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Patient Centred Care Platform







The potential of the London Health and Care Collaboration is key for healthcare progression RECRUITMENT

THE FACTORS BEHIND THE CRISIS What are the reasons for the current recruitment issues?


UPDATING REGULATORY REQUIREMENTS The importance of revising our medical device requirements in hospitals


HEALTH BUSINESS MAGAZINE ISSUE 16.3 15.6 Patient Centred Care Platform







The potential of the London Health and Care Collaboration is key for healthcare progression RECRUITMENT


What are the reasons for the current recruitment issues?



The EU debate and the NHS On Thursday 23 June 2016 the UK will vote either to remain in or leave the European Union (EU), with either outcome having a large impact on the day to day running of the NHS. The ‘Leave’ campaign has argued that the money that the UK government sends to the EU, rumoured to be £350 million a week, should be spent on the NHS instead.


UPDATING REGULATORY REQUIREMENTS The importance of revising our medical device requirements in hospitals


However, Health Secretary Jeremy Hunt and NHS chief executive Simon Stevens have warned of the multifacted dangers of leaving the EU. At a time of tight budgets and a need for extra investment, they argue that a possible exit would hit the economy, and consequently hit the NHS. Hunt said: “It’s been true for 68 years of NHS history that when the British economy sneezes, the NHS catches a cold and this would be a terrible moment for that to happen at precisely the time the NHS is going to need extra investment.” More crucially, 80 per cent of hospital leaders have warned that a ‘Brexit’ would cause a further staffing crisis. Over 17,000 nurses and health visitors are from EU countries, which equates to six per cent of total staffing numbers, while just under 10,000 hospital doctors come from EU countries, equating to around nine per cent. ‘Remain’ or ‘Leave’, it is wise to remember that there is a lot at stake for the NHS and its greatest resource – its staff.

Michael Lyons, acting editor

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

226 High Rd, Loughton, Essex IG10 1ET. Tel: 020 8532 0055 Fax: 020 8532 0066 Web: EDITOR Angela Pisanu 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

© 2016 Public Sector Information Limited. No part of this publication can be reproduced, stored in a retrieval system or transmitted in any form or by any other means (electronic, mechanical, photocopying, recording or otherwise) without the prior written permission of the publisher. Whilst every care has been taken to ensure the accuracy of the editorial content the publisher cannot be held responsible for errors or omissions. The views expressed are not necessarily those of the publisher. ISSN 1362 - 2541





NHS must reduce discharge delays; ethnic minority harassment; and mental health services failing children


The Campaign for Better Hospital Food provides an update on the national campaign for higher standards in nutritious, healthy hospital food


13 23

The Food for Life Catering Mark is improving food quality. The Soil Association explores the work being undertaken in the healthcare sector


Jonathan Hart, of the Automatic Vending Association, explains the steps the industry is taking to meet the expectations of a health aware nation


Graham Wright, president of HEVAC, explains why heating, ventilation and air conditioning should be monitored closely to ensure a long-term, efficient and effective operation in hospitals


Nick Bowles, of the Association of Professional Staffing Companies, examines the factors behind the current healthcare recruitment problems and the need for wider collaboration


Great Ormond Street Hospital for Children made great progress in reducing its energy demand and increasing sustainablility last year. Health Business reveals how


Health Business looks back at the success stories from this year’s UK e-Health Week which ran on 19-20 April


With mobile health aiding the speed of demand for instant access in the NHS, we look at the importance of charging infrastructure in hospitals


Health Business’ Ben Plummer explores the potential that mobile health has in helping alleviate the pressures the NHS is currently facing

Health Business




Karen Cunningham, from the IOSH Health and Social Care Group, looks back at its April event and discusses how Belfast Health and Social Care Trust manages hazardous risk assessment


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

62 INFECTION PREVENTION Following a hugely successful conference last year in Liverpool, Infection Prevention 2016 will be taking place at the HIC in Harrogate from the 26-28 September 2016

65 P4H 2016

P4H 2016 provides visitors with the opportunity to network and develop understanding of the current hospital efficiency challenges and development of operational productivity in the NHS


Christina Pond of Skills for Health shares some successes in leadership development in the healthcare sector, and best practice to cope with the changing management landscape


Mike Kreuzer, of the Association of British Healthcare Industries, analyses the revised Medical Device Regulation


John Pryor, of ACFO, discusses fleet management, examining the different options available for fleet managers and how to reduce whole life costs for fleets in the NHS


Teresa O’Neill discusses the main aspects of the London Health and Care Collaboration agreement, signed last December and aiming to transform the capital’s healthcare offering


The Design Council’s Haidee Bell outlines some success stories of using better A&E design in the health sector, and discusses how design-led approaches can improve outcomes Volume 16.3 | HEALTH BUSINESS MAGAZINE



Ethnic minority NHS staff more likely to face harassment, survey shows Black or ethnic minority (BME) staff are more likely to face harassment, bullying or abuse compared to white staff across the NHS, according to the results of a new survey. The inaugural report of the NHS Workforce Race Equality Standard (WRES) found that 75 per cent of all acute trusts show a higher percentage of BME staff facing harassment compared to white staff, with 22 per cent of acute trust returns also showed a higher percentage, whilw only five organisations included in the report indicated no gap between BME and white experience. 86 per cent of acute trusts reported that a higher percentage of BME staff do not believe their organisation offers equal opportunities for career progression, with 81 per cent of acute trusts reporting a higher proportion of BME staff having personally experienced discrimination from a manager or colleague. In contrast, the levels of harassment, bullying or abuse from patients were found to be similar for BME and white staff. Responding to the results, Simon Stevens, chief executive of NHS England, said: “This report provides unvarnished feedback to every hospital and trust across the NHS about the experiences of their BME staff. It confirms that while some employers have got it right, for many others these staff survey results are both deeply concerning and a clear call to action. As this is the first year of the WRES, it provides a transparent baseline from which each employer will now be seeking to improve.”

Joan Saddler, co-chair of the NHS Equality and Diversity Council and associate director at the NHS Confederation, said: “The report details findings from the initial WRES programme phase that exposes data trusts have traditionally collected but generally failed to act upon. The opportunity to improve care quality and staff motivation whilst supporting innovation is clearly signalled. Organisations that are serious about improvement for all, will begin planning to be ahead of the next programme phase of wider engagement and alignment of the WRES to a wide range of equality and inclusion approaches.”



Motor neurone disease patients facing long waits, MND Association warns The Motor Neurone Disease Association (MND Association) has released new research that suggests patients diagnosed with the disease are facing long waits for specialist treatment. According to the research, which was released to mark the start of MND Awareness Month, one in five patients diagnosed within the last three years have had to wait a year or more to be referred to a neurologist. Of these, 52 per cent had been referred to other healthcare professionals first who were not as well equipped to deliver accurate care – such as physiotherapists, orthopaedic surgeons or ear nose and throat (ENT) specialists. The MND Association has also cautioned that once patients have been seen by a neurologist many still face further delays. The research found that, while 27 per cent received a confirmed diagnosis within a month, 14 per cent faced a further delay of a year or longer. Sally Light, chief executive of the MND



NEWS IN BRIEF NHS confirms it will not fund PrEP HIV treatment NHS England has reiterated that it will not fund Pre Exposure Prophylaxis (PrEP) treatment, which is used to stop the viral transmission of HIV. It was first confirmed on 21 March that PrEP would not be funded by the NHS on the grounds that local authorities are the responsible commissioner for HIV prevention services, as set out in the Local Authorities Regulations 2013. Facing pressure from stakeholder groups, NHS England’s Specialised Services Commissioning Committee agreed to reconsider the decision. It was concluded that NHS England did not have the legal power to commission PrEP, but that it would remain committed to working with other commissioners to explore the possible provision of PrEP. In response to the decision, Izzi Seccombe, community wellbeing spokesperson for the Local Government Association, said: “This is hugely disappointing and a missed opportunity to launch a ground-breaking method of treatment which could halt the spread of HIV and potentially save lives. “Councils have invested millions in providing sexual health services since taking over responsibility for public health three years ago, and the PrEP treatment could help reduce levels of HIV in the community. “During the transition period to the implementation of the NHS and Care Act 2010, NHS England sought to retain commissioning of HIV therapeutics, which the PrEP treatment clearly falls into. It is, and should remain, an NHS responsibility unless it is fully funded for local authorities to pass on.”

Association, said: “This fatal and still incurable disease kills more than half of those diagnosed within two years. It is notoriously difficult to diagnose, and this new research shows many face 12 months or more of anxiety and uncertainty while their symptoms worsen. This could be in part due to delays between a GP referral and actually getting to see a neurologist, with 16 per cent reporting that it took over three months. “As traumatic as a diagnosis of MND must be, once you know why symptoms are occurring you can make more informed decisions for you and your family. Swift and accurate diagnosis, most commonly from a neurologist, is crucial in ensuring the needs of people living with MND are met from the earliest possible stage.” READ MORE:





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Healthcare Safety Investigation Branch must be independent, MPs advise

The new Healthcare Safety Investigation Branch (HSIB) will only succeed if its independence is guaranteed by law, the Public Administration and Constitutional Affairs Committee (PACAC) has advised. A PACAC report into the creation of the HSIB welcomed its creation and hailed it as a ‘critical step’ towards improving how the NHS in England investigates patient safety incidents, but warned that it must provide a ‘genuine safe space’ for people to speak out. The report advises that for the HSIB to succeed it must be ‘underpinned by primary legislation’ that ensures doctors, patients, families and carers can provide full contributions to safety investigations without fear of punitive sanctions. Bernard Jenkin, chairman of the PACAC, said: “We have consistently called for primary legislation to make HSIB fully independent, and to create a credible ‘safe space’ which will enable the NHS to properly learn from past mistakes. Since we approved this report, it is increasingly evident that the government has accepted this recommendation. “The Secretary of State’s decision to set HSIB up as an NHS quango as a permanent response to our recommendations was both

disappointing and would be unacceptable, but the prospect of a secure legislative base will enable HSIB emulate the successful air, marine and rail investigation branches. “Were the present non-statutory arrangement to be regarded as permanent it would be an intolerable compromise, disregarding consensus between healthcare experts and Parliament, and would put political dogma against forming new public bodies before patient safety. We therefore look forward to the draft legislation emerging.”



Patients locked out of treatment due to global healthcare cuts, study says Patients are being prevented from receiving treatment due to unemployment and healthcare cuts in both England and around the world, according to a new study by Imperial College London. The data was collated by observing the rise in cancer deaths in accordance with every percentage increase in unemployment and every drop in public healthcare spending. The research involved examining World Health Organisation and World Bank statistics on more than 70 countries to analyse the relationship between unemployment, public healthcare spending and cancer mortality, from the years 1990-2010. The researchers found that every one per cent increase in unemployment was associated with 0.37 additional cancer deaths per 100,000 people, while every one per cent drop in healthcare spending was associated with 0.0053 additional deaths per 100,000 people. Mahiben Maruthappu, of Imperial College London, said: “From our analysis we estimate that the economic crisis was associated with over 260,000 excess cancer deaths in the Organisation for Economic Cooperation and Development (OECD) alone, between 2008-2010. “This suggests that there could have

been well over 500,000 excess cancer deaths worldwide during this time.” The research, published in the Lancet medical journal, calculated that for the European Union alone there was an additional 160,000 patient deaths relating to cancer who would not otherwise have died. Maruthappu added: “Cancer is a leading cause of death worldwide so understanding how economic changes affect cancer survival is crucial. We found that increased unemployment was associated with an increased cancer mortality, but that universal health coverage protected against these effects. “This was especially the case for treatable cancers including breast, prostate and colorectal cancer.” Rifat Atun of Harvard University, who co-authored the study, said: “In countries without universal health coverage, access to healthcare can often be provided via an employment package. Without employment, patients may be diagnosed late, and face poor or delayed treatment.” READ MORE:



NEWS IN BRIEF Mental health services failing children, Children’s Commissioner warns Some mental health services across England are failing children with life-threatening conditions, according to data collected by the Children’s Commissioner Anne Longfield. According to the data, 28 per cent of children referred for specialist mental health treatment in 2015 did not receive a service, with some trusts reporting waiting times of over 100 days. The Children’s Commissioner also found that 14 per cent of children considered to have life-threatening mental conditions, which includes those who have attempted suicide and those with psychosis, were also denied specialist support. Longfied said: “Children and young people consistently tell me that they need better mental health support but the information we have received paints a picture of provision that is patchy, difficult to access and unresponsive. “Behind the stats are countless stories of children and young people in desperate circumstances not getting the vital support they need. “I’ve heard from far too many children who have been denied access to support or struck off the list because they missed appointments. I’ve heard from others whose GPs could not manage their condition and who had to wait months to see a specialist whilst struggling with their conditions.” READ MORE:

Ambulance chief resigns over 111 scandal Paul Sutton, the chief executive of South East Coast Ambulance Service, has resigned after a controversial trial that delayed responses to a number of calls. It emerged last year that the trust had run a new pilot without the approval of board members, the 111 NHS helpline or commissioners, which resulted in around 20,000 patients having their ambulances delayed. The trial redirected some 111 calls to the 999 system to allow more time for urgent calls and an independent review undertaken by Deloitte deemed that governance surrounding the pilot was inadequate. READ MORE:



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NHS must reduce hospital discharge delays, NAO warns The National Audit Office (NAO) has said that the NHS in England must get a better grip on the delays patients face when being released from hospital, in order to reduce unnecessary harm and money. The report estimated that NHS discharge delays were costing the NHS up to £820 million per year and warned that delays particularly put older patients at risk because they lost mobility during extended stays. The news comes after delays hit record levels this winter as a result of a lack of support available in the community. The research suggested that for every day kept in hospital, an elderly patient can lose five per cent of their muscle strength, as well as increasing their risk of infection. Figures show that the number of delays has risen by a third in the past two years to 1.15 million days. The delays cost hospitals £820 million, whereas care in the community for such patients would have cost just £180 million. However, the NAO has said the data is likely to be an underestimate, as

Children not receiving key diabetes health checks, study shows

delays were only measured from the point where patients were deemed ready for discharge, which may have also experienced delays in being recorded. Amyas Morse, head of NAO, said: “The number of delayed transfers has been increasing at an alarming rate but does not capture the true extent of older people who should not be in hospital. While there is a clear awareness of the need to discharge older people from hospital sooner, there are currently far too many older people in hospitals who do not need to be there. Without radical action, this problem will worsen and add further strain to the financial sustainability of the NHS and local government.” A spokesman for the Department of Health said that steps were being made to tackle the issues, adding that ‘elderly patients should never be stuck in hospital unnecessarily.” READ MORE:


Sugar tax to hit poorest, TPA warns The Taxpayers’ Alliance (TPA) has cautioned that the planned sugar tax will ‘hit poor families harder’, but has nothing to do with the sugar content of products. The TPA highlighted that tests on coffee shop drinks have shown them to have more sugar than Coca-Cola, despite not being liable to the tax. According to the Treasury, soft drinks would be taxed because they were the main source of added sugar in children’s diets. However the TPA survey found that while Coca-Cola, which contains 10.6g of sugar per 100ml, will be subject to the levy, Starbucks’ signature hot chocolate, which contains 11g of sugar per 100ml, will not. Currently the NHS has advised that the recommended maximum intake of added sugar per day for those aged 11 and over is around 30g. Jonathan Isaby, TPA chief executive,



explained: “The evidence shows that the sugar tax has nothing to do with the sugar content of products, so it is farcical to suggest that this will have any positive impact on people’s diet or lifestyle choices. “This is yet another example of irresponsible meddling from the high priests of the nanny state, introducing entirely unnecessary complications into an already complicated tax system and pushing up the cost of everyday products for hard-pressed families.” A Treasury spokesman said: “Treating obesity and its consequences costs the taxpayer £5.1 billion every year. The levy will be charged on soft drinks because they are the main source of added sugar in children’s and teenagers’ diets, many with no intrinsic nutritional value. “Health experts agree there is a specific problem with sugar-laden fizzy drinks that must be addressed.”


According to a study by Diabetes UK, almost 75 per cent of older children in England and Wales with diabetes had not received key health checks. The study examined 27,689 children and young people and found that only 25.4 per cent of those aged 12 and older had all seven recommended annual checks. Health officials have recommended all children with diabetes should be assessed to ensure they are managing their condition properly. In addition, the National Institute for Health and Care Excellence (NICE) guidelines state that all children with diabetes should have their blood sugar checked each year and that those over the age of 12 should receive six other annual health checks. The report analysed data from children and young people with diabetes up to the age of 24 who attended paediatric diabetes units in England and Wales between April 2014 and the end of March 2016. Over 70 per cent had type 1 diabetes which requires daily injections of insulin. The study noted that those achieving ‘excellent diabetes control’ rose from 15.8 per cent in 2012-13 to 23.5 per cent in 2014-15. It found that 98.7 per cent of all children and young people had received the blood glucose checks, and that 23 per cent had now reduced their risk of future complications from the disease. However, the study warned that the most commonly missed checks among children aged 12 and older included foot examinations, eye screenings and cholesterol testing. Dr Justin Warner, consultant in paediatric endocrinology and diabetes at the University Hospital of Wales and clinical lead at the Royal College of Paediatrics and Child Health, commented: “They form part of a lifetime of screening for complications which, if recognised early, are amenable to interventions that reduce progression.” Bridget Turner, director of policy and care improvement at Diabetes UK, said: “There remains considerable variation in the level of care provided. “This is very worrying because if children and young people are not supported to manage their diabetes well in early life, they are more likely to be at risk of debilitating and life-threatening complications in adult life such as amputations, blindness and stroke.” READ MORE:










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The Campaign For Better Hospital Food looks at the need for high standards in hospital food so that more meals are freshly cooked with care, tasty to eat and made using nutritious ingredients. Katherine Button provides an update on the campaign and the national push for higher standards The Campaign for Better Hospital Food is a Ronseal campaign; it does exactly what it says on the tin. We push for higher hospital food standards for patients, visitors and staff. We work with hospitals to share best practice wherever we find it and we campaign to affect transformational change within Trusts that are taking backwards steps on food. The Campaign for better Hospital Food is part of Sustain; the alliance for better food and farming. The Sustain alliance has campaigned since 2002 for improvements to public sector food standards. Hospital food accounts for around one third of national public sector food spend and the aim has always been to achieve healthy, high quality and sustainably produced food served in hospitals. It’s been a great few years for the campaign and we’ve seen real success and progress. After the head of NHS England Simon Steven’s statement last year that hospitals should be ‘health promoting environments’ we redoubled our efforts to campaign to improve the food offer for hospital staff, many of which currently rely on vending machines or ordering takeaways to the wards. We developed ten recommendations to improve hospital food, liaising with the Soil Association and several trail-blazing hospital Trusts, and presented them to Simon. One of the key recommendations was that hospitals should ensure that there is provision of healthy food for staff on shifts, 24 hours a day to support staff health and well-being.

We recommended that commercial food providers should be tackled head on to better promote healthier options and that Trusts should be empowered to negotiate with retail outlets and catering providers. We asked for better data to be available on the timeline for contract renewal to provide a means of targeting interventions and phasing in change. NHS England sets national targets for hospitals that are called Commissioning for Quality and innovation (CQUIN), and in addition we recommended that these CQUINs should be used to incentivise better food quality and leadership around hospital food.

Written by Katherine Button, project officer, Better Hospital Food, Sustain

Campaigning for Better Hospital Food and measured centrally, which is fantastic news for hospital patients, visitors and staff. Putting the focus on food in this way is a reassuring marker on the journey towards better NHS food. It is also a great moment for the Campaign too as we saw many of our recommendations come to fruition.

FOOD TARGETS AS Hospita A NATIONAL CQUIN l s should The CQUIN means that e a percentage of a that thensure re is hospitals budget will be provisio n of hea dependent on achieving food fo l t h certain food standards y for staff, visitors and shifts, 2 r staff on 4 hours patients. The standards day to s a fall into two indicators. Firstly, the provision of staff he upport alth an healthy food on hospital d well-be premises, including: the ing banning of price promotions

CAMPAIGN SUCCESS We are very happy to report that on the 5 March this year NHS England announced that a new CQUIN on ‘NHS staff health and well-being’ would be one of five national CQUIN targets that apply to all hospital Trusts. The new national CQUINs became operational in April 2016 and all hospitals will now have to report to NHS England on their progress towards meeting these targets, which we anticipate will run for two years. This is the first time that food has been included in this core set of NHS England aims

on sugary drinks and foods high in fat, sugar and salt (HFSS); the banning of advertisement on NHS premises of sugary drinks and foods high in fat, sugar and salt (HFSS); the banning of sugary drinks and foods high in fat, sugar and salt (HFSS) from checkouts; and ensuring that healthy options are available at any point including for those staff working night shifts. The second indicator is better data. Providers will be expected to submit national data collection returns by July !










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STANDARDS ! based on existing contracts with food and drink suppliers. This will cover any contracts covering restaurants, cafés, shops, food trolleys and vending machines or any other outlet that serves food and drink. The data collected will include the following; the name of the franchise holder, food supplier, type of outlet, start and end dates of existing contracts, remaining length of time on existing contract, value of contract and any other relevant contract clauses. It should also include any available data on sales volumes of sugar sweetened beverages (SSBs). The NHS staff health and well-being CQUIN is relevant for four types of provider: acute trusts; community trusts; ambulance trusts; and mental health trusts. CQUIN funds will be paid on deliver of these outcomes. In many cases providers will be able to achieve these objectives by renegotiating or adjusting existing contracts. This is of course fantastic progress and we are eager to see the results. However, although these are financial incentives that will be watched closely by NHS England, there is no legal requirement for these targets to be met. This means that hospitals that fail to meet the standards will not receive a fraction of a percentage point of their overall budget – a big incentive – but for high standards to be guaranteed we must make that extra step and make them a requirement. WE’VE COME SO FAR The first big campaign win came in August 2014 when the Campaign for Better Hospital Food was instrumental in pushing the government into setting minimum hospital food standards in England for the first time. These rules, written into the NHS Standard Contract, require hospitals to have a Food and Drink Strategy and to follow guidance on food and nutrition spread across five documents. This move came as a result of the Hospital Food Standards Panel report, led by Dianne Jeffrey, Chair of Age UK and involving industry and the third sector, including Sustain and the Soil Association’s Food for Life. Unlike the CQUINS these Standard Contract requirements are not monitored centrally by NHS England but we do know that not all hospital trusts in England are yet in compliance with these rules. Performance is predominately self-reported using PLACE assessments and due to the nature of the standards, as recommendations rather than requirements, there is sometimes confusion about what compliance looks like and what best practice might be. So, despite the great progress in getting food standards in the NHS Standard Contract, the standards that apply to hospital food remain weak, hard for hospitals to follow and difficult for regulatory bodies, such as the Care Quality Commission (CQC) and local Clinical Commissioning Groups (CCGs), to monitor. This is why we continue to campaign for an independent body to regulate and



Good diet and nutrition are key to building health and resilience in patients, but also visitors and staff – this means the NHS is well placed to lead by example monitor the quality of hospital food. In some areas the rules themselves require further work. One of the worst examples is a get-out clause in the Government Buying Standards for caterers and commissioners whereby a trust can ‘depart’ from UK legislative standards for animal welfare and food production, if this ‘leads to a significant increase in costs which cannot reasonably be compensated for by savings elsewhere’. The food standards therefore are flawed, and we continue to campaign for improvements, but taken in tandem with the new national CQUIN targets on food there is hope that this is the start of a good foundation on which to build a better food future for our health service. WHY HOSPITAL FOOD IS SO IMPORTANT Good diet and nutrition are key to building health and resilience in patients, but also visitors and staff – this means the NHS is well placed to lead by example. However, at the moment our most recent evidence suggests that 67 per cent of hospital staff would be unhappy to eat the food they serve to patients and six out of 10 patients rely on family to bring them food because they don’t want to eat what they’re served in hospitals. Unhealthy diets resulting in obesity and diabetes are also a growing problem with 64 per cent of adults either overweight or obese and 50 per cent of the NHS’ 1.4 million employees overweight or obese. Treating

obesity and the associated health problems costs the NHS around £6 billion every year – or five per cent of the entire NHS budget. Estimates from Public Health England put the cost to the NHS of staff absence due to poor health at further £2.4 billion a year – accounting for around £1 in every £40 of the total budget. This figure is before the cost of agency staff to fill in gaps, as well as the cost of treatment, is taken into account. Hospital food has a direct impact on our health and there is a clear incentive to drive up standards. OUR FOCUS FOR THE FUTURE Alongside with campaigning for tougher measures and monitoring, we are developing a methodology for measuring and reporting the quality of hospital food. We are also working with partners to hold a pilot workshop to share knowledge and best practice among hospital trusts on how to work with caterers, suppliers, on-site retailers and vending machine providers to improve food standards. Patients prefer meals that are freshly cooked in an on-site hospital kitchen so we continue to campaign for food preparation to be brought back into hospitals, or regional hubs, building nutritional health, saving money and sourcing food locally to support nearby farmers and growers. " FURTHER INFORMATION



Healthy Eating


CATERING achieve the award, what exactly is the Catering Mark and why is it so important?

Written by The Soil Association

FOOD FOR LIFE CATERING MARK Brought to the fore by Jamie Oliver and his school dinners, the Catering Mark recently celebrated over 1.5 million meals eaten in schools, nurseries, workplaces and hospitals every work day. Half of all English primary schools now hold a Catering Mark and the revolution has spread to healthcare catering too. The Food for Life Catering Mark is an independent award that assesses catering in public places against a set of standards developed to help improve the quality of food where people don’t often have a choice. The award provides an independent guarantee that meals are freshly prepared, include local seasonal produce, and are free from undesirable ingredients such as trans fats. All meat achieves UK animal welfare standards, and only free-range eggs are used. Healthy places are drastically in need of healthier food. The Catering Mark is already in hospitals across the country, certifying the staff, visitor and patient food to bronze, silver or gold standard. Better hospital meals can go a long way to supporting patient health and recovery and increasing customer satisfaction. It’s not just catering for patients either – NHS employees are even more at risk, with 25 per cent of staff obese and diet-related illness costing £5.8 billion every year.

The Mark of good food in hospitals The Soil Association provides an update on the work it has done to improve food through its Food for Life Catering Mark, with a specific focus on its work with the NHS and healthcare sector In a move to improve staff health and well-being, NHS England has recently announced a new national Commissioning for Quality and Innovation (CQUIN), ‘NHS staff health and well-being’, which came into force as of 1 April 2016. The Soil Association’s Food For Life Catering Mark is welcoming this news as it supports the good work that they have been doing over the past six years to improve staff and visitor food in hospitals. Healthier food for NHS staff, visitors and patients (with a retail focus) is a key part of the new CQUIN, as targets are set and funds will depend on achieving a number of new approaches. NHS trusts will be expected to achieve a step-change in the health of the food offered on their premises in 2016/17, including the banning of price promotions on sugary drinks and foods high in fat, sugar and salt (HFSS). Successful achievement of these goals will unlock finance for trusts; a huge and welcome motivator to take action. Part of the new CQUIN will also require healthy options to be available at any point



including for those staff working night shifts. The Catering Mark can offer guidance in how to improve food served in hospitals, including how to find suitable alternatives. On delivering these outcomes, CQUIN funds will be paid to NHS trusts for compliance to the requirements. The Soil Association’s Food for Life programme is committed to ensuring that the food offering in hospitals reflects a hospitals’ position as a healthy place so has developed a series of support packages with the Food for Life Hospital Leaders team and the Catering Mark to support and exceed achievement of the new CQUIN requirements. The CQUIN also complements the aims of the Food for Life Catering Mark and current holders of the award will find themselves well informed to take advantage of this opportunity. But for those still to

WHO DOES IT APPLY TO? There are now over 40 hospital sites in the UK who have stepped up to achieve a Catering Mark, whether for their staff restaurant or for patient feeding. This work has been achieved in partnership with Trusts and their caterers. One food service provider, ISS Healthcare, have committed to bring all of the sites they cater for to Catering Mark standard, the last is due to be awarded in summer 2016. Achieving a Catering Mark is no mean feat and takes commitment from management right through to catering and serving staff. Menus will often be changed to incorporate more seasonal ingredients, fresh produce will need to be sourced, suppliers consulted and more meals prepared freshly by trained staff.

The road to ital osp better hlong one. a food is e who chose s But tho ke steps to to ta their food e improv rtainly not ACHIEVING A will ce alone CATERING MARK be

To help caterers find more suitable ingredients, Soil Association Certification has set up the Catering Mark Supplier Scheme, giving caterers more options for sourcing local fresh produce, or farm assured meat.

For example, Acorn Dairies supply around 3,500 litres of organic milk to the Freeman Hospital in Newcastle direct from the dairy – great for local food and good for people too, as a recent report by Newcastle University, published in the British Journal of Nutrition, found that organic milk contains around 50 per cent more beneficial omega-3 fatty acids than non-organic milk. Another Catering Mark Supplier Scheme member, Yearsleys, supply Red Tractor assured meat, sustainable fish and fresh produce to a range of hospital caterers across the country. They’ve been part of the Supplier Scheme for just over a year and now supply around 150 hospitals, helping healthcare caterers to improve the sourcing and provenance of their ingredients. This supports local economies and through the Catering Mark Supplier Scheme, provides caterers with the reassurance that their food is free from undesirable additives (such as trans fats or aspartame) – crucial to achieving a Catering Mark. Yearsley’s said: “Our customers are always very pleased to hear that we are members of the Catering Mark Supplier Scheme and that we can help them improve their food sourcing practices and achieve the Catering Mark. Its great to know that we are helping to improve the food served in hospitals and supporting British producers at the same time.” Once the catering team has decided to apply for the award and made changes, an inspector from the Soil Association will visit and spend time checking the site to ensure their ingredients comply with the standards. Providing there are no issues, the Catering Mark will then be awarded. Inspection is annual so hospitals need to make sure they keep up the good work. Many hospitals choose to celebrate the award with a presentation, which helps share the good news with more staff and visitors and generate positive publicity. Across the country hospital Catering Mark celebrations are being reported in local papers and industry publications. This recognition is a welcome change from negative healthcare news stories papering the press. North Bristol NHS Trust was one of the first hospital restaurants to achieve the Catering Mark Silver award. The trust has an Environmental Policy which commits them to monitoring and sourcing local, organic, seasonal and fairly traded food. With help from the Soil Association’s Catering Mark team, the team at North Bristol were able to find suitable local, sustainable suppliers and fulfil their environmental aims. Gary Wilkins, head of catering at North Bristol NHS Trust, said: “The Catering Mark is something tangible to show patients, visitors and other interested parties just how important providing improved patient meals is for us here at North Bristol NHS Trust. But it’s not just the patients that benefit, we feel we are really contributing to the local economy and feeding back into our community.”

The quality of food at Southmead hospital is often reported by patients; a recent patient satisfaction survey scored 95.1 per cent for food. Over 93 per cent of dishes are prepared from local ingredients, freshly on site without controversial or undesirable additives, GM and artificial trans fats, and ingredients that are farm assured and better for animal welfare. SUPPORT FROM THE CATERING MARK The effects of the Catering Mark stretch further, to employees and the local community. Staff training is emphasised as part of the scheme, giving employees skills that they might otherwise not have. They can take these skills and satisfaction back to their homes, helping to raise awareness of the value of cooking and good food in the community. The Catering Mark supports British farmers and the wider economy by encouraging the use of ingredients produced in the UK – research shows a return on social investment of over £3 for every £1 spent. The standards set by the Catering Mark are also recognised in key policy at government level. The Food for Life Catering Mark is cited in the government’s Plan for Public Procurement, which addresses wider aspects of quality within food and catering – such as ethical, environmental and social considerations. Based on the Government Buying Standards for food and nutrition, the Plan seeks to achieve consistent standards for all food procured by central government departments, as well as providing best practice recommendations for food providers and procurers. Catering Mark holders are recognised within the Plan as being well-placed to score good or excellent against the Plan’s ‘Balanced Scorecard’ criteria. The economy has also benefited from the take up of the Catering Mark. There is now over £40 million spent on Red Tractor assured meats by Catering Mark holders per year, increasing from £23 million in 2014. In addition, £9 million is spent on organic, £5 million on MSC and £4.7 million on RSPCA assured products through the scheme. The road to better hospital food is a long one. But those who chose to take steps to improve their food will certainly not be alone. The rewards are there too for those who strive to meet the challenge. !

The Soil Association’s Food for Life Catering Mark provides an independent endorsement that food providers are taking steps to improve the food they serve, using fresh ingredients which are free from undesirable additives and

Healthy Eating


The Food for Life Catering Mark Standards Bronze Meals contain no undesirable food additives or hydrogenated fats. 75% of dishes are freshly prepared. Meat is from farms which satisfy UK welfare standards. Eggs are from cage-free hens. Menus are seasonal. Training is provided for all catering staff. Free drinking water is available. No endangered fish are served. Information about where the food has come from is on display. Suppliers meet food safety standards. School caterers meet government guidelines for food and nutrition. Silver and Gold The Silver and Gold Catering Mark Standards work on a flexible points system, which rewards spend on ethical, environmentally friendly and local ingredients, and recognises steps to offer healthier menus. At Silver, at least 5% of ingredients are organic and a selection of local or UK produce is served. A number of steps are taken to make meals healthier. At Gold, at least 15% of ingredients are organic, a significant proportion of the ingredients caterers use must be from the UK or produced locally and further steps are taken to make healthy eating easier.

trans fats, are better for animal welfare, and comply with national nutrition standards. FURTHER INFORMATION


the healthier vending solution for your hospital • Free on loan equipment • Fully trained Operators • A.V.A Quality Audited • Healthier Options only in machines • Royalties back to the Trust us to find out more about the future of vending at your Hospital

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Written by Jonathan Hart, chief executive, Automatic Vending Association

The healthy voice in providing choice



The consumer demand for choice in vended snack products is growing in hospitals. Jonathan Hart, of the Automatic Vending Association, explains the steps the vending industry is taking to meet the expectations of a more health conscious nation Most retailers know that, in this day and age, providing consumers with choice has never been so important, especially when it comes to helping them maintain a healthy diet. The big retailers have already taken very visible steps to support the healthier choices of consumers and their families. For example, in 2014 Lidl and then Tesco removed unhealthy snacks from their checkouts and other supermarket chains including Aldi and Sainsbury’s followed suit. Research by Mintel in April 2016 also found a strong consumer demand for healthier, lower sugar snacks, with 70 per cent of respondents agreeing that manufacturers should do more to reduce the sugar in their snacks. The sugar content of snacks and drinks has been a particular focus of the nation and media in recent months, with the recent announcement that a ‘tax’ on sugary drinks would be introduced. The Automatic Vending Association (AVA) has had healthy vending at the top of its agenda for quite some time, proactively working with a number of partners including health organisations and universities to do what it can to shape a snacking landscape that responds to the growing consumer demand for wider product choice. The AVA works hard to ensure its members are always one step ahead of trends and

consumer demands and are altering product ranges in response to this.This is especially important in vending as vending machines are limited on the number of different products they can stock in contrast to larger retail outlets, such as supermarkets. The AVA is producing a set of Healthy Vending Guidelines for its members, encouraging them to consider moving away from just traditional vending, and think of stocking more low fat, low sugar and low calorie products.

Budget announcement, the UK government announced that it was planning to take action against the high quantities of sugar found in certain drinks, by placing a tax on the sugary drinks industry for drinks that contain more than 5g of sugar per 100ml, with an even higher tax being placed on those that contain over 8g of sugar per 100ml. In the Queen’s Speech in May, it was announced that the sugar tax would be introduced in April 2018. The AVA, which has long been working to provide more education and choice around snacks, takes the position that more priority should be placed on enhancing education and understanding around nutrition and the importance of following a healthy, balanced diet which can include treats in moderation.

Incre focus o asing conten n sugar many int has led fl expertsuential an organis ations t d o the intr oductio back n of a sugar tax

STANDING UP TO SUGAR TAX During the last 12 months, there have been numerous national news stories around the health risks of consuming too much sugar, including reports that revealed the amount of ‘hidden sugar’ in fizzy drinks and also hot drinks served at high street coffee shops. Increasing focus on sugar content has led many influential experts and organisations, including Cancer Research and the UK Health Forum, to back the introduction of a sugar tax. In March 2016, as part of the Chancellor’s

VENDING MACHINES IN HOSPITALS Like all retail environments, vending machines are there to provide a choice of products in line with current consumer demands – meaning they stock what people want to !



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Vending is a 24-hour, secure, unattended, convenient option ideal for locations like hospitals where vending is relied on by staff, patients and visitors for food and drinks round the clock ! buy, where there is a need for their service. Vending is a 24-hour, secure, unattended, convenient option ideal for locations like hospitals where vending is relied on by staff, patients and visitors for food and drinks round the clock. In Wales and Scotland, the products sold in vending machines in hospitals have been regulated since 2008, ensuring contents that are high in sugar or calories are controlled. In Scotland, all vending machines must be stocked with at least 30 per cent ‘healthy’ products. Demand and tastes are of course always changing too, and healthy snacks are becoming more widespread in vending machines all over the UK, and this includes those in hospitals. In England, the Automatic Vending Association recently met with the Hospital Caterers Association to discuss working together to widen the product offering in hospital vending machines further. The AVA is keen to ensure it works effectively with hospitals to ensure their vending machines cater for a range of dietary requirements including low sugar, low fat, low calorie along with other requirements such as high fibre and gluten free. However, it is not just vending machines that hospitals should regulate. In February 2016, campaign group Action on Sugar found that high street cafe’s hot drinks contain

up to 25 teaspoons of sugar. Many of the offending high street coffee shops also have outlets located in hospitals. These should have similar restrictions to those affecting vending machines to ensure an ‘even playing field’, and better transparency when it comes to any high sugar or ‘unhealthy’ products that are served in hospitals. SHAPING THE SNACKING LANDSCAPE OF THE FUTURE Despite this growing consumer demand for healthier options, reports show that the majority of retail snacks are still high in fat, sugar and/or calories. Mintel’s April 2016 research shows that just 11 per cent of snack products launched in the UK in 2015 had a low, no or reduced sugar claim, whilst eight per cent carried a low, no or reduced fat claim and just four per cent carried a low, no or reduced calorie claim, suggesting there is still a long way to go to ensure more healthy snacks are available to consumers. Amy Price, senior food and drink analyst at Mintel, sees this as a window of opportunity for retailers and product developers. She said: “This suggests that exploring healthier formats in these areas could be a way to appeal to snackers.” The AVA has long recognised this need too, and has been actively involved in driving awareness and education around

Jonathan Hart, chief executive, Automatic Vending Association

healthier snacking options, that are also suitable for vending, for some time. For the last three years, the AVA has worked with Culinary Arts Management students at University College Birmingham to co-run a module called the Culinary Product Development Challenge. The module challenges students to create alternative, new healthy vending snacks that are calorie controlled. In 2015, the Culinary Product Development Challenge’s winning team – called TOP’D – produced a delicious, healthy polenta-based snack to win. The creative students used gluten-free polenta grains to make a crunchy shortbread base topped with a range of British dessert-inspired flavours to meet the brief of a snack that was under 400 calories and wheat free. The AVA plans to continue working with UCB in the years to come, ensuring it is playing a key part in educating the product developers of the future about creating a wider range of snacks that respond to the growing consumer demand for healthy snack products. AVEX Health options in vending are also exhibited at the AVA’s biannual vending event AVEX. At AVEX 2015 a Health and Wellbeing Zone was created, featuring 11 stands promoting healthier vended products. The new zone was created in support of the growing number of vended products that are calorie controlled or specially tailored to meet a range of dietary requirements and offered a great opportunity for the industry and visitors to the event to learn more about popular healthy snack products. The Health and Wellbeing Zone was a huge success, and as a result, it will be a feature of AVEX 2017, due to take place at NEC Birmingham in September 2017, ensuring that awareness and education around healthy vending options and snacking continues to grow. " FURTHER INFORMATION



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Graham Wright, president of HEVAC, explains why heating, ventilation and air conditioning should be monitored closely to ensure long-term efficient and effective operation The topic of heating, ventilation and air conditioning rarely raises a pulse among national newspaper editors. It is seldom-mentioned in the popular press unless these essential building services have gone wrong in a high profile setting, such as a hospital. That was the case just two years ago when the air conditioning at the new £430 million Southmead Hospital in Bristol failed, causing the cancellation of 200 operations before the site had even opened. And it was again the cause for the headlines surrounding the Royal Free Hospital in north London last summer when patients were left sweltering after the

system broke down on two wards. Such stories demonstrate why the end goal for any facilities manager in a healthcare setting should be that no occupant of the premises notices the HVAC system, or their absence, at all. If they are working correctly, everyone from patients to porters will simply go about their business in a comfortable environment, without a second thought to the services functioning behind the scenes. It is no secret that, central to any hospital HVAC system’s operation, is its maintenance and cleanliness. Ventilation

VENTILATION HYGIENE The Workplace (Health, Safety and Welfare) Regulations also cover healthcare and say that mechanical ventilation systems, including air conditioning, are regularly cleaned, tested and maintained to ensure that they are kept clean and free from contaminants. Furthermore, the Guide to Good Practice TR/19 Internal Cleanliness of Ventilation Systems (published by the Building Engineering Specialists Association, BESA) offers professional ventilation hygiene providers in-depth guidance on how ventilation systems should be cleaned and maintained. This includes criteria for ensuring new ductwork systems are protected during the installation period and before they are commissioned. Meeting standards in cleanliness is one key part of the job for healthcare facilities managers. But in these straitened times for the health service, there is more that hospital facilities managers can do with their HVAC plant to ensure that not only is it keeping patients and staff comfortable and free from the threat of harmful bacteria, but also that it is performing as efficiently as possible. A sound grasp of energy usage and where it is being wasted can make a significant impact on a building’s energy costs. Energy efficiency is an issue looming large for every major building owner, and it is no different for the nation’s healthcare facilities.

A sound grasp usage a of energy is being nd where it make a wasted can sig impact nificant building on a ’s ene costs rgy

Written by Graham Wright, Heating Ventilating and Air Conditioning Manufacturers’ Association

Creating and maintaining a healthy building

ductwork provides the ideal breeding ground for potentially harmful bacteria, and hospitals have a responsibility to prevent the spread of infections as stated by the requirements set out in the Health Technical Memorandum 03-01. The document gives comprehensive advice and guidance on the legal requirements, design implications, maintenance and operation of specialised ventilation in all types of healthcare premises.

Facilities Management


ENERGY USAGE It is a little known fact that climate control and ventilation systems are responsible for nearly half of the energy consumption in non-residential buildings. What is more of a concern though is the fact that building design expectations in terms of energy consumption can be over-optimistic. Research done by the Chartered Institute of Building Services Engineers (CIBSE) made a comparison between energy use in a model building as envisaged by Part L of the !




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EFFICIENCY ! Building Regulations, and that of a real world example. It found that while hot water and heating performed similarly to the modelled building, annual consumption in Kilowatts per hour per m2 (kWh/m2) for cooling and the operation of fans, pumps and controls were far in excess of the expected levels. Overall, the actual energy consumption was roughly 200kWh/m2 over and above the predicted figure, with cooling and fans, pumps and controls contributing the

classes A, B, C or D to levels of control in a building and showing the resulting energy savings that can be expected. Although spending hours interrogating such a document is unlikely to be a high priority for a busy building manager in a large healthcare site, it’s a worthwhile investment of time for those offering advice on energy-saving technologies in hospitals where finding savings in every aspect of their operation is on the agenda. The ability to

Intelligent control is crucial, as it allows monitoring zone-by-zone within a building, ensuring that heating, cooling and ventilation levels are optimised to maximise comfort largest chunks of that usage. The outcome of CIBSE’s research was a document called TM54: Evaluating Operational Energy Performance of Buildings at Design Stage. The idea is that it can be used as a tool at design stage to avoid such vast performance gap between how a building performs on paper and what it does once operational. For new build healthcare projects, such a guide could prove invaluable by facilitating better specification, with clear instruction to ensure the purpose and usage of the building has been understood by the construction team. It can also help to support improved installation and commissioning, which are equally important; and better operation, which requires the end user to have a firm grasp on the control strategy for the building, as well as monitoring and recommissioning where necessary. Existing hospitals, however, are beyond this stage, and so require another set of tools with which to assess and improve energy efficiency. The Energy Performance of Buildings Directive, first introduced in 2010, and the 2012 European Buildings Directive, are the EU’s main legislation concerned with reducing carbon emissions in buildings. These directives have resulted in further work, including the more recent British and European Standard EN15232: Energy performance of buildings. Impact of Building Automation, Controls and Building Management. This paper, as its title suggests, looks closely at how beneficial a robust controls strategy can be in terms of improving energy efficiency. At the heart of BS EN15232 is a structured list of controls and building automation technologies that have an impact on energy use in buildings. The Standard includes a method to define minimum requirements for controls in different types of building, including offices, hospitals, schools, retail and restaurants. The Standard also offers a detailed method for assessing the impact of particular types of building control on the energy performance of a given building, assigning

provide evidence supported by a recognised Standard makes BS EN15232 a powerful tool. Going back to CIBSE’s recommendation that clear specification is an essential part of the route to operating a building as closely as possible to its expected efficiency levels, the Standard can also help here. It will assist clear specification of a building energy management system (BEMS), and provides calculations to determine the impact of building controls on the energy efficiency of a building by comparing two energy-demand calculations using different functions. In this way, specifiers can calculate the different potential costs and set these against the potential energy savings in the short and long-term – useful business insights into the effects of investing in BEMS. INTELLIGENT CONTROLS Where HVAC is concerned, integrating climate control with other building systems using intelligent controls can improve the overall efficiency of a building and reduce energy use. Intelligent control is crucial, as it allows monitoring zone-by-zone within a building, ensuring that heating, cooling and ventilation levels are optimised to maximise comfort. Intelligent controls, in combination with remote monitoring, provide a comprehensive history of the system, helping to optimise settings and operation to maximise energy savings, improve comfort and enable preventative maintenance. It is instructive for today’s hospital facilities managers to perhaps look back at what BEMS in these settings was used for in the early days. Often it would be no more than a glorified on/off switch for plant and central monitoring for faults. Today, trusts such as Barking, Havering and Redbridge University Hospitals Trust, who oversee Queen’s Hospital in Romford, are taking energy wastage seriously. Jason Davie, Energy Manager, Queen’s Hospital for contractor Sodexo says: “As part of our drive to help the Trust meet its Carbon Emissions Reduction targets, buildings

energy management and efficiency is key. For a complex modern buildings like Queen’s Hospital this is achieved through advanced BMS, which helps in monitoring and control of HVAC systems for internal environment. We are eliminating waste of energy in unoccupied areas by proactively programming our HVAC system inline with the occupancy times of individual business areas.” Watchful monitoring through an integrated Building Energy Management System is most certainly the best way for hospitals to get a handle on energy performance, especially on a site as sprawling and complex as a large hospital.

Facilities Management


EXAMINING OPERATIONS Although not applicable to hospitals, the newly introduced Energy Savings Opportunities Scheme (ESOS) may well be a worthwhile exercise for a hospital facilities manager to undertake. Following the ESOS model, an assessment would inspect an organisation’s energy use and examine the efficiency of that energy usage, thereafter making recommendations for improvements. For this reason, despite not falling under the Scheme, hospital facilities managers may want to pursue an ESOS style examination of their operations. Introducing energy saving measures recommended by an ESOS assessor could make significant cost savings. An audit of just how comprehensive your current monitoring and controls strategy could yield plenty of information on which to lay the foundations for a better approach to running the buildings so many millions of us depend on. " FURTHER INFORMATION Graham Wright, HEVAC president



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AGENCY STAFFING – TOWARDS A BETTER ALTERNATIVE The current government clampdown on agency staff has prompted an urgent need to seek out new ways of working to protect high quality patient care, argues Alexander Chilvers of 18 Week Support

Agency staff spending has contributed significantly to the NHS deficit. Such costs have risen more than tenfold in the last two years to £3.3 billion. The use of temporary staff can be beneficial, providing Trusts with flexibility to meet increased demand quickly and ensure adequate staffing levels are in place without risk to patient safety. However, an over-reliance on agency staff has become commonplace at a huge cost to the NHS – up to £3,500 per locum consultant per shift – and is simply unsustainable in the long term. This has led NHS England to introduce a cap on agency staff, and to impose ‘expenditure ceilings’ on the use of such staff from April 2016. These strict new rules are designed to ensure that no temporary staff are paid more than permanent employees. During the last Select Committee hearing (May 2016), Jeremy Hunt appeared positive: “The Agency Bill is beginning to level out. We saved £290 million since October compared to the trajectory of agency spend at that time. Two thirds of Trusts are saying they are making savings.” However, the latest figures suggest that the Bill is being grossly underestimated – with nine out of ten NHS Trust’s breaching the cap, and spending on agency staff continuing to rise. The requirement to make continuing savings is placing trusts under enormous strain, and inherently this impacts adversely



upon workforce productivity (as evidenced by recent marked reductions in trust productivity metrics). It is therefore imperative that trusts embrace a new way of working in order to meet waiting time targets and to deliver a health service fit for purpose. Furthermore, a National Audit Office report concluded that the rise in spending was mainly a direct result of Trusts’ increasing need for agency staff, often to cover unfilled vacancies. Its findings suggest that 75 per cent of the increased spending occurred from greater use of agency staff and higher average hourly pay rather than from an increase in fees. THE SOLUTION 18 Week Support has been working with NHS Trusts to deliver clinical solutions designed to help them meet their waiting time targets. Its services are delivered below the national tariff, which means that, in many cases, NHS Trusts generate a surplus when utilising this solution. Dr Conal Perrett, CEO and founder of 18 Week Support, said: “All of our clinical staff work within the NHS. Our clinical leads in each speciality all hold substantive senior NHS consultant posts within London Teaching Hospitals and are recognised leaders in their respective disciplines. “We manage every aspect of the patient journey from referral to discharge, reducing

new to follow up ratios in contrast to an agency solution. 18 Week Support prides itself on working seamlessly with existing clinical teams to provide high quality patient care.” Alex Chilvers, co-founder and operations director of 18 Week Support, said: “Working with an accredited in-sourcing provider, a Trust can increase its throughput of patients by utilising spare capacity out of hours, evenings and weekends. “Working with an experienced provider that can cope with larger volumes as a result of injecting the required staffing levels means that patients that otherwise would not be seen can be treated, and Trusts can generate income from commissioners. “It also neatly offers potential to meet the seven-day working agenda by exploiting spare capacity within the hospital facilities.” CONCLUSION NHS trusts have become dependent on agency staffing in order to provide short term, flexible clinical solutions. However, with spiralling costs, this ‘quick fix’ has been a major driver of the NHS deficit. Furthermore, the introduction of tighter rules on how Trusts work with agencies will only add to their workforce crisis. Using an in-sourcing provider is therefore a logical and effective solution to facilitate Trusts in the management of their ongoing staffing issues, to meet waiting time targets and deliver a better standard and quality of patient care, as well as to comply with the recent new ‘rules of the game’. 18 Week Support is a CQC registered in-sourcing provider, working to deliver additional capacity to NHS Trusts. Through its strategic provision of outpatient and surgical services to clear existing backlogs across multiple clinical specialties, 18 Week Support is well placed to assist Trusts in achieving their waiting time targets. ! FURTHER INFORMATION Contact Alexander Chilvers by emailing: or visit the website at:


Who will fill the NHS vacancies? Nick Bowles of APSCo examines the contributing factors to the current healthcare recruitment problems and highlights that more collaboration is key Healthcare recruitment is an issue which is now not only at the forefront of the sector, but also the wider public consciousness. Recent news that management group, NHS Employers, has given the green light for nurses, paramedics and pharmacists to be trained to ‘fill in’ for doctors is the latest in a long line of stories which illustrate the deep and complex issues surrounding staffing within the NHS. It’s no secret that the health service has suffered from acute skills shortages in recent years with regular updates on the junior doctor strikes, understaffed A&E units and locum doctors raking in thousands per shift all featuring on the front pages on a regular basis. However, the deep rooted causes of the current landscape are all too often misunderstood, and government initiatives designed to ease the situation are yet to reveal any indication of success. An ageing population, retirement cliffs and insufficient talent pipelining have all contributed to the current acute shortage of permanent healthcare professionals. This shortfall has created a climate where NHS trusts are now, more than ever before, relying on a flexible workforce to cope with demand. BAD PLANNING TO BLAME? While, for some time, the recruitment profession seemed to be the pinnacle of blame for soaring agency staff spend, a recent report from the Public Accounts Committee, a select committee of the House of Commons, attributed the current shortage of frontline staff in the NHS to bad planning and cost cutting, stating there has been ‘no coherent attempt’ to work out staffing requirements for David Cameron’s promised ‘seven-day NHS’. This is something that the ethical recruitment companies that we have consulted with have long been telling us. Indeed, the Association of Professional Staffing Companies (APSCo) has previously offered its support in helping the Department of Health (DoH) to understand the sector, and how to maintain a healthy, competitive, but fair and transparent recruitment supply chain. We were not invited to engage on this issue in any meaningful capacity before controversial

agency spend guidelines were introduced by Monitor in the latter months of 2015. Monitor guidelines stipulate that trusts can only recruit from agencies that have been awarded a place on one or more NHS approved frameworks. As from April this year, locum pay must now also be in line with substantive rates. While we support the sentiment behind these new rules, our experience has led us to question the validity of this scheme, with evidence suggesting that its success is not what Monitor would have hoped to achieve. In February this year, specialist healthcare recruiter, MSI Group, obtained data on guideline compliance from Freedom of Information requests sent to every Acute and Mental Health NHS Trust in England. At the time, the guidelines specified that trusts could not pay locums more than 55 per cent above substantive pay rates. The data revealed that 79 per cent of NHS Acute and Mental Health trusts recruited staff outside of NHS approved staffing frameworks. It also revealed that 90 per cent of trusts had been forced to exceed the pay caps. Consequently, just four per cent of NHS trust were, at the time, fully compliant with government guidelines surrounding the use of agency staff. We are yet to view data on compliance since pay rate caps dropped again in April this year.

70,000 shifts were filled under this clause. Even more concerning is that these caps could put patient safety at risk by destabilising the quality and continuity of flexible staffing into the NHS. A consultation document on the proposals, released just weeks before the caps were implemented, stated that the price caps are intended to ‘encourage staff to return to permanent and bank working’. This was simply naïve. Front line recruiters in this area tell us that agency workers within the NHS work flexibly because their family life or lifestyle does not allow them to work permanently. They foresaw that taking away flexibility would result in trusts becoming unable to fulfil their staffing requirements because temporary staff would move away from the NHS, and also that the quality, safeguarding and compliance of staff could suffer. When David Cameron outlined landmark plans to create a ‘truly seven-day NHS’ by extending GP opening hours, I am sure his motives were rooted in a desire to increase patient safety. However, as the Public Accounts Committee pointed out, logistics behind such a grand plan were not thoroughly investigated. Somebody failed to recognise that any increase in patient access to front line services is likely to exacerbate existing GP and Nurse Practitioner shortages. There is a clear correlation between the controversial continued rise in the use of temporary nursing staff and the decrease (of 16 per cent since 2010) in nursing training places – which are offered to students wishing to enter nursing – within the NHS. Many believe that Jeremy Hunt’s recent decision to axe student bursaries for nurses will further impact the talent pipeline into the profession, with the NHS’s Pay Review Body arguing that both the supply and quality of people applying to train as nurses could fall because the bursary system is to be replaced by student loans. !

Data revea that 79led per cent of N H S Acute and M trusts r ental Health ecr outside uited staff approv of NHS ed framewstaffing orks

EXTERNAL PRESSURES The sad fact is that Monitor’s guidelines fail to take into account the external factors impacting the NHS’s staffing crisis. As a result, MSI Group’s research indicates that trusts are repeatedly having to fall back on a clause which allows them to breach guidelines when patient safety will be compromised and there is ‘no alternative’. In fact, between November 2015 and February this year, over


Written by Nick Bowles, head of stakeholder engagement, the Association of Professional Staffing Companies

An abundance of issues causing the shortages




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STAFF SHORTAGES ! THE DOCTOR DILEMMA It’s not only nurses who are at risk of dwindling in numbers. Doctors are also becoming thin on the ground. In 2014, applications to GP training were so low that an unprecedented third round of applications was opened. In some areas, the fill rate for GP trainee jobs was as low as 62 per cent; even after this third round. One in eight posts nationally was vacant, and it has been speculated that pressure of workload is a contributing factor. In fact, according to a recent report by the Healthcare Foundation, 60 per cent of UK GPs found general practice extremely or very stressful and 22 per cent were made ill by stress in the past year. Subsequent reforms to boost the number of family doctors by 5,000 over five years with a £2.4 billion cash injection, as outlined in the government’s General Practice Forward View, have the potential to boost talent in this field. However, while it is encouraging to see a more strategic approach to long-term workforce planning, increasing the number of trainee GPs recruited is only sustainable if there is the talent available to fill these positions – and a culture conducive to retention. To add to this cocktail of staffing woes, it is worth noting that a staggering 45 per cent nurses currently working in the NHS have the right to retire within the next five years, and GPs are being urged

An ageing population, retirement cliffs and insufficient talent pipelining have all contributed to the current acute shortage of permanent healthcare professionals to come out of retirement to address the vast numbers of unfilled vacancies. This ‘retirement cliff’, coupled with a rising population means that the NHS desperately needs to review its strategic workforce planning strategy if it is to have any hope in addressing future demand. CO-OPERATION IS KEY Any professional working within the healthcare arena will recognise that the staffing crisis is a sizable problem in the NHS. But what’s become increasingly clear is that these issues seem to have been compounded, rather than alleviated, by recent guidelines introduced by Health Secretary Jeremy Hunt. With evidence suggesting that the agency

price caps are doing little to ease the cost pressures that the NHS is facing, retraining various other medical staff to take on some duties traditionally assigned to doctors does seem a sensible option to explore in the short-term at the very least. However, I am unsurprised that unions have warned against using it as a quick fix for problems in the NHS. It is imperative that decision makers at the DoH engage with the recruitment profession to gain further insight into the complexities of the NHS staffing problem if we are to find a practical, long-term solution to this pertinent issue. " FURTHER INFORMATION

Patient safety, nurse retention and quality recruitment are all tied in with one major thing – happy nurses A recent REC Healthcare seminar discussed life post the 55 per cent cap imposed in April of this year and the general consensus was that the lives and safety of patients and the public were being put at risk due to the double blow of major understaffing and no longer being able to rely on agency support. Jim Mackey, Monitor chief executive, said: “Clinical leaders are taking decisions every day to make sure wards are staffed safely, with rotas based on the needs of patients and sound clinical reasoning.” But how effective are these measures? The message is mixed and somewhat confusing. On the one hand, the REC and other bodies have identified shortfalls in staffing because nurses are less likely to take shifts, placing further stresses on already maxed-out departments such as A&E. Regulator Monitor, however, has responded with its own findings that 64 per cent of trusts have found it no more difficult to fill shifts since the capping (they have not specified if these trusts have

remained within the caps, or are one of many that still source off framework when required). There is an assumption underlying the caps that nurses should not benefit financially from working for an agency over bank for their trust. But what if this isn’t a financial decision? What if our nurses are looking for change, flexibility and a chance to be able to actually see some patients – not spend time completing computer-based paperwork? As an independent agency, Medicat has built a very solid reputation in a corner of the market for experienced and talented emergency nurses and we continue to supply to trusts despite the framework imposition. However, as a small fish in a big pond Medicat knows it cannot

compete with the larger, national agencies nor can it financially justify joining the framework - so what does the future hold the company and others like it? Jim Mackey says: “I guess we will have to, as they say, ‘just keep trucking’, and continue nurturing and developing our team of specialist nurses where we can, ensuring their pay is equal to their talent and they continue to serve as exemplary pillars of healthcare when out in the community.” “We, and others like us, will have to continue providing a service that is based on quality – not quantity – and hope that over time it is recognised that patient safety, nurse retention and attractive recruitment are all tied in with one major thing – happy nurses.” FURTHER INFORMATION 0117 968 4474



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Investing heavily to make large energy savings Great Ormond Street Hospital for Children NHS Foundation Trust (GOSH) was recognised for its achievements by winning Energy Management awards at the NHS Sustainability Awards and the Camden Business Awards last year. The headline figures for the 2014/15 year were a 14 per cent weather-corrected reduction in total energy demand compared to 2013/14 and a 13 per cent reduction in its Scope 1 & 2 emissions. Great Ormond Street Hospital has invested heavily in becoming more energy efficient in the past few years. The largest investment came in the form of a new Energy Centre which became operational in 2013 and incorporated a Combined Cooling, Heat and Power (CCHP) engine which is backed up by three efficient boilers and is connected to two absorption chillers. This new Energy Centre provides energy to half of the trust’s estate with an older boiler set providing for the other half. The trust is installing a second CCHP this year and creating a site-wide district heating circuit in 2017.

ENSURING EFFICIENCY Such a massive change to our energy strategy took time to run correctly and effectively, but by working closely with our CCHP maintenance contractor and by constantly reviewing the control strategy we managed to make the Energy Centre run efficiently throughout 2014/15 and the benefits have been substantial. Our electrical output from the engine has improved by over 15 per cent and we have utilised over 100 per cent more heat output compared to 2013/14. We have estimated the annual financial savings to the trust to now be around £500,000. The improved controls have seen 35 per cent less gas burned by the boilers. For other capital projects we explored Energy Performance Contracts and undertook a full Investment Grade Audit (IGA) with an Energy Saving Company (ESCo) following an OJEU procurement exercise. Following the IGA the

ESCo decided that there weren’t sufficient savings opportunities to proceed with an Energy Performance Contract. However, the process was still extremely valuable as the detailed audit helped us identify the best projects to take forward based on real business cases. This enabled the trust to proceed with a number of energy saving projects which are now managed in-house. These include installation of LED lights, solar film, improved sub-metering, a sophisticated solar panel system and a behaviour change campaign. INVOLVING THE HOSPITAL COMMUNITY The programme of energy saving activity for last year started on NHS Sustainability Day 2014 with a very successful poster and screensaver campaign. We had a series of five sustainable behaviour pledges from five of our most senior members of staff. They were displayed via posters and screensavers across the trust. The campaign was very well received and we saw an immediate eight per cent reduction in electricity consumption the following month. This was followed up with the launch of our Carbon Culture online community platform, displaying our building level electricity consumption on a public website. We have also placed a widget on the trust’s website which gives a site-wide view of our daily electricity consumption and its cost as well as the associated carbon footprint. Our Carbon Culture platform captures sustainability activity and stories that are going on across the hospital. This tool is designed to help the GOSH community share experiences with each other and with the wider Carbon Culture community, identifying practical ways to use resources more efficiently. The Carbon Culture platform also supports our on-going behaviour change campaign. We have appointed Global Action Plan, the team behind the hugely successful Operation TLC campaign at Bart’s Health NHS Trust to run a version of this campaign which is suitable for a children’s hospital environment.

Written by Brendan Rouse, energy manager, Great Ormand Street Hospital

Health Business hears from Brendan Rouse on how Great Ormond Street Hospital for Children made great progress in reducing its energy demand and becoming more sustainable last year

The l hospita per 4 saw a 1 athercent wereduction ed correct tal energy in to ompared c demand 013/14 to 2

IMPROVING SUSTAINABLE DEVELOPMENT The energy saving projects for 2014 at GOSH addressed each of the three pillars of sustainable development; our society, our finances and our environment. We have delivered cost savings of over £300,000 compared to the previous year on our utility bills. We have reduced our impact on the environment, local air quality and !



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! the problematic London micro-climate by cutting our overall energy consumption and carbon footprint by 14 per cent, significantly reducing the heat rejection from our CCHP system and running our boilers less frequently. Our behaviour change strategy and online presence is promoting the importance of sustainability and is poised to inspire staff, reduce the barriers to behaviour change and provide practical solutions for minimising energy use across our operations. THE IMPACT FOR PATIENTS Our guiding principle at Great Ormond Street is ‘the child first and always’, which is why we care about our environmental impact. We believe that the health and well-being of the population is closely linked to environmental issues and climate change is even more significant in the context of child health. We are committed to providing world-class healthcare whilst being environmentally responsible. We are making improvements to our buildings and processes, and helping our staff to take actions to create the best surroundings and service for our patients and staff. We aim to be world-class in our energy and water use and to limit the waste we produce, creating a healthier world for generations to come. " FURTHER INFORMATION



Patients at Great Ormond Street Hospital have helped to design and launch a project that aims to promote cleaner air around the hospital, making it a better and safer environment for patients, especially those with respiratory conditions. The project was initiated by the Sustainability Team at GOSH and was supported by Go Create! As part of ongoing sustainability work at the hospital, research was carried out that showed pollution from car exhausts was a major cause of air pollution outside the hospital. GoCreate! then asked patients and siblings on respiratory wards to explain how dirty air affects their condition and give suggestions on how they felt air quality around the hospital could be improved. The team asked children to portray their thoughts in a creative way by drawing pictures. These pictures have now been put together to create fun walking maps from all the major stations in the area to GOSH, including places of interest, playgrounds, museums, and child-friendly cafés to enjoy on the way. The sustainability team also set out to tackle the two main causes of air pollution outside the hospital, drivers idling in their vehicles – where engines are left on while stationary – and visitors arriving in polluting vehicles.

To reduce the incident of vehicle idling GOSH has worked with Camden Council to turn the street into a ‘No Idling Zone’, using street signs which have been designed with the help of some of our respiratory patients. The hospital’s ambulance provider has also pledged that their drivers won’t keep their engines running while waiting outside of the hospital. Brendan Rouse said: “Reducing air pollution decreases the negative health impacts on everyone, but it’s even more important at GOSH where we see hundreds of patients with cardio-respiratory conditions at the largest paediatric cardio-respiratory unit in the country. “We hope the project will improve the air quality on Great Ormond Street and encourage more visitors to use low or zero-emission forms of transport, improving the environment for our staff and everyone who lives and works nearby.”

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Unleashing the power of e-health

UK e-Health Week


UK e-Health Week proved to be a great success again this year, as nearly 3,000 health and care professionals, along with approximately 60 IT suppliers, turned up in force on the 19-20 April to see and hear the very latest about e-Health. Health Business casts its eye back over the show As this is one of only two digital health events supported by NHS England, numerous health leaders from the organisation attended, including chairman, Sir Malcolm Grant, director of digital technology, Beverley Bryant and chief scientific officer, Sue Hill. All three senior leaders from the NHS offered insightful talks across the two day event with Bryant focusing on interoperability being the key to a paperless NHS, Hill giving an update on the Genomes Project she is leading and Grant delivering the closing keynote at the event, speaking about how genomics and data are a big part of the future of health in this country. NHS DIGITAL REPLACES HSCIC Arguably the biggest news of the week was announced by Minister for Life Sciences, George Freeman, as he informed attendees that the HSCIC had changed its name to NHS Digital and a new appointment in Noel Gordon would be the new chairman as of the 1 June, taking over from current incumbent, Kingsley Manning. The news sparked a huge buzz around Olympia, with many agreeing that this change would certainly benefit the NHS moving forward into a paper free era by 2020. Aside from the NHS Digital update, Freeman also gave the opening keynote on the second day, talking about how the digitalisation of the NHS is hugely important for the future of health in this country. He was also part of the National Information Board (NIB) Leadership Summit, addressing why it is imperative that the NHS becomes digital within the next four years. Furthermore, chief executives from across the health and care system received the portfolio and governance plans for Personalised Health and Care 2020 following the outcome of the Spending Review. The NIB also agreed proposals for the future work programme and sign off of the NIB annual report.

LOCAL DIGITAL ROADMAPS Another major topic of much discussion was the use of Local Digital Roadmaps (LDRs) and how vital their role will be moving forward. The talk was led by Paul Rice, head of technology strategy for NHS England, along with four other guest speakers. Luke Readman, chief information officer for Waltham Forest, Newham and Tower Hamlets CCGs, argued that LDRs will be an extremely important tool to use as we edge closer towards a digital era. He said: “LDRs are an extra tool explaining what our priorities should be and if it is governed properly it will become an established part of the top tiers of our discussions. If we all pull together and make LDRs work this could get discussions about a paperless NHS to the top table. It will be used as a lever to help change and a lever to try and access funding to support that change.” Tim Ellis, a programme manager digital for NHS

“There is a fu in expe ture, ctat of youn g peoplion e have ex pectatio, they of healt ns h c a r which I e am real ly gratefu l for”

England, explained how Sustainability and Transformations Plans (STPs) can align with LDRs, while also clarifying that they are still currently in the process of helping people understand what a digital footprint means. ‘E-HEALTH NEEDS TO BE USED CORRECTLY FOR THE FUTURE’ Lord Victor Adebowale, a non-executive director with the NHS and chief executive of Turning Point, discussed how e-Health needs to be used properly for the young people in the UK, while also addressing the need for proper communication and relationships with e-Health being paramount for the next generation. Adebowale pleaded with the audience by saying ‘don’t fail your kids’ – meaning that if e-Health isn’t used in the correct manner then it would be useless to use. He added: “There is a future, in expectation of young people, they have expectations of health care which I am really grateful for. They expect it to be prevented; they expect to be citizens, not patients. They expect relationships from not getting ill. They expect technology !



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EVENT REVIEW ! to be designed with them, not for them. There will be challenges. We need to use tech and we need to co-produce the means of enhancing relationships and communication. We need to engage the citizens in health and social care. How do we build in the use of technology for the young? These all need to be addressed urgently.” PULLING TOGETHER IS THE PRIORITY Andy Kinnear, head of BCS Health Group, echoed Adebowale’s sentiments about everyone pulling together to achieve a seamless transition towards paper free. He explained: “Trying to deliver the agenda will be a huge challenge. People will be working on different areas as we move into a digital era and it is all about getting the machine working together, working with network groups, working with CIOs, working with professional bodies and ensuring that we all pull together.” Arvind Madan, director of primary care for NHS England, also commented on how pulling together is a necessity and for GPs it is absolutely critical. Madan said: “When I started my role in December, my ambition was to try and bring some insight into what the frontline of general practice looks like and feels like within the NHS England team. We want to try and create a stronger connection with the profession. To develop a vision, develop a size and scale in teams with and across practices and the direction we want general practice to take.” Dame Fiona Caldicott gave a talk on her latest review, commissioned by the Secretary of State for Health, regarding the controversial system. However, she announced at UK e-Health Week that this won’t be released until 23 June at the earliest due to EU referendum ‘purdah’. She said: “The review may be put down the pile by the government, in which case it may be after 23rd June when we can get feedback on it, as once published it will go out to public consultation. This will be useful as we can then gauge how the public feel.” VANGUARDS, LEADERSHIP SUMMITS AND PLENARIES While the Five Year Forward View and Personalised Health and Care 2020 frameworks were hot topics during the week, a number of other pertinent issues were addressed including vanguard sites, RightCare and population health. Vanguards were discussed at length on day one, with pioneers speaking about their involvement at a vanguard site and how e-Health is creating exciting developments, in addition to providing a strategic overview of the programme. New models of care occupied significant interest, with a major focus being placed on how these are being used. Andy Evans of Sherwood Forest Hospitals, offered examples of how these have been trialled. A panel discussion followed this, with business

UK e-Health Week


Bev Bryant, DIrector of Strategic Systems and Technology, NHS England

challenges, clinical engagement, business transformation and technology solutions being discussed at length, with a particular focus on how these need to be introduced. Three other plenaries took place including a Nursing Plenary which was chaired by Hilary Garrett, Director of Nursing, NHS England. These lively panel sessions focused on how e-Health can empower nursing and midwifery, and included panel sessions discussing how technology and informatics can be used to enhance experience, outcomes and care. INTERNATIONAL EMRAM AWARD An award was presented as part of the second day’s opening keynote given by Stephen Lieber, CEO of HIMSS, to Cambridge University Hospitals Trust (CUH) for reaching Stage 6 of their international electronic

is by no means the end of it. Some of the things we configured for the go live have been replaced already. What is clear is our hospital won’t be the same again.” THE IMPORTANCE OF E-HEALTH WEEK With the 2016 UK e-Health Week now at a close, health leaders explained how important an event like this is as they move forward into a digital era. Beverley Bryant commented: “This event brings together professionals, CIOs and suppliers so they can work together to help make this reality and it is also about sharing best practice. Everything that we want to do has been done somewhere, but we might not know about it so everyone who comes together at this HIMSS UK event can speak to each other, learn lessons and it will be beneficial for everybody.”

While the Five Year Forward View and Personalised Health and Care 2020 frameworks were hot topics during the week, a number of other pertinent issues were addressed including vanguard sites, RightCare and population health medical record adoption model (EMRAM). CUH is the first trust to receive EMRAM Stage 6 for the effective use of technology in providing high quality patient care within a year of its new electronic patient record (EPR) going live. Hospitals that reach Stage 6 have established clear goals to improve safety, minimise errors and recognise the importance of healthcare IT. Afzal Chaudry, chief medical information officer at CUH, explained how the award came about: “We started this in 2010 and we spoke to Dame Mary Archer about what it would take to introduce an electronic patient record. We had a series of old systems that were rapidly running out of support. Although our quality of care was extremely good, we knew that there were many more things we wanted to do. An initial period of four months was spent with stakeholders and we decided that an integrated system was best for us. “Now, colleagues come up to me saying they understand how the system works rather than asking for my help. However, this

HEALTH INSIGHTS PREVIEW In June, HIMSS UK will launch their 2016 Spring/Summer series of Health Insights events, beginning in Birmingham on 15 June, then off to Manchester on the 22, Leeds on the 29 and London on the 6 July. These are free one day regional events targeting healthcare professionals. Over the series, you will hear from the people who are setting the direction and meeting challenges, such as achieving the 2020 target for a paper free NHS. The events aim to diffuse innovation across the country and provide you with the tools and knowledge to apply the second you get back to work. The three key elements of each event will comprise of talks regarding Sustainability and Transformation Plans, Interoperability and Local Digital Roadmaps. These three tools are vital for health professionals to know more about as we move into a new digital era. " FURTHER INFORMATION



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Fully charged for a long day’s work Hospitals are a fast paced, people centred workplace that requires up-to-date information instantly. With the use of mobile technology facilitating this demand, Health Business looks at the charging and storage capacities that hospitals must contend with Portable devices are becoming more and more important in hospitals, and with the push towards a paperless NHS gathering force, nurses and doctors are becoming increasingly reliant upon them. The Integrated Digital Care Technology Fund states that ‘digital systems have the potential to benefit patients and clinicians by enabling safer, more joined up care through the sharing of comprehensive clinical information’. Access to accurate, timely and comprehensive information can transform the quality and efficiency of healthcare through improved clinical workflows, increased care optimisation and greater patient involvement - increasingly the hallmark of a modern, high quality healthcare system. In order to maintain this push for digital records, hospitals must ensure that devices are always on and connected. However, with the current pressures on NHS staff, whether it be from excessive patient numbers, long waiting times, delayed discharges or not enough staff, it can be too easy to forget to charge a device during or at the end of a shift. A possible solution to this issue evolves around the possibility of installing USB-powered storage on site. With most devices being USB-powered, such an installation would be productive, effective and useful for staff and patients. Furthermore,

hospitals can maximise efficiency and reduce the likelihood of damage by considering the use of USB ports integrated into a standard twin switch socket. This eliminates the need for PAT testing of adapters, minimises the number of charging blocks being bought into the hospital, and reduce the possibility of damages. From a user perspective, a fixed installation USB charger requires a single charging cable which can be used for multiple devices, rather than separate, bulky adaptors for each device. From an installation perspective, twin switch socket USB ports allow buildings to make use of existing wiring behind existing power points. A number of companies already manufacturing such sockets claim that the USB integrated technology also accounts for efficiency, with charging time being optimised by accounting for the characteristics of the cable being used, and new technology monitoring the specific charging requirements of each device, thus allowing the socket to power each device accordingly.

STORAGE Storing iPads and other mobile devices is very different to piling up the clipboards at the end of a shift. Patient information, data records and hospital administration details are all being held on smaller devices with larger memories and capacities. But with advancement comes risk. Problems arise in the fields of security, charging, storage and updating devices. Most hospitals which utilise a large number of laptops, iPads or other mobile devices on a daily basis will have storage carts on the hospital floor. Carts are convenient as they not only store a number of devices back-to-back, but can easily be used to transport them all from one ward to another. Mainly seen in the administrative section of offices, their size is not overwhelming, allowing for flexibility and suitability to a busy hospital floor – as well as countering the likelihood of theft.

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CHARGING ! and friends will want to spend as much time with them as possible. Hospital waiting rooms are commonly full with anxious parents, children and spouses, trying to pass the time while they await news from an operation, an appointment or surgery. Casting the memory back 20 years, such visitors would be seated with a selection of popular magazines to cipher through. However, as the hospital has become more digitalised, so has the waiting room. Mobile devices enable visitors to play games, watch films, or, more importantly, keep relatives up to date with the latest news. But what happens when a battery dwindles to a low level? What happens when visitors

can no longer distract themselves and begin to worry? What happens when the ability to keep other family members informed disappears? Patients and their families need to be able to communicate with each other during such critical moments of their lives, and therefore it is crucial to have the infrastructure in place to charge mobile devices. Mobile phone charging stations are becoming a staple in most hospitals, as the patient experience becomes more aligned to the digital revolution. Charging towers, which are very popular in the US, but are slowing becoming established in UK hospitals, allow a number of people to charge their devices simultaneously.

Mobile devices enable visitors to play games, watch films, or, more importantly, keep relatives up to date with the latest news

PATIENTS There was an outdated belief that mobile phones interfered with medical equipments, preventing them from working properly. While medical devices have an array of safety technologies to stop interference from taking place, mobile devices are now commonplace among staff. While there are guidance notices in most hospitals about the appropriate use of mobile usage by patients and visitors, such as the use of phone photography, institutions are far more lenient towards their usage than previous decades. The hospital bed can be a restrictive and intimidating place to lay. Doctors and nurses come and go throughout the day in quick "

Mobile Devices


Free Wi-Fi launched at hospitals across east Kent Patients at hospitals across east Kent are now able to keep in touch with family and friends over the internet following the launch of a free Wi-Fi service. A new system has been designed and installed by the East Kent Hospitals Trust’s own IT team and is also available to visitors. The technology will be rolled out for East Kent Hospitals University NHS Foundation Trust, which includes William Harvey in Ashford, Kent & Canterbury and QEQM in Margate. Hospital chiefs say the facility has been introduced to enable patients and visitors to access information they may need and to connect to social media sites while on the premises, benefiting particularly those who are in hospital for an extended time. At present, an average of 1,200 devices are being logged onto every day at hospitals in Thanet, Canterbury, Ashford and Dover, providing particular benefits for those on longer stays. Andy Barker, director of IT, said: “Since the service began last month, on an average day, there have been approximately 1,200 Wi-Fi devices connected to the patient Wi-Fi network, which shows just how much our patients and visitors appreciate having this facility available to them. “We enable streaming services and most communication programmes, which allow patients to keep in touch with family and friends.”




New Point of Care Solution transforms Vital Signs Capture and Nursing Assessments in Hospitals A new Observation Capture solution, which allows the electronic recording of vital signs, nursing assessments and associated care plans at the point of care, has recently been launched by Hospedia. Using a handheld tablet device, smart phone, COWS or the Hospedia bedside terminal, clinical staff can now easily record patient observations, helping to recognise, escalate and alert medical staff to deteriorating patients in a more effective and timely way, in line with recommendations from National Guidelines. The bi-directional data feeds also means that it updates the ExtraMed Patient Flow System in real time. This new addition to the already proven Clinical Solutions range from Hospedia not only provides greater efficiency, but also improves accuracy in monitoring and recording. The system also caters for the provision of unlimited assessments and associated care plans, delivering greater Patient Flow integration and increased management and oversight.

To find out more about how this could transform your current hospital processes, visit or contact for a without obligation demonstration

HOSPITAL BENEFITS National Early Warning Scores are calculated automatically reducing the risk of errors and improving patient outcomes The automated highlighting of deteriorating patients to ward staff, supports early intervention At a glance prompts and task lists improves compliance with clinical standards The ability for hospitals to define their own assessments Flexible and fully future-proof Full audit trail and charting of results

Mobile Devices

CHARGING ! succession, sleep is hard to achieve and medical speech can be confusing. Technology can help make that experience more comfortable by providing a sense of familiarity to an unfamiliar setting and allowing a patient more information than doctors may have had time to deliver first hand. A DIGITAL NHS 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. 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

Access to accurate, timely and comprehensive information can transform the quality and efficiency of healthcare through improved clinical workflows, increased care optimisation and greater patient involvement 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 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. " FURTHER INFORMATION

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“Dario’s ‘Hypo Contact’ feature can remotely inform caregivers of low blood glucose readings via phone message.”

Your Smartphone is now a Smart Meter with Dario... Blood glucose meters were bulky, inconvenient and impractical, until now. The Dario Smart Meter has the power to turn your smart phone into a smart blood glucose meter. The sleek all-in-one design is not only attractive but functional and convenient, fitting easily into pockets or bags. Your lancets, test strips and finger sticking device will always be to hand, whenever you need them. The Dario Smart Meter system uses your smartphone to provide you with not only your blood glucose levels but also a comprehensive selection of other facts, figures and statistics on both Android and IOS.

Dario is able to provide you with actionable advice as well as display your successes visually and graphically for an at a glance interpretation of your blood glucose trends.

These facts and figures can then be viewed as graphs and charts giving the user the power to take control of their diabetes.

Not only this but Dario is able to sync up with certain fitness apps to automatically keep track of calories you may have burnt during exercise, giving you one less thing to worry about.

Track blood glucose patterns and see in real time how what you eat and do affects your BG levels. By entering target blood glucose levels as well as low and high level warnings

As if all these things weren’t enough, Dario is connected to one of the largest databases of food in the world. Keeping track of your carbs has never been easier.

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As mHealth evolves and the sector adapts to its benefits, there are a number of ways that it could help address and alleviate the pressures the NHS is currently finding so difficult to deal with. Health Business’ Ben Plummer explores the possibilities The integration of mobile technologies into the NHS has been slower than the way it has been adopted by the broader public. However, as was found in a 2015 study, 98.9 per cent of doctors and 95.1 per cent of nurses own a smartphone, while 73.5 per cent and 64.7 per cent owned a tablet device. Additionally, 92.6 per cent of the doctors and 53.2 per cent of nurses found their smartphone to be ‘very useful’ or ‘useful’ in helping them to perform their clinical duties, all of which indicates that ‘mHealth’ now has a broader role to play in the healthcare sector. This is also true for the other side of the mHealth coin; the increasing role of the patient in their own care, via booking remote appointments with GPs, usage of health and wellness apps that promote healthy living, portable diagnostic tools, and online therapeutic communities – all of which indirectly benefit the NHS by bringing healthcare closer to home. As mHealth evolves and the sector adapts to its benefits, there are myriad ways that it could help address and alleviate the pressures the NHS is currently finding so difficult to deal with.

h mHealt tors oc brings dnts closer ie and pater digitally, togeth removing while to meet d the nee-to-face face

WEARABLES, APPS, PREVENTION & MANAGEMENT The prevalence of mobile technologies in the NHS has led to the rise of mobile-ready software that allows nurses and doctors to monitor difficult patient conditions through a smartphone or tablet. This effectively makes diagnostics and sources of shared intelligence portable, and helps communalise important data, making it accessible to those administering care within large and disparate hospital

environments. This kind of access is particularly beneficial during peak A&E times, and at night when there are fewer staff on duty. Major rollouts of systems that are compatible with mobile devices have become more common in recent times. Late in 2015, South Tyneside NHS Trust made public its plans to achieve the national target of becoming solely digital by 2020 with a specific push to encourage its staff to work in a ‘mobile way’. On top of this, North Middlesex NHS Trust, with a more ambitious target of total digitisation by 2017, have undertaken an initiative to scan one million documents, formatted identically as the original paper record, into its in-house central portal, which has been live and accessible to staff

Written by Ben Plummer, Health Business

The evolution of mobile technology in the NHS

Mobile Health


through mobile means for five years already. Outside of the hospital, mHealth has also had a noticeable effect. In January last year, NHS England medical director Professor Bruce Keogh made the bold prediction that wearable technology could play a ‘crucial’ part in the future of diagnostics in the NHS, saying that it ‘enables you to predict things, to act early and to prevent unnecessary admissions, thereby not only taking a load off the NHS but, more importantly, actually keeping somebody safe and feeling good’. In an effort to ‘stop patients from reaching crisis point and being admitted to hospital or visiting their GP’, Guy’s & St. Thomas’ NHS Trust earlier this year gave 25 heart failure patients a ‘kit’ comprised of scales, a blood !



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FOUR TOP TRENDS TO ADOPT IN HEALTHCARE DATA ANALYSIS The healthcare industry has never been more focused on data, with its promises and its pitfalls, as it is today. From slashing healthcare spending to detecting fraud or coordinating care across multiple providers, improved use of healthcare data has been held up as a ‘silver bullet’ to slay all kinds of healthcare monsters

DASHBOARDS ON THE HOSPITAL FLOOR Healthcare providers are more focused than ever before on improving patient experiences. The Care Quality Commission (CQC) sets and monitors standards for care in England but individual establishments strive to understand and improve their own performance through patient feedback. The CQC is just one of the bodies formed to monitor key aspects of healthcare performance in the UK and pushing health out into communities. But providing efficient and effective care has always been a driving mission for hospitals – and improving patient throughput helps hospitals do exactly that while improving patient experiences. By arming doctors, nurses, administrators, shift coordinators, and nurse managers with secure, authenticated access to dashboards, leading hospitals like St George’s NHS Trust are optimising the flow of patients throughout the hospital system. Tom Dewar, of St George’s Healthcare NHS Trust, commented: “By capturing rich, timely insight into the hospital’s behavior, the team is able to advance care coordination, improve care quality and increase healthcare efficiency.” Hospitals interested in taking this approach can leverage user profiles that manage views based on role or assignment to capture efficiency while also managing appropriate access to private health information (PHI). Filters that allow users to drill down to a particular ward also speed insight. Select a solution that enables near real-time insight to support fast problem solving.



ALIGN THE ORGANISATION AROUND OUTCOMES Effective data analysis can help in tracking and maintaining critical performance metrics. By allowing individuals within care facilities to see and understand their own data, mistakes in data interpretation and far less likely. Hospitals should standardise on a single business intelligence solution that can take advantage of the power of data visualisation. According to researchers at the University of Pennsylvania School of Medicine, the human eye can process data at approximately 10 million bits per second. Using data visualisation takes advantage of that power to provide intuitive, easy-to-understand images to stakeholders across the hospital. Additionally, a business intelligence solution that can blend data from disparate sources – from data centers to spreadsheets – will provide you with a ‘single source of truth’ and ensure that stakeholders are driving decisions from the same data. CENTRE ON THE PATIENT Most regulatory organisations in the UK are now focused on capturing, assessing and making change recommendations based on patient feedback. Putting people at the heart of care delivers a system of change that sets the agenda for change around the needs of the people going through the system. Enabling a patient-centered view can help to coordinate care – reducing costs and improving outcomes. One great way to support this is with visual dashboards that

offer fast insight across your patients’ complex landscape of interactions, files, and treatments. This requires a business intelligence solution that can access disparate data without writing back to the original source. Individual departments often use different data platforms, so the ability to blend that information is crucial. The sheer quantity of data that a patient – especially one with multiple chronic conditions – can generate can be daunting. Choose dashboards that allow providers to quickly absorb high-level information while also providing the option of drilling down into the data for more information. EMBRACING HEALTHCARE’S SOCIAL SIDE Social medicine is a new frontier for most care providers. It was not long ago that the very concept of offering any sort of caregiving interactions via public forums would have been considered not only distasteful, but downright forbidden. Today, while many NHS trusts make use of Tableau for internal data analysis, NHS UK is making health and social care data available to the public. This open data allows people everywhere to see how the NHS is performing in a range of areas including, hospitals, GP practices, mental health care, and public health services. Taking this a stage further, healthcare data analysts can now follow the example of other industries and turn to social data analytics. Choose a solution that can link social media data with transactional data already stored in your system to identify the most influential channels. Given the sheer volume and velocity of social media interactions, you will want to make sure your solution is able to aggregate and extract data when it makes sense for more efficient analysis. Prepare for the future of healthcare data – today. ! FURTHER INFORMATION


The prevalence of mobile technologies in the NHS has led to the rise of mobile-ready software that allows nurses and doctors to monitor difficult patient conditions through a smartphone or tablet ! pressure cuff and a portable blood oxygen measurer that connects to a smartphone and transmits the results to the physician. The overarching goal of the trial was to not only help the nurses monitoring the patient in predicting potential warning signs, but also to encourage the patient to be aware of their lifestyle and how it could potentially worsen their condition. Fitness tracker manufacturers such as Fitbit, Jawbone, and Misfit all offer products that work in conjunction with smartphones to record general activity and exercise throughout the day, as well as sleeping patterns. While this data is rudimentary and of little use in clinical terms, it provides the user with goals and targets that help improve on or maintain a healthy lifestyle, which in turn serves to help prevent health issues such as obesity before they need to be cured, or require NHS treatment. According to The King’s Fund, there are about 15 million people with long-term conditions, who account for ‘about 50 per cent of all GP appointments, 64 per cent of all outpatient appointments and over 70 per cent of all inpatient bed days’. A prominent example is diabetes, which costs the NHS 10 per cent of its annual budget, or £1.5 million a minute. Diabetes is another chronic condition that has benefited from the increasing capability of mobile technology, with tools now on the market that allow sufferers to record blood glucose levels and immediately

input the results into their smartphone. This information can then be communicated to a care provider, who will be able to address any problems much more efficiently, while simultaneously giving the patient more control over the day to day management of their health than has ever been possible before. It is obvious that the wearable and mobile technology arena is very much in its infancy in relation to the health sector, and there is much testing and evaluating of their benefits on a clinical level to be done before they become commonplace in the healthcare system. But it is realistic and sensible to take these innovations as more than a novelty, and begin to think creatively and with an open mind as to how they can be strategically applied to issues that GPs, doctors, and workers on the frontline struggle to handle throughout the NHS. MISSED APPOINTMENTS AND CARE AT A DISTANCE Missed appointments are a well documented, serious financial strain on the NHS, with missed GP appointments costing ‘in excess of £162 million a year’, and missed outpatient appointments costing the NHS as a whole £750 million a year. To combat this, a study was conducted by the Institute of Global Health Innovation at Imperial College London, the Department of Health and the Behavioural Insights Team, that found that by simply texting patients, notifying them of their appointment and

Mobile Health


the associated cost to the NHS, ‘Did Not Attend’ (DNAs) fell by almost a quarter. This success was replicated in 2016 in Gwent, Wales, where reminding patients of appointments seven days, then again two days, in advance, as well as the cost of the appointment should it be missed, reduced DNAs by 30 per cent. An approach like this is a positive example of how the NHS can exploit how we are now inextricably reliable on our phones as a way of planning our routines in day to day life to its advantage. There is also now evidence of trusts exploring the potential to help patients at a distance through video appointments, in order to tackle the pressures that hospitals face in having to see patients on site where that may not be strictly necessary. If a patient only requires a routine check up, without the apparent need for a physical examination, then it makes financial and logistical sense to offer a ‘pre examination’ to assess whether more intimate treatment may be necessary. A successful example of this approach in practice was a pilot, ran by South West London & St. George’s NHS Trust, wherein Skype appointments were offered to patients of two departments – Sutton Community Mental Health Teams and the Deaf Community Teams – to ‘see if patients benefit from the opportunity to have an alternative way to have consultations’. In a case study of the trial, the Trust said: “Patients did not take part if they were not comfortable with the idea or if clinicians did not think they were suitable. All initial consultations remained face-to-face, were only permitted on Trust devices, and had to be conducted in a quiet place where they would not be interrupted or overheard by other people. All patients who used Skype were very positive about the process, and "


Mobile Health

TECHNOLOGY ! all patients said they would definitely use it again in the future.” REMOTE BOOKINGS Another way that patients can get the medical attention they need is through remote appointment bookings via third parties. NHS approved, online GP services such as Babylon Health, Push Doctor, Zesty and Dr Now offer online consultations with medical professions for a fee, either as a subscription service or on a ‘pay per consultation’ basis. At a time where GP surgeries are struggling to deal with the weight of demand from an ageing population, this can be an attractive option for both doctors who can register to the service in order to make the most of their time between appointments – or in place of cancelled ones – and patients who have been unable to get the attention they need within a timeframe which they feel they need. There are more advanced technologies in the same vein that will no doubt rise to significance, such as portable diagnostics and implantable smart objects. However, as it stands, mHealth’s main, demonstrable benefits are how it brings doctors and patients closer together digitally, while removing the need to meet face to face, and its ability to place valuable data in the pocket of caregivers. As the populations grows and ages, and

budgets become ever tighter, it becomes clearer every year that both the traditional methods of treatment, and the cumbersome, paper heavy internal processes that are still prevalent in NHS institutions, face soon-to-be insurmountable logistical problems. It therefore makes sense both from a medical and business perspective to explore the possibilities that the mobile internet can offer, and be open to collaboration with

experts in the field of mHealth to help aid its integration into the healthcare system in a similar way to how it has been embraced by the private sector. " FURTHER INFORMATION

As mHealth evolves and the sector adapts to its benefits, there are myriad ways that it could help address and alleviate the pressures the NHS is currently finding so difficult to deal with

The future of healthcare is here today: providing realtime vitals through wearable and mobile technology Healthcare has a real dilemma on its hands. In England, 15 million people have a long term medical condition accounting for 70 per cent of all the money spent on health and social care. This equates to 50 per cent of all GP appointments, 65 per cent of outpatient appointments and 70 per cent of all in-patient bed days (Department of Health, 2015). These figures continue to grow. Multi award winning mobile innovators, MediBioSense believe it has the prescription to help resolve this issue. Providing wearable clinical grade technology and integrated healthcare mobile applications MediBioSense is revolutionising the way health is measured and tracked and transforming the landscape of medical treatment. The company’s innovative solutions also improve the quality of patient care while reducing costs. It allows healthcare providers to harness and utilise the technology consumers have in their smartphones. Ultimately its solutions help people to stay healthy, monitor chronic conditions

more effectively, reduce time in hospitals, enables early awareness and pro-active prevention of illness and thus reduces time and use of health services. MediBioSense mobile applications connect via Bluetooth to a wearable patch that detects the following vital signs and biometric measurements: ECG, heart rate, heart rate variability, respiratory rate, skin temperature, body posture and steps. Further integration allows for SpO2 and NEWS score. The technology should not be confused with consumer wearable healthcare products where accuracy rates can have error margins of up to 25 per cent. MediBioSense solutions and the technology it utilises is cleared for medical use (ie. hospitals,

emergency care, GP’s) in Europe (CE), Japan (Ninsho) and the USA (FDA) and have clinical grade accuracy. MediBioSense solutions is unique in the fact that it allows real-time continuous patient remote monitoring right across the patient pathway. Be it by the GP, hospital, nurse, community, carer and indeed by the individual themselves and is the only clinical grade solution on the market that can utilise consumer owned mobile devices (iPhone and Android). The ability to view data via the patient’s mobile device or via secure remote login provides a potential that truly contributes towards an integrated service approach. This year alone MediBioSense has delivered its mobile wearable patch patient monitoring solution to a leading chain of 46 hospitals in the US and has seen its mobile technology used by the Red Cross and Emergency Services. FURTHER INFORMATION Tel: Tel: 07833 478408



Health & Safety Written by Karen Cunnngham, chartered member of the Institution of Occupational Safety and Health



The control of substances hazardous to health Following its April event on hazardous substances in healthcare, Karen Cunningham, from the IOSH Health and Social Care Group, explains how risks presented by hazardous substances are managed by Belfast Health and Social Care Trust It is important that robust COSHH (control of substances hazardous to health) Management Systems are put in place to manage the potential risks associated with staff exposure to hazardous substances arising out of the delivery of healthcare services. There are many risks in the industry which must be considered. They may include: exposure to waste anaesthetic gases; manually cleaning/decontaminating medical devices and surfaces; preparation, handling, administration, reconstitution and disposal of cytotoxics and other pharmaceuticals; the clinical care of patients with infectious diseases; exposure to non-medical gases such as liquid nitrogen, argon, carbon dioxide, helium and nitrogen; dusts associated with casting materials; the use and disposal of sharps instrumentation; the use, handling and storage of medical gas cylinders; substances used to preserve and fix specimens and tissues; substances used for surgical hand disinfection and skin cleaning prior to procedures; potential exposure to natural rubber latex containing products; substances associated with engineering, prosthetics and other workshops; handling and transporting dangerous goods; and dusts associated with baking.

BELFAST HEALTH AND SOCIAL CARE TRUST Belfast Health and Social Care Trust delivers integrated health and social care to approximately 340,000 citizens in Belfast and provides a range of specialist services for the population of Northern Ireland. With a workforce around 22,000, they are one of the largest trusts in the United Kingdom.

There y are manhe t risks in ich must y wh industr idered. They be consude: exposure l may incte anaesthetic to was s & manual gase ning clea

LEGISLATIVE CHANGES In addition to the requirements of the COSHH Regulations and associated approved code of practice, recent legislative changes have introduced new responsibilities. One of these is the Registration, Evaluation, Authorisation and Restriction of Chemicals (REACH) 2007. This relates to the registration of substances with the European Chemicals Agency; the introduction of ‘downstream user’ responsibilities; additional information in safety data sheets; restriction/reclassification of chemicals; the introduction of DMELs (derived minimal exposure levels), DNELs (derived no effect levels) and PNECs (predicted


no effect concentrations); substances of very high concern; and reclassification of formaldehyde as a Class 1B carcinogen. The other is the Classification, Labelling and Packaging for Supply (CLP) Regulations 2009 (amended 2015). This relates to the replacement of previous CHIP Regulations, the introduction of Hazard Statements (replacing Risk Phrases), new Global Harmonised System (GHS) – warning symbols, and reclassification of substances under CLP following evaluation through the REACH process.


The trust, through the provision of its services, uses a wide range of hazardous substances which fall under the scope of the COSHH regulations. Services delivered include cardiology, anaesthetics and theatre services, medicine and neurosciences, cancer services, nephrology and transplant services, rheumatology, dermatology services, maternity and women’s services, dentistry and child health, trauma and orthopaedics and adult and children’s community services. COSHH WORKING GROUP AND PROCUREMENT The trust has established a COSHH Working Group, reporting to the Joint Health and Safety Committee, which forms part of the trust’s assurance structure, with membership across the directorates and from the procurement and logistics services. This working group has many functions. It must identify high-risk substances currently in use within the trust and determine effective trust-wide management arrangement for elimination, substitution or safe control. It develops a formal procedure for service areas/

COSHH assessors to manage ‘substances of very high concern’ and the future procurement of hazardous substances, with a significant emphasis on safer alternatives. It prioritises the substitution of substances with carcinogenic constituents from use within the trust. It also ensures the potential health effects of procured products are considered at the contract stage in addition to elimination

assessments for their services in various departments. A standard COSHH risk assessment template is used throughout the trust. Sample risk assessments have been created for assessors’ reference, accessible through the trust’s intranet, together with COSHH guidance notes, flowchart and inventory. It identified the use of non-medical

Belfast Health and Social Care Trust, through the provision of its services, uses a wide range of hazardous substances which fall under the scope of the COSHH regulations and substitution of high-risk substances. In addition, its role is also to revise the trust’s policy (and amend the COSHH policy accordingly) on the use of high-risk substances (e.g. substances which cause cancer, heritable genetic damage or asthma). It is also to further investigate if safer processes/substances are available, as well as consider the benefits for procuring a chemical management system for the trust in light of the recent registrations and reclassifications of chemicals products under the REACH regulations and subsequent changes to the role of the COSHH Risk Assessor. It worked in conjunction with Procurement Services to introduce safer needle devices to all areas of the trust in order to reduce sharps injuries associated with use and disposal, through a Safer Needle Devices Group. RISK ASSESSMENTS AND POLICIES There are also a number of risk assessors working together to develop COSHH risk

(asphyxiant) gases associated with particular processes and pieces of equipment and raised the need for COSHH risk assessments and associated controls to be put in place. The management of these gases now form part of the terms of reference of the Medical Gases Committee. The trust has developed and continues to review a number of policies and supporting documentation on, for example, COSHH, Prevention and Management of Latex Sensitisation, Management of Tuberculosis Policy and New and Expectant Mothers. INSPECTIONS AND AUDITING The trust undertakes health and safety of particular services focused on the management of hazardous substances, resulting in recommendations including improvements in strategies for occupational exposure monitoring, arrangements for future procurement and the elimination of substances of very high concern. It has developed and implemented a Belfast Risk, Audit and Assessment Tool (BRAAT) – a self-assessment tool to assist trust service areas establish their level of compliance with the trust’s health and safety policies including COSHH. The resultant action plan is used to assist service areas address any outstanding issues and links with the trust’s Risk Register process. Service areas’ submitted scores may be randomly selected for a validation visit. The trust has a team of four health and safety managers, who are Chartered members of the Institution of Occupational Safety and Health (IOSH). They provide advice and support to partnered directorates and COSHH risk assessors. Evidence to demonstrative substantive compliance with regional health and social care health and safety audit criterion, known as Controls Assurance, is submitted on an annual basis. Dangerous goods safety advisers have been appointed in laboratories and medical physics and a multi-professional scoping exercise was completed to establish the trust’s compliance with the Carriage of Dangerous Goods (ADR) legislation.

COMMUNICATION AND TRAINING The health and safety team introduced three key themes to raise awareness of the need for service areas to audit their health and safety management systems, one of which was to reduce needle stick injuries. These themes continue to be highlighted to managers and staff at all trust health fairs. COSHH-related issues regularly feature in the internal quarterly newsletter, Safety Matters, for example assessing risk from exposure to biological agents, respiratory health surveillance and managing risks associated with working with asphyxiant gases. A new quarterly COSHH update was introduced to inform trust COSHH risk assessors of changes in legislative requirement, revisions to policies, guidance and associated documentation. Safety Message of the Week, featured on the trust’s intranet, has included an article on raising awareness of the circumstances in which exposure monitoring may form part of a COSHH risk assessment. The trust has organised several IOSH modern COSHH management courses for the estates, pharmacy and health and safety staff. A professional development event in conjunction with the IOSH Health and Social Care Committee on hazardous substances in healthcare was held in the trust in April 2016. The trust’s Statutory/Mandatory Training Matrix includes three courses. They are: COSHH Awareness, which is required to be completed by all relevant staff every three years; COSHH Risk Assessment for all nominated COSHH Assessors (initial training); and COSHH Risk Assessment Refresher for all trained COSHH Assessors every three years.

Health & Safety


HEALTHCARE AWARD The trust participates in external benchmarking through the All Ireland Annual Occupational Health and Safety Award Process and in 2015 was awarded the NISO/NISG All Ireland Healthcare Award. The entry submission included sections on hazard identification and risk management, health and safety training and proactive health and safety management. The trust continues to implement and review systems to manage hazardous substances associated with the delivery of its services. !

Karen Cunningham is Lead Health and Safety Manager in the Belfast Health and Social Care Trust. She previously worked for a number of healthcare providers. She is a chartered member of the Institution of Occupational Safety and Health (IOSH), the world’s largest membership organisation for safety and health professionals. She is a member of IOSH’s Health and Social Care Group committee, which helps professionals within that industry network and share best practice. FURTHER INFORMATION



Health+Care 2016


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ReminiScent: Showing dementia friendliness makes sense Smell & Connect is a sensory conversation aide that can be used to initiate conversation and demonstrate compassionate, high quality care. Inclusion of patients with dementia, or other issues that cause people to become withdrawn, in friendly chatter can help support emotional well-being. For those with impaired cognition, the senses provide multiple channels to draw people into conversation. Designed by ReminiScent, Smell & Connect cards provide a simple, effective tool that can be used by both professionals and families alike to combat the isolating effects of dementia. Perfect for dementia companion schemes, or dementia activities on hospital wards, Smell & Connect combines images and story telling with scent, a magic ingredient that can be enjoyed on many different levels. Sharing the cards is a fun and easy way

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Health+Care 2016


The largest national conference for integration 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. 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 business, 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 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, 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 !

Visitors Health+ to C need on are ly app a deleg ly once for a will grate pass, which nt ac all areacess to of the e s vent

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 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



Health+Care 2016


Get your independence back – get your socks on with the Sockson aid

Need help putting your socks on? Do you suffer from: • Back Pain • Joint Pain • Arthritis • Obesity

Socks On

takes the strain and struggle out of putting your socks on in just 3 simple steps. Step 1. Roll socks onto the perspex cups at chest height. Step 2. Wind the handle down to lower the socks. Step 3. Insert your foot into the sock, push foot forward on a downward angle and the sock simply rolls over your foot.

Specifications Height: 121cm Base: 40x60cm Easily folds down so you can take your Socks On with you.


Get your independence back For a full demonstration video go to:

A unique and non-invasive device for administering opioids and oral medicine Would you like to bring comfort, autonomy and mobility to your patients? Reduce the hospital’s stays? Improve the medical staff’s working conditions? Ethimedix has a solution. The SmartBottle is a unique and revolutionary medical device for controlled drinkable drug delivery. Non-invasive, portable, programmable, secured whether for in or outpatients and perfectly tamper-proof, the SmartBottle offers a unique and new approach to controlled drug administration without any risk of abuse, misuse and diversion for the patient and the health care provider. Whether the SmartBottle is used at home, in a hospital or a clinic, it is particularly suited for post-operative, chronic or palliative pain relief, ensuring that the patient’s treatment is individualised and fully secured.


Thanks to the biometric authentication, the SmartBottle prevents accidental drug overdose and guarantees the adherence to treatment by the patient. Provided with its exclusive and secured software, the SmartBottle is easy to program and records each treatment for traceability and journaling.The SmartBottle has been developed by Ethimedix, a Swiss based company set-up in 2010 providing a state of the art medical device, first used with drinkable morphine, and bringing ‘pain relief at the touch of a finger’! FURTHER INFORMATION


Mike Milligan, a New Zealander broke his back in a car accident in 2007 and could not put his socks on due to severe back pain so he invented his ‘Sockson’ dressing aid which enables you to put your socks on whilst standing upright. The Sockson dressing aid enables anyone required to wear socks, anti-embolism compression socks or Lymphedema arm stockings, the means to put these on quickly and simply without the need for an OT or nursing aid assistance. It gives elderly people with restricted movement, people with bad backs or people recovering from surgery or medical treatments, a safe, quick and independent method of dressing themselves. The usual response Sockson receives is “Wow that was quick, can you do that again...’’ Sockson is a start-up company based in the SW of the United Kingdom and its target markets are care homes, assisted living

community, rehabilitation centers, the National Health Service and Hospitals. The product has a world-wide patent. It has been trialled and tested and has CE certification. For more information about Sockson, please visit the website. FURTHER INFORMATION Tel: +44 7907748213 mike@compression www.compression

Helping healthcare managers to do the job they are passionate about Health and care managers have their own specialist trade union providing individual employment advice and representation and a voice in public debate. Managers in Partnership (MiP) has 6,000 members including 100 chief executives throughout the UK’s NHS, private and voluntary health and care sectors. Led by high-profile chief executive Jon Restell, MiP’s team of professional officers give members the personalised employment support they need in the rewarding yet challenging environment of health and care. In all our satisfaction surveys members praise MiP’s officers for support that is expert, objective, empathetic, accessible and responsive. On the wider stage MiP negotiates on behalf of managers with employers and government on pay, and terms and conditions including pensions. The union lobbies

policy-makers on the key issues that affect managers. It speaks up for the value of managers in great health and care delivery and pushes back hard against manager-bashing by politicians and the media. Through its conference, magazine and communications the union shares best practice and celebrates managers and management. For more information visit the website, call Laura on the number listed below, or drop by MiP’s stand to meet Jon and MiP’s officers and pick up some goodies. FURTHER INFORMATION Tel: 020 7121 5146

EVENT PREVIEW ! 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 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

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 in the main conference lecture theatres 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

Health+Care 2016


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 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 "






A unique device for controlled drinkable drug delivery Patient Autonomy and Mobility Biometrically Personalized Pain Relief Device Non-Invasive Analgesic Liquid Delivery Homecare, Ambulatory or Hospital Environment Secured Drinkable Drug Dispenser

Visit us during Health + Care at booth B60 to demo our new product




Health+Care 2016


Ornamin family tableware: encouraging independence with eating and drinking The key issue when it comes to developing tableware for people with physical limitations is to encourage them to eat and drink independently. After all, shaky hands, limited movement in the neck or the lack of a functional second hand make it hard for them to eat and drink on their own. Having to be fed, or spilling on the table or on yourself can have a negative effect on self-esteem and could even lead to a refusal to eat. The features of the family tableware compensate for just these types of disability and facilitate independent eating and drinking: holding products securely in place, preventing them from slipping out of hands and allowing people with just one hand to eat on their own with ease. And the best benefit yet: all features are hidden in the design so they are hardly noticeable at first glance. Universal design is the appropriate term and implies ‘designed for everyone’.

This means developing products in such a way that they can be used by everyone equally, without adaptations or specialised additions. Since eating is a family affair, it goes without saying that everyone is part of the family: whether they’re old, young, with or without a disability, no one should be left out. That’s why Ornamin pursues one goal with its family tableware: it aims to bring everyone to the table. FURTHER INFORMATION Tel: +44 (0) 121 717 4724

Specialising in the development of primary healthcare premises Apollo Capital Projects Development Ltd specialises in the development, investment and management of primary healthcare premises in the UK; from multi-tenanted medical centres to single GP surgeries, dental practices and pharmacies. Apollo has a dedicated team of property professionals each with vast experience of delivering high quality healthcare buildings working in partnership with clients to help them achieve their goals. The Apollo team can offer development services; project managing an entirely new building, an extension or refurbishment of an existing building, taking on the full responsibility for the entire development process. Apollo also offers a consultancy service, which provides advice and support to practices including the writing of appropriate business cases for premises improvements,


project development and construction management services and advice regarding the sale and leasing back of premises as well as advice regarding the disposal of premises following the relocation to a new facility. Apollo will ensure that particular attention is paid to delivering value for money, the best sustainable building design and the use of quality materials to increase the building’s longevity and reduce operating costs. Apollo works with integrity and flexible to help clients find solutions to their property challenges. FURTHER INFORMATION Tel: 07881 921 364

GRANDPA CAN EAT BY HIMSELF The special features of the tableware by ORNAMIN hold products securely in place on the table, prevent them from slipping out of hands and allow people with just one hand to eat on their own. The best benefit yet: all features are hidden in its design.

The three raised edges of the NON-SLIP BOARD prevent toast from moving.



INDEPENDENT EATING AND DRINKING Visit us on stand N62 at the Health+Care. 58


Health+Care 2016

EVENT PREVIEW ! 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-are 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’; ‘Residential Care Innovation’; and ‘Future of Public Health’. " FURTHER INFORMATION

The primary healthcare property experts Apollo specialises in the development, investment and management of primary healthcare premises in the UK – from multi-tenanted medical centres to single GP surgeries and dental practices. GP PREMISES DEVELOPMENT • Offices in Ipswich, Leeds, Shrewsbury, Glasgow & Cardiff • Low risk, fast-track solution to estates problems in the primary care. • Our team of dedicated professionals understands premises and care models. • Single Point of contact from start to finish and into management.

CONSULTANCY SERVICE • Project Inception Document (PID) writing, Outline Business Case and Full Business Case production • Project Management of 1$5' / &55' schemes and GP self developments. • Development Management services to assist GP practices in developing their own assets and maximising returns / minimising risk. • Strategic Estates advice and complete portfolio / asset management solutions.

If you need advice or have a healthcare development project you would like to discuss please contact Rob James today on 01685 878881 or 07881 921364 or email



Health+Care 2016


A powerful partnership to transform children’s mental health services

Transforming the future of mental health and well-being services for children and young people Visit us at stand C165 at Health + Care 16 to find out more

Delivering Excellence in Health and Social Care Our recruitment process entails: • Identity Checks • Safeguarding (Disclosure and Barring Service (DBS), Enhanced Disclosure) • Right to Work • Work Health Assessments (SEQOHS) • Employment History and Reference Checks • Professional Face-to-Face Interview

01332 986 330 •



Children and young people’s mental health in the UK and the services in place to support them are increasingly under scrutiny. There is widespread agreement that we are failing to meet their needs at a time when huge numbers are experiencing emotional and mental health problems. It’s a complicated picture with a multitude of factors involved – and not helped by the way services are currently structured. Children and young people experience delays getting access to services or are even being turned away. National charity The Children’s Society runs local services helping children and young people when they are at their most vulnerable. Award-winning Xenzone has been pioneering online counselling services in the UK for over a decade. Now, The Children’s Society and Xenzone have a blended digital and face-to-face solution to

transform mental health services for vulnerable children and young people aged up to 25. Together we will widen access to services by removing tiers and providing a joined-up model of care. This unique and comprehensive model will be delivered across a network of partners, working with established health and social care systems and with clear pathways to specialist mental health services. Meet us at stand C165 at Health+Care. FURTHER INFORMATION commission-us@

Offering temporary and permanent workforce in health and social care Situated in the East Midlands, J24 Resourcing Limited is a specialist recruitment company operating in the Health and Social Care Sectors, providing both temporary and permanent recruitment solutions in the UK. Primary coverage is across the Midlands, with the strongest candidate base and client network. J24 Resourcing supplies candidates through a variety of clients which include MSPs and Neutral Vendors to local authorities, NHS Trusts, and via PSL’s for both local and National care organisations. J24 Resourcing provide staff across a multitude of settings including hospitals, mainstream residential homes, looked after children accommodation, secure units, PRU’s, nursing homes, day centres, sheltered accommodation and supported housing schemes in addition to services in the community. J24 Resourcing Limited primarily recruit and undertake

assignments to source candidates applicable to various other roles within the health and social care industry as per client demands such as HCA’s, RGN’s, RMN’s, RNLD’s, residential childcare workers, adult support workers, qualified social workers, social work assistants, supervised contact workers, occupational therapists, project workers, tenancy support workers, DV support workers and youth offending workers. The company prides itself in delivering excellence in Health and Social Care Recruitment. FURTHER INFORMATION Tel: 01332 986 330

Infection Prevention



The science behind infection control Following a hugely successful conference last year in Liverpool, Infection Prevention 2016 will be taking place at the HIC in Harrogate from the 26-28 September 2016 Organised by the Infection Prevention Society this is the largest infection prevention conference and exhibition of the year. There will be in excess of 800 delegates in attendance and over 100 exhibitors. The scientific programme will deliver an array of renowned speakers covering all your infection prevention needs. With an exciting programme on offer, this event promises to offer delegates the latest in infection prevention research, education and expertise, with inspiring speakers and informative sessions. Confirmed speakers include: Mary Dixon Woods who will deliver the EM Cottrell Lecture; Eli Perencevich who will deliver The Ayliffe Lecture; Prof A.P.R. Wilson; Professor Gary French; Brett Mitchell; Hugo Sax; Tim Boswell; Peter Hoffman; John Coia; Kieran Hand; Martin Kiernan; Jon Otter; Hilary Humphries and many more. This year’s programme features specialist streams on surgical site infection and new to infection prevention. There will also be four specialist workshops focusing on writing for publication, mental health, audit and surveillance and the ambulance service. Outside the dedicated streams and workshops there will be inspirational presentations from national and international speakers. This high quality educational event supports continued professional development for all disciplines and will be invaluable in your revalidation. It has been awarded 14 CPD credits by the Royal College of Pathologists.

The c scientifime programer an iv will del enowned fr array o covering all rs speake r infection you ion prevents need

CONFERENCE STREAMS Due to the resounding success from previous years, Infection Prevention 2016 is once again offering separate one day conferences at the show. The Infection Prevention in Care and at Home one day conference is taking



ABSTRACTS An integral part of conference is always the oral papers and poster presentations. They provide the ideal opportunity for those working within infection prevention and control to share best practice and research with the chance to network with colleagues. If you/your team has a quality improvement, scientific project or piece of work that you have been working on which you would like to share then why don’t you consider submitting an abstract for presentation as either a poster or oral paper. The abstract submission deadline is Monday 13 June 2016.

Infection Prevention

place on Wednesday 28 September and this event will discuss some of the 21st century challenges we face in care homes and care at home in looking at the latest evidence and applications for practice. This day will be of relevance for all staff and, in particular, those senior staff with the accountability for infection prevention within the organisation. The programme will consist of the following sessions: A matter of time and touch, by Roy Browning; Laundry – New Insights by Sally Bloomfield; Outbreaks – recognise, report, control by Dr Evonne Curran; Using infection prevention and control (IPC) audits to drive quality improvement, by Gary Cousins; Surveillance of healthcare-acquired infection in the homecare service, by Eilish Creamer; Visualising the invisible, by Colin Macduff and Alastair MacDonald; Dental health in older people, by Isabelle Tucker; and Catheters and prevention of Catheter Associated Urinary Tract Infection (CAUTI), by Gill Manojlovic. In addition, The Infection Prevention in Dentistry One Day Conference is also taking place on Wednesday 28 September. This one day conference will be of interest to dental surgeons, dental nurses, infection control support dental nurses, general dental practitioners, orthodontic group nursing managers, special dentist nurses and those with an interest in infection prevention and control. The day will enable delegates to advance their skills, gain four CPD hours and network with like-minded colleagues. This programme will cover sessions on: Spreading odontogenic infections and severe oral sepsis: Riina Rautemaa, PHE studies on the transmission of prions and the efficacy of washer disinfectors, by Dr Jimmy Walker; Surveillance for antimicrobial resistance in dentistry – no room for complacency!, by Professor Andrew Smith; Infection prevention and control in dental labs, by Peter Hoffman; Oral sex and HPV – the missing link, by Natalie Foley; Show me the evidence – infection prevention guidance and practices in dentistry, by Christine Whitworth; and Instrumental decontamination within the dental setting, workshop, delivered by George McDonagh.

The Infection Prevention in Care and at Home conference will discuss some of the 21st century challenges we face in care homes and care at home in looking at latest evidence and applications for practice EXHIBITION The exhibition at Infection Prevention 2016 will feature products and services from over 100 companies working within infection prevention and control. Some of these companies will be long term supporters of IPS, but the exhibition will also feature some new faces, new products and recent innovations. The exhibition offers the ideal opportunity to discuss your particular infection prevention and control requirements with a huge range of specialist companies. For exhibitors,

it is the chance to meet a wide range of influential professionals and decision makers who will be attending the main conference event and the specialist one day events. !

Infection Prevention 2016 is taking place at Harrogate International Centre from 26-28 September 2016. Early bird price valid until Monday 4 July 2016. FURTHER INFORMATION annual-conference



Advertisement Feature



ENERGY COST SAVINGS IN THE HEALTH SECTOR Every year, some £8 billion is being spent on running hospitals and health care facilities in the UK, and of this, £500 million is on energy. Procurement is key... The NHS is aiming for a 15 per cent real term reduction in costs by April 2021, and energy savings initiatives will play an important part in achieving this goal, as the report by Lord Carter for the Department of Health has confirmed. However, while all eyes are focused on implementing energy efficiency measures, few Trusts and health care facilities have considered optimising energy procurement strategies. It is commonly assumed that the general public sector procurement solution delivers the best deal. However, with energy costs falling, most of the 1,200 hospitals and 3,000 supporting facilities of the NHS today stand to benefit from adopting a more progressive procurement strategy, while ensuring their budget is met and protected against rising prices. ECOVA IS ACHIEVING £350,000+ ANNUAL SAVINGS FOR TRUSTS IN THE MIDLANDS When Ecova entered into discussions with major UK Trusts, located in the Midlands, the Trusts had already spent the past five years working on energy efficiency and reducing consumption. On-site solutions such as sub-metering, LED lighting, passive detection and stand-by generation had already been introduced. At the same time, the Trusts were still procuring energy through a generic public sector option. The first step was for Ecova to spend time with the Trusts to understand their energy needs. At the same time, Ecova offered the Trusts full transparency and a deeper understanding of the UK energy market, its recent movements and future outlook.



As a true partner, Ecova agreed to develop a bespoke model for the Trusts that would demonstrate the actual benefits of using a more flexible procurement strategy. AN AUTOMATED MODEL PROVED THAT A FLEXIBLE APPROACH IS THE RIGHT CHOICE Over the past four years, the wholesale cost of both natural gas and electricity in the UK has continued to decline, with significant volatility exhibited in the overall downward trend. At the beginning of May 2016, the traded cost of electricity for the 2019 winter season is almost 10 per cent below the current winter 2016 price. This trend suggests that a flexible and dynamic approach to energy procurement can deliver significant commercial savings. In order to allow the Trusts to fully understand and compare the benefit of a flexible approach, Ecova created a Procurement Simulation Model based on the consumption energy costs the Trusts had incurred over the previous three years. Using a transparent and fully automated procurement process (no human involvement), the model demonstrated the wholesale energy costs that would have been achieved through systematically buying 20 per cent of volume requirements on a day-ahead contract, 30 per cent on a month-ahead contract, and 50 per cent season ahead. The results were overwhelming, showing an average of 10 per cent annual savings each year over the previous three years, on both electricity and natural gas wholesale prices. The Trusts then requested a more detailed and current evaluation of the benefits of using Ecova to manage its energy procurement.

PROVING CONSISTENT OUTPERFORMANCE OF THE MARKET Following the Trusts’ request, Ecova shared insight into the specific procurement strategy it uses for similar-sized clients. Ecova demonstrated that its strategy and expertise, applied over the same time period, would have provided at least 14 per cent average savings on the Trusts’ current contract, exceeding 20 per cent during certain months. The evidence was more than satisfying, and in 2015 the Trusts chose Ecova as a partner for energy procurement. Ecova is currently set to achieve at least £350,000 in cost savings for the Trusts over the first twelve months. While savings naturally depend on energy market movements, Ecova is already on track to exceed its commitments: during the first two months, Ecova already reached £129,000 of savings DEEPER INSIGHT FOR YOUR TRUST Ecova UK is happy to provide information on the above project. We would be delighted to examine what we can do for you. In addition to the above example, Ecova is able to provide further savings through invoice validation, by managing agreed site capacity, red zone and Triads usage, to name just a few. ! FURTHER INFORMATION Richard, Patricia Barrett,


P4H 2016


The countdown is now on to P4H 2016 In support of the current hospital efficiency challenges and the ongoing development of operational productivity within the NHS, P4H 2016 will provide you with a unique opportunity to enhance knowledge, share best practice and network with marketplace peers, across a single day Following the success of 2015’s inaugural P4H – The Procurement Event for Health, the event returns this year with a bigger agenda, more speakers addressing the strategic direction of procurement in the NHS and more training opportunities than ever before. Set against the backdrop of Lord Carter’s recently published report on Operational Productivity in the NHS and initiatives such as Department of Health’s NHS Procurement Transformation Programme, P4H 2016 is set to help procurement professionals address their efficiency target of two-three per cent. Jin Sahota, director of Supply Chain at the Department of Health will give the opening address in the Keynote Arena on NHS Procurement – The National Programme. Jin only recently started working with the Department of Health, managing the supply chain, supplier relationship management and supply chain resilience. With over 25 years of experience in leading global operations and sourcing, you will hear what elements of his private sector experience he believes will help transform the way procurement works within the NHS. The Keynote Arena also features Andy McMinn MCIPS, chief procurement officer of Plymouth Hospitals NHS Trust who will be sharing his experiences and perspective on

the changing NHS procurement environment. We are also set to hear some regional perspectives and approaches from: Mike Doyle and Brian Mangan from NHS North West Procurement Development; John Swords, head of procurement, Health & Safety Executive, Republic of Ireland; and Jim Miller, interim director of procurement and commissioning & facilities in NHS National Services Scotland. Chaired by Professor Duncan Eaton, of the All Party Parliamentary Health Group, attendees will be invited to contribute with questions, experiences and views.

TRAINING ZONES Training forms a major element of P4H with four distinct training zones designed specifically to help buyers of all levels within the NHS enhance their overall knowledge, collaborate and share best practice. All four training zones offer CPD certified training sessions covering the most topical subjects and directly aligned to ongoing marketplace initiatives and developments. Delegates will be able to choose from 11 sessions within the Professional Procurement Skills Zone on topics ranging from ‘Choosing the Right Procedure’, ‘Understanding Framework Agreements’ and an update on the ‘UK Public Contracts Regulations’ to three sessions on workforce and staffing procurement, dynamic purchasing systems and a favourite this year, ‘Addressing the Efficiency Challenge’.

Session will off s er strate enable gic advice to dep and tru artmental transpa st-wide efficienrency and c eProcur y in the eme Zone nt EFFICIENT PROCUREMENT In the eProcurement Zone the sessions will offer strategic advice to enable departmental and trust-wide transparency and efficiency. You can catch up with the government’s !



P4H 2016


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Material Handling Specialists in a Material World

We pride ourselves on the quality and durability of our products, whilst providing cost effective and competitive solutions to our customers. Contact our sales and design team for further details Bryant Plastics Ltd., Tel; 01535 357480 Web; email;

Providing holistic, person centred care within the comfort of your own home G&P Healthcare Ltd is a CQC registered nurse-led home healthcare company specialisng in providing holistic, person centred care within your own home. It provides care for adults and children with all care needs including complex health conditions. The company was established by Gayle Finlayson and Par Law, who are qualified nurses with over 40 years of experience in nursing between them ranging from ITU to specialist palliative care. G&P has a team of children’s and adult nurses that work within its branches to support all clients. G&P Healthcare provide highly experienced QCF qualified staff who are trained by G&P’s complex care nurses in tracheostomy and airway management, peg, nasogastric feeding, ventilation management, suctioning, oxygen therapy, full medications management, adult and children’s basic

life support along with any other complex health training required for clients. G&P also specialise in providing clinical skills training to external care providers throughout the UK. G&P Healthcare offers high quality training, insuring staff are at a competent level while ensuring the training is evidence based and meets CQC and legislative requirements. Training is delivered by qualified complex care nurses with several years’ experience. FURTHER INFORMATION Tel: 01332 497470 gayle.finlayson@

SUPERMAX HEALTHCARE – NEWCOMERS INTO THE UK NHS Supporting Innovation & Education within Healthcare Procurement P4H Conference - 13th July NEC Birmingham. COME ALONG AND VISIT OUR STAND: HALL 7, STAND 84





EVENT PREVIEW ! 2020 Digital Strategy, eInvoicing with Peppol and how inventory control systems can revolutionise your procurement operation. Implementing initiatives from other’s experiences can give you a short cut to transformation.

how collectively they saved £850 million collectively. They will be running a live swap shop so bring one savings success with you and you can start swapping. P4H hosts three Collaboration Zones: the Procurement Advice Hub where you can

Set against the backdrop of Lord Carter’s recently published report on Operational Productivity in the NHS, P4H 2016 is set to help procurement professionals address their efficiency target of two-three per cent Sometimes, the Best Practice Case Study Zone offers golden opportunities to take away ideas that are simple but make a huge difference to your operations. If we were to recommend one session, don’t miss the NHS Savings Swap Shop with Nick Hodgson, supplier development advisor at the Royal Devon and Exeter Foundation Trust and Andrew Varley, clinical procurement specialist, Taunton and Somerset NHS Foundation Trust. They will be sharing how their Swap Shop collaboration brought together ten trusts in the South West of England and

get advice on training, consultancy and eProcurement systems; the Career Advice Hub where you can gain tips and advice on how to expand your experience and make your career count; plus the Buyer Engagement Village where suppliers and buyers can have real conversations about what they’re both looking to achieve. EVENT PARTNERS We are delighted to welcome back our event partners: Crown Commercial Service; NHS Shared Business Service; NHS Commercial

P4H 2016


Solutions; NHS East of England Collaborative Procurement Hub; NHS London Procurement Partnership; NHS North of England Commercial Procurement Collaborative; NHS Northwest Procurement Development; NMHS Supply Chain; Healthtrust Europe; and the Health Care Supply Association. All our partners offer advice to buyers about purchasing from their frameworks to achieve best pricing and the chance for suppliers to discuss framework opportunities. The Product Showcase offers buyers the chance to meet directly with suppliers and discover new products, innovative services and take away ideas which can make a real impact on productivity and results. P4H 2016 is one day of everything a buyer or supplier needs to make a real difference to their day to day operations and overall savings targets. With over 230 buying organisations registered to attend, join them and take advantage of the biggest day for health procurement this year. "

Public sector delegates can register for free and private sector delegates can book tickets for £95. FURTHER INFORMATION



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DEVELOPING TOMORROW’S LEADERS TODAY It’s tough out there – and it’s likely to get even more challenging over the next few years. Constant, understandable calls for improvements in care quality and safety, alongside increasingly tight financial pressures, have put NHS leadership and management firmly in the spotlight The three-Ps – patients, politicians and press – increasingly look to healthcare commissioners and providers for exceptional leadership of their organisations, their systems and their people to meet ever increasing demands in fluid, unpredictable environments. At Finegreen, we understand the issues and opportunities faced by executives, senior clinicians and managers in this challenging, yet exciting, healthcare environment – because we talk to leaders of healthcare organisations every day. That’s why we have established a new Board Capability Division to support healthcare commissioners and providers - and have built a team of experienced leaders equipped with tools and approaches to face current and future challenges. Firstly, we offer good governance guidance and support to commissioners as they establish new organisational models and help them understand the structural and leadership implications to avoid common pitfalls. We also support healthcare provider organisations with governance reviews, which not only develop senior leader capability but also save public money. Our supportive approach to peer reviews demonstrates our commitment to helping NHS organisations build improved capability to become more self-regulated and share good practice. Secondly, we recognise that both current and future leaders need support in thinking and working more strategically in a world which is constantly evolving. For this, we offer leadership programmes and executive coaching services which support professional development and challenge existing thinking in order to develop potential. Because we appreciate the importance of academic recognition we have teamed up with the Business School at Leeds Beckett University, so that healthcare executives are able to attain appropriate qualifications which are recognised and valued throughout the sector. These programmes include Post Graduate Certificate and Diploma courses, enabling leaders to work towards a full Master’s degree in Executive Leadership, and which can be undertaken by both existing and aspiring executives and senior managers.



FUTURE LEADERS Our Bridging the Gap programme is specifically aimed at supporting the development of future leaders. It provides a short, but intensive, insight into life as an effective director and enables managers to make more informed choices about their development, and their future, as well as supporting board succession planning. In partnership with the Inspiring Leaders Network (ILN), we have adapted this to enable organisations to create Shadow Boards, which provide real-time opportunities for existing senior managers to provide perspectives on current, strategic board issues, and allow boards to view current talent and gain new insights. NHS organisations which are benefitting from these services include; South West Yorkshire Partnership NHS FT; Harrogate & District NHS FT; Northern Lincs & Goole NHS FT; York Teaching Hospital NHS FT. As one client, a senior clinician, explained recently: “The insights I have gained about directorship and effective board working have been invaluable in helping me appreciate work at board level and enabled me to think and work more strategically.” Another HR Director said: “I should have done this programme 10 years ago – before I became a director.” The Finegreen Board Capability team spearheading this work has more than 15 years’ experience working with boards and senior leaders in various sectors across the UK and Europe. As Finegreen’s CEO, Neil Fineberg explains: “The challenges of running a complex, multi-million pound, 21st century health service requires its leaders to learn new approaches, skills and strategies. “It’s exactly these types of opportunities and challenges that our executive development programmes are designed to address and support. And because we engage experienced, current directors as tutors, coaches and facilitators they are able to provide practical guidance alongside modern management theory.” He sums up: “We have invested heavily

in this area in recent years because the feedback we have been receiving from boards and directors tells us that the increasing complexity of the modern-day NHS requires new ways of seeing the future.” More information about Finegreen’s Board Capability Division is available from either Neil Fineberg (neil.fineberg@finegreen. or David Hannath, Director of Board Capability (david.hannath@finegreen. or through the website at SUMMARY OF SUPPORT Here’s a brief summary of the support on offer from Finegreen to help healthcare organisations improve and develop personal and organisational performance: Good Governance Support: guidance on establishing new organisational structures (e.g. federation models and mergers); improving organisational governance and performance; Peer Review support (in line with the well-led framework); effective change leadership (leading in new organisations and volatile environments). Executive Development: accredited and tailored leadership development programmes; improving board level effectiveness; aspiring director’s programmes; events and networks for professionals. Executive Coaching & Mentoring: current and future CEO support; influencing at board level; dealing with executive dilemmas; senior leader career and development coaching. ! FURTHER INFORMATION


Leadership development in the healthcare sector is changing. Christina Pond, executive director of core contracts and policy at Skills for Health, shares some NHS successes and explains best practice Over recent years, the issue of leadership and the pursuit of effective leadership development has become a major focus in healthcare. But when we talk about management and leadership development, it’s important not to just think about an individual as leader because leadership in the NHS, or

indeed anywhere else, is a dynamic process. It’s about a set of relationships that exist in a complex system, and it is important to focus on both the context in which that person is working, and the skills that they will need to draw on at different times and for different challenges.

Skills for Health offers management and leadership development courses that support managers to develop their workforce. Additionally, all of our core skills and knowledge frameworks specifically identify the knowledge and skill required for people leading the transformation of care. The concept of the framework is that it can be used by the individual themselves to identify their learning needs, it can be used by an employer to identify what they need their workforce to be able to do, and it can be used by an education provider to develop a curriculum.

Written by Christina Pond, Skills for Health

Leadership and the new development landscape



SUCCESS THROUGH TRAINING We worked with the Salisbury NHS Foundation Trust, to devise a leadership programme for managers. The trust wanted to help its Grades 5 and 6 staff embrace the challenges of leadership and management, learning how to balance conflicting demands on time and find ways of improving services to the public. The trust had already identified their development needs, and so Skills for Health worked with them to identify the required training, and a delivery model that utilised a mix of face-to-face sessions, e-learning and coaching. The aim of the eight-month programme was to help participants – including administrative and clerical staff and nurses – to identify the personal qualities of a good leader. Developing an understanding of effective team leadership, they learnt how services could be delivered more effectively by empowering team members, and studied a good leader’s use of emotional intelligence. Skills for Health delivered a number of one-day workshops, including introduction to leadership, leadership styles and qualities, dealing with change and communication skills.

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MANAGEMENT ! they had developed skills and knowledge around leadership and management, whilst participants evaluated their achievements using the NHS 360-degree feedback system. Thanks to the training, the trust’s patients have benefited as a result of the new ways of working which have since been implemented. For example, a physiotherapist improved the way that elderly patients were taken through the hospital, while another clinician improved the running of a retinal screening clinic. Participants reported feeling better equipped to carry out leadership duties, particularly with regard to managing teams, and they increased their understanding of different issues and working environments. All the modules in the leadership development programme were matched to the Management and Leadership National Occupational Standards, thus ensuring transferable skills. Janine Osmond, head of Learning and Development for Salisbury NHS Foundation Trust, said: “Our staff have had their eyes opened to management and leadership, and as a result, our patients have benefited through improvements to their services.” ONE SIZE DOESN’T FIT ALL As the Salisbury Trust example shows, we work with leaders to help them support, develop and coach their own workforce. It’s not a one size fits all approach. Whittington Hospital NHS Trust also worked with Skills for Health to develop a competence-based leadership programme. The trust pioneered the programme for front line managers. The intention was to provide a wider range of skills and strategies for new managers to draw upon when fulfilling their roles, reducing high levels of dependence on middle and senior managers. Training and development to support first and second line managers identified a gap in skills around performance management, so the competence-based leadership programme ‘Coaching Skills for Managers’ was created to increase participants’ confidence, as well as their ability to deal effectively with challenging staff issues. Supported by Skills for Health the trust used the Management Standards Centre competences as a guide to ‘plug’ skills gaps. The resulting programme focused on specific management activities such as motivating and supporting staff, monitoring progress and quality of work, and conflict resolution. A total of 17 people completed the programme and it has been judged especially successful for those new to management roles. Feedback from participating managers was positive, with many reporting increased confidence and greater ability to communicate and manage staff. Colleagues have also seen an improvement in appraisals, with more sensitive handling of work issues. The programme has stimulated interest in coaching skills across the Trust and has resulted in a further programme,

across two trusts, to roll out coaching skills in partnership with 60 managers and staff side representatives. Carrie Graham, who worked on the Transformation Programme Team at Whittington Hospital, said: “Giving participants these practical skills equips them for the challenges of being in a management role. The skills and competences developed are practical, and act as a boost to individuals in their working lives.” In practical terms, Skills for Health recommends ‘ten top tips’ for good practice in leadership, which emphasise the true purpose of leadership – namely to nurture ability and inspire people to achieve incredible things. The first touchstone for leaders to look at is finding supporters in order to build a receptive local culture and a critical mass for change. A successful leader should engage with colleagues and key stakeholders to build support and trust. BEST PRACTICE FOR MAKING CHANGE Those who are seeking change shouldn’t forget that it’s fine to ask the ‘killer’ question and challenge existing models. Just because something is done a certain way does not mean that it is being done in the best way. Enquiring minds must seek advice from those who have knowledge in areas where they are lacking and invite challenge. Keeping the approach simple is key – an organisation needs a shared direction of travel that everyone understands, but those involved in delivering change must have ownership and feel involved in the creation of the vision for change. You should value people and show appreciation, as an organisation is only as good as its staff. Think about creative ways of recognising the efforts of staff and celebrating achievement. Any good leader must also admit when they have made mistakes – and be honest with themselves and others when they are wrong, or simply don’t



know. Personal integrity and openness are important characteristics of any leader. Remember the benefit of a ‘team’ and do not try to go it alone. A good leader should have the confidence to draw upon all available resources, including the skills and abilities of others. After all, by delegating and sharing, you enable and develop their skills. Good communications can play an important role in building a sense of team within an organisation and can help encourage meaningful dialogue between different parts of an organisation. And don’t forget that a dialogue is just that – meaning you must commit to really listening as well as broadcasting your ideas. Make no judgements, just understand the subtext of what people are saying, and pay as much attention to the non-verbal signals as to verbal presentation. As a leader, you lead by example, so be what you want others to be. You need to ensure that what you do and what you say reflect the values and behaviours you expect of others, so make sure you are setting the right example. A key for any leadership success is to never stop learning. For a very few people leadership comes naturally, but for the vast majority leadership skills need to be developed. In today’s ever-changing workplace it is important to not only develop your leadership skills but to also work on the skills and knowledge vital to your profession. Finally, make sure that you know yourself, as effective leadership begins with self-knowledge. You need to understand your own emotional responses and be aware of the impact that people and situations have for you. The skills of self-awareness and self-regulation, components of your emotional intelligence like other leadership skills, can be developed. They are absolutely vital to success when it comes to leadership development. " FURTHER INFORMATION

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Mike Kreuzer, of the Association of British Healthcare Industries, looks at the revision of the Medical Device Regulation, and the consequential strengthening of requirements Medical devices have been in existence ever since the first humans used the materials around them like stone, twigs and bones to effect some sort of medical treatment. Of course our ancient ancestors would not have understood the term ‘medical device’ but even as early as Neolithic times (7000BC) there is evidence of teeth being drilled. By Roman times medical devices had developed considerably and they had an array of surprisingly sophisticated devices at their disposal, some of which are recognisable today. Today, medical devices that are properly designed, manufactured and used for their intended purpose, can be of immense benefit, but devices that are sub-standard or are used inappropriately can also do immense harm. It is no surprise therefore that medical devices are very heavily regulated, and rightly so. MEETING STANDARDS Until relatively recently, regulation consisted of setting out a list of requirements that a

product had to meet and these requirements were applied in a prescriptive manner. The problem here was that because of the speed of technological development and innovation the rules were invariably out-of-date before the ink was dry on the regulatory documentation. This meant that patients were often at risk of being denied access to the most effective technology purely because the device could not meet these prescriptive regulatory requirements This dilemma, which was also evident in other areas of product regulation, resulted in the creation of the ‘New Approach’ in the European Union shortly before the creation of the Single Market. The New Approach marked a departure from the earlier prescriptive method of regulation to something which is more flexible and provides patients with

Written by Mike Kreuzer, executive director, Regulatory & Andy Vaughan, consultant, ABHI

The revision to Medical Device Regulation

timely access to innovative devices, provided these meet all the safety and performance standards. The New Approach sets out requirements which specify that a device must be ‘safe’ but does not specify precisely how a manufacturer should achieve this. The ‘technical’ interpretation is left to ‘voluntary’ standards which manufacturers are expected to meet where applicable. However manufacturers who can demonstrate that their device is ‘safe’ using a route other than these specific standards may legally place their product on the EU market. This flexible approach helps to give EU citizens the benefit of prompt access to the latest innovative medical technology. (The ‘New Approach’ has recently been updated to become the ‘New Legislative Framework’). There are currently three directives in the EU covering medical devices, these being: 90/385/ EEC Active implantable medical devices (covers all powered implants e.g. pacemakers); 98/79/EC In vitro diagnostic medical devices (covers any medical device which is intended for in vitro testing); and 93/42/EEC Medical devices (covers most other medical devices). Any product which falls within the scope of the above must comply with the requirements of the particular directive (or national transposition) to be legally placed on the EU Market. This article concentrates on the general medical devices directive (93/42/ EEC) but the others operate in a similar way. The oversight of medical devices in the EU is risk based with devices being separated into one of four classes depending on the risk to the patient. The risk classes are Class I (lowest), Class IIa, Class IIb and Class III (highest). A typical Class I device would be a tongue depressor and a typical Class III device would be an implantable heart valve. Class I devices are further subdivided into Class I ‘measuring’ and Class I ‘sterile’. Any medical device other than a basic Class I will require the intervention of a ‘Notified Body’ in some capacity. Notified bodies are designated by EU Member State ‘Competent Authorities ‘. The UK competent authority is the Medicines and Healthcare products Regulatory Agency (MHRA). A particular notified body may have a limited scope so is not able to cover all aspects of medical device assessments and manufacturers should ensure their chosen notified body can undertake the assessments they are going to need. There are five medical device notified bodies’ in the UK and just under sixty across the EU. All medical devices, irrespective of their !

Medical Devices


T new re he g will rep ulation r a signifiesent strengt cant of the r hening eg require ulatory ments






REGULATION ! risk class, must meet the requirements of the legislation that are applicable; the risk class however determines the interest the authorities take in you. For a Class I device it is usually only necessary to inform the competent authority in an EU member state in to which you are placing the device on the market. However, for a Class III device your notified body will want to take a detailed look both at your organisation’s product design and production facilities but also at the technical documentation for the device itself. One of the important aspects of medical device regulation in the EU is Post Market Surveillance, where a manufacturer is expected to gather information on how their device is performing ‘in use’. This information can help determine whether any corrective action on existing devices is necessary (e.g. field modification or recall) or as data to be used to improve the design of future products. Should any device be implicated in the death or serious injury of a patient this must be investigated promptly and thoroughly, the root cause established and corrective action initiated. This is usually overseen by the competent authority. THE MEDICAL DEVICE DIRECTIVE The Medical Device Directive has been with us for over 20 years now, and is being revised in the light of experienced gained. In the interim the EU Commission initiated a ‘Joint Action Plan’ which tightened up the oversight of notified bodies and introduced an enhanced programme of unannounced audits on manufacturers. These elements have been incorporated in the proposal for a revision to the legislation. The proposed revision to the Medical Device Directives is currently in the final stages of the EU political process and is expected to be published towards the end of 2016. The revision has made a significant number of changes, not least: the change from a Directive to a Regulation (avoids variation in national ‘interpretations’); the extensive use of Delegated and Implementing Acts; the alignment of the medical device legislation with the New Legislative Framework; the merging of the active implantable and general medical device legislation into one Regulation; the proposal for added pre-market scrutiny for high risk devices; the proposal for legal controls on the reprocessing of single-use devices; the proposal for the greater control of the use of ‘hazardous substances’ in medical devices; the proposal for increased requirement for Clinical Investigations and evidence; and the proposal for a ‘reclassification’ of some devices. The original proposals for Medical Device and InVitro Diagnostic Device Regulations were made by the EU Commission in September 2012. The proposals are subject to the ‘Ordinary Legislative Procedure’ (Article 294 of the TFEU) and consequently were passed to the EU Parliament and EU

The Medical Device Directive has been with us for over 20 years now, and is being revised in the light of experienced gained Council. The EU Parliament agreed its first reading position in April 2014. The Council has taken more time than the Parliament and only arrived at an agreed text in September 2015. The proceedings have now progressed to the ‘Trilogue’ stage where the Council, Parliament and Commission attempt to arrive at a text that is acceptable to all the parties. REGULATORY REQUIREMENTS The new regulation will represent a significant strengthening of the regulatory requirements. A couple of examples follow. Previously the manufacturer of a Class III device submitted the technical documentation to their notified body for assessment and review, and if satisfied the notified body would issue an ‘EC Design Examination Certificate’. Provided the manufacturer met the other requirements of the legislation, they were entitled to ‘CE mark’ the device and place it on the market. The revised legislation will probably introduce another layer of oversight in the shape of an EU level ‘expert panel’ in addition to the notified body, leading to some additional delay. The proposal for the reprocessing of singleuse devices (SUDs) is also controversial and represents a backward step in the

Medical Devices


opinion of industry as it means patients could be exposed to additional hazards. Manufacturers design and manufacturer SUDs to be used once, therefore they do not have the durability of reusable devices. Further, reusable devices are designed to be reprocessable and all the nooks and crannies that could harbour harmful material are scrupulously designed out and the effectiveness of any reprocessing validated by the manufacturer. This is not a consideration for a single use device which is intended to be discarded after use. Doubt must therefore exist as to what extent a reprocessed SUD can be totally ‘safe’. The revised legislative proposal is, in general, welcomed by the industry as a significant step in patient and user safety, though in some areas concerns still exist, as things stand, about whether the additional regulatory load is justifiable. Until the final text is published nobody can be certain about what the exact requirements will be. Once published however, the serious work will begin for all concerned in adapting to the new legislative environment. " FURTHER INFORMATION


Case Study


Helping healthcare providers to build a culture and practice that drives excellence in patient safety In 2000, Sir Liam Donaldson published the seminal report ‘An organisation with a memory’. The report stated: “Inquiries and incident investigations determine that ‘the lessons must be learned’, but the evidence suggests that the NHS as a whole is not good at doing so.” The report suggested some key areas which the NHS needed to develop to modernise its approach to learning from failure. These included a call for better systems for reporting and analysis when things go wrong, a wider appreciation of the value of a system approach to learning from error and a more open culture which encourages reporting and discussion when things go wrong. Since 2000, there have been a number of positive developments in patient safety in the NHS, including a national system for reporting and sharing learning. However, a series of major investigations and reports since 2000 suggests that as a whole, the NHS doesn’t always investigate and

learn from mistakes as well as it could. There is evidence that barriers to an open reporting culture still exist and that local systems for investigating incidents, identifying the contributory factors and implementing and embedding learning are sometimes inadequate. A recent report from the CQC raised concerns about the quality of incident investigation and learning in the NHS. The evidence suggests a range of shortcomings in the existing response to adverse events across the healthcare system. Patient Safety investigations are often poorly resourced, with a lack of expertise and skills. But the real enemy to a true learning culture in healthcare is something that comes up time and time again.

Healthcare organisations must choose safety The common lesson comes back to an evident truth highlighted recently by Don Berwick. Berwick said that all healthcare organisations must choose between safety or fear; that both conditions cannot exist side by side. Day-in day-out, the NHS provides world class, often lifesaving care to millions of people. It is paramount that the NHS is able to strike the right balance between ensuring there is accountability where appropriate, and fostering a culture where staff can report and openly discuss error with the confidence that they won’t be blamed unfairly. New technology and tools can play an important role in making it as easy as possible for healthcare organisations to get this right. The choice the NHS has is clear: safety or fear – an organisation with a memory or an organisation that continues to miss opportunities to learn and improve. FURTHER INFORMATION

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John Pryor of ACFO discusses fleet management, examining the different options available for fleet managers and how to reduce whole life costs for fleets in the NHS

Fleets are leading the drive to cut vehicle emissions and Chancellor of the Exchequer George Osborne drove public and private sector transport operations further along the ‘green’ route in the government’s Spring Budget. Cost reduction remains fleet decision-makers’ agenda-topping issue and Osborne hopes his Budget measures will further drive the take-up of ultra-low emission cars - defined by the government as models with emissions of 75g/km of carbon dioxide (CO2) or below – and vans. That includes encouraging demand for electric models with the government hoping that by 2040 every new car and van in the UK will be an ultra-low emission vehicle (ULEV). Whether running fleets in the public or private sectors, operating budgets are under the microscope and in principle cash can be saved by operating ULEVs. That’s because they attract the lowest taxes for both employers and employees. However, it is critical when reviewing fleet choice lists that decisions should be based on whole life costs – as well as ensuring vehicles are fit-for-purpose – because they provide the best forward estimate of the real costs to an organisation, in delivering business mileage, over a replacement cycle. Never has that been more important than in

Written by John Pryor, chairman, ACFO

A fleet update for vehicles in the NHS

operated by fleets and small businesses. Currently 30 cars and nine vans – either pure electric, range-extended or plug-in hybrid vehicles – are categorised as ULEVs that meet the eligibility criteria for the government’s plug-in grant, which helps purchasers offset the higher cost of such vehicles. Corporate choice will continue to increase further with an additional 40 models expected to come to the market over the next three years, according to the Department for Transport (DfT). Allied to fleet decision-makers searching for financial savings in their choices of company cars and vans is a desire to reduce their organisation’s carbon footprint as a policy of good corporate citizenship. Two years ago, the coalition government announced that it was to lead by example as all of its car fleets were provided with millions of pounds worth of funding to introduce plug-in cars and vans and that was followed a few months later with a scheme to allow the wider public sector, including the NHS, councils and police forces, to introduce more plug-in vehicles. In both cases, chargepoints would also be installed to provide infrastructure support for the new cars and vans. Cars and vans would, said the DfT, be recommended on a like-for-like basis and the reviews would consider the whole life cost of the vehicles to ensure that each replacement made economic sense. It was against that background that Osborne announced in the March Budget that, following a review, the government had decided to continue to base company car benefit-in-kind tax on CO2 emissions from 2020/21. He also announced that, ahead of announcing rates for 2020/21, the government is to consult on reform of the bands for ultra-low emission vehicles (below 75g/km of CO2) to refocus incentives on the cleanest cars such as zero emission and hybrid plug-in vehicles. That suggests that rather than a single rate of tax for cars with emissions of 0-50g/km and for those with emissions of 51-75g/km as currently, there could be a greater granularity for vehicles effectively mirroring the remaining ratings system by increasing exponentially the threshold per every 5g/km. In recent years, the Chancellor has enabled fleet operators and company car drivers to forward plan by providing tax rates five years in advance of implementation. That has now reduced to four years and means that fleet and drivers running cars into a fifth year are left in the dark as to their tax liability. It is pleasing that the Chancellor has confirmed !

Fleet Management


HS Many Ntions a organis oduced r t have in y sacrifice r car sala es as part schem tension to of an ex ee benefit employ kages pac

respect of ULEVs where electric cars may be cheaper to operate than petrol or diesel rivals. Whole life costs reflect all the projected, vehicle-specific costs associated with operating a vehicle over its fleet life irrespective of whether a vehicle is owned or leased. Fleets and small businesses are leading the charge for plug-in cars and vans as new vehicle registration figures surged to record levels in 2015, eclipsing the combined total of 21,486 plug-in vehicles sold between 2010 and 2014. Data from Go Ultra Low reveals that plug-in car registrations accelerated rapidly last year to a record 28,188 units, surpassing 2014 volumes (14,532) by 94 per cent. Further analysis of the data reveals that the fleet sector is outpacing overall UK plug-in car growth. Within the national tally, the 18,250 corporate plug-in registrations total comfortably eclipsed the 2014 figure of 8,860 ULEVs. Fuelling the demand is a greater choice of models and that trend will continue in 2016 and beyond as motor manufacturers continue to expand their range of ULEVs. Meanwhile, demand for plug-in vans increased more than a fifth (22 per cent) last year with registrations totalling 819 units versus 673 in 2014. Almost all those light commercial vehicles are being




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WHOLE LIFE COSTS ! his intention to retain CO2 emissions as the basis for company car benefit-in-kind tax. It has become a well-established system that is straight-forward to understand and implement. Meanwhile, April 1, 2017 will see reform of the Vehicle Excise Duty (VED) regime for newly registered cars from that date. First year rates of VED will vary according to the carbon dioxide (CO2) emissions of the vehicle – £0 for 100 per cent electric cars. A flat standard rate of £140 will apply in all subsequent years, except for zero-emission cars for which the standard rate will be £0. Cars with a list price above £40,000 will attract a supplement of £310 on the standard rate for the first five years in which the standard rate is paid. In further Budget 2016 measures to encourage uptake of ULEV cars, the Chancellor announced: the 100 per cent First Year Allowance (FYA) for businesses purchasing low emission cars would be extended for a further three years to April 2021. The 100 per cent FYA had been due to end on March 31, 2018; that the main rate (18 per cent) threshold for capital allowances for business cars, currently set at 130g/km, will be reduced to 110g/km of CO2 and the FYA threshold to 50g/km from April 2018, to reflect falling vehicle emissions; that the CO2 threshold for the lease rental restriction is linked to the threshold for capital allowances for business cars, so the rate will be reduced from 130g/km to 110g/km from April 2018; and that

the government would further review the case for the FYA and the appropriate business car emission thresholds from 2021 at Budget 2019. Vans are widely used across the NHS and the Chancellor announced an extension of Van Benefit Charge support for zero-emission vans so that in 2016/17 and 2017/18 the charge will remain at 20 per cent of the main rate, and will then increase on a tapered basis to 5 April, 2022 – 40 per cent in 2018/19, 60 per cent in 2019/20, 80 per cent in 2020/21, 90 per cent in 2021/22 and then equalising with the standard charge in 2022/23 – a two-year extension from the original timetable. The government says it will review the impact of the incentive at Budget 2018 together with enhanced capital allowances for zero-emission vans. In 2015/16 the rate for electric vans was 20 per cent of that applied to conventionally fuelled vans and the rate had been expected to rise to 40 per cent in 2016/17, 60 per cent in 2017/18, 80 per cent in 2018/19 and 90 per cent in 2019/20 with the rates equalised in 2020/21. Separately, many NHS organisations have been introducing car salary sacrifice schemes as part of an extension to employee benefit packages. However, the government is becoming increasingly concerned that the popularity of salary sacrifice schemes is impacting on its tax take as they attract income tax and National Insurance contribution advantages

over salary. In his Budget statement, Osborne said it was the government’s intention that pension saving, childcare and health-related benefits such as cycle to work should continue to benefit from income tax and National Insurance relief when provided through salary sacrifice arrangements. The Chancellor did not specifically mention car salary sacrifice schemes, but experts have suggested that as tax rules favour ULEVs the Chancellor was unlikely to take action that would outlaw schemes. However, he could decide to introduce an emissions cap that would limit employees to choosing only ULEVs, including electric models, within car salary sacrifice programmes. ACFO would advise NHS organisations to be aware of the government’s review announcement when investigating the introduction of salary sacrifice arrangements. In conclusion, the government has laid the tax platform for encouraging further take-up of ULEVs including electric vehicles and manufacturers are responding to global demand for emission reductions with an ever-widening choice of such cars and vans. There is no doubt that ULEVs and electric vehicles have a role to play across NHS fleets, but it is essential that operating decisions are made on the basis of whole life costs. "

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Written by Cllr Teresa O’Neill, London Councils’ executive member for health

Healthcare collaboration in the capital

The London Health and Care Collaboration agreement was signed in December 2015. London Councils’ Teresa O’Neill discusses the most important points of the agreement and what this could mean for health and care in London Reform of health and care services has never been more important. A daunting financial outlook faces the NHS and local government and England’s growing and ageing population is placing huge pressure on social workers, carers, doctors and nurses. In a city as vast and diverse as London, local leaders felt that having more powers and flexibilities which enhance working more closely together across different organisations would help London to make swifter progress on a range of health and well-being issues, such as improving the quality and sustainability of services and increasing investment in prevention and early intervention. Following the successful devolution of public health responsibilities to local government in 2013, there was an appetite for more. London’s aspirations align with the NHS Five Year Forward View, which identifies three key areas that need to be addressed: reducing health inequalities by investing in prevention; reshaping care delivery to ensure people’s care needs continue to be met; and ensuring that health and care services are efficiently run and receive appropriate levels of funding.

A CAPITAL CHALLENGE The scale of the challenge in London cannot be underestimated. The NHS posted a £2.3 billion deficit in the first nine months of the 2015/16 financial year and London boroughs must cope with a projected £700 million funding shortfall by 2020. In the next two decades London will be home to 10 million people and the number of residents aged 65 and over living in the capital will grow by over 44 per cent. These realities galvanised London’s health leaders to take the reins and secure a devolution deal from government. London Councils joined forces with NHS England, Public Health England, the Mayor of London and CCGs to make a comprehensive case to government for devolving power and flexibility over local spending on health in the capital. In December 2015, London reached a

milestone in its journey towards health devolution when an agreement was signed committing local government and the NHS to collaborate in order to increase prevention and integration, shape new sustainable models of care and make better use of assets. Another agreement was signed by government and national bodies committing to work with London – primarily through five pilots – to unlock devolution to support and accelerate reform. The devolution agreements operate on three levels. Locally, boroughs will work on joint multi-year plans for integrating health and care to deliver Health and Wellbeing Board strategies, with alignment of provider plans, underpinned by pooling of budgets, joint commissioning and local asset planning. At a sub-regional level, strategic partnerships will be forged through joint arrangements to develop and secure delivery of clinically and financially sustainable new models of !

London Council s joined f o r c e s with NHS En g l a n d , Public Health Mayor England, the of CCGs toLondon and compre make a hens case ive




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SERVICES ! care across acute, primary and social care, with sub-regional estate plans and scheme development to support transformation. Political leadership for the devolved health and care system will come from the London Health Board. As well as working with the devolution pilots, London’s health and care leadership is committed to developing the workforce and skills, strategic estate planning and collaboration at city level to address wider determinants of health, and London-wide frameworks, such as new payment models for use at sub-regional and local levels. PILOT PROJECTS Exploring how health devolution works in practice through five pioneering pilot projects will give London’s health leaders a way of testing their proposals in the context of a complex, diverse and dynamic city. Lessons learned and progress made by the pilots will inform future decisions about how to devolve power and responsibility across London. HARINGEY: PREVENTION Haringey is seeking a whole system approach to prevention, focusing on using planning and licensing powers to create healthy environments and piloting new ways of helping people into employment.

BARKING AND DAGENHAM, HAVERING AND REDBRIDGE: ACCOUNTABLE CARE ORGANISATION Integration of health and care services to focus on early intervention and managing the chronically ill is the aim of Barking and Dagenham, Havering and Redbridge’s pilot project. By developing an accountable care organisation (ACO), they hope to integrate care services to better serve the needs of the local community. This would also involve integrating commissioning and sharing financial risks and benefits of joint ventures. NORTH CENTRAL LONDON: ESTATES A partnership between five boroughs – Barnet, Camden, Enfield, Haringey and Islington – is working to ensure the best possible use is made of the current NHS estate, by incentivising the release of unused assets and securing the space needed for integrated services. LEWISHAM: INTEGRATING SOCIAL CARE WITH PHYSICAL AND MENTAL HEALTH SERVICES Expanding joint commissioning will help health and care leaders in Lewisham integrate services around their Neighbourhood Care



Network, which, in the next two years, will focus on adults over 60, severe mental health, children with complex needs and early intervention with children. HACKNEY: FULL INTEGRATION OF HEALTH AND SOCIAL CARE In order to make better use of funding and improve results, Hackney will integrate its health and care services. This will include exploring different integrated delivery mechanisms and incentivising prevention. The pilots will test health devolution in London, exploring how greater collaboration, integration and devolution work in practice, including impacts within and beyond the London system. These will eventually help us to work towards a clinically and financially sustainable landscape of commissioning and provision, living within annual budgets and delivering fiscal balance. This will benefit patients and care users as it will reform the way services are provided to emphasise maintaining their independence and well-being. " FURTHER INFORMATION

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Embracing a design-led approach can improve outcomes says Haidee Bell of the Design Council, who shares the success of better A&E design which has been diffused across the health service A&E departments in England deal with more than 21 million patient attendances every year. These increasing patient numbers have put A&E departments under strain in the delivery of services, which can negatively affect the experiences of both patients and staff. Patients, who are already feeling vulnerable, can become frustrated and hostilities can easily arise. Healthcare staff, many of whom are working long shifts in a high-pressure environment, often bear the brunt of these tensions. Staff well-being in A&E departments is often very low, which can in turn affect morale. However, for patients entering a complex system, human contact is the best way to provide guidance, help and reassurance. Improving staff morale and engagement therefore has many benefits, both for patients and for the service as a whole. Increased staff satisfaction will reduce turnover, absenteeism and their associated costs and leave staff feeling more able to offer compassion, dignity and respect. Design Council’s A Better A&E programme demonstrated an opportunity to use a design approach to improve the patient experience, reduce hostility and aggression and provide solutions which demonstrate value for money to healthcare commissioners. DESIGN SOLUTIONS FOR A BETTER A&E Design Council partnered with three NHS trusts we considered broadly representative of A&E departments across the country (Chesterfield Royal Hospital NHS Foundation Trust, Guy’s and St Thomas’ NHS Foundation Trust and University Hospital Southampton NHS Foundation Trust) to research, develop and test solutions in operational A&E departments. We started by examining reports on recent aggressive incidents in UK A&E departments, and reviewed previous attempts to control and reduce this type of behaviour in public-facing

services. This research was supplemented by ethnographic research, with more than 300 hours spent conducting observations and interviews in A&E departments. We identified six ‘perpetrator characteristics’ of individuals who commit acts of aggression or violence, and nine ‘triggers’ of violence and aggression. These included the waiting experience, the effect of the environment on people’s behaviour, and how the intense emotions that play out in A&E create a ‘melting pot’ of anxiety. A team, led by design studio PearsonLloyd, worked with specialists in organisational dynamics and clinicians to create ideas for new communication systems, staff support services and secure spaces. The design team sought to create solutions that would improve the patient experience. For patients, this meant being better informed at every stage of their journey through A&E and remaining in control of decisions. The final recommendations provide physical changes within the A&E departments as well as creating behaviour change among patients and staff. This ‘Guidance Solution’ aims to reduce anxiety levels by using signage, leaflets and digital platforms to provide information about the department, waiting times and treatment processes. The ‘People Solution’ supports frontline staff in their interactions with frustrated and aggressive patients. Staff are given opportunities to discuss issues and concerns, with the aim of boosting morale and

reducing staff absence, and an induction booklet introduces new staff to the working culture and dynamics of the department. PROVING THE IMPACT OF DESIGN The Guidance and People Solutions were installed and initially piloted in 2012 at two A&E departments: Southampton General Hospital (University Hospital Southampton NHS Foundation Trust) and St George’s Hospital (St George’s Healthcare NHS Trust). Comparator control sites with similar characteristics were also selected for the respective pilot hospitals. Independent evaluators, Frontier Economics and ESRO, robustly tested the impact of the design solutions by collecting primary patient and staff data through immersive methods, collecting secondary A&E data and undertaking cost-benefit analysis. Pre- and post-implementation data from the pilot hospitals were contrasted with one another, and to comparable A&E departments where the design solutions were not implemented. The evaluation enabled us to demonstrate an impact on the patient experience, the levels of aggressive and hostile behaviour and overall value for money. By clarifying the A&E process and improving the physical environment we were able to demonstrate an improved patient experience and reduced potential for escalation into hostility. 75 per cent of patients said that the improved signage reduced their frustration during waiting times and complaints about information and communication fell dramatically. Both patients and staff observed significant reductions in acts of non-physical aggressive behaviour. Threatening body language and aggressive behaviour fell by 50 per cent !

Written by Haidee Bell, head of design programmes, Design Council

Revolutionising Britain’s primary care systems

Healthcare Design

Credit: Jill Tate


Effect efficien ive, t an sustain able pud servi blic users fi ces put the rst design , and have at th heart eir



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DESIGN ! post implementation. Associated improvements in staff morale, retention and well-being have also been reported. Installing the solutions has demonstrated considerable value for money. The benefits of the solutions outweighed the costs of implementation by a ratio of 3:1, meaning that for every £1 spent on the design solutions, £3 was generated in benefits, with the greatest cost savings coming from reductions in aggressive behaviour. In reality, these are conservative estimates of the potential benefits which could be realised from implementing the design solutions in A&E settings. Other potential benefits, such as reductions in stress-related absences, increased staff turnover and changes in litigation costs, were not included as they could not be reliably measured within the short time of the evaluation. THE ADOPTION OF THE A BETTER A&E SOLUTIONS The evidence of the impact of the solutions has supported a campaign to see wider adoption across NHS trusts. The project has generated considerable interest: to date, 42 Trusts from across the UK and beyond have enquired about installation of the solutions. PearsonLloyd have won awards for the two solutions and are invited to speak about the project at events around the world. However, the diffusion of innovation in the health service is slow and it took until 2015 for demand for installation to take off for the business. For PearsonLloyd, it has been a lesson in adapting to different commissioning models across the UK health system and being responsive with their offer to reflect different processes and cultures. PearsonLloyd works with each trust to customise the solutions to the requirements of each department and also offers a template package to allow Trusts to install the Guidance Solution at a lower cost. Kelly Pollard, from PearsonLloyd, highlighted: “I’m delighted that the solutions are now starting to show impact across sites in the UK since we know how powerful they are in improving the patient and staff experience. For us as a business it’s been a challenge to scale this service, with different commissioning processes and routes to implementation, though it has encouraged us to be responsive in the service we are offering and I’m very proud of the impact we have been able to achieve.” Having an internal champion who really understands the approach and value offered is central to the uptake of the solutions. Hospitals are naturally risk-averse environments, therefore being able to identify someone with ability to navigate internal hospital politics and commissioning processes gives the approach credibility and helps to open doors to implementation. To date, A Better A&E’s Guidance Solution signage has been purchased and installed by a further 10 trusts beyond the initial pilot sites.

APPLYING THE APPROACH BEYOND A&E For Design Council, the project has informed our work within other healthcare settings. We recently worked with the Royal College of Midwives on a programme to explore ‘better births’, in which we undertook design research with patients, midwives and clinicians and identified opportunities for providing a better experience in hospital-based maternity centres. The environment is known to impact on the process and outcomes during labour and birth and we were keen to understand what environmental factors affect patients’ confidence and sense of care. We uncovered opportunities to look at the timeliness, tone of voice and consistency of the information presented to expectant parents throughout pregnancy and birth as well as the necessary transitions that people undertake through different environments when they give birth and how to remove avoidable anxiety. As with an A&E environment, patients enter a ‘triage’ system first, so there are some direct lessons that can be drawn about from the A Better A&E project about solutions to improve the staff and patient experience. WHITTINGTON HOSPITAL Design Council has also worked on two projects with the Whittington Hospital in London, one of the UK’s busiest hospitals, to look at how best to use space to improve the user experience. Over a year, Design Council Design Associates Anna White and Sean Miller worked closely with Whittington Pharmacy to analyse the service and pinpoint areas where improvements could be made. We took a co-design approach, which meant that the designers’ focus was on allowing pharmacy users to create a space collaboratively that would work best for them. The project has measurably improved the patient experience at the Whittington, boosted staff morale and increased sales at the pharmacy. Importantly for the hospital, it has also produced a design model that can be

applied to other spaces within its walls and a willingness to experiment. The success of the pharmacy project had demonstrated that the design process could help improve the experience and efficiency of hospital services for both patients and staff, and a similar approach was later taken for its Ambulatory Care Centre, where we worked with more than 70 people across the Trust including managers, clinicians, administrators, infection prevention and control staff and patients. This gave everyone using the space a voice in the design process. The new Centre had to be a dynamic space, allowing for a range of different departments with a wide spectrum of treatments for both children and adults. Fundamental to the design was the idea that this should be an entirely new kind of space – a chance to create a world-class unit that didn’t feel like a hospital. The centrally located phlebotomy booth combines so much of what is successful about the new Centre. While private when necessary, it is positioned directly in the communal space demonstrating the Centre’s challenge to clinical traditions of keeping treatments, waiting and administration separate. The space very literally demonstrates the integrated care model. The success of these projects has shown that the design process could help improve the experience and efficiency of hospital services for both patients and staff. New efficiencies and ways of working have been discovered, large financial savings made and, having used the co-design process, staff feel more involved in decision-making processes. Design Council believes that effective, efficient and sustainable public services put the users first, and have design at their heart. These examples show that by embracing a design-led approach, outcomes can be improved, measured and scaled. "

Healthcare Design



The A Better A&E programme demonstrated an opportunity to use a design approach to improve the patient experience, reduce hostility and provide solutions which demonstrate value for money to healthcare commissioners Credit: Tilt




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Health Business 16.3  

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Health Business 16.3  

Business Information for Healthcare Professionals