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VOLUME 17.3 www.healthbusinessuk.net






An analysis of the way tech is transforming the care of type 1 diabetes

TOP 10

EXCELLENCE IN ACCIDENT AND EMERGENCY Listing the Top 10 NHS trusts performing above national averages for their A&E departments


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HEALTH BUSINESS MAGAZINE ISSUE 17.3 VOLUME 17.3 www.healthbusinessuk.net






Will a vote for health pay off? As we go to print, the UK electorate is visiting polling stations across the country to cast their votes for the 650 elected representatives that will sit in Westminster on our behalf.



An analysis of the way tech is transforming the care of type 1 diabetes

TOP 10

EXCELLENCE IN ACCIDENT AND EMERGENCY Listing the Top 10 NHS trusts performing above national averages for their A&E departments


While Brexit has formed a large part of the campaigning discussions, with the Prime Minister urging the country to back her ‘Theresa May’ campaign to ensure the best possible deal for the UK in EU negotiations, the NHS has regularly and rightly found itself as the main discussion point. Remember, it was only in January that the British Red Cross labelled the current NHS landscape as representing a ‘humanitarian crisis’. For all the talk of ‘strong and stable’ leadership, the health service has continued to crumble under overwhelming pressures and restricted funding. The winter crisis, the lack of spend on social care and missed waiting times exemplify the state of the NHS – in need of more money than any party has pledged. Whichever party is sitting in Whitehall as you receive this magazine has an uphill task on their hands. The Nuffield Trust recently argued that no major UK party has pledged enough to meet the NHS funding gap – a gap that, under current plans, will widen as the NHS faces the prospect of receiving less than half the money it needs to avoid getting worse over the next Parliament.

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Many people, I am sure, placed a vote for health on 8 June. Lets hope that it is recognised in the upcoming months by a government prepared to necessarily fund our NHS and prevent the current situation getting worse.

Michael Lyons, 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:


226 High Rd, Loughton, Essex IG10 1ET. Tel: 020 8532 0055 Fax: 020 8532 0066 Web: www.psi-media.co.uk EDITOR Michael Lyons ASSISTANT EDITOR Rachel Brooks PRODUCTION EDITOR Richard Gooding PRODUCTION DESIGN Jo Golding PRODUCTION CONTROL Ella Sawtell, Jo Sharrard WEBSITE PRODUCTION Victoria Casey ADVERTISEMENT SALES Jeremy Cox, Jake Deadman, Spencer Freedman, Yanina Stachura, Terry Edwards, Lucy Rowland, Damien Ennins ADMINISTRATION Vickie Hopkins, Charlotte Casey PUBLISHER Karen Hopps REPRODUCTION & PRINT Argent Media

© 2017 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 1478-7687

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Returning retirees could cost NHS £500m a year; NHS faces £20bn funding hole; and pressures force cancelled children’s ops

10 HB TOP 10

With news that the majority of NHS A&E departments are failing to meet four hour waiting time targets and research showing significant variation across trusts, Health Business takes a closer look at those departments which are performing best in our June Top 10 list


The Community Transport Association’s James Coe discusses the benefits of pursuing a ‘Total Transport’ approach to non-emergency patient transport, following the association’s recent report on the topic



Elisabetta Zanon, director of the NHS European Office, reflects upon the NHS Confederation’s Mental Health Network annual conference in March, and the likely impact of Brexit upon mental health services in the UK


Youth has the worst access of any group to mental health services, yet there are thousands of resources in the digital world alone for mental health. Brian Runciman, part of BCS, The Chartered Institute for IT, examines the relationship between IT and mental health services



There is no better health condition for illustrating the power of technology than type 1 diabetes. Here, Ben Moody, head of health and social care at techUK analyses the self-management of diabetes, as well as how technology is advancing wider NHS care



With the NHS recently being the target of a large scale cyber attack, James Kelly, of the British Security Industry Association, discusses some of the key considerations when securing information destruction services



The latest figures from NHS Improvement indicate that ‘agency controls’ have saved the NHS an impressive £1 billion since they were introduced in October 2015. In this article, Nick Bowles focuses upon the UK’s impending withdrawal from the EU and its potential to change NHS recruitment


Broadmoor Hospital is one of three high secure mental health facilities in England. Due to open later this year, Health Business looks at the importance of developing and providing secure facilities to offer the best mental health care and how the refurbishment project has developed

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Temporary or modular buildings are proving to be the healthy choice for hospitals looking to quickly overcome problems relating to peak-time demand. Jackie Maginnis, of the MPBA, investigates the popularity of temporary or modular buildings in healthcare


The Asbestos Removal Contractors Association look at the occupational handling and removal of asbestos materials in the NHS, as well as outlining how the association’s audit scheme provides the necessary reassurance to it’s members


Hospitals can be very large and complex buildings that pose more fire risks than other environments. The Fire Industry Association analyses the risks and steps to take to ensure safety


The Sustainable Development Unit were among a number of health organisations to feature in a report from Health Care Without Harm. Health Business looks at best practice in reducing the NHS’ climate footprint, as well as listing the 2017 winners at the NHS Sustainability Awards


Health Business investigates the main talking points leading up to this month’s Health+Care, mainly concerning STPs, which feature heavily in the show’s Keynote Theatre


The challenges we face in health and social care are a direct result of the success in supporting people with complex health conditions to live longer. Nadra Ahmed, chairman of the National Care Association, discusses health and care integration and the current unsustainable solutions to ongoing challenges


The Copper Development Association highlights some of the most interesting findings of a recent paper published in the Internal Medicine Review, which looked at the efficacy of antimicrobial copper in contributing to more hygienic hospital environments. Plus a look at the Infection Prevention Conference


The naturally compromised immune systems of many patients in hospitals increases the risk posed by the Legionella bacteria. Health Business explores how hospitals can mitigate against the threat


With a number of large retailers agreeing to cut the proportion of sugary drinks they sell in their hospital shops in England, Health Business looks at the measures in place to limit sugar intake in hospitals


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NHS faces £20bn funding hole

Returning retirees could cost NHS £500m a year A new report by the Nuffield Trust has warned that the NHS could face an extra annual bill of £500 million if retired British citizens living in Europe return to the UK for care post-Brexit. Currently, there is a scheme whereby the 190,000 British pensioners now living in Europe get their healthcare costs paid as part of the S1 scheme. If the scheme were to end, it is estimated it would cost £979 million annually – instead of the £500 million the UK pays into the S1 scheme at present. Moreover, if all of these pensioners decided to return to the UK, the report predicts that

the NHS would need 900 additional NHS hospital beds a year in order to treat them, as well as approximately 1,600 more doctors, nurses and other workers to provide the care. Additionally, as has widely been reported, there could be a shortage of 20,000 nurses by 2025/26 if migration from the EU is limited, while the cost of medicine could rise, potentially to £100 million, if the UK were to leave the European medicines licensing system. READ MORE:



NHS planning to delay or cancel spending The King’s Fund’s latest quarterly monitoring report has revealed that the NHS is now planning to delay or cancel spending in half of local areas this year to meet financial targets. How is the NHS performing? finds that 50 per cent of clinical commissioning group (CCG) finance leads say that achieving this year’s financial forecast is likely to depend on delaying or cancelling spending, while over 40 per cent say they plan to review or reduce the level of planned treatment they commission following the recent downgrading of the 18-week referral-to-treatment target. NHS finances improved over the last quarter of 2016/17, but the report warns that ‘the underlying financial position

remains gloomy’, with the 2017/18 financial year promising to be another difficult one for the NHS. 43 per cent of trust finance directors expect to overspend their budget and a similar 46 per cent expressed concern about meeting financial targets. The report also highlighted an improvement in A&E performance, with 90 per cent of patients admitted, transferred or discharged within four hours. However, only nine per cent of finance directors believe that the NHS will meet the commitment that 90 per cent of patients will spend no longer than four hours in A&E by September 2017. READ MORE:


Three leading think tanks have argued that the NHS faces a £20 billion funding hole, no matter which political party wins the General Election. Writing to The Times, the King’s Fund, Nuffield Trust and Health Foundation urge political parties to establish a long-term answer to rising health spending or be forced into wasteful emergency bailouts. They argue that, under current plans, the NHS will receive less than half the money it needs to avoid getting worse over the next Parliament. Projections by the Office for Budget Responsibility (OBR) suggest that the ageing population, rising cost of new drugs and other pressures mean the NHS will need £155 billion a year to maintain services, with analysis of party manifestos showing that figures fall short for the Conservatives, Labour and Liberal Democrats. The three groups also warn that services will worsen and patients will wait longer and be denied new drugs because no political party is offering enough for the NHS to cope with an ageing Britain. READ MORE:



NHS advised to ‘think the unthinkable’ on cuts The Health Service Journal (HSJ) has reported that parts of the NHS in England are considering ‘savage’ cuts in a bid to meet financial targets. Senior managers and officials from NHS England and NHS Improvement and health managers in 14 areas of the country with the highest overspends are discussing measures, with the regions told to draw up radical plans to reduce overspending, including controversial and unpopular measures such as closures of maternity and Accident & Emergency departments. The 14 areas under particular pressure, reported to be on course to miss agreed ‘overdraft limits’, are: Bristol, South Gloucestershire and North Somerset; Cambridgeshire and Peterborough; Cheshire (Eastern, Vale Royal and South); Cornwall; Devon; Morecambe Bay; Northumbria; North Central London; North Lincolnshire; North West London; South East London; Staffordshire; Surrey and Sussex; Vale of York and Scarborough and Ryedale.





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GP waiting times set to ‘rocket’ A new study has found that soaring demand will mean the average waiting time for patients to see their doctors will ‘rocket’ in the coming years. The survey of 830 GPs found that waiting times for a routine appointment is approximately 13 days, which is up from 10 days in 2015. With GPs predicted to have to

spend four hours a week longer seeing patients by 2022 just to keep pace with demand, British medics predict times could get worse. Chaand Nagpaul, BMA GPs committee chair, said: “Unless the government takes decisive action, waits to see a GP will rocket to several weeks in the coming years as patient demand continues to rise,

and will seriously compromise patient care. The government needs to urgently stem inappropriate demands on general practice when it has determined that one in four GP appointments are avoidable.” READ MORE: tinyurl.com/y8ffufqz



NHS pressures force cancelled children’s ops

Infection prevention cuts threatening patient safety

NHS figures have revealed that thousands of children’s operations are being cancelled each year as a result of bed, staff and equipment shortages. The data shows that 46,211 operations have been cancelled over the last four years, with 12,349 surgeries on children and young people cancelled during 2016-17 alone. The figure for 2016-17 is 35 per cent higher than the 2013-14 figure of 9,128, highlighting the rising pressure on NHS staff and facilities. The figures, which were obtained by Labour under freedom of information requests, are believed to be higher than the above figures, as they only cover approximately half of England’s 153 acute hospital trusts.

Cancellations were the result of the unavailability of equipment, or indeed equipment failures, as well as unavailable surgeons or anaesthetists. Other hospitals cited a lack of either intensive care or high-dependency beds in which to care for children after their operation, as well as overbooking lists and lack of their time. Labour’s Shadow Health Secretary, Jon Ashworth, said the figures were ‘an absolute damning indictment of the Conservatives’ neglect of the NHS’, emphasising the ‘unnecessary stress’ for ‘entirely unavoidable reasons’. READ MORE: tinyurl.com/yd2u2cco

Following a poll of its members, the Infection Prevention Society (IPS) is urging health providers to maintain investment in infection prevention and control (IPC) teams to prevent serious risk to patient safety. It is estimated that 300,000 patients a year in England acquire a healthcare-associated infection as a result of care within the NHS, annually costing the NHS at least £1 billion. The poll found that 30 per cent of professionals working in infection prevention and control have witnessed a reduction in the IPC services where they work. Moreover, 28 per cent reported a reduction in IPC posts or hours, meaning that 35 per cent have been asked to do additional non IPC responsibilities as part of their job. Additionally, 29 per cent of members polled stated that their most pressing concern associated with this was ‘serious risk to patient safety through infection spread’, while nine per cent highlighted ‘not being able to meet new national requirements such as E.coli targets in England’ as the main concern. READ MORE: tinyurl.com/y8sg672s


Long surgery waits ‘have tripled in four years’ The Royal College of Surgeons (RCS) has warned that the number of patients waiting six months or more for surgery has tripled over the past four years. NHS data has shown that, despite nine out of 10 patients still treated within 18 weeks, approximately 130,000 people had been waiting for operations after being referred to a consultant in March this year, compared to 45,000 in March 2013. Additionally, figures show that nearly 20,000 people had been waiting for more

than nine months for surgery in March, three times more than in the same month of 2013. The average waiting time for planned surgery is now just over six weeks, with 90.3 per cent of patients treated in under 18 weeks. While NHS England state that it had cut the number of patients waiting more than a year for treatment by nearly 13,000 over the past five years, its chief executive Simon Stevens has reiterated earlier this year that unprecedented pressures means that it

could no longer guarantee treatment within the 18-week target time for operations such as knee and hip replacements. The RCS says this is resulting in more people waiting for six to nine months or more for surgery, in specialities such as ear, nose and throat, brain and spinal, and general surgery, with the biggest increases in waiting times happening in dermatology and gynaecology. READ MORE: tinyurl.com/y99evjxd



HB Top 10



HB Top 10: assessing success in A&E services With news that the majority of NHS A&E departments are failing to meet four hour waiting time targets and research showing significant variation across trusts, Health Business takes a closer look at those departments which are performing best



In January this year, the National Audit Office (NAO) cautioned that emergency hospital staff were finding it increasingly difficult to cope amid unprecedented, rising demand, the recruitment crisis and wider NHS pressures. The NAO review examined ambulance performances in England and outlined that the majority of ambulance services were not meeting the eight-minute target. It also highlighted that while the rise in demand had risen by 30 per cent over four years, the correlating rise in budget has only been 16 per cent over the same period. In addition to this, the Royal College of Paramedics (RCP) warned in April that the number of times hospital A&E units in England had to close their doors to ambulances almost doubled in the 2016-17 winter , when compared with the previous three. Citing research from the Nuffield Trust, Winter Insight 3: The Ambulance Service indicated that in the last five years, the number of category A calls (the most serious) resulting in an ambulance arriving at the scene of an incident has increased by 7.4 per cent year on year (from 2.5 million in 2011/12 to 3.3 million in 2015/16) – whereas over the same period there has been an average annual increase of 2.1 per cent in the number of emergency admissions to hospital, and a 1.6 per cent average annual increase in the number of attendances at A&E. The report revealed that the three main urgent response time targets have been met in only six out of the last 49 months, and none have been met since May 2015. The most recent figures published, covering January this year, show that just 67 per cent of ‘Red 1’ calls for ambulances (which include those for cardiac arrest patients who are not breathing and do not have a pulse), and only 58 per cent of Red 2 calls (which are serious, but less immediately time-critical), received a response within eight minutes – significantly off the target of 75 per cent. The HB Top 10 A&E list has been compiled through analysis of released NHS England data covering A&E performance for the first quarter of 2017. Trusts with a major A&E department were ranked based on their ability to meet the four hour target standard, examination of innovative A&E-specific schemes and Care Quality Commission (CQC) rankings. Among the number of trusts failing to meet targets, these organisations have exceeded expectations and performed admirably, despite the rising pressures that hinder their performance levels.


Luton and Dunstable University Hospital NHS Foundation Trust

98.5 per cent of 24,882 CQC: good/outstanding June 2016 Ranked top of the list, (and officially top performer in the country) Luton and Dunstable

University Hospital NHS Foundation Trust saw 98.5 per cent of the 24,882 patients which visited it‘s A&E in the first quarter of 2017 within the four-hour time period. According to the trust’s latest CQC report: “Visionary leadership from the board to all areas of Emergency Department (ED) resulted in the ownership of the emergency pathway throughout the hospital. The leadership team in ED over the past five years had transformed the service from one of the worst performing ED’s in the country, to one of best performing nationally. This significant improvement in performance, despite a continuing rise in year on year attendances, had been recognised at a national level by senior NHS and government leaders. “During 2015/16, more than 98 per cent of patients attending the ED completed their care within four hours, against a national target of 95 per cent. This has been achieved at a time when the hospital has experienced its highest number of attendances ever, with the ED now seeing more than 300 people a day.” Mr David Kirby, operational medical director, at Luton and Dunstable also confirmed that the trust has secured planning permission for a helipad as part of its emergency service offering, commenting that it was ‘another step towards the site’s redevelopment’ that will see ‘critically unwell patients receiving the life-saving treatment they need, faster’. tinyurl.com/ybbrbavq


Sheffield Children’s NHS Foundation Trust 97.1 per cent of 14,331 CQC: good/good, October 2016

In second place, Sheffield Children’s NHS Foundation Trust saw an impressive 97.1 per cent of A&E visitors within the target four hour time. Furthermore, the trust’s latest CQC report praised: “The care and commitment provided in the A&E department was found to be excellent and the trust had consistently met the A&E four hour target for the previous 12 months.” It also extolled the department’s drive ‘to deliver care closer to home and reduce unnecessary admissions’. In an interview with the Nursing Times, Sally Shearer, director of nursing and quality at the trust, spoke about how the trust has worked with the University of Sheffield to develop an advanced nurse practitioner course, aimed at supporting A&E and other areas. The hospital carried out a modelling exercise to look at patterns in A&E attendance and patient flow in Sheffield Children’s Hospital’s A&E. The exercise informed the trust with an understanding of how many children and young people come through the door, where they are coming from, what conditions they are presenting with, their age group and other necessary details. The

HB Top 10


advanced practitioner roles enable specialist individuals to work in ED, granting a range of skills in the department ‘so when a child comes through the door they can be directed to the person best suited to help them’. tinyurl.com/ydewe6gx


Birmingham Women’s and Children NHS Foundation Trust

96.1 per cent of 15,448 CQC: outstanding/ good, February 2017 Following up in third place, Birmingham Women’s and Children NHS Foundation Trust achieved a noteworthy 96.1 per cent of A&E visits seen within four hours. Over 270,600 patients visit the hospital each year, including over 53,000 ED patients, 175,000 outpatients and approximately 44,000 inpatient admissions. According to the trust’s latest CQC report, inspectors noted how kind, caring and compassionate staff were towards children, young people, and their families. It also applauded the hospital’s use of an admission avoidance board, which updated attendees about alternative support available to them in the community which could mean they were seen quicker elsewhere. The trust also piloted a service with the aim to reduce readmissions to the hospital, by having health visitors conduct follow-up calls to patients who had been discharged from ED. tinyurl.com/yddypc4r


Alder Hey Children’s NHS Foundation Trust 96.7 per cent of 14,714 CQC: good/good, December 2015

Alder Hey Children’s Hospital has the biggest and busiest ED in Europe, seeing around 60,000 children and young people each year. In 2015, the casualty unit was rebuilt at a cost of £237 million. The new hospital building contains 270 beds and 16 operating theatres across five storeys. The A&E department is staffed by 11 nurses and between six and 10 doctors at any given time. During its first 24 hours of operation, the trust took in took in 159 patients – including three major trauma patients. The design of the new A&E means each child now has their own room with a plasma screen, providing access to Alder Hey TV. There is also a multi-sensory room for children with autism. Other features of the new hospital include an indoor treehouse, outside play decks for the six wards, and a relaxation garden. Patient waiting areas also have interactive screens for patients and families to use. tinyurl.com/y72qsk2a !



HB Top 10




Gateshead Health NHS Foundation Trust 95 per cent of 21, 434 CQC: good/good

The design of the Emergency Care Centre at Gateshead Health NHS Foundation Trust was recognised by NHS England as a best practice model providing a single point of access for emergency care. As part of the North East Urgent Care Network, the trust was involved in the northern regional whole-system transformation vanguard for urgent care. The planned outcomes were to create and implement one urgent and emergency care model providing consistent care, wherever patients presented with no difference in the clinical outcomes delivered. The £32 million newly built A&E facility, which opened in August, won the Infrastructure accolade at the 2015 Royal Institution of Chartered Surveyors’ (RICS) Awards Grand Final for ‘heralding a new era in medical design’. The facility combines the traditional A&E, walk-in centre, medical and surgical assessment and urgent children’s services all under one roof. This means trauma patients do not need to be moved around a large hospital site for the various tests by different departments, as they can all be carried out in a single, dedicated unit. The panel extolled: “It brings together all the medical facilities required to treat patients during an emergency into a single bright modern building that is also welcoming. All of this, coupled with the latest wireless technologies, which streamline patient flow, make it an outstanding winner by far which will greatly benefit the Gateshead community and surrounding areas for generations to come.” tinyurl.com/ya9g3akr


South Warwickshire NHS Foundation Trust

95.3 per cent of 15,172 CQC: requires improvement/ A&E ‘good’ at Warwick hospital, March 2017 In its CQC report, South Warwickshire NHS Foundation Trust was noted for ED specific areas of outstanding practice, including its use of reminiscence therapy for patients with learning disabilities, dementia and mental health conditions. The ED staff also worked with external agencies to provide services, including substance misuse liaison specialist support for patients and consistently exceeded standards in terms of the amount of time people spent in the department waiting for treatment. The amount of people waiting four to twelve hours from the decision to admit until being admitted



Ranked top of the list, Luton and Dunstable University Hospital NHS Foundation Trust saw 98.5 per cent of the 24,882 patients which visited it’s A&E in the first quarter of 2017 within the four-hour time period was consistently lower than the national average, with no patients waiting over 12 hours for admission between September 2014 and August 2015. This meant that patients could access services in a timely way. Responding to the praise, Glen Burley, chief executive, said: “We employ some of the best clinicians in the country and are extremely proud of the services that we deliver across Warwickshire and of our teams that provide them. After reviewing the CQC report from our inspection in March it highlights a number of very positive findings, rating us ‘good’ or ‘outstanding’ in 46 out of 59 categories. “The report confirms that we have been recognised nationally in many areas, in particular our work within A&E and urgent care to improve patient flow where we are now providing support and advice to other organisations to help them improve safety. The CQC has reported that our culture is positive and open with excellent staff survey results and patient feedback. There were only three recommendations that the CQC highlighted as important and these have all been addressed. We have requested a re-inspection at the earliest convenience with a different inspection team.” tinyurl.com/ycv6ulqy


Western Sussex Hospitals NHS Foundation Trust

93.6 per cent of 31,6444 CQC: outstanding/ outstanding, April 2016 Western Sussex Hospitals NHS Foundation Trust achieved a noteworthy overall rating of outstanding and an outstanding rank for emergency services for its A&E departments at St Richard’s Hospital and Worthing Hospital. Last year (April 2016), A&Es in Worthing and Chichester were ranked fourth in the country in terms of A&E performance, seeing 96 per cent of people within four hours. The CQC report commended: “The trust had programmes of work to improve patient flow through the hospital. The hospital met the national target of seeing, treating, admitting or discharging 95 per cent of patients within four hours, ending the year in the top 20 trusts in the country.” Chairman Mike Viggers said: “Achieving 96 per cent against a back drop of ever-increasing demand for our emergency services is truly impressive and credit

must be given to all the trust’s staff in every department who work so hard to prioritise high-quality care for patients.” Marianne Griffiths, chief executive, said: “Our staff have worked incredibly hard to achieve this hugely impressive result, this year helping more patients than ever before. Across the country, 2015/16 has been probably the worst ever year for A&E performance with the national average falling below 85 per cent, so we are immensely proud of the exceptional standards we continue to provide to the people we serve. tinyurl.com/ybahxjsa


Ipswich Hospital NHS Trust 89.2 per cent of 20,587 CQC: good/outstanding, April 2015

Rated good overall and outstanding for its provision of urgent and emergency services, the CQC recognised an ‘open culture for quality improvement’ at Ipswich Hospital. The Emergency Therapy Team (ETT) at the trust has extended it service from 8am to 8pm fo 365 days-a-year to prevent unnecessary hospital admissions while helping to successfully discharge those who have received care and are clinically fit to go home. The ETT team is one of only a handful nationally to offer extended hours, and has recruited additional staff to help provide the service. Team members will assess patients promptly after they arrive at hospital and provide any therapy they may need or arrange specialist equipment, such as walking aids, to allow them to return home as soon as they are clinically fit, in turn avoiding an admission to the wards. If a patient does need ongoing hospital care, the team will make sure they go to the right ward to best meet their needs. The expansion comes after figures show the therapy team completed 7,213 patient assessments between October 2015 and September 2016. Of these: an admission was avoided in 79 per cent of cases referred to the team from ED, the fracture clinic and Brantham Assessment Unit; 93 per cent of FAB patients seen by the team avoided an admission; and 19 per cent of patients seen by the team in the EAU were assessed and discharged the same day. Hannah Lord-Vince, team lead, said earlier this year: “The ETT has been a great success since its launch in 2010, and is helping

patients to return home more quickly every single week. We are delighted that we will become one of the first hospitals in the country to offer extended hours when the service expands on 1 April, which means we will be able to help even more people to avoid a hospital admission.” tinyurl.com/y8dn5fxv


South Tees Hospitals NHS Foundation Trust 94.1 per cent of 29,116 CQC: good/good, October 2016

The A&E department at The James Cook University Hospital, part of South Tees Hospitals NHS Foundation Trust, has around 2,000 patients a week coming through its doors. The trust has recently launched a new ‘navigational’ model which will direct patients away from A&E in a bid to focus resources on those in need of urgent care. The model aims to change the way people access emergency care so that the ED can focus on those patients with life threatening illnesses or injuries who really need their help and expertise – which is what the ED is really for. Keir Rumins, Emergency Department Matron, said: “Patients often come to the ED because they don’t know the best place

to go for treatment, or they may feel their symptoms can only be treated at hospital.” Dr Janet Walker, chair of South Tees Clinical Commissioning Group, which supports the scheme, said: “During our public urgent care consultation around the changes to urgent care services, it was a common response that A&E should be used by the sickest patients and that those with minor conditions should be treated elsewhere. The navigation model allows senior nurses to identify those patients with minor ailments that can be directed to primary care to have their needs met. Patients will be educated about which service best meets their needs, and how best to access help in the future.” tinyurl.com/ybu6ewx2


Northumbria Healthcare NHS Foundation Trust 92.3 per cent of 23,480 CQC: outstanding/good, May 2016

Last Summer, Northumbria NHS Foundation Trust published a ‘One Year On’ update on the improvements achieved thanks to its new model of emergency care. The Northumbria Specialist Emergency Care Hospital is now the largest receiving ED in the north east and the centralisation of

HB Top 10


care has resulted in a 15 per cent overall increase in urgent and emergency care activity, with over 150,000 attendances across both the Northumbria hospital and at 24/7 Urgent Care Centres in Hexham, North Tyneside and Wansbeck hospitals. The move has also contributed to a 14 per cent reduction in emergency admissions to hospital with almost 7,500 less people being admitted, resulting in a £6 million saving for the local health economy. The news came at the same time as the CQC 2015 Survey, released in June 2016, which found patients had rated Northumberland and North Tyneside as among the best in the country. Annie Laverty, director of patient experience at Northumbria Healthcare NHS Foundation Trust, said: “These national results are truly excellent and further demonstrates that here at Northumbria our patients experience compassionate care delivered by dedicated, caring staff in first-class environments. While we have consistently performed well in national surveys, the changes we have made to transform emergency care last year have had a huge positive impact on patient experience and led to significant improvements in our results.” tinyurl.com/y6vuutdk !

The RCP warned in April that the number of times hospital A&E units in England had to close their doors to ambulances almost doubled in the 2016-17 winter compared with figures from the previous three years



Patient Transport Written by James Coe, policy and public affairs executive, Community Transport Association



Delivering non-emergency patient transport

James Coe, policy and public affairs executive at the Community Transport Association, discusses the benefits of pursuing a ‘Total Transport’ approach to non-emergency patient transport The Community Transport Association’s (CTA) and Urban Transport Group’s latest paper, Total Transport: A Better Approach to Commissioning Non-Emergency Patient Transport, shows that by taking a ‘Total Transport’ approach to non-emergency patient transport (NEPT), the NHS could save millions through better commissioning practices, and patients could receive more suitable transport to and from health settings. The CTA is a national charity working with over 1,600 charities and community groups across the UK that all provide local transport services that fulfil a social purpose and community benefit. Community transport is about providing flexible and accessible community-led solutions in response to unmet local transport needs, and often represents the only means of transport for many vulnerable and isolated people. Every year, at least £150 million is provided by the NHS to individual local clinical commissioning groups to provide NEPT. These journeys are commissioned by NHS trusts or Clinical Commissioning Groups (CCGs) who tender services to a mixture of private providers, in-house fleets, and not-for-profit transport providers such as community transport operators. NEPT services provide eligible patients who require non-urgent and planned treatment with free transport to an NHS site. It is intended for patients where medical


or mobility needs mean that it would be detrimental to their condition or recovery if they were to travel by other means. This may be, for example, because they need staff support during or after the journey or because their level of mobility means they would be otherwise unable to access healthcare. TOTAL TRANSPORT CTA’s own surveying found that 74 per cent of community transport operators in England worked in providing transport to health settings but only 24 per cent were remunerated by any local NHS body. Moreover, funding is vital for all charities but often community transport operators feel a lack of recognition of the work that community transport does within this area which is of equal concern. CTA is aware that much of their members work will be off the radar of health service commissioners, evidenced by this disconnect between

the number of charities helping people to reach health settings and those that are remunerated or recognised for the work. This is also an indication that hospital transport services are not being coordinated in a way that makes the most of the plurality of patient transport provision. There is no set model or scale for taking a Total Transport approach to NEPT. Some local authorities and CCGs are exploring retain separate fleets but coordinating services centrally through a joint booking line. Other models aim to fully integrate their fleets and budgets into a shared pool. Ultimately, the model selected should fit local circumstances, taking account of where NEPT is coordinated and who manages the NEPT budget. At its heart Total Transport involves working across different areas of public policy and spending divides to deliver better outcomes for communities and taxpayers through the sharing of resources and expertise. This is why CTA wanted to champion the importance of community transport and those members who are already delivering more efficient use of vehicles, which not only provide a better experience for patients but are making significant savings to the public purse. Total Transport: A Better Approach to Commissioning Non-Emergency Patient Transport? examines how NEPT is currently commissioned and how a Total Transport approach could lead to improvements in efficiency, value for money and passenger experience.

nity Commu rt is transpo viding ro about pd accessible an flexible munity-led e com n respons si solutionnmet local to u rt transpo need

CTA hopes this briefing is used as a tool for community transport operators across the country to discuss how they can play a role in delivering NEPT in their area. In addition, it’s hoped that this report will start new conversations on how CCGs can engage with a broader plurality of providers in commissioning patient transport. CTA believe that patient transport can be commissioned more effectively through a number of steps. A more coordinated, cross sector Total Transport approach to the provision of patient transport could help ensure that patients are provided with vehicles suited to their needs; that fleets owned or commissioned by the public sector are fully utilised; and that patients get to and from where they need to be in a timely manner. Applying this model to health, Total Transport would see multiple fleets brought together in a shared pool (and potentially a single budget,) and under a single point of access. These services would be commissioned centrally, allowing them to be coordinated with appointment times, ensuring the right vehicle is deployed, and down time is better used. Directly involving local authorities in NEPT could help bring a wealth of expertise and experience to its delivery. Indeed, whilst it is usually commissioned by the NHS, NEPT has more in common with the social care transport commissioned by local authorities or with community transport than it does with emergency ambulances.

improved through more innovative models of commissioning delivery which build cross-sector partnerships and networks of provision where people are transported in a vehicle and service most appropriate to their own circumstances and needs. Community transport’s contribution to the health service, however, is about much more than helping manage demand and capacity. It is about giving people who are already feeling anxious one less thing to worry about through a service they trust and is more personal to

them, meaning care starts at the front door of their home and not the waiting room. CTA will shortly be publishing another paper which looks in greater depth at innovations in provision and exploring ideas for creating a stronger role for community transport organisations within patient transport services. !

Patient Transport


FURTHER INFORMATION www.ctauk.org/UserFiles/Documents/ UTGCTATotalTransportReport.pdf

Non-emergency patient transport is intended for patients where medical or mobility needs mean that it would be detrimental to their condition or recovery if they were to travel by other means

SERVICE INTEGRATION This paper estimates that a more integrated transport service which prevented only 10 per cent of the 5.6 million missed hospital appointments each year could save the NHS £74.5 million per year. This is the equivalent of; 83 new MRI scanners; 8,793 heart bypasses; or 13, 252 hip replacements. Despite some of the difficulties in adopting a new approach to transport commissioning, there have already been some benefits realised in NEPT provision. There has been a number of Total Transport pilots and a number of long-standing integrated transport schemes, which means there is now a growing bank of good practice and experience to draw upon which should assist in overcoming many of the challenges identified. In particular, there are already examples of the great work community transport does in health. For example, North Herts CVS recently expanded their services to take over the voluntary car scheme at their local NHS Trust, Lister Hospital, in Stevenage. They doubled their number of drivers, and saw a massive increase in demand with 900 new service users registering with them last year. This is just one example of what can be achieved when services are integrated, and the appropriate service providers are in place to offer NEPT. The quality and efficiency of health related transport could be markedly



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Written by Elisabetta Zanon, director, NHS European Office

The impact of Brexit on mental health services Elisabetta Zanon, of the NHS European Office, reflects upon the NHS Confederation’s Mental Health Network annual conference in March, and the potential impact of Brexit upon mental health services

The potential impact of leaving the EU on mental health services was one of the key topics discussed at the NHS Confederation’s Mental Health Network annual conference in March. With the conference taking place just days before the Article 50 leaving procedure was triggered by the UK, it was no surprise that mental health leaders wanted to reflect on what the changes ahead will mean for services in their sector. While a range of potential implications on mental health were discussed, there are three key areas of impact which were particularly emphasised during the event. THE STAFFING CHALLENGE The NHS reliance on overseas workers is well known, with data from NHS Digital showing that, as at September 2016, the NHS workforce in England included almost 60,000 staff with an EU nationality. This includes over 10,000 doctors (the equivalent of around nine per cent of NHS physicians) and approximately 20,000 nurses and health visitors. Our reliance on the EU workforce has increased in the last few years, probably due to the tightening of UK immigration policy on non-EU workers, with NHS trusts in London and the South East, as well as some medical specialties, being particularly dependent on EU staff. More specifically for psychiatry, data from the General

Medical Council shows that around 13 per cent of the psychiatric consultants on the Specialist Register qualified in the EU/EEA. The adult social care sector is also highly dependent on the EU workforce, with approximately six per cent of their staff in England being non-UK EU nationals. If we take health and social care together there are over 160,000 EU nationals working in the combined sector in England, with additional staff working in services in Northern Ireland, Wales and Scotland. While we welcome the recent announcement that more healthcare professionals will be trained domestically from now on, we are also aware that workforce planning is an inexact science and that it takes at least seven years to train a doctor and up to 12 years to train a consultant. Mental health services face a particular challenge of shortage of personnel, including psychiatrists. Between 2012 and 2015,

Mental Health


psychiatry saw a drop of 10 per cent in the number of doctors in training in the UK. Furthermore, over a third (41 per cent) of psychiatrists in training were non-UK graduates, the highest proportion of any medical specialist training programme. In 2016, psychiatry increased its training place fill rate in England, but 20 per cent of places remain unfilled. Plans to reduce net migration to the UK and to control movement from the EU post-Brexit could therefore have a serious impact on the ability of ensuring a continuing ‘pipeline’ of staff to respond to the increasing demand of mental health services. Helpfully, under the leadership of NHS Employers, 35 health and care organisations have decided to join forces and have created a coalition to ensure that the sector has a strong voice throughout the Brexit negotiation. Called the Cavendish Coalition, the group’s aim is to secure that the health and social care sector will have the workforce required to deliver safe, high quality care across the UK after Brexit, by focusing on three priorities: advocating for certainty about ‘right to remain’ for EU staff already working in the sector; promoting future migration and employment policies which will enable !

The im of leavi pact EU on mng the en health servicetal s was discu NHS Co ssed at the nfe Mental deration’s Networ Health k confereannual nce



Mental Health



A recent survey by the Chartered Management Institute found a steep rise in the number of those saying that they are more stressed than a year ago, specifically mentioning the uncertainty generated by Brexit as one of the reasons ! continued recruitment into the UK from the EU and beyond; and stimulating increased domestic recruitment and retention. The NHS Confederation’s Mental Health Network is a member of the Cavendish Coalition. RESEARCH AND ACCESS TO INNOVATIVE TREATMENTS With only around six per cent of the total UK health research spend going into mental health, it is left to the EU to fill the gap. The EU is the largest single funder of mental health research in Europe and one of the 10 largest funders globally, with, for example, the EU’s 7th Framework Programme for Research having invested €1.92 billion in brain research during 2007-12. The lack of understanding of the biological causes of mental health disorders is one of the reasons behind the dramatic slowdown in the development of new drugs to treat neuropsychiatric disorders, compared to physical illness, and



explains why it has been so important to join efforts at EU level to address the challenges in mental health research. With this in mind, it will be important to ensure that post-Brexit mental health clinicians and researchers in the UK maintain the ability to conduct joint collaborative research with leading EU counterparts, as well as ensuring that NHS mental health patients continue to have the opportunity to participate in EU-wide clinical studies on new treatments. With the UK expected to leave the European Medicines Agency’s regulatory system after Brexit, there is also uncertainty about which regime will apply in the UK in the future to govern the development and approval of new medicines. It will be crucial to ensure that NHS mental health patients will not be negatively affected by this and, in particular, that they will not suffer from delays in accessing innovative treatments which become available on the EU market in the future.

Access to innovative treatments could also be impacted by the risk of increased financial pressure on the health service in case supplies imported from the EU become more expensive due to a weak currency and the application of tariffs and custom controls in the future. PEOPLE’S MENTAL HEALTH AND WELL-BEING To many, the vote to leave the European Union came as a shock and has generated a feeling of insecurity, with several people worrying about the potential personal, economic, and political consequences of leaving the EU. This sense of anxiety is more acute for those citizens whose individual lives will be directly affected by the vote, and in particular the 3.2 million EU citizens living in the UK and the 1.2 million UK citizens living in the EU, who do not know whether they will be able to continue to live, work or study in the UK, or the EU respectively, after Brexit. Alongside this group of people who are directly and personally impacted by Brexit, there is a wider population group who worry about the possible consequences of leaving the EU’s internal market and the impact this could have on their economic activities and jobs in the future. A recent survey by the Chartered Management Institute of about 800 UK managers found a steep rise in the number of those saying

Brexit will happen at a time when the NHS is confronted with unprecedented financial and service pressures and has put in motion a programme of sustainability and transformation plans to adapt the way in which it delivers care that they are more stressed than a year ago, specifically mentioning the uncertainty generated by Brexit as one of the reasons. A climate of uncertainty, if perpetrated for a long period of time, could impact on the mental and physical health of people, potentially leading to an increase in demand of services. The analysis above shows that leaving the EU will have significant implications for mental health services and the wider NHS. Brexit will happen at a time when the NHS is confronted with unprecedented financial and service pressures and has put in motion a programme of sustainability and transformation plans to adapt the way in which it delivers care, which also embeds mental health services. With these challenges in mind, it will be critical to ensure that Brexit does not put in jeopardy the progress achieved so far by creating additional pressure and instability for our healthcare system.

equal footing, it is imperative to ensure that Brexit will not slow down efforts towards closing the parity of esteem gap. The NHS European Office will work closely with the NHS Confederation’s Mental Health Network in the coming months to further assess the implications of Brexit on NHS frontline services and help negotiators make sense of how leaving the EU would impact on mental health services and their users. ! FURTHER INFORMATION www.nhsconfed.org/europe


More important still, with significant progress accomplished in recent years to bring physical and mental health on an

Mental Health


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Digital Technology Written by Brian Runciman, BCS, The Chartered Institute for IT



Digital resources for mental health care There are thousands of resources in the digital world alone for mental health. Here, Brian Runciman examines the relationship between IT and mental health services It’s no secret, indeed it’s the motivation for a campaign platform for BCS, that healthcare provision and its relationship with technology is struggling. In May of this year, the Institute ran an event that asked whether the NHS can truly deliver person-centred care. That question is hugely important as the UK faces the challenges of the multidisciplinary nature of health and care. Primary, secondary and tertiary care very rarely join up well – even whilst each individual part can do a great job. The issues seem to be even more fraught in the mental health arena. Youth has the worst access of any group to mental health services. Yet, interestingly,

there are literally thousands of resources in the digital world alone for mental health. Entrepreneurs are stepping up to address existing problems, so what’s the problem in the NHS itself? As with any health service, the overall strategy for dealing with mental health issues includes parents, schools, youth workers and others, it’s not just about digital. Although digital is just part of a health provision landscape, however, there are rich resources out there. But for younger members of society facing mental health issues even this digital landscape appears to be letting them down. At the BCS Health Informatics Scotland conference in 2016, Dr

When tal en facing m ficultiest f i d h t l r hea ften staich o e l p o h pe ogle, wead o G h t i l w ley to is unlik to good them rces resou


Diane Pennington discussed empowerment for those with mental health issues. She presented with Dr Trevor Lakey, looking at the youth perspective, and set the context with a quote from the 2013 British Journal of Psychiatry, which showed, as mentioned above, that youth have the worst service access of any age group. With well over 10,000 apps in the mental health area, quantity is not the problem. It’s much more about understanding people’s lives and how they communicate and, of course, it’s about quality. One interesting motivator mentioned is that those with mental health issues often want to help their peers, as they are the first to find out friends’ problems. Some good exemplars cited were Ayemind, which aims to create a digital platform to support young people in mental well-being and create digital resources for it; and the Docready app, which is designed to help with a person’s first GP conversation on mental health. The Ayemind resource page includes a toolkit for workers, which covers all levels of experience, from basic knowledge to practitioner level information. The ongoing issues for trusts in this area are trend watching (keeping an eye open for new things to bring in), getting organisational policies usable, curating resources, developing staff (supporting workflow to include, for example, social media) and so on. FINDING GOOD RESOURCES Dr Pennington looked at the issue of finding good resources, as there is a very broad range and they are not always joined up. They vary very much in approach too

Digital Technology

– from pages of plain text describing depression, to interactive tests for anxiety and online chat services like Childline. One interesting approach mentioned was the personal stories from e-mental health charities like mindyourmind, which replaces ‘like’ buttons with ‘fistbumps’, uses videos from celebrities and interactive games (although, as Dr Pennington said, it can be difficult to engage people with these when competing against the production values of the likes of Call of Duty...). Facebook and Twitter can be good for personal stories too. All these things open up conversations and are often instigated by people who have been through the situation. In apps there are mood trackers, meditation apps, inspirational quote apps and more. Young people’s specific needs from mobile technology include safety, with the idea of confidentiality; avoiding cyberbullying and avoiding stigma. Then comes engagement, functionality, social interaction and accessibility issues. Women use these services more than men, but research shows that they are still not fully trusted. SEARCHING FOR HELP When facing mental health difficulties people often start with Google, using their own terms (for example, ‘life sucks’, ‘I want to die’), which won’t lead them to good resources. But even if a result returned is good, it still needs to be appropriately formatted. For example, if a result is too text heavy, people won’t read it – they are much more likely to view video, interact with forums, or even use light-hearted quizzes and the like. Another problem is that no-one looks past the first page of a search, which makes some negative resources easier to find. That could include pro-anorexia sites, and even sites that give suicide method

In May this year, a new campaign was launched to inspire those in a position to harness technology, to gather people working on health and care digital and bring them into a multi-disciplinary community recommendations. As Dr Pennington pointed out, ‘we can’t compete with what Google returns, so need to set up and encourage the finding of positive information’. In the BCS role of making IT good for society this raises some interesting questions about the moral role of algorithms and search engines, and those who design them. Can, or should, they continue to be agnostic about results in areas like this? A recent study on how online content makes us feel asked participants to search for things to make them feel better, and it showed that these searches are actually quite difficult to articulate. Explorathon 2016 asked people to search for feelings-oriented services or content, but the end result was that people tended to search for things they already knew would make them feel better – such as an uplifting song – rather than being able to do a search in more general terms that returned helpful results. There are clearly some excellent resources out there. The sheer number of them indicate that there is a need, and that those in IT are clearly trying to fill it. But there is still work to do. THE BIGGER PICTURE AND GETTING INVOLVED Beyond the issues of mental health, or the specifics of any one area of healthcare and its domain-specific issues are larger things that

need to be resolved – predominantly under that banner heading of ‘person-centred care.’ In May this year, a new campaign was launched to inspire those in a position to harness technology to put people and their communities first. It aims to gather people working on health and care digital and bring them into a multi-disciplinary community. That way it can help them to share ideas, good practice, and turn that into standards that they apply to themselves. Its objective is to unlock the potential of everyone involved in making health and care the best it can be, harnessing information and technology. It’s called Well Connected and is brought together by The Federation for Informatics Professionals in Health and Social Care (Fed-IP), organised by a coalition comprising of BCS, The Chartered Institute for IT, CILIP, IHRIM and Socitm. The pledge asks an individual to: actively promote and demonstrate their commitment to putting communities first in health and care, and to set an expectation that others do the same; seek to learn, develop and share what delivers the best health and care; not tolerate professional or organisational rivalries that conflict with what communities need; and play an active role in their own professional community, and multi-disciplinary communities that support these aims. ! FURTHER INFORMATION www.bcs.org/category/6044




Ben Moody, head of health and social care at techUK, analyses the self-management of diabetes, and how technology is advancing NHS care through the use of wearable technologies Given the myriad pressures on the NHS, the multi-billion pound P2020 digitisation project is understandably under increasing scrutiny. Issues such as waiting times, finance and staffing dominate the reasons that people give for dissatisfaction with the NHS and the temptation for politicians and public servants can be to focus on short-term gains in those areas. But investment in technology not only has the potential to improve health outcomes – it is also a vital part of the solution to those fundamental issues. I spent the best part of the 2010s (that decade with no name) working in diabetes

charities, most recently focusing on technology and the NHS for the type 1 diabetes (T1D) charity JDRF. There is perhaps no better health condition for illustrating the power of technology than T1D – so I’ll use that condition here to show how tech can help in a wide range of areas. For context – T1D has no known cause or cure. It often develops in children, sometimes before

they reach a year old, but diagnoses peak between the ages of 10 and 14. That said, more people get it over the age of 20 than below – Theresa May’s pancreas decided to stop producing insulin in her 50s. It’s a condition that can affect any one of us at any point and there’s nothing you can do about it. Once you have it you have to take insulin every day for the rest of your life, regularly measure glucose levels and carb count every meal. It has a great burden on !

Diabe UK esti tes that 99 mates of diab per cent self-maetes care is nag wearabement: technol le o be impogy can rtant


Written by Ben Moody, head of health and social care, techUK

How tech can revolutionise the patient experience

Digital Technology



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CFH Docmail cares about our NHS Going beyond the envelope to save you money... Shirley Priestnall is Head of Information within the Operational Delivery Unit at University Hospitals of Leicester NHS Trust. One of the busiest Trusts in the country with over one million outpatient attendances a year resulting in 80,000 appointment confirmations a month. Despite budgets being cut to the bone, by taking the step to outsource and use hybrid mail, Shirley was able to not only transform the efficiency and professionalism of the process but also save the Leicester NHS Trust £170k a year.

“We have the facility to tweak any template immediately. A change in personnel or the footer happens at the touch of a button. The on demand process removes the requirement to hold stock.

Shirley says, “Our admin system meant that letter would be printed at one of a number of printers and we risked picking up the wrong letter or a failure to print. The print was poor, the letter templates were very rigid, single sided and we couldn’t always say exactly what we wanted. The clinic location was so abbreviated that patients often got lost. It became the biggest source of complaints. With 1,000,000 patients attending every year the knock on effect was huge.

“Data is received 7 days per week. CFH process these files twice per day. Each letter is streamed to its despatch method based on the rule within the appointment date. If the appointment is within 8 working days, the letter is sent 1st class, same day. Monthly volumes are 65,000 letters.

“Window envelopes compromising patient confidentiality or the address could not be viewed properly. Staff were adding hand written details or corrections none of which looks professional and inspires patient confidence. Anecdotal evidence suggested that letters had not been received.” “The move to CFH Docmail has been transforming. “Outpatient appointment letters are requested on-demand as appointments are agreed during the working day. They are generated from the Trust’s Patient Administration System. Data is collected by the CFH Print Spooler which is located on the Leicester NHS server. “Letter templates have been re-developed using a limited number of letter types, with customisation rules to govern the detail of the content. The rules accommodate large print letters where patients have requested these and identify letters requiring Braille translation.

“We print dynamically on pre-printed base stock. Pre-printed map stock for the 3 hospitals means that each patient has a colour map with full directions. Leicester NHS has a bespoke envelope (one DSA and one 1st class). “The £170k a year we have saved has been on hard costs like paper, ink and post, the real saving when you take into consideration staff time and the reduction in inefficiencies is much greater. “The quality improvement both in terms of presentation and patient support has been considerable. “We also have the benefit of an excellent support team at CFH who anticipate and remind us of any decisions that need to be made.”

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! individuals, their families and the health service. So how can tech reduce this burden? QUICKER, MORE ACCURATE DIAGNOSES Let’s start at the beginning. If T1D isn’t discovered early it can lead to diabetic ketoacidosis (DKA). Harmful substances called ketones build up in the body, which can be life-threatening if not spotted and treated quickly. Yet type 1 diabetes is often misdiagnosed as type 2 diabetes or not diagnosed at all. In fact, 25 per cent of people with T1D are in a state of DKA at diagnosis, often rushed to hospital in an ambulance. Earlier diagnosis would get people on to insulin earlier and avoid DKA. Whilst no-one is advocating swapping qualified health professionals for robots, intelligent symptom checker apps can be easier to access and offer early warnings of what your symptoms could be. Groups that are known to be reluctant to visit doctors could be alerted to the likelihood of a more serious problem whilst simply using their mobile phone. Technology can also help to direct people to the right part of the health service, for faster diagnosis, reducing unnecessary tests and hospital time.

Digital Technology


In January 2015 NHS England reported that 91 per cent of patients are now registered with a practice that offers online booking, but only 6.5 per cent of patients actually use the service TRANSFORMING PATIENT SERVICES Technology has hugely improved the way that people transact with a whole range of services – reducing laborious tasks and environmental waste, providing quicker, better levels of service and allowing us to get on with more interesting things. The Nuffield Trust estimates that there are around a million consultations in General Practice every day. In January 2015, NHS England reported that 91 per cent of patients are now registered with a practice that offers online booking, but only 6.5 per cent of patients actually use the service. The cost of the patient and the professionals’ time in booking these appointments in person and over the phone – with confirmation letters posted afterwards – must be huge. For people with long-term conditions like

T1D this problem is exacerbated, due to the sheer number of healthcare professionals they will need to see. In any given year they are likely to pick up more than a dozen prescriptions, have any number of blood tests, have a review with a diabetes consultant up to four times a year, foot checks, a retinal scan and so on. For most people this involves a mess of paper, multiple visits, different institutions and no consideration of the effect on their ability to work/study/parent etc. The future iteration of NHS.UK should fix this. There are plans afoot for NHS.UK to become the one stop shop for health services that your online banking can be for your finances. A simple portal, backed up by scheduling software should allow more coordinated care, with appointments scheduled to fit in with life not the other way round. Changing "



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Whether distributing items inside the hospital campus or out into the wider CCG area, the logistics of moving and tracking items and samples are often problematic – yet crucial! Think hospitals – and you’re bound to conjure up the mental picture of doctors and nurses; ambulances and beds. But the smooth running of an NHS Trust is so much more. From property maintenance to parking, from catering to communications. To ensure that clinical staff have the appropriate support, data, supplies, products and services is a huge and critical component of healthcare delivery. Of good medical outcomes. And just as large corporate and logistics organisations have embraced the use of technology to become lean, to enhance efficiency and eliminate waste – so the NHS needs to follow that example in order to ‘balance the books’. Better record keeping, simpler and more accurate reporting and the replacement of paper records with digital data is the key. Take the process of courier services. Goods, chemicals, supplies, products and many other things are often delivered to a central trust store. For redistribution throughout the estate. It’s still common to see this carried out with handwritten documentation – later filed in ring-binders and stored on shelves. ENTER BARCODES – SAVING MONEY, IMPROVING ACCURACY A central facilitator of modernisation is the barcode. With a good database, one scan completes the transaction. And ensures a clear, unambiguous record is kept for swift interrogation later. A second pillar to move the NHS forward in the digital revolution is the capture of electronic digital signatures. Add GPS map coordinates and bingo! There is a factual record of what/who/where. That can be instantly interrogated to show proof of delivery. And good systems can instantly alert the watchful eye of management if distribution or collection tasks have not been completed in the planned timescale. In our private lives, we are all so used to ordering online, getting realtime updates pushed to our smartphone and having excellent, ever-improving logistics services. Live digital data, regardless of whether the distance is just down the road (think taxis or pizza deliveries), or a national distribution centre hundreds of miles away.



It’s 2017, there is no reason why the NHS should not make full use of similar technologies. Hundreds of sheets of paper records every day could be saved. Eliminating the need for storage. Cutting out the human element of filing and subsequent research when there’s a dispute about service levels. USING THE UBIQUITOUS SMARTPHONE Using smartphone technology, several trusts have already led the way. Working with Assistive Partner and their UNIQUS Dispatch logistics software, coupled with the UNIQUS GO mobile workforce app, available exclusively on Microsoft Windows phones. Use of the smartphone camera to scan barcodes. The phone’s screen and a finger to capture signatures of package or service recipients digitally. And the phone’s inbuilt GPS to track and record the location coordinates in realtime. All leading to live status reports on the whereabouts of vital hospital supplies or important pathology samples on their way to the laboratory. Even internal mail distribution can be managed and tracked using the same software tools. And why stop there? Assets can have a barcode added and their whereabouts or service requirements tracked and recorded easily. Performance data, proof of delivery and other critical management information such as volumes and day can be accessed and reported on in the blink of an eye. Providing clarity of a job well done. And peace of mind that effective, safe controls are being used in conjunction with

modern technology to ensure that the most efficient support services are in place. Enabling clinical staff to focus on patients. Without the worry and distraction of chasing ‘stuff’. EXTENSION OF USE TO COMMUNITY SUPPLIES Embracing commonplace technology need not be confined to hospitals. “The customers we have started to work with are already thinking about the benefits of using UNIQUS and the UNIQUS GO app more widely,” says Julian Cobbledick, director at Assistive Partner. “We have been involved in NHS viability studies of the positive impact these software tools have in ensuring accurate tracking of things like community clinical waste”. He went on: “Supplies to district nursing and continence teams are also coming under the microscope and are ideal candidates for efficiency gains”. In short, NHS support services are emerging from the 20th Century and realising there are benefits from the paperless digital revolution which we all take for granted elsewhere in our daily lives. Assistive Partner creates software for healthcare. Their software has featured in recent award winning customers for HFMA Costings and Excellence in Public Procurement. Their trusted UNIQUS software is in use by over 28,000 healthcare professionals throughout the UK. ! FURTHER INFORMATION www.assistivepartner.co.uk

PATIENT CARE ! appointments could be much easier, reducing the waste of countless letters and the wasted time of both patients and professionals. SUPPORTING SELF-MANAGEMENT Diabetes UK estimates that 99 per cent of diabetes care is self-management. For all of the talk about wearable devices, their application to the general public has largely been restricted to leisure and fitness. But for people with health conditions like T1D, wearable technology can be life changing. Wearables can be hugely important in helping people to manage their own condition, but people often struggle to get devices funded on the NHS. Insulin pumps have been around for more than 20 years but uptake in the UK is still much lower than in other countries. More recently, continuous glucose monitors such as the Dexcom G5 and Abbott Freestyle Libre have proved to be life changing for people with T1D, and there are more than 20,000 Britons self-funding the Libre alone. The Five Year Forward View is committed to ‘accelerating the quicker adoption of cost-effective innovation – both medicines and medtech’. Whist devices need to be assessed on their individual merits, the numbers of people willing to self-fund these devices at a cost in excess of £1,300 per year speaks volumes. And as companies like Medtronic and Big Foot Biomedical begin to link pumps and CGMs, combining them with algorithms that calculate the right dose of insulin at the right time, we are beginning to see the

Providing people with the digital tools to manage conditions like type 1 diabetes would help to establish a new, healthier and more affordable relationship between patients and the NHS true potential of type 1 technology – the automation of insulin delivery. These devices are just coming to market and could present the biggest advance in treatment since home blood glucose testing began. Peer support can also be of great value in helping people to self-manage their condition, without any cost to the health service. The vibrant online T1D community meet regularly online for ‘tweetchats’ and there are lots of regional Facebook groups. They share experience, advice and offer support. For a condition that affects roughly one in 160 of the UK population this can be extremely powerful as parents and children often won’t know anyone in the same school who shares their condition. THE POWER OF DATA The digitisation I have described – of diagnoses, interactions, devices and so – all produces a huge amount of data. This data can be extremely useful in improving care. Diagnoses data can be used to spot clusters and patterns. Data comparing interventions and outcomes can be used to plan care better. Data from an individual’s wearable device can greatly enrich the quality of an appointment with a Consultant. And all of this data can be useful for medical research.

Digital Technology


This all depends on the ability of data to be shared across different devices and care settings. techUK’s Interoperability Charter brings together more than a hundred NHS suppliers committed to principled data sharing and the benefits it can bring. We will continue to work closely with the NHS as it looks to make interoperability standard across NHS systems. AND ALL OF THIS WILL SAVE MONEY The real financial cost of long-term conditions like T1D comes from treating complications (including kidney failure, nerve damage, stroke, blindness and amputation). The cost of these complications, which are often avoidable, is expected to almost double by 2035. Providing people with the digital tools to manage conditions like T1D would help to establish a new, healthier and more affordable relationship between patients and the NHS. And by keeping people out of hospital it would also alleviate the waiting times, financial pressures and staff capacity issues that people describe as their main reasons for dissatisfaction with the NHS. " FURTHER INFORMATION www.techuk.org



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James Kelly, chief executive of the British Security Industry Association, discusses some of the key considerations when securing information destruction services With the NHS recently being the target of a large scale cyber attack, never has there been a more important time for healthcare professionals to consider the importance of information destruction. Last year, figures released by fraud prevention service Cifas showed worrying figures regarding identity fraud. The statistics, which came from 277 banks and businesses, revealed that there were nearly 173,000 recorded frauds in 2016, reported by the BBC as ‘the highest level since records began 13 years ago’. As such, this increasing risk of fraud means ensuring that patient and staff records, as well as financial documents, are destroyed securely, is an absolute necessity. Hospitals and other healthcare

establishments contain a wealth of valuable items, such as pharmaceuticals and medical equipment, meaning they are already an attractive target for thieves. However, the personal information stored within the healthcare sector can be an even more lucrative target, providing criminals with the means to commit fraud and identity theft. The information stored within the healthcare sector is vast, including names, addresses, birth dates, National Insurance information, financial details and family histories, which must all be stored securely so as to comply with the Data

Protection Act. This compliance applies right down to the destruction of such information, as improper storage or destruction of such information can mean the organisation in question is breaching the Data Protection Act, resulting in hefty fines from the Information Commissioner’s Office (ICO) and huge reputational damage to the establishment. DATA PROTECTION PRINCIPLES Under the Data Protection Act 1998, everyone responsible for using data has to follow the specific data protection principles. Such principles include: ensuring that data is used fairly and lawfully, for limited, specifically stated purposes; used in a !

Written by James Kelly, chief executive, British Security Industry Association

Secure information destruction is more important than ever

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! way that is adequate, relevant and not excessive; accurate; kept for no longer than is absolutely necessary; handled according to people’s data protection rights; kept safe and secure; and is not transferred outside the European Economic Area without adequate protection. The seventh principle of the Data Protection Act stipulates that an organisation must take appropriate measures against accidental loss, destruction, or damage to personal data and against unlawful processing of the data. In order to fully comply with the Data Protection Act, a handler must have a written contract with a company capable of handling confidential waste, which can provide a guarantee that all aspects of collection and destruction are carried out in a secure and compliant manner. ELECTRONIC MEDIA AND INFORMATION DESTRUCTION While the use of electronic media is increasing – making cyber crime an even more threatening risk – people are still printing from the screen onto paper, especially in a healthcare environment. Furthermore, electronic media will also need to be disposed of at some point, such as a computer or laptop that is no longer operational. As such, when looking to destroy both paper and electronic media waste, it is absolutely essential that if you do not have the in-house expertise and knowledge, do not take any risks and make sure you take the time to outsource the destruction to a professional information destruction provider. Information destruction covers a wide range of materials, including paper, computer hard drives, laptops hard disks, CDs, DVDs, USBs, credit cards and SIM cards. It can even be applied to branded products, such as uniforms of badges, which, if in the wrong hands, could allow a criminal to gain entry into restricted areas of a premises undetected. Secure information destruction means that such materials are destroyed to the point that they cannot be reconstructed. Don Robins, chairman of the British Security Industry Association’s (BSIA) Information Destruction Section, provided some essential advice to key decisions that may be looking for a secure information destruction supplier: “When selecting an information destruction company, steps should be taken to ensure they will protect your digital data until it has been safely destroyed. Often, these steps are common sense, but surprisingly the major consideration is the initial financial cost rather than the positive assurance gained from using an accredited destruction company. Make sure your choice of company uses security cleared personnel, that they have clear and secure procedures from collection through to destruction, that you have selected the appropriate destruction particle size for the material being destroyed and that they provide a destruction certificate.” He went to on to add that: “You should also check for references; make sure you know who the actual information destruction service provider company is, check that they are members of a professional association, such as the BSIA, and draw up a contract with explicit requirements. Possibly, the first step is to make sure you have a person within your organisation that will be responsible for the destruction of media assets and the data contained on them.” CHOOSING A REPUTABLE SUPPLIER In addition to these important steps, the most important factor in secure data destruction is choosing a reputable supplier that complies with the essential European standard BS EN 15713:2009 for security shredding, as well as BS 7858 for staff vetting. Don explains: “It is crucial to keep these standards in mind when sourcing an information destruction supplier, as these standards ensure that the companies providing data destruction services are doing so in a secure manner which provides maximum security for your information.”

The personal information stored within the healthcare sector can be an even more lucrative target, providing criminals with the means to commit fraud and identity theft BS EN 15713:2009 is a crucial requirement as it provides recommendations for the management and control of collection, transportation and destruction of confidential material and recycling in order to ensure that the materials will be disposed of securely and safely. The BSIA’s Information Destruction Section was actually a key player in the development of the EN 15713 standard and helped provide specifications on how the processes should be handled within the secure data destruction industry. The standard contains specific requirements pertaining to the confidential destruction premises, the contracts between the client and the organisation, the personnel working for the destruction company, the collection and retention of confidential material, the vehicles used, environmental requirements as well as customer due diligence. To help customers gain a full understanding of the requirements set out in EN "

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When looking to destroy both paper and electronic media waste, it is essential that if you do not have the in-house expertise that you take the time to outsource the destruction to a professional information destruction provider ! 15713, the BSIA’s Information Destruction Section created a helpful guide to highlight the essential elements of the standard, as well as providing some best practice advice when procuring an information destruction company. The guide can be downloaded free of charge from the BSIA’s website. Procuring a professional, reputable information destruction company must be at the top of the priorities list for key decision makers and corners must not be cut when it comes to quality. The BSIA recently commissioned a white paper titled The (Real) Price of Security Solutions – A White Paper on the Challenges of Buying and Selling High-Quality Security Solutions which explores the price versus quality debate from the perspectives of both buyers and sellers of security solutions. The purpose of the paper was to identify the relative advantages and disadvantages between low-priced and high-quality solutions; unsurprisingly one

of the key findings of the paper highlighted the fact that end users would find it far more beneficial to invest in high-quality security solutions rather than making decisions on initial purchase price alone. A positive collaboration between the security provider and the buyer is also extremely important, allowing the security buyer to gain a clear understanding of the end user’s needs so that they may provide them with a suitable solution. The results of the white paper serve to reinforce the fact that healthcare professionals must only source an information destruction provider who meets with EN 15713 in order to guarantee a quality service. By working closely with your supplier, they will also be able to develop a good understanding of your destruction requirements, developing a regular schedule and contract to suit your needs. " FURTHER INFORMATION www.bsia.co.uk

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THE VISION OF A PAPERLESS NHS BY 2020 The pressure is on the NHS to embrace the digital age, making IT more mission critical than ever before in the healthcare sector. As one of the world’s largest organisations, the NHS faces a huge challenge to eliminate paper usage in hospitals, clinics, surgeries and amongst administrators. Today, outsourced data management companies, such as Restore, help the NHS harness new technology by offering secure services that capture, process, manage, retrieve, share and destroy when necessary, critical documents and information digitally across all platforms. DIGITAL TRANSFORMATION A ‘paperless’ NHS will require total data solutions for the billion pieces of critical information from the point of creation through to when it’s destroyed at the end of its life cycle. It is imperative to protect patient confidentiality, employee and supplier data with robust controls, by using contractors who are suitably experienced and accredited. Many trusts are still lagging behind in digitising medical records, which could be a headache for IT leaders in charge of boosting digital technology adoption to meet the ambition of a paper-free NHS at the point of care. Some health and IT professionals remain deeply sceptical about the 2020 mission, however, ownership and management of paper records – and the dysfunction of losing them – costs the NHS a lot of money. Nearly two thirds of clinical time on ward rounds is spent filling in and filing paper records, impacting hugely on time to care ratio. IMPROVING PATIENT CARE A number of trusts have already taken the bold step towards paperless health care. The NHS Digital Maturity Index for the 239 trusts, which measures the extent to which healthcare services in England are supported by the effective use of digital technology, paints a varied picture of how far the hospitals are with the digital transformation agenda. In Scotland, NHS Lanarkshire’s Acute Operating Division (NHSL), which comprises of three hospitals – Hairmyres, Monklands and Wishaw General – wanted to improve patient

care and bring its administration into the 21st century. It had two main ambitions: to review and digitise 340,000 legacy records located across all three hospital sites; and to phase out paper right at the start of the patient journey. NHSL chose Restore as its scanning partner, and as a result a scanning department was set up at Hairmyres, designed as a beginning-to-end process that enabled scanned images to be uploaded into the trust’s portal. NHSL’s head of Health Records, John Duncan, said: “NHS Lanarkshire made a strategic decision to digitise paper records across three acute hospitals. We have modernised the health records service, freed up valuable space, reviewed, standardised and rationalised clinical documentation, and introduced improved document flow to support patient care – all big positives.” Outsourcing patient documents and data to accredited contractors offers an additional layer of cyber security against the loss of vital information or breaches of personnel data, whether intentional or accidental such as disasters like fire or flooding. It can also free up valuable ward space and reduce time spent on administration within hospitals. COMMERCIAL BENEFITS FROM OUTSOURCING The solution for any particular trust will depend on factors such as local circumstances, budgets and resource. Digitisation is a specialist process that cannot be underestimated. Outsourcing does offer commercial benefits in terms of switching on or off the required resources and allows NHS staff to continue delivering patient care. It is vital to understand that simply digitising paper records is not enough. The solution must offer facilities to stop production of new paper through generation, management and

Written by Paul Moonan, Managing Director, Restore Scan

Hospital trusts and primary care practices are on a transformational digitisation journey towards a future less reliant on paper, creating a healthcare system which provides safer, more effective, leaner and efficient services and, in the process, one that meets the government’s target date of a paperless NHS by 2020

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integration of electronic medical records. An Electronic Medical Record (EMR) must be in a document management system that is connected with other hospital systems and processes so it can be exchangeable and shareable among all practitioners. For many trusts this may mean an interface tailored to their specific needs, not an ‘off-the-shelf’ solution. Benefits to be expected from the right digitisation solution include the delivery of EMR at the point of care at the right time, every time, guaranteeing the accuracy and quality of information delivered; freeing up space to provide more treatment facilities and easier access. There is no magic bullet solution. The NHS digitisation programme is behind schedule but secure data solutions are available through document management partners that can wean the NHS off its reliance on paper and help it to move forward with a digital infrastructure that, like the health service itself, can be the envy of the world. ! FURTHER INFORMATION www.restore.co.uk Paul Moonan, Managing Director, Restore Scan



Recruitment Written by Nick Bowles, head of stakeholder engagement, APSCo



Brexit and the challenge of NHS recruitment

The current recruitment problems staring the NHS in the face are multifaceted. Nick Bowles, of the Association of Professional Staffing Companies, focuses upon just one of the factors – the UK’s impending withdrawal from the European Union It’s now been 18 months since Monitor, now part of NHS Improvement (NHSI), introduced pay caps in an attempt to curb spend on staffing. Since then, the controversial measure has been hailed as a success by NHSI, with the public body reporting that 40 per cent of trusts have reduced spend on non-permanent staff by more than a quarter since October 2015. However, behind this veneer of victory, UK hospitals continue to face significant and ongoing challenges around recruitment, and with Brexit on the horizon, the seas look set to get rougher. The latest figures from NHSI indicate that ‘agency controls’, including price caps on agency workers, have saved the NHS an impressive £1 billion since they were introduced in October 2015. Much of this saving can be attributed to the demise of rogue ‘off framework’ suppliers and the extortionate rates they demanded. However, these savings have also come at a cost. A survey by NHS Providers, published in December 2016, found that only just over a quarter (27 per cent) of NHS trust chief executives were confident they had the right staff numbers, quality and skill mix to deliver high quality healthcare for patients. For this reason, trusts continue to recruit outside of NHS approved frameworks in the interest of patient safety. A recent freedom of information request by a regional newspaper, The Star, for example,



found that Sheffield Teaching Hospitals has spent more than £90 million on contractors over the last four years – the equivalent to the average annual salaries of nearly 4,000 nurses. Furthermore, the top five paid locums alone cost the NHS over £5 million in 2015-16. NHSI estimates that £300 million per year could be saved if all medical locums charged rates within the set price cap.

the NHS has relied on skills developed overseas to keep the wheels in motion. However, the UK’s decision to leave the European Union looks set to further impact access to expertise. According to data from the House of Commons Library, over 200 different nationalities are represented within the health service with immigrants accounting for 12 per cent of NHS staff in England. Just over 60,000 of these are nationals of other EU countries and of staff who joined the NHS in 2016, nine per cent were from the European Union. Although we are yet to witness the UK’s final deal with the EU in terms of freedom of movement, the number of EU nationals registering as nurses in England has dropped by 92 per cent since June’s referendum. Furthermore, freedom of information responses compiled by the Liberal Democrats indicate that 2,700 EU nurses left the health service in 2016, compared to 1,600 in 2014, representing a 68 per cent increase. And it’s not only nurses who seem to be reconsidering their options. The British Medical Association (BMA) recently reported that 42 per cent of

Latest m fro figures ate that dic NHSI in y controls’ ‘agenc d the NHS an ve e have sa sive £1bn sinc d s impre ere introduce they w October in 2015

CONCENTRATING ON THE CAUSE The truth is that while the introduction of measures to decrease staff spend have no doubt been successful to an extent, they are designed to treat the symptom of the recruitment crisis rather than the cause. The Royal College of Nursing (RCN) estimates there are currently as many as 24,000 open vacancies for nurses across the UK and our recruitment consultancy members continue to report dire skills shortages across the healthcare arena. We must address this dearth of talent at the root before we find a solid and sustainable solution to ongoing skills shortages. In recent years a failure to pipeline future talent has created a landscape where

European doctors are thinking about quitting the UK following Britain’s vote to leave the EU, while the General Medical Council (GMC) has found that 60 per cent of doctors from the EEA said they were considering leaving the UK at some point in the future. Of those professionals, 91 per cent said the Brexit vote was a factor in their considerations. Looking forwards, questions around free movement will have to be answered before trusts can get a true steer on future workforce needs. The recruiters we work with report that trusts are dreading a scenario where European nurses leave Britain, and British pensioners now living overseas simultaneously return home. Paul MacNaught, director at the Department of Health, recently told the Health Select Committee that it is estimated that the presence of 190,000 British pensioners in other EU countries saves the British health system about £350 million every year. The RCN has called for European nurses to receive indefinite leave to remain post Brexit over serious concerns over numbers – there is little indication how likely this is to come into fruition. STAFF ENGAGEMENT Aside from an apparent drop in morale amongst professionals from EU countries since the referendum, the health service is also contending with wider issues around staff engagement. A one per cent cap on pay rises is one such example, with the TUC estimating that nurses face losing more than £2,500 in real terms by 2020 when inflation is taken into account. Our members tell us that many nurses boost their pay from substantive roles with contract work, which is why proposed new rules preventing permanent NHS staff picking up extra shifts in other trusts sparked fury



Aside from an apparent drop in morale amongst professionals from EU countries since the referendum, the health service is also contending with wider issues around staff engagement throughout the sector. NHSI had hoped that the ban would cut a further 25 per cent from trusts’ agency worker bills. The plans were withdrawn at the eleventh hour. As Michael Ellis, director at specialist healthcare recruiter, MSI Group, explains: “At least 60 per cent of professionals working in this way also have a substantive post. This proposal, which was passed without consultation with nursing bodies, would have decimated access to talent to the detriment of patient safety. It’s a good thing the proposal fell down.” Ellis’ frustration at policy introduced without necessary consideration of the potential ramifications is echoed throughout the healthcare recruitment sector. The recent publication of long-awaited final legislation on off-payroll working in the public sector, or IR35, is one example. Public sector end clients are now responsible for determining the status of a contractor’s assignment to supply services through a Personal Services Company (PSC) or LLP, as outlined in the Finance Bill 2017. Those who are deemed to be ‘inside’ of IR35 are now taxed at the same rate as an employee. The recruiters that we work with tell us that doctors are increasingly renegotiating pay rates to compensate for this erosion from IR35. While nobody can fault efforts by NHSI to slash excessive spend on frontline staff, the reality is that there is simply not enough talent available – and willing – to work for the NHS

on a permanent basis. Professional recruitment consultancies are playing a vital role in ensuring that the health service continues to meet safe staffing levels – often parachuting in valuable expertise at very short notice. Moving forwards, NHSI is introducing new, more detailed, reporting standards on staffing in an attempt to pinpoint areas of excessive spend. These are to include details of the ten longest serving agency staff working during the reporting period, the highest cost agency staff and details of all shifts worked above £120 an hour, with confirmation of CEO sign-off. However, while access to talent is scarce, the market will always determine rates which can be achieved. The General Election already sparked debate around the recruitment and retention of healthcare professionals, with Labour pledging to lift the existing cap on pay rises while reintroducing student nurse bursaries to boost talent pipelines. The Conservatives, meanwhile, say that a good deal with Europe will enable us to inject significant and much needed funds into the NHS once we have left the union. While we are yet to see the outcome of this dialogue, one thing is certain – the NHS’s ability to access and retain talent must be high on the agenda of Brexit negotiations and election manifestos alike. ! FURTHER INFORMATION www.apsco.org


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Developing the reach of mental health facilities



Broadmoor Hospital is one of three high secure mental health facilities in England, treating men who have serious mental health or personality disorders. Health Business looks at the ongoing refurbishment and other similar projects, as well as the importance of developing secure facilities to offer the best mental health care possible There are numerous low-cost and high impact design changes that can be made that will improve the well-being of patients, staff and visitors in hospitals and clinics across the UK. Research has repeatedly shown that people make up their mind about organisations and individuals very quickly, and this is no more evident than in healthcare settings where first impressions matter. But if we are to believe that first impressions matter when someone walks through a hospital door – be it a first time patient, a family visitor or prospective staff – how important does the design of mental health hospitals need to be? On average, patients stay at Broadmoor Hospital for five years. The hospital has undertaken numerous improvements to help make sure that during this time, staff can provide patients with the best possible treatments, in surroundings which support therapy, encourage recovery and achieve

the most effective outcomes. Refurbishment projects, especially those dealing with a mixture of old infrastructure and an imperfect site, always pose a challenge to hospital designers and external architects. Sheffield Health & Social Care NHS Foundation Trust found that the accommodation at its Longley Centre offered little access to open space and was no longer adequate for those in need of psychiatric intensive care, so much so that the trust’s chair Alan Walker said that the site was ‘limited in terms of the healing environment if offered to service users’. The new Psychiatric Intensive Care Unit (PICU), delivered by P+HS Architects at a cost of £4.5 million to the trust, has ten

bedrooms and accessible courtyard areas which permit safe levels of observation by unit staff. In addition, there is an occupational therapy room, a sensory room, a quiet room, lounges, and an activity room as well as office accommodation and staff facilities, all of which are contained within the unit. A BUILDING FIT FOR PURPOSE Opened in 1863 as Broadmoor Criminal Lunatic Asylum, the building now known as Broadmoor Hospital had not kept pace with the speed of change in mental health assessment, treatment and care, with a Care Quality Commission (CQC) report in 2009 finding that the Victorian building’s !

Broadm new lay oor’s have 16 out will 234 bed wards and s, the nee ‘eliminating periods d for long of o and conbservation s usherintant g’



Health centre shines in 2017 RIBA Awards



The Ballymena Health and Care Centre has won a RIBA Northern Ireland Award 2017 and will now go forward to compete for a RIBA National Award, the most highly regarded architecture prize in the UK.

Ballymena Health and Care Centre (Credit: David Cadzow)

On average, patients stay at Broadmoor Hospital for five years. The redesign allows staff to provide patients with the best possible treatments, in surroundings which support therapy, encourage recovery and achieve the most effective outcomes ! accommodation was no longer suitable or fit for purpose. The building, like many others of its period, is costly to maintain and, hosting a mental health hospital, contained too many blind spots between buildings and along corridors. In the Autumn of 2013, West London Mental Health NHS Trust began a major redevelopment of the Broadmoor Hospital site, to modernise the way in which care was provided and to improve working conditions for its staff. Leadership at the hospital felt that a completely new building would allow for the modernising of services and the creation of a site that was specifically designed for the delivery and progression of 21st century mental health care. In the original plans, patients, services and staff would move into the brand new hospital buildings in the Spring/Summer of 2017. As the site began its refurbishment, West London Mental Health NHS Trust outlined the expected benefits of the re-design its in ‘The Broadmoor Hospital Redevelopment Project’ leaflet. It advised that the new hospital’s layout, which will have 16 wards and a total of 234 beds, will ‘eliminate the need for long periods of observation and constant ushering’ of patients, instead offering patients more ‘independent accessibility which greatly aides the recovery process’. The beds will have the ability to accommodate 210 patients, with 24

flexible beds left spare for use when necessary. Furthermore, a two-floored central building will house a variety of services, including all therapy and educational services, a multi-faith centre, vocational services workshops, the family visiting suite and the patient physical health care centre. SUSTAINABLE HOSPITAL AWARD The Broadmoor Hospital redevelopment team won a Sustainable Hospital Award at the 2016 Health Business Awards. Announcing the category’s winning entry, The One Show’s GP, Dr Sarah Jarvis, told the audience: “This award recognises the contribution the Broadmoor Hospital redevelopment project has made towards sustainability by reducing the impact of healthcare facilities on the environment and the smarter use of energy.” The award was the third the team had won in as many years, after gaining the prestigious Green Apple Award received in 2013, and the Institute of Civil Engineers (ICE) award, collected in 2015. Speaking after the event, Keith Thomas, said: “We incorporated a number of environmental elements from the outset to ensure the delivery of greener buildings. These included an extensive enabling works programme to create safe habitats for displaced wildlife, the recycling of over 4,200 tonnes of concrete from our decommissioned hospital

The centre opened to the public in February 2016, at a cost of £14 million. The project was designed through collaboration between two large Scottish practices, Keppie Design and Hoskins Architects, following a competition by Northern Ireland’s Department for Health. The big challenge in the design was how best to accommodate both NHS and council run services alongside six GP practices in order to make the services more integrated and accessible to the community. The 8,000m² centre situated on the existing Braid Valley Hospital site brings together a wide range of primary, intermediary, diagnostic and community health facilities. The clinical departments are split across two floors and organised around the main arrival space: a large internal atrium. The atrium affords views to an open courtyard, which assists the building users’ orientation and allows natural daylight and ventilation to the large number of cellular spaces that make up each department. The building has been designed to achieve a BREEAM Very Good rating, while its robust and textured brick finish provides a formal public presence in the community and integrates the building into the wider site. FURTHER INFORMATION tinyurl.com/y93ts5j2

buildings and the installation of a combined heat and power unit to make future energy consumption much more efficient. As you can see, sustainability has played an important role in this project, so we’re delighted that our work has been recognised by the judges.” "

West London Mental Health Trust (WLMHT) is one of the most diverse providers of NHS mental health and community services in the UK, providing care and treatment for around 62,570 people each year. FURTHER INFORMATION www.wlmht.nhs.uk/about-wlmht/ redevelopment/broadmoor-hospitalredevelopment



Building the future of Healthcare The use of off-site construction is on the rise within the public and private healthcare sectors, as it brings many benefits. The engineered and factory assembled products offer significant advantages in many areas: Faster return on investment due to reduced programmes. As the modules are manufactured on a flow line there is no risk of late delivery due to inclement weather or site restrictions. At Premier Modular’s East Yorkshire manufacturing hub, 20 modules a day can be produced, approximately 2500m2 per week. As much as 75% of a building is manufactured offsite, this reduces construction traffic and noise in the sensitive health environment - meaning a hospital can maintain its high quality day to day care standards whilst expanding its service offering. Premier Modular’s range of high quality modular building systems are a range of long-life, steel-framed or cost-effective timber-framed buildings, for either permanent or temporary use in single or multi-storey applications. Ideal for single-storey GP surgeries, through to complex multi-storey ward accommodation, operating theatres, x-ray rooms and MRI facilities – all of which can incorporate our concrete floor option. The company is a Client-focussed solution provider with a strong commitment to R&D, ensuring the most innovative products are available to the market.

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Temporary or modular buildings are proving to be the healthy choice for hospitals looking to quickly overcome problems relating to peak-time demand. With the help of Jackie Maginnis, of the Modular Portable Building Association, Health Business explains why Temporary or modular buildings are now firmly in evidence at hospitals nationally, and their popularity shows no signs of diminishing as increasing numbers of healthcare managers discover their benefits for themselves. Given the critical nature of the healthcare industry, the necessity to quickly source low cost, modern and fully functional buildings is imperative. Because these structures are manufactured off-site to the highest specifications,

they can also be installed without causing disruption to daily routines on-site. What’s more, modular buildings can be created to fit into small spaces with unusual shapes. The Modular and Portable Building Association’s (MPBA) chief executive Jackie Maginnis said that healthcare managers greatly appreciate the possibility of sourcing these cutting-edge facilities both quickly and cost-effectively. She explained: “Modular buildings can be manufactured with ultra quick lead times and !

Give the crit n nature ical NHS, th of the to quick e necessity ly cost, m source low o fully fu dern and nct buildingional is impe s rative


Written by Jackie Maginnis, Modular Portable Building Association

Helping hospitals overcome increased demand in the UK

Modular Buildings



Modular Buildings

CONSTRUCTION ! supplied as an extension or an ‘add-on’ to meet peaks in demand. Sometimes, healthcare managers aren’t aware that these structures are available as a permanent – as well as a temporary – option at a cost to suit their needs. Other major benefits of modular buildings include energy compliance, meeting the latest regulations and the ability to create buildings that are designed to meet the precise specifications of that hospital’s requirements.” FULLY FUNCTIONAL HOSPITAL BUILDINGS Modular units are planned and designed to suit specific user requirements. Buildings are also created off-site in a factory, which enables urgent clinical services to be delivered faster, resulting in minimum disruption in a hospital. A misconception, in some quarters, is that once a modular building has been installed, it can’t subsequently be moved and used elsewhere. The beauty of temporary buildings is that they can be removed and reused in other parts of that hospital complex – or elsewhere – as the need arises. Modular buildings are constructed to the latest healthcare standards fully compliant to all building regulations and encompass ‘Part L’ energy efficiency – which means some modular buildings also have lower carbon emissions. Members of the MPBA produce the required Energy Performance Certificates, so a customer can be certain of the energy rating for a building. It’s the ‘flexibility’ of a modular approach that gives healthcare managers the greatest benefits. And this is particularly relevant when it comes to urgent and difficult projects. The length of time it takes to install new modular buildings will vary according to a hospital’s specific requirements and the ease of access to the site among many more considerations. But it will always be quicker than ‘conventional’ construction projects. The benefits of a quick installation combined with minimal on-site disruption are not to be overlooked. And they’re also major reasons for the increasing popularity of modular buildings within the healthcare sector. But those healthcare managers thinking of going down the modular route should talk to industry directly. OFF-SITE CONSTRUCTION As patient-led demand grows, healthcare environments are continually looking to adapt and expand their facilities quickly and cost-effectively. The healthcare sector doesn’t have the time or resources to commission lengthy construction programmes and, reflective of this, the NHS new construction framework has been created solely for the supply of modular buildings. Modular buildings are built in controlled, energy-efficient environments. From initial works to completion, it takes up to 67 per cent less energy to produce a modular building, compared with a traditionally-built project. Whilst initial, on-site ground works

It’s the ‘flexibility’ of a modular approach that gives healthcare managers the greatest benefits. in the construction plans, and this is particularly relevant when it comes to urgent and difficult projects are being completed; modules – which make up a modular building – are manufactured off-site, in a controlled, factory environment. Pre-fitted with electrics, plumbing, heating, doors, windows and internal finishes before they are taken to site, modular buildings are now also installed with energy-efficient systems such as PIR sensors, enhanced ‘U’ values and solar panels. Not only is the off-site manufacture greener, buildings are also designed to be energy-efficient for their entire life cycle. When you build off-site, you plan and construct with meticulous precision. It takes strategic thinking and rigorous co-ordination, but modular construction allows for minimal disruption to staff and patients which is particularly key in the acute care environment. Off-site construction also allows for a 90 per cent reduction of the total number of deliveries to site as well as reducing up to 90 per cent of waste generated as the structure is recyclable. VELINDRE CANCER CENTRE CASE STUDY Velindre Cancer Centre is a vital service provider in Wales, offering treatment and support to over 1.5 million people in south east Wales and beyond. The centre is also incredibly busy, with over 50,000 new outpatients being referred every single year. Mike Ellery, capital development and operations manager, said: “The centre had offices spread throughout the building, some in locations that would be better suited to patient care. We wanted a new office block to consolidate our administration staff in one location, in turn allowing us to expand our patient care areas.” The hospital chose to use modular construction for the new office block because of the time of year construction would take place. Ellery commented: “We wanted the building in place early in the year. We knew that traditional construction would be more at risk of delays through the

winter, whereas a modular building gave us a better guarantee on deliverables.” Aware of Wernick Buildings’ reputation as a provider of high quality modular buildings, the hospital contacted them. The building was manufactured in just six weeks in Wernick Buildings’ factory, only 25 miles down the road. While the building process was swift and easy, the installation proved a little more challenging. Ben Hitchcock, contracts manager, said: “The proposed site was located between protected buildings and a protected tree. The lift also required a 250-tonne crane which presented a challenge in itself; it took us an hour just to get it on site. When a building is going to be over clad, we construct the external walls of the units using colourcoated steel that may otherwise go to waste, regardless of colour. This can lead to some strange looking buildings, and I had to speak to a number of concerned locals when they saw the multi-coloured units being installed. I was happy to put their fears to rest.” Once the units were installed, it wasn’t long before the external finish of white render with cedar cladding features, was complete. The building also features external lighting and security systems, vital for the out of hours working often conducted in the building. Internally the building features conference rooms, open plan office space, disabled access lift, toilet facilities and an ADT alarm system. Mike Ellery, pleased with the finished product, commented: “Staff are very happy with the new building, it’s spacious, open and bright. The on-site team were also excellent at communicating with us and local residents to ensure the finished building was to everyone’s satisfaction.”

This article included input from Wernick and Actavo. " FURTHER INFORMATION www.mpba.biz



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The Asbestos Removal Contractors Association look at the occupational handling and removal of asbestos materials in the NHS, as well as outlining how the association’s audit scheme provides the necessary reassurance to it’s members It is vital that all property owners of premises constructed prior to the year 2000 take the risks from asbestos seriously. Asbestos, the class 1 carcinogen, is the greatest cause of work-related deaths in the UK. Current figures show that approximately 4,500 people die each year in the UK from asbestos related diseases, predominantly in the form of mesothelioma, lung cancer and asbestosis. Therefore, UK law places responsibilities on property owners to ensure that both employees and non-employees are not exposed to health and safety risks as a result of the presence of unmanaged asbestos. The 1974 Health and Safety at Work Act places a duty on every employer to ensure, so far as is reasonably practicable, the health, safety and welfare at work of all employees. This requires the NHS to have a

robust management plan which can easily be communicated to and understood by all those who have a duty under the plan. The Control of Asbestos Regulations 2012, Regulation 4, places a legal duty on those who own, occupy, manage or have responsibilities for premises that may contain asbestos. Those who have these responsibilities will either have a legal duty to manage the risk from this material; or a legal duty to co-operate with whoever manages that risk. The requirement is to manage asbestos, not to necessarily remove it. If materials are in good condition and managed so that they cannot be disturbed, a periodic check might be all that is needed. With a large number of premises, and

Written by the Asbestos Removal Contractors Association

The legal duties in managing asbestos

a large number of employees and visitors, maintenance work is inevitable and accidental damage is often possible. Therefore, all NHS premises which were constructed prior to the year 2000 will require an asbestos management plan based on a management survey. The purpose of the management survey is to manage asbestos containing materials (ACMs) during the normal occupation and use of the premises. Additionally, the Construction (Design and Management) Regulations 2015 (CDM 2015) places explicit responsibilities on clients. As the client is at the head of the procurement chain, they have the final say on the course of action to be taken during a project. The law therefore requires that clients, when asbestos removal is required, make suitable arrangements for managing the project, and maintain and review those arrangements throughout the project, to ensure health and safety risks are managed appropriately. Therefore, the NHS is responsible for ensuring appropriate arrangements are in place to manage and organise projects. This means appointing suitably competent people and providing them with sufficient information, time and resources to do the job properly. If asbestos removal is required, the client needs to appoint competent asbestos removal contractors.



AUDITING REMOVAL WORK PROVIDES REASSURANCE As the NHS needs to appoint suitably competent people, they need to make reasonable enquiries to satisfy themselves that asbestos removal contractors are appropriately resourced and competent for the work. How and !

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HEALTH & SAFETY ! what information can support this? Guidance on CDM 2015 states: “When considering the requirements for designers and other construction professionals, due weight should also be given to membership of an established professional institution or body. For example, do these bodies have arrangements in place which provide some reassurance that health and safety is part of the route to membership of their profession?” Audits are a method of monitoring both good management and good risk control, providing reassurance for all parties. In 2000, the Asbestos Removal Contractors Association (ARCA) introduced an audit scheme to provide reassurance of compliance with relevant legislation, to support members’ performance and therefore maintain standards, and to support clients, like the NHS. Member contractors need to participate in ARCA’s audit scheme, which requires two satisfactory site audits every year, to join and maintain membership of the association. To take a further step towards supporting consistent high standards and a higher level of reassurance, ARCA enhanced its audit scheme in January 2017. Members still need to complete two satisfactory site audits every year, however, ARCA audits are now unannounced, meaning that ARCA members (excluding Ireland) will not have prior knowledge of when, or where,

an ARCA auditor will be assessing their performance. Therefore, being unannounced, ARCA site audits are now an even stronger system of reassurance for all parties. Under CDM 2015, once the NHS had appointed a contractor, they would need to provide the contractor with sufficient information, time and resources to do the job properly. For example, an asbestos removal contractor will need appropriate pre-construction information in order to prepare a suitable work plan, and contractors need time (and access) to assess the premises properly and discuss key site information with the NHS. Also, an asbestos analyst must be appointed for licensed asbestos work, as the analyst will be required to verify that a work area has been thoroughly cleaned and that airborne fibres in the work area are as low as reasonably practicable, prior to handover for reoccupation or demolition etc. The NHS does have a challenge, mainly due to an extensive portfolio of premises and being the largest employer in the UK. However, with a sound asbestos management plan, which is communicated effectively throughout the NHS, and with the guidance and support available, the NHS can continue to meet its health and safety obligations. " FURTHER INFORMATION www.arca.org.uk



Asbestos failings Barroerock Construction Limited has been fined £750,000 after repeated asbestos failings, which put 200 workers put at risk from asbestos on office conversion job. It was found in both HSE investigations that incidents could have been prevented if Barroerock ensured they had effective management controls in place to avoid the risk of exposure to asbestos. For breaching the CDM regulations the company was fined £750,000 and ordered to pay costs of £14,874.68. Speaking after the hearing, HSE inspector Melvyn Stancliffe said: “The company’s failings in this case has put many workers at risk to the exposure of asbestos. It was clear there was an endemic failure to effectively manage the construction work on the site in a way which ensured that asbestos materials were not disturbed until removed under appropriate conditions. Failing to prevent the breathing in of asbestos fibres on the site is reckless.”




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Hospitals can be very large and complex buildings that pose more fire risks than other environments. The Fire Industry Association analyses the risks and steps to take to ensure safety The Sun reported in 2016 that University Hospital Coventry, a £380 million hospital which opened 10 years previously, was hit with a substantial bill after it was revealed that builders had failed to fire-proof it. Of course, this is no fault of the doctors and other medical staff working in the building, but it does highlight the dangers that a fire could do to a building and how important it is to comply with fire regulations. Regardless of the type of building, the fire regulations for England and Wales are all part of a piece of legislation called the Regulatory Reform (Fire Safety) Order 2005. This legislation sets out all the responsibilities of the owner of the building (called the ‘responsible person’ in UK legislation). In simple terms, the ‘responsible person’ must ensure the safety of all of the people within the building. In a hospital setting, the real crux of the matter is the sheer volume of vulnerable people within the hospital building that must be protected

in the case of fire, along with all the staff and visitors to the hospital. As a legal responsibility, the ‘responsible person’ must carry out a fire risk assessment to manage the risk to the vulnerable people. FIRE SAFETY MEASURES Hospitals can be very large and complex buildings. The main risks for fire in a hospital are the main risks of fire everywhere, but with hospitals there are more risks. There’s the risk of patients with limited mobility as well as all the flammable substances that most buildings do not contain, such as chemicals and oxygen supplies, and all the flammable materials within a pharmacy or an operating theatre. Even if one simply considers the sheer volume of curtains and bedding within a hospital, that presents a risk too, because naturally cloth is flammable.

The Department of Health has published a wide range of guidance for hospitals on the potential risks involved, called ‘Fire safety measures for health sector buildings (HTM 05-03)’. This guide is essential reading for a ‘responsible person’ as it outlines some important factors to consider in terms of fire safety, and is both thorough and comprehensive. The guidance outlines almost everything that one should consider in terms of fire safety – from general fire safety, to more specific aspects such as provisions for textiles and furnishings, escape lifts, and fire detection and alarm systems. All of these guides are available to download from gov.uk, but the Fire Industry Association (FIA) is also available for practical and technical advice and guidance regarding fire risk assessments and fire alarm systems over the phone. Of course, a great consideration is the patients themselves and the danger present to them in the event of a fire. Due to limited mobility, a plan should be drawn up for progressive horizontal evacuation, whereby each floor or section of the hospital acts as a different ‘compartment’ for a fire. When the fire approaches a nearby compartment, staff and patients should evacuate that compartment, rather than evacuating everybody from the whole building at once. This is why passive fire protection – insulation from fire within the walls, doors, and windows is vital – as it blocks fires from travelling from one compartmented area to another. This is the reason that fire doors are such an important part of trying to contain the fire in the room behind the doors. Fire doors are designed to help stop the spread of fire beyond the doors; it helps in the event of an evacuation situation to keep the fire contained within the designed ‘compartment’ of the building. However, in a hospital, fire doors are often propped open or bashed into by hospital trolleys. But this can be exceptionally dangerous as it increases the risk of fires !

Written by the Fire Industry Association

The threat of hospital fires and how to mitigate against them

Fire Safety


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Understanding the evacuation plan and having a robust system for the event of a fire is a necessity. Even more important is the need to communicate this plan to the staff, particularly in a situation where fire alarms need to be tested ! spreading through the building. Keeping the doors closed keeps the fire safely behind the door, allowing for a greater escape time. Therefore, it is vital not to prop fire doors open with hospital trolleys or cause damage to them as this reduces their effectiveness. Additionally, hospital trolleys banging into manual call points (the button that activates the fire alarm) is one of the prime causes of false alarms in hospitals. Research sponsored by the FIA from earlier this year, entitled Investigations into the causes of false fire alarms, highlighted that despite this problem being exceptionally common, it is something that can easily be remedied. The solution is to ask a specialist fire alarm company to install a special plastic cover to go over the call point, which should protect it from getting banged or knocked by busy staff with trolleys. Not only do false alarms cause time to be lost investigating the cause, they also cause distress to patients who may

give in regards to fire safety is just to remain vigilant; keep the fire risk assessment up-to-date and follow its recommendations to the letter. The fire risk assessment forms the entire basis of the fire safety management strategy for the building, and should be reviewed on a regular basis. Talk to staff and make fire safety an integral part of caring for patients. All staff should be involved. As a minimum, fire safety training should be carried out once a year, but it depends on the needs of the staff and patients as well as the type of training – staff should be made aware not just of the evacuation procedure, but of how to use evacuation equipment such as sleds, chairs, or other equipment designed to evacuate the immobile. Additionally, portable fire extinguisher training is such an important part of the strategy; if staff are trained to know how to use a fire extinguisher, they can combat small fires (no larger than a waste paper basket, for example), which will prevent the fire getting bigger and becoming a problem. Training staff how to use the equipment in a practical sense and letting them use it in a mock-fire situation will help increase their confidence and help them to provide better care for the patients overall. "

be worried that there is a real fire on the premises. It is therefore recommended that alarms have a delay before sounding. During this time, a team should investigate the cause of the alarm – and confirm if the fire is real or false. If a fire is confirmed, the evacuation plan including progressive horizontal evacuation should be followed. EXECUTING THE EVACUATION PLAN Understanding the evacuation plan and having a robust system for the event of a fire is a necessity. Perhaps even more important is the need to communicate this plan to the staff. Communication is key, particularly in a situation where fire alarms need to be tested. Best practice states that a fire alarm should be tested weekly – but it is vital to inform staff of the test to minimise disruption and allow the staff to reassure patients that it is not a real fire alarm. This is why the best advice anyone could

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I'm happy with Warp It and it's made my work life easier by being able to supply many staff with items they wouldn't be able to purchase normally, I get a lot of positive feedback. - Jeannie Hetcalfe-Hall, Cheshire & Wirral Partnership NHS Foundation Trust

Warp It has been absolutely fantastic for our Trust – we made our money back easily during our pilot. Our admin function takes an hour a week or less, and we have had a lot of positive feedback from users. They have been pleased with how simple it is to use and they are grateful that Warp It is there when budgets run dry! - Nick Fayers, Nottinghamshire Healthcare NHS FT

This is a fantastic service that saves much needed cash. Staff should be encouraged to check this website before ordering any office supplies. Thank you. - Manar Elkhazindar, NHS Highland

Do you see images like this around your estate? We help large organisations just like yours streamline the reuse of surplus assets, furniture, consumables and equipment. We set up online marketplaces giving staff visibility on surplus assets right across the estate and within other organisations. This stops staff buying assets that other staff already have surplus to requirements. By maximising participation in the program you will: Lower procurement costs, Lower waste costs, Reduce waste and carbon emissions The system is used by the likes of the whole of NHS Scotland, Guy's and St Thomas' NHS, Leeds Teaching Hospital and 20% of the NHS. The service is also used by the majority of Universities , Central Government and Councils. Contact us at: info@warp-it.co.uk - 0800 048 9755 - www.warp-it.co.uk




Reducing healthcare’s climate footprint The Sustainable Development Unit, Barts Health NHS Trust and Sussex Community Trust have all provided case studies that feature in a report from Health Care Without Harm. Health Business analyses the examples of best practice in reducing the NHS’ climate footprint, as well as listing the 2017 winners at the NHS Sustainability Awards Climate change is linked to an increase in the frequency and intensity of extreme weather events, explaining the increase in heat waves, changing rainfall patterns, rising sea levels, wildfires, drought, and intense cold spells. These events can have a detrimental effect on human health by disrupting ecosystems, agriculture, food quality, water quality, air quality, and damaging infrastructure. Additionally, these systems can directly affect human health by causing heat-related illnesses, infectious diseases, cardiovascular diseases, injuries, and respiratory diseases. Climate change induced events place great burden on health systems to cope with the consequences of such incidents. These range from a hospital’s ability to support a flood of patients after an extreme weather event, to the potential damage to infrastructure, or the ability to control infectious diseases. The burden of responsibility that lies with health systems in the face of climate change is enormous. For this reason, strengthening public health services must be a central component of all nations’ climate change adaptation measures and policies. There are also large financial consequences, with the World Health Organisation estimating that there will be an increase of $2-$4 billion in annual health care costs by 2030 as a direct result of climate change. Healthcare infrastructures have a large climate footprint. The approximately 15,000 hospitals across the European Union have a high demand for heating and electricity and require a large amount of energy for transport, lighting, ventilation, air conditioning, and electric and electronic equipment. Health systems are also major consumers of medical goods and equipment, which are often produced in carbon-intensive processes in the developing world under unsafe, toxic, and unregulated conditions and need to be run interrupted. Reducing healthcare’s climate footprint: Opportunities for European hospitals and health systems, published by Health Care Without Harm Europe, provides case

studies from across Europe that highlight the impressive efforts made by selected organisations in reducing their institution’s climate footprint. The report also takes a look at some useful tools and systems developed by the NHS Sustainable Development Unit in England, a behaviour change programme in UK, and a German NGO. OPERATION TLC The report includes a detailed case study on Barts Health NHS Trust’s Operation TLC project, (which we covered in Health Business issue 16.4) an award-winning behaviour change programme developed by the trust together with behavioural change charity Global Action Plan. The programme seeks to train hospital staff, providing education and knowledge to help the adoption of best practices in areas which save energy and money, while creating a healing environment for patients.

Operati on TLC is an awa behaviord-winning program ur change by Bart me developed Trust ans Health NHS d th Action Pe Global la charity n

Examples of interventions included: closing doors and windows to help control heating, which resulted in improved levels of comfort and privacy; dimming or turning off unnecessary lighting, and switching off unused equipment – both during day and night. This helped reduce noise, heat, and bright light, which in turn helped patients rest; and opening blinds so that patients benefited from daylight, rather than relying on artificial light. This helped them follow a more natural sleep cycle. Barts Health saved £49,000 in the first year of the programme by simply turning off equipment that could be safely switched off during non-working hours, and by placing reminder stickers close to the light switches. Thanks to the Operation TLC programme, in two years the trust reported one-third less sleeping disruptions and 38 per cent fewer patient requests to change room temperatures, which saved 1,900 tonnes of CO2 and £428,000. CARE WITHOUT CARBON Sussex Community NHS Foundation Trust (SCFT) delivers care from nine community hospitals and 65 health centres across !



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A great hospital roof isn’t just about materials and labour. It’s about the technical understanding and insight that comes from working extensively in the healthcare sector. It’s about having a wide choice of BBA approved systems and cost neutral renewable solutions. It’s about partnership and comprehensive end-to-end support – from design consultation and bespoke specifications through to live site monitoring which delivers on time and within budget. All this goes into a Langley roof – with access to approved contractors and installers and after care support – all designed to minimise risk and deliver roofing excellence. In other words, we put everything we have into your roof, so you get more out of the project, and end-users get more

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CARBON FOOTPRINT ! nearly 1,000 square miles, contributing 6,400 tonnes of CO2e annually to the NHS’ carbon footprint. In order to reduce carbon emissions, the trust has implemented a programme called Care Without Carbon (CWC), which has been created by the NHS for the NHS. CWC is an action plan that provides a simple framework for delivering sustainable healthcare. The programme strategy works to cut carbon, save money, and support staff and patient well-being. The SCFT aims to reduce its total CO2 emissions by 34 per cent by the year 2020 compared to 2010 levels, and expects to save £4.75 million

through the implementation of the CWC strategy. These targets were set as a means to comply with the UK’s Climate Change Act, which sets legally-binding carbon reduction targets of 34 per cent by 2020, 57 per cent by 2030, and 80 per cent by 2050, all compared to 1990 levels. The trust has a long-term objective of becoming a carbon-neutral health care provider. The CWC programme has driven significant reduction of carbon emissions across the trust’s healthcare activities. Between 2010 and 2016, the trust reduced its absolute carbon footprint by 1,623 tonnes CO2e, a 21 per cent reduction in six years.

The SCFT aims to reduce its total CO2 emissions by 34 per cent by the year 2020 compared to 2010 levels, and expects to save £4.75 million through the implementation of the Care Without Carbon strategy

NHS SUSTAINABILITY The scope and size of the health and care sector creates an enormous opportunity to use improvements in its operations and its purchasing power to make sustainable choices that will benefit the economy, the environment, and the health of the greater population. These wider benefits are precisely the objectives of the Sustainable Development Unit (SDU). Considering the three pillars of sustainability – environmental, social, and economic – the SDU develops tools, strategies, policies, and research, in order to empower the health and social care system to fulfil its potential as a leading sustainable and low carbon organisation. In 2015, six years after the Carbon Reduction Strategy was launched, the NHS in England achieved an 11 per cent reduction in CO2e, compared to 2007 levels, while the wider public health and care sector witnessed reductions of 13 per cent. This bettered the 10 per cent target set for itself, which is quite an achievement considering NHS activities increased by 18 per cent over the same period. According to the report, the emission reductions were achieved through a 16 per cent reduction in procurement activities, a four per cent reduction in energy emissions, and a five per cent reduction in emissions from transportation. "

NHS Sustainability Awards 2017 Efforts by NHS organisations across the country to futureproof and reduce the environmental impact of services were recognised last month at the 2017 NHS Sustainability Awards, held at Imperial College London on 17 May. The overall winner of the NHS Sustainability Awards, presented to the NHS organisation that has demonstrated an all-round sustainable approach which encompasses change at both ground and board level, was awarded to Central Manchester University Hospitals NHS Foundation Trust, who were also celebrating winning in the Waste Management and Public Health categories. Showcasing evidence of top-down leadership on sustainability issues, the Royal Bournemouth & Christchurch Hospitals NHS Foundation Trust were awarded the Workforce Development award. Aneurin Bevan University Health Board were recognised for their innovation in pioneering a ‘world first’ recycling process at St Woolos and the Royal Gwent, whereby polypropylene instrument wrap, previously considered clinical waste, is treated to produce a commodity that has revenue value. North East Ambulance Service NHS Foundation Trust were the recipient of two awards at the event, firstly in the Energy category where the trust’s estates team’s energy saving awareness was heralded, and secondly for the trust’s energy performance in the Finance category. The Newcastle Hospitals sustainability team won the NHS Sustainability Award for Food for its campaign to improve the sustainability of the catering department at the Freeman hospital. The team worked with chefs to create an appropriate menu to encourage the use of local, organic, Fairtrade and meat-free meals, as well as introduced two anaerobic digesters, for food preparation and returned plate waste, which have saved over three Olympic sized swimming pools worth of water each year. University College London Hospital Foundation Trust won in the Reuse category for their crutch collection and reuse scheme, while The Shrewsbury and Telford Hospital NHS Trust won in the Travel category for making cycling to work an easy choice. Find out more about the 2017 NHS Sustainability Awards at http://nhssustainabilityawards.co.uk



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HELPING THE NHS SAVE ENERGY AND COSTS The latest ERIC report from October 2016 reported that the total annual energy usage from all energy sources across the NHS Estate amounted to 11.9 billion kWh, an increase of 3.5 per cent from 2014/15. In this article we demonstrate how further reductions in cost and energy consumption can be made to help the NHS reach its next carbon reduction target. But what if you could reduce this further and possibly exceed targets? Making savings on energy expenditure is always high on the agenda within finance and energy departments and the NHS is no exception. But where do you start and what do you need to do to ensure energy is reduced and costs are kept to a minimum? PROCUREMENT Energy is still one of the NHS’s significant expenses and the starting point is to consider your energy procurement and most importantly your energy procurement strategy, whilst at the same time ensuring that the supply is sourced from a compliant route such as an established framework. A review of your energy procurement should initially start with a complete review of the type of supply contract you are utilising. This could be a fully delivered fixed price contract with no visibility of the commodity element nor third party non-commodity costs, as they are all fixed within your unit rate, or a bespoke flexible risk managed solution, which is completely transparent and enables you to optimise the commodity element while scrutinising third party non-commodity costs. Non-commodity costs are made up of obligatory charges and levies from third parties. In 2015/16 this charge accounted for around 50 per cent of a customer bill. The contract type selected will often be determined by an organisation’s appetite for risk and/or the requirement for budget certainty and these discussions should always include input from all key stakeholders within your organisation. Bespoke flexible risk managed portfolios have become more common in the market place and are underpinned by a robust risk management strategy. With rising third party non-commodity costs you can also achieve further savings through the transparency of these costs and elements such as Triad avoidance or Distribution Use of Systems (DUoS) optimisation. Once a contract type and strategy have been completely defined then all supply information is verified and tendered to the appropriate suppliers in the market place with all offers being analysed and the best supply contract selected. Following this



it is imperative to be able to monitor the future energy markets to look for the most opportune time in the market to purchase all or some of your energy requirements. INVOICE VALIDATION – ONLY PAYING FOR WHAT YOU USE Suppliers’ contracts and invoices can be very complex and difficult to understand and as a result it is inevitable that some billing errors will be missed if not validated correctly. With flexible and energy only contracts becoming a more popular way of buying energy, additional validation is required to balance reconciliation statements from suppliers and check the growing number of third party charges. It is estimated that between three per cent and five per cent of utility expenditure can be saved by fully validating all elements of the suppliers’ invoices. Further savings can be achieved by reducing time spent by internal staff dealing with utility issues. This type of saving can often outweigh the cost of an energy bureau service, which should equate to less than 0.5 per cent of the total utility expenditure.

ACCOUNTS PAYABLE – FASTER SOLUTIONS, ACCURATE RESULTS Changing to electronic billing and using a system that can import and validate these invoice files provides a much more efficient way of processing utility invoices. Once validated, invoices can be included on a consolidated accounts payable file that can be imported into most accounting software. This process further reduces the time internal staff spend processing invoices and also ensures that duplicate or incorrect payments are eliminated. MONTHLY EXECUTIVE REPORTS – HAVING THE RIGHT DATA AT YOUR FINGERTIPS The Estates Return Information Collection (ERIC) is the main central data collection for hospital estates and facilities services from the NHS. ERIC is a resource of valuable data that enables the analysis of Estates & Facilities information from NHS t rusts and PCTs in England. Completing your statutory reports accurately can be rather stressful and time consuming especially if your data is limited or incomplete.

The Estates Return Information Collection (ERIC) is the main central data collection for hospital estates and facilities services from the NHS

WHAT CAN YOU DO? Analyse the 30 minute profile data usage to see what load is being used during the DUoS red band periods. Determine what load could be moved to other times and recommend actions to reduce consumption during this peak period. The results can then be monitored to see the impact of the actions taken. Calculate the cost of energy used during the red band times. Undertake a site survey, to identify key plant that could be timecontrolled to reduce red band consumption.

Identifying where energy is being wasted is essential, because if you can’t see it you can’t save it. Profile alerts are an intuitive way to combat energy and waste Limited or incomplete data is a common issue experienced when completing ERIC reports, however having this data provided to you on a report, such as our monthly executive report (MER), can help ensure statutory reports are easier to complete. The report is a comprehensive provision that contains the following sections: Database Statistics – showing how many sites, accounts and meters are being monitored; Monitoring Point Analysis – showing the breakdown of meters across the estate; Invoice Statistics – showing the number and value of invoices processed in the period; Billing Query Information – showing the bill validation savings to date, and outstanding queries; Management Report – showing overall consumption, CO₂ and costs for the last three years; Electricity/ Gas/Water Performance Analyses – showing the top 10 poorest performing properties by cost, consumption, energy PI, average p/kWh and year on year increase. Section 7 (energy) and section 8 (water) of your statutory report, can be completed using our MER which provides all the information you need about your electricity, gas and water consumption all in one place. Having all of this data at your fingertips will ensure that your statutory reports are easier to complete. The data provided within the MER is both accurate and easy to use. The screenshot below forms part of the MER and shows the number of queries raised by value as well as the top 10 consuming sites. PROFILE ALERTS – HIGHLIGHTING WASTAGE Identifying where energy is being wasted is essential, because if you can’t see it you can’t save it. Profile alerts are an intuitive way to combat energy waste and other exceptional consumption. Profile alerts are successful in identifying energy waste

directly and in suggesting behaviourial changes that can be implemented to reduce wastage. Profile alerts work for both small and large multi-sites that use HH or AMR electricity meters and data loggers, providing great cost and time saving opportunities. Setting consumption targets and undertaking proactive monitoring, is a great way to ensure that you are only using what is needed. STC provide half-hourly and AMR profile data management for electricity, gas and water meters and loggers. We use sophisticated software modelling to build a picture of a site’s consumption profile, which is then automatically monitored for exceptions. Any deviations will trigger an email alert, and can be viewed on a map-based site exception dashboard. Reporting can quickly highlight which sites are over target, enabling swift corrective action. The example on the page opposite shows the weekday, night and weekend consumption data and threshold for a particular site. DEMAND RESPONSE – AVOIDING PEAK TIMES With the introduction of the capacity market, reducing energy usage during peak times is crucial. For example, radiation departments in hospitals could reschedule appointments outside of the DUoS (Distribution Use of System) red band times. Our analysis of the profile data can assist with identifying periods of consumption that could be reduced during peak times. Peak times are typically 4pm – 7pm Mon – Fri, however peak times can vary by region. DUoS charges during the red band period can be significantly more expensive than other periods. These charges are likely to rise as demand increases. By shifting the electrical load away from that period can help reduce costs, without the significant capital outlay.

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SUB METERING Sub metering enables you to monitor energy usage for tenants, individual departments, pieces of equipment or other loads individually to account for their actual energy usage. With sub-metering, a clear and accurate picture of how and when energy is being consumed inside a facility is available. This ensures that all metered areas can see what they are using and any tenanted areas are charged accurately and only pay for what they use. Having this data available online would enable the NHS to view their consumption and engage in energy efficiency monitoring and behavioural changes, making the building a more sustainable property. Benefits of sub-metering include: accurate energy monitoring, real-time energy consumption; granular in-depth review of facility energy data; better informed to make decisions that can help optimise energy performance; ability to record actual energy usage (no estimates); comparison of usage across similar facilities over time; ability to identify and eliminate wasted energy; and early access to maintenance issues for repair before critical equipment fails. COMPLIANCE Although the CRC scheme is nearing its demise in 2019, annual returns and audits will still be required. Savings can be made here by ensuring that estimated invoices are kept to a minimum by using Profile / AMR data or self-read meter readings. This will save an uplift of 10 per cent on estimated data when purchasing allowances. !

If you would like to find out more about how STC Energy can help you save time, money and energy, get in touch today! For solutions and services that work use STC Energy (part of the Inspired Energy group). FURTHER INFORMATION Call us on 0208 466 2915 Email us on info@stcenergy.com www.stcenergy.com



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Health+Care returns on 28-29 June 2017 at London ExCel. It’s the only place where CCGs, NHS Trusts, IT, primary and social care professionals can come together and get 1000’s of practical solutions to help with the challenge of turning ambitious transformation plans into action - securing the future of the health and care services for generations to come.

NEW for 2017 Your badge will give you access to the brand new Digital Healthcare event that runs alongside Health+Care. You will learn more here in just a few hours than you could in months from your organisation. SECURE YOUR FULLY SUBSIDISED PASS BY USING BOOKING CODE HB17 AT HEALTHPLUSCARE.CO.UK/HB17

Keynote Speakers Include:


Matthew Swindells National Director: Operations and Information

Jim Mackey Chief Executive

Claire Murdoch National Mental Health Director

Health+Care is run in association with:

Philip Dunne MP Minister of State for Health

Lord Carter of Coles Will Smart Chief Information Officer

28–29 June 2017 | ExCeL London Organised by:


Seeking health and care transformation

Health+Care 2017


Health Business investigates the main talking points leading up to June’s Health+Care event, mainly concerning STPs, which feature heavily in the show’s Keynote Theatre Health+Care, taking place on 28-29 June 2017 at London’s ExCeL, enables more than 10,000 senior health and social care professionals to forge new partnerships and productive ways of working in challenging times, focusing on the delivery of cultural, service, system and digital transformation that’s essential to securing the future of health and social care systems. The event is a rare opportunity for colleagues from across the NHS, local government, care homes and the voluntary sector to come together on an equal footing to network, collaborate and share learning around implementing change. The focus will be on how to deliver real, impactful transformation across local health economies. SUSTAINABLE HEALTH AND CARE Dame Ruth Carnall, conference chair and former chief executive of NHS London, will open the conference and welcome delegates to Health+Care 2017 in the Keynote Theatre, before the day’s first plenary debate begins. Jim Mackey, chief executive of NHS Improvement, said that STPs will ‘reboot the NHS’ and ‘help cut enormous overheads’. An esteemed panel of health and social care experts and local system leaders will discuss how local systems are pulling together to build a sustainable health and care sector and the hurdles along the way. STPs also form the main talking point in the first Big Conversation, in which a panel of leading healths experts discuss how best to embed mental health on whole-style transformation, including progress in implementing the Five Year Forward View for Mental Health and which STPs are leading the way in rethinking the approach to mental health and well-being across local systems. In the afternoon of the first day, Professor Sir Bruce Keogh and Professor Matthew Cripps will address how better population healthcare is everyone’s business and what we can expect in terms of things happening differently via NHS RightCare’s work. This will explore positive patient outcomes, the importance of the role of clinicians in reducing unwarranted variation and how NHS RightCare will support a sustainable NHS. The first conference day in the Keynote Theatre will end with an analysis of the more controversial and complex challenges for all STPs – how to deliver large-scale transformation of acute hospitals. Leaders from different STP footprints will share their ongoing experience of reconfiguring acute services and how they are overcoming the hurdles – be they political or practical. LOCAL LED CARE SYSTEMS The first session on 29 June will feature a cross-party debate on the NHS and social care funding. David Hodge, leader of Surrey County Council, Health Select Committee member and MP Helen Whately, Jonathan Ashworth, Labour Shadow Health Secretary, and Liberal Democrat Health Spokesman Norman Lamb will tackle the issue of whether STPs really do have the power to reverse the crisis in the NHS and how best to sort out the crisis in social care, that led to Surrey County Council proposing council tax hikes of 15 per cent to combat deep cuts. Sir David Behan, chief executive of the Care Quality Commission (CQC), will then present his keynote address on leadership, innovation and safe care, outlining the CQC’s strategy towards innovation and improvement. The Keynote Theatre will finalise

its sessions by hearing the closing plenary address, to be presented by Philip Dunne, Minister of State for Health. SUSTAINABILITY THROUGH TRANSFORMATION Speaking in the Sustainability through Transformation Hub, Andy Hardy, chief executive officer at the University Hospitals Coventry and Warwickshire NHS Trust, will lead three case studies on the immediate impact of STPs, before a finance focused session explores the different approaches that leaders of STPs and their partnership organisations are taking to achieve financial sustainability across local health economies. A session on Key Enablers for Change will monitor Vanguards that are effectively mobilising people to self-care, to take responsibility for their own health and to engage in shared decision making with clinicians. There will also be a session on STPs and other transformation programmes that have rationalised estates quickly and made financial gain, followed by discussion and Q&A with an expert panel. ! FURTHER INFORMATION www.healthpluscare.co.uk

A social enterprise dedicated to improving the lives of people in care Encourage Activity is a social enterprise dedicated to improving the lives of people living in a care environment. The business initially provided hourly activity sessions to older people living in a care home or sheltered housing scheme, using competitive, game based activities to encourage older people to be more active. Starting in Worcestershire, Encourage Activity quickly grew to provide sessions to over 50 venues across the area on a regular basis, making activity part of a daily routine for many older people. Encourage Activity has now expanded to offering a training course that teaches care staff how to provide fun and engaging activities to their residents in a safe and friendly environment. Training takes place within the care venue

so that delegates have the opportunity to learn new skills in a familiar environment. The training has been developed in conjunction with Age UK and is accredited by The Open College Network. In addition to providing activity sessions and training to the care sector, Encourage Activity also works with individuals who want to set up their own groups in local town and village halls for their community. Please get in contact for further information on any of the company’s services, advisers would be happy to talk through your requirements. You can find Encourage Activity on stand C88. FURTHER INFORMATION encourageactivity.co.uk



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Although the pursuit of digital excellence in the NHS continues, the adoption of technology across the health service remains, at best, patchy. Yet, during 2017, where sustainability and transformation are national watchwords, the NHS’ ability to optimise technology will become crucial Our challenge is to deliver sustainable and affordable high-quality services, and underpin them with efficient processes that drive health outcomes. On its own, technology is not the answer; but it is undoubtedly part of the solution. That is certainly the case at Southport & Ormskirk Hospital NHS Trust, where technology has played a central role in the improvement of paediatric diabetes services. PAEDIATRIC DIABETES: CONTEXT Paediatric diabetes remains a major challenge in the UK which has the fourth highest number of children and young people (CYP) with diabetes in Europe. Although the most recent National Paediatric Diabetes Audit (NPDA) shows steady improvement in the number of CYP achieving excellent diabetes control, it’s still one of Europe’s worst-performing countries in terms of blood glucose control. Glucose control is just one of many NICE metrics to benchmark performance in paediatric diabetes. Paediatric Day Units (PDUs) are required to record and report patient progress against seven health checks; HbA1c, BMI, blood pressure, urinary albumin, cholesterol, eye screening and foot examination. However, the realities of clinical practice, and the complexities of managing paediatric patients, make completing all seven health checks difficult. Non-attendance rates are particularly high in young adult clinics, whilst ensuring patients maintain accurate diaries for clinical review is a perennial challenge. However, completing these seven care processes is just one part of the problem. For many trusts, recording and accessing the data to enable optimal patient care is an additional challenge. A high number of PDUs still use paper-based systems to manage patient information. With much diabetes care carried out in community settings, this not only impacts the speed, continuity and quality of care, it makes mandatory audit processes expensive and inefficient. This is one area where technology can make a significant difference. The holistic challenges of paediatric diabetes



care are familiar to Southport and Ormskirk. In 2011, the trust was audited by the CCG and found to be an outlier in terms of overall HbA1c outcomes. Furthermore, it had the highest DKA admission rates and hospital admissions due to diabetes. With NPDA data submissions dependent on manual data entry, our 2011/12 submission had excluded 49 out of 117 patients because of incomplete data, while the MDT noted a 43 per cent incomplete record of care processes due to manual data entry procedures. We knew that if we were to meet national standards and maintain the ICO’s reputation for high-quality children’s services, we needed to improve communications by harnessing technology. In 2012, to coincide with the introduction of a mandatory NPDA and the Best Practice Tariff (BPT), we deployed Twinkle, a specialist electronic health record system for paediatric diabetes patients. The system gives our diabetes teams – whether they’re in the hospital or the community – instant access to patient records. This allows us to undertake monthly audits to identify patients where intervention may be beneficial and helps us highlight patients with poor metabolic control, frequent DNAs or those who have been admitted as inpatients. With greater visibility of what’s happening with our patients, we have the insight to make pro-active and informed responses to their needs. The monthly audit has become a 10-second job and at the click of a button we are able to highlight the patients in greatest need of our attention to keep their treatment on track. What’s more, the system provides a real-world health check on our own performance – allowing us to review PDU performance against core care processes. Better still, our ability to demonstrate that we’re meeting national standards has helped us unlock funding through the BPT.

it’s just one piece of a complex jigsaw. But evidence shows that we’re heading in the right direction. National audits reveal year-on-year improvements in the core areas. In 2013, HbA1c levels showed marked improvement, whilst hospital admissions and length of stay were significantly reduced. In 2015/16, 33.2 per cent of our CYP with Type 1 diabetes had an HbA1c of less than 58 mmol/mol, compared to the national figure for England and Wales (26.6 per cent). Similarly, the PDU’s completion rate of all seven key care processes was 15 per cent higher than the national figure. These results are borne out in patient satisfaction surveys, which consistently highlight that both CYP and parents recognise and value the PDU’s use of technology in supporting their needs. The introduction of technology that allows patients to download data from their devices both in outpatient clinics and from home, and our careful use of social media, have played a valuable part. Digital transformation is not a quick fix for the NHS – and there are many barriers in its way. But it’s too easy to fall at the first hurdle. Technology, whether that’s information management systems, mobile tools or social media, when used together can transform healthcare services in the UK. This case study/article is by Paediatric endocrinologist May Ng, MBBS (Hons), FHEA, FRCPCH, LLM, PhD, of Southport and Ormskirk Hospital National Health Service (NHS) Trust and Hicom. Twinkle is Hicom’s paediatric diabetes management solution. !

THE OUTCOMES It would be misleading to suggest that technology has been the single driver of improvement at Southport and Ormskirk –

FURTHER INFORMATION Tel: 01483 794 945 admin@hicom.co.uk www.hicom.co.uk


With so much coverage pre-election about both the social care sector and the NHS, Nadra Ahmed, chairman of the National Care Association, discusses health and care integration The challenges we face in health and social care are a direct result of the fact that, nationally and globally, we have made great leaps in supporting people with complex health conditions to live longer – something we as a society should celebrate. Medical research and pharmaceutical advancements have enabled people to conquer debilitating conditions, which in years gone by would have ended their lives. What we have failed to do is to plan for the help and support they need as they age and their health care needs increase. In fact, we have systematically failed to plan for the future needs of an ageing population despite the fact that we have

been predicting it for the past two decades. It should come as no surprise to anyone that we would be facing a challenge which would put pressure on health and social care services, but for some inexplicable reason the people who were making the decisions around services ‘fit for the future’ failed to do anything to plan for it. Instead what we have managed to do is to systematically dismantle any form

UNSUSTAINABLE SOLUTIONS TO ONGOING CHALLENGES The reality of it is that as healthcare needs have grown we have found ourselves in the midst of challenging financial budgets. In the name of austerity we have created unsustainable solutions to ongoing challenges. Public services have been cut in favour of more favourable privately !

We failed t have the futu o plan for an agei re needs of despiteng population h predict aving been in the lastg it for t decade wo s

Written by Nadra Ahmed, chairman, National Care Association

An integrated health and social care system

of support to keep people independent and created pockets of deprivation for some of the most vulnerable people in our society. The fact that these are the very people we promised we would support from cradle to grave and all they had to do was to pay into an insurance scheme which would fund it, is neither here nor there. We have taken their money, which was their investment for old age and now want them to fund themselves. How on earth can there be any justification in the logic behind this? I understand that the NHS was not originally set up for the numbers it is currently servicing but actually, that is not the problem of the generation that bought into it, it is the problem of the generation that needs to keep it sustainable.

Joined-up Care



Joined-up Care


INTEGRATION ! funded services which have then been commissioned at unrealistic expectations at nominal costs. The result is the crisis we currently face, the NHS under severe pressure and social care at the brink of collapse.

We must not be blinded by the fact that this is only a funding crisis, because actually the challenges we face go much deeper. We could get all the money we ask for but without the health and social care professional to

Surely, the time has come for us to invest in the healthcare workforce in such a way that it is a long-term investment which builds confidence in health and social care and sees free movement between the two


deliver it we will not be able to meet our obligations. We have a severe shortage of nurses and health and social care auxiliary staff which will no doubt be compounded by the impact of Brexit. The image of health and social care is such that attracting staff into the roles is becoming a greater challenge than everyone anticipated. We have an opportunity to take remedial action to stem the tide and make sure that we do not continue to fail our citizens at their most vulnerable. In order to do this we need to have an honest discussion with all partners around the table. Health and social care have to work together to create sustainable

solutions to a growing challenge; a challenge which brings with it great opportunities. Social care has many masters but health care has one and that in itself creates tensions but this should not be seen as a barrier. When we look at the fact that bedblocking is costing the NHS an unsustainable amount of money from an ever decreasing pot, social care has to be the answer and actually it quite easily could be. We only have to look at the financial factor i.e. – Mr S in an NHS bed is costing the state £2,125 per week because he has some complex physical needs and has onset of dementia. In a residential care setting he will only receive funding of about £500, if eligible, or through local authority funding could be cared for at home for about £250 for 14 hours a week and community health care support for an undetermined amount depending on what unpaid care support he may need. All three options must look at what Mr S’s actual care needs are and how they can be met, but what is important in this is that a hospital bed should be the least favoured option based on the fact that all acute care needs will have been met at the point of a care assessment ready for discharge. The reality is that once we have met the acute care needs of an individual we should be working together to ensure that they are no longer left in an inappropriate setting, which is going to disadvantage someone else who may need that bed/care. The social care market has evolved in such a way that we are now looking after people who were, two decades ago, being cared for in NHS long stay wards receiving medical support from clinicians and support staff. These people were highly skilled and trained to meet the physical and mental health needs of vulnerable people at different stages of their lives.

The entrepreneurial nature of the social care provider began to develop services to meet growing healthcare needs and so the challenge was taken. The traditional care home resident was moved into a home care setting with nominal support despite their frailties and nursing care clients came into social care settings. The impact of this was that social care staff needed additional skills and knowledge to deliver care which was appropriate for the needs of the people coming into our services. With this in mind we need to create a dialogue which acknowledges the fact that social care provision is now undertaking health tasks which the NHS receives funding for. We must look at what a care setting delivers and map it to traditional health tasks and then look at how we actually commission care. Individuals should have an equal amount of funding available to them whether they are in a health or a social care setting if their assessed care needs are the same. Clearly, if those needs decrease as a result of social care intervention in the short term then that should be reflected but a stroke sufferer or someone with MS or Parkinson’s has the same care needs whatever setting they are in. The dichotomy of the current system is that once they leave hospital and are admitted into a social care setting we assume that the same quality of care can be delivered at less than a quarter of the cost. We must also look at equalising the training of the workforce who deliver the care. We have had a huge drive to upskill the social care workforce and raise their status. We must stop believing that nurses in social care settings are less skilled; they must be allowed to use their skills as they would in a clinical setting. Surely, the time has come for us to invest in the workforce in such a way that it is a long term investment one which builds

The social care market has evolved in such a way that we are now looking after people who were, two decades ago, being cared for in NHS long stay wards receiving medical support from clinicians and support staff SOCIAL CARE PROVISION Social care on the other hand was set up for people who were mildly confused and no longer able to manage daily tasks without support; home helps would feel that they were now at risk living alone. We did not cater for incontinence or indeed any other physical or mental health condition and usually end of life care meant that they may need to be transferred if their needs became of a clinical nature. However, as costs from the public purse spiralled so ‘austerity’ measures took a hold and long stay wards were closed pushing people into social care provision at a fraction of the cost.

confidence in health and social care and sees free movement between the two. Both areas would see benefits; we see many social care staff go on to become excellent nurses and we see nurses who leave hospitals come into social care and turn services around. We must promote this and enable people to make the transition in a positive way and so create domestic options to recruit staff into health and social care settings. The important thing to remember in all that we do in health and social care is that at the heart of all decision, whether financial or clinical, the person we care for must not be let down. If we are saying that we cannot

Joined-up Care


Over 80s abandoned by social care system Age UK called on political parties to put social care at the heart of their election manifestos as research revealed that a third of over 80s are receiving inadequate care and support. Age UK, the country’s largest charity dedicated to helping everyone make the most of later life, conducted research into the UK’s social care system, paying particular focus to the number of older people who do not get the help they need with Activities of Daily Living (ADLs). Figures show there are around 2,622,000 people over 80 living in England and almost a million have at least one ADL, while thousands are affected by several different ADLs. Analysis by the charity indicated more than half of those with three or more ADLs have been worst affected by the gap in availability of adequate social care. Of the 926,000 over 80s with at least one ADL: 53 per cent get no assistance at all; of those who do get help, for 70 per cent it does not fully meet their needs; and 794,000 do not receive any help or receive support that does not always meet their needs. Of the 260,000 people over 80 with three or more ADL: 33 per cent are not receiving any help; and 56 per cent have unmet needs due to not receiving enough help. For the 2017 General Election on 8 June, Age UK has continued to urge the next government to ensure that older people receive dignified care at home, in hospital and in care homes. FURTHER INFORMATION tinyurl.com/y8qubpvs fund their care at an appropriate level then we must have an honest conversation with the public and not raise expectations to such a level that people then feel let down. The NHS was the envy of the world for acute care and remains a torch of hope, but what we must recognise is that it needs partners in delivery and social care has to be an equal partner not a side issue, a solution not the problem. We could start by making sure that government appoints a Minister for Social Care and Health! ! FURTHER INFORMATION www.nationalcareassociation.org.uk







A review paper newly-published in Internal Medicine Review looks at the large body of peer-reviewed literature demonstrating the efficacy of antimicrobial copper in rapidly killing bacteria and contributing to more hygienic hospital environments. This article, contributed by the Copper Development Association, highlights some of the most interesting findings of the paper Providing an initial overview of clinical research, the paper, entitled Potential of copper alloys to kill bacteria and reduce hospital infection rates, says: “The findings suggest that copper alloys enhance hospital hygiene protocols because they act passively, requiring neither training nor human intervention to kill bacteria and reduce hospital-acquired infections.” It also observes that hand washing and

surface disinfection, pillars of infection control, as well as interventions such as UV light and HP systems, are ‘episodic or one-time approaches.’ As soon as the decontamination process ends, contamination can immediately begin to accumulate. Copper

alloys provide a continuously-active solid surface that can alleviate this problem. LAB WORK VS

There CLINICAL TRIALS The paper goes on to is ampl compare laboratory evidenc e versus clinical research, e to encoura noting that lab tests g e h ospital to adop are conducted ! s antimic t the use of ro alloys abial copper s their in part of fect control ion


Written by Bryony Samuel, Copper Development Association

The infection prevention potential of copper alloys

Infection Control



Infection Control



! under ideal, controlled conditions, with surfaces sanitised before being inoculated with a known bacterial strain. By contrast, clinical samples are taken in hospitals by swabbing component surfaces that may be contaminated with several different species of bacteria. They may also contain residues from cleaning solutions, oil from people’s hands and other chemical contaminants. This underlines the need for both types of research. Highlights from the review of clinical trial results include a study conducted in a US medical ICU, where it was found that 6.5 hours after disinfection, bacterial burden rebounded by 30-45 per cent (depending on the type of disinfectant used, in line with the hospital’s standard practice). This underscores that cleaning helps to reduce bacterial burden, but its benefit dissipates within a few hours. In a subsequent study in the same hospital setting, three beds were equipped with antimicrobial copper bed rails, with three standard plastic beds serving as controls. The bacterial burdens on the copper rails were significantly lower than those on the plastic rails, with those on the copper rails approaching the proposed ‘terminal cleaning’ target of just 250



‘The findings suggest that copper alloys enhance hospital hygiene protocols because they act passively, requiring neither training nor human intervention to kill bacteria and reduce hospital-acquired infections’

colony forming units per square centimetre. This is the cleaning goal after a room is vacated, prior to the next patient occupying it. Describing another US clinical trial exploring bioburden reduction, the paper notes that when copper chair arms and trays were compared to wooden arms and plastic trays, the copper trays showed an 88 per cent reduction in bacterial burden and the copper arms showed a 90 per cent reduction. Even the wood at the side of the copper arm inlays displayed a 70 per cent reduction, which was attributed to a lower rate of cross contamination from the copper surface. ‘Fewer bacteria survived on the copper alloy surface and therefore a smaller number of bacteria were available to be transferred to the adjacent wood on the side of the arm of the chair.’ A further example of this ‘halo effect’ is described in a clinical trial that took place in a Chilean paediatric ICU, where eight rooms had antimicrobial copper components and eight control rooms were standardly equipped. In addition to significantly reducing local bacterial burden, it was reported that the introduction of copper alloys in the study rooms suppressed the microbial burden recovered from components in nearby control rooms. The paper suggested that this may be ‘a result of suppressed cross contamination’. In discussing one of the best-known pieces of research – a multi-centre US study looking at the impact of antimicrobial copper surfaces in ICUs – it quotes the conclusion that introducing only six copper items into each study room resulted in a 58 per cent reduction in infections. These surfaces comprised less than 10 per cent of the room’s total touch surface area. THE COST PERSPECTIVE The final issue addressed is perceptions of cost surrounding antimicrobial copper surfaces. The review observes that ‘the initial cost of outfitting a copper alloy room may be perceived as an issue. However, the extra cost can quickly be recovered because infections are expensive to treat.’ An example of research exploring this subject is described, based on the number of infections antimicrobial copper could prevent in the ICU environment. Clinical researchers stated that ‘the extra cost of copper components was recaptured in less than two months’. CONCLUSIONS In its conclusions, the paper notes ‘there is ample evidence currently available to encourage hospitals and other patient treatment centres to adopt the use of antimicrobial copper alloys as part of their infection control protocols… Antimicrobial copper alloys may also have intangible benefits, such as demonstrating to patients that your organisation cares about their well-being’. It further observes that the copper alloy components used in the referenced studies were fabricated from 100 per cent solid metal, saying that ‘the copper alloy was not applied as a coating, which can wear off, or introduced as particles in a proprietary plastic matrix that makes up less than five per cent of the surface area’. A final area of interest is that ‘the greatest potential benefit of wider use of antimicrobial copper alloys to control infection has the potential to inhibit the emergence of new antibiotic-resistant strains.’ Based on reports from the US CDC, the ‘abuse and overuse’ of antibiotics is a major contributing factor in the emergence of resistant bacteria. Also to be considered in this process is the role of horizontal gene transfer, a major cause of the spread of multidrug resistance in bacteria. This is ‘essentially blocked by copper surface killing because the bacteria die rapidly with few to no survivors’. The review finishes by saying that ‘consideration should be given to deploying components made from solid metal antimicrobial copper alloys as an additional tool in the fight to reduce hospital-acquired infection’. A broad range of antimicrobial copper touch surfaces are available from suppliers around the world, in colours ranging from the metal’s familiar red to the variants of its alloys: golden, bronze and even a silver colour resembling stainless steel. ! FURTHER INFORMATION www.antimicrobialcopper.org

Infection Control


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Patient safety through infection prevention

Infection Prevention 2017


Taking place on 18-20 September at Manchester Central, the IPS Annual Conference is structured around one of the main pillars of effective NHS care – that no patient is harmed by a preventable infection. Health Business looks ahead to the show, and highlights some key discussion points

Covering the latest current and emerging threats, the Scientific Programme Committee for 2017’s Infection Prevention Society conference have produced a comprehensive series of lectures, specialist streams and meet-the-expert sessions. This years programme sees the introduction of a new international engagement stream and new facilities and estates sessions to help discuss, resolve and inform on those difficult issues that impact so much on infection risks, and the perception of risks, in a variety of healthcare settings. Neil Wigglesworth, IPS President and immediate past editor of the Journal of Infection Prevention, will welcome all delegates and guests to the conference and update the audience on what to expect form Infection Prevention 2017. Another key introductory session will be hosted by Karen Wares and Craig Bradley, who will give the audience an opportunity to network, explain their top-tips for infection prevention and describe the opportunities available for an infection prevention practitioner. YOUR MICROBIAL ARMOR Dr Nicola Fawcett, chief investigator of the Antibiotic Resistance in the Microbiome Oxford (ARMORD) Study, which assesses the effect of antibiotics on the gut microbiome using Next Generation Sequencing, will host a session on 18 September on ‘Your Microbial Armor’, which will analyse the importance

The clear evre is id that ea ence rly interve n t i o n th infectio n preverough causes and examine the saves li ntion evidence for prevention from ves as w a public health perspective. ell as cost to the THE HEALTHCARE BUILDING NHS Professor Satoshi Hori, director of

of a patient’s microbes in their ability to resist colonisation and infection by pathogenic organisms, and how this is affected by healthcare interventions such as antibiotic use. Sharon Leitch will also present on day one of the conference on ‘Barriers to decontaminating non-invasive devices’, which will examine the problems associated with unclean patient care equipment, outlining the current barriers to decontaminating non-invasive patient care equipment and providing recommendations for consideration. Cleaning will also form the basis of Christina Bradley’s session on ‘Cleaning - what, with what and how often’. Exploring the ever-growing importance of preventing infection outside hospitals, Tracey Cooper will provide a national and global perspective to her session ‘The importance of community infection prevention and control’, while Judith Potter will discuss norovirus on acute healthcare provision and suggest ways to minimise the impact, in her first day session on ‘Norovirus – How can we minimise the impact?’. Jacqui Reilly, lead consultant for IPC in Health Protection Scotland (HPS), will present on ‘Bloodstream infections’, providing an overview of current epidemiology, burden,

infection control in six group hospitals and professor of infection control science in the Juntendo University, will aim to inform delegates on the importance of incorporating infection prevention into the healthcare building in his session on day two of the conference. His talk will summarise the rational and evidence of infection prevention interventions associated with facility designs and management in the newly built Juntendo University Hospital, as well as the significance of maintaining a clean environment in healthcare facilities. Dr Deverick J Anderson, associate professor in the Division of Infectious Diseases and Department of Medicine at Duke University, will look at ‘Automated room decontamination devices’, summarising, comparing, and contrasting ‘no touch’ disinfection technologies such as vaporised hydrogen peroxide and UV light, asking the audience whether we should use these technologies routinely to reduce healthcare-associated infections. The second day of the conference, 19 September, will also host a discussion session on hand hygiene. Under the bracket of ‘This house believes all five moments of hand !



Case Study


A global pioneer in the field of patient safety, Datix explains why it has created Datix Cloud IQ Datix Cloud IQ is a safety and quality improvement system. It enables healthcare organisations to generate and implement strategies to optimise delivery of efficient, targeted and effective care. The system reflects the ‘Plan – Do – Study – Act’ process of continuous operational improvement; its main purpose is to provide a clear path to learning from instances of poor or sub-optimal care, taking users from the initial capture or identification of incidents, feedback or surveys through a range of techniques focused on delivering insight, understanding problems, devising cost-effective improvement strategies, implementing those strategies and then measuring their effectiveness. Maintaining an approach established during the 30 years that Datix has been a global pioneer in patient safety improvement, Cloud IQ is the result of Datix’s continued drive for innovation; a culmination of academic collaboration, extensive research and continuous user engagement. It introduces a wealth of new capabilities, significantly extending the value and



benefit of its software and offering many key new features requested by its users. Advancements in software capability in general, and cutting-edge data analytics in particular, mean that we have been able to produce a cohesive range of incredibly effective tools that drive forward the company’s mission to give its customers opportunities to learn from things that go wrong. Cloud IQ is grounded in the wealth of research that surrounds quality improvement in general and healthcare quality improvement in particular. In his 2000 report ‘Organisation with a Memory’, Sir Liam Donaldson pointed out that ‘the lessons must be learned’ but the evidence suggests

the NHS as a whole is not good at doing so. He called for better incident reporting and analysis and a wider, system approach to learning from error and poor outcomes. This report led to the creation of the NRLS and NPSAS, but despite clear effort from such organisations and from the NHS itself, more recent inquiries have identified ongoing shortcomings in implementing and maintaining improvement. Similar experience has led to similar statements elsewhere – such as Don Berwick’s comment that ‘the biggest issue facing the American healthcare system is our inability to improve’ and Lucian Leape’s reflection that ‘the single greatest impediment to error prevention is that we punish people for making mistakes’. Cloud IQ responds to these issues by providing a framework within which problems can be analysed in an open and transparent forum, generating and embedding effective improvement strategies to overcome them. FURTHER INFORMATION datix.co.uk/IQ

Infection Prevention 2017

EVENT PREVIEW ! hygiene are equally important and need to be given the same amount of attention’, Professor Didier Pittet will argue for the motion, while Professor Michael Borg will argue against. Pittet is the hospital epidemiologist and director of the Infection Control Programme and World Health Organization (WHO) Collaborating Centre on Patient Safety, University of Geneva Hospitals & Faculty of Medicine, Geneva, Switzerland. Borg heads the Department of Infection Control at Mater Dei Hospital in Malta, where he chairs the hospital’s Infection Control Committee and the country’s National Antibiotic Committee. CUTS THREATENING PATIENT SAFETY It is estimated that 300,000 patients a year in England acquire a healthcare-associated infection as a result of care within the NHS, annually costing the NHS at least £1 billion. Following a poll of its members, the IPS is urging health providers to maintain investment in infection prevention and control (IPC) teams to prevent serious risk to patient safety. The poll found that 30 per cent of professionals working in infection prevention and control have witnessed a reduction in the IPC services where they work. Moreover, 28 per cent reported a reduction in IPC posts or hours, meaning that 35 per cent have been asked to do additional non-IPC responsibilities

An estimated 300,000 patients a year in England acquire a healthcare-associated infection as a result of care within the NHS, annually costing the NHS at least £1 billion as part of their job. Additionally, 29 per cent of members polled stated that their most pressing concern associated with this was ‘serious risk to patient safety through infection spread’, while nine per cent highlighted ‘not being able to meet new national requirements such as E. coli targets in England’ as the main concern. Dr Neil Wigglesworth said: “There is clear evidence that early intervention through infection prevention saves lives as well as significant cost to the NHS. While some hospitals and healthcare providers recognise this, with 65 per cent of our members reporting that infection prevention services are being extended or maintained, others are cutting back. This will have an inevitable

impact on patient safety and could cause significant disruption to health service delivery. We are all working to achieve the new targets to reduce E. coli and other infections, and need NHS leaders and commissioners to maintain investment and help us reach these goals.” "

IPS are celebrating 10 years of IPS on 8 June this year and will be celebrating and showcasing their achievements over the past decade at this years conference. FURTHER INFORMATION www.ips.uk.net/education-events/ annual-conf2017-home-page

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Realising the risks of Legionella bacteria The naturally compromised immune systems of many patients in hospitals increases the risk posed by the Legionella bacteria. Revisiting advice from Radio-Tech Ltd, Health Business investigates how facilities managers can ensure Legionella does not fester and grow within their system

h Althougla is l Legionele, there ab preventarly 6,000 are ne ear across y cases a , including Europe England 350 in ales and W

The Health & Safety Executive (HSE) defines Legionellosis as a collective term for diseases caused by Legionella bacteria including the most serious Legionnaires’ disease, as well as the similar but less serious conditions of Pontiac fever and Lochgoilhead fever. Legionnaires’ disease is a potentially fatal form of pneumonia and everyone is susceptible to infection. The bacterium Legionella pneumophila and related bacteria are common in natural



water sources such as rivers, lakes and reservoirs, but usually in low numbers. They may also be found in purpose-built water systems such as cooling towers, evaporative condensers, hot and cold water systems and spa pools. If conditions are favourable, the bacteria may grow, increasing the risks of Legionnaires’ disease. It is therefore important to control the risks by introducing appropriate measures outlined in Legionnaires’ disease – The Control of Legionella bacteria in water systems (L8).

Although Legionella is preventable, there are nearly 6,000 cases a year across Europe, including around 350 in England and Wales, commonly manifesting in poorly-maintained air conditioning and water systems. By ensuring that water temperatures are kept outside of prime growth temperatures (20-50°C) facilities managers can ensure Legionella does not fester and grow within their system. Usual practice is to take temperature readings manually to ensure that this does not happen.

COMMON MISCONCEPTIONS Recent doubts over how accurate, and therefore safe, this is have, however, called for a new measurement and monitoring system. As the age of manual data monitoring draws to a close, the benefits of more accurate systems are being exploited. An ideal system is one that automatically and consistently takes readings over a regular time period and sends this information to the person responsible for its monitoring. Poorly advised monitoring or inaccuracies in data collection can be fatal. There are many misconceptions in the field of Legionella monitoring causing both dangers to human lives and costs from government issued fines. Partial knowledge can be as dangerous as no knowledge when dealing with Legionella. A common misconception among those monitoring is that a Legionella monitoring system is not necessary if a Thermostatic Mixing Valve (TMV) is in place. This is not the case.

unsure about whether you have taken the necessary steps to prevent a fatal Legionella outbreak in your building, contact a reputable Legionella specialist or monitoring system supplier for more information. Whatever you do, don’t wait for an outbreak to prompt you. WHAT YOU MUST DO If you are an employer, or someone in control of premises, including estate managers, you must understand the health risks associated with legionella. Duties under the Health and Safety at Work etc Act 1974 (HSWA) extend to risks from Legionella bacteria, which may arise from work activities. The Management of Health and Safety at Work Regulations (MHSWR) provides a broad framework for controlling health and safety at work. More specifically, the Control of Substances Hazardous to Health Regulations 2002 (COSHH) provides a framework of actions designed to assess, prevent or control the risk from bacteria like Legionella and take

There are many misconceptions in the field of Legionella monitoring causing both dangers to human lives and costs from government issued fines. Partial knowledge can be as dangerous as no knowledge when dealing with Legionella The truth is, although it can appear to aid your Legionella control, the TMV is not designed for this purpose and so is ineffective. TMVs were originally designed to prevent scolding at the outlet when hot water systems distribute water at very high temperatures. Distributing the hot water at high temperatures (in excess of 60˚C) will eliminate Legionella, but once this water has passed through a TMV risks increase as it mixes with the cold supply especially on infrequently used outlets. Should the cold water supply be the source of contamination you could have a potential outbreak. Additionally, should there be a fault in the hot water the risk of contamination is increased if and when it is distributed at lower temperatures. Even with TMV’s in place you should still monitor the temperature of your water system. The approved code of practice states that regular monitoring of both hot and cold water temperatures should be carried out on the input to TMV’s on a sentinel basis, monitoring the temperature control regime. Full government guidelines of the do’s and don’ts of Legionella monitoring can be found in Legionnaires’ disease – The Control of Legionella bacteria in water systems (L8). It is vital that these guidelines are properly understood in order that defences are built high in the battle against Legionella outbreaks. In producing these guidelines, the government has made us responsible and we must act on the information we have. If you are

suitable precautions. The Approved Code of Practice: Legionnaires’ disease: The control of Legionella bacteria in water systems (L8) contains practical guidance on how to manage and control the risks in your system. As an employer, or a person in control of the premises, you are responsible for health and safety and need to take the right precautions to reduce the risks of exposure to Legionella. You must understand how to: identify and assess sources of risk; manage any risks; prevent or control any risks; keep and maintain the correct records; and carry out any other duties you may have. Carrying out a risk assessment is your responsibility. You may be competent to carry out the assessment yourself but, if not, you should call on help and advice from either within your own organisation or from outside sources, e.g. consultancies. You, or the person responsible for managing risks, need to understand your water systems, the equipment associated with the system such as pumps, heat exchangers, showers etc, and its constituent parts. Identify whether they are likely to create a risk from exposure to Legionella, and whether: the water temperature in all or some parts of the system is between 20–45 °C; water is stored or re-circulated as part of your system; there are sources of nutrients such as rust, sludge, scale, organic matter and biofilms; the conditions are likely to encourage bacteria to multiply; it is possible for water droplets to be produced and, if so, whether they can be dispersed over a wide area, e.g.

Are heart surgery machines spreading infection?



An article in the New Scientist in May highlighted the possibility of patients undergoing heart surgery getting infected with a deadly strain of bacteria, spread by machines used to cool blood. Speaking to the European Congress of Clinical Microbiology and Infectious Diseases in Vienna at the end of April, the University of Iowa’s Daniel Diekema said that the design of blood-cooling machines is flawed and was an infection risk that was ‘hiding in plain sight for decades’. Diekema says that the use of devices, such as valves or blood-vessel grafts, during open-heart surgery causes the risk, as the surgery depends upon machines to cool and warm up the blood. During the operation, machines contaminated by the bacteria can blow them out into the operating room, where they can land on the devices to be implanted. Mycobacterium chimaera, the microbe present, has been reported in a number of blood-cooling machine brands, and of the 110 known cases of mycobacterium chimaera spreading in heart patients so far, half of those infected have died. Hospitals around the world have started notifying patients who are at risk to tell them to watch out for symptoms, mainly if the type of machine first identified as contaminated was used in their surgery. Read more at tinyurl.com/y8q8gcg9

showers and aerosols from cooling towers; and whether it is likely that any of your employees, residents, or visitors are more susceptible to infection due to age, illness, a weakened immune system, and whether they could be exposed to any contaminated water droplets. Your risk assessment should include: management responsibilities, including the name of the competent person and a description of your system; competence and training of key personnel; any identified potential risk sources; any means of preventing the risk or controls in place to control risks; monitoring, inspection and maintenance procedures; records of the monitoring results and inspection and checks carried out; and arrangements to review the risk assessment regularly, particularly when there is reason to suspect it is no longer valid. ! FURTHER INFORMATION www.hse.gov.uk/legionnaires/what-is.htm



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Water Hygiene Services • Legionella’s Risk Assessments adherent to HSE ACOP L8

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Asbestos Management and Consultancy • Asbestos Risk Assessments inline with HSG264. We provide you with a clear and easy to follow survey report which includes, tailor management plans, full itemised register with photos and findings and UKAS accredited laboratory sample results. • Asbestos testing and UKAS approved sampling • Safe and efficient removal of asbestos containing materials


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With so much information available, it can be hard to understand your responsibility around compliance, so it’s time to explain it in steps we all understand WHY Legionella bacteria are common in nature and can easily colonise in man-made environments such as hot and cold water distribution systems. Once bacteria has grown in the water system, inhalation of water vapour can lead to Legionnaires Disease. With an estimated 250 cases in the UK each year, and approximately 18% of these resulting in fatalities, our water hygiene team will provide you with the assurance that you are statutory compliant and that water hygiene risks are minimised. COMPLIANCE If achieving compliance internally or using a third party to ensure compliance once setup correctly, the process is simple and should integrate into the general running of the building with minimum disruption. Our experience shows us that some third party companies can make the process over complicated and training internal staff can pull your stretched resources away from your primary focus, costing more over the longer term. Our advice to all our customers would always be research. For assurance we always point anyone who asks to the HSE website, it describes the law quickly and simply, as in leaflet INDG458, published 04/12 Under general health and safety law, as an employer or person in control of a premises (e.g. a landlord), you have health and safety duties and need to take suitable precautions to prevent or control the risk of exposure to legionella. Carrying out a risk assessment is your responsibility and will help you to establish any potential risks and implement measures to either eliminate or control risks. You may be competent to carry out the assessment yourself but, if not, you should ask someone with the necessary skills to conduct a risk assessment. NPS GROUP Part of the NPS Group (who are wholly owned by the public sector), NPS Infinity is a provider of high quality property, design and construction consultancy services. Employing over 1000 staff across 26 UK offices, NPS has a wealth of experience in helping our clients understand their property assets and ensuring their property portfolio is performing, as it should.

COMPLETE COMPLIANCE SOLUTION NPS Infinity has the capability to provide comprehensive water quality management services throughout the UK. Building on the support and expertise of our holding company, NPS Group, we provide extensive, reliable personalised services to both local government, public sector clients and private business customers alike and have vast ranging experience in meeting water safety compliance through risk assessments, modifications, installations and renovations. NPS Infinity is passionate and committed to keeping our customers water-safe and compliant and informed throughout every step of our delivery process, enabling you to be fully aware of your own duties for water systems under health and safety law and legislation. As well as Water Hygiene, NPS Infinity offer a full range of compliance requirements. Feedback from our current client base is that they want to focus on delivering their own client needs and know that a professional consultant is taking care of the building needs. RISK ASSESSMENT AND MONITORING A fundamental part of the HSE Approved Code of Practice (ACoP) L8 requirement is the need for a business to undertake regular monitoring and checks of water systems to ensure everything is compliant within guideline parameters. Our experienced team of water hygiene engineers can provide you with a reliable and cost effective water system management service, ensuring your water systems remain free from the spread by Legionella bacteria. We not only have the vast experience and knowledge to provide a high quality, efficient service, but we also have the values and ethos to understand how invaluable it is to ensure you as a client are confident in understanding the measures you can take to proactively ensure the tailor-made service we provide. We ensure our service is unique, flexible and client focused through thorough planning and undertaking of comprehensive Legionella risk assessments, identifying all potential sources of risk associated with Legionella within your building’s water system. Our engineers undertake an initial survey of the water systems on your site, determining what needs to be included within the scope

of a comprehensive, concise and quantifiable risk assessment. Our risk assessments are clear, tangible, easy to interpret and are fully adherent with the HSE Approved Code of Practice for the control of Legionella in water systems, ACoP L8 and the guidance found in the latest British Standard, BS 8580:2010. Once the Legionella risk assessment has been completed, our qualified water experts will make recommendations for any modifications and renovations needed to the water services, which may be necessary in order to ensure regulatory compliance with the current legislation. PAPERLESS Keeping up-to-date records is just as important as having the checks carried out. NPS Infinity use the latest version and best in its class to ensure your records are kept online in your own web portal. Working without the need for paper ensures both you and the consultant has instant access to the latest information all the time. SINGLE POINT OF CONTACT Support to our customers doesn’t stop at the Risk Assessment or monitoring. Using our highly experienced engineers, we can offer the full package, which includes the option to complete the remedial works highlighted in the Risk Assessment. Again, this removes the need for you to place separate orders and managing separate contractors. FIXED PRICES Our vast experience in the public sector shows that some of our clients worry about engaging consultants due to concerns about spiralling costs. Similar to our work ethic and quality we want to separate ourselves from our competitors by offering fixed and transparent prices. This gives cost certainty and best value to the customer. Compliance could be from as little as £350. ! FURTHER INFORMATION kelly.dew@nps.co.uk




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Conveniently located hub for business activity

In a city of legends Crowne Plaza Nottingham is starting a new story after undergoing a major transformation. Within easy reach of the M1 and Nottingham Railway Station it is the largest hotel in the city and enjoys a prime location. The hotel is able to hold from two to 400 guests and has 17 conferences, meetings and event rooms specifically designed to encourage connectivity and bringing people together. Alongside this you will find 210 newly refurbished bedrooms, a recently transformed bar and lounge, an on-site spa and car city centre car parking. Cultural visits begin a short stroll from the hotel at


the Theatre Royal and Royal Concert Hall, while shoppers can start their spree at nearby intu Victoria and Broadmarsh shopping centres. The hotel is also handy for historic Nottingham Castle and art shows at Nottingham Contemporary. From hearty buffet breakfasts at Lace Maker Restaurant to fine international cuisine at Swatch Restaurant and drinks in the elegant adjoining bar and lounge, the hotel makes a great spot for dining and networking. FURTHER INFORMATION Tel: 0871 942 9161 cpnottingham@ valoreurope.com




First-rate furnshings for the healthcare sector

Bridge is an innovator and installer of soft furnishings and anti-ligature products for all applications. Its dedicated team love what they do, creating effective spaces that provide design integrity, function, quality and most importantly, maximise the safety of vulnerable persons in healthcare environments. Bridge’s goal is to enhance the quality of life for those living and working in healthcare environments, mental health units and rehabilitation clinics through carefully designed and installed soft furnishings and anti-ligature solutions. As innovators, Bridge is flexible in the way it works and

loves a challenge. The company will tailor its service to meet your needs. With experts at every desk, working with some of the UK’s leading healthcare groups and as an approved supplier to the NHS, listening to the ever changing demands and requirements of the healthcare sector, coming up with the best solution is its passion. Years of working with designers, hospital managers, contractors and key manufacturers in the industry means Bridge can promise to provide the best products and service whatever your budget. FURTHER INFORMATION Tel: 0800 619 6190


With a number of large retailers agreeing to cut the proportion of sugary drinks they sell in their hospital shops in England, Health Business looks at the measures in place to limit sugar intake in hospitals As worded by NHS England chief executive Simon Stevens: ‘a spoonful of sugar may help the medicine go down but spoonfuls of added sugar day-in, day-out mean serious health problems’. On 21 April, NHS England announced that leading retailers, including the likes of WHSmith, Marks & Spencer, Greggs, the SUBWAY® brand, Medirest, ISS and the Royal Voluntary Service, would be voluntarily reducing the amount of sugary drinks they make available in hospitals. The scheme was launched after a consultation heard of other sugar cutting options including the introduction of a fee or the implementation of a ban on sugar-sweetened beverages on NHS premises. The initiative involves reducing the total volume of monthly sugar-sweetened beverage sales per retailer, per NHS outlet, reaching a target of 10 per cent or less of total volume of drinks sales for the whole month of March 2018 and continuing thereafter and in future contracts. The news comes after widespread concern over the effect sugary drinks are having on the public, with sobering calculations from the National Diet and Nutrition Survey revealing that four in 10 teenagers drink a bathtub of sugary drinks every year.

leading reason for hospital admissions for children aged between five and nine. Indeed, the food products sold in NHS locations can send a powerful message to the public about healthy food and drink consumption. NHS premises receive heavy footfall from the communities of which they are a part, with over one million patients every 24 hours, 22 million A&E attendances and 85 million outpatient appointments each year. The UK central government buying standards good practice guidelines dictate that all sugar sweetened drinks should be in packs no bigger than 330ml and no more than 20 per cent of the drinks

NHS s ha England d that ce announ retailers leading voluntarily e would bg the amount reducin gary drinks of su able in avail als hospit

RISING LEVELS OF OBESITY Official figures have shown that the prevalence of obesity among adults in England rose from 4.9 per cent to 25.6 per cent between 1993 and 2014, with nearly a third of children aged between two and 15 classed as overweight or obese. In addition, the Faculty of Dental Surgery has warned that sugar consumption is also one of the main causes of tooth decay in children, with tooth extractions now the

Written by Rachel Brooks, Health Business

Just a spoonful of sugar?

purchased by the organisation may be sugar sweetened. No less than 80 per cent of the drinks in the vending machine may be low calorie or no added sugar (including fruit juice and water). Since sweetened drinks (unlike some foods) have no nutritional value, the government has put in place a particular crack down on the selling of sugary liquids. In the UK, there are well over 500,000 machines vending around seven billion items per year. The problem of course, is that currently the majority of machines are usually dispensing processed, basic and sugary food products. NICE guidance directs that local authorities and NHS organisations should ensure that any vending machines in their venues that are used by children and young people offer healthy food and drink options. However, it is wise to consider that unhealthy eating and drinking is not just a problem for patients and the general public, but for employees working in the environment. A recent survey found obesity to be the most significant self-reported health problem amongst NHS staff, with nearly 700,000 NHS staff estimated to be overweight or obese. NHS England has noted that there is no single policy which will provide the solution to reducing sugar consumption, but rather a need for a variety of population-level interventions which focus on improving healthy behaviours, to ultimately reduce the burden of obesity and create a health-promoting society.



VENDING STATISTICS Governments and health systems around the world, including in Mexico, Hungary and Australia, have already implemented fiscal policies on sugar. Meanwhile hospitals in New Zealand and dozens of organisations in the US have banned the sale of sugar-sweetened beverages on hospital premises altogether. Official statistics from the Automatic Vending Association’s (AVA) 2016 UK Vending Industry Census has shown that: the UK vending industry turnover has increased by two per cent to £1.53 billion; the number of open-site cashless transactions per month has doubled in 2016; and 39 per cent of cold drinks sold in 2016 were low sugar/diet or water. FURTHER INFORMATION the-ava.com


Products & Services




Worth Fire Protection is a Kent based fire alarm company with over 20 years’ experience. It works throughout, Kent, London, Essex, Hertfordshire, Surrey, Sussex, Bedfordshire, Hertfordshire and beyond where viable for all parties. It is a BAFE, constuctionline and safe contractor approved company, with engineers that are all DBS certified. Worth Fire Protection can offer a professional client care in Fire alarms, extinguishers, nurse call, cctv, door access and emergency lighting to name but a few. Worth Fire Protection has multi skilled engineers and specialist engineers that are dedicated to a single field. The gives the company a broader range of skills and any issues are easily resolved through its teams. Worth Fire Protection are technically astute and adaptable and believes its common sense is a major

Agrippa fire door holders have been installed into one of London’s care homes to ease access for staff and residents. Nightingale House offers residential, nursing and dementia care to men and women over the age of 60. With over 300 residents, staff in the care home required a solution to replace their existing fire door holders. Bianca Temple, said: “We started to search for an alternative when the door retainers we had fixed to the fire doors began to fail. We require the doors to be held open in the office and communal areas to ease access for staff and residents. “The Agrippa holders were installed into the care home very quickly by our on-site engineer. We have a fire alarm test each Monday and the Agrippa holders have never failed to close the doors.” The Agrippa door holders provide a safe and legal solution to

Fire protection services for your environment

attribution to the company and, along with its flexibility, allows its contracts to run smoothly and efficiently for clients. Worth Fire Protection’s worksheets are on tablet form and once completed will be emailed directly to its office to allow the services and works to be seen in ‘real time’. The company finds this is beneficial to each party in an industry so reliant on up-to-date paperwork and procedures. FURTHER INFORMATION Tel: 01634 325835 admin@worthfireco.uk www.worthfireprotection.co.uk


Firesec – one stop fire and security provider

In the challenging working environment of the public sector where cost savings are key, but without the compromise of service, Firesec is an experienced and trusted one stop fire and security provider with its finger on the pulse of the health sector. Delivering cost savings, meeting deadlines, maintaining systems and focusing on first time fix emergency response is Firesec’s specialist field. Take advantage of Firesec’s ‘System Health Check’ and let the company see what it can do to make your facilities or maintenance department perform better. Firesec prides itself on


providing a fast and reliable service, assisting clients with: fire alarms; emergency lighting; risk assessment and training; fire marshall and extinguisher training; intruder alarms; CCTV systems; door entry systems; and nurse call systems. Firesec is continually working with a wide variety of customers, designing maintenance programmes tailor made to meet their needs in all types of industrials, commercial, domestic and retail environment. FURTHER INFORMATION Tel: 0845 056 9815 Email: info@firesecelec.co.uk firesecelec.co.uk


Agrippa holders installed at London care home

holding open fire doors. The devices are battery-powered and can be installed in less than 10 minutes, meaning there is very little disruption during fitting. The ‘listen and learn’ technology used in the Agrippa fire door holder means that the devices record the sound of the building’s specific fire alarm. When the fire alarm sounds, the Agrippa devices recognise the sound and close the fire doors, preventing the spread of smoke and fire. FURTHER INFORMATION Tel: 01388 770 360 enquiries@geofire.co.uk


Pinnacle: fire detection and emergency lighting

With over 25 years of experience in the industry, Pinnacle Fire & Electrical is perfectly placed to provide fire detection and emergency lighting services at competitive prices for all commercial and domestic customers throughout the wider London area. The company offers impartial best practice advice on supply, design, installation, and commissioning of systems to suit all budgets. It is third party accreditedBAFE/BSI/NICEIC/FIA. Being a member of independent bodies within the UK ensures it is audited and remains competent to meet all appropriate high quality standards that noncertificated companies may lack. It’s no secret that fire detection

and emergency lighting saves lives in the home or place of business. Having a fully working alarm is essential to the on-going safety of personnel. From simple smoke detection devices to fully addressable fire panels Pinnacle Fire & Electrical aim to ensure your premises remain protected. Implementation of periodic maintenance to comply with current British standards ensures your fire systems remain reliable. Contracted customers are entitled to 24-hour emergency callout. Pinnacle also offers a free survey and quote and aim to beat any genuine like-for-like quotes. FURTHER INFORMATION Tel: 0208 8416066 sales@pinnacle-fire.co.uk



Dark Knight Security, based in Berkshire, was established in 2008 with a vision to improve the image of security. It is the company’s goal to provide a quality service in an industry where this focus can often be neglected. This has given Dark Knight Security a competitive edge, which in turn has built long lasting relationships with a broad range of clients, who continue to work with the company to exceed their expectations. Quality means recruiting the best people, building strong working relationships, continual staff training and above all, acting with integrity.

Legionnaires’ disease is a potentially fatal type of pneumonia, contracted by inhaling airborne water droplets containing viable Legionella bacteria. Such droplets can be created, for example, by: hot and cold water outlets; atomisers; wet air conditioning plant; and whirlpool or hydrotherapy baths. Anyone can develop Legionnaires’ disease, but the elderly, smokers, alcoholics and those with cancer, diabetes or chronic respiratory or kidney disease are most at risk. Health and social care providers have a legal requirement to conduct a Legionella risk assessment of their hot and cold water systems, and should ensure that adequate measures are in place to control the risks. Aquarius Water Solutions Ltd undertake all tasks in relation to water hygiene, from monthly temperature regimes and tank disinfections to audits of current schemes carried out by site

Dark Knight Security A vision to improve the image of security

With a primary focus on London, Surrey and Berkshire, the company delivers security solutions for private, commercial, corporate and industry clientele across the UK, with the aim of always providing the best possible service at the most cost effective rates. Contact Dark Knight Security to discuss your security requirements and find out more about the range of solutions the company can offer you. After all - your security matters. FURTHER INFORMATION Tel: 0843 289 3727 darkknightsecurity.co.uk info@darkknightsecurity.co.uk

Quality water treatment at a competitive price

Products & Services


personnel or subcontractors. The company can design a bespoke programme of Legionella monitoring to suit your individual needs. Its aim is to achieve high levels of hygiene in water systems and compliance with all the relevant statutory requirements (ACOP L8, HSG 274 Part 2 & HTM 040-01) Please get in contact for a free no obligation quotation or to discuss your requirements in more detail FURTHER INFORMATION Tel: 01252 216222 info@aquariuswater.co.uk www.aquariuswater.co.uk



Fire alarm installation, design and maintenance

Nagels: a well-established supplier to NHS trusts

Meritas specialises in providing fire alarm system design, installation, commissioning and maintenance to a wide range of healthcare organisations and commercial companies. It also provides specialist services within the NHS covering; motorised fire damper (MSD) and fire damper (FD) inspections and maintenance. This work Meritas provides for one of the UK’s largest facilities management companies. In addition to the above; Meritas also specialises in the design, installation and maintenance of; emergency lighting, fire door retainers, nurse call and fire extinguishers. The company also offers a wide range of security solutions covering: access control, door entry, gates and barriers, CCTV systems, intruder alarms and public address systems.

Its extensive range of products for car parks within hospitals ensures it can provide you with all of your requirements needed to create a stress free environment for patients, staff and visitors alike. Signage for hospitals is often the first impression for visitors and patients and Nagels’ expertise and understanding of this makes it the ideal partner to advise and consult on signage needs. Nagels is expanding the range of signs required by its NHS clients into both internal and external signage, with the addition of safety, security, directional and instruction based signage for all areas of the hospital. Recognised for its quality, all Nagels’ signs are manufactured taking advantage of the latest

Meritas’ aim and commitment is to offer a first class service to meet your specific needs; you can be certain it has the experience, knowledge and knowhow to support your business needs. It works with clients and partners to understand their business and personal objectives and to make sure the right systems and services are in place to meet their business objects, budgets and time frames. Meritas’ engineers are fully trained and work to; BAFE, NSI and safe contractor standards. FURTHER INFORMATION Tel: 01376 295060 info@meritas.co.uk www.meritas.co.uk

manufacturing processes, technologies and materials. Nagels will carry out site surveys for clients and install the signage through a network of approved, fully trained installation teams who are equipped, skilled and experienced in working within the NHS environment. Nagels’ experienced design team will work closely with you ensuring that the signage produced will be to your specific requirements. Nagels signage is available to order via its online web portal. Bespoke designs are also available via the portal. FURTHER INFORMATION welcome.uk@nagels.com www.nagels.com



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The industry leader in ligature resistant/ suicide safety

Behavioral Safety Products designs and supplies ligature resistant products that are technically sound, aesthetically pleasing, and functional. BSP is a single source provider of ligature resistant building products, focusing primarily on the patient bedroom and bathroom. Our goal is to provide rapid access to critical products as facilities face steady increases in patient acuity and greater difficulty in patient monitoring. We not only supply, but provide engineering input, product support, and field experience to assist behavioral health facilities, emphasizing

ethics and professionalism and furnishing sound technical advice reflecting over 41 years of field experience. In this ever-evolving industry, BSP continues to forge ahead and innovate to stay ahead of the curve to meet the new challenges our industry faces every day. On a daily basis, we work one-on-one with facilities, architects, and engineers to be front-runners by problem solving as new safety issues arise in the behavioral industry. FURTHER INFORMATION www.besafepro.com


The sustainable way to safely and effectively clean buildings

AlgoClear Softclean is a simple method developed for the treatment of roofs, walls and general amenity. It is non aggressive in nature. The system comprises the chemical and the equipment needed to deliver it effectively and safely onto the roof. The process is particularly suited to porous materials. The active ingredient of AlgoClear Pro is a high purity quaternary ammonium. It kills 99.9 per cent of the microbial life and is a potent algaecide killing in the process their reliant hosts – moss and lichen. It does

not affect any known material used in construction. It has a rapid breakdown rate after use, leaving residues absorbed by bacteria. It is approved for the cleaning of children’s play areas. The Softclean technique is inherently safe for the building and the public. The application technique is well controlled and the applicators trained to work with minimal disruptions to the occupier and the operatives work safely. FURTHER INFORMATION info@algoclear.com


The publishers accept no responsibility for errors or omissions in this free service AGFA Healthcare UK Alfamax Catering Services Aquarius Water Solutions ARI-Armaturen UK Assistive Partner Badgemaster Behavioral Safety Blackburn Special Products Bridge Contract Interiors Bridon Healthcare Furniture Carecheck Central Medical Supplies CFH Docmail CHGIP CloserStill Media Crowne Plaza Nottingham Cybersmart Daikin Applied Services Dark Knight Security Datix



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Improving Patient Safety At Omnicell we’re campaigning for safer standards of care in the management of medication across the NHS

Between October 2015 and September 2016 more than 190,000 medication errors involving the prescribing, dispensing or administering of drugs were reported in England to the NHS National Reporting and Learning System. The vast majority, nearly 150,000, were reported by hospitals. Omnicell technology can help dramatically reduce, if not eradicate, these medication errors in hospitals. Contact us to find out more. www.omnicell.co.uk | 0161 413 5333 | automationsalesuk@omnicell.com Campaigning for safer standards of care

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Health Business 17.3  

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Health Business 17.3  

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