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What happens when medical devices perform incorrectly? PLACEMAKING

DESIGNING BETTER HEALTHCARE Proving that changes in design can improve well‑being of patients, staff and visitors


A VISION FOR HEALTHCARE IT Engaging patients in the digital future of the NHS



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One, two, three strikes – you’re out?




On Thursday 19 November, results from the junior doctor’s ballot revealed an overwhelming majority, 98 per cent, in favour of strike action against changes to their contracts.

What happens when medical devices perform incorrectly? PLACEMAKING

DESIGNING BETTER HEALTHCARE Proving that changes in design can improve well‑being of patients, staff and visitors


A VISION FOR HEALTHCARE IT Engaging patients in the digital future of the NHS


As a result of this, the British Medical Association (BMA) has warned of ‘inevitable’ disruption to patients, with the likely result causing the rescheduling of thousands of routine appointments, tests and operations. BMA leader Dr Mark Porter said: “We regret the inevitable disruption that this will cause but it is the government’s adamant insistence on imposing a contract that is unsafe for patients in the future, and unfair for doctors now and in the future, that has brought us to this point.” Health Secretary Jeremy Hunt, who offered a basic pay increase of 11 per cent to appease the fallout, has said: “We hope junior doctors will consider the impact this action – especially the withdrawal of emergency care – will have on patients and reconsider.” Labour Shadow Health Secretary Heidi Alexander has written to the Prime Minister David Cameron to ask him to intervene, claiming that the profession has ‘lost confidence’ in Hunt. Hunt, it appears, is ready to return to the negotiating table, maintaining his stance on the whole situation. However, with the growing pressure to let independent arbitrators, mainly Acas, help handle the dispute and with strikes planned for the 1, 8 and 16 December, for how long will Hunt hold face? Michael Lyons, acting editor

P ONLINE P IN PRINT P MOBILE P FACE TO FACE If you would like to receive all issues of Health Business magazine for £120 a year, please contact Public Sector Information Limited, 226 High Road, Loughton, Essex IG10 1ET. Tel: 020 8532 0055, Fax: 020 8532 0066, or visit the Health Business website at: PUBLISHED BY PUBLIC SECTOR INFORMATION LIMITED

226 High Rd, Loughton, Essex IG10 1ET. Tel: 020 8532 0055 Fax: 020 8532 0066 Web: EDITOR Angela Pisanu ASSISTANT EDITOR Michael Lyons PRODUCTION EDITOR Richard Gooding EDITORIAL ASSISTANTS Tommy Newell, Rachel Brooks PRODUCTION CONTROL Jo Golding PRODUCTION DESIGN Jacqueline Lawford WEBSITE PRODUCTION Victoria Leftwich, Dan Lee ADVERTISEMENT SALES Ben Plummer, Jeremy Cox, Amanda Frodsham ADMINISTRATION Vickie Hopkins PUBLISHER Karen Hopps REPRODUCTION & PRINT Argent Media

© 2015 Public Sector Information Limited. No part of this publication can be reproduced, stored in a retrieval system or transmitted in any form or by any other means (electronic, mechanical, photocopying, recording or otherwise) without the prior written permission of the publisher. Whilst every care has been taken to ensure the accuracy of the editorial content the publisher cannot be held responsible for errors or omissions. The views expressed are not necessarily those of the publisher. ISSN 1362 - 2541






Junior doctors vote to strike; whistleblowing policy for NHS staff; and practices pilot funding doubled

The NHS was urged to make better use of technology at the NHS Innovation Expo. Health Business discusses the vision for technology across the NHS


The MPBA discusses why fast track buildings prove to be the healthy choice for hospitals during peak-time demand

17 ARCHITECTS FOR HEALTH Christopher Shaw, senior director of Medical Architecture, outlines what design measures should be practiced to aid wayfinding in hospitals

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NHS Health and Care Innovation Expo returned on 2-3 Sepetmber, with around 5,000 people each day gathering for the latest in healthcare innovation Nithya Kutty discusses the factors behind positive staff wellness and successful workforce development

With asbestos posing a major health risk, Steve Sadley discusses the challenges the NHS has with asbestos management

23 FACILITIES MANAGEMENT The NHS could save millions if estate managers take a closer look at heating, ventilation and air conditioning systems, says the B&ES Association


The Carbon and Energy Fund’s Kevin Hegarty reports on a busy year targeting zero carbon for zero cost in the NHS


Kerry Hallard of the National Outsourcing Association explores how outsourcing is having, and will continue to have, a positive impact on the NHS


53 HB AWARDS 2015

3 December 2015 will mark the annual Health Business Awards, which recognise the significant contributions made inside and alongside the NHS


The British Parking Association introduces radical new accreditation for healthcare organisations: the Professionalism in Parking Accreditation


The Better Hospital Food campaign is one of a number of projects and campaigns to improve hospital food


Dr Matthew S Capehorn discusses what can be done to change the dynamics of the nation’s growing obesity crisis

With more than 500,000 medical devices used every day, Mark Grumbridge of the MHRA discusses the importance of reporting incidents




Dr Jim O’Brien, of Public Health England, discusses the importance of acting now to combat diabetes

Steve Mellings, of ADISA, discusses the problems facing data disposal and how it should be best managed








The modern hospital poses an attractive habitat for a range of pests. So how should pests in healthcare be handled?


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Junior doctors’ ballot: 98 per cent vote in favour of strikes Results from the junior doctors’ ballot revealed an overwhelming majority in favour of strike action, continuing their dispute with ministers over a new contract, with 98 per cent voting in favour of industrial action. The figures shows 98 per cent voted in favour of a full strike while 99 per cent voted in favour of action just short of a strike. The first strike is due to begin on 1 December, with more strikes to follow on the 8 and 16 December. Industrial action on 1 December will involve junior doctors stilling staff emergency care, while the


other two dates will involve a walkout in the knowledge that other medics, including consultants, staff doctors and locums will be available to plug the gaps. The British Medical Association (BMA) commented an ‘inevitable’ disruption would be caused to patients, likely to lead to the cancelling and rescheduling of thousands of routine appointments, tests and operations. The NHS will be forced to manage the crisis by prioritising emergency cases. While BMA leaders have admitted they regretted this, they maintained ministers had left them no choice after claiming the new contracts were ‘unsafe’. The BMA balloted over 37,700 members of the workforce, with 76 per cent taking part in the vote. During the strikes, services are likely to be disrupted, however the BMA has contended that the aim of doctors taking part will not be to maximise disruption. After the result of the ballot was announced, BMA leader Dr Mark Porter said: “We regret the inevitable disruption that this will cause but it is the government’s adamant insistence on imposing a contract that is unsafe for patients in the future, and unfair for doctors now and in the future, that has brought us to this point.”


NHS missing key targets, according to latest figures The latest data from NHS England has shown that in September the health service missed its A&E target to see, treat and discharge patients within a four hour time slot. This is the 12th time in 13 months performance has dropped below the 95 per cent. Performance was also below set target levels on access to cancer treatment, diagnostic tests and ambulance response times. At the end of September, 1.9 per cent of patients had been waiting over six weeks for diagnostic tests – nearly twice the proportion that should be suffering such delays. Additionally, hospitals have been struggling to get patients out when they are ready to leave. The monthly data also showed that ambulances missed their target to answer 75 per cent of the most serious 999 calls in eight minutes – the fourth month in a row it has not been achieved. On top of this, the NHS 111 phone service missed its target to answer 95 per cent of calls within 60 seconds, and the 62-day target for cancer treatment to start was missed with nearly one in five patients waiting longer. However, six of the eight cancer



NEWS IN BRIEF Seven-day GP scheme leaves out-of-hours struggling Out-of-hours providers are finding it difficult to recruit GPs for shifts after the seven-day GP access pilots began offering double the hourly rate, leaders have warned. The official evaluation of the seven-day GP access pilots revealed that they were ‘competing’ with out-of-hours providers for GPs, leading to incentives that were ‘unsustainable’ in the longer term. John Harrison, of the Northern Doctors Urgent Care (NDUC) group claimed that this has caused ‘mayhem’ for out-of-hours providers. Harrison told GP publication Pulse that out-of-hours organisations had always had to carefully manage local GP workforce as only a limited number want to work out of core hours, but they could not compete with Challenge Fund schemes offering ‘£100 an hour plus’ for shifts. Harrison said: “In Teeside, the local doctors won a Prime Minister’s Challenge Fund bid. They couldn’t get enough [GPs] for themselves to cover their rotas, so what do they do? They put it out at double the out-of-hours rate, £100 an hour plus, where the rest of us are dealing with about £47 to £50 an hour. We lost a quarter of our workforce.” READ MORE:

targets were achieved, while the 18‑week target for patients to be seen for non‑emergency operations such as knee and hip replacements was met. Shadow Health Secretary Heidi Alexander commented that the data highlights the possibility for the ‘most difficult winter for 30 years’. She said: “There is now clear evidence that the cuts to social care are not only devastating for the lives of vulnerable older people, but are having a knock-on effect on the NHS.”


Mental health early deaths worrying, says report A report by the Open Public Services Network, part of the Royal Society for the Encouragement of Arts, Manufactures and Commerce, found that one in four areas of England has unacceptably high rates of early deaths among people with mental health problems. The review looked at deaths before the age of 75 in more than 200 local areas between 2011-2012. It found that in each area, the premature mortality rate was higher among those with mental health problems, with 51 of such areas deemed ‘particularly worrying’. The research also discovered that those with mental health illnesses were six per cent less likely to have blood pressure tests, nine per cent less likely to have screen for cervical cancer and 15 per cent less likely to have a cholesterol check. READ MORE



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NEWS IN BRIEF Cancer Drugs Fund consultation opened NHS England and the National Institute for Health and Care Excellence (NICE) have released a consultation document that seeks to overhaul the Cancer Drugs Fund (CDF). The CDF was established in 2011 to fund cancer drugs which the health watchdog, NICE, has rejected for widespread use on the NHS. It has allowed approximately 72,000 patients to access drugs not routinely funded on the NHS. READ MORE:

NHS managers urged to stamp out discrimination Simon Stevens, chief executive of NHS England, has called on NHS managers to lead a new drive to stamp out discrimination across healthcare. Speaking at the Managers in Partnership Annual Conference in London, Stevens reminded organisations about the new Workforce Race Equality Standard (WRES) that is due out next April, saying it would provide the impetus and accountability needed to make improvements. His comments follow new analysis from The King’s Fund, which assesses staff experience at work in 2014. The report, entitled ‘Making the difference: diversity and inclusion in the NHS’, found wide variation in discrimination based on gender, ethnicity, sexual orientation, religion and disability status across the country. The highest levels of discrimination were observed in ambulance trusts, and black employees were the most likely to face racial discrimination, while all other non-white groups were far more likely to report experiencing discrimination than white employees. Muslims were found to be the most likely to face discrimination due to faith and disabled staff reported very high levels of discrimination, the highest among all the protected characteristics groups. Stevens said: “By introducing a new workforce race equality standard, we have chosen to hold up a mirror to the NHS each year to ask how it looks and feels to the people devoting their professional lives to looking after patients and the communities we serve. “Today’s new report paints an important picture of what is happening. It represents a call to action for everyone in the NHS.” READ MORE




Whistleblowing policy for NHS staff unveiled A national whistleblowing policy has been unveiled, which aims to give NHS staff more support to raise concerns about quality of care. The new policy has been developed by Monitor, NHS England and the NHS Trust Development Authority (TDA) and is the first of its kind for NHS staff. It aims to improve services for patients and the working environment for staff across the health sector by supporting them to raise concerns and improving how services learn from them. The proposals detail who can raise concerns, how they should go about doing so and how organisations should respond, as well as setting out a commitment to properly investigate concerns when they are reported. Tom Grimes, Monitor’s Head of Enquiries, Complaints and Whistleblowing, said: “We want to encourage a culture where raising concerns becomes normal practice in the NHS and foster an environment where concerns are taken seriously and investigated properly. “We will support the NHS to improve services for patients and a key part of that is listening to its staff and learning lessons. But this will need commitment throughout NHS organisations, from members of the board to those working in frontline services.” Dr Kathy McLean, Medical Director at the NHS TDA said: “We know that when trusts take concerns seriously and investigate them properly they are often the ones which provide the best standard of care and treatment to

patients. It is hugely important that trust boards are able to listen to what their staff have got to say and then use that to take action to deliver improvements for patients. This policy should help them do just that.” Dr Mike Durkin, NHS England Director of Patient Safety, said: “If we are to truly put our patients first, we must create a culture where owning up to mistakes and speaking out about poor care is fully encouraged and embraced. This policy should support that.”



Practices to shut early on Christmas Eve NHS England has revised its guidance allowing GPs and staff to leave early on Christmas Eve and New Year’s Eve. In a letter to practice managers, NHS England informed practices they could ‘close doors’ early over the holiday period, as long as they ensured that care provided during core hours was ‘appropriate to meet the reasonable needs of patients’. Minimum requirements will involve an answerphone message directing patients to an out-of-hours service that the practice has organised beforehand. GP leaders have approved the move and declared the directions a ‘U-turn’ on previous guidance on holiday opening hours. NHS’s England’s new stance represents a reversal of its previous policy, whereby head of primary care Dr David Geddes insisted that the holiday hours were ‘non-negotiable’. However, in a new letter, Ginny Hope, head of primary care at NHS England South, said: “As a minimum, you will need to have a

system in place so that patients can access GP services, including urgent care, either by ringing the surgery ([and either] being able to talk directly to a clinician [or receiving] an answerphone message signposting the patient to an on-call GP for the practice.” Dr Robert Morley, chair of the General Practitioners Committee’s (GPC) contracts and regulations subcommittee, informed GPs that the revised holiday opening guidance applies to all practices across England. He said: “NHS England has had to do a U-turn, that’s the key message. NHS England has been persuaded by the British Medical Association’s (BMA) argument and has accepted what the contractual obligations actually are. There is no contractual obligation for practices to remain open as long as they put in arrangements to deal with emergencies.” READ MORE:




700 GP practices benefit as NHS doubles funding for pilot NHS England has doubled funding for its national pilot of clinical pharmacists in general practices, with 700 practices set to benefit from the £31 million funding. The decision to expand the scheme is due to ‘overwhelmingly positive responses’ from GPs and the recruitment of 403 clinical pharmacists, hired to begin immediately for a Spring 2016 launch. NHS England has announced that the pilots will cover 83 practices in London, 230 in the South of England, 183 in the Midlands and 203 in the North. Overall the project will span across a population of 7.6 million patients. The scheme will run for three years and NHS England will subsidise 60 per cent of the costs for the first 12 months, including a ‘training programme’. After one year, funding will drop to 40 per cent and then 20 per cent. Practices which already employ pharmacists have reported they play an ‘invaluable role’ in alleviating GP workload by assuming tasks involving the management of medicines and freeing up GP time to focus on patients with increasingly complex care needs. While GPs welcomed the swift implementation of the scheme to support the acute workforce crisis, they counselled more time needed to be dedicated to the recruitment and retention of GPs in general practice. In a statement, NHS England advised that pilots were chosen based on their potential to improve GP access and reduce workload. It said: “Additional funding was found to more than double the number of supported applications after the panels were impressed by the outstanding quality of responses.” The pilot was developed as part of an ongoing NHS England, Health Education England, the Royal College of General Practitioners (RCGP) and the General Practice Committee (GPC) ten point GP

workforce plan. The plan promoted the aim of expanding general practice teams to properly take advantage of physician associates and advanced nurse practitioners. GPC chair Dr Chaand Nagpaul said the pilots were a ‘positive and important opportunity’ to relieve some of the pressure on GPs and should be available to all practices. He said: “We need to ensure that the benefits from these pilots can be extended to all practices nationally, so that GPs can be supported to have the time to see the increasing numbers of patients with complex and long-term conditions, and in order to provide quality and accessible care.” RCGP chair Professor Maureen Baker said: “The feedback that we have received from our members who already have a practice based pharmacist is that they play an invaluable role, so we are pleased that NHS England has taken the idea so seriously and so swiftly brought it to fruition.” NHS England chief executive, Simon Stevens, said the pilot would be a ‘winwin for GPs, pharmacists and patients’. READ MORE


NHS IT savings require £8 billion The NHS needs to spend an additional £7.2 billion to £8.3 billion on digital technology over the next five years in order to achieve necessary savings, according to a report by management consultancy firm McKinsey. The McKinsey report, which is dated April 2014, claims that the background to its work is the need within the NHS to close the gap between essentially flat fund funding and rising costs and demand that could reach £30 billion by 2020-21. Through the ‘Five Year Forward View’, NHS England has argued that £22 billion could be found through investment in prevention and new ways of working.

The report contends that savings of between £3.2 and £3.9 billion can be found in the acute sector by investing in electronic health records and in systems to improve quality. The report believes that the NHS will need to provide investment of £5 billion to £5.2 billion to secure the savings, and further estimates that it would need to spend £2.3 billion to £3 billion on training, adoption and running costs. This takes the total bill to £7.3 billion to £8.2 billion. READ MORE




BDA white paper for a healthier workforce The British Dietetic Association (BDA) has published a whitepaper highlighting dietitian-led wellness initiatives, following NHS England’s £5 million investment to improve the health of NHS staff. The BDA’s white paper entitled ‘Work Ready Programme: Supporting healthier working lives through dietitian-led wellness initiatives’ identifies how good nutrition and hydration, alongside other healthy habits and good employment practices, keep the UK workforce healthy and productive. Suzanne Rastrick, NHS England’s Chief Allied Health Professions (AHP) Officer, has encouraged the AHP workforce to engage in the delivery of the initiative. She explained: “There are a number of challenges to introducing well-being initiatives to an organisation as complicated and vast as the NHS but, as one of the largest employers in the world, we recognise the benefits. “I want to encourage the NHS to use its dietetic workforce to assist in the delivery of Simon Stevens’ initiative for our organisation and also to recommend that other organisations looking for advice use a dietitian. I believe the Allied Health Professions have among them people with the training and experience to deliver a healthier NHS workforce.” BDA chairman, Dr Fiona McCullough, said: “UK workers spend a significant amount of time in the workplace, and some organisations are offering information and benefits to their employees to support them in adopting healthier habits. “Choosing the right source of help and advice can sometimes be a confusing task. Dietitians are the ‘Gold Standard’ when it comes to nutrition and food professionals.” READ MORE




Modular Build


Written by The Modular and Portable Building Association

Helping hospitals overcome increased demand

The Modular and Portable Building Association discusses why temporary or modular buildings are proving to be the healthy choice for hospitals looking to quickly overcome problems relating to peak-time demand Temporary or modular buildings are rapidly becoming a popular solution for hospitals seeking to overcome high patient demand and are now firmly in evidence at hospitals nationally. Their popularity shows no signs of diminishing, as increasing numbers of healthcare managers discover the benefits for themselves. Given the critical nature of the healthcare industry, the necessity to quickly source low cost, modern and fully functional buildings is imperative. Because these structures are manufactured off-site to the highest specifications, they can also be installed without causing disruption to daily routines on-site. What’s more, modular buildings can be created to fit into small spaces with unusual shapes.

The Modular and Portable Building Association’s (MPBA) chief executive Jackie Maginnis said that healthcare managers greatly appreciate the possibility of sourcing these cutting‑edge facilities both quickly and cost-effectively. She explained: “Modular buildings can be manufactured with ultra quick lead times and supplied as an extension or an “add-on” to meet peaks in demand. Sometimes, healthcare managers aren’t aware that these structures are available as a permanent – as well as a

temporary – option at a cost to suit their needs. Other major benefits of modular buildings include energy compliance, meeting the latest regulations and the ability to create buildings that are designed to meet the precise specifications of that hospital’s requirements.”

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DESIGN & BUILD  Jackie added that a misconception – in some quarters – is that once a modular building has been installed, it can’t subsequently be moved and used elsewhere. She continued: “The beauty of temporary buildings is that they can be removed and reused in other parts of that hospital complex – or elsewhere – as the need arises. “Modular buildings are constructed to the latest healthcare standards, fully compliant to all building regulations and encompass ‘Part L’ energy efficiency – which means some modular buildings also have lower carbon emissions. Members of the MPBA produce the required Energy Performance Certificates, so a customer can be certain of the energy rating for a building.” CONSTRUCTION STANDARDS Jackie added that it’s the ‘flexibility’ of a modular approach that gives healthcare managers the greatest benefits, which is particularly relevant when it comes to urgent and difficult projects. The length of time it takes to install new modular buildings will vary according to a hospital’s specific requirements and the ease of access to the site among many more considerations, but it will always be quicker than ‘conventional’ construction projects. Jackie adds: “The benefits of a quick installation combined with minimal on-site disruption are not to be overlooked. And they’re also major reasons for the increasing popularity of modular buildings within the healthcare sector. But those healthcare managers thinking of going down the modular route should talk to industry directly. This will without doubt save money. The Modular and Portable Building Association has members who have been fully vetted before joining. Our members will consistently provide the highest quality structures and meet the needs of any healthcare project.” PRINCESS ROYAL UNIVERSITY HOSPITAL Princess Royal University Hospital, in Kent, recently found itself with what seemed like an insurmountable problem, as increasing patient numbers were stretching the limits of the hospital’s facilities. A critical decision unit, where patients could be cared for while an assessment is made to decide where in the hospital they should be treated, was needed urgently. The building of this new critical decision unit was completed in under eight weeks from breaking ground through to completing the building, including all services connections to the main hospital. MPBA member Wernick Buildings won the tender for the project with a modular approach that could address the hospital’s complicated requirements. Simon Reffell, director of Wernick Buildings, explained: “Traditional methods of construction may have taken more than twice as long to deliver this building, and that’s without

Modular Build


Princess Alexandra Hospital in Harlow, Essex identified the need for additional space to help cope with increased demand over the winter period and a fully serviced 20-bed ward facility was constructed in less than three months factoring in possible weather delays. Quite apart from having the extra facilities that much sooner, a shorter build time also reduces the disruption to the rest of the hospital. This really is an excellent example of how modular can offer innovative solutions for complicated construction projects.” It was decided that the best place for the new building was in the existing ambulance bay adjacent to the Accident and Emergency ward. However, from a construction point of view this area offered several challenges of its own. Hemmed in on three of its four sides, and sitting partly above the entrance to the underground car park, any solution would need to overcome problems of severely limited space and weight distribution. With a raft of complications facing the otherwise ideal site, the hospital needed someone who could overcome these engineering issues in such a tight space, while providing high quality patient accommodation. As the modular bays were built off site, the only challenge the limited space posed was during craning. There was just enough space to allow the crane to sit within the hospital boundaries, and drop in the eight modules from the lorries delivering them on an adjacent road. With the modules in place and a link established to the existing building, the final stages of fitting out could begin, bringing the unit up to HTM (Health Technical Memoranda) and DDA (Disability Discrimination Act) compliance. The fit-out included bedhead trunking incorporating medical gasses, nurse call systems, access control and CCTV fire escape ramps and nurse stations. The inclusion of air conditioning also proved to be very popular with staff, providing a comfortable environment in the building – especially during the recent summer months. PRINCESS ALEXANDRA HOSPITAL Princess Alexandra Hospital in Harlow, Essex, identified the need for additional space to help cope with increased demand over the winter period and a fully serviced 20-bed ward facility was constructed in less than three months. Portakabin were responsible for the construction and worked closely with the hospital’s trust on the design of its new interim ‘short stay assessment unit’ and final drawings were approved overnight. Clive Austin, project lead manager at Princess Alexandra Hospital, said that he and his colleagues were

‘delighted’ with the new building. He said: “We went out to a number of modular building suppliers and Portakabin was the first to ensure a handover date within our timescales. We were confident in the company’s track record and that Portakabin Hire buildings met the required NHS standards. Its Crown Commercial Service framework agreement also allowed us to fast track the order. “It meets all permanent building standards and complies with NHS requirements, which means it will serve us well for as long as we need it. Portakabin worked with us around the clock to meet the deadline and incredibly, this fully serviced facility was completed in just 10 weeks. The building was handed over three days ahead of programme – a remarkable achievement given the time constraints and scale of the building.” The gradient of the site required extensive ground works, including five foot foundation pads which Portakabin completed within just one week of receiving the order. Portakabin handled every aspect of the build, giving the Trust a single point of contact for the entire project. The work carried out included all site works, installation of climate control systems, data communications, fire alarms, nurse call systems, bedhead trunking, medical gas services, automated doors, video entry, furnishings and a link bridge to connect the new ward to the main hospital. The 747m2 building incorporates a mix of four-bed and single-bed ensuite rooms, a large reception area, nurses’ station, shower rooms, kitchen, utility rooms, quiet room and stores. This project is now being used by Portakabin Hire to demonstrate how it delivers interim building solutions to help healthcare providers meet response times during peak periods. It delivers short-term solutions for ward accommodation, recovery suites, dialysis units, diagnostics, out‑patient departments and treatment centres. All the hospital facilities are constructed to the latest healthcare standards, including HTM (Health Technical Memoranda), HBN (Health Building Notes), SHTM (Scottish Health Technical Memoranda) and HAI-SCRIBE (Healthcare Associated Infection System for Controlling Risk in the Built Environment). L FURTHER INFORMATION




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Placemaking Written by Christopher Shaw, Medical Architecture

Clock View hospital Ward entrance with view to day activity areas


Designing the health care environment Design in hospitals can be utilised to ease patient experience. Christopher Shaw, senior director of Medical Architecture, outlines what measures should be practiced to aid wayfinding There are ten low-cost and high impact design changes that can be made that will improve the well-being of patients, staff and visitors in your hospitals and clinics. Each of these small steps has its own reward; a few modest initiatives in sequence will help change the outlook and expectation of staff, patients and the public. When times are tough design matters most. Each crisis creates its own opportunities. Become your own design champion, bang the drum and focus relentlessly on small things that will make a difference. In the past decade I have met inspiring individuals, nurses, managers and Trust chairwomen who have helped turn their hospitals into more confident and positive organisations during a period of austerity. Don’t feel bad about investing in better places for staff. A happier and more professional workforce makes for better care. The award-winning Kings Fund ‘Enhancing the Healing Environment’ programme which provided modest grants for projects that improved the environment where care was

delivered is no longer active. However, the database of completed projects provides a great place to look for what can be achieved. WELCOMING AND RECEPTION First impressions matter. Research shows that people make up their mind about organisations and individuals very quickly. For a person arriving at your clinic or hospital for the first time, the first 15 seconds will determine what they think of your ethos. This conditions both nervous patients, and prospective skilled staff. Understanding arrival can be a blind-spot to those who work in the environment on a daily basis. It was a shock to me to be told that my office doorbell label was unreadable, although I walk past it each day I simply hadn’t noticed. Look again at that journey with fresh eyes. Take a camera and notepad; imagine yourself as a patient, a wheelchair user, or a potential staff member. You will be surprised at what you find. Key points to keep in mind include: a clean and clear view of site signage; obscure

unsightly features with low-level landscaping; illuminate the entrance and remove inducement for smokers to hang around; ensuring the reception or at very least the next place a visitor is to go to is clearly visible and you approach the entrance; and make the reception area accessible and ensure it communicates the kind of welcome your organisation should give. COMMUNICATION AND WAYFINDING Hospitals are complex and confusing environments for visitors and many staff alike. Imagine your clinic or hospital as a strange city rather than the place you know. As a stranger you build a sense of orientation through directions and landmarks. Signage can have a part to play, but without being seen as a whole system it can be confusing and rapidly becomes outdated. Confused visitors are under stress and cost you money by wasting staff time. Look at your signage with a fresh eye. Does the language make sense to someone unfamiliar with a E



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ARCHITECTS FOR HEALTH  medical environment? Is it consistent and easily understood by someone who may have poor eyesight? Hospitals and clinics are full of redundant signs and pointless messages which contribute to a sense of institutional chaos. Safety or statutory information should be minimal and grouped to be relevant. Very occasionally it is vital for temporary signage but this should be short term. A sensible plan is to exert control over ad-hoc signage and ensure it is someone’s responsibility (particularly effective if it is a board member) to remove unnecessary signs. Signage is a comparatively cheap but important tool in creating a legible and efficient estate asset. There is a large body of material available to help you including standard NHS Guidance. When considering the use of signage it is important to recognise inefficient movement and flow is frustrating, wastes time and costs money. You should look at signs as a whole system of wayfinding, check the coherence of your guidance, and remove irrelevant messages, signs and notices, as they undermine the quality of your organisation. PLACEMAKING A good signage strategy provides a set of stepping stones. Just as we navigate a city by streets, parks and squares, a health setting needs places for individuals to construct their journey. This rule applies equally to a GP practice and a large teaching hospital. Any redecoration cycle offers the chance for some place-making. At the most basic level, panels of strong colour can delineate a place. More time should be spent on planning, local lighting, artwork or modern photographic wall finishes which can provide a strong memorable impact. Frail and elderly people or those with dementia will benefit from using ‘landmark’ places as locations to rest and gather ones thoughts. Make sure that directions to toilets are clear and consider providing handrails and seating at these important places if space is available. Waiting and sub‑waiting spaces are ‘destinations’ and need distinct characteristics – use colour, lighting and materials to endow the place with an identity distinct from the surroundings. Make placemaking part of the normal redecoration cycle, walk the routes and identify the main decision points or destinations, select distinct colours or materials to make the place distinctive and consider how best to reassure patient’s and visitors through simple information and comfortable seating. DAYLIGHT AND VIEWS There is a vast body of evidence that daylight and view are therapeutic and speed recovery through a variety of physiological effects. For example, daylight is calming, helping to reduce anxiety or stress which lowers blood pressure. Daylight provides a familiar representation of subtle skin colour and

Glenside Health Campus has an open and attractive reception

facial modelling, helping communication and lending to better diagnosis. A sense of the time of day and season which a view of sky or an attractive garden helps circadian rhythms which are produced by natural factors within the body. Light is the main cue, turning on or off genes that control the body’s clock. Resist the short-term desire to fill in courtyards with ‘useful’ space. The downside of lost quality, inadequate lighting and ventilation regularly outweigh the promised benefits. Thus it is vital to make the best of the windows you have. Consider how you can maximise interest with a few potted plants and solar powered lights and, if possible, contemplate installing a roof light in dark deep spaces. ART AND AGEING Many hospitals and clinics have art exhibitions and artists working to improve lighting, wayfinding, gardens and clinical areas. In 2011, the British Medical Association published a paper on ‘The psychological and social needs of patients’ which found that creating a therapeutic healthcare environment extends beyond the elimination of boredom. Arts and humanities programmes often have a positive effect on inpatients. The measured improvements include inducing positive physiological and psychological changes in clinical outcomes, promoting better doctor-patient relationships and improving mental healthcare. If you don’t have an arts programme then establish one. If you have an existing arts programme re-energise the work by linking exhibitions to other initiatives and make well-lit display spaces to exhibit the best items of art therapies. Our increasingly elderly population means that care settings need to respond to the needs of older patient’s visitors and staff. There are a number of common themes that should be part of the design champion’s toolbox. For example, slips and falls by frail older people are debilitating and costs the NHS millions of pounds. Small changes in lighting, décor and handrails can deliver immediate dividends. Dementias and reduced cognitive range means that the environment needs to work harder. Contrasting tones and colours should be used to delineate doors, floors

and skirting boards and familiar signs and symbols used instead of words where possible. There have been positive initiatives such as the King’s Fund ‘Environments of care for people with dementia’. Furthermore, accessibility and safety of the environment are core CQC standards, and should form part of any new work or cyclical maintenance. Note that reductions in slips and falls is as important as lowering the incidence of hospital acquired infection. BRAND IDENTIFY In the last few months, the closure of an NHS hospital and likely demise of the Trust was blamed by the chief executive on a ‘tarnished brand’. In a turbulent world any organisation needs to cultivate a consistent and positive identity. Nurturing small things that sit outside the core function of delivering healthcare makes a difference to public perception. It would be beneficial for you to use design to articulate your organisation’s professional ethos and recognise that the NHS ‘brand’ is a valuable partner. Consider standardising on a well matched palette of materials, furniture, fixtures and fittings as good landscape communicates a calm quality. CARING FOR CARERS Don’t feel bad about investing in the work environment. The quality of clinical staff has the greatest impact on patient well-being, while the calibre of the workplace plays an important role in recruitment and retention of staff. NHS workplaces are generally less attractive than those found in other sectors. It costs up to £50,000 to recruit a clinician in the NHS. A review of non-health workplaces can be worthwhile and can show the way to providing an environment that is professional and helps your workforce feel valued. It is vital to remember that experienced NHS staff are valuable, so consider ‘business lounge’ rather than ‘hot-desk’. In addition, think about ways to maximise utilisation of space by making it look and feel valuable, share space wherever practical and provide ‘oasis’ places for frontline staff to de-stress. L FURTHER INFORMATION



Asbestos Written by Steve Sadley, Asbestos Removal Contractors Association




Face-to-face with asbestos management With asbestos posing as much of a health risk as ever, Steve Sadley, chief executive of ARCA, discusses the challenges the NHS has with asbestos management The asbestos problem facing the NHS is essentially no different to the problems faced by any property owner or employer with a large portfolio of premises constructed prior to the year 2000. That is, they are responsible for ensuring that employees and non-employees are not exposed to health or safety risks as a result of the presence of unmanaged asbestos. In the case of the NHS this includes in-house maintenance teams, members of the public


visiting the premises and external contractors. The main difficulties for the NHS arise due to scale. The NHS is responsible for a large number of pre-year 2000 properties and a large number of employees. The NHS is reported to be the fifth largest employer in the world, behind McDonalds, Walmart, the Chinese Military and the US Department of Defense. The Health and Safety at Work Act 1974

places a duty on every employer to ensure, so far as is reasonably practicable, the health, safety and welfare at work of all employees. Therefore, as the largest employer in the UK, the scope of the NHS’s duty is larger than that of any other UK employer. The challenge to the NHS is to fulfil this duty. This requires a robust management plan which can easily be communicated to and understood by all those who have a duty under the plan. HUMAN COST The human cost of asbestos disease is devastating and significant exposures are entirely avoidable. Current figures show that approximately 4,500 people die each year in the UK from asbestos-related diseases (predominantly mesothelioma, lung cancer and asbestosis). Also, the financial and reputational costs of getting asbestos management wrong are substantial. While the NHS devotes considerable resources to asbestos management, there are occasions when the system breaks down and inadvertent asbestos exposure occurs. An example of where the NHS failed to manage their asbestos problem is highlighted in the case of West Hertfordshire Hospitals NHS Trust. The Trust’s estate team, whose work

is to carry out small repairs and maintenance projects, where external contractors are not needed, was carrying out their work without knowing that asbestos was present or being trained to identify or control exposure. PUTTING STAFF AT RISK Between April 2000 and December 2011 the estates team could have disturbed asbestos fibres in the course of a job, but would have had no way of knowing or protecting themselves. During the prosecution the court was told that over the 11-year period, the Trust had identified some of the asbestos materials at their sites but did not have a management plan in place to control the risks associated with the deadly fibre. As a result, West Hertfordshire Hospitals NHS Trust was fined £55,000 and ordered to pay £34,078 in costs after pleading guilty to four breaches of the Control of Asbestos Regulations 2006 and a single breach of the Health and Safety at Work Act 1974. Additionally the Royal Liverpool and Broadgreen University Hospitals NHS Trust were prosecuted by the Health and Safety Executive (HSE) after asbestos fibres were discovered in the basement of its offices at Derwent House on London Road in January 2013. The Court heard that the organisation had failed to act on a survey carried out in 2006 which identified that an area of the basement may contain asbestos, and recommended that its condition should be properly assessed. A HSE investigation found that workers had regularly been visiting the basement to access patient records. The risk to them came to light on 9 January 2013 when the NHS Trust’s health and safety manager noticed that the doors to an out-of-use goods lift in the basement were damaged. The lift doors contained asbestos, which meant there was a risk of exposure to those accessing the basement. A subsequent survey found that asbestos fibres were present in several different areas of the basement. The Royal Liverpool and Broadgreen University Hospitals NHS Trust, of Prescot Street in Liverpool, was fined £10,000 and ordered to pay £696 in prosecution costs after pleading guilty to two breaches of the Health and Safety at Work Act 1974 on 26 February 2015. MANAGING ASBESTOS The Trust, in line with the 2006 survey, should have assumed asbestos was present in an area of the basement and taken appropriate action to make it safe for people working there. Instead, workers were allowed to regularly visit the basement to access patient files increasing the risk of exposure to the potentially-deadly fibres. It is vital that

organisations take the risks from asbestos seriously and deal with asbestos in a controlled and safe manner. When asbestos is managed well, inadvertent exposure can be prevented so that the health and safety of individuals is not put at risk. The Control of Asbestos Regulations 2012, by virtue of Regulation 4, places a legal duty on those who own, occupy, manage or have responsibilities for premises that may contain asbestos. Those who have these responsibilities will either have a legal duty to manage the risk from this material; or a legal duty to co-operate with whoever manages that risk. A LEGAL DUTY The Control of Asbestos Regulations 2012 places a legal duty to ‘manage asbestos in non-domestic properties’ by: finding out if there is asbestos in the premises, its amount and what condition it is in; presuming the materials contain asbestos, unless strong evidence that they do not; making and keeping an up-to-date record of the location and condition of the Asbestos Containing Material’s (ACM) or presumed ACMs in premises; assessing the risk from the material; preparing a plan that sets out in detail how to manage the risk from this material; taking the steps needed to put this plan into action; reviewing and monitoring the plan and the arrangements made to put it in place; and providing information on the location and condition of the material to anyone who is liable to work or disturb it. The requirement is to manage asbestos, not to necessarily remove it. If materials are in good condition and managed so that they cannot be disturbed, a periodic check might be all that is needed. With a large number of premises, and a large number of employees and visitors, maintenance work is inevitable and accidental damage is often possible. Therefore, all NHS premises which were constructed prior to the year 2000, will require an asbestos management plan based on a management survey. The purpose of the management survey is to manage asbestos containing materials (ACMs) during the normal occupation and use of the premises. The dutyholder can compile a management survey where the premises are simple and straightforward. Otherwise, an asbestos surveyor is needed. A management survey aims to ensure that: nobody is harmed by the continuing presence of ACM in the premises or equipment; that the ACM remain in good condition; and that nobody disturbs it accidentally

Currentow sh figures ximately pro that ap people die 4,500 year in each from the UK related s‑ asbestoeases dis



When a premise, or part of it, needs upgrading, refurbishment or demolition a refurbishment/demolition survey is required. This survey, which does not need a record of the condition of ACMs, is normally carried out by an asbestos surveyor. A refurbishment/demolition survey aims to ensure that nobody will be harmed by work on ACM in the premises or equipment and that such work will be done by the right contractor in the right way. The survey must locate and identify all ACM before any structural work begins at a stated location or on stated equipment at the premises. As it involves destructive inspection and asbestos disturbance, the area to be surveyed must be vacated and certified ‘fit for reoccupation’ after the survey. REMOVING ASBESTOS If asbestos removal is required, the NHS, as the client, needs to appoint competent asbestos removal contractors. As a client the NHS is at the head of the procurement chain and has the final say on how projects are run. They have enormous opportunities to set standards for project delivery, including health and safety management. Therefore the law requires that clients make suitable arrangements for managing a project, and maintain and review these arrangements throughout the project to ensure health and safety risks are managed appropriately. Clients, like the NHS, are not expected to be ‘experts’ in either construction work or asbestos work and do not need to directly manage or supervise the work themselves. However, they are responsible for ensuring appropriate arrangements are in place to manage and organise projects during both the ‘pre-construction’ and ‘construction’ phases of the project. This means appointing suitably competent people and providing them with sufficient information, time and resources to do the job properly. A STRUCTURED APPROACH Successful projects require good coordination and cooperation between all parties. Clients’ decisions, actions and inaction have an enormous impact on how work can be delivered, causing contractors to fail to meet industry and legal standards and potentially leaving clients with substantial criminal and civil liabilities, lengthy delays and disruptions to projects. With a well‑communicated structured approach to asbestos management, the NHS can ensure that they continue to meet the challenge to comply with health and safety regulations across their extensive portfolio. To support all clients ARCA has published a guidance note: Guidance on Clients Responsibilities on appointing Asbestos Contractors. L FURTHER INFORMATION




Innovative, hard surface hospital UV-C disinfection systems from Surfacide There is no time like the present to start saving money in the NHS; especially when a large part of that saving will also be saving lives in the process. The cost of Hospital Acquired Infections within the NHS is on the rise; with a typical MRSA infection costing approximately £7,000 and a C.Diff infection costing around £10,000. One London NHS Trust has spent in the region of £1,353,000 in direct costs on MRSA and C.Difficile infections alone between 2013 and 2014. This is before any fines and the cost of negative press to the Trust. The NHS alongside their facilities and estates team need to look for ways to reduce these costs, and with the rise of new and innovative technologies on the market, there has never been a better time to invest in them for long term benefits for all. One of the new technologies available to the UK market is the Surfacide UV-C disinfection system. Surfacide provides an evidence-based, automatic UV-C room disinfection system that eradicates multidrug resistant organisms including C.Diff, MRSA, VRE, CRE, and Acinetobacter. With a worldwide patented triple-emitter system, the Surfacide Helios system implements multiple emitters into the patient environment that allows all areas of a patient room,

bathroom, ward or operating theatre to be disinfected, with complete disinfection time taking from as little as 10 minutes. With its unique features such as the multiple emitters that do not require repositioning once set up in the room, the laser validation that accurately calculates the amount of time needed to disinfect the current space, and the ‘scrub feature’ that allows set points within a room to be disinfected without the risk of the UVC being delivered outside of this area, rooms can be turned around more quickly and efficiently, whilst having the confidence that a room has been completely disinfected. The automatic process of the system and the

quicker turnaround times frees up more time for nurses to spend on nursing rather than cleaning, and allows FM staff to achieve more in a shorter amount of time. This has a domino effect on the rest of the patient pathway; not only due to the reduced direct and indirect costs of hospital acquired infections across the NHS, but the efficiency of all staff involved. When it comes to improving efficiency, saving money and lives; prevention is most certainly more cost effective than the cure. FURTHER INFORMATION Tel: 01371 875522

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The NHS has the potential to save millions if estates managers take a closer look at heating, ventilation and air conditioning systems, says the Building & Engineering Services Association The Building & Engineering Services Association (B&ES) has identified an area of building efficiency where the NHS could not only save money but reach savings targets. A study by cost consultants EC Harris, identifying £1.5bn worth of savings the NHS could make by improving efficiency across its estate, was unveiled at the recent Healthcare Estates conference in Manchester. The current annual bill for NHS estates management stands at £7.2bn and is rising at almost eight per cent every year despite the austerity measures introduced by the coalition government. Conference delegates responded by urging the Department of Health (DoH) to renew the publicly funded £50m pilot programme run by several trusts last year to trial energy saving strategies and to bolster the department’s own Encode sustainability design guidance. Trusts that ran the pilot schemes were able to reinvest their savings from reduced energy bills in frontline patient care. However, DoH spokesman Peter Sellars told the conference there was no more ‘capital spend available’ for another round of energy efficiency schemes. Although he did say: “The ministerial team are always asking us to do

more about the energy efficiency agenda. The evidence shows that the way we currently manage our estates is not sustainable.” Sellars urged trusts to look for alternative sources of funding such as the Green Investment Bank. ENERGY EFFICIENCY Experts who spoke at a session organised by the B&ES identified lots of ‘low hanging fruit’ that almost every healthcare facility can find to quickly and cheaply improve its energy efficiency. Estates managers were urged to carry out extensive measuring and monitoring to investigate how well their heating and cooling systems were operating. In many cases, they will find they are working against each other because occupants have been changing the temperature settings, the B&ES speakers said. This situation is often made worse by building users opening the windows because they feel hot, rather than turning the heating down. Even relatively new hospitals could benefit from extensive

rent The cur bill annual states e for NHS ent stands m manage7.2bn and at £ almost t a g n i s is ri er cent eight p year every


Written by The Building & Engineering Services Association

NHS temperature systems could save millions

re-commissioning to eradicate this type of problem, delegates heard. Facilities managers (FMs) should make sure there is a temperature ‘dead band’ programmed into the controls by optimising the set points to ensure the heating and cooling systems do not end up running at the same time and wasting huge amounts of energy. Darren Jones of specialist consultancy Low Carbon Europe also told the session that ventilation systems were always overlooked as a source of potential savings. He said that optimising the way air is supplied to just one operating theatre could save a hospital £5,000 in annual running costs. That could add up to £10m a year if replicated right across the whole of the NHS and would also avoid 80 tonnes of carbon emissions. He said that any ventilation fan that is over five years old is almost certainly inefficient and a replacement would pay for itself in less than three years. Healthcare FMs could cut running costs by 29 per cent by replacing the fans in their air handling units and the addition of heat recovery to ventilation systems can reduce costs in non-clinical areas by up to 30 per cent. Even more basic measures like having grilles and filters cleaned regularly can save thousands of pounds a year. Mr Jones urged hospital FMs to measure air flow rates to get an E

Facilities Management



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BUILDING EFFICIENCY  idea of how well their systems were working and look for ‘free cooling’ opportunities – where the system will cool the building without the need for the refrigeration circuit to operate. He said: “When we survey NHS buildings, we often find that the chillers have free cooling circuits that are not being used because the building managers are not familiar with the controls. We need to train people to take advantage of this so that the refrigerant plant only runs when it is really needed.” Jones pointed out that partial free cooling was possible even when the outside temperature was as high as 18 degrees. He continued to say that variable speed drives are often installed in plant rooms, but have just been left at a constant speed setting, which defeats the object. RECOVERING PATIENTS David Fitzpatrick, sales and marketing director of Ruskin Air Management, told the conference that, because the primary focus tends to be on operating theatres and critical areas, the well‑being of recovering patients and hospital staff can be forgotten. He said that his company’s research among bed management teams revealed their top priority was to help patients recover more quickly. This means that a high standard of indoor air quality (IAQ) is required in general areas, according to Mr Fitzpatrick. Fitzpatrick said: “Things are already pretty fraught in A&E as it is, so having poor air quality is just going to make everyone feel even worse. The ventilation, therefore, needs to be able to contend with airborne contaminants and volatile organic compounds; as well as cooking and body odours, but it was often not designed with any of those things in mind.” Ruskin is actively involved in the design and refurbishment of healthcare ventilation systems and Mr Fitzpatrick said that a big problem his team encountered was the fact that an area was often designed for one purpose, but was reconfigured and used for something else at a later date. He added: “We are seeing increased demand for a mixed approach to ventilation that combines natural, low energy solutions wherever possible with powered ventilation only where it is essential. This provides the necessary amount of flexibility so the system can adapt to changing uses and conditions, but also keeps the initial capital cost down. Natural ventilation measures are generally fairly easy to install, but the controls are critical to ensure the system works properly.” In fact, 80 per cent of ‘quick wins’ in hospitals are linked to making better use of Building Management Systems (BMS) that are already in place, but are not controlling as many of the building functions as they are capable of, the B&ES experts explained. AIR PURITY Maintaining high levels of air purity in clinical and general healthcare facilities remains a major priority, but B&ES indoor air quality expert Peter Dyment said many FMs were missing the growing threat from increased outside air pollution. The increase in the concentration of diesel particulates, particularly in urban areas, since the government encouraged the adoption of diesel vehicles has led to a worrying rise in respiratory diseases, he said. However, the Health Technical Memoranda (HTM) used to guide NHS managers on a wide range of design issues do not cover contaminants that might enter the building from outside. Dyment told the conference: “HTM guidance concentrates on the transmission of diseases inside hospitals and a lot more needs to be done about the potential health impacts of outdoor pollution. 360,000 premature deaths in the EU are already down to worsening air pollution.” Mr Dyment, who is a consultant for Camfil Farr, cited newly revised guidance from B&ES: ‘Guide to Good Practice – Internal Cleanliness of Ventilation Systems’ (TR/19) as a good source of advice for healthcare premises managers on tackling the threat posed by poorly maintained ventilation systems. He added: “Many of the measures needed are very low cost, such as cleaning intake grilles, and will payback in hours because of the immediate running cost and health benefits.” Mr Dyment explained that energy saving filters were now

a much more significant section of the market ‘growing by 20-30 per cent per year.’ He said: “They will also last two or three times as long as commodity products.”

Facilities Management


FIGHTING ON THE FRONTLINE Persuading NHS trust boards to spend money on remedial measures is not easy because they are fully focused on frontline patient care, but Mr Fitzpatrick said it was important to avoid talking about the technical issues and express the possible investment in terms of its direct impact on improving conditions for patients and how energy savings can be reinvested in patient care. One very easy way to cut costs, while also improving ventilation rates, is to replace standard windows with louvred openings. These meet health, safety and security requirements, but can improve ventilation rates by 15 per cent due to their larger ‘free area’, he added. Many conventional windows have to be secured shut for safety reasons. B&ES Eastern Counties regional manager Mike Malina warned delegates against the use of renewables for ‘token’ reasons and said they should only be considered once an ‘energy hierarchy’ had been put in place first i.e. measures to reduce energy demand along with energy efficiency improvements to existing systems. He also said heat pumps could not be deployed as direct replacements for boilers unless other improvements to the building were first carried out such as better insulation and a proper controls strategy. Malina said: “NHS managers usually say there is no money for energy efficiency measures, but relatively small investments can realise huge savings in such energy intensive buildings. There would be no need to raise taxes to pay for more investment in the NHS because energy efficiency improvements pay for themselves and free up more tax payers’ money for frontline patient care.” L FURTHER INFORMATION

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The news that seven acute hospitals made zero carbon at zero cost to the NHS, is just one success story showing that it has been a busy year for the Carbon and Energy Fund. The fund’s David Mackey reports

NHS carbon output by 163,000 tonnes per annum. This is the equivalent of making seven acute hospitals carbon zero The Carbon and Energy Fund (CEF), in conjunction with the Countess of Chester Hospital and NHS SBS, is on target to exceed its objectives of assisting Trusts in reducing carbon and making savings. It has over 25 projects completed, in installation or in procurement that will replace over £200m of ageing infrastructure, deliver £40m of gross savings per annum and reduce the NHS carbon output by 163,000 tonnes per annum. This is the equivalent of making seven acute hospitals carbon zero. The CEF is a vehicle to bring together the specialist expertise required to undertake an

energy efficiency infrastructure project. Rather than every Trust having to undertake its own procurement for advisors and contractors, and to pay lawyers, the CEF brings it all together with a source of 15-year funding. The funding is repaid throughout the life of the contract, and the Trust’s costs are repaid through guaranteed savings underwritten by the contractor using the CEF’s proven contract. COMBINED HEAT AND POWER Most Trusts find they get new plant for old, and make an annual cash saving too. The National Audit Office briefing for the House

Written by Kevin Hegarty, The Carbon and Energy Fund

Generating savings through heat and power

of Commons Environmental Audit Committee on ‘NHS and Sustainability’ reported in March 2015 that the NHS could save over £180 million per year by reducing its carbon emissions and that the largest carbon and cost savings could be achieved by combined heat and power installations in acute trusts. Combined heat and power (CHP) is a highly efficient process that captures and utilises the heat that is a by-product of the electricity generation process. By generating heat and power simultaneously, CHP can reduce carbon emissions by up to 30 per cent compared to the separate means of conventional generation via a boiler and power station. The heat generated during this process is supplied to an appropriately matched heat demand that would otherwise be met by a conventional boiler. CHP systems are highly efficient, making use of the heat which would otherwise be wasted when generating electrical or mechanical power. This allows heat requirements to be met that would otherwise require additional fuel to be burnt. For many Trusts, CHP is the measure that offers the most significant single opportunity to reduce energy costs and to improve environmental performance, with existing users of CHP typically saving around 20 per cent of their energy costs. CHP has and continues to be adopted by many Trusts and installation of this type of equipment is a major contributor to the guaranteed savings on which the CEF projects are based.



CASE STUDIES Among those proving the case for CHP is the Nottingham University Hospitals NHS Trust where installation of a CHP unit has recently been completed at its Queens Medical Centre site. This unit alone will reduce carbon emissions at the hospital by 10,595 tonnes per annum and produce an annual saving of £1.8 million. Also proving the case is the Wirral University Hospitals NHS Foundation Trust where installation of a CHP unit at both Arrowe Park Hospital and Clatterbridge Hospital is reducing carbon emissions by 3,859 tonnes per annum and producing an annual saving of £788,000 across both sites. FINDING THE SOLUTION Although it is easy to think that CHP is the answer to everything, it isn’t; it is just part of the solution. Demand reduction methods such as LED lighting, variable speed drives, cultural change and BMS need to form part of the overall scheme. The CHP is sized to meet the reduced demand therefore creating the greatest amount of savings. This is where the CEF projects come into their own as the contractors on the Framework look at all these multi saving measures in order to produce the best possible outcome for the Trusts. Over the last twelve months the CEF has achieved a number of firsts, its Oxford University Hospital Scheme has started construction and E



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 at the time of going to print is still the largest project to be approved by the TDA at c£47m. This scheme will place the NHS at the forefront of UK heat revolution as two hospitals are linked via a heat network and other public and private sector organisations will have access to lower carbon heat. Darent Valley Hospital is due to complete construction on its own CHP scheme proving that Trusts with PFI hospitals can still save energy and costs using the CEF PFI method of contract integration. The success of this pilot has led to Great Western Hospital and University Hospitals Coventry commencing procurements. Meanwhile, Tayside Health Board are the first Board in Scotland to agree a contract via the CEF Framework to upgrade the energy infrastructure across three sites: Ninewells Hospital, Dundee; Perth Royal Infirmary, Perth; and Stracathro Hospital, Brechin. This is the first of three projects the CEF is involved with in Scotland. The CEF is finalising its next tranche of projects and it has c£100m of capital available and up to 12 slots for the next 12 months. There are one or two slots still available on tranche 5, which is now fully approved, and these will be allocated on a first come first served basis. L FURTHER INFORMATION

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HEALTHCARE ELECTRONIC DOCUMENT AND RECORDS MANAGEMENT Use of established technologies to solve patient information problems in NHS Trusts is viable, has been proven, and is delivering real and tangible benefits. So where do we go from here and what else can technology deliver? The UK NHS is the ‘envy of the world’ – a bold headline which is largely true. Like any national service that deals with huge numbers of staff, customers, and complex processes, there are failings which must be (and are) properly scrutinised and typically followed by directives for improvement. Using technology to improve healthcare delivery and patient care has been a hot topic over the last few years. Technology is not just making its presence felt in operating theatres and hospital wards - NHS Trusts and PCTS are quickly becoming aware that being able to access, store and share patient records is as crucial to improving patient care as the latest breakthroughs in medical science. The need for an efficient and effective information management system manifests itself across all levels of modern healthcare provision. It encompasses everything from consultants and surgeons accessing x-rays and scans from workstations across a hospital complex, ending the need for the cumbersome transfer of paper records from one site to another, with the incumbent risk of them being misplaced or lost or misused; to administration staff using systems that help automate selected processes, saving time and money. Add a dose of security and audit, and suddenly, the prospect of a system that mandates governance and eliminates un-scrutinised misuse, becomes quite real. This has been achieved in some NHS Trusts who took the bold step to deliver change some years ago and are now leading the way forward. IMPLEMENTATION The implementation of such an electronic system turns around the culture of information. Much like the NHS’ founding principle, the modern information management system provides a ‘cradle to grave’ auditable trail of legacy documents such as patient records and correspondence. Implementing an electronic information management solution delivers the proverbial ‘double whammy’ of improving accessibility, whilst ensuring that healthcare providers like NHS Trusts and PCTS are fully compliant with their legal obligation in storing healthcare records. Document management or ‘electronic filing’



started with turning paper into electronic files, which can save, space, be moved around and shared. Lessons learnt from early adoption of such systems are now being realised through more sophisticated Electronic Document & Records Management (EDRM) Systems which include electronic content. Add a dose of systems integration, workflow, electronic forms, content extraction, and compliance, and suddenly organisations are beginning to realise tangible benefits from this technology. With appropriate safeguards in place, EDRM has a proven track record of long-term cost savings combined with increased efficiency with no loss of security (in fact, enhanced security). DOCUMENT MANAGEMENT The core component of any information management strategy is document management. Unfortunately, document management is still regarded as a luxury and, in many cases, used as glorified electronic filing of patient records, with little or no return from investments in such systems which fail to deliver information at the pointof-care. EDRM offers much more than an electronic filing system - EDRM can deliver an effective, enterprise-wide approach to patient information management, integration, delivery, and workflow, for both clinical and non-clinical applications. It is the underlying technology which provides a compound document repository that can be shared among many departments, to unify the document repository, provide access to the Integrated Patient Record – at the point-of-care, and support generation and management of patient information without relying on paper. The key requirement is to capture and manage legacy (paper) patient records. The majority of document management solutions in use provide facilities for capturing, managing, and delivering electronic patient records. Organisations looking to digitise legacy records have to meet a variety of business objectives which may include: cost related to maintaining existing record libraries; pressure on storage space, especially if moving to a new site; operational costs - finding and delivering records, especially across a

number of geographically distributed sites; strategic objectives related to operational performance and Efficiency gains; and customer services. Solutions based on EDRM technologies are in place and have delivered varying benefits in terms of space utilisation, efficiencies in delivery legacy records, access when required, etc. EDRM systems also provide additional benefits in terms of audit and life-cycle management. It is important to align digitisation of legacy records with specific processes within a Trust, rather than simply digitising records to alleviate problems related to storing and using paper. For example, the ‘scan-on-demand’ approach applied to the Outpatient process has enabled a number of Trusts to realise very tangible benefits including year-on-year cost savings while delivering ‘paperless healthcare’ – a good example of process mapping and application of the right IT solution to manage the huge transformational changes.

MANAGE ELECTRONIC INFORMATION EDRM offers a centralised information repository which is not restricted to storing scanned legacy records. Electronic patient information is generated by many information systems in use, for example, clinical and laboratory systems, PAS, portals, decision support, EPR, medical devices, etc. A portion of this information sits in structured repositories, ie. within relational databases and is used to generate human-readable documents as and when required. These documents may be output in read only format (eg. PDF) and saved on storage servers. Some devices will output patient information into read-only documents which are saved on storage servers. Most Trusts hold large volumes of such information across storage servers. Access is at the file level, ie. a user will navigate through folder and sub-folder structures looking for specific files which follow agreed naming conventions. These documents are disconnected with any other patient records. LETTERS AND ELECTRONIC FORMS Once existing electronic repositories are migrated into EDRM, its important to ensure that systems no longer feed storage subfolders, ie. new patient information can be captured at source and imported into EDRM. EDRM supports integration with multiple systems and devices that generate patient information. These include medical devices that record vital signs – a key area of concern as currently, most medical devices work autonomously, ie. data from medical devices is (manually) transcribed and re-keyed into IT systems for reuse, or simply printed and saved on paper, adding to the scanning volumes. Data Collection - hospital data systems hold a wealth of patient information, yet data entry is duplicated on a daily basis. Using EDRM in this area alone is delivering real benefits to secretarial staff and helps to improve data quality. Electronic Forms extend the functionality offered by current forms - to design and publish web based forms which contain intelligence in the form filling process. The completed forms are automatically captured and saved in EDRM where they can trigger workflows for post-capture processing. Furthermore, and specifically with eForms, data captured within forms is available as electronic and machine-readable data which does not require recognition and which can be re-used multiple times within back-end systems. This offers the potential for huge savings in administration and for automating clinical workflow processes. Search and access functionality, including content search, must be provided. EDRM supports searching by all document attributes, including patient demographic data. Content (text) searching is also supported – images and electronic documents can be text recognised to generate searchable text, ie. practioners can find documents by

searching for content within documents and make use of data analytics to help unlock information contained within patient records. ADVANCES IN TECHNOLOGY Advances in recognition technologies are beginning to unlock the vast amount of information locked in scanned records and make this information available to practioners. Using technology to add value to scanned records is enabling practioners to access and view legacy case files in a manner consistent with how they access and view on-going and new information, regardless of how the legacy records are digitised. TOOLS FOR VISUALISING DATA DASHBOARDS & REPORTING EDRM holds and has access to large amount of data – both patient-related data as well user and audit data. Dashboards provide visual interfaces to large data volumes, with the ability to drill down to specific data items and documents simply by clicking on an object. This will allow users to visualise pre-defined reports and quickly identify transactions of interest – high level reports will be provided to enable users to carry-out ‘what-if’ tasks. The reports and dashboards must be viewable on-line, printed, and exported. It is important to ensure that access to patient information can be controlled and audited. EDRM offers higher levels of security compared with paper records libraries. The security facilities support restrictions to sections within a patient’s casenote as well as restrictions to the entire casenote for designated patients. Thus, a user’s rights can include blocking access to any information held on specified patients. If access to a patient record is granted, further restrictions can be added to protect sensitive parts of a record, for example sexual health and mental records. All access is strictly controlled and audited. EDRM provides a comprehensive audit trail (accessible only to designated administrators as read only, i.e. tamper proof) which records all user activity including which documents were accessed and the operations carried out – e.g. viewing, modifications, etc. Support processes for moving, sharing, and using patient information – Workflow Patient data originates from many sources. EDRM is set up to capture this information and in some cases make it easier to collate this information which is held and managed in EDRM. Integrated Workflow makes it possible to pro-actively use this information by relaying it to those who need it, when they need it, for further action. Thus, data received from a PAS can be used to visually show a patient’s progress along the selected pathway while workflow will ensure that the relevant team is kept informed and provided with the necessary information to enable them to progress the patient’s care, measured against defined targets. Ensure compliance with

appropriate information governance guidelines The combination of external threats (hackers, malicious damage, fire, theft, flooding, etc.) and legal obligations (Data Protection Act, Freedom of Information Act, and Civil Procedures rules on Electronic Discovery) surrounding the issue of storing and safeguarding crucial information applies to all businesses across all sectors. Data merely stored on computer hard drives or paper-based filing systems are particularly vulnerable to loss or destruction. Failure to manage electronic documents as formal corporate records will mean that organisations will not be compliant with government legislation. At the very least, compliance demands a high-level inventory of a company’s information assets and investment and careful application of available technology.

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SUPPORT SHARING OF PATIENT INFORMATION ACROSS NHS EDRM is widely used for sharing patient information within a Trust, including geographically distributed sites. Sharing patient information across different NHS organisations is a key topic of interest, for example - patients can move around anywhere in the UK (and abroad) and may need treatment wherever they are. This has led to a number of initiatives and technology drivers to ensure that patient information is readily accessible and not held within any proprietary system, and that all required information for medical decisions is both correct and available to healthcare professionals. Rather than enforce yet more standards on suppliers of IT in healthcare, standardisation in the way information is stored is being widely adopted, leading to Vendor Neutral Archiving (VNA). VNA-enabled patient information can be easily shared across medical specialties, organisations, and IT systems. It means enhanced patient safety with elimination of unsafe drug interaction. It means prepping AE in advance of a patient’s arrival when seconds are precious and less duplication of medical testing – as well as diminishing the cost and management of mountains of redundant healthcare data. A VNA breaks the connection between the application and the archive, freeing data. It provides a virtualised approach to information management with storage fully controlled by hospital IT – not the IT vendor. The key message is that careful application of established EDRM technologies is delivering measurable improvements and benefits. These must be applied to address strategic requirements, rather than using EDRM as a short-term measure to solve paper problems. The technology is not rocket-science, but has evolved gradually as customer demands, interoperability, and web accessibility have evolved. L FURTHER INFORMATION



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INNOVATION IS KEY TO HR TRANSFORMATION Debbie Nolan, business development director at arvato UK, discusses how new technologies can help health organisations transform their HR functions, creating back-office efficiencies to combat the mounting financial challenges in the NHS

organisations that face such a complex HR challenge are St Helen and Knowsley Teaching Hospital Trust and NHS National Services Scotland (NSS), with NSS using the system to provide support for 3,600 specialist staff across 24 locations. HR Direct has also allowed the central team at St Helens and Knowsley Teaching Hospital Trust to streamline a particularly complex HR operation – the management of employment matters for 2,500 junior doctors in training on behalf of over 150 organisations across Cheshire and Merseyside. By providing a 24 hour service which can be accessed remotely, St Helen’s and Knowsley have bypassed this logistical problem. This has enabled employees to prioritise patient care, through removing the need contact a working hours-only helpdesk. Following the recent announcement that the NHS is expected to face a £2 billion annual deficit for the 2015-2016 financial year, health organisations are having to take urgent action to cut costs even further while still protecting patient care. Consequently, trusts are increasingly looking for new ways of creating efficiencies across back office services, including transforming the delivery and organisation of their human resource function. While saving costs remains the primary objective, the Francis Review, which identified a clear link between employee well-being and patient care, has provided an added impetus for change. As a result, trusts are starting to focus on reducing the administrative burden on HR teams, to allow them to concentrate on key strategic issues. PROVIDING A NEW MODEL FOR HR In the search for a solution, NHS organisations are beginning to embrace new technologies to achieve HR transformation. One such innovative technology is HR Direct; a central online HR platform which has been implemented across eight health organisations in the UK and serves over 34,000 NHS employees. The unique selfservice system, available 24 hours a day, provides both managers and employees with access to an organisation’s HR policies and procedures – from information on pay, employee relations and development policies to induction materials and terms



and conditions – together with a library of frequently answered questions (FAQs). Staff can update and consult their information online without the need to contact the HR team, making line management duties far easier. In addition, it has removed the dependency on HR teams when it comes to dealing with basic HR queries, freeing up time to focus on strategic issues, such as workforce planning. The platform, which was developed by arvato in partnership with East Cheshire NHS Trust, has already delivered widespread improvement. For example it has reduced the number of calls to East Cheshire NHS Trust’s helpdesk by 25 per cent, simply by allowing staff and line managers to resolve day-to-day queries themselves. DELIVERING MEANINGFUL CHANGE HR Direct’s ability to boost efficiency whilst driving down costs, together with its scalable nature, has seen seven other health organisations across the UK implement bespoke versions of the system. As a result, each one has been able to take advantage of the different benefits that the platform has to offer. The issue for some NHS organisations is delivering an efficient HR service for employees working across a large geographical area – a scenario which often results in high resource demands and difficulties in rolling out HR policies and procedures effectively. Two health

A TRANSFORMATION SPRINGBOARD Together with providing efficiency savings through self-service and process standardisation, the platform’s simple set-up and configuration means it can act as a springboard for major overhaul projects. This is the case at Blackpool Teaching Hospitals NHS Foundation Trust, who have used HR Direct as an enabler for HR transformation. The tool has been implemented to disseminate consistent communications to all employees, provide increased access to a HR information repository and also post mandatory training on the site. This has improved employees’ access to courses, leading to an overall increase in audit compliance. Additionally, the tool’s flexibility has meant that it could be integrated quickly and seamlessly with the Trust’s existing intranet in time to act as a building block for a new HR model, helping to underpin HR service quality improvements. With cost and resource pressures expected to increase in the short and in the long term, all NHS organisations are going to have to rethink how they deliver services. New systems and technologies, such as HR Direct, can help HR departments unlock much-needed savings and enable an improved, more streamlined service. L FURTHER INFORMATION Please contact Debbie Nolan, business development director, on 07827 341 312 or visit


With the dependency on outsourcing growing and the support dwindling, Kerry Hallard of the National Outsourcing Association explores how outsourcing is having, and will continue to have, a positive impact on the NHS

In June, iGov and Serco partnered up to conduct the ‘Efficiency Challenges in the NHS’ report. The related survey revealed that the majority of directors, department heads and managers working within NHS organisations believe that outsourcing and shared services will make an important contribution to the success of the NHS over the next five years. This positive perception of outsourcing from those at the top of the NHS is a stark contrast to that held by people generally in the UK. National Outsourcing Association (NOA) research has revealed that 80 per cent of the UK public do not think outsourcing helps UK PLC; 22 per cent claim to actively dislike the outsourcing industry, while only 19 per cent believe outsourcing can help the UK reduce its deficit. Outsourcing has long

THE FACTS ON OUTSOURCING Let’s put the facts straight. Outsourcing is currently the second largest aggregate employer in the UK, responsible for over three million jobs. In its simplest form, outsourcing is the use of third party specialists to deliver a particular business function or process over a sustained period. It is not to be confused with privatisation (yet it is in the media all too frequently). When a government body outsources an operation, it usually maintains full control and accountability for that service, while privatisation takes ownership away from the government. Furthermore, outsourcing is not to be confused with offshoring – many companies set up facilities of their own offshore, while plenty of outsourcing takes place here in the UK. The use of specialists makes eminent sense today, just as it did when the division of labour was introduced as a theory thousands of years ago. These specialists are experts in their fields and in addition to bringing process efficiencies – brought about through process excellence and technology investments – service providers today also bring productivity improvements and further innovations. Today, public sector bodies, including the NHS, need to be able to act in a 24-hour global environment and outsourcing helps them do just that. And it’s a misconception that outsourcing necessarily involves sacrificing quality in order to cut costs. There’s no doubt that, in this modern world of mass communication and social media, organisations pay a high price for delivering substandard services. That’s why so much emphasis is placed on the need of ‘more for less’ – the best outsourcing partnerships involve a delicate balance of improved services and reduced costs. David Cameron knows this better than anyone. The coalition government spent a whopping £120 billion on outsourced public services during its five-year term, almost double what was spent by Labour previously. Government departments nationwide are using outsourcing to deliver services on time within decreasing budgets, often to a higher standard. E

Written by Kerry Hallard, CEO, National Outsourcing Association

Is outsourcing Dummy headline more to fit this than essential spaceever? tight as possible



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had an image problem, especially where the NHS is concerned. So why is it that NHS directors and managers recognise outsourcing’s value, but the UK public doesn’t? It’s important to look at where each group is getting its information from. Unfortunately, in the case of Joe Public, that’s the media, where the UK outsourcing industry is constantly misrepresented. Only high profile outsourcing failures make headlines – particularly those concerning the public sector. Meanwhile, the vast majority of successful outsourcing contracts, which deliver our country with valuable cost savings and efficiency gains, get little-to-no coverage.



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THE BENEFITS OF INSOURCING 18 Week Support is a CQC registered team of senior NHS consultants working nationally to help NHS Trusts clear existing backlogs and meet waiting list targets A major challenge for NHS Trusts is to deliver safe and effective care with declining resources – less time, fewer staff, less money. Waiting lists continue to grow. At the same time, Trusts are under increasing pressure to improve service delivery – while undertaking cost-cutting measures. Furthermore, waiting list targets put enormous strain on Trusts to deliver care on time – those who fail and keep patients waiting more than 18 weeks can face penalties up to £5,000 per patient, per month under the new NHS ‘fining’ regime. Traditionally, ‘outsourcing’ (mainly to independent sector providers) has been a way to tackle such problems. Outsourcing can be flexible, and permits Trusts to gain access to additional clinical capacity to reduce patient waiting times. These benefits often come with a heavy price tag and potential patient safety concerns. Moreover, research suggests that using private hospital providers who charge above the national tariff is simply a ‘quick fix’ that adds to the Trust’s problems. Recent research by Centre for Health and Public Interest (CHPI) found that Trusts struggle to monitor such contracts and that it is difficult to know whether a provider is ‘cutting corners, or reducing quality in order to gain extra revenue.’ A NEW SOLUTION Insourcing is a relatively new concept. It involves an independent provider carrying out services ‘in-house.’ Clinical teams are brought in to work directly within the Trust and in collaboration with existing inhouse clinical teams. This has a number of benefits over outsourcing. These include: reduced waiting times; improved patient care; reduced administrative burden of outsourcing; making better use of existing resources; real time updates to PAS/ patient records and clinic letters; safer care; and less adverse reputational risk. By utilising any spare assets or capacity within a Trust, insourcing allows for a high volume of patients to be seen in a relatively short space of time. This can help a Trust clear backlogs, and simultaneously meet an increase in demand. Paradoxically, more activity leads to more income and reduced waiting times – whilst also reducing the threat of penalties being levied by Commissioners. Moreover, because insourcing may be delivered below the national tariff, any savings can be passed directly on to the Trust.



By bringing in external expertise to work alongside a Trust’s own clinical and operational teams, there is the added bonus of creating a shared learning experience and boosting staff morale – another major NHS concern, and one which is inherently tied to performance. Insourcing also enables the Trust to retain overall control over service delivery. By seeing patients within a hospital’s own setting, the Trust can monitor the safety and efficiency of these services and any concerns or complaints can be dealt with quickly. BETTER PATIENT CARE While outsourcing can be expensive and a burden to manage, insourcing makes better use of existing resources. There is a greater continuity of care and improved patient flow as patients are seen within the Trust’s own setting and managed from referral through to discharge. Research has indicated that patients prefer to be seen at an NHS Trust as opposed to a private setting, so there is less risk of patient non-compliance or high cancellation rates. DNA rates for an insourced solution are also consistently lower than for outsourcing. Furthermore, because the Trust manages the back-office administrative support, there is no risk to patient confidentiality or issues of information governance. Administrative errors, such as duplicate bookings, can be avoided, meaning precious resources are not wasted. INNOVATION IN PRACTICE 18 Week Support worked with an NHS Foundation Trust to deliver additional capacity. Patients with eye diseases including retina, cataract, glaucoma, diabetes and eyelid disorders were treated in weekend eye clinics. There were 2,076 new and follow up attendances over seven weekends, with a

general discharge rate of 66 per cent (new) and 44 per cent for follow up. Glaucoma had a 69 discharge rate for new attendances and seven per cent for follow up, while retinal had a rate of 44 per cent for new and 38 per cent for follow up attendances. 98 per cent of patients said they would recommend the service to family and friends. The DNA rate was three per cent. Simon Kelly, a Consultant Ophthalmologist, said: “The weekend eye clinics have now allowed a backlog of patients to be attended to, this is important as these conditions may be time-sensitive and blinding. This is about patient safety and quality of care, furthermore patient satisfaction levels with our weekend eye clinics was very high.” CONCLUSIONS Campaigners and pressure groups have long argued that the NHS should remain public and not be sold off to private contractors. The use of insourcing makes this plausible, whilst also tackling the much needed problem of long NHS waiting lists. Insourcing enables efficiency savings to be directly fed back in to the Trust, allowing expansion towards a seven-day service without the need for negotiating with Trust staff who may not wish to be involved with such enhanced hours. L

18 Week Support is a well-respected and experienced provider for insourcing solutions. It is clinically led by a team of senior specialists working nationally. FURTHER INFORMATION Please contact Alexander Chilvers on 0207 034 8057 or email achilvers@ Alternatively, visit

NHS SAVINGS  Yet even the government isn’t vocal in its support of UK outsourcing – Whitehall would usually rather castigate the industry in order to save ministerial skins rather than publicly admit the overwhelming good outsourcing does for our country. With both the media and the government desperate to be disappointed by outsourcing, it’s hardly a surprise that the UK public has such little affection for the industry. NHS OUTSOURCING CASE STUDIES In contrast, those working in the NHS who actually manage contracts see the statistics concerning outsourcing on a daily basis. They are fully aware of its true value and how fundamental outsourcing is to keeping the NHS going. From Thatcher through to Cameron, the UK’s health service has become increasingly reliant on private sector support. Today, the Centre for Health and

Worcestershire chose to outsource the operation to. Within two years, Xerox completely transformed the Trust’s record management functions. Documents were digitised, increasing reliability and efficiency, while the staff involved received better training and were better incentivised. And, to top it all, £2 million in savings is expected over the course of the following 10 years. John Thornbury, Worcestershire’s director of ICT, put it best when he said: “Important as this team is to patient care, we could never have focused on them the way Xerox has.” And there’s Mid Essex Hospital Services NHS Trust, who achieved savings of 28 per cent, along with a vastly improved orthopaedics operation, by outsourcing specialist clinical procurement to INVERTO. Under INVERTO’s supervision, procedures were broken down and rebuilt from the foundations upward, streamlining processes and eliminating

The coalition government spent a whopping £120 billion on outsourced public services during its five-year term, almost double what was spent by Labour previously Public Interest estimates that the provision of clinical services by the private sector to the NHS is now worth £20 billion a year, one-fifth of the overall healthcare budget. So where is all that money going, and is it providing value? Here are a select few from the wide array of successful NHS outsourcing and shared services case studies that the NOA has come across over the past few years. Let’s start with NHS Shared Business Services, the ‘integrated single financial environment’ launched 10 years ago now used by 40 per cent of NHS providers and 100 per cent of commissioning groups. Establishing the organisation was a huge transition, where over 6,000 users had to become quickly accustomed to a brand new system. The project was rolled out across as many NHS organisations as possible, in order to bring the greatest possible benefit to the British taxpayer – which it did. Savings of over £224 million were achieved over the course of nine years, smashing the original target set. NHS Shared Business Services was a worthy winner of ‘Shared Services Centre of the Year’ at the NOA Awards 2014. The outsourcing of back office functions such as record management is also vital to the NHS. Prior to 2009, Worcestershire NHS Trust had 60 records management staff – based across three hospitals and one overcrowded library – using 10 different legacy systems, responding to thousands of requests with deadlines they couldn’t possibly meet. Responses were delayed, putting patients at risk, with one to two per cent of all records going missing entirely. Enter Xerox, the service provider

inefficiencies. Within the first three months of the outsourcing partnership £300,000 has been saved, without changing any of the suppliers or products used by the Trust. LESSONS FOR THE NHS TO LIVE BY A 2014 report compiled by six different NHS bodies has found that the NHS budget will face an annual £30 billion shortfall by the end of the next parliament if practices do not improve. Additionally, our health service faces further jeopardy thanks to the UK’s slowing economy and an ageing population demanding evermore healthcare services. Not to mention the fact that further Conservative cuts seem to lie around every corner. So who, or rather what, is going to save our NHS? You guessed it – outsourcing. But there’s more to it than that. The NHS is in



dire need of more outsourcing contracts like the aforementioned: collaborative, well-planned and properly executed. With Capita recently signing a £1 billion megadeal to provide the health service with administrative support, and more contracts of a similar nature expected over the coming years, it is vital that the NHS takes the following lessons to heart if it is going to maximise the success of its outsourcing. Firstly, to follow outsourcing best practice. That means not outsourcing a problem and expecting it to magically disappear without further input. The NHS needs to collaborate fully with its service providers, sharing business objectives and taking the time to nurture and maintain every relationship. Secondly, take full advantage of new technologies. The NHS has a flawed track record when it comes to integrating new technologies with its operations; service providers can help here. Robotic process automation and artificial intelligence are just two new prospects that stand to change the face of modern outsourcing. The NHS could be transformed too, provided it partners with the right best-of-breed suppliers. Additionally, to learn from the private sector. Outsourcing is a dynamic, evolving industry, meaning those working in it need to constantly hone their skills. The government should follow in the footsteps of the private sector and provide NHS contract managers with the extensive outsourcing training they deserve, and support that training with incentives, qualifications and accreditation. Doing so will greatly improve the vocational happiness of those individuals and, in turn, have a positive impact on their outsourcing. L In early 2016 the NOA will host an event that will focus on the latest public sector outsourcing trends, where the future of outsourcing in the NHS will be extensively covered. If you are interested in learning more about the event, please do get in touch. FURTHER INFORMATION


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There are more than 500,000 medical devices used in healthcare settings every day and they transform the lives of many millions of people every year. Mark Grumbridge of the Medicines and Healthcare products Regulatory Agency, discusses the importance of reporting incidents Mark Gumbridge, Senior Clinical Advisor at MHRA

The vast majority of medical devices used in healthcare settings perform well, but, occasionally things do go wrong. When they do it is important it is reported to us so we can investigate with our clinical and technical experts, as well as the manufacturer, and, where necessary, take action to prevent it from happening again. Within this, healthcare professionals play a vital role to make sure equipment is working reliably, safely and effectively in delivering vital, sometimes life-saving care to patients. SOME FACTS The Medical and Healthcare products Regulatory Agency (MHRA) received more than 13,500 adverse incident reports last year, up from 8,500 in 2009 and on a steadily rising curve. Almost 7,000 of these reports came from manufacturers and slightly fewer than 3,000 came from the NHS. A rise in reports does not necessarily mean there are more incidents. It is more likely that reporting is getting better. It is also important to note

Scheme. Many people think this is only for medicines but the Yellow Card Scheme now supports the reporting of all suspected problems or incidents with all healthcare products, not just suspected side effects to medicines. It is simple to use and all reports are investigated by specialists at the MHRA. It is important such incidents are reported, no matter how small you may think it is. It can help to identify emerging trends which can help us, or the manufacturer of a device, to issue updated advice on the use of a device or, in extreme circumstances, to remove the device from use. Many of the reports we get do not mean a complete failure of a device but nevertheless, we are interested to receive these as they can provide valuable information which we can feed back to the manufacturer or the specific user group. A manufacturer’s response may be to look at design changes to improve their device. These changes might make it more difficult for the device to be inappropriately used or feed into changes to the instructions for use or training support packages which are developed to support introduction of devices to new users. The information we receive may also feed information to professional bodies (such as the medical Royal colleges) so they can consider if there are any changes to education and training programmes needed, in order to reduce the risk of avoidable adverse incidents in the future. Adverse incident reporting is a vital part of supporting continuous improvement in the way devices are used and so contribute directly to the development of medicine.

Written by Mark Grumbridge, Senior Clinical Advisor, MHRA

Issuing guidance to healthcare professionals

Medical Devices


To prot patient ect are a nus there of meth mber use to c ods we on monito tinually safety o r the f me devices dical

that when an incident is reported to us, it does not necessarily mean the device was at fault. Yet, it is still important that adverse incidents are reported to us. The numbers coming from NHS sources, however, has actually been declining in recent years and this has been a matter of considerable concern. So much so we have been working with NHS England on a major project to re-establish both the responsibilities and connections with the system to reverse this trend. To protect patients there are a number of methods we use to continually monitor the safety of medical devices. YELLOW CARD SCHEME One of the important ways anyone can report a problem with a medical device to the MHRA is through our Yellow Card

MEDICAL DEVICE SAFETY OFFICERS We’re working with NHS England to make adverse incident reporting easier and to improve the management of medical device incidents in the health service, through the appointment of Medical Device Safety Officers with specified roles. They will be invited to attend monthly medical device webinars covering significant events and identified safety themes, and examples of learning and best practice from across healthcare sectors. In March 2014, MHRA published a joint E



Global leaders in aerosol drug delivery.

The Aerogen Solo delivers 4 times more medication to patients lungs.1 1. 2. 3. 4.

Ari et al. 2010 Evaluation of Aerosol Generator devices at 3 Locations in Humidified and Non-humidified Circuits During Adult Mechanical Ventilation. Berlinski A, Willis JR. Albuterol delivery by 4 different nebulizers placed in 4 different positions in a pediatric ventilator in vitro model. Respiratory care. 2013;58:1124-1133 Dailey P, Tina T, Santos J, Gurung P. Performance improvement plan for pediatric patients in respiratory distress: Clinical experience. Respiratory Therapy. 2015;10:27-29 Graham R, Melton R, Mullaly A, Rhone S, Fink J. Does technology matter? One intensive care unit’s experience. Poster presentation at ERS. 2012

HEALTHCARE GUIDANCE  Patient Safety Alert with NHS England which required the NHS and large independent healthcare organisations to identify medical device safety officers (MDSOs) to champion reporting of and learning from adverse incidents with medical devices. There are currently 296 medical device safety officers around the United Kingdom and they act as a point of contact between MHRA and NHS England. To support the MDSOs there are monthly online exercises (webexes) with MHRA and NHS England. To further this relationship, we held a national conference in early 2015 to facilitate dialogue between MDSOs and the centre and support progress in the promotion of medical devices safety and increase reporting. MONITORING AND MAINTAINING To assist with the ongoing monitoring of the safety of medical devices we set up the Devices Expert Advisory Committee (DEAC). This was formed following an independent review on MHRA access to clinical advice and engagement with the clinical community. This new committee replaced the Committee on the Safety of Devices. The DEAC is responsible for providing independent, expert strategic advice to the agency in support of its role to ensure that medical devices are acceptably safe and are used effectively. Membership of the committee is made up of clinicians from various specialties such as anaesthesia, cardiology as well as internal experts. It will also support the agency in developing and maintaining collaborative relationships with clinical professional bodies. Patient safety is our top priority and we have robust safety monitoring systems in place. Where incidents do occur, we take swift and robust action to protect patients. Since 2013 we have been working with the Department of Health to improve procurement processes in the NHS with the aim of freeing up money and resources in support of frontline care. In order to do this, the NHS will soon adopt

GS1 standards for products (including medicines and medical devices), patient identification (using bar coded patient wristbands) and locations in order to improve purchasing efficiency, control of supply chains within hospitals and patient safety. GS1 standards are also one of the main systems being adopted worldwide for Unique Device Identification (UDI) and in support of the eProcurement programme MHRA has started to use UDIs based on GS1 standards in healthcare recalls. Barcodes based on the GS1 standards can be read at any point in the healthcare supply chain so that a product subject to a safety alert can be quickly located and recalled. When combining the unique identification of patients with the unique identification of healthcare products, it means that every procedure, product, or implant for every patient can be directly attributed to them and

health services about a medical product recall using GS1 Unique Device Identifiers. This was a significant milestone for the healthcare industry and set the scene for how important patient safety information like recalls will be communicated to patients and healthcare professionals alike in the future.

Medical Devices


PATIENT GROUP CONSULTATIVE FORUM The MHRA Patient Group Consultative Forum (PGCF) is open to people with an interest in medicines and medical devices and patient groups who can find out the views of their members and feed these views into the Forum. We hold up to four meetings per year in London, with additional opportunities to participate in dialogue through electronic means such as surveys and webinars. This initiative supports the agency’s commitment to the principles of patient and public engagement and involvement.

Earlier this year, MHRA informed the health services about a medical product recall using GS1 Unique Device Identifiers. This was a significant milestone for the healthcare industry recorded on their electronic record, giving complete end-to-end traceability all the way from manufacturers to patients. Patients can have peace of mind knowing their implants are immediately identifiable and connected to their personal records. Additionally healthcare professionals can identify quickly which patients are affected, should a safety concern arise with a particular device. New regulations for medical devices are currently under negotiation in Europe. These will supersede existing medical device directives and will require UDI for all devices sold in Europe with phased implementation beginning in the next few years. With early implementation of GS1 standards, the NHS in England will be ahead of the curve. Earlier this year, MHRA informed the

The PGCF is expanding and currently has more than 70 individual members representing between them a wide range of different medical conditions, charitable organisations and patient and carer networks. Some of the conditions represented by members of the Forum are: heart disease; asthma; diabetes; cancer; and muscular dystrophy. Member organisations include: Action Against Medical Accidents; Bladder and Bowel Foundation; Diabetes UK; Cancer Research UK; British Heart Foundation; British Kidney Patient Association; Independent Cancer Patients’ Voice; and Asthma UK. L FURTHER INFORMATION www. organisations/medicines-and-healthcareproducts-regulatory-agency


Asset Disposal Written by Steve Mellings, Asset Disposal & Information Security Alliance



Asset disposal: don’t allow unecessary risk Not a day passes by without news of a new data breach. Steve Mellings, of the Asset Disposal & Information Security Alliance, discusses the problems facing data disposal and how it should be managed The incidence of data breaches is on the rise. It seems that public and private sector organisations are left embarrassed because they’ve suffered a ‘cyber-attack’ and there is a predisposition for most readers to assume these issues are as a result of a highly sophisticated attack on our networks. The reality in many cases is very different and in a recent survey by Big Brother Watch they listed the top 10 data breaches suffered by HMG and nine of the 10 were nothing to do with ‘cyber’ – they were basic human error or process failure. So whilst the press (and security industry) waxes lyrical about the need for increased cyber defences, most government departments and businesses as a whole need to pause for breath and take stock of the situation they currently find themselves in. There are a whole array of very basic vulnerabilities which exist and require very little expertise to exploit that need addressing. Areas such as staff training and awareness, physical security, hardware configuration, third party management and data governance are all critical within the overall effort to protect data. Solid foundations need to be put in place in all of these areas and initiatives such as the DP Governance method are beginning to help organisations understand what to do rather than looking at ISO certifications or cyber essentials which only go so far. One such area of continued poor performance is ICT asset disposal. In the same Big Brother report, the health sector’s ICT disposal featured as two of the 10 top data breaches. So what is the problem? Why does a seemingly innocent and simple business process go wrong? Before I attempt in this short space to shed some light on this process I must first start with addressing the importance of changing the perception of ICT disposal. PERCEPTION Within the NHS I’ve seen Informatics and IT teams treat retired ICT assets as nothing more than door stops. I’ve personally inspected equipment left in a public



corridor all still holding data and in another trust I’ve seen a publicly accessible fire exit stairwell used as a storage area. Furthermore as the industry looking to win business from this sector we see on an on-going basis an enormous indifference to the seriousness of the process. Tenders coming out with little service specification and with the majority of the weighting being on price. We constantly see RFPs being released with only cursory equipment lists and then a request for ‘best bids’. Some tenders are embarrassing as the authors clearly have no knowledge of the process and use terminology incorrectly making the submission literally impossible to comply with. All of this from a sector which holds the highest volume of the most sensitive personal data available. So for any organisation looking to manage risk within ICT disposal they must first change their perception. Their partners are not IT dustmen, they perform an essential part of the effort to protect data. Once this process is looked at in a different light it will be seen that whilst there are risks throughout, they can be neatly categorised into three key areas. INVENTORY MANAGEMENT With inventory list accuracy ranging from 60-80 per cent for equipment on the network it can hardly be surprising that when ICT asset disposal companies come to collect equipment it is often done so after a request such as ‘we have a van full’ or ‘I’ve got a few bits’. Sometimes an inventory list is provided but is virtually a work of fiction and bears no resemblance to the actual assets ready for collection. So why is this important? An inventory list is essential if the releasing company is going to have any hope of showing control over the process. How can the chain of custody be shown to exist through various internal stages and therefore mitigate the likelihood of internal and external theft? For those organisations who comfort themselves with ‘certificates of destruction’, ‘waste transfer notes’ or even

‘audit documents’ I would suggest that this is cold comfort. After all, how can you evidence that all of your items have been processed when you don’t even know what you released? VENDOR MANAGEMENT Most organisations will engage with a third party to perform these services (recent FOI studies show this to be over 90 per cent). As such how this partner is selected and managed is an imperative part of this process. Vendor selection is perhaps the greatest concern in this sector. The industry itself is highly competitive and historically has done very well out of organisations seemingly happy to just give old infrastructure away. However, this has significantly changed in the past few years and with the exception of companies who offer ICT disposal as part of a portfolio of IT services, it is extremely difficult to offer these services for free without absolute guarantee over the volume and quality of equipment. Why? The second user market has become far less buoyant for older technology and commodity pricing has decreased significantly in the past 12 months. This has meant that the recycling value of equipment is about 30 per cent of the level where it was previously. It makes sense therefore that if the resale value is lower, the material value is lower and the type, quality and age of equipment unknown then no one can be absolutely assured that they

can cover their costs from a collection. Hopefully it can be seen that to base selection just on price in a highly competitive market is a questionable strategy. It’s interesting to note within the ICO’s NHS Surrey (£200,000 fine) penalty notice that they specifically make mention of poor vendor selection and this incident should be used as a case study for others. In 2012, the ICO released some guidance notes for this process but even though these notes are clear and simple to follow our recent FOI studies were able to show on average that over half of the respondents do not currently meet legal requirements when disposing of ICT assets. The most critical area where organisations fail is to not have a contract in place and to not audit their partners. At the Asset Disposal & Information Security Alliance (ADISA) we have carried out over 200 audits within this sector and I think we can speak with some authority that without constant auditing even the very best operators can allow normally rigorous processes to slip. Outside of our certified members we’ve seen all sorts of practices such as issuing of certificates of data destruction before equipment is processed, down streaming of equipment to other service providers, auctioning off of equipment which is of low spec or not financially viable to repair and the use of all sorts of curious data over writing tools in use. Remember, EA licences and exemptions only

refer to the environmental handling of assets not data security. Furthermore, ISO 27001 can be scoped such that the service provision falls outside of the audit regime. We have seen many examples where the ISO certification is literally nothing to do with the service being offered and so offers no guarantee of service quality. TECHNICAL SOLUTION I think we all know that delete doesn’t work but organisations are still taking little responsibility when it comes to dictating what tools should be used on their data carrying media. The technical solution can get even more confusing when there are occasions that a CESG-approved software overwriting tool might give a ‘pass but with exceptions’ and generate the report. Those exceptions generally are not easily accessible to a user and require forensic recovery but unless the releasing company dictates the behaviour you are leaving your vendor to make those types of decisions (we are doing a research project on this very issue this month). Earlier on this year in conjunction with the University of South Wales we did a study into the factory reset commands on smartphones. We were able to show on some Apple iOS and Blackberrys that this reset command worked but on Android handsets it typically did not! For any organisation now using solid state media they need to be aware that there are no government approved software overwriting

Asset Disposal


tools. Furthermore, many destruction tools don’t actually impact on the storage element of the media itself (the NAND cells) so some traditional drilling or punching process may not work. SO HOW TO MANAGE RISK? My intention was not to try to write a piece on ‘fear uncertainty and doubt’ but moreover to try to highlight that this seemingly simply process of ICT Disposal is a critical part of the data protection and information security process. The easiest way of managing risk is to simply engage in this process in a more intellectual way. Have an inventory of equipment which is being released. Release it to a professional company who holds relevant certification (such as ADISA), contract with that company and include a detailed service specification, and finally, audit them. (Or if you don’t want to, sign up to the free monitoring service offered by ADISA and get copies of our independent audits to arrive on your desk). The solutions are out there and there are ways of meeting all different types of budget. Any ADISA member will be able to help you better understand what a sensible process would be and what the best technical solution is. So don’t allow unnecessary risk, work with your ADISA partner and rest assured that asset disposal doesn’t have to be a risky business. L FURTHER INFORMATION

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SOLIHULL FIRST TO PILOT NEW WAY OF WORKING Leaders of the four organisations behind Solihull’s integrated care programme, ICASS, have signed an agreement with Caradigm, the leader in enterprise population health, to pilot a new way of working across health and social care involved in its vision to transform the way population health is managed.” The agreement was signed on 30 June 2015.

The agreement opens the door to a 12 month pilot scheme, the first of its kind in the UK, which will help health and social care teams in Solihull to work together more effectively, creating a truly joined up health and social care economy. Speaking on behalf of ICASS leaders, Dr Patrick Brooke, Accountable Officer for Solihull Clinical Commissioning Group, explains the significance of the agreement. He said: “There are already some great examples of health and social care teams working together in Solihull – such as our award winning Supported Integrated Discharge (SID) service. Through this new agreement with Caradigm we will be able to build on those existing ways of working to ensure everyone involved in a person’s care has access to the right information at the right time. This is another way of making sure that we put people’s needs at the centre of our health and care system.” Ian James, Director of Communities and Adult Social Care for Solihull Council, continues: “People who use care and support services in Solihull have made it clear that they only want to tell their story once and want to feel that their care comes from one team, regardless of which organisation the staff actually work for. Working with Caradigm and using their technology and experience will help us to develop



smarter ways of working together which will benefit people receiving our services, their carers and the staff involved.” COMMUNITY WELL-BEING Andrew Foster, CEO of Heart of England NHS Trust says: “The initiative will be another step in the increasingly close working across the public sector in Solihull and the move to Solihull Hospital expanding its role in the health and well-being of the community.” John Short, CEO of Birmingham and Solihull Mental Health NHS Trust, says: “We are committed to the increasing partnership of public sector agencies working together in Solihull. Today is another step in that direction. There is a real commitment to putting Solihull citizens first and public sector agencies working together to support them.” Richard Craven, Vice President and Managing Director for Caradigm EMEA comments: “Solihull recognises that the next stage to achieving integrated care is to use automation and IT as an enabler. By automating workflow and co-ordinating care across all stakeholders, not only will the day-to-day patient experience improve, but the whole Solihull care system will also gain valuable efficiencies. We are extremely impressed at the level of commitment shown by Solihull and are proud to be

ABOUT CARADIGM Caradigm is an award-winning population health company dedicated to improving patient care, advancing the health of populations and reducing healthcare costs. Its enterprise software portfolio encompasses all capabilities critical to delivering effective population health management, including data control; healthcare analytics; care coordination and management; and wellness and patient engagement. Caradigm UK is based in London, with its global headquarters in Bellevue, WA. USA. Caradigm solutions is operating in more than 1,500 hospitals worldwide, and connects to about 500 customer systems and to data for more than 175 million patients. In addition, its identity and access management solutions are employed daily by over 1.2 million users, ensuring patient privacy and security by safeguarding access to patient health information. ABOUT ICASS ICASS (Integrated Care and Support Solihull) is a five year programme to improve care and support for the borough’s ageing population, in particular those who are frail or living with dementia. ICASS is part of Solihull Together for better lives, a shared commitment to improve the co-ordination of health services in the borough. This commitment includes putting people who use these services, their carers and families, at the heart of decision making. By working together we will deliver better outcomes and experiences for our population. Partners in Solihull Together for better lives are: Birmingham and Solihull Mental Health NHS Foundation Trust; Heart of England NHS Foundation Trust; Solihull Clinical Commissioning Group; Solihull Metropolitan Borough Council; Healthwatch Solihull; Solihull’s Primary Care providers; Solihull’s Voluntary and Community Sector; and lay members representing people using services, their carers and the wider Solihull community. L FURTHER INFORMATION Caradigm’s press office: 01296 733 867


Desiring the technology for the future, now

Information Technology


Following Jeremy Hunt’s challenge to the NHS to make better use of technology at the NHS Innovation Expo, Health Business discusses the vision for technology across the NHS The Health and Care Innovation Expo 2015 returned to Manchester in September and witnessed an array of speakers from across the sector sharing their experiences, plans and goals for transformation in the NHS. Tim Kelsey, the national director for patients and information, who is leaving the organisation to take up a new post in Australia by the end of the year, confirmed that NHS England will be launching an endorsement programme for apps, with an ‘NHS kitemark’. He said: “There are approximately 97,000 health apps. Who knows how many of those are safe or not? The NHS now needs to encourage people to use digital services and that is why we are launching the endorsement programme.” DIGITAL ENGAGEMENT Health Secretary Jeremy Hunt aligned his opportunity to speak with the thought expressed earlier in the day by Beverley Bryant, director of technology at NHS England. His keynote was directed at digital engagement, arguing that use of technology for healthcare had not kept pace with innovation in other areas of life such as the use of smartphones and the internet. In the UK, it is reported that 84 per cent of the population use the internet, while 59 per cent use a smartphone. Contrastingly, and of

worry to Hunt and the Department of Health, only two per cent have had any degree of digital interaction with the NHS. This is despite the promotion of apps, of which Hunt has encouraged smartphone users to familiarise with. These can allow patients to routinely check NHS advice, services and medical records. Hunt has stated an ambition to have a quarter of smartphone users, equalling 15 per cent of all NHS patients, using apps by the end of the next financial year. Claiming that patients should exploit technology more to help better manage their own care, Hunt issued his belief that by 2016, all patients in the UK should all be able to securely access their GP electronic records online in full. Access to medical records would lead to a profound change in culture in a way that is transformative for people with complex or long-term conditions. Hunt said: “I also want patients not just to be able to read their medical record on their smartphone but to add to it, whether by

recording their own comments or by plugging in their own wearable devices to it.” Hunt continued to he say that, by the end of 2018, all doctors and nurses will be able to access the most up-to-date information across GP surgeries, ambulance services and A&E departments, no matter where a patient is in England. By 2020 this will include the social care system as well. He said: “Powerful patients need to know about the quality of healthcare being provided, but they also need to be able to harness the many innovations now becoming possible. To most of us it feels like there has been more change in the way we book taxis, shop, bank or store photos than the way we access healthcare. Yet for every single one of us healthcare is more important than all of those things. “Experience from other countries suggests that opening up access to your own medical record leads to a profound change in culture in a way that is transformative for people with complex or long term conditions.” E

By ll 2016, a the s in patient ld all be UK shousecurely able to their GP access ic records electrone in full onlin

Health Secretary Jeremy Hunt’s keynote speech was directed at digital engagement


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knowledge and experience of NHS and related healthcare sector requirements combined with a uniquely developed automated intelligent process for scanning and capturing data, results in the provision of a solution which can improve operational efficiencies and make substantial savings in most organisations. For many years Auto Docs has transported, scanned and captured highly sensitive documents for its NHS and other public and private sector customer base, supplying secure scanning, data capture and response handling and online hosting of image retrieval services as a part of its core services. The company also has developed an industry leading system of identifying and sorting forms which do not meet NHS payment criteria

and therefore can assist in eliminating reject forms and improve your operational cash flow. Auto Docs offers a total UK based service. All Auto Docs staff are highly trained, skilled, qualified and operate from the company’s UK locations, so you can be confident of where your forms and data are at any time and know on a personal level who is handling them. For a free digitisation consultation on how Auto Docs can assist you to improve efficiency and save significant costs please contact the company via the details below. FURTHER INFORMATION Tel: 0141 647 9873

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DIGITAL ENGAGEMENT  SECURITY Hunt has also taken several opportunities to reassure the public that their personal medical data is being held securely. Amid recent cyber hacking cases, most notably telecoms company TalkTalk, which revealed that nearly 157,000 customers had their data breached, such reassurances need more weight behind them. Acknowledging that the NHS ‘has not yet won the public’s trust in an area that is vital for the future of patient care’, Hunt announced several measures to increase security of confidential medical information. These include a review of standards of data security for patients’ confidential data across the NHS to be carried out by the Care Quality Commission (CQC). The CQC is to have significant input from National Data Guardian for health and care, Dame Fiona Caldicott, with the work expected to be completed in January with recommendations on how the new guidelines can be assured through CQC inspections and NHS England commissioning processes. As released in the ‘Accessing and sharing health records and patient confidentiality’ report in October, the NHS is introducing Summary Care Records – electronic health records of essential patient data – to enable healthcare staff across the country to provide immediate care and treatment. NHS England and the Health and Social Care Information Centre will also introduce the programme, a national collection of anonymous patient data to enable population-level analysis of health trends. TECHNOLOGY REVIEW As part of his bid to carry the NHS into the modern age of digital engagement, Hunt has said that he wants to ‘change the face of modern medicine beyond recognition’. He said: “These changes are being driven by technology and by our ability to use data differently. And although healthcare has lagged behind the travel, retail and banking sectors in embracing what is possible, we are now on the cusp of changes in modern healthcare that will be as profound for humanity as the invention of the internet.” At the end of October, Hunt also revealed that Robert Wachter will lead a review into the digital future of the NHS. Wachter, chief of hospital medicine and chief of medical service at the University of California San Francisco and author of The Digital Doctor, has previously examined the rise of healthcare IT systems in the US. It is due to report next summer. Hunt has commented that the review will be similar to the review on clinical safety in the NHS, which was undertaken by Don Berwick in 2013. POSSIBLE PAPERLESS A Digital Health Intelligence NHS IT Leadership Survey has discovered that 67 per cent of NHS IT leaders believe the healthcare service can reach the NHS’s ‘paperless’ targets by 2020.

Information Technology


Through the ‘Five Year Forward View’, NHS England has argued that £22 billion could be found through investment in prevention and new ways of working. The report contends that savings of between £3.2 and £3.9 billion can be found in the acute sector by investing in electronic health records It surveyed members of the Health CIO Network and CCIO Leaders Network in August 2015 and found that 67 per cent of respondents were ‘quite confident’ or ‘extremely confident’ that the NHS could significantly reduce paper and reach paperless targets by 2020, with only 14 per cent saying they were ‘not at all confident’ or ‘not very confident’ of achieving the target. The idea of a ‘paperless’ NHS was first introduced by Hunt in 2013. However, only 28 per cent said they were confident that patients would have this read/ write access to their records, with 53 per cent saying they were not confident. The survey also asked respondents of their top three IT priorities, with 73 per cent saying ‘moving to paperless working’, 68 per cent saying ‘improving quality of services’ and 67 per cent saying ‘supporting new models of care’. Meanwhile, management consultancy firm McKinsey has warned that the NHS needs to spend an additional £7.2 billion to £8.3 billion on digital technology over the next five years in order to achieve necessary savings. The McKinsey Report, which is dated April 2014, claims that the background to its work is the NHS’ need

to close the gap between essentially flat fund funding and rising costs and demand that could reach £30 billion by 2020-21. Through the ‘Five Year Forward View’, NHS England has argued that £22 billion could be found through investment in prevention and new ways of working. The report contends that savings of between £3.2 and £3.9 billion can be found in the acute sector by investing in electronic health records and in systems to improve quality. Further savings could be found in productivity improvements resulting from investment in community, mental health and primary care services, integrated working, and digital channels for patient access and monitoring. The report believes that the NHS will need to provide an investment of £5 billion to £5.2 billion to secure the savings, and further estimates that it would need to spend £2.3 billion to £3 billion on training, adoption and running costs. This takes the total bill from £7.3 billion to £8.2 billion. L FURTHER INFORMATION organisations/department-of-health



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PUTTING USERS AT THE HEART OF DIGITAL SERVICE DESIGN Is your service useful to your users? Have you created something valuable in their day-to-day lives? Have you spoken to your real users? These three questions underpin every project we roll out task-based personas, however, simplifies the process because it’s based on what the users want to do wit the service, not what car they drive, what music they listen to or who they vote for.

Low Certainty Most important assumptions

High Proximity

“Even a small connection to the people who benefit from your work not only improves productivity, it makes people happier” – Laszlo Bock, Google. Earlier this year, Valtech were engaged to help deliver the discovery phase for NHS Choices. The NHS Choices team have vanity metrics that would make any private sector organisation swoon. Although they get over 40 million unique site visits a week to, they fully understood from qualitative and quantitative insights, that they were not meeting user needs for all demographics. Our approach during this discovery phase was based on the LeanUX principles of build, measure learn, collaborative design and quick feedback loops. These simple principles allow you to understand user needs and unearth the value of what you’re building, early enough to adapt what you’re doing so you’re not building irrelevance. This isn’t about technology, the premise requires a collaborative approach with a multi-disciplinary team of user experience designers, developers, creative, content specialists, subject matter experts and user researchers. So what did we actually do to focus on user needs? Firstly, based on existing insight we narrowed down the content of NHS choice to address the most common symptomatic conditions. Chicken pox, selected for its commonality, it is symptomatic and



emotive. Understanding the user need state is just as important as understanding user needs. Then we went through the following steps: Assumption mapping is a great place to start, it’s a collaborative exercise where the whole team contribute - placing the project assumptions that are important to them on the grid below. The assumptions are discussed with the team and appropriately place in one of the 4 quadrants. We use the axis of uncertainty and proximity to allow the team to visualise and prioritise the most uncertain and closest assumptions to address: For chicken pox, the team established that the majority of assumptions lay in High Proximity and Low Certainty. These are high priority. One important benefit in creating this visualisation is that it automatically creates a backlog, and the whole team has been a part of it. Within two hours of project kick off, transparent deliverables begin to take shape. TASK-BASED PERSONAS We compliment the assumption mapping by beginning to work out who the users are based on looking at the data. What tasks are being completed and what could this mean that the user actually needs. Personas sometimes can be too detailed and can turn into a cottage industry. Creating lean

USER JOURNEY MAPPING This isn’t about how the user interacts with your service, but rather how your service fits into their lives. It’s an important distinction that allows real objectivity in making decisions and is enabled partly through “Pause > Reflect > Decide”. What we found with chicken pox was that people firstly looked for assurance from from friends and family, then doctors, before going on line. HYPOTHESES DRIVEN DEVELOPMENT We are then ready to address our highest priority assumptions and build our hypotheses. Hypothesis driven development is essential in building what matters, specifically to the user. Each hypothesis is essentially an experiment that we want to validate with real users. Once we have created our testable hypotheses it time to go and meet real users. We interviewed on a weekly basis, including many parents whose children had chicken pox at the time. As previously mentioned the needs state of the user is important to fully understand the emotions people using your service experience; anxiety, worry or anger. This is not the same as testing a service to renew your car tax. As the quote at the beginning of this piece reflects, allowing the team visibility of users in a live, test-lab environment creates a connection imperative in healthcare service creation. We iterated this process over four weeks, each week gaining greater knowledge and confidence that we are building the right thing. Inspiration for these techniques comes from Jeff Gothelf’s Lean UX: Applying Lean Principles to improve user experience. L FOR MORE INFORMATION

EVENT REVIEW respite services for their ‘perfectly imperfect family’ and others like them, and Dr Kate Granger, who presented the Compassion in Care awards that are named in her honour. Most of all, Health and Care Innovation Expo 2015 was a celebration of innovation and improvement in the NHS, and a rallying call to further integrate efforts and spread adoption of the best new ideas, with a huge range of practical learning in the unique Pop-up University. Tim Kelsey, National Director for Patients and Information and Chair of the National Information Board, commented on this celebration at the event. He said: “For me, Expo was a moment in time which confirmed that real progress is being made to make our NHS more transparent and more of an authentic collaboration between patients, the public and those who serve them.” SPEAKERS The two speaker stages at Expo 15 ran a full programme on both days, offering inspiring and relevant speakers from across health and care. Delegates from international clinicians and health experts from industry, NHS England directors, leaders from government and arm’s length bodies, and senior figures from the NHS and care services. The key speakers included Health Secretary Jeremy Hunt, Chief Executive of NHS England Simon Stevens, NHS England’s Medical Director Professor Sir Bruce Keogh, Chief Nursing Officer Jane Cummings, National Director for Patients and Information Tim Kelsey, Non-Executive Director at NHS England Lord Victor Adebowale, and Director of Digital Technology Beverley Bryant.

Encouraging innovation in healthcare World experts and UK health leaders met at the Health and Care Innovation Expo 2015, celebrating ideas, technology and progress in the field of NHS transparency and collaboration The Health and Care Innovation Expo 15 returned to Manchester on 2-3 September and was hosted once again by NHS England. Around 5,000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development. This year, the Expo was highly anticipated as the two days happened within the first 100 days of the new government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepared to take over a £6 billion devolved health and social care budget, while delegates were able to meet the people behind the 37 vanguards developing and testing a range of new models of modernised care.

Health and Care Innovation


NHS England Chief Executive Simon Stevens announced major new work to support NHS staff to improve their own health and well-being, with specialist packages for GPs suffering signs of burnout, while Secretary of State for Health Jeremy Hunt challenged the NHS to ensure all patient were able to access their full medical records online by 2016, accompanied by a commitment to a review of data security. Delegates also heard from inspirational figures including Dame Tanni GreyThompson and the Wheelchair Leadership Alliance, Sharon King and her daughter Rosie, who championed strong

FEATURE ZONES The Expo’s programme was designed to scrutinise early evidence from NHS England’s progress against the NHS Five Year Forward View. Delegates met the early adopters and pilot sites that have embraced this challenge and are already making a difference to patients. The four major feature zones, each running their individual programmes of events, learning and networking, dominated the exhibition space and focused on the biggest areas of growth and progress for health and social care improvement. The Health and Care Devolution in Greater Manchester Zone provided an exclusive in‑depth look at the exciting developments in Greater Manchester as the region embarked on its ambitious health and care devolution project. Delegates were able to witness the progress made, the overwhelming case for change, E

The f major f our zones d eature the spa ominated c on the be and focused of grow iggest areas th and soc for health improv ial care ement




2018 The business of delivering healthcare is becoming increasingly complex. Providers are being tasked to deliver quality care whilst cutting costs and meeting strict targets yet still ensuring patient safety and improved operations.


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EVENT REVIEW  and the work still to do, as the six-month countdown to financial devolution began. Digital technology is a key enabler of prevention-focused health and social care, integrated services and early identification of those at risk. Expo 15’s Digital Zone showcased some of the hidden innovations that are delivering a dynamic health and care ecosystem. Delegates saw how new technologies are supporting commissioners and providers in achieving local digital roadmaps and learned about how digital innovations are transforming health and care services for patients. In March 2015, NHS England announced the first 29 ‘vanguard’ areas that would be supported through the £200 million Transformation Fund to develop and implement innovative new models of care. The vanguards are developing local health and care services to keep people well, and bring home care, mental health and community nursing, GP services and hospitals together. Delegates at the New Care Models Zone found out more about how their plans are progressing and what the future might look like in these areas. The NHS Diabetes Prevention Programme is a commitment of the NHS Five Year Forward View, and as part of the work to develop the national programme, seven innovative ‘demonstrator’ sites around the country have been running pilot projects in which they see more patients, monitor and test their local programmes and help to co-design and implement the national work. Delegates at Preventing Diabetes found out about their progress and insights. REFLECTION Reflecting upon the Expo, Simon Stevens said: “Expo 15 was a really fantastic event. Despite all the pressures and trials and tribulations around the front line of the health service, there was a sense on the part of the people who where there that actually there is a route forward that a number of people can chart and are getting on with. It was a very practical, sleeves-rolled-up kind of event, at no cost to either the NHS or the taxpayer.” Prof Sir Malcolm Grant, Chair, NHS England, added: “Health and Care Innovation Expo is a remarkable act of engagement between the NHS and so many of our stakeholders. Five thousand people come through the door each day. I hope that in future years we can continue to build on this important part of the NHS, presenting not just what it is doing, but listening to a much broader community who engage with us at the different events and seminars concentrated over the two days.” L

Health and Care Innovation


Health Secretary Jeremy Hunt

Chief Executive of NHS England Simon Stevens delivers his keynote speech

Tim Kelsey, National Director for Patients and Information

Next year, Health and Care Innovation Expo will be taking place on 7-8 September 2016, Manchester Central. FURTHER INFORMATION



Workforce Development Written by Nithya Kutty, NHS Leadership Academy

Recognising leadership in the work place Recognising what good leadership looks like is just as important as having leadership in place. Nithya Kutty of the NHS Leadership Academy discusses the factors behind positive staff wellness and successful workforce development As an organisation that hopes to exemplify great leadership practice, our purpose is to work with individuals and organisations to deliver excellent leadership across the NHS. We know that great leadership leads to better patient care, experience and outcomes. But to achieve that we need to start by modelling that philosophy and ensure that our employees are happy and looked after. This is difficult in a work environment where, like every other work environment, we encounter a combination of diverse personalities, viewpoints, expectations, communication issues and conflicts. This means it’s critical to get different people to work effectively as a team and increase work place productivity and job satisfaction. All this can only be done by motivating employees and letting them embrace their strengths to become a better leader. We look at an organisation’s characteristics like an iceberg. While on the surface it appears like the mission statements, strategies, policies, and the corporate structure guide



the successful running of an organisation, it’s below the surface that the real drivers lie. The emotions, aspirations, fears, frustrations, passion – it’s these underlying currents that really steer any organisation. Frequently, and sometimes quite unintentionally, the emphasis on these ‘below the surface’ unquantifiable, but tangible imperatives gets diluted while running an organisation. But we know that the greater the alignment between the top and the bottom, the higher the probability of being a successful organisation that listens and respects its people. THE LEADERSHIP ROLE The prevalence of avoiding responsibility and decision making, absenteeism, blaming others for lack of delivery, downplaying the importance of uncompleted work, or assigning undue importance to relatively unimportant work are all signs of an unhappy employee. So how do you combat these issues and how does leadership play into all this? The answer is simple. Take your employees

more seriously, make them feel empowered and valued, and show trust in them. At the NHS Leadership Academy, we take our employees and their health and well-being very seriously. Ensuring engagement, support and understanding their motivation and drivers are keys to a successful solution. We ensure our employees are ‘looked after’ and are involved in the solution by investing in them and giving them training and learning opportunities to enable them to fulfil their potential. WE’RE ALL LEADERS Leadership is not equivalent to a specific position or job title. True leadership is the ability to influence people to achieve a better result for a common cause – which can be for the organisation or wider society. The most effective leaders have a strong sense of self; they understand the qualities that make other people want to follow them, and they know how to adjust those qualities when circumstances require them to do so.

hip Leaders t is no o a ent t equival position. specificership is the d True lea to influence ability to achieve fact that the work they do people ter result has a direct impact on the wider healthcare service. a bet

The most effective leaders are those who instil trust, anticipate and manage conflicts fairly and objectively, inspire others to reach their full potential. So how do you unlock and tap into your staff’s leadership capabilities?

MORE TRAINING OPPORTUNITIES As an organisation that offers outstanding leadership programmes to health and social care, we also offer the same to our employees. As a starting point we encourage all our employees to enrol in our leadership foundation programme – Edward Jenner. The Edward Jenner programme is an open access, online learning package that will support individuals as they develop essential leadership skills. It is open to all and leads to an NHS Leadership Academy award in Leadership Foundations. It has been designed with health and care staff, for everyone working in a health and care context. Highly practical and patient-focused, it’s a great way to understand the purpose, challenges and culture of the NHS. It’s flexible and enlightening, helping people get a fresh perspective on the impact they have on the patient experience – either directly or indirectly. We also run a range of internal workshops, group coaching, personal and professional development and mentoring. Our talent management resource is offered externally, just as much as we share it to external organisations, and we encourage true and honest feedback. The tools, programmes, resources, and healthcare leadership model are offered to empower staff and reinforce the

Stephen Flynn, an Edward Jenner participant, said: “The Edward Jenner programme has helped me reflect on how I relate to other people in the work environment, and how I can develop strategies to allow me to lead authentically and with conviction. It has shown me that leadership is present at all levels and can be practiced by anyone regardless of their role. “Doing Jenner has been a thought-provoking and rewarding experience, helping me realise that even small acts or changes can make a huge difference to the system and patient care.” DIVERSITY IN LEADERSHIP Diversity in leadership leads to improved health and greater experiences of the NHS. An inclusive workplace that understands the needs of its employees makes them feel valued and respected. It has a significant and positive impact on employee retention. Global research suggests companies that hire a diverse workforce, speak and educate staff about the power and need for inclusion tend to appeal to the wider system and people. As a national organisation, we support the evidence that diversity in leadership leads to improved health and greater experiences of the NHS. We welcome the challenge of making significant changes and supporting staff members from black minority and ethnic (BME) backgrounds to move into leadership roles. This means that as a service we would be better able to support a diverse patient population in the future. There are countless benefits to building a

Workforce Development

diverse and inclusive workforce at every level of a company, not least the need to address a looming retirement crisis by pulling in talent from historically under-tapped demographics. We have regular inclusion and diversity workshops and inductions to educate existing staff and new staff about the importance of diversity, fair representation of workforce and inclusive leadership. This is a preventative measure used to increase awareness and avoid discrimination and the wider system – all of this directly impacts the staff culture and our organisational culture and value. CARE IN, CARE OUT Investing in leadership and staff wellness is crucial as it is the glue that holds the organisation together. In healthcare, happy and well engaged employees have a direct influence on patient care and excellent patient experience leads to low mortality rates. So what we do and how we treat our staff is crucial. When you think about it; when a patient receives an excellent healthcare service, that not only makes a difference to them, but their neighbours, family, and ultimately their community and the society at large. To maintain staff morale and well-being, we have a designated health and well-being team who ensure the smooth running of physical and mental fitness activities throughout the year. Through such activities, we strive to be a beacon of best practice in all areas of leadership development and are committed to ensuring we develop a workforce that is fair, diverse and fully representative of those we both serve and employ. All managers are not leaders, but every leader is a manager. So the goal should not be to make everyone happy or despondent, but to understand how to capture individual talents and get the best out of each contributor. Instead of focusing on what it takes to be a successful leader, if individuals focused on how their sphere of influence will grow then there will be a wider impact on their career and the organisation. Ultimately the NHS was conceived as a result of a social movement. It was to create quality, change the society and make people’s lives better, and that is what the NHS Leadership Academy does every day. It’s about our vision for a better society, more inclusive, equal and fair for everybody. But the ultimate challenge lies in the implementation. As we all know behaviour change takes time and is different for every individual but when reinforced consistently, it is possible that with the help of different programmes, multiple touch points, strong leadership, and an unwavering commitment your employees will start feeling differently about wellness and what it means to them and feel more valued. The process is simple – empower your staff because they make all the difference. L FURTHER INFORMATION



TO REQUEST YOUR 2015 REINTEC CATALOGUE TEXT REINTEC TO 64121 / 08456 02 82 71 Safety / Value / Availability / Support

Health Business Awards


Awarding excellence in our healthcare

With the Health Business Awards fast approaching, Health Business previews the ceremony, and lists the shortlisted entrants for each of the prestigious categories Being held on the 3 December 2015, the Health Business Awards has established a reputation for showcasing the success stories in the health sector. First held in 2007, the Awards recognise and celebrate the significant contributions made each year by organisations and individuals that work inside and alongside the NHS. The event, taking place at the Grange Hotel in St Paul’s, will be hosted by Dr Mark Porter – GP and medical correspondent at The Times, doctor on The One Show and presenter of Radio 4’s flagship medical series Inside Health. Registration for the day will begin at 11.30am with a drinks reception. Those attending will be able to network with fellow professionals and discuss projects, products and services with the sponsoring organisations. AIR AMBULANCE SERVICE AWARD Sponsored by MD Helicopters, this award recognises the hard work and dedication of the Air Ambulance sector, which operates as 18 separate charities that raise over £35 million per year in funding. The 2014 Winner was Dorset and Somerset Air Ambulance. This years nominees are East Anglian Air Ambulance, Midlands Air Ambulance Charity, Cornwall Air Ambulance, and Essex & Herts Air Ambulance Trust. ESTATES AND FACILITIES INNOVATION AWARD Sponsored by Swallow Evacuation & Mobility Products, the Estates and Facilities Innovation Award recognises NHS and other healthcare organisations that have developed innovative procedures for managing and maintaining healthcare facilities. The three contenders for 2015 are North Bristol NHS Trust, Heart

of England NHS Foundation Trust, and Royal United Hospitals Bath Foundation Trust.

will be hoping to take home the accolade of Healthcare Recruitment winner.

ENVIRONMENTAL PRACTICE AWARD This award will recognise the individual NHS project (smarter use of energy, transport, waste management) that has furthered the progress of environmental practice in the NHS. Guy’s and St Thomas’ NHS Foundation Trust, University College London Hospitals NHS Foundation Trust, Derby Teaching Hospitals NHS Trust and East Sussex Healthcare NHS Trust are nominated for the Award.

HOSPITAL CATERING AWARD Sponsored by McCain, the Hospital Catering Award is presented to the NHS Trust that has strived to improve the standard of food and its nutritional value for the benefits of both patients and staff. Pennine Acute Hospitals NHS Trust makes a second nomination appearance, alongside Hinchingbrooke Health Care NHS Trust and University Hospitals of Morecambe Bay NHS Foundation Trust, also nominated for a second time.

HEALTHCARE IT AWARD The wider use of computer technology in the NHS is evident throughout the world, with many countries citing NHS projects as examples of good practice. Sponsored by Voice Connect, this award will recognise an organisation that is responsible for implementing a ground breaking IT project that demonstrates clear cost benefits to the wider NHS. Pennine Acute Hospitals NHS Trust, NHS Northern, Eastern and Western Devon CCG and Leicester City CCG are competing for the Award this year. HEALTHCARE RECRUITMENT AWARD Improving patient access and choice depends on the quality and availability of staff in all areas of the hospital practice. Sponsored by de Poel health+care, this award will recognise the NHS organisation that has developed a robust recruitment policy that delivers both safety and continuity to patients. Guy’s & St Thomas’ NHS Foundation Trust, Sandwell and West Birmingham Hospitals NHS Trust, and University Hospitals of Morecambe Bay NHS Foundation Trust

HOSPITAL CLEANING AWARD This award, sponsored by i-Clean Systems, acknowledges the efforts made by NHS organisations in recent years to raise standards in cleanliness and reduce the risk of hospital acquired infections. Sussex Community NHS Trust, Weston General Hospital, Central Manchester NHS Trust, Hampshire Hospitals NHS Trust and Nottingham University Hospitals NHS Trust are the 2015 shortlisted entries. HOSPITAL PROCUREMENT AWARD Dartford and Gravesham NHS Trust/London Procurement Partnership, NHS Collaborative Procurement Partnership and Plymouth Hospitals NHS Trust will all be hoping to be the recipient of the Hospital Procurement Award. This award, sponsored by Aerogen, recognises the NHS Trust that has delivered value for money and increased efficiency through smarter procurement practice. The winning trust will demonstrate the success of partnerships and collaborations to achieve procurement excellence and cost effectiveness. E





Intelligent bedside pressure distribution monitoring that is revolutionising treatment of pressure ulsers Reducing the incidence of pressure ulcers plays a vital role in improving outcomes for individuals as well as reducing the costs associated with treatment. Figures from 2013 suggest that the prevalence rate of pressure ulcers in healthcare environments (including nursing homes, care homes, independent sector care providers, community nursing and hospitals) was 4.7 per cent. Quite apart from the unnecessary suffering caused, the daily costs of treating a pressure ulcer are estimated to range from £43 to £374. Until now, carers have not had a bedside tool capable of distinguishing accurately between high and low pressures, or assessing the effectiveness of their interventions in terms of moving and turning patients. With the launch of a brand new and ground breaking development now being used in the acute market, healthcare specialist Sidhil has changed all that. Sidhil’s innovative Monitor, Alert, Protect (M.A.P) system is the UK’s first continuous bedside pressure monitoring system, and can be used in conjunction with almost any mattress system to provide 24/7 data on pressure levels developing between the patient and the support surface.

delineated in red and orange, and lower pressure areas showing as green and blue. The real time ‘pressure map’ image gives accurate detail on each individual, enabling carers to reposition accordingly, reducing pressure in the identified areas. Experience in the acute market indicates that ‘micro-movements’ can reduce pressures dramatically, which is particularly effective for people where full body repositioning or even turning may be restricted. The implementation of Sidhil’s M.A.P system allows live and individual monitoring and management of pressure distribution. In addition, the pressure sensing mat is flexible, which means it is suitable for use with people of different weights and sizes, even bariatric cases. Already in use in the acute environment in the UK, Sidhil is expecting to have a M.A.P system available for nursing, residential and community applications later this year. The system is available both for sale and for rental from Sidhil, with the purchase price believed to be less than the cost of treating one Grade 1 pressure ulcer.

The system uses a pressure sensing mat to identify high and low pressure areas between the individual and the support surface. The outer layer of this mat consists of a medical grade biocompatible material, which houses thousands of sensing points capable of accurately imaging the body of the person lying on the support surface. This information is sent to a monitor attached to the mat, where it is displayed as a real time, colour coded high resolution image, with areas of high pressure clearly

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©2015 Doctor’s Associates Inc. SUBWAY® is a registered trademark of Doctor’s Associates Inc.

EVENT PREVIEW  INNOVATION IN MENTAL HEALTH AWARD Sponsored by Lloyds Pharmacy, this accolade is awarded to NHS organisations who have made strides to improve to the experience and overall care of its patients. NHS Northern, Eastern and Western Devon CCG, Cheshire & Wirral Partnership NHS Foundation Trust, Bradford District Care NHS Foundation Trust and University Hospitals Coventry and Warwickshire (UHCW) NHS Trust will all be present at The Grange Hotel and will be hoping not to leave empty handed. NHS PUBLICITY CAMPAIGN AWARD This is awarded to the campaign which can demonstrate success in achieving its objectives. The winning campaign can be either internal or external and can combine media including press, radio, television and outdoor advertising. NHS Arden & GEM CSU, Liverpool Community Health NHS Trust and the Royal College of Nursing are nominated in this category. OUTSTANDING ACHIEVEMENT IN HEALTHCARE Sponsored by CCube Solutions, this is awarded to an NHS organisation that has achieved success in its role and brought benefits to the wider NHS through the dedication and expertise of its staff. This year, the award will be presented to one of Cornwall Partnership NHS Foundation Trust, Salford Royal NHS Foundation Trust, Frimley Park Hospital NHS Foundation Trust, Basildon & Thurrock University Hospitals NHS Foundation Trust or Papworth Hospital NHS Foundation Trust. PATIENT DATA AWARD The need for timely, effective information in healthcare is key to realising the benefits of the huge investments in NHS staff and buildings. This award will recognise the most innovative introduction of new technology for secure storage, retrieval and distribution of data throughout the

NHS. In 2015 it will go to Bath and North East Somerset CCG, University Hospitals of Leicester NHS Trust, NHS Arden & GEM CSU or Poole Hospital NHS Foundation Trust. PATIENT SAFETY AWARD Sponsored by Ascom, the Patient Safety Award is presented to the NHS Trust which has made great strides in providing a safe hospital environment for patients, and has taken action to reduce hospital acquired infections and mortality rates. NHS Northern, Eastern and Western Devon CCG, The Pennine Acute Hospitals NHS Trust, Great Western Hospitals NHS Foundation Trust, Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust and Royal Brompton & Harefield NHS Foundation Trust will be hoping to follow the success of 2014 winner, Great Ormond Street Hospital Foundation NHS Trust. SUSTAINABLE HOSPITAL AWARD The environment in which people live and work, has a key influence on their health. This award, sponsored by Mitie, recognises the NHS hospital that has made progress towards sustainability through the smarter use of energy, transport, waste management etc. in order to strive towards a reduced impact of healthcare facilities on the environment. The Isle of Wight NHS Trust, Guy’s and St Thomas’ NHS Foundation Trust and Queen Victoria Hospital NHS Foundation Trust will be aiming to celebrate success in the Sustainable Hospital Award on the night. NHS COLLABORATION AWARD Sponsored by ISS Facility Services Healthcare, this Award is presented to the NHS Trust which has worked with other public/private sector organisations, such as local government, police, fire, charities, schools etc. to engage the local community in preventative campaigns. This year, the nominated entries are Staffordshire and Stoke on Trent Partnership NHS Trust, NHS Northern, Eastern and Western

Devon, Essex & Herts Air Ambulance Trust and NHS Great Yarmouth and Waveney CCG. HOSPITAL BUILDING AWARD This Award, sponsored by CCube Solutions, will be made to the new hospital building project that raises the standard of the healthcare environment and demonstrates value for money and project management excellence. The nominations this year are University Hospital Bristol NHS Foundation Trust, Royal United Hospital Bath NHS Foundation Trust, Alder Hey Childrens’ NHS Foundation Trust and Northumbria Healthcare NHS Trust.

Health Business Awards


NHS FINANCE AWARD NHS Finance Award recognises a hospital trust which has developed prudent financial practices which represent good value for the taxpayer. Sponsored by Fathom, the possible winners for 2015 are Bolton NHS Foundation Trust, NHS Leeds West Clinical Commissioning Group, Royal Free London NHS Foundation Trust, and University Hospitals Coventry and Warwickshire NHS Trust. CLINICAL COMMISSIONING AWARD Sponsored by Fujitsu, this Award recognises the recently formed CCG sector, and an organisation which has quickly made an impact to reduce hospital admissions through preventative practice. NHS Castle Point and Rochford CCG, NHS Southport & Formby CCG, North West Reading CCG and NHS Lambeth CCG are up for the honours. HOSPITAL SECURITY AWARD Sponsored by Pass Training Consultancy Ltd, East Lancashire Hospitals NHS Trust, Norfolk and Norwich University Hospital NHS Trust, NHS Merton Clinical Commissioning Group and Royal Liverpool University Hospital will be hoping to celebrate at the end of the night. L FURTHER INFORMATION

McCain: taste, texture and an appetising appearance Scottish hospital caterers are discovering the benefits of McCain Signatures Chips after they made a big impression in hospital trials. Wesley Baxter, catering team leader at the Golden Jubilee National Hospital, Clydebank, said: “You know what you’re going to get with McCain, great quality products that taste good, present well on the plate and perform consistently, day after day, which is vital when you’re feeding large numbers. I really can’t praise them highly enough. “We trialled a number of products but the chips were a particular highlight. There’s no comparison to other products on the market, I can’t see how they could be bettered. Good chips need to have a crisp outer texture,

been a big favourite on hospital menus in England because of their consistent taste, texture and appetising appearance, whether they are held, cooked in a regen oven or delivered to far away wards. To discover the benefits of McCain Signatures chips for yourself contact McCain to arrange a trial. Or for more ideas and to see how else McCain Foods can help you, visit the website or contact the foodservice team. soft fluffy interior and an appetising, golden colour, and these chips meet that criteria.” McCain Signatures Chips have long




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Written by Nick Teasdale, British Parking Association

PiPA: Welcome to the healthcare revolution The British Parking Association’s Nick Teasdale provides an introduction to a radical new accreditation for healthcare organisations: the Professionalism in Parking Accreditation Many organisations offer parking services that are a cut above the average, but how many are truly excellent? The British Parking Association (BPA) plans to find out through a new, audited accreditation: the Professionalism in Parking Accreditation (PiPA). Excellence in parking is a product of organisational professionalism, and this concept lies at the heart of PiPA. We are initially launching PiPA for healthcare providers such as NHS trusts and, in time, we will make this revolution in professional standards available to other parking sectors. What, though, does it mean to be a professional organisation? It means you take seriously every aspect of your parking operation. It means you treat your

parking staff as ambitious professionals and provide them with the support, encouragement and recognition they need to develop skills within parking. It means you acknowledge your responsibilities in society and adopt the ethical ethos of an organisation that meets the needs of the wider community. It means you are committed to improving your parking services continuously, in response to car park user feedback. All of this will help to ensure that your customer service is peerless. Only a professional organisation can achieve that goal. Organisations that hold PiPA can shout from the roof-tops: we are professional, we epitomise excellence.

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NEW DAWN FOR HEALTHCARE PARKING NHS trusts and other healthcare providers work tirelessly to deliver an optimal level of clinical care. For many healthcare organisations, that effort is reflected in their provision of parking. This dedication is exemplary, and it is high time that it was recognised. PiPA will go one step further than recognition: it will celebrate professionalism in healthcare parking. We are launching PiPA in healthcare parking precisely because this sector is so important. No one enjoys a visit to a hospital or a doctor’s surgery. If someone does make that visit, it is generally because they are ill. Why, on top of that, should they feel stressed about parking? How does it help anyone if a doctor, nurse or surgeon is also stressed about parking? A professional organisation will take steps to help minimise anxiety in its car parks. Accredited healthcare providers will become nationally-recognised role-models for parking professionalism and excellence. PiPA will help raise levels of customer service for patients, E





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ACCREDITATION  visitors and staff, and it will recognise the high standards that already exist. It will help increase patient, visitor and staff satisfaction and ease their worries about parking. It will improve the reputation of NHS trusts and other healthcare providers, and it will help to counteract adverse publicity in the media. PiPA is a new dawn for healthcare parking. Yet for the BPA, it is the next logical step in our long march towards professionalism in parking. Founded in 1970, the BPA has always strived to increase professionalism: our articles of association declare that we will ‘work for the general advancement of standards.’ In partnership with the Association of Chief Police Officers, we run the Park Mark Safer Parking Scheme, helping to improve safety standards in car parks. We launched our Approved Operator Scheme (AOS) in 2007 and have steadily raised the bar for standards in private-land parking through our celebrated code of practice. Since 2010, we have also delivered two voluntary charters for parking, with one dedicated to healthcare parking. Our healthcare parking charter has now evolved into the sector-specific sections of the new, audited PiPA standard for healthcare parking. We will build on all the lessons learnt throughout our 45 year history to create a comprehensive accreditation that is sensitive to the needs of the healthcare parking sector. Although PiPA reflects the accumulation of considerable experience at the BPA, it also represents the beginning of an exciting new journey. As we embark on this journey, we are keen to take you with us, every step of the way. KNOWLEDGE AND EXPERTISE PiPA is and will continue to be the product of collaboration between BPA members, key stakeholders and staff at the BPA. It is the ultimate synthesis of professional knowledge and expertise. The development of PiPA for the healthcare parking sector offers an object-lesson in collaborative development and consultation. From the very beginning, we were



This approach to auditing combines high standards with the flexibility needed to meet the needs of a diverse healthcare parking sector. It is an audit you can truly rely on determined to seek the views of our members in healthcare parking, ensuring that the first phase of PiPA truly reflects this sector’s needs. At last year’s BPA Annual Conference, we asked our members to determine the general direction for PiPA development. Since then, we have gained valuable insights through meetings of our healthcare special interest group and through a dedicated PiPA development workshop. In collaboration with key partners such as the Healthcare Facilities Consortium, we have consulted NHS trusts through detailed electronic surveys, and a further survey provided us with useful intelligence from motorist and patient groups. In parallel with PiPA development, we helped the Department of Health as it drafted the new Health Technical Memorandum for parking, and we considered this document and the ‘NHS patient, visitor and staff car parking principles’ while developing PiPA. Most recently, we have worked with two NHS trusts to test the PiPA assessment methodology. We have learnt invaluable lessons during the tests, which strengthened the PiPA standard and paved the way for a robust new accreditation. There can be no doubt that PiPA reflects the deepest and broadest range of contributions from the healthcare parking sector, helping to make this the new benchmark for parking professionalism. As we roll PiPA out to other parking sectors, we will continue to consult at every step, capitalising on the unparalleled knowledge and expertise of BPA members and key stakeholders.

your organisation’s initial application for a PiPA audit, the BPA will send you a special PiPA audit pack, and we will ask you to submit a pre-audit self-assessment form. One of our expert area managers will then review the form and ask you for any additional evidence during a site-visit audit. The audit will focus on the nine key assessment standards for the healthcare parking PiPA: customer service and stakeholder relationships; safer and properly maintained parking facilities; fair pricing and easy-to-use payment services; fair enforcement of parking terms and conditions; impartial and fair appeals service, accessible to all; clear and comprehensive parking information; employee well-being, development and recognition; social responsibility and equality of service delivery and continuous improvement. Throughout the audit process, you will have access to a guidance document, which will suggest possible evidence-types that you may like to consider for each PiPA assessment standard. The area manager will then submit your organisation’s audit results to a moderator, who will ensure that standards are met at a consistently high level. Once you have achieved PiPA, your accreditation will last for two years, with an interim self-assessment to maintain standards at the half-way point. This approach to auditing combines high standards with the flexibility needed to meet the needs of a diverse healthcare parking sector. It is an audit you can truly rely on.

AN AUDIT YOU CAN TRUST The PiPA audit for healthcare parking is rigorous but fair, and has evolved through the recent tests with two NHS trusts. Following

JOIN THE PIPA REVOLUTION PiPA was recently the focus of a reception at the House of Commons, and the campaign to spread the word about PiPA continues to gain momentum. NHS trusts and other healthcare providers can now seek PiPA accreditation, and interest is sky-high. If your organisation wants to ride the wave of support for enhanced professional standards in healthcare parking, contact us today. PiPA is an accreditation that will make your organisation proud. So why not join us at the start of this revolution and help make professionalism the new norm in healthcare parking? L

Are you a healthcare provider? If so, you can join the PiPA revolution today by emailing membership@britishparking. for more information and to express your interest in becoming accredited. FURTHER INFORMATION






Putting healthier food on the hospital menu With hospital food often being considered a cause for national shame, stronger standards are highly sought after. The Better Hospital Food campaign is seeking government intervention to keep good food out of the bin, and healthy food on hospital plates In August 2014, the Better Hospital Food campaign urged the government to set hospital food standards in England. Consequently, The Hospital Food Standards Panel, led by Dianne Jeffrey, chair of Age UK, recommended five legally‑binding food standards for the NHS. The government’s standards included requirements that: hospitals should screen patients for malnutrition and patients should have a food plan; hospitals must take steps to ensure patients get the help they need to eat and drink, including initiatives such as protected meal times where appropriate; hospital canteens must promote healthy diets for staff and visitors – the food offered will need to comply with government recommendations on salt, saturated fats and sugar; and that food must be sourced in a sustainable way so that it is healthy, good for individuals and for our food industry. Following the standards publication, Secretary of State for Health Jeremy Hunt announced that hospitals would, for the first time, be ranked on the NHS Choices website for the quality of their food. This looks at how hospitals perform on the quality and choice of food, readily available fresh fruit, dietitian approved menus, food availability between meals and the cost of food services per patient per day. Speaking after the announcement, Hunt said: “We are making the NHS more transparent, giving patients the power to compare food

on wards and incentivising hospitals to raise their game. Many hospitals are already offering excellent food to their patients and staff. But we want to know that all patients have nourishing and appetising food to help them get well faster and stay healthy, which is why we’re introducing tough new mandatory standards for the first time ever.” FOOD FROM THE OUTSIDE However, despite some initial progress, the standards that apply to hospital food remain hopelessly weak, are not being properly monitored and are likely to be ignored. The campaign urges Westminster to set new, higher standards, and to place them into law. It is also essential that the standards are checked by an independent organisation trusted by both patients and staff. The hospital food problem is not a new one. In a major indictment of the state of hospital food in this country, a 2011 survey for the Soil Association revealed that nearly two thirds (63 per cent) of people bring in food from outside hospitals because the meals they were served were unappetising. Over a third (35 per cent) said that they think hospital food is unacceptable and over half (53 per cent) claimed that they would not be happy serving the meals they were given to a child. Nearly every independent survey of hospital food since 1963 has concluded that NHS food is neither appetising nor nutritious. The Soil Association found

a significant number of examples of strikingly good practice: well-run hospitals, where those in charge, and their skilled and committed catering staff, understand the importance of good quality, nutritious and satisfying food. In these hospitals, the food makes a positive contribution to patients’ well-being and staff morale. Those running hospital trusts with unhealthy food say they cannot afford better quality, but the hospitals that are doing a brilliant job are not necessarily those spending the most on their food service. It reports how one hospital saved £6 million a year by cooking with fresh, local ingredients; another sources yoghurt from a local supplier for two thirds of the price of the nationally-approved supplier. In 2002, the Audit Commission noted that higher cost hospital food did not necessarily equate with better food – hospitals spending half as much as the highest were often able to provide better quality food than those spending more. More than a decade has passed since then, and much of the same discussion is played out. The NHS is vividly searching for new ways to make savings, especially given the aims of NHS England and the findings of the Carter report, but why enforce cuts on hospital food when the quality of the food is risked? Over the last few years, in Cornwall, hospital spending of over £1 million with Cornwall suppliers generated an additional £900,000 for the local E

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HEALTHY EATING  economy. Hospitals may resist changing their food because they claim it is all too complicated, as they are being asked to make food healthier, source it locally and reduce their climate impact all at once. In fact, these priorities can go hand in hand. Moving to healthier diets means moving to more environmentally-friendly food. The best hospitals’ food is good for patients, good for NHS staff, good for British farmers and food businesses – good for Britain. But the majority of hospitals are delivering hospital food that is bad for patients, bad for staff and bad for Britain. The Oxford Health NHS Foundation Trust closed its hospital kitchen doors for the last time this autumn as, despite best efforts from campaigners, the Trust moved its community hospitals to a cook-chill food system. The kitchens at Wantage, Didcot, Wallingford and Witney hospitals have all been shut down in order to save around £300,000 a year. The Trust never said how many staff posts were at risk from the changes, but said it was ‘working to redeploy staff to other posts within the trust’. Opposition to the closure gained support from celebrity chef Raymond Blanc and a petition against the decision gained 474 signatures, but ultimately proved unsuccessful. The Better Hospital Food campaign also revealed that the closure of hospital kitchens at Oxford Health NHS Foundation Trust will mean that more than £1 million of food which can

currently be spent on fresh food will now be spent instead on ready meals, creating a loss of more than £3 million in economic benefits for Oxfordshire communities. This includes the loss of local jobs and withdrawal of vital business for local businesses. Katherine Button, of the Campaign for Better Hospital Food, said: “Most people prefer a home-cooked dinner to a ready meal and the same principle applies with hospital food. When a hospital kitchen closes, patients, staff and hospital visitors are more than likely to end up eating reheated frozen food, or chilled food delivered by van, sometimes transported for miles, topped up by unhealthy snacks from coffee shops and vending machines. “If we care about the health and well‑being of patients and their families, then they need to be served good, fresh food to meet their needs. Food is also a vital opportunity for a hospital’s money to be invested in the local economy, with hospital chefs buying fresh ingredients from local farmers and other suppliers. When a hospital kitchen is lost, all these benefits are lost as well.” Alex Meredith, Faringdon town councillor, said: “We still believe fresh food is the best way to make people better and give them a good experience in hospital. And because of the way the government is supporting healthy eating, there is a chance this sort of decision might be reconsidered in future and



hospitals would have to reopen their kitchens, which would be a very costly process, but we have got to keep asking them to do that. “These community hospitals are so small, patients got to know the cooks and knew what was going on the menu each weekend I was talking to people they got really excited about it, and part of a hospital’s care should be keeping people’s spirits up, but that has been lost.” ABOUT SUSTAIN Sustain: The alliance for better food and farming advocates food and agriculture policies and practices that enhance the health and welfare of people and animals, improve the working and living environment, enrich society and culture and promote equity. Representing around 100 national public interest organisations working at international, national, regional and local level, the Alliance was launched at the UNED-UK hosted Healthy Planet Forum on 17 June 1999. It was formed by merging The National Food Alliance and the Sustainable Agriculture Food and Environment (SAFE) Alliance, both of which had been established for over 10 years. L FURTHER INFORMATION

Whatever your commercial catering equipment requirements are, our priority is you! Reliable commercial catering equipment design & installation Client base of care homes and experience in the health sector Friendly, experienced team are here to help For more information about CES and our services contact us on 0845 878 7030 & quote CESCARE or alternatively, please visit our website at:

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Obesity Written by Dr Matthew S Capehorn, National Obesity Forum



Changes in the management of adult obesity Obesity is still one of the biggest public health epidemics that we face in modern society, and we do not appear to be winning the battle. The National Obesity Forum’s Dr Matthew S Capehorn dicusses what could be done to change the dynamics In the UK we still have one in four adults classified (by BMI) as clinically obese, and a more staggering two thirds of the adult population are either overweight or obese – meaning that more of the population are at an unhealthy weight than a healthy one. This shows no sign of reducing, with increasing numbers of children at an unhealthy weight, with nearly one in four of our children beginning Reception Year at school (aged four-five) being overweight or obese, which rises to one in three by the time they leave primary school in Year 6 (aged 10-11). The McKinsey Report published in December 2014 suggested that more than 2.1 billion people worldwide (nearly 30 per cent of the total global population) are either overweight or obese, nearly two and a half times as many as the number who are under-nourished, with obesity now responsible for five per cent of all deaths, despite being a preventable condition. The global economic impact from obesity is estimated at roughly $2 trillion (2.8 per cent of GDP), which is roughly the same impact as smoking or the armed forces, war and terrorism. Should current trends continue, half the global adult population will be obese by 2030. In the UK, the previous Foresight Report published in 2007, projected that if nothing is done about the obesity crisis then over half of the UK population will be obese (as classified by BMI) by 2050, with direct and indirect costs potentially bankrupting the NHS with costs of £49.9 billion per year. The McKinsey Report suggested that in 2012 the total cost of obesity in the UK was already at £44.7 billion, second only to smoking.

working in the field of obesity for some time. The McKinsey Report reinforced the findings in the Foresight Report that suggested the causes of obesity are multi-factorial, and so any one single intervention is likely to have little impact. In the report’s own words, a systemic, sustained portfolio of initiatives, delivered at scale, is needed to address the burden, which is what clinicians have been arguing for. However, this has not been introduced despite the acceptance of successive governments of the need to tackle the crisis. We still do not have obesity management as a mandated service provision within our NHS, nor the necessary funding required to finance it, nor any incentivisation for our healthcare professionals to prioritise its management. We cannot expect change without some radical strategies to address these issues, rather than paying lip service to it by introducing more public health measures aimed at prevention. The McKinsey Report estimated that a comprehensive programme, in the UK alone, could save the NHS £1.2 billion a year. It stressed the importance of education and personal responsibility (albeit not in isolation), as well as individual behaviour change and a shift in societal norms. It clarified that public health campaigns for prevention have little evidence and are likely to have low impact, yet treatment interventions are well evidenced and can have much greater impact, yet the government and society still focuses too much on prevention, despite the fact that treating the overweight

The Report y e s n i McK ted that estima ehensive r a comp e, in the UK m program, could save alone S £1.2bn the NH nds a pou year

WHAT SHOULD BE DONE? What should be done has been a matter of debate for politicians, commissioners of services, the public and even clinicians



prevents obesity, and treating obesity prevents severe or ‘morbid’ obesity, and so on. Furthermore, the focus of many government policies seems to be aimed at tackling childhood obesity. In our hearts we might feel that this may well make sense, to prevent the next generation of children becoming overweight or obese. However, whilst living in an obesogenic environment or perhaps even just a home environment where the parents do not eat the correct foods, or do not serve the correct portion sizes, or lead a sedentary lifestyle with insufficient physical activity, there is the possibility that any education (or weight reduction in the overweight/ obese) is wasted and not be the best use of resources, as children (in particular young children) do not re-educate their parents. An interesting clinical argument is to focus attention on adults and parents who are overweight and obese. By addressing their weight and unhealthy lifestyles, they can educate their own children and introduce behaviour change that will lead to a healthy weight and lifestyle, thereby tackling the problem in the adult and child population. Speaking on the Health At A Glance: Europe 2014 report, Simon Stevens, the chief executive of NHS England said: “If we act together – as the NHS, as parents, as schools, the food industry, we can get back into shape. We know that for people at risk, losing just five-seven per cent of your weight can cut your chance of diabetes by nearly 60 per cent. If this was a pill we’d be popping it – instead it’s a programme

of exercise, eating well and making smarter health choices, and we’re going to start making it available free on the NHS.” WHAT IS BEING DONE? Recently there has been focus on the care pathway for obesity management, specifically looking at the different tiers of intervention, criteria for accessing the different tiers, and who should have the responsibility for the commissioning of these services. The weight management pathway is now accepted to be formed by four tiers, and the Department of Health (DoH) recently demonstrated the differences between the Tiers as follows, but states it is for information rather than as a definition. Tier 1: ‘Behavioural – Universal interventions (prevention and reinforcement of healthy eating and physical activity messages), which includes public health and national campaigns, providing brief advice’. Tier 2: ‘Lifestyle weight management services, normally time limited’. Tier 3: ‘Clinician led multidisciplinary team (MDT) – A MDT clinically led team approach, potentially including physician (including consultant or GP with a specialist interest), specialist nurse, specialist dietitian, psychologist, psychiatrist, and physiotherapist’. Tier 4: ‘Surgical and non-surgical – Bariatric Surgery, supported by MDT pre and post-op’. In April 2013, government health reforms made primarily Tiers 1 and 2 of these weight management interventions the responsibility of Public Health but moved this department to Local Authority control. Locally elected, non-medically trained individuals could now influence the purse-strings for essential NHS services such as weight management. Other pre-existing challenges remained such as the ‘postcode lottery’ of varying provision of bariatric surgery across the country. THE TIER SYSTEM With the NHS restructure came NHS England recommendations, prepared by the NHS Commissioning Board (NHS CB) Clinical Reference Group for Severe and Complex Obesity, intended to address these concerns. Among other things, this document outlined the arrangements for funding of bariatric surgery for the population of England, and was intended to define the eligibility criteria. The proposals addressed some of the findings in the NCEPOD Report into bariatric surgery, which was concerned that sufficient medical management and psychological support was not being offered to patients prior to bariatric surgery, and the new guidelines have been largely welcomed by clinicians. In practice however, the NHS CB policy document for severe and complex obesity highlighted an even bigger variation in the availability of suitable Tier 3 non-surgical MDT services. Prior to April 2014, there was huge variation in the availability of what would be considered Tier 3 specialist centres for the MDT provision of weight management. In some areas these services were being commissioned by Public Health England (PHE) and therefore local authority, in other areas they were being commissioned by Clinical Commissioning Groups (CCGs), but in the majority of areas they had no specific Tier 3 service, or a version of it was being provided by the surgical Tier 4 providers, which introduces a potential for what should be intensive medical management to prevent the need for bariatric surgery turning into a period of just pre-operative preparation for surgery. Currently approximately 60 per cent of CCG regions have access to some form of Tier 3 intervention (suggesting that 40 per cent do not!), yet the majority of those that do are not in dedicated primary care based centres like the



Rotherham Institute for Obesity, and instead a loose interpretation of Tier 3 services, or are delivered by surgical teams in a Tier 4 setting. After considering a range of options, the DoH working party concluded that in terms of future commissioning responsibility, CCGs were the preferred option as the primary commissioners for local weight management multi-disciplinary team interventions (Tier 3). Furthermore, NHS England should consider the transfer of all but the most complex adult bariatric surgery (Tier 4) to local commissioning once the predicted increase in volume of Tier 4 activity has been realised and once locally commissioned Tier 3 services are shown to be functioning well, and that local authorities should remain as the commissioners of Tier 1 and 2 of the obesity care pathway. Perhaps the biggest shake-up within the NHS management of obesity will come on April 2016 when the transfer of responsibility for commissioning bariatric surgery passes from NHSE to CCGs. Having the same commissioner responsible for Tiers 3 and 4 would also hopefully encourage increased investment at a Tier 3 level, in order to realise potential savings from reduced need for expensive Tier 4 bariatric procedures, as a consequence of successful intensive medical management. However, the concern is whether CCGs are prepared for this major change. It may be ironic that despite some significant changes in the care pathway for weight management over the last few years, little detail has made it into the media spotlight. The likely cause for this is most likely that more press attention is given to advocates of an unworkable sugar tax that for a number a reasons is unlikely to help solve the obesity epidemic. If we want to tackle obesity, we need to review the evidence and be radical in our strategy without going down the route of a ‘nanny state’. Even in times of austerity, the health-economic argument for treating obesity is clear, but it will not happen without more action from policy makers. L FURTHER INFORMATION

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Diabetes Written by Dr Jim O’Brien, NHS Diabetes Prevention Programme, Public Health England



Tackling Britain’s waistline to fight diabetes With the problem of obesity a major concern for the nation’s health, Dr Jim O’Brien, of Public Health England’s Diabetes Prevention programme, discusses the importance of acting now to combat diabetes and other related illnesses Obesity is the biggest health issue of our time. The figures are something we cannot ignore; almost two thirds of adults are overweight or obese. One in ten four to five year-olds are obese and by the time they leave primary school this doubles to nearly one in five. We have to recognise that current approaches are not making enough impact and we need to tackle this with new and different solutions. The risk of being overweight or obese has serious and negative consequences on an individual’s health. It increases the risk of life-threatening diseases such as heart disease, Type 2 diabetes, and some cancers. As well as the health risks to the individual, obesity currently costs the NHS and wider economy £27bn a year. Sugar is a major contributor to excess calories in the diet which leads to weight gain and obesity. Earlier this year, the Scientific Advisory Committee on Nutrition (SACN) released a report looking at the link between carbohydrates, including sugar, and a range of health issues. They found that too much sugar in the diet can have serious health consequences. The recommendations include reducing the amount of sugar in the diet to no more than five per cent of daily calories, about half the previous maximum and minimising the consumption of sugar-sweetened drinks. A WHOLE SYSTEMS APPROACH Children and teenagers are consuming almost three times as much sugar than the new maximum recommendation, and most of this is coming from sugary drinks. Children aged 11-18 get most of their sugar from soft drinks (29 per cent), which is not surprising since one can of sugary fizzy drink contains around seven cubes of sugar. Table sugar and confectionery (21 per cent) and fruit juice (10 per cent) are also large contributors to the sugar intake of 11-18 year olds. The responsibility is not just on individuals and families to reduce sugar consumption and take in fewer calories. There are a range of complex factors that cause obesity, including the environment we live, work and play in,



as well as advertising and promotions. A potential solution is a whole systems approach that takes into account all aspects of everyday life with a strong focus on prevention. It is essential we focus on actions that can prevent people developing conditions such as diabetes. Focusing on prevention will not only improve health outcomes, but it also means we are actively addressing well-being and tackling health inequalities. It means we can also potentially reduce the workload of frontline healthcare staff and help ensure the financial sustainability of the NHS. The NHS and organisations within the wider health system have recognised that more needs to be done to respond to the prevention challenge. This means getting really serious about delivering early interventions and preventative services. Plans to act on this have already taken shape in the form of the NHS Prevention Programme Board, which was established in January 2015. Chaired by Duncan Selbie, Public Health England’s chief executive, the Board has made a strong start since the first meeting to make sure we deliver on our promise to get serious about prevention. Work underway in the past year includes the NHS Diabetes Prevention Programme (NHS DPP).

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THE WEIGHT OF THE PROBLEM There is a direct association between the growth in Type 2 diabetes and Britain’s expanding waistline, as those who are overweight or obese are at higher risk of developing the condition. Around 90 per cent of those already with Type 2 diabetes are overweight or obese. Current trends in obesity are set to get worse; 70 per cent of people will be overweight or obese by 2034 and one in ten will develop Type 2 diabetes. Unless we begin to reduce excess weight and obesity we won’t reduce diabetes.

Most people would be shocked to know that around 22,000 people with diabetes die early every year. It is estimated that there are five million people at high risk of Type 2 diabetes in England – a disease that is often preventable. The figures, released earlier this year, were compiled by Public Health England’s National Cardiovascular Health Intelligence Network (NCVIN), and provide the most accurate and robust estimate of how many people over the age of 16 in England have blood sugar levels in a range indicating a high risk of developing Type 2 diabetes, otherwise known as non-diabetic hyperglycaemia. Diabetes is a serious chronic health condition and is the leading cause of preventable sight loss in people of working age and is a major contributor to kidney failure, heart attack and stroke. As well as the human cost, Type 2 diabetes costs the NHS £8.8 billion every year, almost nine per cent of its annual budget. A large proportion of Type 2 diabetes can be prevented. This is why Public Health England (PHE), NHS England and Diabetes UK are setting up the (NHS DPP.


This will be the first programme of its kind to be carried out on a nationwide scale, and will deliver on the prevention commitment set out in the NHS Five Year Forward View and PHE’s Evidence into Action last year. An evidence review published by PHE earlier in the year shows programmes similar to the NHS DPP can be successful in preventing 26 per cent of people at high risk of Type 2 diabetes from going on to develop the condition compared to those receiving usual care. People supported by diabetes prevention programmes lose, on average, 1.57kg more weight than those not on a programme aiming to significantly reduce diabetes risk. Lifestyle factors, including weight, physical activity levels and diet, are important like the inherent factors of ageing and ethnic background in determining the risk of developing Type 2 diabetes. The NHS DPP will focus on providing support to participants on changing their behaviour in these areas to reduce their risk. The NHS DPP will offer at least nine months of information, support, group and one-to-one sessions on weight loss, physical activity and diet. Practitioners, clinicians, academics and the public are currently being consulted on a proposed outline of the programme.

DEMONSTRATOR SITES Aside from reducing incidences of Type 2 diabetes, the NHS DPP also aims to reduce the life-changing complications associated with the disease, like heart, stroke, kidney, eye and foot problems, and reduce costs to the NHS in the long term. In 2015/16 we are working with seven demonstrator sites who will work with us on developing and implementing this national programme. This will then be followed by a procurement of behavioural interventions and the commencement of a phased national roll out in 2016-2017. The ‘demonstrator sites’ will help us design and set up an effective Diabetes Prevention Programme nationally; giving us an opportunity to learn practical lessons from delivery in action in different communities across the country. In particular, the sites will provide local perspectives on the service model, including: any potential barriers; what works best to ensure effective implementation; strategies to recruit people onto the programme; how best to retain at-risk individuals for the full length of the programme; and aligning the NHS DPP with existing services. People will be referred into the programme through three ways. Firstly, routine GP and clinic appointments will provide opportunities

to identify those at high risk, and in many cases GPs will already have identified certain individuals. Secondly, those who have already been identified in the past 12 months as having a ‘non‑diabetic hyperglycemia elevated risk level’, which is when people without a diabetes diagnosis have a higher blood glucose level than what is normal, will be targeted. RISK ASSESSMENT In addition, the NHS Health Check programme is offered to adults between the ages of 40 and 74 and includes a diabetes risk assessment and blood test as part of the check, as well as referral to lifestyle interventions, such as weight management services. This already provides an established mechanism to assess up to a million and a half people every year. The NHS DPP has the potential to be a truly game-changing programme, helping people regain better health, by reducing obesity and delaying or stopping the progression of Type 2 diabetes, all of which will help reduce pressure on the NHS. L FURTHER INFORMATION



Pest Control



Written by the British Pest Control Association

The problem of patients and pests


Hospitals are vulnerable to infestation. The modern hospital functions on a 24-hour, 365-day basis, with several thousand staff, patients and other visitors, supported by a wide range of services. As such it resembles a small city, creating a very attractive habitat for a range of pests. So how should pests in a healthcare environment be handled? There have been times when infestation in hospitals was not being appropriately managed. In the early 1980s, records indicated that about 65 per cent of UK hospitals were infested with oriental cockroaches, and about 10 per cent had pharaohs ants. At that time, Crown Immunity of hospital premises was seen as one reason why infestation was not being taken seriously, and public concern eventually resulted in the lifting of Crown Immunity in 1984. This move, together with the introduction of measures by the Department of Health, including the preparation of a Model Contract for Pest Control, and the establishment within each hospital of a trained nominated officer with responsibility for the management of pest control, brought about a gradual improvement. Importantly, these measures changed the culture of

pest control in hospitals, by showing that it was possible to eradicate many pests that had formerly been considered as fixtures. Across the UK, there are many hospitals that formerly had deeply entrenched infestations that have now not had a significant infestation for several years.

e There ar itals sp many hoerly had m that for ntrenched deeply ens that have o infestati not had an now ion for infestatl years severa


UP TO SPEED There is, however, no room for treading water. The issues around infestation and its control do not stand still. Feedback on recent nominated

officer training courses indicates that infestations of cockroaches, bed bugs and other pests in hospitals are still all too common. Recent reports also indicate that some pests, such as rats and mice, are on the increase across the UK, and this is being reflected in hospitals. In addition, entirely new pests such as ghost ants have appeared in the UK, and are becoming increasingly widespread. In addition to changes in pests, changes in the health service also bring new challenges. In some of the latest facilities, pest control appears to have fallen down

the gap between the management company and the Trust. Pest control, where this has been considered at all, has sometimes gone out to tender along with catering, cleaning, security, and car parking, with no consideration of existing arrangements or of the specific requirements of the site. Sometimes, significant questions have subsequently come to light about the design of details in new buildings, for example with respect to pigeon roosting sites close to air intakes and clinical facilities. Old buildings can also bring their own problems. On numerous sites, redundant buildings sit empty prior to demolition, and some hospitals have removed these from the pest control contract in order to save costs, which can lead to several problems. At one site, rats became established in a redundant building that was no longer subject to pest control inspection, and started to cause a persistent problem in the nearby Out Patients Department. LITIGATION The risk of litigation in relation to infestation has grown in recent years. The lifting of Crown Immunity created the possibility of legal action under food safety legislation, and for some hospitals this has since become reality. Of course all Trusts will also have a duty to provide a safe working environment for staff, and this extends to the prevention of pest infestation. Similarly any Trust that provides accommodation for staff will also have responsibilities to ensure that this is free of pests, and failure to do so again creates the possibility of claims. In addition, there is the real possibility of claims being brought by members of the public, perhaps in relation to an infestation, illness or infestation which they believe they may have acquired in hospital. As hospitals and Trusts now become increasingly competitive, the indirect costs of high profile litigation on the public and professional perception of the unit may well exceed the direct costs of Court action. Faced with these and other issues, those with responsibility for the management of pest control within Trusts and hospitals need to actively maintain a broad professional competence in this area. WHERE CAN THEY HAVE COME FROM? Upon finding an infestation this is normally the first question to be asked, but often the last to be answered, if at all. We can normally identify which factors are conducive to infestation, but it is often very difficult to look at a particular current infestation, and work out its origin with any degree of certainty. Of course we know that feral pigeons  visit the site at intervals, and may become established if they find regular food (particularly if it is deliberately placed out for them), and sheltered roosting sites. Rats, squirrels, foxes, and feral cats are all

likely to respond similarly. At the other end of the scale, we presume that most stored food pests such as beetles, moths, mites etc, normally arrive within food products. However some storage insects are also associated with bird’s nests, which may provide an alternative route into a building. Pests such as pharaohs ants, cockroaches and bed bugs do not normally colonise buildings very rapidly under current UK conditions, and the actual infestation routes are often difficult to identify. An infestation that re-appears some months after a treatment programme is much more likely to be based on survivors of the old

Pest Control


However the recent upswing in bed bug infestations has created particular problems for hose suffering from haemophilia. Rodents are recognised as carriers of a number of diseases and human cases of Weils disease occur regularly in the UK. At-risk groups are seen as those spending time in areas infested with rats, with cases having occurred in construction workers, watersports enthusiasts, sewer workers and others. Birds are also increasingly recognised as capable of transmitting a range of human pathogens. For example outbreaks of Listeria have been shown to be caused by birds pecking milk bottle tops, while E. coli 0157

The risk of litigation in relation to infestation has grown in recent years. The lifting of Crown Immunity created the possibility of legal action under food safety legislation, and for some hospitals this has since become reality infestation, rather than on newly‑arrived pests. Once a hospital is truly free of cockroaches, ants, or other infestations of this type, years can easily pass before a new infestation appears. DO WE NEED TO ACTUALLY ERADICATE THEM? The reasons for keeping the hospital free of infestation are many, and reducing the risk of litigation and adverse publicity are clearly important. However within the hospital environment, reducing the risk of infection is likely to be uppermost in most peoples minds and with cases of infection contracted within hospitals believed to be running at a high rate, the co-existence of patients and potential sources of infection cannot be tolerated. Studies of insects such as cockroaches, ants and houseflies have shown that these insects acquire a very wide range of human pathogens from their environment (e.g. refuse areas or drains) and are potentially able to transfer these to other areas. The pathogens are carried externally, or via their faeces or vomit. Nonetheless conclusive evidence of human infection by crawling insects is hard to establish although there are several cases that support this theory. With houseflies, there is now recent research overseas to show a statistically clear link between housefly infestation and gastroenteritis. Although disease transmission by some blood-feeding insects is a major problem globally; fleas, bed bugs and mosquitoes are fortunately no more than a severe nuisance in the UK at present. Research has revealed no evidence to link biting insects with infections such as hepatitis and HIV, for example.

has been shown to occur in the faeces of gulls that have been feeding on refuse. Although direct effects of infestation on patients and staff are of greatest concern in hospitals, infestations can cause a wide range of other problems. For example, an infestation of food stores is likely to result in quantities of food being discarded and the enforced closure of catering, and damage to electrical cables by rodents is a fire hazard, as well as putting computing and communication systems at risk. PUTTING PROCEDURES IN PLACE Almost all hospitals and Trusts will have pest control arrangements already in place. However the process needs to be reviewed at regular intervals, especially prior to re‑tendering for pest control work. Key aspects ensure that each hospital has a nominated officer with responsibility for pest control, and ensure that they have been specifically trained to monitor the NHS pest control contract. Moreover, adopt the NHS model pest control contract, ensure it is tailored to meet your needs, and go through a rigorous competitive tendering process at the next opportunity. Use of this contract has been instrumental in driving down hospital infestation rates in recent years. Finally, select a competent contractor. The British Pest Control Association (BPCA) is the UK trade association representing organisations with a professional interest in pest control. All BPCA members meet our strict membership criteria, hold the relevant pest control insurances, and are fully qualified and trained to deal with your pest problems.  FURTHER INFORMATION



Products & Services




With over 1,300 CHP units and 150 commercial biomass boiler schemes successfully installed from 10kW instant heat systems to 1MW district heating schemes, Aston Cord Energy Services Ltd has the skills and knowledge required to design and install a system to best suit your requirements. Aston Cord Energy Services Ltd is an experienced company of engineers and installers of biomass boilers, heat pumps, solar hot water, combined heat and power units (CHP) and full heating and domestic hot water systems. It has a dedicated and experienced team ready to work with suppliers, architects, builders and directly with property owners to look at any heating requirements. When looking to change or upgrade your existing heating system one of the most important aspects is to have an experienced heating engineering company involved

Based in the North West of England, CB Renewables is at the cutting edge of the renewable energy industry. CB Renewables works closely with its global manufacturing partners which gives the company access to a large support system of designers and technicians to ensure that design and installation maximises the energy efficiency benefits you are targeting. The team of installers are all fully MCS accredited to design and install all forms of energy delivery, including; ground and air source heat pumps, solar photovoltaic (PV), solar thermal, underfloor heating, rainwater harvest, energy saving lighting systems and controls, biomass boiler energy systems. Working across both public and private business, CB Renewables has completed major installations within healthcare, industrial and agricultural

Installing renewable heating technologies

from the outset. Choosing the best heating system for your circumstances can depend on many factors including location, the heat demand, available space, government incentive schemes and your budget. Aston Cord Energy Services Ltd will tailor your system to meet your demands. To find out more or to discuss your future project contact a member of the team at Aston Cord Energy Services Ltd. FURTHER INFORMATION Tel: 01453 844485



Since its inception in 2006, Eta Energy has provided cost saving energy solutions to public sector, commercial and industrial clients. Drawing on wide ranging expertise, the company offers carbon reduction programs and efficiency savings for steam, low temperature hot water, biomass heating systems, variable flow networks and boiler plant. In the health sector, Eta Energy provides specialist energy consultancy for building and boiler house facilities. Services include first inception feasibility studies and system design through to implementation for all heating and cooling plant, risk assessments in compliance with HSE guidance notes (INDG436) and troubleshooting existing systems. Recent major health sector projects include: CHP & LTHW boiler replacement at Bedford Hospital with £100,000 projected annual savings; a steam boiler upgrade and partial

Syzygy Renewables is the UK’s leading renewable energy consultancy specialising in roof-top solar PV. The company advises commercial property owners and occupiers who are seeking to exploit renewable energy opportunities and want a specialist to help them deliver the right solution. Working with many of the leading commercial property owners such as Land Securities, British Land, Hammerson and Segro as well as the UK’s leading pension fund managers including Aviva, Legal & General and Henderson, Syzygy has advised on and project managed over 80 roof-mounted Solar projects across the UK to date. Syzygy advises clients on how and where they can generate renewable energy, providing them with a fully integrated solution.Taking projects from the feasibility stage, design, identifying the right contractors and running a

Providing expert cost saving energy solutions


Green technology: saving you energy and money

de-centralisation with high efficiency LTHW condensing gas boilers at Luton & Dunstable Hospital, providing £90,000 projected annual savings; design and specification support for a Scottish hospital in the decentralisation and removal of a low efficiency steam boiler with three LTHW condensing plant rooms with full commercial payback modelled in four years; and a full steam boiler house risk assessment for Northampton General Hospital. FURTHER INFORMATION Tel: 0845 389 2170


sectors proving its capability and delivering considerable savings to clients. The company’s partnership approach to projects means that from conception, design, project management through to installation, its clients are kept fully informed and remain the key focus. For more information about CB Renewables and how it can support your move to a greener energy profile please visit the CB Renewables website. FURTHER INFORMATION Tel: 0151 547 7606

Identifying opportunities for renewable energy

detailed tender process, project management and ultimately managing the completed operational assets ensuring they continue to operate efficiently and importantly the Feed-in Tariffs are collected. Syzygy is not a contractor, but exists to help clients engage the best contractors on the right terms with the best design, ensuring the work is properly supervised and the client gets the best value. The team at Syzygy are passionate about Renewable Energy and have over 18 years of industry experience. FURTHER INFORMATION Tel: 0203 697 6488



Solar UK is an installer of both solar thermal and photovoltaic solar systems and a solar thermal manufacturer with over 17 years of industry experience. Solar UK is an expert in the field and has undertaken a number of bespoke projects including working with London Zoo to provide hot water for the pygmy hippo enclosure, installing over 50kWp of PV panels on new housing estate projects to meet government targets and bringing hot water to the New Bodleian Library at Oxford University and the New Birmingham Dental Hospital at Pebble Mill, Birmingham. Each of these projects came with unique obstacles to overcome and requirements to meet, in which Solar UK’s

Advanced Therapeutics UK Limited (ATUK) is a UK wide distributor of specialist medical devices that meet real clinical needs, simplify therapy and improve quality of life. ATUK is the exclusive UK distributor for Dario™, a product range by Labstyle Innovations, built around a cloud based Diabetes Management System. Dario™ is designed with convenience, efficiency and results in mind, providing the perfect solution to diabetes management and putting it in the palm of the user. Alongside this, it is also the UK’s sole distributor for the latest Continuous Glucose Monitoring technology, Dexcom® Inc’s G4® Platinum and G5® Mobile, as well as having distributing exclusivity for Sooil’s DANA R insulin pump, the smallest and lightest conventional pump currently available. These innovative products all work to

Developing leading solar technology in the UK

expertise and years of knowledge proved to be priceless. Along with completing bespoke commercial and communal projects, Solar UK also caters for all domestic solar needs. These aspects cover a range of facilitites from servicing to brand new installations. Having completed projects as far away as the Canary Islands, Solar UK has the capability to help tailor a solar package to suit any need. If you have a solar requirement contact Solar UK today by phone or email, or if you want to learn more about solar, visit the Solar UK website. FURTHER INFORMATION Tel: 01424 772903

Providing technology to simplify medical therapy



Marlux Medical, part of the OrthoD Group, introduced the first disposable privacy curtain in the UK and is now leading the way in supplying innovation with Microban antibacterial technology built-in to its products as standard. Supported by a UK based manufacturing team, Marlux Medical has been trading since the 1980s and has established a specialist reputation for the supply of disposable curtains to both NHS Trusts and private hospital groups throughout the UK. Becoming part of the OrthoD

In recent years, research has focused on the infection risk presented by the clinical environment. This is not hugely surprising, given the concern about high patient infection rates and the grim spectre of antimicrobial resistance meaning that we are entering an era of ‘bad bugs and no drugs’. Current thinking is that the environment plays a major role not just in the acquisition and spread of infection, but also in the spread of antimicrobial resistance. The focus is now on unrecognised fomites - items we touch without thinking. Take a look at the blind cords, pull-cords for lights, fans or alarms in your facility – when were they last cleaned; how often are they touched? There is abundant evidence on the efficacy of antimicrobial copper. Bacteria, viruses, yeasts and fungi all die rapidly on

Leading the way with Microban technology

Group Ltd in 2006, Marlux Medical continues its strong partnership with Microban to provide a wide range of antibacterial standard and custom curtains to help provide an additional level of protection against bacterial growth. For more information about Marlux Medical and the products currently available to you, please visit the company’s website or call its customer services team. FURTHER INFORMATION Tel: 01217 835777

Products & Services


improve patient health, provide a flexibility of lifestyle and achieve excellent clinical outcomes. ATUK provides high quality training and support to diabetes teams and patients, having the flexibility to be able to offer an efficient, reliable and yet friendly service. The 24 hour technical support is provided by a UK based team. ATUK takes pride in its ethos of working within the highest ethical and moral standards. FURTHER INFORMATION Tel: 01926 833 273 www.advanced

What would you find on your blind pull chords?

contact with it. Clinical studies shows that there is more than 80 per cent microbial reduction on antimicrobial copper surfaces, between touches and between cleans The Sturge Group offers ball chains made from solid antimicrobial copper, in gold or silver appearance, to give you longevity, performance, aesthetics... and fewer microbes. When fitting blinds follow the recommendations as set by the BBSA. FURTHER INFORMATION Tel: 01384 455 426



Products & Services




Better training reduces risk. It doesn’t require exhaustive studies of past regulatory action to discover that data breaches, particularly in the public sector, have many common, repeating elements. We really should be learning from these mistakes; however, much of the training available today doesn’t look to the root causes and so fails to protect both organisations and individuals. The recent email disclosure of highly sensitive medical data by a London NHS clinic serves as a stark reminder that we humans remain very capable of repeating errors that can lead to devastating harm. Incorrectly sending emails with contact details in the ‘To’, rather than the ‘Bcc’ box, has happened before and will happen again. It’s time to train staff better. It’s time to learn from other professionals, where mistakes can be deadly. Human Performance and Threat and Error

Siobhan Scott founded LA Virtual Admin after spending 27 successful years working for the Civil Service within Whitehall. Her high profile roles ranged from Private Secretary to Senior Government Policy Advisor. Siobhan wanted to utilise the invaluable skills and qualifications she gained throughout her career within Government to set up an efficient and highly skilled virtual assistant business to help sole traders and small businesses with a wide range of administrative duties they may not otherwise have the time or budget to do themselves. Siobhan has successfully worked with Government departments, local authorities, small businesses and other organisations by providing a comprehensive range of administrative services. She has built up a portfolio of office skills including data analysis, financial management and researching,

The secret to effective data protection training

Management (TEM) are crucial elements of airline pilot training. Incorporating TEM principles into data protection training builds invaluable confidence in staff to identify threats (outside of their control) and errors (which they make) which demonstrably lead to harm and significant fines. When staff are enthused and given skill and opportunity to become involved, they can be more so much effective in predicting and preventing the breaches we continue to see. FURTHER INFORMATION Tel: 0203 291 3415



Expert virtual office administration

writing and publishing reports. She is now an accomplished and resourceful Virtual Assistant and an accredited member of the UK Association of Virtual Assistants, working virtually or in-house within the West Sussex area. LA Virtual Admin can complete a one–off project or provide ongoing back office support to give sole traders or small businesses those extra hours in a day to successfully run their business. FURTHER INFORMATION Tel: 01903 715733


Trusted administrative assistants you can trust

D-Tangle: making earphones user friendly

Based in Fareham, Hampshire, DataWizard has been operating for over three years, carrying out a broad range of professional administrative support services for businesses and charities, delivering a timely and reliable service. DataWizard can provide a virtual admin service (one off or regular) for when your admin team is overloaded e.g. holidays, sickness, seasonal peaks or to release staff for other projects. DataWizard offers a range of administrative services including letters, reports, presentations, quotations, online emails and appointments, data entry, mailshots, mail merge and envelope filling. DataWizard can improve efficiency by creating databases to hold records and automate much of a manual paperwork system, e.g. customer contacts; orders; stock control. Data is backed up

D-Tangle is the first product of Laidback Life; a company that aims to design and bring to life commodities that will make every day products more user friendly, easier to handle and at the same time more enjoyable. D-Tangle is an innovative, patented product that prevents earphones from getting tangled in a fun and easy way. It has a unique, internal spring mechanism where users can place their existing set of earphones and automatically unwind them – as simple as that! D-Tangle is compatible with most brands of earphones like the ones of iPhone, Samsung, Senheizer, Nokia, Sony etc. D-Tangle can fit any cable up to 1,200mm in length and 1.25mm in width and also comes with a removable clip feature. D-Tangle comes in five different colours; blue, red, white, yellow and black. Another important feature

regularly and security is always of utmost importance to reflect the clients needs for confidentiality. DataWizard is happy to accept work via email, post, courier, telephone, conference calls or video calling (usually Skype). The work can be transferred on CD, hard copy (printed or hand written) or during face to face meetings. A detailed, no obligation, written quotation, based on requirements will be provided before any work is undertaken therefore the total cost is known in advance. FURTHER INFORMATION Tel: 01329 481202


is its advertising capabilities. Anyone can customise D-Tangle according to their liking. This could be an individual wanting to place their name on D-Tangle or a big corporate company that wants to place their logo. D-Tangle has an international patent and is ready to take international markets by storm. The company is looking for distributors/retailers that will be ready to accommodate D-Tangle. More information and contact details can be found on the D-Tangle website. FURTHER INFORMATION Tel: +357-22-447300



Gone are the days of paying fixed labour costs for staff during the quiet times as you only pay for what you need. An ideal solution for dealing with variable workloads or merely to help out with the growing demands on your own administration staff when they are overloaded, off sick or on holiday. Outsourcing your digital audio and copy typing to an external online provider not only frees up valuable time for you to concentrate on the more important aspects of your business but it can also be an efficient and economical way of acquiring a typing service at a fraction of the cost of employing a typist or secretary. Files can be securely uploaded for transcription into MS Word via the internet; be it verbatim interviews, general meetings, disciplinary or grievance meetings, conference calls or

FOZ Designs has been busy producing remarkable print, graphic and web designs along with brands and publications for consumers and businesses in fine and applied arts, government, education, third sector and the wider community. As one of the most modern commercial printers in London, it has a long established reputation for providing exceptional reliability, with high quality, cost effective print solutions to a wide range of clients. At the core of every design project, FOZ Designs aims to reflect commercial clarity and inspired creativity. The company ensures that its ideas match your goals and deliver the results you set out to achieve. It provides clients with a range of design services, including websites, advertising, annual reports, brochures, catalogues and corporate stationery. FOZ Designs provides a vast spectrum of printing potential

Accurate and quality trascription services

simple letters you need typing by an online team of professional transcribers who manually type up everything that is said. By paying per audio minute according to the duration of the recording, it’s like having your own secretary and administration office whenever you need, but without the burden of office space, training or salaries. This makes it the perfect solution for those who may at times have large volumes of work needing to be typed within a short time-frame. For more information please visit the XS Typing UK website. FURTHER INFORMATION Tel: 0207 993 5674

Energetic and creative printing and branding



Videos can be used to improve the quality of patient care. Video provides a great way to communicate more effectively with your patients. It can also improve the patient experience, support self-management, help patients to prepare for meetings, encourage compliance, reduce the volume of DNAs, increase capacity and save time. The tricky bit with video is getting them made. It can be time-consuming and expensive. However, Health and Care Videos, in partnership with Torbay and South Devon NHS Foundation Trust, has solved that problem for you. Health and Care Videos has created a library of over 250 videos to help patients through their treatment pathways and to support staff. The videos can be used alongside existing leaflets, appointment letters and face to face care, and make important information more easily digestible and accessible.

MedHand International AB is a developer of mobile medical resources. The company’s patented mobile library application, called Dr Companion, provides a suite of leading medical books from major publishers (such as OUP, Elsevier, Wiley etc.), and is used by thousands of healthcare professionals, medical trainees and medical students to provide answers at the point of care, sometimes in remote locations. The Dr Companion App can be downloaded free of charge from the various App Stores and its functionalities include cross-title search, bookmarking, highlighting and annotation. The App is available for iPhone, iPad and Android users. MedHand will be launching a Windows App later this year. Once downloaded, no internet connection is needed to access the App and its content. More

Using videos to improve and enhance patient care

Each of the videos in the Health and Care Video library can be branded with your own logo and contact details, and prices start from only £50 per video. Alongside the company’s specialist experience, its unique production process means that Health and Care Videos can reliably and quickly produce clinical videos for your own speciality. For more details visit the website or get in touch by phone or email. FURTHER INFORMATION Tel: 01803 656599

Products & Services


from business cards, marketing materials, catalogues and brochures as well as creative concept design, all from within an in-house capability. As a client you will be offered the very best in service. FOZ Designs will ensure the finished product exceeds your expectations every time whilst being on time - a great combination. FURTHER INFORMATION Tel: 020 8981 9396

Mobile resources for healthcare professionals

than 170 leading medical titles are available as MedHand Apps. MedHand offers special institutional packages that include a number of pre-selected titles, which are distributed to all users. Alternatively, users can select a specified number of titles from a bespoke titlelist. Subscribers may also choose to add their own local documentation to the App (for example, local guidelines). MedHand also offers bespoke App development services. For more information, please email or call Isabel Rollings, quoting ‘PSI’. FURTHER INFORMATION Tel: 07833 451595



Advertisers Index




SAS Lining Services is a company specialising in the application of thermoplastic road markings. The company covers all aspects of road markings including: extrusion/ vibraline (multi mark machine); milled studs (cats eyes); high friction surfacing (BBA Type 1 Approved) and thermoplastic road markings to public highways, car parks and industrial estates meeting all requirements for private and local authorities work. SAS Lining Services has been trading for 12 years, building a reputation of quality and reliability while undertaking numerous Council Term Maintenance contracts. The company is ISO9001, National Highways Sector Scheme 7, CHAS accredited as well as Construction Line (60872) approved – working

With over 30 years’ combined experience, Total Parking Solutions (TPS) Ltd has achieved a reputation as one of the leading providers of car parking services, operating extensively throughout the UK. The company provides consulting and parking management services across the UK. Operating extensively in the health sector, TPS provide clients with a range of solutions from Pay and Display, Pay on Foot, Access Control and a Pay on Exit linked to ANPR, a system highly recommended by the Department of Health for use on NHS sites. In addition, TPS provides parking enforcement and associated management services. For TPS, managing parking is not just about fulfilling a contract. It’s about having an in depth understanding of its business and the business of its clients. Providing solutions means

The thermoplastic road line markings specialists

24/7 covering all of Yorkshire, North East/North West England and the Midlands. Staff team members are experienced, qualified and skilled to NVQ Level 2 standard and attend continuous training with Road Safety Marking Association and CITB to further build knowledge and skills. The company’s relationships with all team members is based on equality and mutual respect. FURTHER INFORMATION Tel: 01482 633860

Leading providers of car parking services

harnessing the most advanced technical products, systems, knowledge and resources that are available, combined with a client centric focus to provide user-friendly innovative parking solution, as a major player in the UK parking market. For more information on TPS services please visit the Total Parking website or telephone Colin Johnson to discuss your specific requirements. FURTHER INFORMATION Tel: 0845 257 3540


The publishers accept no responsibility for errors or omissions in this free service 18 Week Support 34 Advanced Therapeutics 71 Aerogen 38 Arvato UK 32 Aston Cord Energy Services 70 Automated Document Services 44 Bosse Interspice 60 Caradigm UK 42 Catering Equipment Solutions 63 CB Renewables 70 Ccube Solutions 30, 31 Cefndy Healthcare 65 DataWizard 72 Decorative Panels Lamination 10 ETA Energy Systems 70 Fiat 26 FOZ Designs 73



Greyhound Stoves 29 Health and Care Videos 73 i-Clean Systems 14 iCompli 72 ISS Mediclean 6 LA Virtual Admin 72 Laidback Life 72 Langley Waterproofing 18 Marlux Medical 71 Medhand International 73 Modulek 14 OKI Systems 48 Olympus Medical IFC ParkingEye 56 Peugeot 58 Principles Media 62 Reintec 52 Ricotech 41 Rotowash 29

SAS Lining Services 74 Schneider Electric 8 Seat 24 Sidhil 54 SolarUK 71 Sturge Industries 71 Subway 54 Surfacide 22 Syzygy Renewables 70 Text Local 12 Thermatic 25 Total Parking Solutions 74 Towergate Insurance 16 Valtech_ 46 Wilo UK 28 XS Typing UK 73 Yeoman Shield IBC Zycko 4

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