to support new GP commissioners. The agile working technology is strengthening the link between the GP community and supporting them in their new role as Commissioners. To improve communication and collaboration, 10 key CCG staff with financial, information and service development experience are now attached to the 31 GP practices in the local area. The technology allows them to work in primary care premises alongside the GPs and practice staff they support. As all primary care centres are set up for wireless and linked to the central systems, CCG staff can remotely access central data on activity and benchmarking to share with practices and support the practices review of commissioned activity and the development

Agile working technology is strengthening the link between the GP community and supporting them in their new role as Commissioners phones, introducing flexi-desks, scanning and central storage services, the new technology has enabled us to deliver against each of these objectives and our combined on-going annual savings had reached over £400,000. Through rationalising our estate, we dramatically reduced our footprint from seven buildings down to two – reducing carbon emissions and estate overheads. Since April 2011, travel costs have also reduced by 15 per cent through removal of unnecessary business mileage claims locally and in the wider Yorkshire and Humber area through the use of technology. Productivity increased as the time spent travelling was cut, generating more available work time during the day; saving even just 30 minutes a day travel generated seven per cent additional

of alternative service arrangements. The flexible working solution provides secure broadband and remote connection to the CCG’s network, emails, files and applications without needing to return to base. Agile working is also reducing the amount of time busy GPs need to spend on their commissioning responsibilities. Thanks to the technology, CCG staff can provide real time, instant responses to queries from GPs and practice staff. Having the ability to access CCG data at a GP’s desk and discuss the issues promptly means staff do not defer answers to subsequent visits. It also means GPs do not need to travel to head office to discuss and review financial issues, saving them valuable time in discharging their new responsibilities.

EASING THE TRANSITION The changes required by the commissioning reforms required significant movement of staff to new locations, new organisations and new roles. In March this year NELCTP ceased to exist and we are now a CCG with full commissioning responsibilities. CTP staff have dispersed and now sit in many other organisations: the Commissioning Support Unit, NHS England and the CCG for example. We now have just 50 members of staff who are based in the central CCG offices delivering support to both health and adult social care commissioning. Having a flexible organisation has allowed us to make these changes without delays from infrastructure complications. As staff already work in flexible buildings with mobile technology and remote access to networks, new teams have been created without physical upheaval. Agile working also means staff can ‘touchdown’ in new bases without needing a new IT infrastructure or to transport hardware and paper files. With a large geographical area that staff are being drawn from, agile working is a fundamental part of our strategy. Staff formerly employed by the CTP who have gone to other areas have taken mobile IT equipment with them and we have expanded the wi-fi network to new locations so they can still work flexibly in their new roles.

Written by Eddie McCabe, North East Lincolnshire CCG

At the heart of the transformation of the NHS in our area, North East Lincolnshire Clinical Commissioning Group (CCG) commissions integrated health and adult social care services, using local knowledge and leadership. Following recent NHS reforms, the form and function of our organisation is still evolving, but we’re using agile working to put us in a good position to adapt and build a flexible team. We’re building on the success of North East Lincolnshire Care Trust Plus (CTP), which worked in partnership with BT to reduced office space, eliminate unnecessary journeys and improve productivity through flexible working, helping the CTP to achieve combined annual savings of over £400,000. Thanks partly to our mobile, flexible workforce, we felt able to be one of the first organisations in the country to enter into the authorisation process to become a fully-fledged CCG. Employees at all levels routinely share work spaces, work remotely in the community and at home. The agile working programme, implemented by BT in 2011, has helped us to adapt to our new responsibilities – supporting GP commissioners; easing the transition of Trust staff to new organisations and locations; and improving the culture for CCG staff.

IMPROVING THE WORK CULTURE The mobility provided by agile working is allowing the people who work centrally at the CCG headquarters to take on new pieces of work and integrate into new teams. For example, the ability to simply sit with a new team, be part of their conversations and pick up the key issues is invaluable. Being a visible manager to the new team, rather than sitting in some other office, facilitates the handover and reassures staff about the changed management arrangements. The flexible workspace means that building capacity has been further reduced as staff move to other organisations, reducing overheads. On top of this, all the productivity and cultural benefits which flexible working provided at the CTP continue to benefit CCG staff. Agile working has been so successful that it has become ‘business as usual’ and is no longer treated as a ‘project’. However, we are still looking for ways to enhance our mobile working practices. L FURTHER INFORMATION







Mike Sinclair, chair of the Health Informatics Congress, looks at the leading event for informatics, clinicians and senior managers and reflects on the need for healthcare to further embrace technology the increased quality and effectiveness of health and care across the UK and beyond.

HC2013, which took place at the Birmingham ICC from 16-17 April 2013, attracted more than 2,100 visitors, all seeking to learn, share and debate best practice as well as providing an educational tool in order to better understand wider government policy in the changing healthcare landscape. HC is an annual event organised jointly between BCS, The Chartered Institute for IT, and HIMSS (US-based health informatics society) with Citadel Events providing event management services. This event is the UK’s leading health informatics forum, featuring an exhibition and conference presentations from a range of health and care leaders and practitioners from the UK and the world. THE EVENT’S ANNIVERSARY 2013 was the 30th anniversary of the event and included some notable keynote addresses, including Archbishop Desmond Tutu (chair of the Global eHealth Ambassadors’ Programme), Tim Kelsey (national director for the NHS’ Patient’s and Information), Andrea Spyropoulos (president of the Royal College of Nurses), Gillian Leng (deputy chief executive of NICE), John Williams (director of the Health Informatics Unit at the Royal College of Physicians), Paul Hodgkin (CEO for Patient



Opinion) and Mark Davies (medical director of the Health & Social Care Information Centre). The main conference programme also featured significant input from a wide variety of health and social care organisations and experts, including patients and patient representatives. This impressive range of contributors to the event reflects the diverse and pervasive status of technology in society today. Healthcare is not alone in its need to embrace technology and embed it in daily practice for the betterment of society. Global e-health challenges led the way at HC2013 with Archbishop Tutu’s address being followed by an interview session moderated by broadcaster Nick Ross. Professors Ricky Richardson and Dick Kitney outlined how technology can be used to support the improvement of health experience and outcomes for populations across the world. The remaining session in the two-day event allowed professionals from across the health and social care sectors to review current examples of best practice, hear about developing national policy and strategy, witness the launch of new national initiatives and debate with experts and patients on how these things can all be developed for

HOW VISITORS LEARNT AND BENEFITED Visitors to the exhibition would have seen the latest technical developments from more than 100 different suppliers and partners who attended the event, giving delegates an insight and access to the new products on the market. Supplier-led presentations in the exhibition hall covered a wide range of issues that suppliers were dealing with directly in the clinical and healthcare environment. Some specialist talks focused on how technology can support specific clinical processes, but an overall theme seemed to spread across these talks in relation to how technology and information can be used more and more to facilitate the flow of communication across care settings and specialties. And this theme was reinforced by an Intellect-hosted conference session, which ran open workshops, one was driven by the patient experience and the other by leading health and social care practitioners. PATIENT EXPECTATIONS Emerging messages from these sessions included patient expectation of health and social care services, in terms of providing more joined up approaches to care and treatment. Forcing the issue on some long-standing issues, such as: “Why are my patient records not controllable or accessible to other departments or hospitals?” clearly demonstrated continued frustration of having to repeat and explain everything to multiple health and social care professionals. Open debates at the event also featured across the conference programme, including discussions on: the importance of standards in taking forward electronic health records, the need for records in the future to be focused on the patient, with support for specific contexts, diseases and interventions to be secondary, and the potential contribution of clinical data to research if it is collected carefully at the point of care. The Royal College of Nursing ran a session that provided examples of embedding technology and digital services into nursing practice, which culminated in a debate on



service” and the role of nursing in it. Other conference streams addressed specific perspectives about how the information and technology domains can be best utilised to improve health and social care systems and outcomes. Specific details on some of these are available through the event website, www., where session presentations are available. Some session videos can be found, while one-to-one interviews with leading speakers and suppliers at the event outline some interesting and stimulating ideas on how the key issues can be taken forward. HC2013 PRESENTATIONS With over 120 speakers, it is impossible to cover all the issues in just one article, but if you want to know more on some of these sessions, visit the site ( for copies of the presentations that were given on a wide range of topics. Some of the subjects covered at the event were: thoughts on the revised IG Toolkit, setting standards for health record collection and other key issues hosted by the Institute of Health Records & Information Management, NHS England’s stream on policy development and implementation, a collaborative approach to use of clinical standards from NICE, CQC and the Health & Social Care Information Centre, how private healthcare providers are coping with their specific information governance and integration challenges. Other subjects were: views from governing and regulating bodies, such as Monitor and the Cabinet Office, as well as the international aspect of this event is a major feature every year, providing delegates time and again with great opportunities to learn from others around the globe, and HC2013 had presentations from Ireland, France and Kuwait focusing on how UK-based businesses may spread their experiences to other countries. ADDITIONAL VALUE ACTIVITIES In addition to the main conference sessions, the two-day event also accommodated some “fringe”, or additional value activities, including an interactive Skills Zone (with CPD certification provided by the University of Brighton), where visitors could learn from experienced practitioners and develop specific skills in a wide range of areas. All attendees would have gained more than one thing from attending the event, whether it was from hearing key-note presentations, browsing the exhibition, attending the skill zone or picking up some interesting observations on making things work around information flows from business guru Ken Olisa, at the end of day one. James Norman, director of IM&T at The Royal Liverpool and Broadgreen University Hospitals NHS Trust said: “NHS IT directors are tasked with deciding what conferences will be of real benefit to their organisations and this year HC2013 proved to be one of those. Not only did it provide an excellent

networking opportunity, with a wide spread of healthcare provider organisations from right across the UK attending, but also it delivered real value through the chance to listen to speakers and stimulating discussions on real issues prevalent to the NHS right now.” KEY VALUE PROPOSITION Justin Whatling, chair of BCS Health echoed this sentiment saying: “People need to take the time out to develop new skills to use in

service leaders and an inspiring address from Archbishop Desmond Tutu helped to demonstrate the importance of technology in improving the healthcare of millions.” Steve Lieber, president and CEO of HIMSS said: “The show has been a huge success, and HIMSS looks forward to playing a significant role in supporting the healthcare IT industry to reach its full potential.” Next year’s event, HC2014, will take place from 19-20 March at the

An interview session moderated by broadcaster Nick Ross, president of HealthWatch, came after a video address especially recorded by Archbishop Desmond Tutu in his capacity as chair of the Global eHealth Ambassadors’ Programme their work environment, build new contacts that can help them and to learn how others have delivered best practice. If we can learn from each other then we can avoid making the mistakes others have made. This is a key value proposition for engaging in HC2013.” Matthew D’Arcy, e-government specialist for Public Servant magazine and online editor for, said: “HC2013 provided a highly informative conference with influential speakers. It was extremely useful, both in terms of delivering a deeper understanding of crucial themes in the digitally evolving health service, and in providing a wealth of newsworthy material. Engaging talks from health

Manchester Central (formerly G-Mex), providing plenty of space to expand the conference and exhibition and cater for an even larger audience. L FURTHER INFORMATION




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A look at the 2013 healthcare events calendar


29-30 September – NEC, Birmingham Pharmacists are facing a host of challenges in these tough times, from medicine shortages to declining NHS margins, whilst on the other end of the scale, a variety of opportunities including Medicine User Reviews and the New Medicine Service, which if understood properly, can considerably benefit pharmacy businesses. As the biggest show for the pharmacy industry, created for the industry and now led by the industry, the Pharmacy Show allows delegates to get the very latest information on all of the changes taking place in the sector, as well as advice from leading experts on how they can adapt to take advantage of the opportunities. With six FREE, CPD-accredited conference streams, social and networking events, and thousands of specialist pharmacy products and services from more than 300 premier suppliers – the Pharmacy Show is attracts pharmacy contractors, pharmacy professionals, pharmacy technicians, counters staff and pharmacy buyers from both primary and secondary care industries.


30 September-2 October – Excel, London Infection Prevention 2013 is the UK’s largest infection prevention and control event. It brings together the healthcare community to discuss the latest thinking around infection control such as the global threat of infection spread, antimicrobial prescribing and stewardship, behaviour change, cleaning, disinfection and Sterilisation, and outbreak investigation and management. Delegates benefit from an exhibition of the latest products and services to combat infection as well as an informative conference programme with a line up of expert speakers. For the 2012 event, 93 per cent of the delegate evaluations said their overall conference experience was good or very good.


8 October – Olympia 2, London The Healthcare Efficiency Through Technology Expo facilitates discussions on how to deliver better patient care and outcomes through technology. As well as being a showcase for innovation, technology and best practice, the Expo also brings together senior executives, clinicians and GPs, patient facing organisations, regulatory bodies and local authorities with senior government officials and healthcare specialists from not-for-profit organisations and private sector businesses. The Healthcare Efficiency Through Technology Expo is free to attend for everyone from the NHS, public sector, charities, social enterprises, voluntary and not-for-profit organisations. By registering to attend, you will gain access to a high level conference; 25 hours of seminars throughout five seminar theatres; and Comprehensive exhibition area featuring up to 100 leading providers.




18 October 2013 Exeter Chiefs Rugby Club and Conference Centre, Exeter Organised by the new Rural Health Network, the event will focus on the latest developments in rural tele-health, diagnostics, tele-care, rural proofing, commissioning rural health services and provide an opportunity to attend best practice workshops on a range of subjects of interest to Clinical Commissioning Groups, clinicians, practitioners and partners of those involved in providing health and social care to rural communities. The Rural Health Network (RHN) was established last November following a successful inaugural Challenging Times conference in Nottingham. The conference will also feature several cutting edge workshops highlighting specific ‘best practice’ projects or initiatives, an opportunity to hear the latest on the DEFRA rural proofing toolkit which NHS England commends to all organisations involved in health delivery as well as current issues in relation to rural health resourcing.


5-6 November – NEC, Birmingham Paperless working, a zero harm NHS and EHI’s Big EPR Debate will all be high on the agenda at this year’s EHI Live conference and exhibition. This year’s conference focuses on themes that are at the very centre of healthcare reforms in the UK with streams on The Big EPR Debate, health secretary Jeremy Hunt’s call for a paperless NHS by 2018, and the challenges of Dame Fiona Caldicott’s second review of information governance and information sharing. Giving delegates the chance to discuss these issues with like‑minded people makes EHI Live 2013 an unmissable event. Now in its sixth year, EHI Live attracts visitors and delegates from around the UK and beyond who are keen to listen to industry figures and investigate new technologies. EHI Live continues to focus on the frontline use of technology by IT staff and clinicians alike with a newly created app zone, a feature dedicated to use of open source technology, the co-location of the CCIO Leaders Network annual conference as well an exhibition that already features more exhibitors than last year.


27-28 November, Excel, London The acute hospital is changing, senior hospital managers are being asked to do more with less. Hospital Directions Conference is responding to these changes by providing hospital leaders with high-quality training, on a range of essential topics, driving quality and promoting excellence within every role to produce the best care within all NHS trusts. Hospital Directions will deliver practical solutions via the seven stream seminar programme – completely transferable to day-to-day roles, whilst providing opportunities to network with clinical leaders and partake in hands-on, interactive sessions. Experts will speak on service redesign, integration and innovation; improved use of information, evidence and technology; new approaches to leadership, recruitment and performance management; flexible and efficient estates and facilities management; and progressive procurement and use of the private sector.



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Fire Safety


Phil Lewis-Farrell, a chartered member of the Institution of Occupational Safety and Health (IOSH), explains fire safety and training in a hospital setting Fire safety and training is vital for a hospital. Not only does it mean the hospital complies with the law, but it also helps to protect anyone visiting, staying in, or working in the premises, making sure they are not being put at unnecessary risk. Training is essential, as it shows personnel what to do in the event of a fire and how to evacuate patients if necessary. Not only that, though, it also promotes awareness of fire hazards and how to identify them. MANAGEMENT PROGRAMME Fire safety is there because, in a fire, certain people in a hospital would not be able to evacuate on their own. So it’s a legal requirement that a fire safety management programme is put in place in all health care facilities, which guards against the outbreak of fire and protects the hospital’s occupants if a blaze occurs. A programme must include: a fire safety management structure, with clear roles for all key personnel; strict housekeeping practices and fire prevention activities and practices; routine checking, testing and maintenance of fire protection systems and equipment; development and testing of clearly defined procedures for an emergency; training of staff in fire safety and evacuation – prevention, theory and emergency actions to take; and maintenance of records relating to equipment, systems and training, and trial evacuations. POSSIBLE RISKS There are a number of fire risks in a hospital, but the main ones are: smoking – careless disposal of cigarettes in prohibited areas, smoking in toilets and other prohibited areas; contractors – hot and electrical works, which require permits and must be controlled by the designated person(s) on-site. Other risks in this situation could be careless storage/ disposal of painting equipment and working with gas; arson – fires have been lit to distract staff from burglary, or started by disgruntled patients waiting in emergency rooms; compartmentation compromised – if breached, floors, doors, ceilings, walls and windows may no longer be able to prevent spread of fire; fire doors – present risk if damaged (intumescent strips should be in place, with gaps between doors assessed

correctly). They should be able to close automatically when fire alarms are sounded; electrics – an “electrical permit to work” system should be in place, with equipment assessed, approved and documented by technical services. Sockets should not be overloaded, with any use of extension cables approved first. Damaged appliances or wiring should be reported, not repaired by staff. Gases – appropriate storage and transportation of medical and industrial gases must be practised, with restricted access to areas where stored; kitchens – deep-fat fryers pose a risk, so appropriate fire extinguishing systems should be in place. Ducts in kitchens must be cleaned and certified, with storage of oils and fats controlled and emergency shut-off valves for gas/electrics in place. Waste – appropriate, designated facilities must store rubbish, with bins able to be locked and secured to prevent arson; flammable liquids – have flashpoints above 32°C (89.6°F) and must be stored in a secure and well‑ventilated area.

This is similar in Scotland and Northern Ireland, where anyone with control of the premises must take steps to prevent fire and mitigate its detrimental effects. However, the main responsibility is on the building owner, employer and management in the Republic of Ireland. From there, responsibility cascades down and the “responsible person” could actually be the staff nurse in charge at the time.

Written by Phil Lewis-Farrell


GOVERNING LAWS In England and Wales, the Regulatory Reform Order (Fire Safety) 2005 (RRO) came into force on 1 October 2006. This replaced fire certification under the Fire Precautions Act 1971, plus many existing laws, including the Fire Precautions (Workplace) Regulations 1997. RRO 2005 stipulates a general duty to ensure, so far as is reasonably practicable: the safety of employees; that non-employees take such fire precautions as may reasonably be required in the circumstances, to

Fire safety is there because, in a fire, certain people in a hospital would not be able to evacuate on their own. So it is a legal requirement that a fire safety management programme is put in place in all healthcare facilities Only daily supplies should be kept in wards; furniture and fittings – must be assessed for flammability and emissions. Risk of fire might be more difficult to control in some hospital areas, such as places accessible to the general public. Certain patient areas are also high-risk, especially those where they are dependent on assistance to evacuate, or attached to life support equipment. DUTY HOLDER In a hospital, in England and Wales, the main duty holder is the “responsible person(s)”, anyone with control of the premises.

ensure that the premises are safe; a duty to carry out a fire risk assessment The main duty holder is the “responsible person”, but this is extended to any person who has control of the premises. They are required to: consider who may be especially at risk; eliminate or reduce fire risk, as far as is reasonably practical, and provide general fire precautions to deal with any risk; take additional measures to ensure fire safety, where flammable or explosive materials are used or stored; create a plan to deal with any emergency and, where necessary, record any findings; maintain general fire precautions and facilities provided for use by firefighters; keep any risk assessment findings under review. E



HEALTH & SAFETY  Meanwhile, employees, visitors and others in the building must make sure their actions, or non-actions, do not result in other people being exposed to danger from fire. In Scotland, fire safety is covered in the Fire (Scotland) Act 2005 and the Fire Safety (Scotland) Regulations 2006, but both impose obligations on “duty holders” and neither can be considered in isolation. RISK ASSESSMENT Any “process” fire precautions, such as risk assessment, fall under the jurisdiction of the UK Parliament. These precautions are designed to prevent outbreak and fire spread from work processes, taking into account the type of risk from whatever work activity and process is being assessed. This is different to general fire safety, which covers warning, firefighting and escape. The 2006 Regulations say managers should assess the risk of harm from fire and keep those risk assessments in continual review. Part 3 of the Fire and Rescue Services (Northern Ireland) Order 2006 and the Fire Safety Regulations (Northern Ireland) 2010 came into effect on 15 November 2010. Duties these impose fall into seven general categories: carrying out fire safety risk assessment of premises; identifying fire safety measures necessary as a result of the fire safety risk assessment; implementing fire safety measures using risk reduction principles; putting in place fire safety arrangements for the ongoing control and review of the fire safety measures; complying with specific requirements of the fire safety regulations; keeping fire safety risk assessment and outcome under review; record keeping. TRAINING RESPONSIBILITY Normally, the fire safety officer, or a designated safety professional, is responsible for organising and delivering the training. But a fire consultant might be employed to carry it out. Giving staff training sessions in fire prevention and emergency procedures might also be necessary, particularly to account for evacuating large numbers of ill patients. Local management must check that staff attend training, just as staff have a responsibility to attend themselves, but ultimately the “responsible person” will be held accountable. It is a legal requirement that all staff – permanent, temporary, part-time, contract and voluntary – train in fire safety. But training will help a hospital protect itself against fire, allowing staff to understand how fire spreads, how to raise the alarm, use fire extinguishers and save lives. Training also promotes good housekeeping, defect reporting, knowledge of using evacuation equipment and emergency plans, how to carry out fire drills and what legislation fire safety falls under.

About the author PRECAUTIONARY MEASURES Fire safety can vary from area to area and can be broken down into two: active and passive. Active fire precaution measures are systems which must activate in an outbreak of fire. It includes fire detection and alarm systems, emergency lighting, firefighting equipment and fire evacuation equipment. In ward areas, staff must have training and the right equipment and means to evacuate people, while in outpatient areas staff must know how to direct patients to a place of safety. Passive fire safety covers the structure and building, which must include features to contain fires or slow the spread. It also includes provision of escape routes and exits, fire resistance to the building structure and access to, and around, the building. All staff should learn about specific fire hazards within their area of work and how to assist in an evacuation. While fire safety training in hospitals can be generic, evacuation procedures are specific to the area in which they are developed. A good example of this would be within a spinal unit: if an evacuation was necessary, stringent steps would have to be taken to ensure no further harm, such as the use of spinal boards with head blocks. Hospitals must also provide the means to evacuate, with aids such as evacuation sheets, evacuation chairs and other items identified in the risk assessment.

Fire Safety


Phil Lewis-Farrell MSc is a chartered member of the Institution of Occupational Safety and Health (IOSH) and a certified member of the New Zealand Institute of Safety Management (NZISM). She is an IOSH mentor, a former vice chair of IOSH Fire Risk Management Group, and a former chair of IOSH Ireland Branch Fire Risk Management Section. with an action plan of how to achieve that. The fire safety risk assessment should be reviewed, regularly, to account for fires or near misses, changes in use of equipment, building alterations, new equipment and many other issues. Patients and visitors (human factors) do complicate the risk assessment process, as they are always unpredictable and therefore extremely difficult to assess. Patients can be confused and visitors can be upset or irate, bringing a whole host of complications to consider. A Control of Contractors’ Policy should be in place to guide on fire safety surrounding contractors on-site, who are not immediately employed by the hospital.

A typical risk l fire hospita nt includes RISK OF e BUDGET CUTS assessmifying those There have been big t , n s ide zard a h improvements in e r fi hospital fire safety: at risk, aluation of detection methods and and ev fire safety evacuation aids have g existin asures advanced, and building me regulations have become more

TRAINING SESSIONS General training will cover: legislation; theory of fire – fire triangle; classes of fire; combustion, convection, radiation and fire spread; active and passive fire safety; analysis of hospital fires; types of fire hazards; fire prevention measures and emergency procedures; and home fire safety. There is also an area of practical training on using fire extinguishers, evacuation equipment and the evacuation process itself. Fire wardens will also be trained to carry out their roles appropriately, with the aim of being able to understand and contribute to hospital fire risk assessments and emergency planning procedures. This training covers: legislation; fire safety warden role and responsibilities; fire science; hospital fire precautions; hospital fire engineering; and fire alarm and evacuation strategy.

WHAT DOES A TYPICAL HOSPITAL FIRE RISK ASSESSMENT INVOLVE? People at risk and fire hazards must be identified, before evaluating the associated risks and deciding if the existing fire safety measures are adequate. The fire safety risk assessment information must be recorded, with details on how best to eliminate, or mitigate risks,

stringent, reducing the chance of fire starting in the first place. This is good news for hospital staff and users, who rely on the fact that they will be protected against the risk of fire. But the risk of budget cuts does present a problem: funding is vital to maintain the quality of fire protection, keeping up-to-date with the latest techniques, training and equipment. As new technology and building standards improve, it would be reasonable to hope and expect that fire safety will also improve. New hospitals and refurbishments all assist in protecting life and property, and worldwide research is on-going into how new technology can help to advance fire safety. But this is an area where most understand its importance, especially those who have experienced a fire for themselves. After all, even a small fire can be devastating to a hospital. While management do understand the human and financial cost of a fire, we now need all hospitals to make the link between emergency planning and business continuity, to fully prepare fire safety and training systems for the future. L FURTHER INFORMATION



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