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HEALTHCARE IT

AL MEDIC S E DEVIC ENT EM SUPPl Ltechnologiessi;n a t Medic evelopmen nd a d ; t e lates spital car o n h a e pr DIs c how U patient e v impro fety sa

FACILITIES MANAGEMENT

RECRUITMENT

OBESITY

SUGAR TAX What impact will the proposed levy have on obesity and its associated costs? FINANCE

SQUEEZED FINANCES

Can the NHS deliver the efficiency savings targeted for 2020? INFECTION CONTOL

KEEPING INFECTIONS UNDER CONTROL Assessing the risks still posed by ’superbugs’

PLUS: DATA HANDLING • MENTAL HEALTH • PATIENT SAFETY • PROCUREMENT


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HEALTH BUSINESS MAGAZINE ISSUE 16.2 15.6 VOLUME 16.2 www.healthbusinessuk.net

HEALTHCARE IT

AL MEDIC ES DEVIC ENT M s; gie SUPPLE technolo s in al pment Medic and develo latest spital care; pre-ho w UDIs can ho ient ve pat impro ety saf

FACILITIES MANAGEMENT

RECRUITMENT

OBESITY

SUGAR TAX What impact will the proposed levy have on obesity and its associated costs? FINANCE

SQUEEZED FINANCES

Can the NHS deliver the efficiency savings targeted for 2020?

Comment

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

Not so sweet a deal? Healthcare was conspicuous by its absence in Chancellor George Osborne’s 2016 Spring Budget. With mounting financial pressures, missed efficiency targets still running rife and the national press jumping on reports that funding forecasts have been drastically underestimated, many would have expected healthcare to feature more prominently in the Chancellor’s plans.

INFECTION CONTOL

KEEPING INFECTIONS UNDER CONTROL

Assessing the risks still posed by ’superbugs’

PLUS: DATA HANDLING • MENTAL HEALTH • PATIENT SAFETY • PROCUREMENT

It is unclear if the NHS is truly capable of meeting the £22 billion in savings targeted for 2020, with forecasts expecting figures to show an overspend of at least £2 billion for the last financial year. Mark Dylan of the Nuffield Trust examines the current financial challenges facing the NHS on page 11. The headline-grabbing announcement was the introduction of a ‘sugar levy’ on drinks, with the promise of reducing childhood obesity and raising more money for youth sports. It remains to be seen if such a tax could have any significant impact on obesity levels and the pressures it places on the NHS and, as Dr Matthew S Capehorn discusses on page 86, opinions appear to be conflicted among experts and stakeholders. With junior doctors taking part in the fourth round of industrial action, and a full walk out scheduled for the end of April, it seems this announcement may have been a diversion from the real issues affecting health in the UK.

Tommy Newell, assistant 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:

www.healthbusinessuk.net PUBLISHED BY PUBLIC SECTOR INFORMATION LIMITED

226 High Rd, Loughton, Essex IG10 1ET. Tel: 020 8532 0055 Fax: 020 8532 0066 Web: www.psi-media.co.uk EDITOR Angela Pisanu ACTING EDITOR Michael Lyons ASSISTANT EDITOR Tommy Newell PRODUCTION EDITOR Richard Gooding EDITORIAL ASSISTANT Rachel Brooks PRODUCTION DESIGN Jacqueline Lawford, Jo Golding PRODUCTION CONTROL Sofie Owen WEBSITE PRODUCTION Victoria Leftwich ADVERTISEMENT SALES Patrick Dunne, Ben Plummer, Jeremy Cox, Amanda Frodsham, Paul Nicholas ADMINISTRATION Vickie Hopkins PUBLISHER Karen Hopps REPRODUCTION & PRINT Argent Media

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Contents

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CONTENTS

07 NEWS

Manchester gets devolved health budget; calls for whistleblowers in GP practices; and junior doctors strike for a fourth time

11 FINANCE

The Nuffield Trust’s Mark Dylan examines what can be done to help deliver the £22 billion efficiency savings targeted for 2020

15 RECRUITMENT & RETENTION

11 15

Charlotte Bevan highlights the key findings from the Queen’s Nursing Institutes’ recent report on general practice nursing

21 PATIENT SAFETY

It is becoming easier for NHS staff to raise a concern about safety. NHS England’s Neil Churchill outlines the steps being taken to ensure staff feel supported to speak up

23 WASTE MANAGEMENT

Guidance from the CIWM can help producers of healthcare wastes to be aware of their legal obligations. Pat Jennings explains how to stay informed

25 INFECTION CONTROL

The Health Foundation discusses what has been learned from infection prevention over the past 15 years and the risks ‘superbugs’ still pose

23

37 MENTAL HEALTH

Alzheimer’s Society breaks down the key recommendations from its ‘Fix Dementia Care’ campaign

41 FACILITIES MANAGEMENT 25 47

How can technology shape the future of FM? Ian Burden gives his views on the possible benefits for the NHS

44 ESTATE PLANNING

Effectively managing the NHS estate can play an important role in system change. Clive Shore discusses how

47 MEDICAL TECHNOLOGIES

The Medical Technology Group discusses how wider access to trusted medical technologies could improve patient’s life chances

Health Business

51 PRE-HOSPITAL CARE

Dr Nick Crombie, clinical lead for Midlands Air Ambulance Charity, reviews the technological developments in pre‑hospital care and questions how these can be used to improve patient outcomes

54 GS1 STANDARDS

Unique Device Identification and GS1 barcode standards are being introduced in a bid to increase efficiency and improve patient safety. Andy Crosbie gives a break down of how these can be fully utilised across the NHS

57 HEALTHCARE IT

In light of Baroness Martha Lane‑Fox’s recommendations on digital inclusion, Gareth Baxendale gives his view on how digital technologies will shape the future of the NHS

61 DATA HANDLING

Health Business’ Ben Plummer looks at how better data management can improve delivery of care and increase efficiency across the NHS

69 UK EHEALTH WEEK

More than 3,000 health and care professionals are set to attend the most influential e-health event, with a focus on transforming healthcare through information technology

74 PROCUREMENT

Further, Faster is a new online resource designed to help NHS organisations and small technology companies work together

76 HEALTH+CARE 2016

The event for health and care professionals returns to London’s ExCel

83 HOSPITAL INNOVATIONS London’s Olympia will play host to a range of innovative ideas and products, bringing together key decision makers in hospital management teams

86 OBESITY

Dr Matthew S Capehorn weighs in on the ‘sugar levy’ and what impact it could have on consumption, obesity and the NHS

89 CONFERENCES & EVENTS Rachel Parker outlines what to consider when choosing a venue

www.healthbusinessuk.net Volume 16.2 | HEALTH BUSINESS MAGAZINE

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DEVOLUTION

Manchester becomes first region to gain control of health spending Greater Manchester has become the first English region to gain control of its health spending, as part of an extension of devolved powers. The £6 billion health and social care budget has been taken over by the region’s councils and health groups. The Greater Manchester Strategic Partnership is now formed of 37 organisations including hospital trusts, NHS England, the 10 borough councils and GP commissioners. The group will make key decisions on how budgets are allocated and targeted at specific health issues, instead of decisions being made at Whitehall. The government has claimed the move will help integrate health and social care services and ease pressure on hospitals, while improving home care services for patients who need it. Lord Peter Smith, chair of the Greater Manchester Health and Social Care Strategic Partnership Board, said: “I have seen firsthand the progress that has been made since the historic signing of the Memorandum of Understanding in February 2015, which took place between all the major public sector bodies of the region and Whitehall. “Establishing the new system has been the crux of our focus for the past 12 months and we have made unprecedented and unrivalled progress in this regard. Quite frankly, the progress we have made

has been revolutionary for the region and we are in a great place ahead of a new era for health and social care services.” Greater Manchester will remain as part of the NHS with nationally agreed targets, but leaders will be granted more freedoms and flexibilities to tailor their budget and priorities to the region’s needs. The Greater Manchester Combined Authority has said that this will allow health officials to respond to what local people want and delivered greater collaboration across public-sector services to improve services and ensure finances are sustainable. Ann Barnes, chief executive of Stockport NHS Foundation Trust said: “Our priority in Greater Manchester has always been to improve services and outcomes for patients. That’s never changed. But devolution will allow us to do things differently and faster. “For the first time, since the NHS was created in 1948, we will be able to join up health and social care services across our region. It should mean that more people leave hospital sooner and others avoid having to go to hospital all together. “Devolution ties Greater Manchester together for greater change. We know there are challenges ahead, but we’re ready and we’re excited.” READ MORE tinyurl.com/hz98wds

WHISTLEBLOWERS

NHS England guidance calls for GP whistleblowers by 2017 Draft guidance published by NHS England directs that all GP practices must appoint a whistleblower by April 2017. Under the plans, each primary care provider should provide a named individual which staff can turn to raise concerns and receive support. The guidance specifies that the new ’freedom to speak up guardian’ has to be ’independent of the line management chain and not the direct employer’. The guidance follows recommendations made by Sir Robert Francis in his report, Freedom to Speak Up, which investigated the culture of bullying in the NHS. Francis’ report suggested that the GP contract should include a standard for allowing staff to ‘raise concerns freely’. NHS England’s draft guidance instructs that each provider should name an individual, who is independent of the line management chain and is not the direct employer, as the Freedom to Speak Up Guardian; NHS primary care providers should be proactive in preventing any inappropriate behaviour, like bullying or harassment, or discrimination towards staff who raise a concern; and all NHS primary

care providers should review and update their local policies and procedures by March 2017, to align with the agreed guidance. Neil Churchill, NHS England’s director for patient experience, said: “This guidance builds on existing good practice, gives staff in primary care more options to share any concerns and sets out our expectations about how those concerns should be handled.” Dr Chaand Nagpaul, General Practice Committee (GPC) chair, argued: “The real elephant in the room is how we can whistleblow regarding concerns to the wider system problems GPs face, such as inappropriate demands being made of them – like being asked to arrange patient care and prescribe beyond their competence and being asked to take part in schemes with perverse incentives. “This focuses on the microcosm of the GP practice. The far bigger issue here is not being determined in practices but in the wider environment.” READ MORE:

tinyurl.com/gu2tyzt

News

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NEWS IN BRIEF NHS eating disorder waiting times under fire An inquiry led by the BBC has collated data from 41 mental health trusts and has found that the average waiting times for mental health treatment for eating disorders in England varies from 20-180 days, depending on the trust. Data released as a result of the Freedom of Information (FoI) request found that 1,576 people have waited 18 weeks to be seen by a mental health specialist since 2012, while 742 have waited 26 weeks and 99 up to a year. Mental Health charity Beat has called for more investment in mental health treatment for eating disorders. The information showed that waiting times for outpatient treatment has risen by 120 per cent in some areas over the past four years, with patients regularly made to wait over 100 days to see a specialist. There was considerable variation across the country’s regions, with the average wait in Manchester reaching 182 days, while places such as Dorset and Dudley had an average waiting time of just 20 days. In particular, Humber NHS Trust saw a 165 per cent increase in waiting times since 2012, with the average wait for 2015 reaching 82 days. Out of the 55 mental health trusts, 41 responded, with five claiming they did not provide an eating disorder service at all. Commenting on the results, Manchester Mental Health and Social Care NHS Trust said: “Where urgent, patients are seen within approximately two weeks. Waiting times for therapy are longer than we would wish. If more services were commissioned, more services could be provided. The trust continues to work within tight funding levels and with increasing demand.” The Department of Health (DoH) said it had set a new goal to ensure 95 per cent of patients with eating disorders would be seen within four weeks, or one week for urgent cases.

READ MORE:

tinyurl.com/hu2v5ua

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NEWS IN BRIEF NHS to extend pharmacy flu vaccination scheme NHS England and pharmacy leaders are discussing the possibility of renewing the national pharmacy flu vaccination contract for a second season, despite concerns the programme has contributed to a fall in uptake of the vaccinations. According to Pulse, pharmacy leaders are looking for a renewal of the contract ‘as soon as possible’, while NHS England has maintained the arrangements would be announced ‘in the next few weeks’. However, GP leaders have argued that the contract should not be renewed if it has not improved uptake because of the risk that it would further destabilise the programme delivered by GP practices. The contract was originally introduced last September and involved issuing funds to pharmacists across England to provide flu jabs as part of the annual NHS flu vaccination campaign. The campaign was aimed at targeting hard to reach recipients such as working‑age adults. Nonetheless, official figures suggest the uptake of the vaccination has fallen across the country with the General Practitioners Committee (GPC) warning the programme has disrupted established flu clinics and cost practices as much as £4 million in lost vaccine payments. READ MORE:

tinyurl.com/zoblyoq

Diabetes incidence has quadrupled WHO warns A report by the World Health Organisation has warned that cases of diabetes have nearly quadrupled to 422 million in 2014, from 108 million in 1980. The Global Report on Diabetes suggested that high blood sugar levels are linked to around 3.7 million deaths around the world each year. While the report accumulates both type 1 and type 2 diabetes, it accounted the rise in cases to type 2, which is mainly linked to poor lifestyle. In an interview with the BBC, Dr Etienne Krug of the WHO who led the report, said: “Diabetes is a silent disease, but it is on an unrelenting march that we need to stop. We can stop it, we know what needs to be done, but we cannot let it evolve like it does because it has a huge impact on people’s health.” READ MORE

tinyurl.com/jehudp7

News

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JUNIOR DOCTORS

Junior doctors partake in fourth strike Junior doctors in England have taken part in the fourth strike in their campaign against the government’s move to impose the new junior doctor contract. The 48 hour strike began at 08:00 Wednesday 6 April and doctors once again provided emergency cover, however, 5,000 operations and procedures were postponed. The latest strike means the total number of delayed treatments has now hit 24,500 during the dispute. While both the government and the British Medical Association (BMA) are urging for further negotiations, each have remained adamant that they will not compromise on their positions. Further strikes are due to take place from 08:00 to 17:00 on both the 26 and 27 April and will be the first strikes to include emergency care in the history of the NHS. The all-out strikes mean junior doctors will refuse to staff A&E departments as well as emergency surgery and intensive care. Commenting on the strikes, Johann Malawana, leader of the BMA, said: “By pursuing

its current course, the government risks alienating a generation of doctors. If it continues to ignore junior doctors’ concerns, at a time when their morale is already at rock-bottom, doctors may vote with their feet which will clearly affect the long-term future of the NHS and the care it provides. “Responsibility for industrial action now lies entirely with the government. They must start listening and resume negotiations on a properly funded junior doctors’ contract to protect the future of patient care and the NHS.”

READ MORE

tinyurl.com/jzxkkpn

ASTHMA

Asthma diagnosis becoming trivialised, study warns A new study published in the Archives of Disease in Childhood has suggested that too many children are being incorrectly diagnosed with asthma, leading to the illness becoming trivialised in healthcare. The report, entitled Is asthma overdiagnosed? warned that there should be more objective and careful diagnoses, with Asthma UK agreeing that better and more accurate testing is required. Official figures show there are around 5.4 million people currently receiving treatment for asthma in the UK, 1.1 million of whom are children. In particular the report outlined that while steroid inhalers are lifesaving when used properly, their side-effects should not be ignored. As there is no definitive test to determine whether someone has asthma, doctors rely on guidelines to work out if someone has the condition. However, the research suggests that doctors need to think more carefully about each diagnosis they make and consider more objective and even invasive checks to confirm the illness. The study recommends that in instances where the child’s condition is not improving despite the use of asthma medication, doctors should consider other diagnoses’ rather than merely increasing the dose of medication. It also highlights that many children outgrow their symptoms and that

diagnoses should be checked over time to ensure they are still relevant. Professor Mark Baker of the New National Institute for Health and Care Excellence (NICE) said: “Accurate diagnosis of asthma has been a significant problem which means that people may be wrongly diagnosed or cases might be missed in others.” Meanwhile, Asthma UK has called for more funding to increase research and development to procure a definitive test for the condition. Dr Samantha Walker of Asthma UK said: “It is astonishing in the 21st century that there isn’t a test your child can take to tell if they definitely have asthma. Asthma isn’t one condition but many, with different causes and triggered by different things at different ages. Asthma symptoms also change throughout someone’s life or even week-by-week and day-by-day. She added: ”This complexity means that it is both over and under-diagnosed, in children and in adults, so people don’t get the care they need to manage their asthma effectively. As a result, a child is admitted to hospital every 20 minutes because of an asthma attack and asthma attacks still kill the equivalent of a classroom of children every year in the UK.” READ MORE:

tinyurl.com/hvxn6np

Volume 16.2 | HEALTH BUSINESS MAGAZINE

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EFFICIENCY SAVINGS

The big squeeze The NHS faces many historic challenges over the next few years – seven-day working, a transformation of general practice, compiling and using patient data safely and with public support. But the question of money looms above them all. By the account of the Five Year Forward View, the health service must deliver £22 billion in savings by 2020. This is a level of efficiency improvement almost unprecedented in the recent history of the NHS, or indeed the private sector. It represents the projection forwards of a level of financial pressure that has already seen the NHS descend into an increasingly difficult struggle to stay within its means over the last few years.

The totemic sign of this pressure is the deficits run up by hospital trusts. Even optimistic forecasts accept that final figures for the financial year ending in April 2016 will show an overspend of £2 billion, larger than many entire government departments. By the norms of Whitehall, simply spending taxpayers’ money without permission like this is unacceptable. The Treasury has ‘locked’

A FIVE-YEAR BACKWARD LOOK How did the health service get here? The answer is a set of fairly well understood pressures, which apply not just to hospital trusts but to the system as a whole. Four years ago, the Nuffield Trust carried out a study to estimate the future impact of factors driving costs upwards in the health service. We estimated that they would increase at around four per cent each year above inflation. This rising demand E

Even tic optimis ccept ts a forecas al figures that fin financial for the ing in April d year en ill show an w 2016 spend of over llion £2 bi

Volume 16.2 | HEALTH BUSINESS MAGAZINE

Written by Mark Dayan, policy and public affairs analyst, the Nuffield Trust

Mark Dayan of the Nuffield Trust, examines the current financial issues facing the NHS and what can be done to help deliver the £22 billion in savings targeting for 2020

£1.8 billion of bailout money for next year, accounting for most of the Sustainability and Transformation Fund intended to support the NHS in developing new ways of working and models of care. It will be held back unless financial targets are met, in an attempt to give trusts no option but to deliver savings. But the drivers that created this problem remain as intractable as ever.

Finance

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EFFICIENCY SAVINGS  has indeed been seen, most visibly simply in the number of people needing treatment. From 2009/10 to 2014/15 referrals by GPs rose by 16 per cent; emergency admissions through A&E by 18 per cent. Less visible, but adding to the impact of the growing and ageing population, is the increase in the severity of the average patient’s needs, which means each of these cases is likely to require more resources. Forthcoming work by the Nuffield Trust will aim to factor this into estimates of NHS demand and productivity. Meanwhile, NHS funding has risen by only around one per cent each year on average since the study was carried out. On the ground, hospital finance directors and GP managers start each year looking at projected patient numbers and needs that basic sums tell them will be too high to be met from the pot of money they receive, unless significant cost cuts are delivered. They identify these – and many are successfully delivered – but not fast enough to keep up: across the NHS, productivity has recently improved by between 0.3 per cent and two per cent each year. A significant part of the gap has simply ended up as red ink on the balance sheet in the form of deficits.

The capital budget that funds new NHS buildings and equipment, and the Health Education England budget for training clinicians also face cuts in real terms. We at the Nuffield Trust are concerned the overall effect of these will be to undermine attempts to make the NHS more cost effective through, for example, public health prevention and investment in new technology. At the same time, policies around seven‑day working ask the NHS to deliver more – with case studies of weekend working showing that it comes at a significant price. The upshot is that the £22 billion in savings, already an ambitious figure, now looks more difficult to deliver and may not even be enough.

Policies around y a seven‑dthe NHS ask workinger more – case to deliv s of weekend studie ing show work omes at that it c rice ap

SAVED FROM THE CHOP? Last year’s Spending Review was presented as giving the NHS the £8 billion it requested in full. The Forward View, interpreted as demanding this figure, suggested that along with £22 billion savings, this would make it possible to fully close the funding gap by 2020-21. In the context of an austerity budget with large cuts to many other departments, this was a good deal for the health service. Look more closely, though, and the settlement seems somewhat less generous. Overall funding for the Department of Health will actually rise by just £4.5 billion. In percentage terms, that is around 0.9 per cent each year – almost identical to what was received during the last parliament. The reason that the £8 billion for ‘the NHS’ seems larger is because the NHS has been redefined to consist only of a core set of services: NHS England and the bodies it funds. This means that, although the Spending Review increased the resources of NHS England by £8 billion by 2020, it did so by cutting funds from other parts of the Department of Health budget. This means sizeable reductions in public health spending, directed to services which aim to keep people from needing the NHS, which will be cut by at least £600 million.

THE FUTURE IS TIGHT The literally billion‑pound question is where these savings will come from. Perhaps the most important source of efficiencies so far has been the steady improvements NHS trusts can deliver from their back offices and clinical services: more efficient rostering, better procurement, administrative cuts and mergers, and so on. For years the tariff prices paid for care have sought to bake these savings in through an ‘efficiency factor’. Averaging around four per cent over recent years, this ratcheting down of prices made trusts both absorb the costs of inflation and deliver cash reductions in the prices they were paid for providing treatments. Trusts appear to have responded by delivering a significant

Finance

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and will now be called on again is pay. The four-year one per cent pay cap announced at last Summer’s budget, a sizeable real terms cut, could mean several billion pounds in savings compared to a future in which pay rose ahead of inflation. The crucial question is at what cost this will come in damage to morale, recruitment or the retention of staff whose skills could transfer so easily to Canada or Australia. The potential for savings from eliminating agency staffing has been overplayed at times. It is important to remember that they will have to be replaced by permanent staff: the only savings will be from the ‘agency premium’ by which agency staff currently exceed the usual rate of pay. Even so, this might realistically deliver hundreds of millions of pounds in savings. But none of this adds up to £22 billion by 2020 – or anywhere close. To get to that, the NHS will need not just to deliver productivity savings to fill the gap we diagnosed four years ago, but to shrink the gap itself – by reducing the rise in demand, especially for hospital services. This is what many of the Forward View’s new models of care aim to do, whether through treating patients in scaled-up general practices instead of in hospital, or by preventing need from developing in the first place by providing better preventive care to at-risk groups like care home residents. Yet evaluations by the Nuffield Trust and others of innumerable previous initiatives to reduce hospital admissions in a cost‑effective way show that they hardly ever bear fruit in the short term. Changing how people work so fundamentally that it actually

The potential for savings from eliminating agency staffing has been overplayed at times. It is important to remember that they will have to be replaced by permanent staff proportion of this – although not all, which accounts for the emergence of deficits. Seen in this light the £5 billion in new savings identified with much fanfare by Lord Carter’s recent review is no more than business as usual for many NHS trusts. It represents an annual recurrent efficiency saving of around two per cent a year, and while meeting that target will help prevent providers’ underlying deficit getting any bigger, it will not be enough to even start to close the gap. That suggests the ‘sustainability fund’, set to deliver £1.8 billion in bailouts for 2016-17, will need to be replicated in the years that follow. Another area which has delivered significant savings over the last five years

changes the health and behaviour of patients takes several years, time that the NHS may not have. The ‘hard-edged’ sustainability plans currently being produced by 42 areas across England will include ambitious commitments to manage demand. Central bodies hope that if they apply enough pressure to meet these, local areas will strain every sinew and manage to deliver them. But where the problem is that nobody actually knows how this can be done, or even if it can, effort in itself might not be enough. L FURTHER INFORMATION www.nuffieldtrust.org.uk

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GENERAL

PRACTICE NURSING

Volume 16.2 | HEALTH BUSINESS MAGAZINE

Written by Charlotte Bevan, the Queen’s Nursing Institute

Nursing the workforce back to full strength

The Queen’s Nursing Institute (QNI) recently launched a major new report on the general practice nursing profession. The report General Practice Nursing in the 21st Century: A Time of Opportunity is based on an online survey completed by over 3400 general practice nurses (GPNs) during 2015. It summarises some of the key challenges affecting the profession today and it is the largest and most up to date survey of GPNs. In the study, the QNI has sought to create a snapshot of the role of the general practice nurse in 2015, based on the perspectives of the nurses themselves. The study was inspired by the 2020 Vision reports that the The recruitment and retention of an adequate supply of nurses is QNI published in 2009 and 2014, which currently a hot topic in the healthcare sector. The QNI’s Charlotte focused on the work of the district nurse Bevan discusses the findings from its report into the challenges (DN). Those studies highlighted the particular affecting the general practice nursing profession challenges facing district nurses, which have led to specific policy responses from the QNI and other healthcare organisations, which are still ongoing. The QNI wished to replicate this work to highlight the unique challenges facing general practice nurses, who undertake very different work and whose employment structure is completely unlike that of their DN colleagues. Headline findings of the survey can be grouped into three categories, workforce, education and employment.   WORKFORCE Regarding workforce, the report found: 33.4 per cent of General Practice Nurses are due to retire by 2020; men are under‑represented, comprising only two per cent of the general practice nurse workforce; 43.1 per cent of GPNs did not feel their nursing team has the right number of appropriately qualified and trained staff to meet the needs of patients; and at the time of the survey, 78.8 per cent had considered preparation for NMC re-validation. These findings highlighted the pressing issue of workforce, with more than a third of current GPNs due to retire by 2020. This situation is generally well known by individual employers who are finding it increasingly hard to fill nurse vacancies in their practices. However, this report provides employers, service and education commissioners with conclusive More d r data on the challenges of succession i h t   a than ent planning for the GPN workforce and the need to develop a robust strategy of curr actice r which will enable the workforce to be p l genera are due replaced with competent practitioners as the current workforce retires. nurses by 2020. When thinking about the skills of e r i t g e in their current nursing team participants to r are findse commented: s r e y o l “Increasingly we are Emp ll nur fi o t working with patients with multiple d r it ha s e i health conditions who previously would c n a c va have been cared for within a secondary care setting. We need to upskill GPN’s, recognise this as a specialist arm of nursing and remunerate appropriately with consistency across the profession around titles, competencies and education.” E

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GENERAL PRACTICE NURSING

There is much that needs to change to both plan for the next generation of nurses who are needed in general practice and to support those who make up the current workforce in primary care  EDUCATION The headline findings relating to education included: 53 per cent reported that their employer always supports their professional development; 10.6 per cent hold an NMC recordable specialist practice qualification in general practice nursing; 32.6 per cent of general practice nurses are independent prescribers; just 27 per cent of the employers offered placements for pre-registration nursing students, compared to 61.5 per cent offering placements to medical students. On training the current and future workforce, one respondent commented: “I think we need to consider some general foundation training for new practice nurses and we need to encourage practices to engage with student nurse placements. It is only by focussing on these things that we can ensure we have a future workforce fit for purpose.” EMPLOYMENT Relating to employment, the key statistics were: 22.8 per cent of nurses working in general practice have two jobs; 32.6 per cent of general practice nurses reported working evening sessions (after 6pm) and 18.5 per cent work weekends; over 38.3 per cent indicated that they undertook visits to patients at home; only 35 per cent felt that their salary reflected their role within the practice; salary and other terms and conditions such as annual leave entitlement vary widely. When asked if salary reflects their role, the majority of participants disagreed, for example one respondent commented: “Not at all. I am a supplementary and independent prescriber and my salary compared to that of my peers who work in secondary care with the same qualification is much less. I work very much in isolation and am often the only clinician on the premises which carries a great deal of autonomy and responsibility.” Whilst evening and weekend work may reflect the opportunity for flexible working, some respondents raised concerns about working unsociable hours, for example: “GP nurses are often very good nurses that have opted for this work because of the hours. If they are forced to work unsociable hours we may well lose some of them from the NHS.” Following the report’s findings, Dr Crystal Oldman, QNI chief executive, commented: “This survey validates the role of the general practice nurse and the support provided by nurses in general practice at every point during a person’s life, from infancy, childhood, adolescence and adulthood, to middle and older age. They are a vital part of the

healthcare system in every part of the UK. The findings of the survey indicate some major challenges and opportunities which need to be addressed. The role of nurses in general practice is expanding rapidly, and many of today’s nurses are now undertaking roles traditionally the reserve of GPs. There is a huge opportunity for increased investment in the general practice nurse workforce, to build the capacity of primary care, move more care to the community and closer to people’s own homes, and ease the pressures on A&E. “The survey findings will be useful to policy makers and workforce planners as they explore new models of care and meet the challenges of an older population with multiple and complex healthcare needs. The number of nurses planning to retire should be of major concern and we need to ensure that enough nurses are attracted to the profession so that patients can continue to receive high quality nursing care for themselves and their families when they attend the GP’s surgery.”

nationally, regionally and locally to determine the numbers of GPNs (including NPs) required, to facilitate the development of the next generation of general practice nurses to meet the health needs of local populations. Thirdly, an increase in the profile of general practice nursing as a specialist area of nursing and a rewarding career option for all – including a target audience of applicants for nursing, student nurses and qualified nurses working in other areas and, fourthly, an increase in the number of substantive student placement learning opportunities for student nurses who express an interest in pursuing a career in primary care, supported by an increase in the number of qualified mentors in the existing GPN workforce. The fifth action proposed by the QNI is for more structured support for those who are new to general practice nursing, including mentorship or preceptorship and appropriate support for skills development, and the sixth is to give more consideration to the terms and conditions of the GPN workforce at a local level to ensure that they are commensurate with the scope and responsibilities of the role - this may include a benchmarking exercise locally, regionally and nationally. To support nurses who are new to general practice, the QNI launched a free online learning resource in January 2016, ‘Transition to General Practice Nursing’, based on the knowledge and expertise of nurses and educators working in the profession.  Throughout 2016 the charity will also work with QNI Scotland to produce new Voluntary Standards for General Practice Nurse Education and Practice, which will enhance the existing Nursing and Midwifery Council specialist practice standards for general practice nursing. L

Recruitment & Retention

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With an more th 3,400 there ents, respond nce that this de e is confi representativ data is UK’s general of the ice nurse pract ation popul

ACTIONS TO BE TAKEN Overall the report provides a clear and detailed illustration of the current challenges being experienced by the general practice nurse workforce. It provides a picture of a highly skilled nursing workforce, enjoying their work with local communities and colleagues, but understanding that there is much that needs to change to both plan for the next generation of nurses who are needed in general practice and to support those who make up the current workforce in primary care. With more than 3,400 respondents from across all geographical areas, there can be confidence that the data presented here are broadly representative of the general practice nurse population in the UK and the QNI has called for co-ordinated actions to be taken to address the issues identified in the report. Firstly, it has called for consideration of the current and potentially greater contribution of general practice nurses, including nurse practitioners (NPs), in meeting the health needs of local populations, particularly in the context of declining numbers of general practitioners. Secondly, the QNI believes that a robust workforce plan should be implemented

The QNI is a charity which was founded in 1887 and originally trained district nurses to treat patients in their own homes. Today it offers a wide range of support to all nurses who work in the community, through financial assistance and educational grants, policy work, campaigns, events and publications. The QNI strongly believes that high quality nursing should be available for everyone, where and when they need it. The title of Queen’s Nurse (QN) was reintroduced by the charity in 2007 and general practice nurses are eligible to apply for the QN title. FURTHER INFORMATION You can read General Practice Nursing in the 21st Century: A Time of Opportunity in full here: tinyurl.com/ zrz35k2 and access Transition to General Practice Nursing here: tinyurl.com/jkjuqqp

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Short staffed? Are you looking for Mental Health Nurses?


GENERAL PRACTICE NURSING Recruitment: the REC’s Vicky O’Brien comments Regarding the issues of recruitment and retention currently facing the NHS, the REC’s Vicky O’Brien says: “The recent caps and controls introduced to reduce agency spend are illogical and counter‑productive in their design, and risk jeopardising patient access to high quality care across the NHS, as well as escalating agency spend in the long term. “Over the past six months, NHS Improvement has introduced a variety of caps and controls to reduce NHS trusts’ agency spend, and dis-incentivise healthcare professionals from choosing locum work over bank or substantive roles. For all these highly disruptive interventions, they have still failed to tackle the fundamental driver of agency spend in the NHS: the shortage of staff willing to work to standard substantive pay and conditions. “While REC members continue to supply staff to cover last minute sickness and spikes in demand, they are also increasingly being called upon to cover longer-term vacancies and staffing

Recruitment & Retention

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placements is consistently flagged in the REC’s ‘Report on Jobs’ survey, the most up-to-date monthly picture available of recruitment, employment, staff availability and employee earnings in the UK jobs market.

gaps caused by years of poor workforce stewardship by the government. As many as 82 per cent of agency bookings by 54 NHS trusts in Q2 2015/2016 were to fill substantive vacancies, an increase from 66 per cent of bookings in Q3 2014/15. “Ensuring our wards are safely staffed is becoming increasingly challenging not only for NHS trusts but also their temporary staffing suppliers. The lack of nursing, medical and care staff available for both perm and temporary

“While we fully support recent efforts to improve booking procedures at trust level, as one acute trust neatly surmised in a recent Kings Fund’s NHS Quarterly Monitoring Report: ‘We need a workforce solution to ensure that we can recruit sufficient nurses and doctors. The increase in temporary staffing is not just down to a lack of controls’. “Stakeholders across the NHS are having to concede that government cuts to training places, high attrition rates due to unfavourable substantive pay and working conditions, and barriers to overseas recruitment are really starting to bite. Nearly everyone, it seems, except the Secretary of State for Health.”

The NHS Agency capping. Is cost opposing true value? From the 1 April 2016; no fooling here, Monitor and the NHS Trust Development Authority will have implemented the final agency rate capping at 55 per cent above AFT banding rates. This strategy though providing a necessary cost saving tool does however provoke questioning thoughts. Can Frame Work suppliers sustain despite being limited by this capping, the same level of service and will the NHS receive not only the cost saving benefits but also the true value? What is the true value? The aged old saying ‘you get what you pay for’ may well be exercised in the near future with Frame Work suppliers having to find their own efficiencies to compensate for the loss in revenue. Will these cost saving measures effect the quality and reliability of their service provision to the NHS? If this provokes a yes, then it suggests that cost savings will supersede true value, which may well become a regrettable sacrifice.

It must also be accepted that the demand for nursing staff by the NHS does exceed the supply from Frame Work agencies, as reported by the Nursing Times with Acute Trusts massively breaching the agency cap. Though restricted by the rapidly evolving nursing agency market conditions, the independent agencies are still very able to provide broadly an excellent competitively priced service. However, their provision to the NHS has become hugely limited accept for when the rules can be overridden in the interests of patient safety. These same market conditions may also

provoke movement of Frame Work agency nurses to independents. If this occurs, then service provision to the NHS by the Frame Work parties may well become impaired further. One might suggest the capping will provide a realistic value in relation to the future costs, but is it an acceptable and sustainable sacrifice? There is much to question with respect to the reactive potential of the capping. This unchartered territory will out of necessity evolve swiftly. Let us hope the independents are given the opportunity to demonstrate and exercise their true value. Is this capping a productive and efficiently effective means of achieving savings, but at the detriment of receiving true value? Only time will tell. FURTHER INFORMATION 0117 968 4474 medicatltd@gmail.com www.medicatltd.co.uk

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HEALTH BUSINESS MAGAZINE | Volume 16.2


RAISING CONCERNS

Patient Safety

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Guardians will help whistleblowers speak out Neil Churchill, NHS England’s director for patient experience, discusses the steps that are being taken to ensure primary care staff feel supported if raising safety concerns There is no greater insight in the drive for NHS improvement than that gained by listening to patients, families and staff. It is now the norm for patients to be asked for feedback. Two-thirds of people with cancer complete the annual Cancer Patient Experience Survey and over 17 million pieces of feedback have now been given through the Friends and Family Test. Complaints, too, can be gold dust for service improvement and NHS England and the Parliamentary and Health Service Ombudsman have recently published a review of the quality of complaints handling in primary care, which demonstrated that outstanding practices are those which make it easy to complain and act on what they hear. FREEDOM TO SPEAK UP Now it is becoming easier for NHS staff to raise a concern about safety. Clinical staff already record incidents on a national reporting system, so that colleagues across the NHS can learn from them. We know, however, that not all staff have felt completely confident in raising a concern with their direct managers. That’s why NHS Trusts have appointed Freedom to Speak Up Guardians, to ensure that issues can be flagged to senior managers in a variety of ways. NHS England is starting a consultation on guidance for primary care organisations, on how they can encourage staff to share concerns. This requires each practice to identify a Freedom to Speak Up Guardian, either within the practice or within another local part of the NHS. In addition, from 1 April, NHS England will become a ‘prescribed person’, which means that NHS whistleblowers who work in general practice, dentistry, ophthalmology and community pharmacy can raise concerns directly with us with potentially the same employment rights as if they make the disclosure directly to their employer. These initiatives are the sharp edge of a bigger effort to promote working cultures in the NHS which are based on the principles of listening, learning and improving.

stage, so that problems can be avoided and lessons learned. To truly adopt such a culture requires strong leadership and openness to what people are saying. Much of the feedback results in small, simple changes that can make a big difference to patients and their families. Sometimes, issues are raised which need a wider response, like what has happened to improve recognition and treatment of sepsis. Feedback can also reveal how the design of services needs to change, for example to better meet the needs of family carers. Ultimately, the most powerful drivers of improvement are the conversations between NHS staff, patients and their families. The NHS is at its most effective when we are open and responsive to what people say. Insight from patients, families and staff are driving improvement throughout the NHS but the approaches recommended in this new guidance will help us be the best we can be. L NHS England recommends that anyone contemplating making a disclosure should first contact the NHS Whistleblowing Helpline on 08000 724 725 or Public Concern at Work on 020 7404 6609. FURTHER INFORMATION www.england.nhs.uk

About Neil Churchill Neil Churchill is director for Patient Experience at NHS England, where he leads improvement work on the quality of care experiences. His brief includes NHS England’s Commitments to Carers, improving experience for people with cancer, working with users of learning disability services to improve quality, improving maternity services, enhancing staff experience and learning from complaints and whistleblowers. Neil is a member of the Executive Board for the Beryl Institute, the global thought-leader for patient experience, and is a trustee for a number of charities. Prior to joining the NHS, Neil had a 25-year career in the voluntary sector at organisations including Asthma UK, Age Concern, Barnardo’s and Crisis. Neil was also a non-executive director for the NHS South of England and a member of the National Information Governance Board. He has a doctorate in art history and lives in Sussex.

AN OPEN CULTURE Healthcare can be a complex task, involving several disciplines at the leading edge of science and our goal must be to enable every member of the team to raise a concern at any

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HEALTH BUSINESS MAGAZINE | Volume 16.2


Waste Management

LEGAL OBLIGATIONS

Recent guidance from the Chartered Institution of Wastes Management is aimed at ensuring all producers of healthcare wastes are aware of their legal obligations and good practice The management of waste from all healthcare premises and practices (including those non‑healthcare premises that produce similar types of waste) involves a considerable amount of fairly complex legislation which must be complied with by all parties involved, from the producer through to the final disposal company. It is not just about the law, however, improved awareness and waste management practices help lower costs, protect staff, and reduce environmental impact. Because of this, the Chartered Institution of Wastes Management (CIWM) has published a range of guidance documents over the last two years to help both healthcare practitioners and others who handle healthcare waste in other sectors to understand what they need to do to ensure that they are complying with the law and implementing efficient and cost effective management procedures. HEALTHCARE TYPE WASTE The latest guidance, published early in 2016 and entitled ‘Managing healthcare type waste from non-healthcare activities’, deals with the management of healthcare wastes produced at premises that are not considered to be traditional healthcare providers. “Existing guidance from the Department of Health covers the management of healthcare wastes in primary healthcare providers such as hospitals, doctors’ surgeries and nursing homes. However, similar wastes which require specialist treatment are also generated in a range of non-NHS contexts, for example beauty salons, tattooists, some types of care facilities, and police stations to name just a few,” explains Wendy Rayner, chair of CIWM’s Healthcare Waste Special Interest Group. “Many of these facilities might be unaware of the regulations governing this waste and we felt it was important to provide support and promote a wider and better understanding of legal requirements and best practice. The guidance seeks to reinforce the message that everyone producing waste has a legal Duty of Care to ensure that it is managed properly and safely throughout the management cycle, from safe handling, segregation, and storage through to collection,

disposal and record keeping. It reflects the fact that more and more SMEs are producing these wastes and may not be confident or have sufficient understanding to segregate waste correctly or engage with waste contractors and secure the right services. “Because these can be niche sectors, they can be hard to reach and so the CIWM SIG intends to engage with relevant trade bodies. The guidance has already been well received by UKHCA, the professional association for home care, and circulated to their members. Other priority businesses might include gyms, where sharps containers are increasingly being provided, nurseries, and the growing number of cosmetic enhancement clinics,” explains CIWM technical officer Greg Logelain. This complements two guidance documents on healthcare waste management published by CIWM in 2014 which have been widely welcomed. An Introductory Guide

audits, as required by the Environmental Permitting (England & Wales) Regulations. Pre-acceptance waste audits are required to ensure that healthcare wastes are sent for the correct treatment and disposal, and robust auditing and reporting practices are essential to ensure compliance. Good auditing and classification systems, however, also brings other benefits, including potentially significant cost savings and carbon footprint reductions that can be realised by efficient and appropriate segregation of higher and lower risk healthcare waste streams. At the time of publication, for example, estimates by the Royal College of Nursing suggested the potential for annual savings of approximately £5.5 million for the NHS if just 20 percent of incorrectly classified infectious waste were to be reclassified as offensive waste with lower associated waste management costs.

Written by the Chartered Institution of Wastes Management

Help is at hand for healthcare waste management

Pre-acceptance waste audits are required to ensure that healthcare wastes are sent for the correct treatment and disposal, and robust auditing and reporting practices are essential to ensure compliance to Healthcare Waste Management in England & Wales April 2014 provides a detailed overview for small producers of healthcare wastes in both healthcare and non-healthcare environments. It is aimed primarily at small producers of healthcare waste, and covers a range of topics including an overview of the legislation, good practice in handling, segregation, storage and transport, and efficient reporting and monitoring systems. PRE-ACCEPTANCE WASTE AUDITS ‘Pre-Acceptance Waste Audits - A guidance document for large healthcare waste producers in England January 2014’ meanwhile, provides simple and concise guidance on pre-acceptance waste

Mat Crocker, head of illegals & waste for the Environment Agency, welcomed the guidance, saying: “It is essential that producers of waste correctly segregate and describe their waste to ensure that it is managed correctly and gets to the right place. “This guidance for producers of healthcare waste sets out how waste audits can help producers both to fulfil their requirements and to enable their waste management contractor to comply with their legal obligations. The Environment Agency welcomes this publication and the work that CIWM has put into its production.” L FURTHER INFORMATION www.ciwm.co.uk

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Advertisement Feature

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INFECTION CONTROL

MODULAR WARDS AND INFECTIOUS DISEASE WARD The North West London Hospitals NHS Trust required a new modular development to provide acute ward accommodation for 48 bed spaces along with a fifteen bed isolation ward and ancillary rooms This was to be housed over five storeys of modular accommodation including a curtain glazed main entrance and top floor plantroom. The main building, measuring 4327 m2, was to be built on a transfer structure to allow continued movement at ground floor of ambulances serving the new facility. THE SOLUTION The new modular wards are positioned in a tight space between the hospitals existing operating theatre suites and emergency department. One of the key priorities for the new ward was a good connection to the existing emergency department. The link was provided by a main link corridor approximately 50 metres in length along with an open plan link area. Planning of the foundations was a challenge due to the existing location at a main substation, HV and LV cables and the main medical gas oxygen supply to the hospital. To greatly reduce any disruption to the Trust and due to the concentration of loads at column positions, an augered pile solution was designed which incorporated 172 piles with diameters ranging between 325 – 450mm. The main accommodation was split over three floors with a 24 bed design to Level 3 and Level 4. Level 5 consists of a state of the art isolation ward with fifteen isolation rooms including positive pressure lobbies.

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Each floor is served by two lifts with the lift lobbies being designed with graphic designed décor stating the name of each floor (named after Crick, Darwin and Elgar). Repeatable room designs were utilised throughout the floors with four bed multi wards, single bedroom accommodation and standardised isolation rooms. Each floor was served with a modern designed reception area including a curved desk, feature decoration and TV displays. Touchdown staff bases were also incorporated into the layout design giving nurses and clinicians an excellent observation point over the wards. All floors were designed and installed to achieve the response factor required by HTM for night ward accommodation using a hollow rib deck construction infilled with reinforced concrete. Internal finishes were of a high standard throughout with all doors to the isolation ward being fully encapsulated. The external finish of the building was a Formica Vivix Rainscreen cladding with the plantroom having a contrasting louvred screen. Within the top floor plantroom is a large amount of specialist equipment including 17 no. air handling units, IPS and UPS equipment and a chiller plant. Each isolation room is served by its own air handling unit to comply with the stringent regulations. These rooms are also monitored by

pressure alarms. Sustainable renewable technologies were incorporated within the building infrastructure along with smart technology LED lighting. MTX commenced on site in February 2015 with a site set up and site strip works. Throughout the project, MTX had a core project team based on site including site managers, construction and M & E manager and a health and safety manager. PLANS AND COMPLETION The module installation had to be planned months in advance with the Trust to ensure logistics and careful co-ordination with all elements of the restricted site space and location. Throughout the lifting operation of all 105 modules, the main one way ring road around the hospital along with the blue light route were not disrupted and maintained clear at all times. The module installation was completed in July 2015 with the trust taking full occupational use of the building in early January 2016. MTX worked closely throughout the scheme with the Trust’s team and capital project manager to deliver a flagship building to a very high standard. L FURTHER INFORMATION www.mtx.co.uk


Infection Control

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SUPERBUGS

Written by Alison Holmes and Raheelah Ahmad of the Health Foundation

Superbugs: knowing the score today and tomorrow The Health Foundation outlines what has been learned from infection prevention and control work carried out over the last 15 years in hospitals in England. Drawing on its recent publication, Infection Prevention and Control: Lessons from Acute Care in England, it examines the potential risks as new threats emerge, including antibiotic resistance and new strains of infection Infection control has been high on the political and healthcare management agenda since the 2000s, and it is easy to forget that this was not always the case. A 2000 National Audit Office (NAO) report was highly critical of the strategic management of Healthcare-associated infections (HCAIs) in England. The report criticised the lack of information about the infections and the limited resources allocated to infection control teams. A key problem identified was that the size and scope of HCAIs was simply unknown. A voluntary scheme for reporting blood stream infections (BSIs) existed during the 1990s, but suffered from problems of completeness and comparability. More broadly, the report suggested that HCAIs had come to be seen

as an intractable problem, regarded by hospital clinicians and managers as an inevitable consequence of providing health care. Such infections were thus regrettable, but were to a large extent tolerated. In 2001, mandatory reporting of methicillin‑resistant Staphylococcus aureus (MRSA) BSI cases in hospitals was introduced, with a few other selected infections included in the surveillance programme in subsequent years. But, despite this intervention, improvement was not immediate.

‘SUPERBUGS’ Criticism remained of the failure of the NHS to ‘get a grip’ on both the extent and the cost of HCAIs. ‘Superbugs’ became a frequent and often vivid topic in the media and a focus of huge public concern and political attention. There was a steady increase in newspaper stories about ‘hospital superbugs’, peaking in the run-up to the 2005 election, and the introduction of the MRSA target in April 2005 (requiring a year-on-year reduction of E

In 2001, y or mandat g of reportinresistant llinmethici coccus aureus o Staphyl A) BSI cases S s (MR tals wa i p s o h in ced introdu

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SUPERBUGS  MRSA BSI rates). The media coverage around HCAIs focussed on three recurring themes: the vulnerability to infection and corresponding fear felt by patients; dirty wards, which, it was claimed, often occurred when cleaning contracts were outsourced and the standards of cleaning dropped; and a demand to ‘bring back matron’, seen as the solution to nurses’ poor compliance with prevention measures. Interestingly, the role of the pressure of antibiotic use in driving this increase was rarely discussed. In 2008, a BBC poll reported that the risk of acquiring an infection was the main fear of the public about inpatient care. Over the last five to 10 years, HCAIs have been less in the headlines, in part due to the dramatic reduction in infection rates from MRSA and C.difficile (CDI). Ideally, these successes should be celebrated and built upon. Unfortunately, the research shows that it is impossible to attribute these reduced infection rates to any one initiative, nor is it possible to say which components of which programme were critical. We do know that multimodal interventions work – such as the creation of a target, alongside the introduction of alcohol gels, media attention and national initiatives. We also know that having the backing of a national campaign (such as the 2004

‘clean your hands’ campaign) gains the attention of trust executives, bringing focus and resource to infection prevention and control, and strong external reinforcement. A GROWING PROBLEM Despite the successes with MRSA and C. difficile (a national target to reduce C. difficile infections was introduced in 2008), other health care associated infections that have not been monitored as rigorously are growing in incidence. Strategies have failed to simultaneously address the linked challenges of: a growing number of people who are immunocompromised - older people, pre-term babies and people with complex conditions being treated with immunosuppressant drugs; new infections, including a growing number of strains of bacteria which are resistant to being treated with antibiotics; and the dangers of infection spreading both

within and outside the hospital setting. The rates of Escherichia coli (E. coli) and methicillin‑sensitive S. aureus (MSSA) have risen since mandatory surveillance for these infections was introduced in 2011, alongside the fall in infection rates for MRSA and CDI. E. coli represents the most rapidly increasing and most common BSI, accounting for 36 per cent of the BSIs seen nationally, compared with 1.6 per cent caused by MRSA. Since these latter infections are not in the national spotlight, their rise has not been systematically addressed, particularly at the hospital level. Care needs to be taken to ensure that all locally relevant HCAIs are monitored in hospitals, not just those subject to mandatory surveillance. At the national level, measures also need to be appropriate and able to change in response to the shifting epidemiology of infectious diseases. Continued on page 31 E

Infection Control

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Despite the successes with MRSA and C. difficile (a national target to reduce C. difficile infections was introduced in 2008), other health care associated infections that have not been monitored as rigorously are growing in incidence

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EN 14126


INFECTION CONTROL

LAKELAND INFECTIOUS DISEASE OUTBREAK RESPONSE

Advertisement Feature

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The unprecedented 2014 Ebola crisis highlighted the risk of the rapid spread of infectious disease and the need for health services globally to ensure local preparedness for dealing with an outbreak Whilst impossible to predict when the next such outbreak will occur, nor what it will be, another event of this type is inevitable and the risk of global spread grows with our increasingly global community. As the world’s leading manufacturer of chemical protective clothing, Lakeland was contacted by the UK governmental Department for International Development (DFID) to assist in the provision of protective clothing for health workers involved in the Ebola relief effort in Sierra Leone. REQUIREMENTS There were several requirements to consider. Firstly, that a fabric that met the requirements of the key CE standard, EN 14126 (garments for protection against infectious agents) – and especially the test within that standard ISO 16604 (NOT 16603 as some proposed), the test for protection against contaminated liquids. Secondly, a garment constructed with sealed seams. Unlike some organisations, the DFID recognised this need; stitched garments make the fabric protection properties useless as stitches create stitch holes, so regardless of fabric protection a contaminant will penetrate via the seam. Additionally, the garment had to meet the requirements of CE chemical Types 3 & 4 (EN 14605: indicates the construction and performance requirements for chemical protective clothing). It was a requirement to meet the huge demand requirements (recommendations indicated seven health workers per infected patient, each of whom would enter the critical zone seven times in a 24 hour period – so each case would require 49 suits every 24 hours). Lakeland’s extensive knowledge and experience along with its position as a global manufacturer meant the company was well able to respond to these requirements – and more. First, analysis of the type of protection required indicated adjustments could be made to an existing product which would have beneficial consequences. The Ebola virus is primarily transmitted through contact with the body fluids of an infected patient. Thus whilst (given the very high consequences of infection) sealed seams normally required for Type 3 & 4 garments

were a need, the critical environment would consist of Type 4 (liquid sprays) rather than Type 3 (heavy jet liquid sprays) hazards, so a Type 4 garment design would be adequate. This has consequences for the garment design, basically resulting in a more simple construction which not only meant lower cost, but also increased manufacturing capacity by 20 per cent and freight efficiency by 10 per cent, so improving the position in terms of meeting the huge demand. In addition, given the high usage, Lakeland proposed waving the requirement for individual bags and a user instruction with each garment. Not only would this reduce cost and improve freight efficiency, it would also address the issue of waste disposal in the field. Following agreement with DFID on these points, Lakeland management worked rapidly with a UK Notified Body to achieve certification of a re-design of the Standard ChemMAX 1 coverall, branded as ChemMAX 1EB, and supply began in October 2014. HIGH DEMAND The very high demand meant that at the time there was simply not the capacity for sealed seam garments in the world to meet it. However, Lakeland’s position as a manufacturer enabled it to invest heavily to increase capacity, in this case trebling sealed seam production in weeks. This would be almost impossible for a business relying primarily on sub-contractors as many socalled ‘manufacturers’ in this industry do; it is difficult to persuade a sub-contractor to invest in rapid, short term capacity expansion. However, Lakeland was able to do so such that the volume supplied increased from the initial 12,000 per week to 32,000 per week in January – and with little effect on supplies for existing customers as it was based on the increase in capacity. PLAY THE PART The work undertaken by the UK, French and US governments in responding to the worst outbreak of Ebola in history has often been overlooked; that work meant what might have been a continent-wide catastrophe – or worse - was controlled and limited largely to the three main countries involved

and by mid-2015 was essentially over. Lakeland Industries was proud to play its part in that response, and the company’s position as a global producer which owns its own manufacturing facilities, combined with its expertise in the design, manufacture and supply of chemical and infectious disease protective clothing derived from forty years’ experience enabled it to be the ideal manufacturing partner, by both maximising short term capacity and optimising the product. The Ebola outbreak highlighted the need for local health services to be ready to deal with any occurrence of infectious disease, and now, as then Lakeland stands ready through its global manufacturing position and unmatched expertise to assist. L FURTHER INFORMATION www.lakeland.com

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CCS COMMERCIAL & MEDICAL CLEANING

We prid ourselv e the high es on we as a standards te to and am work rel challen ish a ge

CHORLEY Infection Prevention is not just for medical CLEANING environments, Chorley Cleaning Service want to work SERVICE with clients to improve awareness with employees and the public All employees undergo NVQ Level 2 in Cleaning and Caretaking as a minimum and NVQ Level 2 in Infection Prevention Control. Our Teams have a working knowledge and understanding of cross contamination and the elements associated with the spread of infection within various environments. As part of our commitment to our teams we reinvest heavily into refresher training and development of our team members to reach their potential with us. Our cleaning teams use Evans Vanodine products who have recently been named as a winner of a Queen’s Award for Enterprise. All safety data sheets are available online, via this website or direct from Evans Vanodine, for instant access and the assurance that you only have access to the most recent issue. We work closely with our preferred suppliers to ensure that innovation that aids us in infection prevention is communicated to our teams and clients within all client sites, sickness can be spread in all environments, with sickness costs experienced in all industries. Chorley Cleaning Service systems and procedures are developed in line with ISO 9001:2008, checking that the system works is a vital part of ISO 9001:2008. We as a business perform internal audits to check how the quality management system is working, we also invite our clients to audit the quality system for themselves. Chorley Cleaning Services (CCS) aim to ensure clients meet the requirements of the Health and Social Care Act 2008 (regulated activities) Regulations 2010. Regulation 12 Cleanliness and Infection Control •The effective operation of systems designed to assess the risk of and to prevent, detect and control the spread of a health care associated infection •Where applicable, the provision of appropriate treatment for those who are affected by a health care associated infection Each site is provided with a schedule of cleaning, all employees allocated to your building are provided with training on the use and reasoning for schedule. CCS provides safe systems of work and training to all employees who may identify sharps as part of their role. Training includes; emergency action to take in event of sharps incident, the importance of colour coding as a method of cross contamination, hazardous waste, sickness policy and reporting.

All employees working within medical environments are provided with a Hepatitis B inoculation. Our teams have comprehensive safe systems of work for all tasks carried out from the use of PPE, the disposal of all waste, including sharps, offensive waste and general waste to isolation and outbreak cleaning. We use the NHS colour coding scheme in all sites. We work to identify all risk categories such as high risk areas treatment rooms, toilets and bathrooms, public thoroughfares and significant risk areas to ensure greater infection prevention. • One-off deep cleans for offices, new builds and renovations, commercial residential and care homes, holiday homes, nursery and educational establishments • On-going contract cleaning for offices, commercial residential and care homes, holiday homes, nursery and pre‑schools • Builders’ Cleans including deep cleans. snagging solutions and high wash and reach window cleaning • High Wash and Reach Window Cleaning • Cleaning/ caretaking relief staff to cover sickness or holidays We have clients in the following sectors: • NHS • Lancashire County Council • Private Businesses within Lancashire Chorley Cleaning Service was founded by Julie McCullagh who worked as a Health and Safety Professional for 10 years within local government. During that time Julie worked closely with the Building Cleaning, Catering and Care Teams building up extensive experience in infection prevention control to Care Quality Commission (CQC) Standards. We provide a comprehensive range of services for: • Healthcare Establishments (G.P.s, Walk in Centres, Dentists etc.) • Educational Establishments • Restaurants • Warehouses • Construction Industry • Holiday Complexes • Offices • Residential Care Homes and Day Centres • Garages • Gyms and Leisure Centres

If you, as a company are in need of cleaning services from a reliable local company with employees who are disclosure and barred service checked (CRB replacement,) trained and competent at what they do, then we are the company for you.

CHORLEY

Call us now: 01257 696009

www.chorleycleaningservice.co.uk ● enquiries@chorleycleaningservice.co.uk


SUPERBUGS

health.org.uk

MRSA bacteraemia rate per 100,000 bed days (all reported)

20

England average 16

12

8

4

Figure 1: Annual rates of MRSA BSIs for NHS trusts in England per 100,000 bed days, 2001/02–2014/15

2014/15

2013/14

2012/13

2011/12

2010/11

2009/10

2008/09

2007/08

2006/07

2005/06

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0

es Measur ion ct for infe eed to n control opriate. r be app andatory lm Nationaveillance sur for ntinue o c t s u m specific s n infectio

 WHAT HAS BEEN LEARNED? Consideration of what has been learned from the infection prevention and control work carried out over the last 15 years in hospitals in England, leads to the following recommendations for how we avoid replicating the mistakes of the past. Firstly, measures for infection prevention and control need to be appropriate and responsive. National mandatory surveillance must continue for specific infections, but it needs to take into account and respond to new and emerging infection threats. Care needs to be taken to ensure that local surveillance is appropriate and all relevant HCAIs are monitored in hospitals, not just those subject to mandatory surveillance, which can skew efforts away from infections that are on the rise or those of local importance. All health care associated BSIs relevant to the local trust should be monitored, and the local surveillance of surgical site infections should reflect the range of surgery performed, not just the mandatory surveillance of orthopaedic joint replacement surgery. Secondly, infection prevention and control (IPC) should remain central to inspection and regulation. Future inspection and regulation needs to consider the local infection profile and the local vulnerable patient groups, specialities or risk procedures, and also include antibiotic stewardship. It must also consider managerial responses to minimising risk so that unintended consequences can be anticipated. Strong management support for IPC, including surveillance support, maximising environmental hygiene and isolation capacity should be tangible and clearly evident. Thirdly, all national-level campaigns to address issues related to infection prevention and control require an explicit framework underpinning how the campaign is intended to work and should be accompanied by an evaluation strategy. It is important that future campaigns are evaluated in order to learn and to be confident in what works and why. Future campaigns must address the basics of what is already known to work for IPC, involve the whole health economy and include an evaluation strategy. We suggest that hospitals need to have the structural and cultural capacity to deliver effective infection prevention and control and antibiotic usage. For example, a range of process and outcome measures should be used to monitor effective IPC. A positive organisational culture should also be fostered to ensure IPC is maintained. Trusts also need to ensure that the goals for infection prevention and control and patient safety are integrated and aligned at the clinical front line. We found that at times those working at the front line were overwhelmed with the requirements for IPC, patient safety and quality improvement initiatives. This can demotivate the exact people who need to remain engaged in IPC. Clearly the goals for IPC and patient safety need to be integrated and aligned so that ‘doing the right thing, in E

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Infection Control

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Sponsored by

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Chroma-HYD This model is designed for the patient. It has a large seat pad and back rest and is fitted with secure arms. This chair has proved very popular with Eye Clinics for use with the slit lamp. However it has also been used in other clinical departments where the patient needs to be raised and lowered by a clinician.

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SUPERBUGS

health.org.uk

160.0 MRSA 140.0

MSSA

120.0

CDI (patients ≥ 2 years)

Rate per 100,000 bed day (all reported)

E. coli

100.0

80.0

60.0

40.0

20.0

2013/14

2012/13

2011/12

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2009/10

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2007/8

2006/7

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0.0

Figure 2: All reported rates England average: MRSA BSI, C. difficile infection, MSSA BSI, E. coli BSI 2001/02 – 2013/14

 the safest possible way’ is the easiest thing for people to do. Clinical and managerial leaders of infection prevention and control are needed at all levels in the organisation. The challenges ahead for IPC mean that it must remain central to the NHS agenda and the work in all health care organisations. As such, clinical and managerial leaders of IPC are needed at all levels with demonstrable managerial and clinical commitment. This must also be supported by champions of good practice who lead by example. We also recommend that the role of the public is clearly defined before they become patients. In the context of often high media coverage, health care organisations need to understand better how the public and patients make sense of publicly available indicators and information. IPC education, awareness of hand hygiene and the optimal use of antibiotics need to be instilled in the wider public before they become patients, since studies have suggested that patients are less likely to get involved at the point of care. Finally, a whole health economy approach is needed for infection prevention and control in future. Bugs don’t differentiate between primary and secondary care or between hospital and home, yet most of the IPC focus to date has been on the hospital. It is time now to move to a whole health economy approach. Measures of HCAI prevention activity and antibiotic stewardship should be developed that span health sector boundaries. Economic analysis of IPC needs to have a system-level approach in order to understand E

Infection Control

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What are health care associated infections? Health care associated infections are infections that develop as a direct result of medical or surgical treatment or contact in a health care setting. They can occur in hospitals and in health or social care settings in the community and can affect both patients and health care workers. Some well-known infections include: MRSA: methicillin-resistant Staphylococcus aureus C.difficile E-coli: Escherichia coli MSSA: methicillin-sensitive Staphylococcus aureus

Volume 16.2 | HEALTH BUSINESS MAGAZINE

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Gastrointestinal Endoscopes Do we need to Shift From Disinfection to Sterilization? The Crisis:

www.anderseneurope.com

Hundreds of patients in US hospitals have fallen ill and more than 150 have died after contracting a superbug infection. Patients were infected with a drug‑resistant bacteria known as carbapenem‑resistant Enterobacteriaceae (CRE) between 2012 and 2014, a result of contact with contaminated endoscopes. Duodenoscopes, were cleaned in compliance with the manufacturer’s instructions but still carried traces of the bacteria which matched cultures taken from ill patients.

The Response: In response to the contamination and infection concerns US FDA released new recommendations on how to enhance the reprocessing of complex endoscopes including: Ethylene Oxide (EtO) sterilisation following cleaning and high‑level disinfection. Whilst the BSG recommendations don’t currently include sterilization using EtO, the three‑hour usage restrictions mentioned in the document don’t apply when sterilizing with ethylene oxide since the endoscope is wrapped in a sterile barrier system.

Going forward: No additional cases of CRE were encountered when reprocessing was switched to gas sterilisation with Ethylene Oxide. Andersen is the first company in the world to achieve FDA registration for an Ethylene Oxide sterilizer that uses a flexible sterilization chamber. The Andersen Series 4 sterilizer, as pictured. The sterilization cycle runs at 50°C with a three hour cycle and uses just 17.6g of EtO and does not require the use of deep vacuum or steam injection. An optional abator is available, that will remove in excess of 99.9% of the EtO. Flexible chamber technology has established itself in the low volume, low temperature sterilization market.

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SUPERBUGS  the full impact of HCAIs and to target interventions. The challenge presented by HCAIs and the need to maintain good infection prevention and control is not going away. Recent studies report that between 5.1 per cent and 11.6 per cent of hospitalised patients will acquire at least one HCAI, with the risk of HCAI greatest in intensive care units (ICUs), where the prevalence is above 20 per cent. It has been estimated that HCAIs cause at least 9,000 deaths per year. Infection prevention and control needs to remain high on the political agenda and high on the ‘to do’ list of all health care professionals if we are to avoid returning to the days of rising infection rates and screaming headlines. L

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The ge challen d by e present the need nd HCAIs aintain good to ma prevention n infectio ntrol is not o and c g away goin

FURTHER INFORMATION www.health.org.uk The Health Foundations’ Infection Prevention and Control: Lessons from Acute Care in England report can be accessed in full here: tinyurl.com/oy2gonv

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Advanced Cleaning (Midlands) Ltd was established in 1984 to fill the need for a specialist Deep Cleaning and Clinical Cleaning Company in environments such as Catering Facilities, Medical Centres, Care Homes, Operating Theatres and all other Hospital Departments. All staff are directly employed, with our Supervisors gaining more than 20 years experience.

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One of the brightest stars of outsourcing for three years in a row In 2013, 2014 & 2015, the International Association of Outsourcing Professionals has ranked ISS among the world’s best outsourcing service providers

With more than 100 years of experience in the service industry and over 500,000 dedicated employees, ISS provides the ‘Human Touch’ to those important jobs that our clients outsource; which is why we are very proud to have been serving the NHS with world class services since 1984.

Operating in over seventy countries ISS provides services within six different areas: Catering, Cleaning, including professional healthcare cleaning, Technical Services, including NHS Estates, Security and Support Services including healthcare logistics, and Facility Management.

For more than 30 years ISS FS Healthcare has been providing the widest range of services to the NHS, nowadays working in over 300 NHS premises across England and Scotland providing the very best ‘award winning’ services, and it is our ambition to continue providing those services for many years to come.

Despite the change of review criteria ISS achieved the highest possible result of four full stars in the 2015 IAOP review. We celebrate this award as an acknowledgment of great service performance, and the part that our UK business has played in the overall picture. Being great is at the heart of our culture and each ISS individual.

Every day ISS employees work as an integrated part of each Client NHS Trust, ensuring that service value is created through ‘The ISS Way’ of customising and delivering our innovative service solutions.

To find out how you can benefit from the experience and skills provided by our 500,000+ service professionals, visit www.uk.issworld.com or contact us at isshealthcare.commercial@uk.issworld.com

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IMPROVING CARE

Fixing dementia care

Mental Health

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

Alzheimer’s Society has recently launched its Fix Dementia Care campaign. George McNamara, head of policy, discusses what can be done to improve the current state of dementia care across the NHS Written by George McNamara, head of policy, Alzheimer’s Society

Poor care in hospital can have desperate consequences for someone with dementia – and can cost hospitals hundreds of millions of pounds. Although there are many examples of excellent care across the country, a recent investigation by Alzheimer’s Society found a hugely variable picture, with too many people with dementia falling while in hospital, being discharged at night or being marooned in hospital despite their medical treatment having finished. Figures from the Department of Health show that people with dementia in hospital account for around 3.2 million bed days a year, with 25 per cent of hospital beds occupied by people with dementia at any one time. Informal reports suggest, however, this is a gross underestimate, with some hospitals stating that 40-50 per cent of their patients have dementia. People are not generally admitted for their dementia, but instead, for falls, broken or fractured hips, urinary tract infections, chest infections or strokes. A significant number of these admissions could be avoided through better support in the community and greater integration of health and social care services. Yet, with adult social care budgets experiencing severe and unrelenting cuts, frail elderly people are increasingly reaching crisis point and being admitted to hospital

as an emergency. Between 2008/9 and 2012/13, Public Health England found that the proportion of people with dementia admitted to hospital in an emergency increased by 48 per cent.

With l cia adult so gets d also result in huge care bung severe can costs for the NHS. In i nc 2013/14 alone, falls experiefrail elderly in hospital of people cuts, ple are with dementia were o e p g n i e estimated to have b y ingl cost the NHS at least increas itted to £15.9 million. These adm tal millions could be invested i p s ho in staff training and adaptions

QUALITY OF CARE To assess the quality of hospital care for people with dementia, we submitted Freedom of Information (FOI) requests to 162 hospital trusts in England and collected first-hand testimonies from people affected by the condition. We discovered that in one trust, 702 people with dementia fell in 2014-15, the equivalent to two falls a day. Last year 28 per cent of people over the age of 65 who fell in hospital had dementia – but this was as high as 71 per cent in the worst performing hospital trust. Independent analysis has shown that, on average, if a person with dementia falls in hospital they spend nearly four times as long there and the resulting complications increase the likelihood of being discharged into residential care. The impact of falls can be devastating for people with dementia and their families, but

to the environment, saving people with dementia the trauma of a fall and the resulting complications. The FOIs also uncovered that last year, in the 68 trusts that responded to this FOI, 4,926 people with dementia were discharged between the hours of 11pm and 6am. In the three worst performing hospitals, four to five people were being discharged overnight per week and only six hospitals didn’t discharge overnight. Discharge at night is considered inappropriate as it is unsafe and disorientating for people with dementia who are less likely to be able to access care and support (e.g. care homes often closed at night). These incidents are potentially disastrous for people with dementia and their families as well as wasting additional millions of pounds. In 2013/14, it was estimated that emergency readmissions cost the NHS £93 million. Length of stay was also found to be hugely E

Volume 16.2 | HEALTH BUSINESS MAGAZINE

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IMPROVING CARE  variable. In the worst performing hospitals, people with dementia were found to be staying five to seven times longer than other patients over the age of 65. In 2013/14, excess days spent in hospital by people with dementia were estimated to have cost the NHS at least £155.3 million. This is a scandalous waste of money which could be far better used supporting people to stay independent and healthy in their own homes. The figures are stark and show a clear financial need to improve hospital care – but at the heart of the issue is the health and wellbeing of those affected. We asked more than 570 people affected by dementia to share their experiences: 92 per cent said hospital environments were frightening, 57 per cent said they felt people with dementia were not treated with understanding and dignity, and only two per cent reported that, in their experience, all hospital staff understood the specific needs of people with dementia. PATIENT OUTCOMES One of the most poignant stories came from Geoff, 86, from Dorset, who has vascular dementia. He is cared for by his daughters, Kay and Sally-Ann at his home. Last year he fell down the stairs, injuring his elbow, head, and fracturing his kneecap and six ribs and was rushed to hospital. Kay and Sally-Ann explained to the paramedics that Geoff had dementia. They told the ward staff, too. They knew all too well that with frequent staff changes and problems in getting access to patient notes they would have to explain to everyone they met that their dad had dementia. Geoff stayed in hospital for nearly a month, and the care he received was poor. After his first operation he was left to fend for himself for five hours before being moved to a ward. Kay and Sally-Ann encountered numerous problems with communication while their dad was in hospital. Although they used a ‘This is me’ tool – a folder with Geoff’s likes, dislikes and specific care needs – to help staff understand his condition, this was locked up with his notes, so staff caring for him often didn’t have the information they needed to provide him with appropriate care. Not all staff knew that Geoff needed help eating and drinking, or help going to the toilet. Yet they knew this needn’t be the case as they had experienced the complete opposite when their mum, who had Alzheimer’s disease, had spent time in a different hospital previously. On a number of occasions, Geoff would prepare to leave and then staff would change their minds. When Geoff was finally ready to go home, the hospital failed to give Kay or Sally-Ann advanced notice despite them repeatedly saying that they would need plenty of warning as they lived an hour away. They found Geoff alone in the discharge lounge with all his medication. He’d started taking all his tablets as they had his name on them and he thought it was the right thing to do.

Vascular dementia sufferer Geoff received poor care in hospital – his daughters Sally-Ann (left) and Kay also suffered from poor communication

GETTING IT RIGHT We recognise that the picture isn’t bleak everywhere – many hospitals are working hard to get it right for people with dementia. In Kingston Hospital, for example, nearly half of patients over the age of 75 have dementia – double the national average. With numbers set to grow, the hospital trust’s first ever Dementia Strategy was approved by its board in January 2014. Its five-point strategy was developed with patients, carers, staff, voluntary and community groups and reflects all of their needs when caring for patients with dementia. The strategy includes pointers to ensure early diagnosis, excellent clinical treatment and care, active days and calm nights and creating dementia friendly environments of care. Kingston Hospital NHS Foundation Trust runs therapeutic activity sessions for patients with dementia every day, including painting, listening to music, craft, knitting and jigsaw

Mental Health

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

needs on arrival is key to someone with dementia receiving appropriate care in a timely way. Many hospitals are not yet set up to deliver this quickly and sensitively, leaving people with dementia waiting in a hectic and distressing A&E department. FIXING DEMENTIA CARE Motivated by the findings of this investigation, in January Alzheimer’s Society launched a new campaign – Fix Dementia Care. Although we appreciate there is no easy or quick solution to fix dementia care in hospitals, we have developed a series of recommendations to help start a journey of change. We are calling on all hospital boards to publish an annual statement on the quality of dementia care in their hospitals, and Care Quality Commission and Monitor to make the quality of dementia care a priority in their regulation of hospitals. Putting this information in the public domain will put an end to a culture in which it is

We are calling on all hospital boards to publish an annual statement on the quality of dementia care in their hospitals, and Care Quality Commission and Monitor to make the quality of dementia care a priority puzzles. All inpatients with dementia have a forget-me-not flower symbol above their beds so that staff are aware that they have the condition and the hospital now has one of the largest volunteer dining companion schemes in the NHS – with more than 300 people, including non-clinical staff, trained to provide additional help and support at mealtimes. It’s not easy for staff to look after people with dementia if the right training and procedures are not in place. Memory loss, difficulties with communication and agitation, which people with dementia often experience, can prevent staff understanding the extent of the medical problem and, in turn, offering the appropriate treatment and support. A proper assessment of their

easier to find out about your local hospital’s finances than the quality of care you’ll receive if you have dementia. It will allow us to stand together to collectively hold hospitals to account, ensuring the continued improvement of hospital care for people with dementia and better use of NHS budgets. L FURTHER INFORMATION For more information on Fix Dementia Care, visit: www.alzheimers.org.uk/fixdementiacare To find out more about becoming a Dementia Friendly Hospital with the Dementia Action Alliance, visit: www.dementiaaction.org.uk/dkit

Volume 16.2 | HEALTH BUSINESS MAGAZINE

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Advertisement Feature

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

FACILITIES MANAGEMENT

NEW HANDRAILS PROVE A SUCCESS AT ROYAL INFIRMARY Bradford Royal Infirmary – part of Bradford Teaching Hospitals NHS Foundation Trust and serving a population of 500,000 people – were the first to take delivery of products from Yeoman Shield’s new range of Guardian Handrails The hospital found that they were persistently having to carry out repair and redecoration of the walls in the service corridor leading to their ENT Out Patients Unit. As one of the main thoroughfares through the hospital building the walls were being marked and damage was being caused to the plaster work from the impact of heavily laden trolleys and carts as well as from the everyday passing by of staff, patients and visitors. The service corridor also slopes from one end to the other with changes in direction. Already in place was an old metal handrail which was looking worse for wear with many layers of paint flaking off from being in continually hit with passing wheeled equipment. For these reasons it was not just a system to protect the walls that was required but one that needed to full fill the requirements of a durable handrail. NEW RANGE Yeoman Shield have recently developed a new range of Guardian Handrails which includes the original 125mm Guardian Handrail and now with the addition of the new Guardian Twin Handrail as well as a 50mm dia. handrail. The new range was introduced to the estates team at Bradford Royal Infirmary during a visit from Yeoman Shield’s area sales manager who discussed the products, options and was able to provided visual samples. After Yeoman Shield carried out a free site survey it was concluded that the solution to Bradford Royal’s corridor damage came in the form of Yeoman Shield’s New Guardian Twin Handrail. The new system consists of an upper 50mm diameter handrail which can be supplied as either a solid Timber, Stainless Steel or PVCu sleeved aluminium rail, connected to the lower protection rail. Available in a choice of colours to help blend into interior designs, Bradford Royal Infirmary chose the PVCu option for the upper rail in light green to co-ordinate with an existing colour scheme. The lower rail, 200mm deep, was also supplied in light green and both were completed with Stop Ends, Wall Returns and Corners in Cream. The installation of the Twin Handrail will help Bradford Royal with their maintenance budgets by reducing greatly the

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requirement for the repair and redecoration of the walls as well as avoiding the replacement of the handrail, proving the product to be a sound ecological and economical investment. TWIN HANDRAIL The Guardian Twin Handrail was installed by Yeoman Shield’s directly employed fixing operatives to both sides of the service corridor. Thomas Molloy, architectural assistant at the hospital, said: “This is a great new product and was the perfect answer to our damage problem. It was fitted by Yeoman Shield’s team with respect and the minimum of fuss in a ‘live’ area allowing the hospital to continue with its everyday business.” Also the main corridor of the ENT Out Patients Department was lacking a handrail product and due to the nature of clients that visited this clinic that might need an aid in walking Bradford Royal chose

another product from the new Yeoman Shield range to fulfil the requirement. 50MM HANDRAIL The Guardian 50mm Handrail, a single circular easy to grip rail in timber, was installed to the wall on one side of the corridor by Yeoman Shield’s fixing team. Fitted on strong and durable PVCu Cream injection moulded brackets the timber handrail which is warm and smooth to the touch also complemented the wood doors and frame work already in situ along the corridor. The different styles, colours and materials available in Yeoman Shield’s New Guardian Handrail range guarantees that they can provide a handrail system to help satisfy customer requirements. L FURTHER INFORMATION www.yeomanshield.com


TECHNOLOGY

Ian Burden of Capita Health Partners, on behalf of BIFM, looks at how effective use of technology in facilities management can bring tangible benefits to the NHS The perennial issue for the facilities manager within the health sector is to ensure that buildings remain fit for purpose, cost effective and correctly located for the delivery of health services to patients. However, this also needs to be done against the backdrop of making £22 billion of savings and complying with new reviews and reports giving guidance on improving services. Perhaps the result will see more use of technology. The NHS Five Year Forward View has provided an opportunity for the NHS to bring major changes to the way services are delivered with a strong sense of direction towards some recommended models. When combined with the findings of Lord Carter’s February 2016 review, the NHS has a good basis for facilities managers and estates teams in the NHS to start to develop and revise their individual estate strategies. LOCAL STRATEGIES In June 2015 the Department of Health asked every Clinical Commissioning Group in England to develop a Local Estate Strategy. The development of these strategies, aligned with initiatives including the Vanguard and One Public Estate, attempts to ensure that the NHS estate is mapped and provides the framework for future adaptation in a meaningful and organised manner. But what are some of the problems that have been overcome and what is being achieved? An overview of the estate is one where the system has become slightly divided, where providers and primary care occupy, acquire and dispose of their individual estates in a fragmented way alongside

new bodies such as NHS Property Services and Community Health Partnerships. This does not provide the whole system solution which could deliver major savings which comes from a more central view of the estate as a whole. Having the opportunity to consider county and city wide strategies provides the opportunity to look at the regional estate in its totality, inside which the providers and primary care estate sit and where a more co-ordinated approach to the estate and investment in the estate can be taken. UTILISING ESTATE Looking at the estate from the commissioning viewpoint, it is apparent that the disparate estates have competing agendas and abilities and, whilst there was a good level of information in some instances, many property decisions were being made on the basis of limited, or no property data. This has meant that in some instances where funds have been used to maintain poorer quality accommodation, with no awareness that a partner organisation may have a fit for purpose building nearby which is under-utilised. Only through the comparison of data and mapping of the estate on Public Health England’s ‘SHAPE’ system, has it been possible to appreciate not only the extent of the estate, but its location and, through the use of dashboards, the lack of some information. The comparison of the dashboards is helping to identify where properties are replicated and, when combined with demographic and needs modelling, helps to target sites which can be rationalised and declared surplus, whilst also

Looking at the m ro estate fssioning mi the com oint, it is viewp that the t apparente estates dispara ompeting have c ndas age

identifying the sites which will form the core estate for years to come. As facilities managers will know, the result of a well formed strategy will help to underpin the decision making process on where and when investment is needed. This will be the case with the Local Estate Strategies where the integration of health and social care can more easily be brought together through the shared use of accommodation, very much in line with the One Public Estate. The strategies will help identify where the NHS could potentially release properties for the construction of new housing to help not only create savings and income for the NHS, but to help relieve the pressure on finding new housing sites – a long standing theme but with the potential to now start delivering a solution.

Written by Ian Burden, Capita Health Partners

Facilitating a technological change

Facilities Management

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IMPLEMENTING TECHNOLOGY However, one of the enablers for many of these changes comes not from the properties themselves, but the ways in which they need to be utilised by staff and patients – the implementation of technology. The ability of staff and patients to interact in new and different ways from those currently, will be a fundamental change to the way in which health services can be delivered. This is a theme within the Five Year Forward View and is very clearly the way in which the sector will start to move in the coming years. This will affect the ways in which the estates will need to change and become more flexible, with a deeper understanding of the ways in which patients will be able to access services remotely and with staff working through flexible and mobile agile working models. So how will buildings have to change to ensure that they remain fit for purpose, cost effective and correctly located for the delivery of health services to patients? The Local Estate Strategies will provide the support and framework for the delivery of the efficient estate, but facility managers will have to ensure that their own strategies fall in to line as well. If the drive is to deliver more services through a technologically enabled service delivery plan, whether this is from patients accessing services or staff seeing patients in a wider range of locations, the facilities manager will need to start identifying the impact of delivering more technology enabled buildings. This does not only mean that buildings will need to have enhanced access to robust data cabling and a wireless systems at a basic level, it will also mean that the way in which the services are E

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TECHNOLOGY  actually being delivered will force a change in the ways in which buildings need to be configured. There will be a greater dependency on being able to drop in to administration spaces, increased use of larger meeting rooms to provide team meetings and potentially a greater need for individual spaces to allow for video conferencing, with an improved and more accessible use of technology providing a robust and achievable solution than in the past. With the drive to integrate social care services with health organisations, access arrangements to sites will form a key issue for the practical day to day use of buildings. From a security perspective, information contained on central systems will be covered by the host organisation, whereas the need to provide physical access to a number of partner organisations who can drop in and use flexible workspace will create a dilemma on how physical equipment and virtual access is made secure. Facilities are going to have to be far more accessible and ready to deal with a wider range of scenario’s including the use of accommodation to see patients, have team meetings and allow access to partner organisations. This will require a robust management solution to ensure that arrangements for accessing services is ‘open’ and yet still restrictive enough to protect staff and patients. Buildings will need to provide efficient accommodation which can not

only provide optimal use of the space, but also ensures that sustainable and fit for purpose facilities are well maintained and supported. The increase in utilisation of buildings from a number of organisations who may drop in, rather than specifically lease rooms, will need close monitoring and a clear pricing structure unless the commissioning bodies (NHS and partner organisations) are prepared to accept that the open use of facilities makes it difficult to easily allocate budgets required to maintain buildings. However, the biggest cost could be the initial installation and maintenance of the technology that will be required to maintain the shared access – this will mean that facilities managers will need to ensure that when considering their own estate strategies, the cost of providing the IT systems is identified at an early stage for funding purposes. THE ROLE OF FACILITIES MANAGERS A particular skill of facilities managers is to identify where and when resources will be required. The location of the estate, mapped against the Local Estate Strategies, may already be decided but the use of non-core facilities will require an informed approach in identifying and securing drop in accommodation and short leases in a range of properties. The alignment of health and social care, alongside working with the One Public

Estate may see a greater utilisation of properties including schools, libraries and other community facilities (enabled by mobile technology) and whilst these will be provided by other organisations, the NHS facilities manager will still need to be aware of where their services are located and need support. In summary, the NHS is still making the drive to make the efficiencies which the government requires, but the greater direction from guidance documents, such as the Five Year Forward View and the Carter Review, alongside the new CCG Local Estate Strategies, is providing NHS facilities managers with an interesting set of new challenges, albeit with a better sense of direction. Facilities managers are well placed to take advantage of this opportunity due to their ability to look at a wide range of disparate issues and introduce a sustainable solution. L The British Institute of Facilities Management (BIFM) is the professional body for facilities management (FM). Founded in 1993, it promotes excellence in facilities management for the benefit of practitioners, the economy and society. It supports and represents over 16,000 members around the world.

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Estate Planning Written by Clive Shore, executive director, Community Health Partnerships

Widnes Urgent Care Centre

Effectively managing the NHS estate Property companies, Community Health Partnerships (CHP) and NHS Property Services (NHS PS) are playing an important role in supporting the service transformation and system improvements agenda highlighted in the Five Year Forward View (5YFV), says Clive Shore, Community Health Partnerships’ executive director to clinical commissioning groups (CCGs) to With more than 1,200 hospitals and 3,000 improve the management of the NHS owned other treatment facilities across England, the and occupied estate, which represents the NHS estate is huge, diverse and complex. third highest cost after staff and medicines. Property can be an important catalyst for To help achieve this, CHP and NHS PS have wider system change, but to achieve that it’s essential to understand precisely supported CCGs with property expertise what the estate comprises of; to carry out the largest and most how it works together; how comprehensive analysis of the The g it meets the needs of the NHS estate ever undertaken. n i l l e communities it serves; Among many other remod idnes W and how it can be inputs, this has included e h t e f c o r u o s e improved to help deliver detailed mapping and R re government policy, data capture, building ealth Ca o an Urgent H t n such as the Five Year utilisation studies and i g e Centr tre is helpin Forward View (5YFV). options appraisals for n CHP and NHS PS improvements across Care Ce uce pressure are working hard the health estate. to red cal A&E to deliver an estate o on l that is responsive to LOCAL STRATEGIES ents change, taking account of Bringing together key departm demographic trends, increasing partners from local health specialisation, integration of health systems to create Local Estate Forums and social care, movement of services (LEFs) has been critical to this. There is no from acute to community, technological prescriptive model, but LEFs are made up of advances and new ways of working. CCGs, acute trusts, service providers, local Last summer, the Department of Health authorities and many others with a direct (DoH) and NHS England provided guidance involvement in the local health system.

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The Local Estates Strategies, developed by LEFs, are designed to: articulate commissioners’ vision for their estate, based on the 5YFV and commissioning plans; bring together core information about the current estate; identify current and planned broad locations for delivery of services; identify any further data required to inform the strategy; outline the opportunities that exist within the estate to meet requirements for the delivery of services; and identify a high‑level next steps plan for implementation. This extensive piece of work has captured a huge body of learning, insight and opportunity. While some of the headline figures confirm an urgent need to improve the utilisation and management of parts of the estate, there are also strong messages that offer a positive way ahead for improvement and delivery. PRIORITIES The major priorities now are to deepen engagement with secondary care and other public sector bodies, in particular local authorities, to encourage and enable partners to apply the learning captured in Local Estate Strategies to implement the changes needed across local health systems, in line with the 5YFV. In addition to this, CHP and NHS PS are playing a wider role in the transformation agenda. This includes active involvement in supporting programmes such as the Devolution agenda, the Government Office’s One Public Estate initiative, and the Vanguard groups being set up to deliver the New Care Models Programme. CHP and NHS PS are also working closely with the DoH to identify potentially surplus NHS land that could make a contribution to the government’s house building targets, support economic growth and also enable wider provision of Extra Care and Key Worker accommodation. Strategic Estate Planning utilisation and appraisal studies are providing trusts and commissioners with options that give full consideration to, and assessment of, current and future clinical needs. Disposal of land for building development is one of the options accounted for in that process.


PRIMARY CARE IN HULL The centre Management pilot for primary care estate in Hull looked to deliver improved buildings management, better services for providers and patients, effective utilisation of bookable space, and the potential for £1 million p.a. extra rental income. Better management of property assets is one of the consistent themes to emerge through work with CCGs. Following a strategic review in Hull, 12 primary care centres are now serviced by a single, rationalised facilities management contract that has replaced four previous agreements. Taking a strategic approach across the estate has seen improved services implemented for buildings management and maintenance; better administration and utilisation of bookable space; regular and constructive communication with tenants, and enhanced patient and visitor experience with improved front of house services. Within this new approach, the application of IT to manage room bookings is helping to deliver an annual equivalent of £1 million in extra rental income for bookable and sessional space. Alongside the obvious financial benefit, the new centre management approach will also help to identify and secure new clinical and social care services for the community. URGENT CARE CENTRE IN WIDNES The reconfiguration of the Widnes Health Care Resource Centre into an Urgent Care Centre

Property can be an important catalyst for wider system change, but to achieve that it’s essential to understand what the estate comprises of last summer is helping to reduce pressure on local A&E departments, while delivering a range of new patient services closer to home and financial savings for the CCG. Widnes in Cheshire has one of the lowest national levels of car ownership, but the closest A&E department is eight miles away. Responding to the need to reduce pressure on the acute sector and reduce A&E admissions, the CCG identified an opportunity for a new Urgent Care Centre. Analysis identified under-utilised space in the Resource Centre, which was reconfigured to create a primary care-facing alternative to A&E. The project has delivered a single reception and waiting room, consolidating the six that were previously spread throughout the building. Administrative space has been converted to clinical rooms and new X-ray, imaging and ultrasound, diagnostics and on-site pharmacy added. In addition to improving patient services, the project aims to achieve a 15 per cent reduction in A&E attendance over five years and make £150,000 savings for the local health economy.

Estate Planning

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INTEGRATED HEALTH AND SOCIAL CARE HUBS IN NORTH MANCHESTER A joint study by partners in the local health system has identified practical opportunities to create integrated health and social care hubs in four communities across North Manchester. By moving services out of ageing infrastructure into under‑utilised modern buildings, the four bases could accommodate district nursing teams and palliative care services in community settings closer to patients’ homes. The evidence produced by this process has delivered a strong foundation for conurbation-wide thinking as Greater Manchester takes on its devolved responsibilities for health and social care. Four of the six primary care centres involved in the study show significant potential for improved space utilisation. The cost to the public sector of the currently under-utilised space is estimated at £900,000 p.a. L FURTHER INFORMATION www.communityhealthpartnerships.co.uk

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MEDICAL DEVICES SUPPLEMENT

The impacts on patients of poor access to some medical technologies; the latest technological developments in pre-hospital care and how these have benefitted patients; and how Unique Device Identification and GS1 standards can help to improve patient safety while increasing efficiency


TECHNOLOGY

The Medical Technology Group considers the impacts on patients of poor access to some medical technologies despite the known benefits and wide availability For nearly 70 years, the British people have had access to universal free health care and public health programmes – from cradle to grave. That was the promise in 1948 when the UK’s hospital service was nationalised in the effort to fight the ‘five giants’ of want, disease, squalor, ignorance and idleness. The social picture in 2016 Britain is quite different to those postwar years. And the NHS fights on different fronts these days – our five giants are the five big killers: heart disease, stroke, cancer, liver and, not least, lung disease. Together, these account for more than 150,000 deaths a year among under-75s in England alone. We have the medical know-how to reduce these numbers, and we have the medical technologies to help patients and so reduce long-term demands on health budgets. We can even argue that there is political will across the spectrum in investing in improving treatment strategies – health expenditure has increased substantially since 1990, albeit from relatively low levels when compared with other countries. And yet the UK still has unacceptably high levels of avoidable mortality – the Department of Health estimates that around one in five, or 30,000, of these deaths are entirely unnecessary. But still we continue to lag behind many other Western countries in how we manage preventable diseases. Here, we look at how wider access to tried and trusted medical technologies could improve the life chances of people living with just two of the big five conditions.

as many women as breast cancer. Most deaths from coronary heart disease are caused by a heart attack. Every three minutes, someone in the UK is struck by a heart attack – around 30 per cent are fatal; and fewer than one in 10 who have an out of hospital heart attack will survive. This is one death every eight minutes or so. Yet in England a postcode lottery will decide if a patient has the best chance of surviving a heart attack. A recent report from the University of Leeds

Heart , disease cer, can stroke, d lung liver an count for ac diseasehan 150,000 more t hs a year deat nder-75s u among ngland in E

Written by the Medical Technology Group

Accessing all areas of medical technology

based on a decade of research involving 300,000 patients under the care of 84 hospital trusts found that nine out of 10 heart attack patients with blocked coronary arteries (potentially most deadly of all, and accounting up to 40 per cent of all cardiac arrests) will receive life-saving treatments using stents to open blocked arteries and restore blood flow to the heart (more formally called primary percutaneous coronary intervention, or PPCI). However, 10 per cent of patients will tragically and unnecessarily die. Patients are twice as likely to get PPCI treatment in hospitals which operate round the clock on seven-day services. Survival chances increase in patients offered this life-saving procedure within 90 minutes of arriving at hospital. And while over the course of the study the number of hospitals providing stents went up, today 43 per cent of trusts which perform the procedure are still unable to offer it round the clock. The Leeds report also found that patients were 30 per cent more likely to receive stents if they were treated by hospitals with more than five cardiologists trained in the procedure. Technology saves lives – but on-site medical professionals need to know how and when to use it to best effect, and need to be there to do so.

Medical Devices

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PREVENTION NOT CURE The NHS has been successfully using Implantable Cardiac Devices (ICDs) for nearly E

IT BREAKS MY HEART TO REPORT Around 2.3 million people in the UK live with coronary heart disease. It is the UK’s single biggest killer – responsible for about 70,000 deaths each year, a third of which are in people younger than 75. It kills twice

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DRUG DELIVERY

AEROGEN LEADS GLOBAL AEROSOL DRUG DELIVERY IN ACUTE CARE Aerogen is a global leader in aerosol drug delivery, specialising in design, manufacture and commercialisation of high performance aerosol drug delivery systems within the Acute Care market All of this combined means patients’ length of stay in hospital and related costs are significantly reduced.

As a market leader in aerosol drug delivery, Aerogen’s innovative technology has changed the science and set a new standard of aerosol drug delivery in critical care which is resulting in better care for the most critical patients from pre-term babies to adults. Founded in 1997, and under the leadership of CEO, John Power, Aerogen has transformed aerosol drug delivery for the most vulnerable patients in an acute care setting. INNOVATIVE TECHNOLOGY Part of the DNA within Aerogen is its commitment to the research and development of breakthrough technology for aerosol medications drug delivery systems. Aerogan’s patented palladium vibrating mesh technology lies at the heart of its category leading aerosol drug delivery systems, and has transformed the treatment of respiratory patients, including those with COPD and asthma. This technology turns liquid medication into a fine particle mist, gently and effectively delivering drugs to the lungs of patients. Innovative products such as Aerogen Ultra and Aerogen Solo, which were developed using this technology, offer improved treatment for patients. These products work for the benefit of patients by delivering 17 per cent lung

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deposition compared to just three per cent from traditional small volume nebulizers. This versatile technology can be used throughout the hospital setting including ICU, HDU, ER, Wards, Neonates and Paediatric departments. In achieving these technological breakthroughs Aerogen has hit many landmark milestones along the way, including becoming the first company in the world to deliver nebulisation to the lungs of premature babies and developing the world’s first silent nebuliser (Aerogen Solo). BENEFITS FOR PATIENTS Offering superior clinical performance and improving treatment of respiratory patients, is at the forefront of Aerogen’s philosophy. This commitment has led to over three million patients, in over 75 countries benefiting from these innovative technologies by receiving more effective and efficient treatment. The superior performance of its Aerosol Drug Delivery systems helps reduce the number of admissions of patients at A&E departments due to the effective technology delivering four times the medication to patient’s lungs than traditional small volume nebulizers, meaning patients receive more than twice the medication in half the time, leading to quicker recovery times and lower admission volumes.

COST BENEFITS Our products are available as standalone devices for attachment to a broad range of respiratory equipment within the hospital setting. These innovative products such as Aerogen Solo, which was developed using this technology, offers less wastage of drugs and significantly reduced hospital care costs, in addition to improved patient care. High levels of staff satisfaction have been recorded, citing many of the clinical and care benefits of this pioneering technology, including its versatility. In addition to being used throughout many hospital care departments, Aerogen can be used for many respiratory therapies, including; MV, HFOV, HFNC, NIV and Spontaneous Breathing, offering ease of management and care for medical practitioners. Aerogen products are also supplied as partnered integrated ventilator products, distributed by major respiratory OEM’s such as Philips, GE Healthcare, Covidien and Maquet. Aerogen’s true business success, and biggest achievement to date, is best demonstrated by the impact the company has had on global healthcare, where Aerogen has led by example in setting a new standard of aerosol drug delivery in critical care which is resulting in better care for the most critical patients. As the company continues to grow and prosper, the impact of its success can be seen from the growing number of patients achieving superior clinical results from Aerogen’s products. L FURTHER INFORMATION Company: Aerogen Ltd Name: Tara Spain Email: tspain@aerogen.com Web Address: www.aerogen.com Address: Galway Business Park, Dangan, Galway, Ireland Telephone: +353 91 540 400


more you smoke the higher the likelihood of developing COPD. So quitting cigarettes still remains the best tactic to prevent COPD, and other life-limiting conditions: 21 per cent of male deaths and 13 per cent of female deaths overall in the UK were estimated to be attributable to smoking in 2013.

Wider access to tried and trusted medical technologies could improve the life chances of people living with just two of the big five conditions  40 years. ICDs prevent heart attacks – and prescribing more ICDs can contribute to further reducing the number of deaths in the UK each year from potentially preventable heart attacks, currently running at 70,000. And the technology continues to improve – in 2012, subcutaneous ICDs were fully launched. These leave the heart and vasculature untouched, providing protection for patients at risk of sudden cardiac death while avoiding potential complications associated with transvenous leads. New generation devices are also enabled for remote patient management, cutting down associated resource management costs. The National Institute for Clinical Excellence (NICE) published its interventional procedure guidance on insertion of subcutaneous ICDs in 2013, recommending ICDs as possible treatment for people who have had a serious ventricular arrhythmia, who have an inherited heart condition linked to a high risk of sudden death, or who have had surgery to repair congenital heart disease. Therefore, all that stands in the way of improved heart patient care on the NHS is access and availability: overall, the UK performs poorly compared to the Western European average for implant rates, ranking a poor 21st for implantable cardioverter defibrillators behind countries such as Estonia, Slovakia and Malta. TAKING A DEEP BREATH Chronic Obstructive Pulmonary Disease (COPD) is one of the most common respiratory diseases in the UK, and is thought to affect over three million people in England. COPD

is the collective name for a number of progressive conditions including chronic bronchitis, emphysema and chronic obstructive airways disease. It kills about 25,000 people a year in the UK – almost twice as high as the European average in 2008. There is no cure for COPD, but it can be alleviated. A range of oxygen and ventilation devices are available on the NHS that can help the patient’s own spontaneous breathing. These therapies have been proven to work alongside other treatments and to improve life expectancy and quality of life. Since they are home-based treatments, these therapies cut the need for expensive hospital bed days or resource-sapping consultant appointments, and the patient’s condition can be remotely monitored. As with other evolving chronic long-term conditions, early detection and treatment of COPD out of hospital is cheaper and more effective in the long run. In fact, as it worsens, COPD is one of the most common causes of unplanned admission to hospital and is expensive in terms of acute hospital care. It costs nearly 10 times more to treat severe COPD than the mild disease. So the earlier COPD is diagnosed, the better for all stakeholders, not least the patient. Surprisingly, despite the high numbers of people thought to be living with COPD, fewer than one in three (around 900,000) have actually been diagnosed with the condition and are therefore receiving treatment. Many people who develop the symptoms of COPD do not seek timely medical help because they often just dismiss them as a ‘smoker’s cough’. Smoking is the main cause of COPD, and the

Medical Devices

TECHNOLOGY

KICKING THE BAD HABIT While the medical professionals encourage the wider population to make positive lifestyle and behavioural changes, the MTG would encourage NICE, the NHS, CCGs and Trusts to consider making their own changes too. When the MTG last wrote a piece for Health Business, we noted that NICE did not then take real cost savings outside the NHS into account when making its recommendations. This is still the case. Too often, initial cost is given as the insurmountable barrier to adopting technology solutions. We urge commissioning budget holders and prescribing clinicians to take the longer view – yes, do look at the opening costs of a treatment, but not in isolation. Balance initial spend with the cost-effectiveness of the treatment over its lifetime, and beyond. And there are even greater savings when bulk buying. Opening access and increasing availability create sustainable financial efficiencies. This change of approach will release doctors to prescribe more devices for a broad range of conditions, benefit many patients straight away, and ultimately cut spend and future waste across the whole health service as it will cut unplanned hospital admissions (as our recent Admissions of failure report found) and deal with patients’ conditions before they worsen and become more expensive to treat. And not to mention reduce patient suffering and improve their quality of life now. LOOKING TO THE FUTURE In the meantime, the world’s best clinicians and scientists based here in the UK will continue to work to improve the lot of people with other once hopeless conditions. At Oxford’s John Radcliffe Hospital, a clinical trial started in 2015 in which six patients who have had little or no sight for many years would have a cutting-edge ‘bionic eye’ implanted. At the start of January, the BBC broadcasted the story of Rhian Lewis who had a tiny 3x3mm chip implanted into her right eye and connected to a tiny computer that sits underneath the skin behind the ear, working to replace the light-sensitive retinal cells in her eye. The programme brilliantly portrays Rhian’s resilience in the face of her condition and the genius of the women and men whose expertise enabled her to see her children’s faces for the first time in eight years. That is the power of medical technology. L FURTHER INFORMATION www.mtg.org.uk

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MEDICAL DEVICES

WHY USE THE NASAL ALAR SPO2 SENSOR?

The Nasal Alar SpO2 Sensor provides accurate pulse oximetry monitoring even in low perfusion cases, with greater patient comfort, lower cost and benefits in the emergency care services In the world of emergency services (EMS), speed is everything. Making quick, informed decisions can be the difference in patient outcomes. The Assurance® Nasal Alar SpO2™ Sensor is your ‘one and done’ solution for fast, accurate and dependable SpO2 readings. The nasal ala point of measurement site means, earlier detection, better perfusion and more dependable monitoring. This site is also easy to access, less susceptible to high noise and vibration environments, immune to ambient light and allows easy repositioning if necessary, due to non-adhesive attachment. EASY TO USE AND COST EFFECTIVE Placement of the Assurance® Nasal Alar SpO2™ Sensor is simple. The ease of accessibility can be very important in EMS vehicles. In addition, this single-patient‑use sensor maintains its placement on the nasal ala comfortably, without adhesives. As a result, the sensor is easily removed and reapplied, eliminating the waste associated with trying multiple sensors to get a good signal. Because the sensor’s receiver is inside the nose, it is naturally shaded, protecting it from the interferences of ambient light. The Assurance® Nasal Alar SpO2™ Sensor is also less susceptible to dropout caused by the noise and vibrations associated with EMS transportation. The sensor is a single patient use device, licensed for use for up to 28 continuous days. A usability and acceptance study in a non-hospital setting showed that 50 subjects could wear the sensor for seven days (4), and when compared to a finger pulse oximeter, the Nasal Alar SpO2™ Sensor was more comfortable and interfered less with daily living activities (4). Furthermore, there were no reported complications associated with skin pressure complications (5,6). As the Nasal Alar SpO2™ Sensor is licensed for long term continuous use, the emergency care patient can be transferred to hospital care whilst the sensor remains with the patient. This can be cost effective, particularly if use of adhesive sensors were necessary to obtain a signal. This also reduces infection risks from any lapse in protocol using reusable sensors.

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BETTER PERFUSION; DEPENDABLE SIGNAL The Assurance® Nasal Alar SpO2™ Sensor is less prone to drop out because it is used on the nasal ala, a central site with a highly consistent blood supply and signal, it is unaffected by many of the most common patient conditions that cause diminished perfusion to the digits leading to signal dropout and resulting in failure to provide an accurate pulse oximetry reading. Traditional finger monitoring may also be limited by injury, presence on the surgical field, non- invasive blood pressure cuff interruption, arm tucking and shivering. GENERAL USE AND ADVANTAGES Unlike fingertip sensors, where signals can easily be lost (2), the Nasal Alar SpO2™ Sensor detects changes in oxygen saturation from the nasal ala, a highly vascular region that is fed by both the external and internal carotid arteries, providing strong and reliable photoplethysmography signals that respond rapidly to changes in arterial oxygen saturation. The nasal alar site is very robust. The lack of sympathetic tone means no signal loss due to reduced temperature or anxiety and minimal effects by diminished peripheral perfusion, ensuring consistent, accurate and reliable monitoring, even at very low

oxygen saturations. The sensor is less likely to be dislodged as the design allows the connecting cable to run over and behind the ear lobe, the sensor is also comfortable and easily removed and reapplied for use during the patient’s hospital stay (1). This new sensor is compatible with the majority of pulse oximetry monitors used in many healthcare settings. Established in the USA as a first choice for a variety of low perfusion conditions, Pentland Medical is now marketing this product in the UK. L REFERENCES (1) Pentland Medical. Nasal Alar SpO2™ Sensor. Product information. http://www.pentlandmedical.co.uk/index.php/ products/nasal-ala-pulse-oximetry-sensor/ (2) Davis DP, Aguilar S, Sonnleitner C, Cohen M, Jennings M. Latency and loss of pulse oximetry signal with the use of digital probes during pre-hospital rapid-sequence intubation. Prehosp Emerg Care 2011;15(1):18-22. (3) Morey TE, Rice MJ, Vasilopoulos T, Dennis DM, Melker RJ. Feasibility and accuracy of nasal alar pulse oximetry. Br J Anaesth 2014;112(6):1109-14. http://bja. oxfordjournals.org/content/112/6/1109. Accessed June 18, 2015 (4) Melker, RJ, et al. Usability/Acceptance Study Final Report Xhale Assurance Nasal Alar Sensor. Feb. 2015. Unpublished data. On file, Xhale Assurance. (5) Lee M, Eisenkraft JB. Forehead pulse oximeter-associated pressure injury. A Case Rep. 2014 Jan 15;2(2):13-5. doi: 10.1097/ACC.0b013e3182a66b29. http://www.ncbi.nlm.nih.gov/ pubmed/25611043. Accessed June 18, 2015 (6) Pfuntner A, Wier LM, Steiner C. Costs for Hospital Stays in the United States, 2010. HCUP Statistical Brief #146. January 2013. Agency for Healthcare Research and Quality, Rockville, MD. http://www.hcup-us.ahrq.gov/reports/ statbriefs/sb146.pdf. Accessed June 18, 2015 FURTHER INFORMATION www.pentlandmedical.co.uk


AIR AMBULANCES

Dr Nick Crombie, clinical lead for Midlands Air Ambulance Charity, discusses the latest technological developments in pre-hospital care and the impact these have had on patients A man was walking along the road and came upon an injured traveller who had been beaten and robbed. The man cleaned the traveller’s wounds, bandaged them, put him on his donkey and took him to an inn where the man and the inn-keeper cared for the traveller. The story of the ‘Good Samaritan’ was told two thousand years ago, but remains as relevant today as it did then. The oil and wine used to clean the wounds are now antibiotics, the bandages are now impregnated with chemicals to promote blood clotting, the donkeys are now state of the art helicopters, and the inns are now Major Trauma Centres, but the principles underpinning pre-hospital care have not changed. Enhanced Care Teams across the world deliver modern and innovative care to the most critically ill and injured patients by air and by land, and the phrase ‘bringing the hospital to the patient’ is often quoted. Within the last ten years the ability of these Enhanced

Care Teams, such as Midlands Air Ambulance Charity, to stabilise and then transfer patients to specialist treatment centres has developed at an ever-increasing rate, with the support of a number of medical interventions and devices. There is no doubt that innovation in the pre-hospital arena has been rapid, embracing technologies tried and tested in hospital as they then become portable, battery powered and affordable.

Written by Dr Nick Crombie, clinical lead for Midlands Air Ambulance Charity

Clearing the air on pre-hospital care

Medical Devices

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patients?’ Even such a simple question is not easily answered. Firstly, how are these outcomes reliably measured and tied to the innovation? When modern healthcare resembles an incredibly complex jigsaw of treatment and specialists that may span weeks or even months of care, how can we determine if changing one small piece of that jigsaw at the start of the treatment pathway has an enduring effect amongst so many other variables? It gets more complicated. There are many innovations that undoubtedly give us extra information about the state of our patient, and information is often useful. However, if the treatment does not change as a result of that information, then have precious minutes and money been wasted performing an investigation that ultimately does not alter the care of the patient? Blood is a good example. In 2008 British E

Within n te the last ability e years thnced Care of Enha stabilise and o Teams ter patients to transf ent centres treatm rapidly has ed develop

NEW TECHNOLOGY There is one fundamental question that must be asked when considering new technology or devices for pre-hospital use: ‘does it improve outcomes for our

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AIR AMBULANCES  military forces started carrying concentrated red blood cells on rescue missions in Afghanistan. In 2012, some UK civilian air ambulances (not Midlands Air Ambulance) followed on the basis that it seemed logical that we should give bleeding patients blood, and the military experience had been positive. There are, in my opinion however, already two flaws in this strategy. The British military were retrieving young, healthy soldiers with absolutely catastrophic injuries caused by high velocity rounds and improvised explosive devices in areas located long distances from field hospitals. This scenario is wholly unrepresentative of the UK civilian population. Secondly, the ‘blood’ we see being given is actually a small fraction of whole blood. It is a concentrated bag of oxygen carrying red blood cells in a preservative solution designed to stop the contents clotting. Without the other fractions of whole blood that contain a myriad of vital components including the clotting factors, giving this can often encourage further bleeding. When the evidence from papers published all around the globe is collated and analysed, there is seemingly no suggestion that giving concentrated red blood cells in the pre‑hospital phase offers any long term benefit to patients. That evidence does not currently exist. And yet there are huge logistical operations in place involving hospital blood banks packaging scarce red blood cell bags into cold boxes, shipping them on motorcycles to some air ambulance bases from where they are carried to patients and transfused, not without risk. The fundamental question ‘does it improve outcomes?’ is not answered. This is the case for the majority of patients who are receiving it, and it is detrimental to the wider population when funds are diverted to the infrastructure to support it. This illustrates one of the problems of rapid innovation. Novel treatment can rapidly become standard practice as the search for the next innovation continues without pause to reflect on efficacy or value. FURTHER DEVELOPMENTS There are several other developments and medical devices that have started to make an

The days of hand-written charts with carbon‑copies that were left, often illegible, at hospitals are changing as EPRs are rolled out across ambulance and air ambulance services impact on pre-hospital services in the recent years. Ultrasound scanners, traditionally used in hospitals to visualise internal structures have become portable, battery powered and produced at a cost that makes them accessible to pre-hospital teams. Using these devices with confidence requires considerable costly training and ongoing experience. It is possible to visualise the heart using a portable ultrasound scanner which may guide resuscitation during cardiac arrest or severe cardiac failure, or used to identify free fluid within the abdomen which may indicate internal bleeding. It is however important to audit the use of ultrasound and how it may impact on decision making. Some patients may receive higher levels of care, for example because free fluid is identified following a traumatic injury warranting transfer to a major trauma centre for further investigation and treatment. If a patient that has suffered a trauma has a normal ultrasound, would that patient receive a lower level of care? That situation would require extreme confidence in the ultrasound and the operator to reliably determine that despite the trauma there was no internal injury. Therefore, it is not enough to procure and use an ultrasound – it is vital to put in place procedures to monitor its use, the effect that it has on decision making, especially if the effect is to reduce the level of care a patient receives, and the outcomes of those patients. One problem with this aspect of governance is that it has traditionally been difficult to reliably follow up patients treated in the pre-hospital environment. They may be taken to different hospitals, sometimes before identifying details are known. There are difficulties passing patient information between organisations for fear of breaching confidentiality legislation. Lastly, individual pre-hospital services may Dr Nick Crombie, clinical lead for Midlands Air Ambulance Charity

Medical Devices

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audit their individual practices in isolation for internal training purposes only. However, this is changing with another technology – electronic patient reports (EPRs). The days of hand-written charts with carbon-copies that were left, often illegible, at hospitals are changing as EPRs are rolled out across ambulance and air ambulance services. These capture live data streamed from compatible patient monitors and as the reports are populated by clinical staff they are able to be viewed by the waiting hospital teams. This integrated technology allows for much faster and more complete feedback. IMPROVING PATIENT OUTCOMES The fundamental question – ‘do these innovative medical devices and practices improve outcomes for our patients?’ remains very difficult to answer, but simply ignoring it in pursuit of newer and more cutting edge technology is not good medicine. This is why seven of the UK’s air ambulance services are participating in the first true trial to ascertain whether pre-hospital blood products do in fact improve patient outcomes. This trial, led by Midlands Air Ambulance Charity, will allow researchers to study the effects of transfusion at the scene of injury, through the emergency department, operating theatres and critical care and on to discharge from hospital. This scale of collaboration between seven air ambulances, nine major trauma centres, four NHS ambulance services and the supporting university trials unit is a considerable undertaking, but will go a long way to providing an answer that services across the globe have been searching for. It is also important that air ambulance services can tell the public with confidence that any new technology and medical devices will have a positive impact on the care of the patients they treat, and trials of this nature will provide that reassurance. Pre-hospital medicine has been practiced since the Good Samaritan came across the injured traveller, but the rapid evolution of technology and devices in this environment can be measured within the last 20 years. There is enormous interest in improving the care of patients within the first hour of injury through technology and innovation and air ambulances are well placed to lead on this. As long as every step forward is measured and reviewed, pre-hospital care will deliver the best of cutting-edge technology to the patients that need it most. L FURTHER INFORMATION www.midlandsairambulance.com

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Medical Devices Written by Andy Crosbie, MHRA Devices Division

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GS1 STANDARDS

Raising the standard of patient safety Andy Crosbie, MHRA Devices Division, explains how Unique Device Identification and GS1 standards can help to improve patient safety while increasing efficiency Patient safety is at the forefront of all that we do at the Medicines and Healthcare products Regulatory Agency (MHRA) and we’re always working to see what more we can do, and how we can improve, to ensure medical devices and medicines are as safe as possible. In 2015 we received and investigated nearly 17,400 adverse incident reports related to

medical devices. This represents an increase of 22 per cent over the last three years. As a result of this we issued 41 Medical Device Alerts (MDAs) and oversaw 810 Field Safety Corrective Actions (FSCAs) undertaken by manufacturers. Whilst it is important to note that a report of an incident does not necessarily mean that the

device was at fault it is still important they are reported and investigated. It is also important that when action is needed the device in question can be easily and properly identified in the supply chain in order for the correct action to be taken. To assist with this we have, for a number of years, been helping the NHS to adopt GS1 standards for medical devices. GS1 STANDARDS These standards are one of the main systems being adopted in Europe and worldwide for Unique Device Identification (UDI). Barcodes based on GS1 standards can be read at any point in the healthcare supply chain so a device that is subject to a safety alert can be easily identified and appropriate action taken quickly and easily. Once it is decided that corrective action is required these new identifiers mean that not only the device but, importantly, patients with the device can be identified so that appropriate advice and treatment can be given. In mid-2015 MHRA informed the medical professionals about a medical product recall using UDIs based on GS1 standards for the first time. This was a significant milestone for the healthcare industry and


set the scene for how important patient safety information about actions such as recalls will be communicated to patients and healthcare professionals alike in the future. REAL BENEFITS Using a UDI system based on GS1 standards significantly enhances the post-market safety of medical devices by: improving reporting and monitoring; targeting recalls; reducing medical errors; and fighting counterfeit devices. Sharing information about medical devices across the supply chain using a single entry point allows manufacturers, suppliers and healthcare providers to exchange information seamlessly; this is especially useful for implant registries and for product safety recalls.

professionals can identify quickly which patients are affected, should a safety concern arise with a particular device. When recalls take place, hospitals can now easily identify all of the affected products that they hold, preventing their use. They can identify all patients that may have been affected by the product – including patients with implants who are now at home – making it quicker and easier for any required actions to take place. By 2020 providers of NHS‑funded healthcare, including the independent sector, must be able to electronically track and trace individual medicines and medical devices to a specific patient.

UDIs o will als uce red help to t products fei counterhe healthcare within t , by making system r to identify it easie oducts pr

IDENTIFYING PATIENTS Once you have identified the device you then need to identify the patient. Since October 2013 all patient wristbands used in the NHS have had to include a GS1 barcode containing at least the following patient information: NHS number; first name and last mame; or date of birth. When combining this 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 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

EFFICIENCY GS1 standards are also being adopted across hospitals to improve purchasing efficiency and control of supply chains with the ultimate aim of improving and protecting patient safetyThe NHS eProcurement strategy – which was launched in May 2014 – includes a mandate from the Department of Health, that means any service or product procured by an NHS Acute Trust in England must be compliant with GS1 standards. Currently every one of the 154 NHS Acute Trusts in England is a GS1 UK member as every Trust has so far achieved at least some degree of ‘readiness’. Compliance with these standards will enable Trusts to manage their non-pay spending through the adoption of master procurement data, automating the exchange of procurement data, and benchmarking procurement expenditure against other Trusts and healthcare providers. COUNTERFEITS While UDIs present a major opportunity to improve healthcare recalls, they will

also help to reduce counterfeit products within the healthcare system, by making it easier to identify products which have not been supplied via the legitimate supply chain. This is a hugely important step in protecting patients in ensuring that only high quality products from approved suppliers are being used in their treatment.

Medical Devices

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NEW REGULATIONS New regulations for medical devices are currently under negotiation in Europe and are likely to be introduced in 2016. These will supersede existing medical device directives and will require UDIs for all devices sold in Europe with phased implementation – according to device risk – beginning in the next few years. With early implementation of GS1 standards, the NHS in England will be ahead of the curve. ALL CAN BENEFIT Strong links, even between a few of a hospital’s operational areas, enhances the patient experience, makes for quicker, safer and more effective treatment and reduces processing time, cost and administration errors. It gives Trusts and healthcare professionals complete visibility. GS1 unique identifiers can be applied to patients, medicines, surgical instruments and more. Put simply, using GS1 standards to uniquely identify every patient, product and place, enable increased patient safety, regulatory compliance and operational efficiency. The use of Unique Device Identifiers presents a major opportunity to speedily identify exactly where products are in case of any safety recalls, as well as reduce any counterfeit products within the healthcare supply chain. They provide a common foundation that, in turn, improves confidence in the delivery of care. L FURTHER INFORMATION www.gs1uk.org

Improving patient care with innovative vein visualisation technology Over 90 per cent of hospitalised patients may require a peripheral cannula to deliver IV therapy, and first time insertion success rates can vary greatly, depending on patient condition and staff skill and experience level. According to the Infusion Nurses Society Infusion Therapy Standards of Practice 2016, vein visualisation technology with patients with difficult venous access can help to increase the number of first successful venepuncture and cannulation attempts and decrease the need for central venous access. Andrew Barton, advanced nurse practitioner, Vascular Access, IV Therapy and OPAT at Frimley Park Hospital, said:

with dark pigmentation skin or tattoos.” The IV-eye® offers simplicity, portability and performance in near infrared (NIR) peripheral vein visualisation technology. More first time successes equals fewer escalations; more efficient care; lower costs; more confident staff and better patient outcomes and experience. To arrange a clinical evaluation or for more information, call or email quoting HB2016. “The IV-eye® is excellent at finding veins for cannulation and particularly venepuncture. I have found it very useful in children, bariatric patients and patients

FURTHER INFORMATION Tel: 01235 828 292 info@novarix.com www.novarix.com

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SP E E C H R E COG N I T I ON . R E D E F I N E D .

Lexacom Echo revolutionises the way in which Speech Recognition can be accessed, delivering a new sophisticated solution to anyone using the advanced digital dictation platform, Lexacom 3.

Lexacom Echo: • Removes any barriers traditionally associated with Speech Recognition • Offers complete flexibility, transparency and a high

• You can choose how to pay; pay as you go or on a monthly subscription basis • Includes profession-specific vocabularies for medical,

level of accuracy with no upfront financial investment

legal and business which are fully integrated and

nor the need for upgraded or expensive PC hardware

updated regularly

• Compatibility with any PC running the Lexacom 3 platform • Offers two modes for dictation, allowing users to choose the most suitable for their needs; Lexacom Echo offers the standard deferred option and Lexacom Echo Live offers the direct option, both available at the touch of a button • Lexacom 3 users can select to use Lexacom Echo as and when they require additional support

• You only pay for what Lexacom Echo transcribes correctly (if using PAYG) • All Lexacom 3 users can trial Lexacom Echo for 14 days, for free. • Offers bespoke 1-2-1 training, to ensure you get the best user experience Lexacom Echo is an important part of the end-to-end workflow. It is tailored for any type of organisation that will benefit from a seamless, secure, all-inclusive service. It will help to reduce heavy workloads in the most efficient and cost effective way possible.

For more information about Lexacom Echo, please contact us by telephone on 01295 236910 or on email sales@lexacom.co.uk or visit us online www.lexacom.co.uk Quote LexacomEchoHB


DIGITAL

SERVICES

The digital NHS

Late last year Health Secretary Jeremy Hunt appointed Baroness Martha Lane Fox to look at how the take-up of internet services could be made widely available and include the 10 million people who currently have no internet access. Martha, of lastminute.com fame, presented her recommendations to the National Information Board chaired by Tim Kelsey. Her recommendations included free Wi-Fi access from health and social care settings, after all, as she suggests, ‘it’s basic infrastructure’. Martha wants a digital health service to be inclusive of those who do not have internet access and start with the disadvantaged first. Martha says: “One of the founding principles of the NHS was to ensure that everyone – irrespective of means, age, sex, or occupation – should have equal opportunity to benefit from the best and most up-to-date medical and allied services available.” There’s no question Martha is excited and impassioned about digital change in the NHS. Martha Lane-Fox says every GP should have at least 10 per cent of its patients using online services by March 2017 and 90 per cent of patients by 2025. She wants to encourage this different way of interaction between doctor and patient by training GPs in digital skills.

to an endorsed set of NHS and social care apps. The workstream suggests that endorsement can encourage health and care professionals to recommend the use of safe and effective digital applications and give greater confidence to patients and citizens to select and use them. PRACTICAL APPLICATION Returning to Martha’s key recommendations, they do appear quite simple; and perhaps obvious to many, after all you can get free Wi-Fi almost anywhere, and in fact many GP practices already offer this. We all use online appointment booking systems to book travel, order grocery deliveries and to reserve a table at our favourite restaurant. But the obviousness of these recommendations perhaps suggests that there is a struggle to move things forward. There are, of course, numerous siloed successes where forward thinking health professionals and CIOs have taken it upon themselves to deliver digital services. Take for example the MyMR (My Medical Record) Personal Health Record initiative implemented by University Hospital Southampton. The service allows a patient to send secure messages via a portal to contact their clinical support team, as well as access to an online journal to track and record patient activity or behaviours based on the condition being treated. Comprehensive guides and advice are provided and tailored for the specific health episode.  MyMR also allows the patient to view hospital appointments both past and future, check medications, weights and test results and a two-way upload of medical documents. As one MyMR patient suggests: “self-management is empowering, liberating and informative.”   Linking up with commercial digital solutions will also be essential. For example, Philips has just announced its plans to make it easier for patients to self-monitor their health using Amazon Web Services (AWS) Cloud and Internet of Things (IoT) technologies. Philips believe this is a key way to reduce the burden on the NHS as it will reduce the number of repeat appointments with a health professional simply to collect statistics. GPs and hospitals will need to be in a position to consume such data in real-time if they are to benefit from this approach.

The oes future dsitive o seem p is a sense re and theeal focus of r ering in deliv lutions so digital atient for p t benefi

THE NEXT STEPS Following on from these recommendations, Jeremy Hunt has announced a £4.2 billion investment to bring the NHS into the digital age. Areas of improvement include an ambition to have a paper-free NHS, investment in cyber security and data consent, a new NHS website and apps for patients, development of a new click-and-collect service for prescriptions, and, of course, free Wi-Fi in all NHS buildings.   Mr Hunt said: “The NHS has the opportunity to become a world leader in introducing new technology – which means better patient outcomes and a revolution in healthcare at home.”   Running in parallel to this ambition are the seven workstreams of the National Information Board. These include objectives such as providing patients and the public with digital access to health and care information and transactions, with a focus on prevention and self-care. This will include a national experiment to give patients a personalised, mobile care record which they control and can edit, but which is also available in real time to their clinicians.   In supporting better decision making on behalf of the patient, workstream 1.2 focuses on providing citizens with access

Written by Written by Gareth Baxendale, chartered fellow of BCS, the Chartered Institute for IT

In light of Baroness Martha Lane-Fox’s recommendations on more digital inclusion across the NHS, Gareth Baxendale, chartered fellow of BCS, the Chartered Institute for IT, discusses the scope for greater application of digital services

Healthcare IT

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CHALLENGES On a very practical level there are challenges involved in delivering digital solutions such as upskilling health professionals with necessary technical skills and creating patient awareness in order to adopt new services. E

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DIGITAL SERVICES  On the matter of digital exclusion, there will be technical constraints to overcome in rural areas that struggle with poor infrastructure, numerous factors come into play such as distances from exchanges and even the type of cabling as many struggle with poor broadband speeds over aluminium (as opposed to copper) wiring. In such cases technology will likely be designed to operate in an offline mode, collecting data and uploading when the patient happens to be in a Wi-Fi area. The alternative could be investment in additional 4G mobile masts in such areas to truly enable digital services. THE NHS TO BE… Speaking to UK eHealth Week, Beverley Bryant, director of digital technology at NHS England, said: “With the Summary Care Record, almost 96 per cent of the population now has one and, particularly in emergency or secondary care, the use of this is really transforming patient care.” She continued: “Our greatest challenge is delivering at scale. We cannot impose top down technology and information services on the NHS. It all needs to be owned locally. It needs to be the day-to-day business of all of the NHS organisations that are delivering care. We know our care organisations need interconnected systems and services to deliver better outcomes for patients, so we will support them to ensure they are ready with the capabilities

Healthcare IT

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On a very practical level there are challenges involved in delivering digital solutions such as upskilling health professionals with necessary technical skills and creating patient awareness in order to adopt new services and infrastructure needed. Strong leadership is vital to delivery of the paper free agenda, from clinical and business leaders who really understand the nature of the NHS and how technology can support their provision of care. For patients, we need to build public awareness of how digital tools and accessing their record can help them if we are to make this work.   “The priority is that we join the NHS up to itself and we join the NHS up to social care and we allow information about patients, like discharge summaries to transfer electronically back to primary care for example. Citizens’ information needs to be transferring across care boundaries between the acute and community and back to primary care. And so we’ve put responsibility at CCG level via the Local Digital Roadmaps to support this across the system.” THE FUTURE The future does seem positive and there is a sense of real focus in delivering digital

solutions for patient benefit; especially those that perhaps came under the banner of digital exclusion. The focus must, of course, remain on patient’s wishes and needs. To this end, many groups such as BCS Health will be working closely with the National Information Board and other partners to support and assist in making a digital NHS a reality and working hard to ensure that digital exclusion is a thing of the past. L

Gareth Baxendale has worked in the technology industry for over 20 years in both the commercial and public sectors. He is currently head of technology for the NIHR Clinical Research Network. Gareth is also a Chartered Fellow of BCS, The Chartered Institute for IT and vice chair of the BCS Health Executive. FURTHER INFORMATION www.bcs.org

37 services at Camden and Islington NHS Foundation Trust rely on Docman Hub to send their documents Camden and Islington NHS Foundation Trust was the first mental health organisation to implement Docman Hub, which was first introduced in September 2011. Based over 12 sites, 37 services at the Trust now use Docman Hub to send documents electronically to GP practices in Camden, Islington, Enfield and Barnet. Lami Akinsanya, Docman project manager at Camden and Islington NHS Foundation Trust said: “We began the project by introducing Docman Hub into our priority services and we are continuing to rollout Docman across the whole Trust. We are currently sending documents via Docman to 94 GP practices in Camden, Islington, and a few in Barnet and Enfield.” Camden and Islington NHS Foundation Trust have reported significant cost savings since going live with Docman Hub. Each month the Trust sends over 2,000 documents through Docman Hub, providing a number of efficiencies and benefits to the Trust. Letters are instantly delivered to GP’s meaning less staff time is spent on admin, postage is significantly reduced and a full audit trail allows each

document to be tracked and reported on. Jo Pollock, clinical team manager, Islington Crisis Resolution Team, added: “Staff like the fact that when they’ve sent the patient documents, they can see via the audit trail that it has been delivered to the GP, which gives reassurance.” Since the installation of Docman Hub, the Trust has been able to meet delivery targets such as the 24 hour discharge summary target. Akinsanya commented: “GP’s now receive discharge summaries within 24 hours which is extremely important from a clinical and patient perspective. Docman ensures confidential information is kept safe, removing the risk of documents being lost and provides patients with quality care.”

Docman Hub has helped Camden and Islington NHS Foundation Trust become paper light and increased the speed of delivery of documents from the Trust to GP Practices but it doesn’t end there. Claudia Gonzalez Burguete, senior administrator and Docman champion user, said: “The great benefit of using Docman is that it saves me a lot of time to do other tasks, it reduces paperwork and typing and I can monitor delivery of the documents via the Docman audit trail. It is also a much faster way to send patient documents to GPs.” As well as rolling Docman Hub out across the whole Trust, Camden and Islington NHS Foundation Trust is aiming to send documents electronically to even more GP practices in Barnet, Enfield and Haringey to become increasingly more efficient and improve patient experience. FURTHER INFORMATION Tel: 01977 664496 sales@docman.com www.docman.com

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Advertisement Feature

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INTELLIGENT LINKING

HICOM FACILITATES INTEGRATED CARE IN NORTHERN IRELAND

As integrated care pioneers work towards the vision of more person-centred, coordinated care, there are growing examples where effectively linked data sets are empowering multidisciplinary teams of healthcare professionals with timely access to vital information

In doing so, we are reducing the burden on NHS resources, removing unnecessary administrative duplication and improving the efficiency of healthcare services. One emerging case of interoperability is Health and Social Care in Northern Ireland (HSCNI), where software and consultancy provider Hicom is delivering interfaces that have overcome historic obstacles to silo’d information, bringing greater accessibility to data and precipitating a shift towards a more modern IT infrastructure which underpins the provision of faster, safer, better care for health and social care professionals.   HEALTHCARE IN NORTHERN IRELAND Healthcare services in Northern Ireland are delivered through five Health and Social Care Trusts, responsible for the management of staff, health and social care services on the ground and with their own budgetary control. The five regional Trusts are Belfast Health and Social Care Trust; Northern Health and Social Care Trust; South Eastern Health and Social Care Trust; Southern Health and Social Care Trust; and Western Health and Social Care Trust.   In July 2013, Health and Social Care (HSC) in Northern Ireland introduced the Northern Ireland Electronic Care Record (NIECR), a digital care record that brings together key information from patients’ health and social care records from throughout Northern Ireland in a single, secure computer system.   Since October 2015, interfaces from Hicom have enabled NIECR to be populated with data captured through each of the five trusts’ diabetes information management systems, which incorporate Hicom’s adult diabetes management solutions Diamond.NET.

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Interfaces for the Trusts’ paediatric diabetes solutions, Twinkle.NET – also from Hicom – are also in the process of being deployed. STANDARD PROCESSES Data captured through the trusts’ diabetes systems is automatically transmitted to NIECR through standard clinical correspondence processes that follow outpatient appointments. Healthcare professionals across the continuum can monitor the status of individual diabetes patients as they move along the pathway. The outcome is more joined-up, shared decision making, and ultimately improved patient care. Gary Loughran, eHealth programme manager, from the HSC’s Business Services Organisation (BSO ITS), responsible for the delivery of the NIECR system, comments: “With Hicom’s Diamond.NET, we’ve been able to make all adult diabetes information from the past two years quickly available through the Electronic Care Record whenever a patient presents themselves in a healthcare setting, irrespective of where they are in the country. “Having this data automatically transmitted to the centralised record means consultants, doctors, nurses, social workers and GPs can be assured that treatment protocols are being followed in an appropriate and timely fashion, facilitating shared decision making and accelerating the most appropriate intervention where necessary.”   ENABLING INTEROPERABILITY Historically, technology has been held up as a barrier to the progress of integrated care; however, the NIECR project demonstrates clearly the advances that have been made. Whereas legacy systems were often localised or fixed in departmental or regional silos,

advances in web technology have brought greater accessibility to data. Moreover, the best web-based solutions and interfaces are built to deliver operability with adjacent solutions, such as – in Hicom’s case – relevant Pathology reports. With multiple morbidities being particularly common in diabetes patients, the effective sharing of data using interoperable systems can play a significant role in mitigating costs. Loughran continues: “It’s important that HCPs across both primary and secondary care are able to make clinical decisions based on full knowledge of all clinical factors such as past history, existing conditions and medication regimes. Because Hicom’s solutions are web-based, once a staff member has authorised access to the NIECR network, they can securely obtain all relevant diabetes data whenever they need it. In this way, Hicom is helping us move away from a silo approach to patient care, by facilitating greater connectivity, broader functionality and integrated data intelligence to our workforce. “Diabetes is one of the key long‑term conditions where patients can benefit from more integrated care; monitoring the status of individual diabetes patients as they move along the care continuum becomes more effective when there is sharing of data using such interoperable systems. “All five trusts are experiencing the value of integrated care; we are pleased that productivity has risen. By combining our existing diabetes systems and NIECR with Hicom, we’re successfully closing the patient safety gap and enriching the level of healthcare provision throughout Northern Ireland.” The road towards integrated care may have been a long one, but despite rhetoric to the contrary, there are increasing examples where barriers to progress are being removed. By partnering with a trusted technology partner, NHS organisations such as Northern Ireland’s HSC trusts are implementing powerful tools to make the most of existing systems to intelligently link high-value data. L FURTHER INFORMATION www.hicom.co.uk


IMPROVING CARE

Getting a better handle on NHS data

Health Business’ Ben Plummer discusses how better utilisation of data can improve the delivery of care and support efficiency savings across the NHS If the NHS is going to achieve its target of being a wholly digital institution by 2020, as outlined by the government, it will need to evaluate how it utilises data in order to improve the delivery of care, as well as, in the face of a projected £2 billion deficit by the end of this financial year, create new metrics by which it measures its performance and efficiency.

We live in a time where our lives are inextricably connected to the internet, and data in its infinite forms can be recorded and transmitted instantly to the cloud – what is referred to as ‘big data’. This opens the door for medical professionals to be able to assess statistics and indicators, in huge volumes, from a bird’s eye view like never before. It’s important to be able to differentiate the

HOW DATA CAN BE SHARED As the NHS continues its initiative to become paperless, there are new technologies that allow nurses to carry out assessments and calculate early warning scores digitally, through mobile technologies and bedside terminals. This data is recorded and then transmitted to a central system, which is accessible to doctors and nurses across the hospital, who then get notified of any developments in the patient’s condition in real time. Having remote access to this kind of data means that caregivers can not only react more efficiently in clinical terms, but as the data is available to all hospital staff, it can improve on the often complicated rota system, which promotes better time management. Outside of the hospital, the sharing of data provides healthcare professionals and patients with a huge scope of possibilities that could lead to a significant portion of care being administered elsewhere. Mobile apps that are centred around fitness and wellbeing collect data on how active the user is, often in conjunction with a wearable device, can be useful on a superficial level in helping combat diseases such as obesity and diabetes, but also online therapy apps for mental illnesses which monitor interactions with the user and flag worrying results back to clinicians for assessment that can lead to potentially life-saving interventions. As technology advances, there is more and more anticipation surrounding projects that promise to be able to provide clinicians with more detailed information about their patients relating to illnesses that can’t be treated by patients themselves. At the turn of the year, The King’s Fund highlighted ‘eight technologies that will change health and care’, one of which noted the potential of ‘portable diagnostics’, such as the AliveCor ECG, which records ECGs and heart rates through an attachment to a smartphone accurately enough for clinical use. The landscape of innovations that harness health data is constantly shifting and evolving, but one constant factor that remains is skepticism from the public as to whether they trust the NHS – and the broader government – to handle some of their most intimate details. As such, it is important to take into account, and create a E

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Written by Ben Plummer, Health Business

various classifications of data in order to make best use of its applications to healthcare, and, broadly speaking, there are three considerations to take into account that can help extrapolate the potential benefits and pitfalls of data in healthcare.

The cloud oor he d opens t edical for m nals to io profess ble to be a tistics ta assess snever like before

Data Handling

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DATA HANDLING

MANAGING DATA IN DIGITAL PATHOLOGY

What can be done to better manage data in digital pathology? Arkivum examines how cloud-based managed data storage can be used to deliver economical and compliant data management The healthcare industry has changed and reformed more in recent years than ever before. In the face of significantly reduced budgets, this has prompted the introduction of new technologies in order to increase efficiency. One of the most significant technology innovations is the growing utilisation of big data. With cutting-edge technologies allowing researchers and doctors to make new discoveries that just a few years ago would never have been thought possible, the resulting data has the potential to shed previously unprecedented light on medical science. However, as the data generated by today’s pioneering work in the sector continues to grow, many healthcare organisations, including hospitals and research institutions, are finding that storing this vast amount of data in a way that fulfils a range of needs and requirements is much easier said than done. Key criteria that organisations need to consider include how long the data is going to be kept for and at what rate the data is going to grow. Also meeting compliance of the NHS Information Governance (IG) Toolkit, as well as ensuring the highest standards of data security via the approved N3 network is essential. STORING DATA Digital pathology is one such area that is significantly benefiting from the application of big data, but equally it is grappling with the issue of finding a suitable home for the sheer quantity of data being created. Many NHS pathology labs are now embracing digital workflows, scanning glass slides into digital images that can be viewed, managed and analysed in a way that transforms digital pathology practices. It is widely believed that digital pathology has significant potential in achieving quicker and cheaper diagnoses, and the field is seeing significant growth as a result. Nonetheless, to put into perspective how much of a challenge storing the data generated by digital pathology processes can be, a small slide scanner running 200 slides per day at medium resolution will generate over 20TB of data per year, which has to be stored, managed and kept secure over decade-long timescales, all the while taking into account the compliance, security, cost and data integrity requirements associated with its storage.

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WHERE DO I START Looking at numbers like this, and when you start to consider what is required to successfully store this data, it quickly becomes clear that digital pathology laboratories, as well as hospitals and other medical research institutions, have a significant task on their hands. The big question being asked by those trying to get to grips with their long-term data storage strategies is “where do I start?” Many digital pathology managers are turning to NHS IM&T (Information Management & Technology) managers to solve this problem for them, some of whom are expanding their local infrastructure, while others are implementing cloud-based services such as Amazon Glacier or Google Nearline. However, simply expanding the local infrastructure to provide sufficient space for these data volumes does nothing to ensure that it is protected from corruption or loss. SPECIALIST PROVIDERS An alternative option, which some IM&T managers are considering, is to bring in a specialist provider of long-term data archiving, such as Arkivum, who can implement a managed service that has been specifically designed from the ground up to provide ultra secure storage for large volumes of data for extended periods of time. Such specialist services also help IM&T managers solve their backup problem. In essence, if data is static and no longer likely to change (slide images being a case in point) then this data can be offloaded to much

cheaper, and more secure, long-term archive storage. By doing this, IM&T can economise by not needing to provide local infrastructure to maintain an unnecessarily large backup window. While data volumes are very large, using a managed data storage service as described above does help to eliminate many IM&T management headaches. Predictable costs and long-term contracts, along with significant local IT cost savings, also provide a very compelling business case. But it is not just digital pathologists who can employ digital archiving services. Healthcare organisations across the board are looking for ways to manage their data and Arkivum strongly encourages hospitals, genetics laboratories, fertility clinics and digital pathologists alike to consider the integrity, security and longevity offered by a specialist data archiving solution – it’s by far the most effective way to ensure that data is protected. To learn more about how straightforward it is to reap the benefits of efficient digital pathology data management, download Arkivum’s new White Paper: Managing Big Data - Reaping The Rewards. The paper details the issues and challenges that are being faced by digital pathology labs when implementing technologies like whole slide imaging and highlights what a digital pathology data storage strategy needs to include. L FURTHER INFORMATION info@arkivum.com bit.ly/ArkivumWP


IMPROVING CARE

 specific strategy for handling and using these two separate tiers of data in order to make them clinically and operationally beneficial. The Monitor Delloite Digital Health in the UK report, released in September 2015, reads: “mHealth apps can spilt into two categories. Consumer-led fitness and wellbeing apps handle low-confidentiality data (personal wellness and activity data) and are usually a consumer-driven purchase. Clinically-led apps manage medium to high confidentiality data (health data and personal medical records); these are used by clinicians, patients or hospital system reporting to aid prevention, diagnosis, and/or monitoring of disease” – Deloitte (http://bit.ly/1KUvbXS)

This leaves the NHS very much open to a cyber attack, which would jeopardise the safety and privacy of patients. Data that has been shared with consent by the public also needs to be recognised as one of the biggest concerns, especially given the NHS’ rocky history with data privacy. The care.data programme was designed to help narrow the gap between what doctors and GPs could share with their patients and vice versa. However, it was widely criticised for its perceived insensitivity towards its treatment of the data, and its complicated and underdeveloped opt-out process. Another example of perceived mishandling of patient data was brought to the fore in September last year when researchers from Imperial College London investigated 79 apps from the NHS Health Apps Library. They found that 70 of the apps transmitted information to online services and 23 of those sent identifying information over the internet without encryption, while four apps were found to be ‘sending both identifying and health information without encryption’.

Data Handling

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Public perception is absolutely key to capitalising on the benefits of data moving forward; regardless of how effectively a countrywide digital information programme has the potential to be, any attempt to implement one is doomed to fail without a national consensus that it is working in the best interests of its patients and their privacy. When KPMG explored attitudes towards how comfortable UK consumers were with granting access to their personal information, 78 per cent of 1,000 UK adults questioned would be happy to share the data collected by fitness bands and lifestyle apps with their GP, but given that more advanced technologies are yet to be tested on a larger scale, it remains to be seen whether sharing ‘medium to high level confidentiality data’ will be embraced by the public. HOW DATA CAN BE APPLIED With the advent of IT systems that facilitate remote patient care, the concept of ‘population health’ has been popularised over recent years, particularly overseas, however, given the imperative need for an NHS that can more effectively integrate health and social care it has been taken more seriously in Britain. By definition, population health takes a view of the overarching healthcare needs of a specific geographic catchment area as a whole, in order for the different medical services to work together in improving health outcomes for the population. E

Data s that ha red a been shnt by the nse with co also needs public cognised as to be ree of the on ecurity s t s e g big s concern

HOW DATA CAN BE TREATED Medical records are said to be more valuable to hackers than even financial data, and with the penetration of mobile devices into the NHS, the issue of security around the data that’s transferred has come into sharp focus in 2016. A survey conducted by security firm Sophos in January highlighted a worrying disparity between the beliefs of the IT managers and CIOs who were asked and the reality of the level of encryption; only 34 per cent had data stored in the cloud encrypted.

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DATA HANDLING

IMPLEMENTING MI VIEW TO GAIN OPERATIONAL INTELLIGENCE The regional NHS Directory of Services team, hosted by NHS Gloucestershire Clinical Commissioning Group on behalf of seven CCGs in the South West, identified a need to analyse and interrogate the vast amount of data created by its health economy providers

The commissioners wanted operational intelligence and an insight into service provision - as distinct from patient demand – from the data provided by NHS 111, out-of-hours services, ambulance and acute trusts. As part of an ‘urgent and emergency care development programme, the Directory of Services team, led by Gavin Reader, had already procured and deployed from Intuiti Solutions, a MiDoS search tool. This enabled clinicians based in call or mobile centres in the field to access the wealth of information in the NHS Directory of Services. However, the volume and complexity of the data captured by MiDoS, when concatenated with existing data sets, led the team to search for a business intelligence tool that could be used by end users without having to rely on an already very busy management information team. CHOOSING MI VIEW Having extensively reviewed the BI market, it was decided that MI View from Total Intelligence was the best fit solution. This was down to: the speed of report design by nontechnical users; the speed of deployment; and the scalability and flexibility of the product. The system is now used to manipulate data received from the MiDoS application through a SQL interface. Various database sources are amalgamated into MI View’s indexes, from which a multitude of queries, crosstab reports and graphs are produced.

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The various data sources are scheduled to update every hour, so the system is providing its users with near real-time information. In addition, a report is automatically produced daily at 8:30 am, about the use of commissioned services over the previous 24 hours. This is emailed as a PDF to various members of the Director of Services team and forwarded to commissioners and key stakeholders as appropriate. PUTTING DATA ON THE MAP The NHS Directory of Services has also been uploaded through a CSV file into MI View and amalgamated with a postcode file containing longitude and latitude information. This means that MI View can be used to map this data onto a Google map and that the Directory of Services team and commissioners can see the location of healthcare services across a geographical patch. In all, 2.5 million postcodes were uploaded into MI View. These were then reduced to 110,000 to cover the specific geographical areas covered by the CCGs in the region. MI View can visually ‘bunch’ postcodes on the Google map and assign a search radius to be used with the Directory of Services. FURTHER DEVELOPMENTS As part of the deployment, MI View is also being used by a local out-of-hours provider. Data is uploaded to MI View via a CSV file on an automated schedule

from its SystmOne clinical system. Through various queries, crosstab reports and graphs, a scheduled dashboard can then be produced and accessed by appropriate users through a browser. Further plans include using MI View to report on data received by the local NHS 111 service. This would involve taking a ‘live’ feed from the host system and then using the various functions of MI View to create commissioner reports and dashboards that could be viewed in a ‘live’ environment. The mapping tool will also be used to identify hot spots of activity. Eventually, the idea is to repeat the process with several other organisations so commissioners can track the patient journey as well as report on additional pathways. Reports and dashboards will continue to be developed for the CCG commissioners as more data streams are established. Commissioners will also be licensed to run their own reports and dashboards whenever required. THE ENABLING TECHNOLOGY Behind this story of course is some really advanced technology. MI View was developed to be a ‘game changer’ in the world of business intelligence solutions. Virtually all presently available solutions in this area were developed decades ago and it shows in their lack of flexibility and the cost, whether to buy or implement or both. Compared to its competitors, MI View is quick to set up and is firmly aimed at the world of self‑service. Today’s organisations do not have the appetite for needlessly long projects to generate management and operational intelligence. The process of responding to ad hoc information demands should take minutes, not days or weeks and shouldn’t necessarily need the involvement of expensive IT resources. MI View was built with this new age in mind, and not for the world that existed decades ago when information requirements were rather more ‘analog than digital’. L FURTHER INFORMATION totalintelligence.co.uk


IMPROVING CARE

Data Handling

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

Within the hospital, there are digital business intelligence (BI) tools and staff rostering systems that have proven effective in maximising resources, which is absolutely critical to combating the huge funding deficit that the NHS is facing, while maintaining a high standard of care  This is done by using expertise from all areas of NHS services, and collaborating to share and analyse data collected to pinpoint problems that arise more commonly. While it’s early days with population health, it brings the NHS a step closer to towards the objective of easing the burden on hospitals and apportioning care based on where it would be most effective and efficient, which can often be in one’s own home, particularly in managing long term conditions. Within the hospital, there are digital business intelligence (BI) tools and staff rostering systems that have proven effective in maximising resources, which is absolutely critical to combating the huge funding deficit that the NHS is facing, while maintaining a high standard of care. By using data collected to clarify where and how doctors spend their time, in conjunction with data on which wards or departments are busiest or require most attention, those charged with running the hospital can base their decisions as to where improvements could be made on statistics that are much more reliable and specific than those that have been traditionally used. Another key issue that data can be used to improve is the huge difference in prices that trusts pay up and down the country for basic, everyday medical instruments, which is costing the NHS an estimated £5 billion. The latest report conducted by Lord Carter of Coles, released earlier this year, once again shone a spotlight on the inefficiencies of the buying decisions made by NHS trusts. ‘SIGNIFICANT UNWANTED VARIATION’ A theme of Lord Carter’s findings, dating back to his first report

last June, has been the lack of collaboration and communication between trusts with regards to the purchases and management choices that they make – a problem he refers to as ‘significant unwanted variation’. Having based the recommendations on conclusions that have been drawn from studying healthcare systems around the globe, the report believes that there is a discernible correlation between good management and financial practices and quality health and productivity outcomes. It proposes that a ‘single integrated performance framework’ be introduced, in order to eradicate the inconsistency with which trusts evaluate different datasets.

With such a framework in place, it would allow the NHS as a whole to aggregate the costs of essential equipment, and the most competitively priced services offered by suppliers, which could be the first step in implementing a top-down procurement strategy to help narrow the funding gap. Data is such an enormous umbrella term that covers so many different areas, it becomes difficult to discern how to handle it and where to apply it. But it is now ubiquitous in our daily lives, and from a healthcare perspective it provides greater clarity and transparency as to how patients can be better treated in and out of the hospital, and how NHS institutions can be managed and work together to improve its services. With the government committed to providing free WiFi in all NHS buildings, huge amounts of health related data will be shared every day, which will quickly become a pillar in how the sector integrates new technologies into the caregiving process. L

Data is such an enormous umbrella term that covers so many different areas, it becomes difficult to discern how to handle it

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Closer to the people who really matter

To the right person The right information

At the right place

At the right time

See how we can help at: Hospital Innovations 26/27APR16 Olympia, London

Healthcare Strategy Forum 17/18MAY16 Heythrop Park, Oxfordshire

HSJ Modernising Healthcare Summit 23/24MAY16 Heythrop Park, Oxfordshire

Patient Safety Congress & Awards 05/06JUL16 Manchester Central

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COMMUNICATION SOLUTIONS

IMPROVING PRODUCTIVITY, MOBILITY AND SAFETY

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Data, and the effective use of it, is key in all areas of our own lives, just look at how we have developed travel, shopping, cars, and space exploration to name just a few We book, pay, find friends, look at recipes, tweet and keep in touch using online methods daily. This means that every day we are gathering vast amounts of information to do with our lifestyles, the way we interact and how transactions that are completed (Facebook, loyalty cards, google etc). Interestingly the data created from where we are, what we do and with whom is recorded from the technologies that we carry and even wear. This is giving an opportunity for further levels of insight that we could potentially use, for example fitness monitoring. This could also give an opportunity to bring in new dimensions to health monitoring and care plans by collecting data automatically for fitness levels, observations etc. This vast production of data requires the tools to gather, inspect, discover trends and then to apply it to other sources to create information. Only when we have enough information, can reliable decisions be made from them. Once a decision is made, it then needs the right method to be become actionable. We know we live in a world where there is an ageing population, driven primarily by baby boomers and increasing life expectancy that will almost double the number of pensioners by 2020. Additionally our own life-cycle choices are driving the need to treat patients differently too. Increased consumption of alcohol, coupled with poor diet and lack of exercise, has resulted in

ballooning levels of obesity and diabetes. Sociological changes mean that we, as patients, are also expecting more in terms of who, where, when and how we engage with our medical professionals. This has driven a requirement to give even more information and a faster more consistent response. Ultimately this has resulted in increased pressure on all front line staff and in particular our A&E departments. Add to this an increase in complexity from life‑changing technological advances in medicine driving better ways of treating ailments. It is clear that, as the demand for care increases, we need to find smarter ways of working and to make life a little easier for our clinical-staff too. It is also crucial that we use data to create the information that helps to provide better diagnosis and lead to more appropriate decisions. Ascom provides dependable onsite communications solutions for all care environments bringing increases in staff productivity, mobility and enhancing safety. Ascom allows staff to get closer to the people who really mater, the patients, by delivering the right information, to the right place, to the right person, at the right time. While we don’t provide the tools to search for the data we do enable it to be presented and actioned by the staff and carers. This enables time dependant decisions and mission critical alerts to be implemented and actioned faster - helping to speed up workflows and improve patient outcomes.

FREEING YOUR STAFF TO DO WHAT THEY DO BEST One of the most reported benefits of a wireless communications solution is that it helps colleagues to stay in touch wherever they are, as no one is tied to a desk. Mobility alone could increase their personal productivity by up to 20 per cent, saving valuable time for example chasing results on the go, communicating directly to the bed after a patient call or instantaneously finding colleagues throughout the hospital. This allows more time to actually spend with a patient. RIGHT RESPONSE AT THE RIGHT TIME Enabling a time related decision or alert to be actioned by the right person improves patient care and outcomes. Ascom can help here by ensuring that time dependant diagnosis decisions and alarms, even directly from patient monitors, are sent out to the relevant clinician with a confirmed delivery. Alerts can be filtered, to remove false alarms, prioritised and then delivered directly to the right staff member’s wireless handset with seconds. This ensures a consistent and effective response reducing time to administer corrective treatment and improving outcomes. AVAILABLE WHENEVER NEEDED Solutions use the site’s own private missioncritical network and business continuity infrastructure, allowing staff to be always be in contact with colleagues, no matter what may have happened outside the building. For example a mobile network or power failure. As part of a complete solution, Ascom’s own designed-for-purpose handsets provide smartphone functionality but also have changeable batteries, are less likely to be broken or stolen and are built to operate 24 hours a day including being passed from shift to shift. Ascom enjoys discussing how it can help in improving productivity, mobility and enhancing safety, so please do get in touch. L FURTHER INFORMATION www.ascom.com/uk +441215028971 mike.pawezowski@ascom.com

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MEDICAL IT

THE UNSEEN FOUNDATION OF THE FIVE YEAR FORWARD VIEW ECA discusses the design and advancement of digital healthcare technology that will one day form the foundation of first class patient care as part of the vision for a better NHS The focus on science and technology is well documented in 2014’s Five Year Forward View and it’s the adoption of medical IT that will become the ‘electronic glue’ that will help our healthcare system become more efficient in its care for patients. Technology lifecycles and long-term R&D into product viability is a concept firmly embedded in the medical IT industry. Research into the projected requirements for medical technology helps in the design and implementation of solutions that medical professionals can rely on for support, sometimes five to seven years down the line. SYMMETRY The NHS is putting a long-term plan in place, similar to the medical IT industry, establishing a unique symmetry between the two – one that has proven extremely successful for the latter. Shifting from the ‘two opposite approaches to information technology adoption’ that have plagued NHS procurement in the past, we will see medical technology become an integral part of day-to-day patient care, long‑term local engagement and a sector-wide plan to transform digital care for the better. As the investment into medical technology continues in-line with the roadmaps set down by the National Information Board, it’s vital that the NHS of 2019 has the technology and equipment it needs to succeed. From wearable biometric sensors to real-time tablet applications, the time for delays in uptake is over. ALIGNMENT AND FLEXIBILITY As we enter Industry 4.0 with the advancements of IoT (the Internet of Things), it’s important to align procurement chains with technology lifecycles, ensuring that the NHS always has the very best to communicate, diagnose and treat. For example: a hospital that procures equipment three years into its lifecycle could get just two years of support before it’s phased-out for the next generation. This can lead to out-of-date equipment, a loss of efficiency and ultimately a costly mandate for upgrade. By aligning the two and normalising this approach, the NHS can

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“It’s vital that the NHS of 2019 has the technology and equipment it needs to succeed.” help build a foundation for first class care on technology that is designed for use in much the way the Forward View describes. The strategies noted in the Forward View help to highlight the need for technology that can be relied and depended upon, not just for GPs and clinics, but hospitals, primary care and the vast range of other healthcare units across the country. This dependence inherently includes the flexibility that we require for the NHS’ diverse treatment portfolio. It’s never been more important to stay current as innovations in medical technology can not only highlight new treatment paths but lay the foundation for adoption in the future and reduce the time it takes to be fully effective.

trusts, hospitals and healthcare facilities. Their experienced team are very much involved in the advancement of industrial and medical IT technology with a unique point-of-view when it comes to patient care, medical standards and solution design. As the UK premier partner for Advantech – one of the world’s premium healthcare providers, they’ve designed solutions that are uniquely positioned to address the needs of medical professionals. From IP54-rated point‑of-care terminals to their modular AMiS medical carts, Advantech and ECA offer a unique approach that can help turn medical requirements into healthcare solutions with a service that is second to none.

ECA – THE UK PREMIER PARTNER FOR ADVANTECH With over three years remaining before the Five Year Forward View is fully realised, we’re now starting to see concepts come to life as they are developed into fully fledged systems that will one day help save lives. ECA sits on the front line of this technology, with over 100 years of combined experience in the implementation of medical solutions for healthcare facilities across the UK. Understanding the unique demands of the healthcare industry; ECA is a highly respected systems specialist in the field with UK projects that have included Great Ormond Street Hospital, Manchester Children’s Hospital, University College London and dozens of

A MUCH WELCOME CHANGE Whilst the adoption of both new and standardised technologies hasn’t always been smooth, the NHS should be praised for accepting a new and hopefully future-ready approach. A technologically equipped health service with foresight to embrace change and welcome innovation will hopefully bring the new NHS in-line with its vision for ‘universal healthcare’ and make it again ‘the proudest achievement of our modern society’. L FURTHER INFORMATION Stand 20 Tel: 0118 929 4990 www.ecahealth.com


EVENT PREVIEW

How can e-Health support the Five Year Forward View?

UK e-Health Week

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On the 19 and 20 of April more than 3,000 health and care professionals and 80 IT suppliers will descend upon London’s Olympia for the UK’s biggest and most influential e-Health event, focused on transforming healthcare through information technology One of only two digital health events supported by NHS England, UK e-Health Week, which is free to attend for the public sector, has launched a number of exciting new streams such as Commissioning, Vanguards and Nursing to incorporate the wider care continuum. These latest e-Health innovations will be showcased to those who commission, implement and use them, enabling attendees to put learning into practice the very next day. Whilst a large audience of people interested in improving healthcare through IT and technology is expected, the event will be particularly relevant to chief information officers, IT directors, IT managers, finance directors, clinicians, nurses, integrated care professionals and commissioners. The main focus over the two days will be to discuss and identify how e-Health can support the Five Year Forward View.

While ar Ye the Five View Forwardhot topic a will be the week, during er of other can play a huge role in a numbent issues n i driving digitisation but t r e p be o s they do need support. l a l l i w As commissioners ed address survey the list of planning

WORKING TOGETHER TO UTILISE TECHNOLOGY A recent Roundtable discussion, which gathered health leaders from both the private and public sectors agreed that all stakeholders needed to work closer together in order to utilise technology effectively within the framework of the Five Year Forward View. Stephen Lieber, president and CEO at HIMSS Worldwide, an independent member organisation in healthcare IT and organiser of UK e-Health Week, argued these types of collaborative discussions on digitisation were crucial: “We have a saying in HIMSS that if you put just government in the room by themselves, you’re going to come up with a government answer; if you put the suppliers in the room by themselves, you’re going to come up with a supplier answer. You’ve got to put everybody in the room together to come up with the right answer.” The talks concluded that commissioners

documents they currently need to write, one stands out as novel and perhaps especially significant. By this summer, every clinical commissioning group (CCG) is required to have created a local ‘digital roadmap’. These must detail how commissioners plan to ‘eradicate the use of paper in the treatment of patients across all health and care services… by 2020’. Moreover, they must fit into the bigger picture of Sustainability and Transformation plans. The requirement to develop plans is just one manifestation of the strong national impetus on healthcare digitisation. Technology is a clear focus of the Five Year Forward View, and the National Information Board’s Personalised Health and Care 2020 sets out a clear plan to get to a paper free NHS – one which includes those local roadmaps as an essential component.

JOINING UP THE NHS Beverley Bryant, director of strategic systems and technology at NHS England, who will be speaking at UK e-Health week, says the mission facing commissioners is a broad one, divided into two main areas. She explained: “First we need to get the NHS joined up to itself, off paper, with information sharing across organisational boundaries for the delivery of care, patients not having to repeat who they are over and over, and clinicians able to access info at the touch of a button to improve and help diagnosis.” She argued that this was ‘about getting our NHS out of the 1990s and into a place that many other industries have enjoyed for a number of years’, and expressed confidence that the Comprehensive Spending Review settlement (Chancellor George Osborne pledged a £1 billion investment in NHS technology over the next five years) means the money is there to make the vision a reality. The second aspect of the digital challenge was, she said, to use technology to meet the self-care agenda that is so central to E

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PATIENT RECORDS

ROYAL FREE HOSPITAL USE OPENTEXT FOR PATIENT RECORDS OpenText received highest product scores in all Critical Capabilities for Enterprise Content Management: Compliance and Records Management Use Cases by Gartner “It is not all about the medical records. There is a danger of having fragmented document management systems.” – Will Smart IMT director of The Royal Free Hospital London. OpenText adds context to the various types and sets of information that flow in and out of organisation by combining structured data with unstructured data while optimising efficiency with workflows, analytics and messaging, allowing for safe and secure mass exchange of data with internal and external stakeholders. Royal Free London NHS Foundation Trust has implemented OpenText Content Suite to store and manage digitised copies of patient medical care records. Using Content Suite, the trust aims to reduce record storage and management costs, effectively managing information and driving value from more than 900,000 unstructured clinical records. “We are reducing paper storage costs, it is secure and we are freeing up space for patient care,” says Smart. “Paper is very expensive to run and organise. We have been employing several people whose only job is to go up and downstairs looking for case notes. Paper case notes can only be in one place at a time. There are benefits around patient care, at the point of care.” At present, health workers at the Royal Free use dual screens, showing the Cerner electronic patient record system and the new digitised case notes. There are plans to move to iPads for clinical staff. “There is always that anxiety that IT will get in the way of the consultation between clinician and patient. We are in the early stages of a journey. Doctors don’t yet have the same ease of use as they have with paper.” Smart says the trust chose OpenText for two reasons: “It is not all about the medical records. There is a danger of having fragmented document management systems. We wanted a platform for staff records, too,” he says. “Secondly, from an analytics perspective we wanted the future possibility of doing semantic analysis on the content, which could help with medical research. As the project has progressed, says Smart, clinicians have been asking for data over and above that which had been captured previously in paper case notes such as some correspondence and test results.

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“We are continuing to add content,” he says. OpenText Content Suite will be integrated with the trust’s Cerner electronic patient records system. “We are making the access as flexible as possible. You can get at the content through Cerner and directly,” says Smart. “We are on a journey. Patients tend not to have single conditions, so that’s why took a big bang approach back in November [2014].” Smart adds that the business case for the project indicates return on investment within seven years. “But we are also improving the experience of patients and using our clinician resources more efficiently because of this system,” he says. “Our partnership with OpenText means that we have been able to draw on their extensive experience of similar deployments globally, including in some of the world’s largest health systems, and access resources to ensure we maximise the value from OpenText.” GARTNER Gartner has independently assessed OpenText for its content management and compliance and records management solution where it received the highest product scores in all Enterprise Content Management Critical Capabilities Use Cases, Trusted System of Record, Regulatory Compliance and LongTerm Digital Preservation. Gartner published its assessment of the Critical Capabilities for Enterprise Content Management: Compliance and Records Management on December 2015 (please scan QR code for link to the reference document). Gartner evaluated 12 global ECM providers against trusted system of record, regulatory compliance, and long-term digital preservation use cases. In all cases, OpenText scored within ‘Good’ or ‘Excellent’. WHO IS OPENTEXT? OpenText Content Suite facilitates an agile information governance strategy designed to reduce risk and mitigate the cost of growing volumes of content in the enterprise. The OpenText Information Exchange is a set of solutions that facilitate efficient, secure, and compliant exchange of information inside and outside of organisations. OpenText creates exceptional employee and customer experiences through its Experience Suite, which provides tools that help improve

digital access to your customers, employees, and providers. OpenText Business Process Management (BPM) Suite supports organisations to model, deploy and optimise business and operational processes, enabling businesses to rapidly analyse, build, and automate any business process. OpenText also delivers built in analytics for data driven apps, with its analytics and reporting products making data-driven applications simple for everyone in your organisation, including developers, employees, partners, IT, and customers. We comply with regulations and standards that are relevant to healthcare by handling regulatory compliance with information governance processes. L

Gartner does not endorse any vendor, product or service depicted in its research publications, and does not advise technology users to select only those vendors with the highest ratings or other designation. Gartner research publications consist of the opinions of Gartner’s research organization and should not be construed as statements of fact. Gartner disclaims all warranties, expressed or implied, with respect to this research, including any warranties of merchantability or fitness for a particular purpose. Visit OpenText (Stand A27) at the UK e-health Week to discuss how OpenText can help you to meet you objectives around providing a paperless health service/ digital health service/enable healthcare services for the Digital World. FURTHER INFORMATION Stand A27 UK E-Health www.opentext.com


EVENT PREVIEW

 the Five Year Forward View. “In this modern age, many people are using technology to help them in their day-to‑day lives, and we need to be harnessing that in the improvement of healthcare.” When asked about the importance of the Local Digital Roadmaps that the NHS has been asked to provide, Bryant said: “I guess you want me to say they won’t get any money – I won’t say that - but I will say again that it is not OK to do nothing anymore. If you were a CEO of a care provider you would not want to be at the bottom of the list. It’s time everyone stepped up to this and we have the support in place to allow them to do it.” She added: “Ensuring technology is embedded throughout the five year Sustainability and Transformation Plans (STPs) is crucial if we are to make better use of public spending. We’ve moved the deadline to June to line up with the STPs because it’s embedded within the guidance that came out in December.” Jane Dwelly, head of health and care innovation at NHS England, argued the growing prevalence of digital information about care was transforming commissioning: “The commissioning system has gone through a lot of change and flux recently, and it’s found its feet. People working in commissioning roles understand better than ever before how to use data to measure outcomes against the value in terms of health, in terms of care, and in terms of finances.” INFLUENTIAL SPEAKERS While the Five Year Forward View will be a hot topic during the week, a number of other pertinent issues will be addressed including: Vanguard sites, RightCare and population health.

UK e-Health Week

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

By this summer, every CCG is required to have created a local ‘digital roadmap’. These must detail how commissioners plan to ‘eradicate the use of paper in the treatment of patients across all health and care services… by 2020’ It is also worth remembering that there will be a plethora of other speakers, Q&A sessions and talks to keep the attendees fully engaged. The main stage programme will include senior NHS England leaders such as Professor Sir Malcolm Grant, Dr Arvind Madan, Professor Sue Hill, Lord Victor Adebowale and Beverley Bryant, while the plenary sessions will provide hands on, tactical advice from those on the ground. Beverley Bryant will present the opening keynote on day one as she discusses ‘Personalised Health & Care 2020’, and its link to the Five Year Forward View. Following the opening keynote, Carrie Grant, known for her work as a Voice Coach on the television series Fame Academy, in addition to being a patient and carer advocate, will give a talk on ‘Remember the Patient’ and her battle with Crohn’s disease over the past 20 years. A dedicated NHS England stream will focus on what it will take to be paperless by 2020 and include talks from the head of technology strategy, Paul Rice, and the National Information Board Leadership Forum Live! Day two will be kicked off with an opening keynote from George Freeman MP, Parliamentary Under Secretary of State for Life Sciences, and Jane Cummings, chief nursing officer for the NHS Commissioning Board.

These will be followed by Arvind Madan, director of primary care for NHS England, who will address the digital opportunity for primary care and what impact it will have. Nursing care, primary care and new models of care will also occupy significant topics of discussion during the second day of the event, in addition to providing the opportunity to learn from digital care success stories. ‘UK E-HEALTH WEEK IS WORTH PRIORITISING’ UK e-Health Week will provide the perfect opportunity for customers and suppliers alike and as Charles Alessi, a senior advisor for preventable dementia in Public Health England, said: “UK e-Health Week is really, really worth prioritising. “It will provide us with a platform to further discuss the priorities of health and social care and how to overcome some of the boundaries, which shows that unless we have the correct data to allow us to have a better understanding across health and social care, it will be impossible to understand  and plan for the future.” L FURTHER INFORMATION www.ukehealthweek.com

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DIGITAL HEALTHCARE

DIGITAL HEALTHCARE – WHY HAVEN’T YOU GOT STARTED?

Advertisement Feature

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

The transformation to digital healthcare in the NHS is well underway. Using technology to improve healthcare delivery and patient care has been a hot topic over the last few years Furthermore, there are many well-known issues related to paper-based delivery of care, such as: physical handling and transport of paper records; lack of audit on who looked at any record; only one person can see a record at any time; cannot easily share records without copying; lost records; escalating costs associated with handling physical records; etc.

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 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 unscrutinised 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 including lessons learnt. TWO KEY POINTS MUST BE EMPHASISED First, paperless healthcare is not a dream - it is real, has been done in the NHS - and, not just once – and does deliver real and measurable benefits. There is plenty of evidence from sites where paperlite, if not paperless healthcare has been achieved over the last five to six years – there is a good and positive track record for all to see and learn from – in other words, it is eminently do-able, and doing nothing is an expensive option. Second, the focus is not technology, or at least, technology plays a small but

important part in meeting the enormous challenges imposed by transformation to digital healthcare- it is about managing that transformation. Actually, its all to do with very careful application of the available technology, to solve defined problems and then build on that success to tackle other problems, but at your pace. The key message is that careful application of established technologies is delivering measurable improvements and benefits. These must be applied to address strategic requirements, rather than 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. To ensure successful transformation to digital healthcare, such lessons must be embraced. ACHIEVING DIGITAL HEALTHCARE Health Secretary Jeremy Hunt wants the NHS to be paperless by 2018, claiming that going paperless would ‘save billions’. In directives, issued in January 2013 and February 2016, Hunt wants patients to have digital records so that their information can follow them. But unlike previous large scale, top-down directives, he wants this driven bottom up and by 2018 any crucial health information should be available to staff at the touch of a button. Most NHS sites hold patient related data on a variety of different media, for example, paper, microfilm and digital. It is currently very difficult to identify exactly what information may be held on a given patient. This has resulted in falling standards for maintaining the patient’s acute medical record; increasing risk and leaving patients and clinicians at a disadvantage.

SCEPTICAL ABOUT GOING PAPERLESS Yet, health and IT professionals remain deeply sceptical that the NHS can be paperless by 2018 – a large percentage of healthcare professionals engaged in this work feel that paperless by 2018 goal is ‘a great ambition, but unrealistic’. The key concerns expressed included: IT compatibility – lack of interoperable systems, and cost of replacing legacy systems; costs, timescales, technology, and cultural changes; and insufficient information about the potential benefits from improved IT systems. TRUSTS A number of trusts took the bold step towards paperless healthcare some years ago. These trusts achieved paper lite health care using Electronic Document and Records Management (EDRM) technologies – not by simply installing IT, but by paying great attention to the underlying processes. Cost effective solutions based on established EDRM technologies offer the chance for trusts to embrace a culture of compliant information management practice to deliver paper lite health care if not paper less. There is no magic bullet solution – just a common sense approach which focuses the available technologies on specific processes to ensure that the solution delivers what is expected of it. The process is a migratory one which promotes a trust‑wide information repository with newly created clinical documents being ‘born’ onto the repository whilst ‘legacy’ information is scanned and digitised in a staged manner. Systems have become more affordable and are delivering real and measurable benefits. L FURTHER INFORMATION www.ccubesolutions.com

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Procurement

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

Working together to create digital harmony Further, Faster is a new online resource which shares practical ways to overcome the difficulties faced by NHS organisations and small technology companies in working together In the November 2015 Budget, the NHS was allocated £1 billion to spend on technology over the next five years to help it become a digitally enabled health service. With national NHS procurement targets requiring 25 per cent of contracts to go to SMEs, small to medium companies should see a fair slice of this. But the reality is that the NHS and SMEs still find it difficult to do business together. The current picture is difficult to measure as fewer than one in ten NHS Trusts record their spend with SMEs, according to a FOI request. The frustration is felt by all sides: SMEs put off by the slow pace of procurement and the slog involved in building business with the NHS; those at the centre working to create a better environment for SMEs to do business with the NHS; and NHS organisations who are working with SMEs, as well as those struggling to persuade colleagues to take risks with new approaches.

opportunities. ‘Further, Faster: Accelerating the pace of digitising the NHS’, was created by ZPB Associates and an expert panel of health entrepreneurs, CEOs and senior NHS procurement chiefs and is supported by Guys & St Thomas Charity. The resource shares the stories of NHS Trusts and SMEs that have successfully worked together, detailing what worked and what did not, from both sides of the relationship. It includes tips by SMEs who want to work with the NHS, as well as advice and lessons for NHS boards and leadership teams who are looking to adopt health tech solutions. It also has case studies, insights and opinion pieces from SMEs who have learned the hard way and put forward their recommendations on topics such as procurement, relationship-building and collaboration.

A new rce esou online rbeen has break to created e barriers h down t aboration to coll n SMEs betwee e NHS and th

SHARING EXPERIENCES Born out of this frustration, a new online resource has been created to break down the barriers to collaboration between SMEs and the NHS, and create future

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BORN OUT OF FRUSTRATION Alex Kafetz, chief operating officer at ZPB explained that the idea to create the resource happened after attending a digital health conference where he asked a question about involving SMEs and got ‘a very vague answer.’ He also described how an SME

representative ‘berated the panel, saying that he felt it was all too difficult, the conference hadn’t helped at all, and he had no faith that the NHS would ever work with companies like his own, and he was giving up.’ In June 2015, ZPB Associates partnered with Guy’s and St Thomas’ Charity to bring together a group of experts from across the healthcare system to discuss practical ways to overcome such difficulties faced by NHS organisations and digital health SMEs in working together. The expert panel, over a series of meetings, came up with practical insights and recommendations for both sides on what to do, what to understand, what to avoid and why it matters. The information was collated to create the digital resource for both SMEs and individuals in the NHS who want to scale the use of technology. Formally launched in March 2016, it offers insights, case studies, opinion and success stories so that people can share and learn, and ultimately build successful commercial partnerships. It is a continually evolving resource, and SMEs and healthcare professionals are urged to get in touch to share their own experiences. THE CRUCIAL ROLE OF SMES ZPB’s chief executive Zoe Bedford, said: Accelerating the adoption and spread of technology-based innovation is as much a necessity for the financial health of the


Dr Ian Abbs, medical director, Guy’s and St Thomas’ NHS Foundation Trust

system as it is for improving health. We are convinced of the crucial role small and medium size tech businesses can play in helping to create an NHS fit for the demands of 21st century patients, citizens and employees. It is frustrating that some of the best British companies are looking to relocate abroad as they’ve found the NHS environment too challenging.” “This online resource is packed with hard won practical advice and examples from both SMEs and the NHS on how they have navigated the system and broke down barriers to embed new innovation which makes a difference” Rob Berry, head of innovation and research at Kent Surrey and Sussex Academic Health Science Network, said: “Good deals between the NHS and SMEs will always depend on both parties working together to recognise and manage some inevitable tensions. “With digital technologies there are major opportunities to re-invent, adjust or tailor to suit the local context, without diminishing the potential benefits. Therefore there are major opportunities to collaborate.” Oliver Smith, director of strategy and innovation at Guy’s and St Thomas’ Charity, said: “It is obvious that digital technology has a huge potential to improve the NHS but just because it is obvious doesn’t mean it will happen easily. By supporting this

Procurement

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

Further, Faster shares the stories of NHS Trusts and SMEs that have successfully worked together, detailing what worked and what did not, from both sides of the relationship, including tips by SMEs who want to work with the NHS honest inquiry, we hope we can accelerate change – giving the NHS and SMEs practical tips on how to bring new ideas to life. In Lambeth and Southwark, where the Charity works, we have only just begun to scratch the surface and see the difference digital health can make to people’s lives and hope these resources will lead to many more opportunities in the future.” BUILDING THE RESOURCE The aim is for Further, Faster to be a continually evolving resource, explains Alex Kafetz: “This is the start of the process, not the end. We want Further, Faster to become

the best and most extensive online library of advice and tips for the NHS and SMEs. “I think it’s incredibly important that the NHS utilises the skills and products from health tech SMEs if we are going to meet the technology commitments of the Five Year Forward View and achieve the vision the National Information Board has set out. “We want all of you to use and improve this resource to make this happen.” L FURTHER INFORMATION www.digitisinghealthcare.com To get involved, email sophie@zpb-associates.com

Providing doctors, nurses and hospital managers with real-time patient information at the point of care VitalPAC is a healthcare improvement system which replaces paper with mobile devices from day one of implementation. VitalPAC’s solutions are designed to work like a doctors’ and nurses’ personal assistant by providing real time patient information on demand. It calculates the very important Early Warning Scores, enabling faster escalations to appropriate clinicians if patient condition deteriorates. It ensures safer handover, confirming continuity of care. It creates transparency and offers realtime access to observations, assessments, pathology and radiology reports and more. Alongside providing clinical support, VitalPAC’s new innovation VitalFLO provides support to hospital managers by enabling real-time patient flow management including discharge. It helps hospital teams to reduce the length of stay by creating a real time picture of hospital capacity and needs. Its smart capabilities rapidly locate the most appropriate bed for a patient and give visibility of discharge intentions and any delays.

While supporting safer patient care, VitalPAC’s solutions also provide unambiguous, real-time information about the timing and quality of care delivered. Healthcare regulators and other bodies are familiar with the system and the wide range of associated quality and patient safety benefits that can be achieved by it. Some of its meaningful evidence and benefits include: a 95 per cent reduction in the number of outbreaks of norovirus following implementation of VitalPAC at Portsmouth Hospital; a 70 per cent reduction in the incidence of cardiac arrests at Croydon University Hospital; a 90 per cent on time day observation and 100 per cent complete night-time observations achieved by Croydon University Hospital; a 15.5 per

cent reduction on mortality in Portsmouth Hospital; and a 65 per cent drop in PVC related bacteraemia in Croydon Hospital. With 80 per cent staff trained, compliance improved from 30 per cent to 80 per cent. Commenting on Portsmouth Hospitals in 2012 during a review of compliance, the CQC said: “The ward was using the VitalPAC system; this clearly showed that staff were following care pathways and detailed records of post operative care and observations were recorded.” According to research, length of stay can be reduced by an average 1.5 days from 7.8 to 6.3 days, saving one hospital more than £2 million per annum. The Learning Clinic, the company behind this pioneering system, started its journey 10 years ago. Today, 30,000 clinicians across 51 hospitals in the UK are using this award winning system. FURTHER INFORMATION Tel: 020 8746 4545 Maheeba.Syeda@thelearningclinic.co.uk thelearningclinic.co.uk

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INTEGRATED CARE COMMISSIONING TECHNOLOGY PUBLIC HEALTH RESIDENTIAL CARE HOME CARE

 twitter.com/commshow

There is only one Commissioning Show and it returns as part of Health+Care, to Excel, London on the 29 - 30 June 2016 Get up to speed on what’s going to affect your organisation whilst also meeting everyone through the 360º care pathway

CCGs

Trusts

Primary Care

Updates on national health and social care policy impacting directly on Trusts

Debate on the big issues facing Trusts including, crippling deficits, the £22 billion challenge, tariff, junior doctors strikes and agency staff caps

• •

• •

Protect the future of your CCG within an increasingly complex health and care system Engage with the wider health and social care community at Health+Care 2016 to tackle system-wide problems, such as Delayed Transfers of Care Evaluate the threat of Devolution to your CCG and discuss how to strengthen your relationship and influence on local government Find out how CCGs are benefitting from the Vanguards and other new care models Engage in debate with other CCGs on where to draw the line on taking on new duties and responsibilities from NHS England Look at the impacts of the Better Care Fund and whether its days are numbered Benefit from expert-led sessions on CCG governance and finance, tackling deficits and staying in the black

Case studies showcasing new collaborative approaches to delivering care, from foundation groups and multihospital chains to accountable clinical networks

Practical sessions on implementing recommendations from the Carter Report and the Dalton Review.

Insight into how plans for health and social care devolution in areas like Greater Manchester will impact Trusts. Find out how trusts in these areas are ensuring they have a voice in the process.

Take time out to focus on the priorities and challenges for general practice in 2016/2017 and beyond Be updated on the big developments impacting general practice, including the New Deal, proposals for a voluntary contract, sevenday working and online access Get new strategies to manage demand, tackle stress and burn-out and build a more sustainable practice Be updated on implementation of the Five Year Forward View and where general practice fits in

Find out how general practice is leading on and engaging in new models of integrated care, including the Vanguards and Primary Care Home. Find out how to form a federation and if you’re already in one then gain tips on how to maximise its potential to generate new income streams, improve quality and outcomes and streamline back-office functions. Take the opportunity to engage with the wider health and social care audience at Health+Care 2016 to tackle system-wide problems that directly impact on your practice, federation or patients

Plus you’ll have the opportunity to network with over 1,000 local authority professionals and more than 2,000 senior care provider professionals

Sessions on quality and safety post-Francis, workforce optimisation, leadership, regulation and other hot topics for Trusts.

Attending Health+Care will help you all DELIVER transformation and integration at scale and pace Speakers include:

Official media partner:

Ian Dodge

Jim Mackey

Samantha Jones

Sarah Pickup

National Director, Commissioning Strategy, NHS England

Chief Executive, NHS Improvement

Director of New Models of Care NHS England

Deputy Chief Executive, Local Government Association

Organised by:


EVENT PREVIEW

Meeting the challenge of transformation

The largest national integrated care conference returns to London’s ExCeL on 29-30 June, providing a world class learning and networking environment for health and care professionals Health+Care is the most comprehensive event for health and care professionals and takes visitors from vision to implementation. With a focus on integration, Health+Care 2016 is comprised of four events: The Commissioning Show, Technology First, The Residential Care Show and The Home Care Show. The four events will run in tandem, allowing delegates to network with anyone from the

entire 360 care pathway at any one time. Visitors need only apply once for a delegate pass, which will grant access to all areas of the event. Health+Care has also secured 4,500 education bursaries to give away as free passes for the event, so if you are a GP, practice manager or a key decision maker of a senior care provider or within the public sector you will be eligible for one of these passes.

Health+Care 2016

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

Passes are available on a first come first serve basis and are usually allocated well in advance of the event. Over 1,000 have already been claimed, so make sure you register soon to avoid having to pay for your ticket. WHY ATTEND? Health+Care satisfies the needs of all key health and care system stakeholders and fulfils all learning needs to disseminate transformation and deliver best practice in a senior peer to peer environment. The event enables visitors to meet and network with like-minded professionals facing similar challenges. Health+Care is the largest national event for the health and care sector but, despite its size, it is still possible for each delegate to follow their own path of learning, directly linked to doing their role better, or they can step outside their area of responsibility and follow personal interests be it clinical, policy, personalisation, public health, technology advancements or simply saving more time and money. In the face of social care funding cuts that are leaving care businesses, big, small and council reliant, struggling to keep afloat, Health+Care promises to bring all of the stakeholders together to discuss preventative steps to ensure the situation does not get any worse, providing a dedicated programme with hard-hitting advice to help care businesses cope with the mounting pressure.

Care Health+s the satisfie all key f needs oand care health lders and stakehorning needs a fulfils leisseminate to d rmation transfo

TRANSFORMATION HUB This year Health+Care presents the first ever Transformation Hub around the theme: ‘Delivering Transformation at Scale and Pace’. This will provide a powerful, topical, thought-leading centre-piece for the event’s core ‘integrated care’ theme and will create a significant and wide ranging communication platform for all those involved. Across England, local leaders of public services are now facing up to the challenge of meeting the needs of their local populations with significantly less resources. The government has embarked on the process of devolving decision making powers and control of available resources to local areas, and the pace is set to quicken. For local areas the challenge of E

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UKAS Accreditation Underpinning Quality in Healthcare Commissioning UKAS accreditation is a mark of quality that can be used by commissioners to easily identify safe, efficient and patient-focused services. Accreditation supports Commissioners in the delivery of informed and effective purchasing, good governance and public confidence. UKAS accreditation is already available within diagnostic imaging, physiological sciences, pathology, point of care testing, and care homes. When commissioning services in these areas, local and national ‘specialised’ commissioners are advised to specify UKAS accredited services, wherever possible. For further information about how UKAS accreditation can help commissioners to make an informed choice and to find a list of accredited providers, please contact UKAS:

Accreditation is absolutely essential to ensure the quality of supply” Lord Carter of Coles, Chair, The Independent Review of NHS Pathology Services

info@ukas.com 01784 429000 www.ukas.com

CPA is a wholly owned subsidiary of UKAS

UKAS will be exhibiting at the Commissioning Show 2016 on 29th & 30th June 2016 at the Excel, London. Visit Stand J33 to find out more about how accreditation can support healthcare commissioners.


EVENT PREVIEW  truly transforming how services are delivered is immense. Not only do new service delivery models need designing, but new organisational models that threaten the existence of existing organisations may be needed. The Five Year Forward View challenged local health economies to respond to the long-term health and social care challenges and there is a clear view that health and social care services could be improved if statutory organisations could manage to work together in a more efficient manner with local areas combining more effectively to join up their approach. A key part of the agenda is the NHS England Vanguard programme which is intended to lead on the development of New Care Models (NCM) by acting as blueprints for the NHS moving forward,

Health+Care speakers the solutions they developed. The question and answer sessions will be moderated and there will be legal, governance and other specialists on hand to provide an immediate point of view on any such matters arising during the session. Around the New Care Models theatre, the same organisations will be invited to exhibit alongside others involved directly or indirectly in the implementation of New Care Models. Delegates will have the opportunity to understand the detail of Vanguard programmes and learn first-hand from their experiences. CONFERENCE STREAMS The 2016 conference streams include a mix of keynote sessions and debates, case studies and presentations and Q&As in the main conference lecture theatres

The 2016 conference streams include a mix of keynote sessions and debates, case studies and presentations and Q&As in the main conference lecture theatres and interactive peer-to-peer workshops and round tables in break-out rooms providing guidance and inspiration to the rest of the health and care system. Whilst the benefits of integrated care to provide comprehensive and personalised care to individuals and populations are well recognised, there are a number of significant barriers to integrated working both real and perceived and support is required to help with the transition from theory to practice. Transformation programmes ideally would have the best expert advice and practical support built in from the start to ensure success, particularly as many of the familiar rules, relationships and assumptions of the NHS are shifting, meaning that building confidence and certainty across local systems becomes even more important. It creates opportunities to help develop and facilitate that implementation, which in turn creates opportunities for any organisation that can assist. ‘Delivering Transformation at Scale and Pace’ will be a central ‘show within a show’ on the main exhibition floor providing content opportunities throughout the event’s content ‘pyramid’ structure for 2016, which includes: plenary/thought leadership; issues/strategy; workshops/ learning; and skills/individual development. At its centre will be a NCM theatre where Vanguards, ‘Fast Followers’ and other initiatives will be invited to present their individual programmes and respond to delegates’ questions - speakers will be encouraged to focus on ‘the how’ of moving from vision to practical delivery, the challenges they encountered and

and interactive peer-to-peer workshops and round tables in break-out rooms. The ‘NHS providers: delivering safe sustainable care’ stream presents a rare opportunity for senior figures from NHS provider organisations to step out of their silos, take a strategic view of the future and find out how their peers are tackling challenges similar to their own. This programme will enable the rapid dissemination of ideas and solutions to support NHS trusts and other provider organisations to operate more efficiently and effectively. High on the agenda will be the implementation of the Five Year Forward View, the Carter Report and the Dalton Review. There will also be discussion and case studies on how hospital care needs to be remodelled for the future, with a move away from traditional institutions towards hospital chains and networks. As part of the NHS providers stream, Jim Mackey, chief executive, NHS Improvement, will outline what NHS Improvement is doing to support the NHS to get back on its feet and work towards long-term sustainability, as well as speak about the role of NHS Improvement in embedding a learning culture across the NHS - Set out his vision for improving quality outcomes for patients and explain why quality and financial objectives cannot trump one another. The ‘Clinical Commissioning Groups-Shaping the Future’ stream will be delivered in partnership with NHS Clinical Commissioners and will focus on how CCGs need to adapt to survive and continue to add value to the rapidly changing health and care system. CCGs will be under pressure to operate E

Over 350 speakers have been scheduled for the event, including:

Health+Care 2016

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

Colin Angel, policy and campaigns director, UKHCA Professor Martin Green OBE, chief executive care England Bridget Warr, CEO, United Kingdom Homecare Association Trevor Brocklebank, CEO, Home Instead Senior Care Dr Geraldine Strathdee, national clinical director, Mental Health Andrea Sutcliffe, chief inspector of Adult Social Care, Care Quality Commission Sharon Blackburn CBE, policy & communications director, National Care Forum Fiona Williams, director of operations, Bluebird Care Group Samantha Jones, director, NHS England Anna Dabek, senior associate, Anthony Collins Solicitors LLP Gareth Stevens, specialist employment lawyer, Leathes Prior Solicitors Catherine Murray-Howard, deputy CEO, Community Integrated Care

Getting to Health+Care 2016

When? 29-30 June 2016 Where? N1, Excel London, Royal Victoria Dock, 1 Western Gateway, London E16, 1XL Opening times: 08:30 - 17:45 The venue offers ample parking and is easily accessible from the M25, M11, A406 and A13. It is only 10 minutes away from central London and accessible from mainline train stations. Additionally, City airport is just 5 minutes away and other airports can be accessed in less than an hour.

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Health+Care 2016

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

Interactive Public Engagement and Survey Systems At Elephant Kiosks and EleSurvey we create innovative touchscreen kiosks and interactive technology systems for patient feedback, public information and clinical audit.

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Interactive public engagement and survey systems How useful are survey software and a public engagement systems if they don’t reach the people you need to connect with? Elephant Kiosks and EleSurvey creates innovative touchscreen kiosks and interactive technology systems for patient feedback, public information, self-service health checks and clinical audit. It focuses on accessibility, inclusivity and usability, creating solutions with a wow-factor that genuinely work for patients. Elesurvey’s initiatives include: EleKiosk, an accessible touchscreen kiosk for public information and real-time feedback; EleSurvey Fully Managed, a managed survey and clinical audit software; EleSurvey Self Managed, a self-service survey and clinical audit software; Live Well In, a digital healthy lifestyle choices directory and portal; SurgeryPod, a health kiosk for self-service health checks Friends and Family Test; and

the most accessible and inclusive FFT in the UK. EleSurvey interactive public engagement and survey systems help organisations deliver engagement strategy where it counts; on hospital wards, in GP surgeries and out in the community. EleSurvey’s products are used by over 150 healthcare, public and voluntary sector organisations, providing inclusive and accessible solutions that genuinely engage, excite and work for patients and the wider public. FURTHER INFORMATION Tel: 01223 812 737 hello@elephantkiosks.co.uk www.elesurvey.com

A Different Approach to Electronic Call Monitoring. “A new and innovative way to monitor the provision of care ”

The Mevarius Care Management & Electronic Call Monitoring Solution is a revolutionary change for the homecare industry to provide a unique and inexpensive solution to monitor the provision of care.

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EVENT PREVIEW  at greater scale, collaborating with each other and other stakeholders across health and social care and this stream will explore what needs to change to allow CCGs greater freedom and flexibilities to innovate and transform care for the local population they serve. Commissioning leads and providers of mental health services will be able to find out about how to turnaround services and reverse the impacts of years of underinvestment in ‘A New Era for Mental Health’. This stream will provide a chance for mental health commissioning leads and providers to share best practice and discuss current challenges and opportunities facing mental healthcare in the NHS. Sessions will include case studies illustrating new models of care focussing on crisis and recovery and new population-based approaches to mental health through health and social care devolution and the Vanguard programme. The ‘NHS Right Care - Commissioning for Value’ stream will include a keynote session outlining the overall vision and principles behind Commissioning for Value and why the decision has been made to embark on a multi-million pound roll-out of Right Care across all CCGs. There will also be a session in the CCG Theatre on commissioning Population Healthcare, variation and value.

Further sessions in the Workshop rooms will take visitors through useful toolkits to support, for example, value-based commissioning guidelines for surgical procedures, taking some of the pain out of making tough decisions and empowering the patient through Shared Decision Making. PRIMARY CARE The transformation of primary care to enable the shift of more activity out of hospitals is fundamental to successful implementation of the Five Year Forward View. The ‘Transforming Primary Care’ stream will look at how general practice and wider primary care is being expanded and fortified through the Vanguards and other new care models. Sessions will include case studies showcasing innovative new approaches to the delivery of general practice at scale –from super-practices and partnerships to highly effective and efficient GP federations. There will be a focus on primary care collaborating with community, acute, mental health and social care in new accountable‑care style organisations. One significant example featured at this conference will be the Primary Care Home – the radical new community-based model of integrated health and social care featuring accountable‑care organisations with capitated budgets for populations of between 30,000 and 50,000.

There will also be case studies showcasing new collaborations between general practice, primary and community care and the greater use of hospital specialists in the community and visitors will have the chance to attend expert clinics to advise on the legal, infrastructure and governance issues around transformation. GP practices and federations can also access advice on how to operate efficiently and effectively in an increasingly tough market as part of the ‘Essential Practice Finance’ stream. This half-day conference stream, aimed at practice managers and GP partners, will include expert-led, highly interactive sessions designed to give you a more in-depth understanding of the growing complexities of general practice finance as well as the enhanced skills you need to protect and grow your practice or federation. There will be an overview of the financial risks and challenges for practices in 2016/17 and advice on identifying new business opportunities and income streams. Further streams to be featured at the event include: ‘Creating Person-Centred Care Systems’; ‘Social Care Commissioning’; ‘Progress in Personalisation’; ‘Home Care Innovation’; and ‘Future of Public Health’. L FURTHER INFORMATION www.healthpluscare.co.uk

A powerful monitoring solution for the provision of homecare services

Assessing certification, testing, inspection and calibration services

Mevarius is a new, low-cost, simpleto-implement solution targeted primarily at frontline care operations. Requiring no set-up or investment cost, Mevarius will increase frontline efficiency; reduce direct operating costs; reduce back-office administration costs; while all the time enhancing an organisation’s CQC compliance and reporting. Care organisations are currently facing significant margin pressures as revenues are reduced from lower care package prices while uplifts in minimum wages have increased operating costs. Such pressures are compounded by an evermore-demanding compliance environment and the need to stay on top of all the associated documentation and requirements to survive and thrive.

The need to drive up the quality of care for patients, whilst delivering efficiency and productivity is a key principle for commissioners of healthcare services. UKAS accreditation is a tool that can be used to support the commissioning of healthcare services that are safe, effective and that continually improve the experience for patients. The influence and use of UKAS Accreditation in healthcare continues to grow across a wide range of areas, to support the delivery of informed and effective purchasing, good governance and public confidence. UKAS, in partnership with the professions, is becoming increasingly active in the healthcare sector. UKAS has been appointed by The College

Therefore organisations are having to revisit existing systems and ways of working and are turning to new technology offerings. Centred around the service user and specifically designed for the care industry, Mevarius provides in one package a unique combination of simple-to-use Visit Monitoring Hardware together with a Suite of Compliant Care Documentation and management operational management tools such as rostering and scheduling all for incredible value. If you are looking to achieve a combination of greater compliance, efficiency and reduced operating costs then contact Mevarius to trial the solution free-of-charge. FURTHER INFORMATION Tel: 0121 796 1160 www.mevarius.uk

Health+Care 2016

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

of Radiographers and The Royal College of Radiologists to manage and deliver a UK wide Imaging Services Accreditation Scheme. UKAS has also been licensed by The Royal College of Physicians to manage and deliver the Improving Quality in Physiological Services Scheme which covers four domains, including: patient experience; safety; clinical and facilities; and resources and workforce. Clinical Pathology Accreditation also accredits pathology laboratories, which are currently transitioning to UKAS accreditation to the internationally recognised standard ISO 15189:2012. FURTHER INFORMATION Tel: 01784 429000 info@ukas.com www.ukas.com

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Advertisement Feature

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

HEALTHCARE SOLUTIONS

ADVERTISEMENT DELIVERING FEATURE OPERATIONAL UPPER CASE RESILIENCE HEADLINE

NHS providers continue to provide the best care possible for Obit, elit in eum sam reprae voluptatur? officiis cum patients thedoloriatur face of increasing demand. Under Qui these conditions escipicipsam hit exerferi quibus,has exceaqui omnis sinctatem. ensuring operational resilience become central to TrustsLa non non nossi ute dis rest dolupta acescipsant everum que nis The Oxford English Dictionary defines resilience as ‘the capacity to recover quickly from difficulties’. Mobile healthcare facilities have become increasingly popular with NHS providers, offering the opportunity to do just that by delivering an almost instant increase in clinical capacity. The Shrewsbury and Telford Hospital NHS Trust has been a leading proponent of mobile healthcare technology in recent years. Engaging on three separate occasions with mobile fleet operator, Vanguard Healthcare, to offer its patients a first rate service in the face of each distinct challenge. TRIALLING NEW TECHNOLOGY The Trust, the main provider of acute care for half a million people, first engaged with Vanguard in late 2013. At this time the Trust needed to refurbish one of two endoscopy suites to gain JAG accreditation. This work entailed completely closing the suite for a significant length of time and the Trust was keen to maintain as much endoscopy activity as possible during this period. Vanguard delivered a Mobile Endoscopy Suite to the Royal Shrewsbury Hospital. The self-contained unit offered the Trust’s surgeons a complete clinical environment, including a procedure room, a six-bed ward and built in washer-disinfectors. With the unit on site the Trust could safely provide additional endoscopy treatments. During the six weeks the unit was on site, clinicians at the Royal Shrewsbury were able to treat a total of 215 additional patients within Vanguard’s facility. A RETURNING SOLUTION With the first partnership proving a success, the Trust quickly re-enlisted Vanguard to provide additional capacity at the Princess Royal Hospital in Telford just three months after the Endoscopy suite was removed. Understanding the importance of maintaining an operationally resilient service, the Trust saw an opportunity to increase access in two of its busiest specialities – orthopaedics and maxillo-facial surgery. Vanguard provided a ‘Visiting Hospital’, a combination of a mobile theatre and eight-

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bed ward unit – effectively functioning as a standalone day-case facility. The theatre unit features laminar flow ventilation within the procedure room making the unit highly suited to invasive orthopaedic procedures. During its 24 week residency at the Princess Royal Hospital the ‘Visiting Hospital’ enabled NHS clinicians to treat 742 patients. As a result of this additional capacity the number of orthopaedic patients treated within 18 weeks of referral increased by a third, whilst the number of maxillo-facial patients treated more than doubled. Alan Campbell, Team Leader for Anaesthetics at The Shrewsbury and Telford Hospital NHS Trust said: “I think it is the future of hospitals, especially to catch up on waiting lists rather than building big expensive theatres.” ONGOING SUCCESS Vanguard’s mobile facilities have played an important role in the Trust’s recent operational resilience. The strategy applied, to make the best use of this temporary clinical capacity, has evolved with each use. It is fairly common over the winter period for NHS providers to convert surgical bed space to free up more space for medicine. This is an efficient means of riding out winter pressures but tends to have inverse effects on elective waiting lists. Utilising the on-demand clinical capacity offered by mobile facilities, The Shrewsbury and Telford Hospital NHS Trust has found a

means to overcome this challenge as well. Since November 2015, the Trust has again utilised a ‘Visiting Hospital’ at the Princess Royal Hospital. Instead of using the additional capacity of the temporary facility to reduce waiting lists, as was the case previously, the unit is being used in a much more preventative  manner. Anticipating additional pressure on facilities at the Princess Royal Hospital, the Trust chose to reorganise a number of its existing wards, providing more space for medicine. However, rather than accepting a significant reduction in the ability to deliver day surgery the Trust chose to offer its patients unbroken access to care within Vanguard’s facility. Commenting on the reaction of the Trust’s clinicians and nursing staff to the facility, Mark Cheetham, Care Group medical director for Scheduled Care, said: “My feedback from the surgeons and the wider team working in here is that they are really pleased, they feel that they’re very productive and that they’re providing good patient care in this environment. They are very pleased with what we have done so far. In fact one of the surgeons asked me if he could have it all year.” To date the facility has enabled treatment of nearly 400 of the Trust’s patients across a wide range of clinical specialities. OPERATIONAL RESILIENCE ON-DEMAND With NHS providers up and down the UK facing a range of constantly evolving challenges, The Shrewsbury and Telford Hospital NHS Trust found ‘the capacity to recovery quickly from difficulties’ utilising Vanguard Healthcare’s mobile facilities. The ongoing success of the partnership between the Trust and the mobile fleet operator has benefitted both local patients and the Trust. L FURTHER INFORMATION Tel: 0845 630 6979* info@vanguardhealthcare.co.uk www.vanguardhs.com *Calls cost 3ppm plus your phone company’s access charge


BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

EVENT PREVIEW

Innovative solutions for the healthcare sector Hospital Innovations will descend upon London’s Olympia on 26-27 April, bringing together key decision makers in hospital management teams who are collectively responsible for the delivery of patient services in the UK Hospital Innovations focuses on four key areas; Innovation, Technology, Finance & Facilities and will address a number of the key issues involved with sessions looking at Telehealth and Smart use of Space. Taking place in London at the Olympia Conference Centre on 26-27 April, the event will offer two days devoted to tackling the key objectives facing the healthcare sector over the coming five to ten years.

TECHNOLOGY A whopping £4 billion will be spent on improving the use of technology within the NHS over the next five years, it has been revealed. The cash will help to realise the government’s vision of a paperless NHS, improving the speed of diagnoses and enhancing services across the country. There is no doubt that technology can play a significant role in meeting these objectives, but new technology innovations are placing

existing NHS infrastructure under pressure, both in terms of IT systems and people. Expected to be announced shortly by Health Secretary Jeremy Hunt, the cash will be spent on introducing systems that enable patients to book services and order prescriptions online, access apps and digital tools, and choose to speak to their doctor online or via a video link. Full details of the funding are still being agreed between the Department of Health and NHS England, but are expected to include: £1.8 billion to create a paper-free NHS and remove outdated technology like fax machines; £1 billion on cyber security and data consent; £750m to transform out-of-hospital care, medicines and digitise social care and emergency care; and about £400m to build a new website – nhs.uk – develop apps and provide free Wi-Fi. Speaking to the BBC’s Andrew Marr Show, Hunt said: “We know that proper investment in IT – it’s not without its pitfalls – can save time for doctors and nurses and means they can spend more time with patients.” As part of its digital drive, the government wants at least 10 per cent of patients to use computers, tablets or smartphones to access GP services by March 2017.At the end of last year, Hunt said free Wi-Fi would also be provided in all NHS buildings in England, but a deadline has still not been set. E

Hospital Innovations

Sponsored by

Transforming healthcare provision through better simulation and modelling

The Cumberland Initiative is a movement to encourage a system’s thinking, simulation and modelling of healthcare scenarios to improve NHS quality of care delivery and save money.   Its core strength is the quality of its team of academics, with their thought-leadership and publication records, who structure the challenges faced by healthcare providers utilising thought-leading strategy.  The Cumberland Initiative delivers through its affiliates. It is not a stand-alone consulting organisation. The Cumberland Initiative builds balanced teams of experts in systems thinking, to undertake simulation and modelling of healthcare scenarios and support radical improvement of NHS efficiency and the quality

of care delivery. Cumberland believes that transforming the quality of care through process and system redesign will produce much higher quality outcomes and cost savings compared with the more traditional incremental improvement exercises, new drugs or better technology and can deliver this much faster. This is a call for systematic remodelling of processes for every care pathway, at policy, commissioning and operational levels. Since the NHS cannot stop work while everything is redesigned, modelling and simulation make coordinating this challenging work possible. FURTHER INFORMATION www.cumberlandinitiative.org

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EVENT PREVIEW  FACILITING IMPROVEMENT Steve Webb, director of the event, commented: “Hospital Innovations is being shaped with the backing of a number of leading NHS trusts and key suppliers who have a vested interest in developing their trusts and improving technologies to make them more efficient. “Providing an event in London that will address their needs, sit and listen to their concerns, understand what exciting and innovative things they are currently doing and what could help provide solutions; the result, we hope, is an event that matches their needs and will provide answers on improving governance, efficiency and productivity while not compromising patient safety.” At the heart of the event will be an event programme focussed on Procurement, Finance, Technology and Facilities with a unique look at the NHS and how it could look in 10 to 15 years’ time. Hospital Innovations will offer visitors and delegates the chance to hear from and interact with leading trusts in the UK. Additionally our supporting organisations and sponsors will showcase new technologies and solutions. KEY SUPPLIERS Jennie Horrocks said: “Static Systems is pleased to be supporting Hospital Innovations. We see the event as an excellent opportunity

At the heart of the event will be an event programme focussed on Procurement, Finance, Technology and Facilities with a unique look at the NHS and how it could look in 10 to 15 years to meet with key decision makers to discuss patient services at the bedside and how we, as a manufacturer, can further develop our products to meet with the ever-changing demands of the healthcare environment.” While Richard Koszykowski, development director from Power Efficiency commented: “We have been working with our sister company Cofely to help identify key cost areas where significant savings can be achieved. In combination with several trusts Power Efficiency has been able to identify energy procurement strategies that can deliver significant cost savings through use of more effective energy trading strategies. Combined with Cofely, who are energy management specialists the combined energy savings over a three year contract are typically over £1 million”. Visitors to the event will be able to talk to companies like Power Efficiency to see how they can help them with deliver similar costs savings through a series of workshops and presentations.

ADDRESSING TRUSTS’ NEEDS NHS trusts supporting the event include: Barts Health NHS Trust, Oxford University Hospitals NHS Foundation Trust, The Pennine Acute Hospitals NHS Trust, Essentia Guy’s and St Thomas’ NHS Foundation Trust, Royal United Hospitals Bath NHS Foundation Trust and Plymouth Hospitals NHS Trust. Each of these will work with the organisers to deliver an event that addresses their needs while sharing best practice with other trusts who attend the event. The conference is ‘free’ to attend for our first 200 NHS and private hospital personnel. Teams from NHS trusts will be able to attend individual workshops, CPD sessions and half day conference presentations while those that want to make the most of the event and book for both days can, completely free. Information on how to register and qualifying free places can be found on the Hospital Innovations website. L FURTHER INFORMATION www.hospital-innovations.com

Transforming the way that art is incorporated into the healthcare space

Operating the world’s largest fleet of mobile clinical healthcare units

Art in Site specialises in creating integrated decorative environments for healthcare buildings. The company’s artists create their own art and also collaborate with and direct artists who work with Art in Site. It uses lighting, creates décor colour schemes and designs wayfinding to complete its work. Art in Site ensures that your project supports staff in their care for patients. The company focuses its work on specific therapeutic aims and is experienced in engaging artists to work with patient and staff communities. Art in Site was founded in 2003 to change the culture of care by transforming the way art is incorporated into healthcare spaces. It knows that improving the environment of the hospital improves the outcome for the patient. Patients and clinicians should have the highest quality

For over 14 years Vanguard Healthcare has supplied portable surgical health centres to the NHS and other providers across the UK and Europe. Each facility offers a state-of-the-art clinical environment which can be delivered and ready to receive patients in as little as two weeks. The uniquely flexible nature of Vanguard’s service has made Vanguard an ideal partner for NHS providers who are looking to bolster their operational resilience. Whether this means reacting to high patient demand over winter, providing unbroken access during refurbishment or even negating the effects of fire or flood – Vanguard offers a quick and simple resolution. Vanguard operates the largest fleet of surgical health centres, including: mobile theatres, wards, clinics, day surgery units and full endoscopy suites. As well as providing on-demand

building so Art in Site allows for the patients to feel included in the working of the building. The company aims to embed in the fabric of the hospital a feeling of reassurance and care while providing the art that the patients deserve. Art in Site is an expert team of consultants, artists, designers and production managers completing each aspect of the work inhouse. It works alongside the client’s design team to integrate art into every aspect of the refurbishment or new build. FURTHER INFORMATION 020 7039 0177 info@artinsite.co.uk www.artinsite.co.uk

Hospital Innovations

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

Sponsored by

clinical capacity, Vanguard also offers a wide range of clinical equipment and teams of highly experienced nursing staff. Since the company was founded in 2002, Vanguard has enabled NHS clinicians to provide treatment to over 225,000 patients – covering 75 per cent of surgery types available on the NHS. Please visit the website for more information. FURTHER INFORMATION Tel: 0 845 630 6979* info@vanguardhealthcare.co.uk www.vanguardhs.com *Calls cost 3ppm plus your phone company’s access charge

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Obesity Written by Dr Matthew S Capehorn, clinical director, National Obesity Forum, clinical manager, Rotherham Institute for Obesity

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SUGAR TAX

Can a sugar tax solve the obesity epidemic? In light of Chancellor George Osborne’s announcement of a ‘sugar levey’ in the 2016 Spring Budget, Dr Matthew S Capehorn weighs in on the affect this could have on obesity levels across the UK The level of obesity prevalence in the UK continues to rise, and it is associated with causing or aggravating over 50 different medical conditions, such as diabetes, hypertension, cardiovascular disease etc. And so unless the increase is stopped we must expect to see an increase in the associated medical problems. If current trends continue, projections in the Foresight Report suggest that by 2050, 50 per cent of adults will be classified as obese by Body Mass Index (BMI), with direct and indirect costs of obesity costing the NHS an estimated £49.9 billion per year. The Health Survey for England Report suggests that we currently have approximately one in four adults that are classified obese by BMI and in total approximately two thirds of the adult population are at an unhealthy weight, i.e. more of us are at an unhealthy weight than a healthy one. It is not surprising then that the public, and now even the government, are prepared to consider more ‘nanny state’ approaches to tackling the problem.

As r of a matteshould e, principl not we tion of a x a t e resist th e need food, food? Wany kind, of those containing ve and more than 8g per to survition 100ml. To put this into c fun context, a typical sugary

THE LEVY In the 2016 Spring Budget, Chancellor George Osbourne announced proposals for a sugar tax on soft drinks, apparently reversing the previous opinion of the cabinet that this was not going to happen. The Prime Minister, David Cameron himself was quoted in October of 2015 as having said that a sugar tax had been ruled out because there were ‘more effective ways of tackling this issue than putting a tax on sugar’. However, the plan, unveiled on 16 March 2016, and subsequently approved by parliament, introduces a levy on companies who produce drinks with added sugars from April 2018, with the proceeds being used to double the funding available for sports in primary schools. The tax does not apply to milk based drinks or fruit juices. The actual fine detail of the tax has not yet been announced, but many healthcare campaigners want it to be in the region of 20 per cent. It is believed that there will be one level of tax for drinks containing at least 5g of sugar per 100ml and a higher rate for

HEALTH BUSINESS MAGAZINE | Volume 16.2

cola drink can contain in the region of 13g of sugar per 100ml (equivalent to nine teaspoons of sugar per can), which can be double the daily recommended intake of added sugar for children. So what is the reason for the apparent u-turn? Does the government now believe that a tax on sugary drinks is an effective way to tackle the obesity epidemic, or have they either given in to pressure from sectors of the public and high profile campaigners, or has it been a carefully crafted headline grabber to deflect attention from other issues? THE PROBLEM WITH SUGAR Sugar is a carbohydrate that provides energy (approximately 4kcals per gram). Added, or refined, sugars (i.e. not naturally occurring in foods) are criticised for having no nutritional value (but does still have a small place in flavouring foods that may have good nutritional value) but will still provide the same levels of energy which, if not used up, will be stored in the body (initially as glycogen – a readily available energy store, but then further excess is stored as fat), adding to

weight and cardiometabolic risk. It is not surprising that healthcare campaigners have been adding pressure to reduce consumption. In 2015 the World Health Organisation (WHO) introduced recommendations to limit ‘free sugar’ (i.e. added sugar) intake to no more than 10 per cent of total energy intake, but with a conditional recommendation to try and aim for no more that five per cent of total energy intake - for a normal adult male, a five per cent limit would be approximately 25g, or six teaspoons full. In 2015, the Scientific Advisory Committee on Nutrition (SACN) was also asked to look at the recommendations for sugar intake by the Department of Health (DoH) and the Food Standards Agency (FSA) and they too recommended that free sugars should account for no more than five per cent of daily dietary energy intake. CONFLICTING OPINIONS Simon Stevens, chief executive of the NHS in England stated that the sugar tax will ‘incentivise soft drink companies to act on the health consequences of their products’, and that ‘while no child needs a daily dose of sugary fizzy water, sadly soft drinks are now our children’s largest single source of diabetes‑inducing, teeth-rotting excess sugar’. Graham MacGregor, chief executive of Action


On Sugar, welcomed the tax but acknowledged ‘that in itself won’t get rid of obesity’. However, Gavin Partington, director general of the British Soft Drinks Association, has claimed that the industry has reduced the amount of sugar in products by 13.6 per cent since 2012, and this has been on a voluntary basis without a tax. Ian Wright, director general of the Food and Drink Federation has been quoted as suggesting the tax is unfair, and would in fact deter companies from developing new and healthier products. He said: “The impositions of this tax will, sadly, result in less innovation and product reformulation, and for some manufacturers is certain to cost jobs. Nor will it make a difference to obesity.” So, who to believe? There is clearly not much debate over the fact that we should all want to see a reduction in sugar consumption, but debate arises over how best to achieve this. Is a tax the best way to go? As a matter of principle, should we not resist the taxation of food? We need food, of any kind, to survive and function, and it has been quoted many times that there is no such thing as an unhealthy food. Free sugars do not provide any nutritional value but do provide energy, which in some circumstances may be needed. Having said this, this is a weak argument when current consumption levels far exceed current recommendations. However, if someone of otherwise healthy weight and lifestyle chooses to have a sugary drink to replenish energy levels, should we be financially penalised by having to pay an additional surcharge on that drink? Food consumption and certainly appetite and hunger are very complex. We know that even when we are physiologically full, psychological hunger plays a big part and we may still crave certain foods. This leads to emotional eating, comfort eating and eating out of habit. Unless these underlying relationships with food are addressed then eating patterns may not change, especially by the introduction of a relatively small levy on sugary drinks. How many of us give in to buying sugary drinks or foods from vending machines, where the price is already far greater than 10-20 per cent above the cost that these could be purchased from a supermarket, and yet the price has not influenced our purchase? CAN IT WORK? Over time a sugar tax could be broadened, and increased, or even introduced to foods with high sugar content, but will this help? It will certainly penalise the poor differentially more than others. Surely education and methods to ‘nudge’ people in the direction of healthy choices is better. If taxation can influence purchasing patterns, in what way does it educate the population on why they should not be drinking those drinks, or educate them at all in healthy diet and lifestyles? In Philidelphia in the United States, and many other US states, they have seen a dramatic reduction in sugar

consumption (without the corresponding reduction in obesity) over recent years as a result of public debate and education, and without taxation. Furthermore, New Zealand has seen a five per cent reduction in carbonated soft drinks without taxation. Has it been proven that introducing a sugar tax does indeed influence purchasing patterns, or consumption, or result in the ultimate aim of reducing obesity levels? In 1974, Value Added Tax (VAT) was first introduced to the soft drinks industry, at a rate of 17.5 per cent, but it coincided with an increase in sales. Currently, France, Finland, Hungary and Mexico tax sugary drinks with the aim of reducing consumption. Sales in Mexico fell by 6-12 per cent after it imposed a 10 per cent surcharge of sugary soft drinks in 2014, and in that first year they generated and extra 18.3 billion pesos in taxation, however in 2015 sales bounced back and there was a negligible difference in consumption compared to 2013 levels. Furthermore, we currently do not know whether reduced sales convey into reduced calorie consumption, or even overall sugar consumption. Sales of sugary soft drinks may go down, but do consumers just compensate by purchasing sugary foods, or getting their ‘sugar fix’ elsewhere? Current modelling provided by the Office of Budget Responsibilities has suggested

Obesity

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as it failed to change eating patterns. Too many people cite the examples of taxation in the tobacco and alcohol industries as ways to curb consumption. However, these are not directly comparable with taxation of foodstuffs as we can (addiction aside) abstain and live without smoking or alcohol but cannot live without food. This is not to mention that the taxation of tobacco nearly quadruples the cost of the end product, which we cannot allow to see happen to food. BETTER OPTIONS? The poor cannot afford further taxation, and it is likely that this tax could penalise them more than others. Rather than introducing a punitive tax on the public, a better way would be to encourage reformulation that results in reduced sugar levels in products at a rate that is acceptable to the population’s palate. However, this is what the food industry has been doing as part of the government’s Responsibility Deal. It is unlikely that this voluntary arrangement had reached its limit, and I suspect that it is in fact still in its infancy. Companies need to make reformulation changes slowly in order to avoid losing their customer base. If the government was serious about wanting to reduce sugar consumption they should have considered imposing deadlines for reformulation within the food industry

Rather than introducing a punitive tax on the public, a better way would be to encourage reformulation that results in reduced sugar levels in products at a rate that is acceptable to the population’s palate that with the anticipated tax, consumption of soft drinks with high levels of sugar will fall by up to five per cent, but then soft drinks with lower sugar levels will increase by two per cent. This is assuming that the tax is passed on to the consumer. Public Health England (PHE) has also acknowledged that ‘price discounting on high sugar products and its consistent impact on purchasing of food brought into the home would likely be greater than even the largest tax already introduced internationally’. With so many discounted offers in our supermarkets, will the consumer even see the tax rise, let alone have an effect by it? In addition, even if overall sugar consumption reduces, do consumers compensate by eating more fat containing foodstuffs, which are more calorie dense (fat has approximately 9kcals per gram compared with 4kcals per gram in sugar) and therefore more obesogenic? There remain far too many factors to know whether this policy will result in reducing obesity levels. Denmark dropped its plans for a sugar tax after it abandoned its fat tax in 2012, only one year after its introduction,

rather than a tax that hurts the consumer. Whenever something like a food group is taxed it becomes elevated to the position of earning revenue, creating an incentive to continue production and increase sales. Here is another obvious comparison with tobacco. Allowing the continued sale and consumption kills thousands of people, but generates billions in tax revenue. Once the government starts receiving income from sugar taxation there is going to be less incentive to ever introduce policies that would have otherwise been more effective at reducing sugar consumption. At present, sceptics of this form of sugar tax will have to take solace in the fact that at least it is to be introduced on sugary soft drinks that have no nutritional value and that we as a nation could choose to live without, rather than a blanket tax on all sugar. However, surely there were better things that could have been done? L FURTHER INFORMATION www.nationalobesityforum.org.uk www.rotherhaminstituteforobesity.co.uk

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A contemporary venue with a unique heritage twist Dynamic Earth is instantly recognisable by it’s canopied tented design. With stunning 360 views across Edinburgh’s picturesque cityscape and Holyrood Park, Dynamic Earth is perfectly situated as a conference and corporate entertainment venue. The five star attraction offers facilities for a range of corporate events. This includes conference space for up to 300 delegates with intimate breakout rooms overlooking the extinct volcano, Arthurs Seat, gala dinners for up to 550 guests and drinks receptions for up to 1200 guests. By booking your next event at Dynamic Earth your company can help support the work we do as an educational charity and be associated with one of Scotland’s most prestigious and iconic organisations.

events@dynamicearth.co.uk 0131 523 1269 www.dynamicearth.co.uk


VENUE SELECTION

Rachel Parker, director of the Association of Event Venues, offers advice on how to choose the right venue to match your needs When planning an event, the one decision that will probably have the greatest impact is the venue. The variables are enormous, ranging from size to location, style to capacity, facilities to access, and this is why it may appear to be the most daunting decision that you will have to make when planning your event. There are four key factors that will help you to narrow the field. Time is an important determining factor, as desirable venues with specific assets or unique surroundings will be booked quite far in advance, so if that is an important aspect of your event then you need begin planning well in advance. Three other factors that will help narrow your choices of venue are your budget, anticipated attendance and the type of event that you are going to be holding. With these factors established, then the search for a venue becomes significantly simpler.

With a date set you can start to put together a time-line which will identify the key milestones you need to reach in order to deliver a successful event. The longer the timeline, the greater chance you will give yourself to build your audience. There are a few short-cuts you can take when looking to find your ideal venue, certainly we can help at the Association of Event Venues (AEV) and there is a list of all member venues on our website as a starting point. SHORTLISTING Now we have a method of creating a longlist of venues from the multitude of options available to you, it comes down to shortlisting and final selection. To help you do this here are some key considerations that will help whittle the list down.

If you haven’t already, you should set up a spreadsheet to break your costs down. This will help you manage your budget and keep costs under control. By doing this you can quickly see how changing factors at differing venues will affect the overall budget. Managing cost is essential and a lower hire cost may allow more room in your budget for other items in the event like marketing and promotion. Knowing exactly what is included within the hire fee and what is extra will help you to compare venues effectively. If you can be flexible on the day and date of your event, it can be a great negotiating tool, as certain days of the week and time of year tend to cost less than others. Location is a central factor to the success of an event. A convenient location means different things for different events. Your event may be aimed at international audiences, in which case the proximity of E

Written by Rachel Parker, director of the Association of Event Venues

Choosing the right venue for your event

Conferences & Events

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

When n ga plannin the event, n that isio one dec ill w ly have probab st impact ate the grehe venue is t

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Coin Street Conference Centre

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Holiday Inn Heathrow M4 Jct 4 Meeting and Events Promotional Offer 2016 The Holiday Inn London–Heathrow M4, Jct.4 enjoys a dedicated Academy conference centre which offers 13 flexible rooms on one floor that can accommodate up to 150 delegates. Coupled with our convenient location, a familiar name, great transport connections and over 600 bedrooms, Holiday Inn London – Heathrow M4, Jct.4 is the perfect choice for your next successful event. Day Delegate Package Rates from £30.00 to include: ● Meeting Room Hire ● All day , Unlimited Tea & Coffee with a selection of Freshly Baked Cookies, Whole Fruits & snacks; nuts Dried Fruit and Seeds ● Brain & Energy Boosting Morning & Afternoon Breaks ● Food For Thought Lunch “Nutritionally Balanced Menu selection designed to keep delegates focused for longer” ● LCD Projector, Screen & Flip charts ● Still & Sparkling Mineral Water ● Confectionery ● Delegate Notepads & Pens ● Hydration Station ● Standard Wifi ● Stationery Box ● Dedicated Meetings Host

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VENUE SELECTION  an international airport and accommodation are important factors. On the other hand, an event whose attendees are within a limited geographic range, a venue within a reasonable distance from most attendees’ homes or places of work may make sense. However, if many attendees will be travelling from out of town, hosting the event at a venue near the motorways or mainline railway stations are ideal. If you are expecting attendees to drive to the event then parking needs to be considered – if you want to provide free parking then that has to be factored into your venue selection or negotiated with your venue of choice. If you have delegates arriving from overseas, you may want to consider their accommodation – is it available at the venue you are choosing or will they be staying in nearby hotels? Can you arrange a group buy or will they be arranging their own accommodation? Some attendees may require business and secretarial services if they are staying overnight so that could be another consideration. You will have a good idea already of the number you are intending to invite to the event. Numbers are important because they will have an effect on the food and beverages provided at the event, often known as F&B. Your venue may be offering you inclusive food and beverages within the overall hire fee (known as DDR daily delegate rate) but you will need to confirm what the F&B minimums are. Simply put, a food and beverage minimum is the specific amount of food and beverage that you, the client, must meet.

It will be helpful to get an illustrated floor plan of each venue. Visit and walk through your favourites at least once if possible. If not, technology should allow you to see a video of the interior at the very least SITE VISITS If your event has a certain brand atmosphere then there is probably a venue that will suit you. This is the bit where I suggest that it really is well worth the time and effort of a site visit. Experience it at first hand and pay special attention to the existing décor inside the venue. Does it fit with the brand values of your event and those attending? What will it take to change the décor if it is inappropriate? The further the existing venue and its décor vary from a given theme, then the more budget and work will be involved in creating that branded environment. In addition to the appearance of the venue, consider the services and amenities that the venue offers. Does a venue have a kitchen and in-house catering, and can it provide catering to your event? Some venues may not have kitchens and, if you are to feed your attendees, then an outside catering company will be needed. Some venues without kitchen facilities may have a partnership agreement with a tied catering company that you may be required to use, or you may be free to bring in your own caterer.

Conferences & Events

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

Event furniture such as tables, chairs and linens are important in dressing your event. Again, a venue may have these in house or may bring in an external supplier, or you may need to organise this yourself. It’s also worth bearing in mind the provision of a crew to set up the venue and de-rig, if the event is sufficiently large and complex. There may also be litter or waste services to consider once the event is over. FLOOR PLANS Even though you will be finding your venue early, if not at the start, of the event planning process, it is still important to have some idea of the types of activities that will be included in the event. These will require resources to support them. When moving from longlist to shortlist it will be helpful to get an illustrated floor plan of each venue. Visit and walk through your favourites at least once if possible. If not, technology should allow you to see a video of the interior at the very least, and some venues even have quite sophisticated fly through models where you can see the entirety of the venue. E

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Conferences & Events

VENUE SELECTION  The layout and floor plan will also allow you to plan things such as audience flow. How the audience will flow before, during and after your event will vary. You will need to know where areas of high traffic will be located, how traffic will move from entry through registration, into the auditorium or around a feature or catering area. If you are planning to have keynote speakers then you may need a stage, lighting and sound – the venue may have one or you may need to bring one in. Demonstration areas are also a consideration to be factored in, as would be any displays of products or services. Event AV or audio-visual can range from simple projectors and screens to full multi projection facilities on a purpose built set, with interactive systems for audience participation – there is almost no limit to the application of event technology but they all come at a cost, so plan carefully. If you are having catering, this should be accounted for, as a buffet will require different layout to a café style arrangement. You may require formal or fine dining if there is an evening event during a multi‑day event, and you may also want to consider how relaxed or strict the timetable of the event will be to cope with overruns and timing changes beyond your control. Always expect the unexpected and build in some contingency.

You may require formal or fine dining if there is an evening event during a multi‑day event, and you may also want to consider how relaxed or strict the timetable of the event will be to cope with timing changes beyind your control HEALTH AND SAFETY Health and safety will be a key factor throughout the planning stages of your event. To assist you in this process, the AEV has produced a document called the eGuide which provides guidance on the health, safety and operational planning and management of events, which has been adopted by many AEV venues, and is a good reference document irrespective of venue. This can be downloaded from the AEV website.

As you can see, there are many things to consider when choosing a venue and this list is not exhaustive. In my experience, if you take the above into consideration when doing your research, I’m sure that you will find the perfect venue for your event. L FURTHER INFORMATION www.aev.org.uk

Leicester Conferences

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Why Strathclyde for your conference? Our £89m Technology & Innovation Centre offers flexible, state-of-the art conference and meeting facilities for up to 450 delegates. We’re right in the heart of Glasgow City Centre, with easy access to transport networks and the SECC. Find out more: www.strath.ac.uk/conferencingandevents t: 0141 553 4148 e: conferenceglasgow@strath.ac.uk

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Get the best products in the industry at the leading security exhibition and be secure The global stage for security innovation and expertise 3 Free education sessions provided for you to learn from the industry’s best and brightest 3 Find the right security solution provider for your business amongst the 600 exhibitors 3 Get hands on experience with the latest gadgets in security technology 3 You can see more suppliers by pre-booking meetings using the Meetings Service

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Those working within the security industries are under immense pressure as the threat to the UK thickens

With the current UK threat from international terrorism placed at severe and the national head of counter-terrorism recently warning that the UK is facing the threat of ‘enormous and spectacular attacks’ from Islamic State on western lifestyles, it is clear that those working within the security industries are under immense pressure to understand these threats and use the resources and technology available to minimise the impact of any terrorist actions. Taking place from 21-23 June, IFSEC International and FIREX International will once again bring together the leading suppliers, associations, thought leaders and businesses working within the counter terrorism, security and life safety industries from across the UK and beyond for three days at London’s ExCeL this summer. The Professional Development Zone, hosting a series of free to attend seminars and panel debates, will feature numerous sessions that will explore issues around counter terrorism and keeping urban populations safe. A highlight across the three days includes a case study from Joe Foster at Safety Awareness Limited on managing the security for the Rugby World Cup 2015. This included security for not just the stadiums but the players, hotels and training grounds. Additionally, sessions on transport and retail security along with a look at the communication barriers between police and the security industry will touch on the very real threat of terrorism and will look at current trends within these sectors and how security professionals can future proof new threats. The IFSEC Smart Zone, new for 2016, will host a dedicated Home Automation

Zone where visitors will be able to test and trial the latest technology, speak to the experts within this field and source the right solution for their business, within the industry already involved include Honeywell Building Solutions, Control4, Habitech and CIE-Group to name a few, and the whole zone will be supported by KNX UK. SEMINAR SESSIONS The IFSEC Smart Zone will also hold free to attend seminar sessions delivered by a range of leading experts and will concentrate on key areas such as the Internet Of Things, systems integration, business intelligence, building information management, cyber security along with a series of relevant case studies. Peter Selby, regional general manager at Honeywell Building Solutions, UK and the Nordics, who will be exhibiting within the IFSEC Smart Zone, said: “With a focus on new industry trends and innovations, IFSEC International provides a great opportunity to showcase Honeywell’s latest technology and integrated security portfolio to an international multi-industry audience. With security evolving into smart building space, and integration becoming a driver for business efficiencies, Honeywell Building Solutions is delighted to be working with platforms like IFSEC International to connect to the right opportunities and publics.” Along with the new IFSEC Smart Zone, IFSEC International have also confirmed that the Physical Perimeter Security Zone will be greatly enhanced for the 2016 edition. The Physical Perimeter Security Zone will now offer much more space to specialist manufacturers to fully display and demonstrate their

products with all aspects of the sector covered including barriers, acoustic barriers, boom barriers, height restrictors, high security street furniture, blast protection, perimeter detection, blast walls, perimeter structures, bollards, protective bunkers, fencing, roadblockers, gate automation and turnstiles. Confirmed suppliers within the Physical Perimeter Security Zone include the UK’s premier supplier of automatic gates, parking barriers, retractable turnstiles and tubular motors, CAME UK along with sister company BPT along with Marshalls PLC, Birmingham Barbed Tape, Blok n Mesh, DEA System, Engtex, GIlgen Doors, GM Techtronics, Kijlstra Precast, LPCB, Nitesite, Robust UK and Townscape Products, to name a few. Also returning for a second year is the Inspirational Speaker Series, after a successful launch in 2015 which saw Baroness Karren Brady, Sir Ranulph Fiennes and Sir Chris Hoy in 2015 take to the stage over consecutive days to share anecdotes from their own illustrious careers and offer some invaluable advice on leadership and achieving success in any field. SPEAKERS Speakers for the 2016 inspirational speaker series have recently been confirmed and organisers are delighted to announce that Colonel Tim Collins OBE, Kate Adie OBE and James Cracknell OBE will each bring their own unique insights and personal experiences to the shows. IFSEC & FIREX International will run from 21-23 June in 2016 and will once again be presented as part of UBM EMEA’s Protection & Management Series, the UK’s largest event dedicated to protecting and managing property, people and information. The series incorporates major events including IFSEC International along with FIREX International, Facilities Show, Safety & Health Expo and Service Management Expo. The series of events annually attract more than 40,000 attendees over three days to ExCeL London. In 2016 the series will run from 21-23 June. L FURTHER INFORMATION For more information on IFSEC & FIREX International and to register to attend the shows please visit: ifsec.co.uk/HBM_PSI

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Products & Services

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

HUMAN RESOURCES

FACILITIES MANAGEMENT

Actus™ Performance Management Software is designed to revolutionise the annual appraisal cycle and create year round conversations that are meaningful and engaging. In addition to appraisal it also supports Nurse Revalidation, 1 to 1 Supervision, Talent Management and pay progression. Easy to use and highly cost effective, it is securely hosted in the UK Cloud and quickly available via the Government’s G-cloud or Digital Market place. The Actus™ software encourages better quality conversations all year round, not just at appraisal, and saves HR valuable time administering staff appraisals and development, freeing them up to focus on developing and retaining talent. Health professionals value the way the system encourages staff to take ownership of documenting performance appraisal and

Placing a defibrillator into a community is a worthwhile and exciting thing to do. However people forget these are medical devices being used on humans, and as such are required to be treated with respect and full governance. If placing indoors, you will be covered by PUWER, but externally you also need to take into account public liabilities, and also any duty of care requirements, as well adherence to legal obligations such as the disability and discrimination requirements. After all anyone can use an externally placed defibrillator, and you cannot discriminate against non-English speakers, disabled, SEN, or any other requirement. This applies both to the actual model defibrillator as well as the storage. These rules also cover the

Increasing productivity and profitability

development actions. This supports a culture with more regular, open discussions about performance and development, removing the need for lengthy annual appraisals that take up time that could be better spent with patients. The software is designed and owned by culture change experts Advance Change who offer full support and training. Advance Change already work with many NHS clients from Trusts to CCG’s, and can easily configure the system to fit the individual needs of NHS and other healthcare clients. FURTHER INFORMATION Tel: 01582 793 053 www.actus.co.uk

PATIENT SAFETY

BUILDING FACILITIES

RL Solutions, creators of easy-touse healthcare patient safety and quality software, has announced a new module for enterprise risk management in its RL6 suite. Risk Register, as it is known, is a user-friendly software solution that has been designed to help quality healthcare professionals identify cross-organisational risks, streamline tracking based on international ISO 31000-2009:Risk Management standards and to support a culture of proactive behaviour. Until now, risk management in healthcare organisations has typically been limited to one or a few departments. Now, quality professionals will not only be able

Calibre Climate Control has long recognised the importance of a diagnostic approach to clients and their individual situations. Like a good doctor, the company tries hard to put itself in your shoes, and get a detailed understanding of your situation and how it affects you; only then is Calibre Climate Control willing to diagnose the issues and suggest a way forward. The company only ever provides solutions if they genuinely match its client’s needs. Does it work? Calibre Climate Control gets a very healthy amount of business by personal recommendation or from long-term clients, so the answer has to be yes. The company provides airconditioning and ventilation solutions for thousands of healthcare professionals, covering design, installation, maintenance, repair and even end-of-life solutions. Trust Calibre to look after

Healthcare software for risk mitigation

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Managing community defibrillator projects – do it right

to document, manage, monitor and mitigate risks more easily, but this shift to enterprise-wide risk management will provide them with the comprehensive data they need to affect change. What’s more, mirroring the company’s other products, this module is customisable, giving healthcare organisations the flexibility needed to suit their specific needs. For more information about RL Solutions’ services, please get in touch by visiting the company website below. FURTHER INFORMATION Tel: 0207 947 4187 www.rlsolutions.com

HEALTH BUSINESS MAGAZINE | Volume 16.2

storage mechanisms, and these need to be up to scratch, and meet the ShockBox standards. The Community Heartbeat Trust charity will help guide you through this minefield, and help you place the right equipment, the right training, the right support and the right governance to make sure your solution is safe, effective and offers a long term benefit to your community. The Trust also provides long term support, as a defibrillator is not just for Christmas… FURTHER INFORMATION Tel: 0845 86 277 39 www.communityheartbeat. org.uk

A medical approach to climate control

your atmosphere with clinical efficiency, surgical skill and above all, care and understanding, and the company is sure you’ll start to feel better soon, as the treatment takes effect. Contact Calibre Climate Control to receive a comprehensive diagnosis of your needs and discover the specialist solution that the company can bring you. FURTHER INFORMATION Tel: 020 3191 9131 sales@calibreclimate.com www.calibreclimate.com


WASTE MANAGEMENT

FACILITIES

PHS Wastemanagement is one of the UK’s leading waste management companies, specialising in the collection and disposal of clinical, dental, pharmaceutical and wastes. PHS’ medical waste disposal and collection services are designed to offer a tailored and cost-effective solution to dispose of all your clinical wastes, including incontinence pads and out of date drugs. With an independent and nationwide network of 27 depots, PHS can provide you with the service you need at the price you want. Ever conscious of its duty of care to the customer and the wider environment, the company will make sure that your waste is controlled and disposed of in the safest and most environmentally effective way and according to Best Practice Guidelines. As an independent licensed

The Syntegra Group is a multiaward winning energy and low carbon building solutions provider with offices in the UK and UAE. With a proven track record of achievement and having worked on some of the most prestigious developments in the UK; the Syntegra Group has vast experience in providing a wide range of consulting, contracting, certification and energy procurement services to clients across all sectors. At The Syntegra Group, staff are wholly committed to tackling climate change by designing low carbon engineering solutions and deploying energy efficient technology to the built environment throughout all stages of a project lifecycle. From M&E design consultancy to Energy Certification and

Pharmaceutical and clinical waste disposal

waste management company, PHS are not tied to any one form of disposal and it strives to offer solutions which help protect and benefit the environment, as well as supporting our customer’s business objectives. PHS offer customers ‘cradle to grave’ services for all their waste management needs, giving them complete peace of mind they are meeting their duty of care obligations. To find out more about what PHS could do for your business, please visity the company website. FURTHER INFORMATION Tel: 02920 809098 www.phs.co.uk

Specialist energy and low carbon building solutions

CONFERENCES & EVENTS

IT

The Falkirk Stadium is the perfect venue to hold a conference, corporate event or business meeting. Built to impeccable standards, the stadium has a range of 10 conference and events rooms to suit any requirement. The experienced hospitality and events team are your guarantee to great service combined with a quality catering offering and excellent room facilities, including free fast speed Wi-Fi and large screen plasma TV’s. With years of experience working with public sector clients, the Falkirk Stadium conference and events team has proven time and time again to provide quality and value to its public sector customers. From a business conference, to a working lunch, finger buffet, formal dining and corporate hospitality, on offer, are high quality menus to suit any event. And with day delegate rates starting from just £30+VAT

There are millions of pounds to be saved in the NHS with better management of capital medical equipment and assets. Improved visibility and management can have a significant impact on expenditure, reducing unnecessary spend on perceived ‘lost’ items, improving whole of life cost, better staff utilisation and supply chain governance. Acumentive’s aim is to provide healthcare organisations with innovative yet cost-effective solutions for real-time asset and equipment locating and management. The systems help Trusts to realise savings, improve efficiencies and productivity, and ultimately deliver better patient care. The award-winning SenseAnyWare software suite delivers scalable, customised solutions for any sized hospital site or across sites.

Products & Services

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Contracting, at The Syntegra Group staff strive to ensure that overall targets and legal requirements for carbon emissions are commercially viable and not only met, but exceeded wherever possible. The Syntegra Group offers total commitment to clients and their own objectives when engaged on projects. Using Syntegra as your energy efficiency turnkey solution provider gives you an effective design, procurement and implementation partner in an ever- changing market. Choose Syntegra Group and help build dynamic sustainable solutions for the built environment. FURTHER INFORMATION Tel: 0207 788 7861 www.syntegra-epc.co.uk

The venue of choice for Locate and manage your meetings and conferences assets and equipment

per person, the experienced conference and events team will ensure your event runs smoothly and exactly to plan. Ideally located, just off the M9 motorway, sited mid-way between Glasgow and Edinburgh and with hundreds of free parking spaces, the Falkirk Stadium is easily accessible via public or private transport. It includes a winning combination of great service, excellent food and a warm welcome, all part of the Falkirk Stadium experience. FURTHER INFORMATION Tel: 01324 618740 enquiries@falkirkstadium.co.uk www.falkirkstadium.co.uk

GS1 certified and hardware agnostic, SenseAnyWare has the unique ability to capture data from multiple sources and technologies. Data can then be aggregated in a way that is inter-operable and of meaningful use to multiple applications and departments within a Trust. In addition to traditional technology such as barcode, RFID or RTLS, the company also offers Bluetooth Low Energy (BLE) tags. The latest in locating and tracking technology, BLE overcomes the challenges of extra infrastructure requirements and can be implemented at a quarter of the cost of Wi-Fi applications. FURTHER INFORMATION Tel: 0208 783 9606 info@acumentive.com www.acumentive.com

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Advertisers Index

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DATA PROTECTION

IT

As the volume and complexity of health data grows, its safe handling is fast becoming an impossible challenge. Much of the harm that has arisen from the misuse of sensitive personal data can be ascribed to poor or absent staff awareness of the risks. Analysis of past data breaches and data mishandling clearly shows that health businesses are making the same errors over and over again - mistakes that staff could have easily spotted if they were well trained and prepared. iCompli’s training methods come from industries where mistakes cost lives; your staff will learn how the systems they interact with (email, their current state of training and knowledge), and the external factors affecting

Evolyst designs and develops innovative apps, websites and software specifically for the health and healthcare sector. The team works with researchers, psychologists and clinicians on evidence-based projects. Working on a multitude of client and in-house projects, Evolyst has expertise in software development, graphic design and research; all of which are needed to create a market ready eHealth product. Example projects include an app to raise the awareness of dementia and assist in early diagnosis; an app to promote healthy eating in families through collaborative gamification; and software to aid physiotherapists through the use of mobile devices, wearables and sensors. Evolyst’s clients come from various sectors and include The University of Warwick, BD Healthcare, Public Health Warwickshire, King’s College London and Coventry University.

Putting complex data regulations into context

them (pressure to complete a task on time) can all lead to a catastrophic mishandling of data. iCompli’s trainers have expertise in many safety critical businesses including offshore oil and gas and civil aviation, from where it brings some of the most advanced thinking in Threat and Error Management (TEM). iCompli teaches staff to understand how their behaviour and actions can dramatically change the risk profile of your organisation. This is not ‘sheep dip’, ‘tick-the-box’ training. It’s data protection training that achieves results. FURTHER INFORMATION Tel: 020 3291 3415 www.icompli.co.uk

NHS DATA

Thousands of products at your fingertips C+D Data owns and maintains a database of over 103,000 pharmacy products which can be exported in a number of formats to suit your requirements. The data contains information such as price, images, pack size and legal classifications. Depending on your requirements, C+D Data can help you with dispensing, ordering, price checking, selling your products, competitor analysis and benchmarking. And that’s just some of the ways customers currently use the data. C+D Data’s customers say that the number one benefit of its data is its accuracy, and you can’t get better feedback than that can you? C+D Data provides one source of data for all of your updates so you won’t have to waste time cross referencing across the

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Drug Tariff and the DM+D – all C+D Data is mapped direct with these sources. C+D Data can also help you avoid errors and save time by using its barcode technology when ordering stock which leads to saving costs. The company’s customers include wholesalers, manufacturers, stock takers, system suppliers, EPoS and PMR, pharmacy head offices, internet pharmacies, hospitals and NHS Trusts. Contact C+D Data today for a free sample. FURTHER INFORMATION Tel: 020 7921 8456 dan.linton@ubm.com chemistanddruggist.co.uk/data

HEALTH BUSINESS MAGAZINE | Volume 16.2

Healthcare app and website developers

Collaboration is also an essential part of Evolyst’s work, having won Innovate UK (the government’s Technology Strategy Board) grants for EHealth projects. Collaboration is always valued highly, and with in-house staff having experience of research at university level, Evolyst has a strong track record of working on innovative research projects. If you have an EHealth project which needs an app, website or piece of software; or you wish to collaborate on a research grant; then please contact Evolyst. FURTHER INFORMATION Tel: 101926 623155 www.evolyst.com

ADVERTISERS INDEX The publishers accept no responsibility for errors or omissions in this free service 4Imprint 22 Acumentive 97 Advance Change 96 Advanced Cleaning 35 Aerogen 10, 48 AGFA Healthcare 84 Aimer Products 35 Andersen Products 34 Arkivum 62 Art In Site 85 Ascom 66, 67 Alantis Medical 14 Bradshaw Electric Vehicles 22 C+D 98 Calibre Climate Control 96 CCube Solutions 72, 73 Chorley Cleaning Services 30 CloserStill Media 76 Coin Street Community 90 Community Heartbeat Trust 96 Continuity West 22 Dundee Heritage Trust 92 Dynamic Earth Enterprises 88 ECA 68 Edinburgh First 92 Elephant Kiosks 80 Evolyst 98 Fiat IFC Fairtrade Vending 22 Hicom 60 HIMSS 69, 71 Holiday Inn London Heathrow 90 iCompli 98 IPU Group 43 ISS Mediclean 36 Lakeland Industries 28,29 Lexacom 56 LU-VE S.p.a 42

Manning Global 16 Marshall Bast 26 Medicat 19 Meritec 58 Mevarius 80, 81 MTX Contracts 24 Murray Equipment 32 OKI Systems IBC Olympus Digital Dictation BC OpenText 70 Patch Media – The HAC 92 PCTI Solutions 59 PHS Group 97 R L Soultions 96 RAB specialist Engineers 42 Sample Answers 20, 45 Sonosite 12 Static Systems Group 20 Step Exhibitions 83, 85 Syntegra Consulting 97 The Cumberland Initiative 83 The Falkirk Stadium 97 The Learning Clinic 75 Total Intelligence 64 Trent Nursing 18 UBM Information 94, 95 United Kingdom Accreditation 78 University of Leicester 93 University of Strathclyde 93 Vanguard Healthcare Solutions 6, 82, 85 Wilo 38 Wyatt International 58 Yeoman Shield 8, 40 Zycko 4


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Health Business 16.2  

Business Information for Healthcare Professionals

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