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VOLUME 17.4 www.healthbusinessuk.net

PARKING

DATA SECURITY

PATIENT HANDLING

DIGITAL TECHNOLOGY

DEVELOPING DIGITAL HEALTHCARE APPS The importance of an extensive apps library for the NHS BARCODING

SURGICAL EQUIPMENT TRACKING Tracing patients, products and procedures to ensure an improved patient safety culture

PLUS: CATERING | HEALTHCARE ESTATES | INFECTION CONTROL | TOP 10


HEALTH BUSINESS MAGAZINE ISSUE 17.4 VOLUME 17.4 www.healthbusinessuk.net

PARKING

DATA SECURITY

Comment

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

Showcasing sustainability success in healthcare

PATIENT HANDLING

DIGITAL TECHNOLOGY

DEVELOPING DIGITAL HEALTHCARE APPS The importance of an extensive apps library for the NHS BARCODING

SURGICAL EQUIPMENT TRACKING Tracing patients, products and procedures to ensure an improved patient safety culture

PLUS: CATERING | HEALTHCARE ESTATES | INFECTION CONTROL | TOP 10

This issue’s HB Top 10 focuses upon the NHS trusts that are leading the way in sustainable initiatives that will lower emissions, cut carbon footprints and create greener working. The NHS has some of the largest estates, buildings and workforces in the world, so operating within the correct environmental and economic boundaries is integral to its day-to-day running. The organisations on our list, as well as all those who are making a difference to their buildings, working patterns and communities who did not make it, are exemplars in sustainable development and carbon reduction. You can read our sustainability Top 10 list on page 15. These themes will also form part of the category list for the Health Business Awards, which are taking place on 14 December at the Grange Hotel, St Pauls, London. Established to celebrate innovation and success within the NHS, the significant contributions made each year by organisations in the areas of environmental practice, estates and facilities innovation, hospital building and sustainability will be recognised as part of a luncheon and awards ceremony.

Follow and interact with us on Twitter: @HealthBusiness_

To find out more, or to enter your organisation in any of the 22 categories, please visit the awards website at www.hbawards.co.uk

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:

www.healthbusinessuk.net PUBLISHED BY PUBLIC SECTOR INFORMATION LIMITED

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

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Health Business is a member of the Independent Press Standards Organisation (which regulates the UK’s magazine and newspaper industry). We abide by the Editors’ Code of Practice and are committed to upholding the highest standards of journalism. If you think that we have not met those standards and want to make a complaint please contact Michael Lyons or Angela Pisanu on 0208 532 0055. If we are unable to resolve your complaint, or if you would like more information about IPSO or the Editors’ Code, contact IPSO on 0300 123 2220 or visit www.ipso.co.uk

Volume 17.4 | HEALTH BUSINESS MAGAZINE

3


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CONTENTS 15

07 NEWS

Academy to drive digital innovation in NHS. NHS ‘achieves superior performance’ compared to other countries. Patients need protecting in Brexit negotiations

15 HB TOP 10

The environment in which people live and work has a key influence on their health. The HB sustainability Top 10 recognises the NHS organisations that have made progress towards sustainability through the smarter use of energy, transport and waste management in order to strive towards a reduced impact of healthcare facilities on the environment

19 IT & APPS

25

There has never been a better opportunity for people to take control of their own health and well-being through the use of digital technology. In this article, Rachel Murphy, digital delivery director of NHS.uk, shares the ambitious NHS plans to harness the power of digital healthcare apps

25 BARCODING

The future of the whole healthcare system depends on us being able to track every person, product and place in it. Glen Hodgson, head of healthcare at GS1 UK, explores how GS1 standards are assisting NHS trusts in identifying individual instruments used in procedures – improving patient safety and inventory management

31

31 DATA SECURITY

With the NHS recently falling victim to one of the highest-profile global ransomware attacks, James Kelly, chief executive of the British Security Industry Association, discusses the impact cyber security has been having on society and the work being done to reduce the risk of product-related cyber crime

73

37 UK HEALTH SHOW

In the build up to September’s UK Health Show, Lyn Whitfield looks over the third Caldicott report and the government response. In this preview article, Dr Alan Hassey, a member of the National Data Guardian panel, also shares his views ahead of his appearance at this year’s event

47 HEALTHCARE ESTATES 92

65 FLOORING

There are a number of key requirements for flooring within the healthcare sector, including ease of cleaning, durability, versatility and hygiene benefits. Health Business examines why hospital flooring must be suitable in all these areas

68 LIGHTING

Organisations across the UK have been increasingly using LED lights for their environmental and budgetary benefits. Brendan Keely, secretary at the Society of Light and Lighting, reflects upon their efficiency savings and the versatility of the technology

73 CATERING

Stewart McKenzie, the new national chair of the Hospital Caterers Association, looks at the role that healthy catering in the NHS has to play in the fight against obesity and diabetes

77 CLEANING

High standards of cleaning are vital in the fight against infection, particularly within the healthcare environment. Health Business examines the complex and challenging aspects of sanitising NHS buildings and facilities

79 INFECTION CONTROL

On behalf of the Water Management Society, Dr Paul McDermott and Dr Susanne Lee write about the control of Legionella risks and other water-related hazards in health care environments. Plus; a look forward to the IPS Annual Conference, taking place on 18-20 September

87 PATIENT HANDLING

The moving and handling of patients is a regular activity for hospital staff but is one which brings with it many health and safety risks. Hillingdon Hospitals NHS Foundation Trust’s Sue Manthorpe and Claire Mowbray examine the issue

90 OBESITY

The number of obesity-related A&E admissions is dramatically climbing, leading to a nationwide increase in spend on bariatric ambulances. Health Business examines the difficulties of growing demand

This year’s Healthcare Estates event takes place in Manchester in October. The conference theme aims to tackle key topics in three streams: strategy and leadership; engineering and facilities management; and planning, design and construction. Health Business examines the three in more detail

92 PARKING

61 ASBESTOS

96 EMERGENCY SERVICES

The problem of asbestos in hospitals is not going away any time soon and there are no easy solutions. The UK Asbestos Training Association discusses asbestos awareness within UK hospitals and the best way to manage it on the NHS estate

Health Business

Contents

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

A number of political parties included promises to abolish parking charges at hospitals in their pre-election manifestos. The British Parking Association looks at the challenge of managing parking and ensuring fair access for everyone With the strapline ‘It’s all about you’, this year’s Emergency Services Show offers anyone working in emergency medical response a valuable opportunity to focus on their own career development and personal health and well-being

www.healthbusinessuk.net Volume 17.4 | HEALTH BUSINESS MAGAZINE

5


Providing The Human Touch

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News

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

HEALTHCARE SYSTEM

DIGITAL

NHS ‘achieves superior performance’ compared to other countries

Academy to drive digital innovation in NHS Three of the world’s top universities will provide masterclasses in leadership and digital as part of a comprehensive programme to provide NHS staff with the right skills to drive digital innovation. The NHS Digital Academy, led by Imperial College London’s Institute of Global Health Innovation in partnership with Harvard Medical School and The University of Edinburgh, will open for applications in September as part of the wider NHS plans to simplify access to care online and ensure hospitals are taking advantage of improvements in digital technology. A virtual organisation, the academy will provide expertise for clinicians and health managers who are delivering an ambitious programme of digital innovation

in the NHS, including how to use new technology to improve patient care and experience, and to deliver efficiencies. It is predicted that 300 candidates will pass through the NHS Digital Academy, each spending up to a year studying part-time. Health Secretary Jeremy Hunt said: “If the NHS is going to have world-class IT systems we need a major programme to spread global best practice – and this links three of the best universities in the world to do just that. The academy will ensure the next generation of NHS leaders is well equipped with the most exciting innovations that deliver the best care available to patients everywhere.” READ MORE:

tinyurl.com/y9eamqmo

BREXIT

Patients need protecting in Brexit negotiations An alliance of leading healthcare organisations has called on the government to protect the interests of patients in Brexit negotiations with the EU. The Brexit Health Alliance, which brings together the NHS, medical research, industry, patients and public health organisations, has warned that patients are at risk unless negotiators ensure issues such as healthcare research and access to new medicines are given the attention needed. The warning comes as the alliance publishes a set of priority areas negotiators must reach agreement on to achieve the best result for patients and healthcare across the UK, including: maximum levels

of research and innovation collaboration; regulatory alignment for the benefit of patients and population health; preservation of reciprocal healthcare arrangements; robust coordination mechanisms on public health and well-being; and a strong funding commitment to the health and public health sectors. The alliance argues that it is in both Europe’s and the UK’s interests to maintain cooperation on all these areas, and is also calling for EU citizens’ right to receive healthcare in the UK to be preserved. READ MORE:

tinyurl.com/ybn4b8rb

The NHS has been judged the best healthcare system out of 11 countries ranked by the Commonwealth Fund. The top-ranked countries overall for their healthcare systems are the United Kingdom, Australia, and the Netherlands, the report found. The UK ‘achieves superior performance’ compared to other countries in all areas except health care outcomes where it ranks 10th. It also finds that the NHS ranks first on care process and equity, and excels in safety. Compared to the other countries studied, the UK put a relatively small amount of GDP into healthcare, at just 9.9 per cent, making its achievement even more notable. Health Secretary Jeremy Hunt said: “These outstanding results are a testament to the dedication of NHS staff, who despite pressure on the frontline are delivering safer, more compassionate care than ever. Ranked the best healthcare system of 11 wealthy countries, the NHS has again showed why it is the single thing that makes us most proud to be British.” READ MORE:

tinyurl.com/y7prflgg

EMERGENCY CARE

50 standards to ensure quality care Emergency care staff are being asked by the Royal College of Emergency Medicine (RCEM) to consider how well their departments meet 50 standards to ensure quality emergency care. Emergency Department Care, a 50-point checklist that covers all aspects of emergency care, has been developed to help medical staff within emergency departments provide better care for patients. The standards cover the patient environment and pathway through the emergency department (ED), treatment of elderly patients and children, care of those with complex needs, education about care, team working and leadership. Dr Taj Hassan, president of the RCEM, said: “In the hectic, often overcrowded environment of the ED, sometimes staff feel they are forced to compromise on the quality of service being provided, in their desire to safely tackle the sheer quantity of patients requiring treatment in order to hit their targets. “While meeting targets is important, it is vital that our primary focus should be on ensuring patients receive the highest possible quality of care. The fundamental points within the guide should already be in place, but this will offer clarification of what best practice looks like and be a timely reminder of the paramount need to ensure quality care ahead of the traditionally difficult winter season.” READ MORE:

tinyurl.com/yaw5ecuo

Volume 17.4 | HEALTH BUSINESS MAGAZINE

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匀攀爀瘀椀挀攀

倀爀椀挀攀


News

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

VACANCIES

Over 80,000 posts vacant, NHS Digital finds More than 86,000 NHS posts were vacant between January 2017 and March 2017, statistics from NHS Digital show, with the NHS body also finding that the number of vacancies rose by almost 8,000 compared to the year before. Nurses and midwives were the posts with the most shortages, with 11,400 vacant positions in March 2017. The figures suggest there were 30,613 full-time equivalent vacancies in England advertised in the month of March 2017 – the highest month on record since collection

of this data began in February 2015. A spokesperson for the Department of Health said: “Staffing is a priority – that is why we have invested in the frontline and there are almost 32,400 more professionally qualified clinical staff including almost 11,800 more doctors, and over 12,500 more nurses on our wards since May 2010.” Janet Davies, general secretary of the Royal College of Nursing, contended: “At the very moment the NHS needs to be recruiting more nursing staff, we learn the number is falling and the

NHS finds itself advertising for more jobs we know it cannot fill. “A lethal cocktail of factors is resulting in too few nurses and patient care is suffering. More people are leaving nursing than joining – deterred by low pay, relentless pressure and new training costs. For the sake of patient safety, the Chancellor must scrap the cap on pay and help to fill the tens of thousands of vacant nurse jobs.” READ MORE: tinyurl.com/ycc4n4go

MANCHESTER

RECRUITMENT

CMA clears Manchester hospitals merger

Hospital trust looking to recruit 350 extra volunteers

In its final report, the Competition and Markets Authority (CMA) has found that the proposed merger between Central Manchester University Hospitals NHS Foundation Trust (CMFT) and University Hospital of South Manchester NHS Foundation Trust (UHSM) will give rise to substantial benefits for the care of patients. The benefits include reductions in patient mortality, clinical complications and infection rates, and outweighs any harm caused by a loss of competition between the merging trusts. Patients who are expected to benefit from the merger include those susceptible to heart attacks or strokes, and those who need vascular surgery or kidney stone removal.

Together, the two hospital trusts operate nine hospitals in Manchester: Wythenshawe Hospital, Withington Community Hospital, Manchester Royal Infirmary, Manchester Royal Eye Hospital, Royal Manchester Children’s Hospital, Altrincham Hospital, Saint Mary’s Hospital, The University Dental Hospital and Trafford General Hospital. In considering the merger, the CMA received advice from NHS Improvement and consulted with local commissioners, local authorities and the devolved health and social care body in Manchester and NHS England, all of whom expressed support for it. READ MORE: tinyurl.com/ycmr54oy

The trust that runs Northwick Park, St. Mark’s, Ealing and Central Middlesex hospitals is aiming to recruit 350 extra volunteers to support staff and patient services. London North West Healthcare NHS Trust currently has 220 volunteers, with most based at Northwick Park and St Mark’s hospitals. The trust would now like to increase the number of volunteers at Ealing and Central Middlesex hospitals. The advertised roles include: mealtime assistants to support patients during mealtime; meet and greet in main entrances and A&E to provide a friendly welcome to patients and visitors; self check-in support to help patients check-in using the new kiosks; and patient companions to read to patients on the ward, facilitate patient surveys and assist and guide patients leaving the ward.

READ MORE: tinyurl.com/y9olhwqu

NHS STAFF

NHS: staff sickness absence decline from 2015-2017 reported NHS staff sickness absence has consistently reduced from 4.44 per cent in the first quarter of 2015 to 4.29 per cent in the first quarter of the 2017, according to NHS Digital’s latest figures. The data, supplied by Health Education England regions, organisations and staff groups, reflects

sickness absence rates and days lost. The data is based on a 365-day financial year. Other key findings from the data include: the headcount was 1,186,420 in April 2017, which is 0.1 per cent less than the previous month and 1.9 per cent more than in April 2016; the full time equivalent total was 1,046,263 in

April 2017, which is 0.1 per cent less than the previous month and 2.0 per cent more than in April 2016; and professionally qualified staff make up 54 per cent of the HCHS workforce. READ MORE: tinyurl.com/ycc4n4go

Volume 17.4 | HEALTH BUSINESS MAGAZINE

9


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News

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

CANCER

PATIENT CARE

Cancer patient experiences are improving

£325 million to transform care for patients A £325 million investment for local projects that will help the NHS to modernise and transform care for patients has been announced by Health Secretary Jeremy Hunt and NHS England boss Simon Stevens. Announcing the investment at the King’s Fund, the health bosses revealed that the initial tranche of funding has been targeted at the strongest and most advanced schemes in the Sustainability and Transformation Partnerships (STPs). 15 areas of the country have been approved, with the greatest sums being used for urgent care in Dorset, surgery in Greater Manchester and cancer care in Cumbria. The investment will deliver faster diagnosis for conditions like cancer, easier access to mental health care, expansion

of A&Es, shorter waits for operations and more services in GP surgeries. The plans include: up to £50 million being made available in Greater Manchester to help hospitals deliver great improvements in urgent and emergency care; £30-£50 million being used to improve access to chemo and radiotherapy in Cumbria; and up to £30 million being invested to create an ‘Urgent Care Village’ at the Royal Derby in Derbyshire. The funding was secured in the budget in March when the government also committed to make further capital investment available in the forthcoming autumn budget. All plans have been developed locally. READ MORE:

tinyurl.com/y758mb9y

IMPROVED CARE

NHS ‘does not need more money to improve’ Mike Richards, chief inspector of the Care Quality Commission (CQC), has said that the NHS does not necessarily need more money to improve care. Speaking to BBC Radio 4’s Today show, Richards claimed that there are more cost-effective ways of running the NHS, such as dismissing ‘very expensive’ agency nurses, but stated that there is ‘no doubt’ the NHS needs more money because of ‘increasing demand on it and the need to transform services’. But he also said ‘things can be done better without more money, and that’s what we are encouraging’. He commented: “What we have seen in our inspections is an awful lot can be done,

even at times of austerity when the money hasn’t been coming through fast. “We have seen a number of hospitals actually getting better during that time, a number of mental health trusts getting better because they have focused on what really matters to patients, on patient safety and on the whole leadership agenda within these hospitals in order to engage their staff and deliver better care.” Richards has called for more beds in the care sector, lessons to be learned from previous mistakes, and the NHS to spend money on a ‘transformation agenda’. READ MORE:

tinyurl.com/y86mr3k9

The National Cancer Patient Experience Survey 2016 has shown that cancer patients feel increasingly positive about their NHS care. The annual survey asked people with cancer across England for their views on their care, and yielded 72,788 responses, rating their care on a scale of zero to 10, with zero being very poor and 10 being very good. Respondents gave an average rating of 8.74, a significant increase from the previous year’s score. The survey also shows significant improvements over the last year in patient care on being seen as soon as they thought necessary for hospital cancer appointments, cancer tests, and cancer treatment. People also reported more positively on areas including involvement in decisions about care and treatment, feeling they were informed enough and treated with dignity and respect. Other findings include 90 per cent of respondents saying they were given the name of a clinical nurse specialist who would support them through their treatment, and when asked how easy it had been to contact this person, 86 per cent said it had been ‘quite’ or ‘very’ easy. READ MORE:

tinyurl.com/y7u5ymeg

MEDICINE

Statins for chronic kidney disease NICE says that statins will help those who suffer with chronic kidney disease to manage their increased risk of cardiovascular disease (CVD). The new NICE standard lists Atorvastatin as the preferred statin to offer patients because it is both clinically and cost effective. Research has shown that there is a connection between reduced kidney function and CVD. Around 2.6 million people in England have chronic kidney disease and approximately 60,000 people die prematurely each year because of the disease. Gillian Leng, deputy chief executive at NICE, said: “We know that a high number of people with long-term kidney problems will develop cardiovascular disease. This means they have an increased risk of suffering a fatal heart attack or stroke. “It is important for healthcare professionals to speak to patients about their treatment options. The effectiveness of statins is now well proven, as is their long term safety. They may appeal to a lot of people who are at risk.” READ MORE:

tinyurl.com/y7bcmslq

Volume 17.4 | HEALTH BUSINESS MAGAZINE

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News

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

TARGETS

NHS England announces new ambulance targets NHS England has announced a new set of ambulance service standards which will apply to all 999 calls for the first time. The new targets are to be applied to every single 999 patient for the first time and aim to provide faster treatment for those needing it to save 250 lives a year. They also aim to end ‘hidden waits’ for millions of patients, ensure up to 750,000 more calls a year get an immediate response, drive improved care for stroke and heart attack, and update a ‘decades-old’ system. Call handlers will change the way they assess cases and will have more time to decide the most appropriate clinical response. The system will focus on ensuring patients get rapid life-altering care for conditions such as stroke rather than simply ‘stopping the clock’.

According to NHS England, ambulances will now be expected to reach the most ill patients in an average of seven minutes. This will free up more vehicles and staff to respond to emergencies. The targets will also help to make patients in rural areas, especially those who are frail and elderly, less disadvantaged than they can currently be. The new system is backed by the Association of Ambulance Chief Executives, the Royal College of Emergency Medicine, the Stroke Association and the British Heart Foundation, amongst others. It comes after paramedics called for the modernisation of a service developed and introduced in 1974, as well as criticism of the current system from the National Audit Office and Health Select Committee.

READ MORE: tinyurl.com/yc6ywmqs

MENTAL HEALTH

DATA BREACH

Mental health crisis services in England are struggling

Data breach leaves doctors ‘vulnerable’

Services for people who are suicidal or self-harming are ‘under pressure’ and facing unprecedented demand, a BBC Radio 5 live investigation has found. The research revealed that 70 per cent of 39 mental health trusts that provided figures for their crisis teams have seen their workload increase. Some had seen referrals rise by as much as 60 per cent, but without an equivalent rise in funding. East London NHS Foundation Trust, one of the 54 mental health trusts who run crisis teams in England that BBC Radio 5 live contacted, revealed its crisis team had seen referrals rise from 7,057 to 11,368 last year – a 60 per cent increase in demand. NHS England said at the time that an extra £400 million will be spent on struggling crisis resolution teams, and at the end of July announced plans to recruit thousands more mental health workers in England. Health Secretary Jeremy Hunt said that the aim is to recruit enough staff to treat an extra one million patients by 2020-21, with plans laid out to improve staff training, encourage those who have left the profession to return, and address

a high dropout rate among trainees. It also includes: 2,000 more nurses, consultants and therapist posts in child and adolescent mental health services; 2,900 additional therapists and health professionals supporting adult talking therapies; 4,800 additional posts for nurses and therapists working in crisis care settings; and more mental health support for women around the time they give birth and early intervention teams working with people at risk of psychosis.

READ MORE: tinyurl.com/ya7hfowm

Hundreds of doctors have had their personal information published online following a data breach at a hospital trust. Personal details of more than 500 Cheshire and Merseyside GP trainees from St Helens and Knowsley Teaching Hospitals NHS Trust appeared on the internet, leaving doctors feeling ‘exposed’ and ‘vulnerable’. The personal data included addresses, phone numbers, and national insurance numbers. The trust has launched an investigation and reported the matter to the Information Commissioner. It has also contacted Google and other search engines requesting that any cached information from the breach be removed. The British Medical Association has called for the trust to get to the bottom of how the release of personal information online could have happened, and is liaising with junior doctors and the trust to ensure necessary steps are taken to support those affected. READ MORE: tinyurl.com/y7t8sqdg

BLOOD DONATIONS

More people in Wales to be allowed to donate blood sooner from 2018 The Public Health Minister has announced that new rules in Wales will allow gay and bisexual men to donate blood sooner from 2018. Current blood donation rules prevent people who engage in some sexual behaviours from giving blood for a 12-month period. The Welsh Blood Service will be reducing deferral donation periods for specific blood donors in Wales as a result of scientific advances and improved understanding of the tests used.

The changes will see: a reduced deferral period of three months for men who have sex with men; a deferral period of three months for commercial sex workers; a reduced deferral period of three months for those who have sex with a high risk partner; and a reduced deferral period of three months for those who have sex with a partner who has been sexually active in areas where HIV is common. The minister has asked the Welsh

Blood Service to look at how the changes can be introduced including the use of more personalised risk assessments for individual donors. The change was recommended following a review on the Safety of Blood, Tissues and Organs (SABTO). READ MORE: tinyurl.com/y7jdg7mb

Volume 17.4 | HEALTH BUSINESS MAGAZINE

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When was the last time you ran a health check on your print costs?

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HB Top 10

SUSTAINABILITY

Top 10: setting a standard in sustainability The environment in which people live and work has a key influence on their health. The Health Business sustainability Top 10 recognises the NHS organisations that have made progress towards sustainability through the smarter use of energy, transport and waste management in order to strive towards a reduced impact of healthcare facilities on the environment The health system in England is a huge employer, with over 1.3 million people working in the NHS alone. Because of the sheer size of its workforce and estate, the health system has a very large carbon footprint. Each year it emits 21 million tonnes of carbon dioxide equivalent or CO2e, making it the largest public sector contributor to climate change in Europe. Because of this, the NHS has obligation to mitigate the effects of climate change and strive towards being a highly effective public sector exemplar in sustainable development and carbon reduction. As this list shows, there are many NHS trusts across the country finding the right balance between economic, social and environmental responsibility, all of which contribute towards a sustainable health service. This list looks at those saving money, cutting their carbon footprint and improving quality in their hospitals. Central Manchester University Hospitals NHS Foundation Trust As part of a trust-wide priorities pledge, Central Manchester University Hospitals NHS Foundation Trust has highlighted the ways in which it can reduce its carbon footprint through technology and staff behaviour change. As part of the Green Impact programme, the hospital has seen sustainable initiatives across the organisation’s department, ranging from upcycling waste to switching off equipment. With 69 teams and 1,824 staff involved, the trust is seeing reductions in its energy, waste and water bills, with sustainability becoming core to all department activity. Among the results, sharps waste has been reduced by a third in surgeries while the trust

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plans to save £1 million by educating staff on the simple effectiveness of switching off lights in unused rooms and corridors and closing windows. By handing the environmental responsibility over to individual teams, the trust has seen green initiatives gain immediate support, with 96 per cent of its staff rating the Green Impact scheme as good or helpful. The Central Manchester University Hospitals NHS Foundation Trust was also the overall winner at the 2017 NHS Sustainability Awards, winning in the carbon and waste management categories, and being commended in the workforce development, travel and energy categories. tinyurl.com/ybh3g2qk North East Ambulance Service NHS Foundation Trust The North East Ambulance Service (NEAS) celebrated a double win at this year’s NHS Sustainability Awards, winning both the finance and energy sustainability categories, whilst also being named the runner up for waste sustainability. Covering 3,200 miles and including 50 stations, 140 emergency care ambulances, 250 patient transport vehicles and 57 rapid response vehicles, the trust faces a number of challenges for managing healthcare waste. To reduce the 18 tonnes of healthcare waste it produced annually, the trust made savings of £12,000 by joining the Northern Consortium healthcare waste contract and providing designated NEAS healthcare bins, meaning staff no longer have to return to base to dispose of their waste, reducing time and carbon omissions. By using LED lighting and renewable power

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in the form of solar panels, installation of combi boilers and updating the hospital heating systems, the trust has reduced electricity and heating costs significantly. The trust also gained Waste Saver Gold Standard, along with Water and Carbon Saver Standards in August 2016 which helped reduce 108 tonnes of CO2 emissions in 2013/14 to 36 tonnes in 2015/16. tinyurl.com/y964sdx3 BARTS HEALTH NHS TRUST Since 2013, as part of an initiative named Operation TLC, nurses, doctors, facilities, security and cleaning staff have taken three simple actions: T – turn off equipment when not in use; L – switch off lights where possible; and C – close doors and windows. Their efforts have resulted in £428,000 saved each year, 1,900 tonnes of CO2 saved annually and a 38 per cent reduction in patients asking nurses to change the room temperature. It is predicted that if the measures were adopted by all trusts, it would save the NHS £35 million a year. Barts Health NHS Trust were the recipients of a 2016 Health Business Award, recognised in the Environmental Practice category for its Cleaner Air for East London programme. Running until last year, the initiative aimed to improve the health of those who work and live in East London by reducing their exposure to air pollution and reduce emissions from hospital sites and the surrounding communities. By the end of last year, it had seen 6,000 air pollution packs deployed and 100,000 people reached with key air pollution messages in East London.

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tinyurl.com/y97vwgr5 ! Volume 17.4 | HEALTH BUSINESS MAGAZINE

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Advertisement Feature

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DIGITAL INFRASTRUCTURE

HOME IS WHERE ASSISTED LIVING & HEALTHCARE IS Assisted Living & Healthcare is a rapidly growing industry in the UK and Legrand, global specialists in electrical and digital building infrastructures, has established a new identity as the Home of Assisted Living & Healthcare With the average living age and the number of individuals considered vulnerable or at risk increasing daily, technology is forming a central role in the delivery of cost effective, efficient and reliable social care and health care services. This technology is quickly advancing as the demand for digitally enabled products and services intensifies. As traditional analogue systems undergo the transition to digital, this is forcing social care and health care services to consider the implications of the digital switchover on their own existing infrastructures, as well as how new technology could allow them to support additional dependants. Legrand’s Assisted Living & Healthcare division designs, manufactures and supplies innovative technology enabled care solutions (TECs) for health, housing and social care services in the UK and Ireland. The division’s new identity brings three separate brands, Tynetec, Aid Call and Jontek, together, to position Legrand as a leader in the assisted living market. Kathryn Burton, Marketing Communications Manager at Legrand Assisted Living & Healthcare, explains: “The technology used by social care and health care services must continue to evolve in order to fulfil the needs of those that depend on these services. Our new Assisted Living & Healthcare identity brings our capabilities in market leading TECs under one roof. “All three brands are very successful in their own right but it was important for us to unite our offering to make it easy for customers to access our expertise and exploit the synergies between our products. This ensures that we continue to provide the excellent products and services our customers have come to expect and in turn will enable us to continue investing and innovating within the industry.” TYNETEC The division’s Tynetec brand specialises in digitally enabled at-home alarm units and telecare devices that work together seamlessly to empower individuals supporting themselves in their own home. The brand also creates a range of grouped living

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HEALTH BUSINESS MAGAZINE | Volume 17.4

and access control systems, designed to ensure that local authorities and housing associations across the UK have flexible and future proofed options to effectively support their residents. National Sales Manager for Tynetec, Stuart Carroll, said: “One of the consequences of the UK’s ageing population is a large increase in incidences where family members or friends find themselves managing a loved one’s long-term health condition within the home environment. “Our products are designed to allow customers and carers to effectively manage health conditions and maintain independence in their own for homes for as long as possible. We focus on providing 21st century technology that supports interoperability with other systems, which is ultimately changing the way we support ourselves and others within the home.” AID CALL Aid Call has been the market leader in wireless nurse call technology for over 40 years, creating flexible and reliable products and solutions that are bespoke to care homes, care groups and hospitals. Chris Donnelly, National Sales Manager for Aid Call, said: “Touchsafe Pro is a direct result of our continued investment in research and development. All Aid Call telecare products and services are developed following feedback from our customers who are at the front line of care delivery. We continually strive to innovate and tailor our offering to specifically meet our customers’ individual requirements regardless of the size or scale of their operations. “Going wireless offers many benefits, not least greater flexibility to provide a more personalised approach to care provision, offering patients greater independence and making them more comfortable in their environment. “Operating a nurse call system over our detected self healing Digi Mesh network offers unrivalled safety that is also quick and undisruptive to fit because there’s no need for cables, as well as offering ongoing room for flexibility and a more cost effective installation with lower life time cost over a traditional hardwired system.”

JONTEK The most recently acquired brand, Jontek, ensures Legrand can offer complete end-to-end TECs, which prompted the new identity as the Home of Assisted Living & Healthcare. This business provides monitoring and response centre software solutions, incorporating telecare, telehealth & m-Care to the public and private sector. Trevor Hoggard, National Sales Manager for Jontek, adds: “Our software gives alarm centre operators the ability to accept calls from both analogue and digital systems on one platform, and as the provider of one of the only digitally enabled platforms in the UK, we are continuously developing our systems to keep up with the evolving needs of our customers.” In the world of assisted living and healthcare, advancements in technology will enable users to benefit from innovative products for many years to come, and Legrand is investing heavily in the development of new technology to meet the challenges that lie ahead for health care and social care services. LEGRAND UK & IRELAND Legrand, which has a presence in over 80 countries with approximately 36,000 employees worldwide, is organised into five separate divisions; assisted living and healthcare, cable management, power distribution, wiring devices and data communications. The divisions rationalise the comprehensive range of products and solutions the company supplies in a multitude of industries, while creating a structure that focuses on their customers. Each product is designed through continued investment in research and development to significantly increase the value-in-use for every user. " FURTHER INFORMATION www.legrand.co.uk


SUSTAINABILITY # University Hospitals of North Midlands A partnership between University Hospitals of North Midlands (UHNM), Southern Staffordshire Community Energy Limited (SSCEL) and Staffordshire fuel poverty charity ‘Beat the Cold’ is building energy and community resilience, reducing emissions, improving health and saving money across both clinical and non-clinical hospital services. Public investment raised the required £335,600 enabling the installation of 1000 solar PV panels on hospital roofs. An agreement between SSCEL and UNHM means cheaper energy for the trust, saving £600,00 over the life of the project and the solar energy Feed-in-Tariffs facilitate a return for investors and a ‘Community Fund’ for Beat the Cold (£300,000 over the life of the project).

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tinyurl.com/y7q7cx65 Nottingham Healthcare NHS Foundation Trust Nottingham Healthcare saw the trust with a local supplier to develop a range of low cost menu options produced from what was technically ‘food waste’, which would otherwise have been destined for landfill. The project has been delivering significant savings – for example, the Broccoli and Stilton soup now uses broccoli stalks instead of the florets, creating an 85 per cent cost saving. Nottingham Healthcare NHS Foundation Trust has also recently been recognised for its adiabatic cooling system, which regulates the temperature within the trust’s data centre at Rampton Hospital, where computer servers used for storage, processing and distribution of large amounts of data are housed. The system uses ‘free cooling’ rather than refrigerant gases, which is more sustainable from an environmental, as well as a financial point of view. The adiabatic cooling solution is expected to deliver an annual energy cost saving of over £30,000.

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tinyurl.com/y8afponm The Shrewsbury and Telford Hospital NHS Trust In March this year, the Shrewsbury and Telford Hospital NHS Trust put forward proposals to make Shropshire’s two acute hospitals smoking-free areas by the end of the year. This is part of a mission to help the people it serves become the healthiest half million on the planet – ‘a bold statement to make, but one we should aspire to achieve’. The trust has also made its trust board meetings paperless, and after re-branding its bicycle user group, now known as Greener Travels, it grew from six members of staff to nearly 200. The trust now has up to 80 members of staff cycling to work every day after encouraging sustainable and active

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travel by introducing 16 new cycle shelters on hospital sites and the creation of new male and female shower and changing areas. tinyurl.com/yblf8gz6 University College London Hospitals NHS Foundation Trust Deemed as ‘leaders in its field’, UCLH has been awarded the Carbon Trust Standard for Water in recognition of the work it has done to measure, manage and reduce water use, which, added to the awards for waste and carbon reduction which it already holds, makes the trust the only NHS trust to hold all three quality marks. UCLH has received particular praise from the Carbon Trust for having clear lines of responsibility for water management and for excellent staff engagement activities. On top of this, the trust plans to continue taking more regular meter readings, allowing anomalies in use to be quickly identified and acted upon. This is helping the trust lower the amount of water it is using year-on-year. In 2015/16, UCLH used 236,500m3 of water.

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tinyurl.com/yap5vdcv Guy’s and St Thomas’ NHS Foundation Trust Guy’s and St Thomas’ NHS Foundation Trust is one of the best known teaching hospitals in London, serving over one million patients a year and employing 12,000 staff. The trust’s recycling rate has increased from 38 per cent in 2013/14 to 56 per cent in

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HB Top 10

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

the catering team’s drive to increase food waste recycling and their efforts to prepare sustainable food for patients, which resulted in the trust earning the Soil Association’s Food for Life Catering Mark bronze award, and efforts to cut costs and improve waste management. tinyurl.com/yany75xh Newcastle Upon Tyne Hospitals NHS Foundation Trust The catering team at the Freeman Hospital, part of the Newcastle Upon Tyne Hospitals NHS Foundation Trust, became one of the first organisations in the UK to receive the Green Kitchen Standard for sustainability in June. The certification was awarded to the catering department after an assessment of its ability to maintain good environmental management, including how they manage water and waste in their operations. This was also recognised at the 2017 Sustainability Awards, where the trust won in the Food category for its efforts to provide the best food available and working with chefs to create a menu which encourages the use of local, organic, Fairtrade and meat-free meals. The trust is also excelling in other departments, promoting low carbon transportation and active travel, installing energy monitors on high consumption equipment, seeking innovative ways to re-use unwanted materials, as well as introduce recycling facilities in all areas.

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tinyurl.com/yaw6k2st

With 69 teams and 1,824 staff involved, Central Manchester University Hospitals NHS Foundation Trust is seeing reductions in its energy, waste and water bills, with sustainability becoming core to all department activity 2015/16 thanks to innovative schemes to make the trust more environmentally friendly, including 4,800 litres of used cooking oil from catering services being supplied every year to Uptown Oil, a local company which blends it to make biofuel to power black cabs and buildings. In 2016, the project to reclad the East Wing at St Thomas’ Hospital won an award for Sustainable Development at the Building Better Healthcare Awards. An innovative and sustainable solution has encased the 13-storey tower in a glazed façade, weatherproofing it and improving energy efficiency. Guy’s and St Thomas’ was also highly commended in three categories of the 2017 NHS Sustainability Awards for Food, Finance and Leadership. This is in recognition for

North Bristol NHS Trust North Bristol NHS Trust was heralded as the overall winner at the 2016 NHS Sustainability Awards, in part for its Sustainable Healthcare Campaign. The campaign, originally launched in 2015, was implemented to reduce the trust’s environmental impact in order to contribute to healthy communities, lives and environments. The same awards ceremony also highlighted the trust’s initiatives to limit water consumption in its hospital buildings. Sustainable urban drainage at the Brunel building of Southmead Hospital led to a 25 per cent reduction in water consumption.

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tinyurl.com/ybmoqn4h "

Volume 17.4 | HEALTH BUSINESS MAGAZINE

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APPS

Rachel Murphy, digital delivery director of NHS.uk, writes exclusively for Health Business magazine on ambitious NHS plans to harness the power of digital healthcare apps There has never been a better opportunity for people to take control of their own health and well-being through the use of digital technology. Consumer behaviour has changed more in the last decade than in the previous 50 years and our means of looking after our own health is an intrinsic part of that revolution. The health and well-being apps market is among the fastest growing of any sector. There are already around 250,000 apps that cater for health and well-being and use of them in the UK is skyrocketing. That is why NHS Digital, working with NHS England, is in the process of developing a digital tools library. In this fast-changing and vast marketplace of apps and digital services, it is important that patients are able to find tools that have genuine potential value to them. The benefits are obvious, both in terms of the opportunities technology can offer to patients for self-care and prevention and in taking pressure off NHS frontline services. If you have NHS approved apps that are

evidenced to work, that will inevitably reduce physical visits to primary care. While some tools will replace the need to visit a doctor in person, other apps and wearables will enhance contact time for patients with clinicians. The increased capability to accurately monitor and measure symptoms will save valuable time, allowing clinicians to focus more on treatment. We hope in time that doctors will be able to prescribe our digital services, of which the tools library will form a part. Indeed, prescribing use of apps or wearables is already happening to a degree, for instance in assisting people to quit smoking. With so many apps available already, and the sector growing so quickly, our job is not to fill a gap in the market, but to provide patients with an informed way of choosing which products are proven to be effective and safe. The NHS is a trusted brand – people believe in it, so if a patient is looking for an app to monitor a health condition or

S The NH ary br Apps Li tly in n is curreent stage, m developeta site now b with a following live aunch a soft l pril in A

HOW WE GO ABOUT SELECTING APPS TO INCLUDE Alongside the tools library we have created a mobile health space for app developers on developer.nhs.uk. This is the means by which developers apply to have their apps accredited by the NHS and included in our library. It is necessarily a rigorous process, with the need to protect the rights and safety of patients paramount. Lots of research is being done to make sure we are prioritising apps that people need and want to use. developer.nhs.uk is an enablement platform, giving developers the tools and information they need to deliver high quality products and allowing us to filter the thousands of apps on offer to pick out the best of the best. It involves a lengthy and extremely detailed assessment to measure the clinical benefits and safety, and technical security, of products or concepts. Clinically, what are the benefits to the user of the app? Is it safe? Is it effective? Is there evidence that it works? Clinicians are playing an integral role in this process. And technically, is the app as watertight as it can be from viruses, malware and other malicious software or potential cyber attacks? Will its use and storing of data be secure, safe and legal? This process will eventually be automated to allow us to increase the volume of apps entering our library. There is no doubt that digitising healthcare means more patient data being gathered and that has its own implications for privacy and security. But there is an opportunity here for patients to become gatekeepers for their own data in a way they have not been able to before. No one is going to make !

Written by Rachel Murphy, digital delivery director, NHS Digital

An apps library for a digital NHS

an element of their lifestyle, seeing ‘NHS approved’ will carry weight. The onus is therefore clearly on us to deliver on that public trust with rigorous assessments.

Digital Technology

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

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© 2017 InterSystems Corporation. All rights reserved. InterSystems is a registered trademark of InterSystems Corporation. 4-17

EMPOWERING HEALTHCARE TO IMPROVE CARE MATTERS.

Accessing patient data is critical to care. That’s why more than 500 million patients and clinicians in 80 countries rely on us to make information reliable and accessible. Because connected care is the best care. Learn more at www3.InterSystems.com/health


APPS

Photo by rawpixel.com on Unsplash

NHS Wi-Fi rolled out to all GP surgeries At the start of July, NHS Digital announced that every patient in England will be able to easily access free to use Wi-Fi in GP practices, under a scheme being rolled out across the country.

In this fast-changing and vast marketplace of apps and digital services, it is important that patients are able to find tools that have genuine potential value to them # using these apps compulsory, of course. Indicators clearly show, perhaps unsurprisingly, that there is a large cultural shift with younger generations. A study by the SAS Future Foundation in September 2016 entitled Analytics for the Future: The New ‘Data Generation’ showed that 67 per cent of millennial internet users in the UK are comfortable sharing personal data with the healthcare sector, compared with 32 per cent for retailers and 28 per cent with social media companies. There will be reservations, and more so among older generations, but the same was said a decade ago of internet banking, which is now commonplace. SOME OF THE APPS ALREADY IN THE NHS LIBRARY The NHS Apps Library is currently in development stage, with a beta site now live

following a soft launch in April, before moving to the next phase this autumn when several demonstrator apps will become available. One app already granted ‘NHS Approved’ status is myCOPD. This helps people with the lung condition COPD to better manage their illness, perfect their inhaler technique, learn to improve breathing, track medication and more. Babylon uses the latest AI technology to assess symptoms and then arranges video or phone consultations with real doctors within minutes. It provides speedy access to online healthcare from anywhere in the world, allowing users to check any symptom, chat with real doctors (recordings of which are made so the patient can recall important treatment advice) and can send prescriptions to your door. Some apps focus on mental health or well-being, such as Chill Panda which measures your heart rate and suggests tasks to suit your state of mind, such

Digital Technology

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

NHS Wi-Fi will be rolled out to all general practices across England by 31 December 2017, with patients then being able to access the internet free of charge in their GP’s waiting room, via their smart phone or tablet. Internet access will be granted through an NHS.UK landing page which will host national healthcare information alongside locally generated content from the general practice or CCG, such as information about local clinics and health services. Patients can use the service to access and download health apps, browse the internet and look up health and care information. Plans are also in place to rollout Wi-Fi to hospitals and the rest of secondary care by December 2018, with the first secondary care trusts expected to receive funding and to start rolling out over the next few months. David Corbett, NHS Wi-Fi Programme Head at NHS Digital, said: “The introduction of free Wi-Fi services across NHS primary and secondary care locations is a response to feedback from patients and staff. It will provide an efficient, reliable and secure platform that will enable patients and carers to access and utilise digital health and care services. This will support improved patient experience and help patients to take more control and have more involvement in the delivery of their care. It will also provide clinicians and other NHS staff with greater access to online information, services and tools which will support them to deliver better care, and ultimately improve clinical outcomes.” as breathing techniques to ease worries. HealthUnlocked links up people with similar health conditions. It has over 700 online communities on topics ranging from cancer and thyroid disease to running and weight loss, as well as four million monthly users. USING DATA INTELLIGENTLY The potential to allow patients to radically increase their ability to monitor and improve their healthcare and well-being goes without saying. But, like other technological !

Volume 17.4 | HEALTH BUSINESS MAGAZINE

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APPS # advances, by ensuring it is a joined up system – not just a stand-alone library of tools in isolation – there is huge potential to use the data that these apps and services will gather. At the front end, apps will allow patients to take greater control of their own healthcare. But at the back end, the datasets that can be obtained will be hugely valuable. Patients using apps will essentially become ‘data donors’ to the NHS. We can use that data to inform what we do, identify areas of greatest need and for clinicians to research patterns and prevalence of conditions and symptoms on a scale not previously possible. This already happens in all sorts of sectors. For example, a sat-nav app’s primary purpose is to help its users get from A to B. But by collecting users’ data it can then show traffic jams – helpful for users collectively and valuable for traffic management agencies working to eradicate bottlenecks. The same applies within healthcare. By responsibly harvesting the data that digital apps and services create, we can see which are most popular, where there is most

No one tool is going to solve all our challenges. But by enabling innovation, and giving patients the digital toolkit they need, we can bring about significantly better healthcare to our public demand and need, and which apps are effective (for example, asking someone to use technology to monitor their alcohol intake works best). And that’s without mentioning the world of opportunities for clinicians to study data from large groups of patients. Technology is developing quickly, and in the near future the use of artificial intelligence, wearables and embeddable devices interacting with apps could provide countless solutions and advances in self-care and prevention. By the NHS playing a leading role in assessing, vetting and accrediting apps – and potentially playing a role in incentivising start-ups to deliver their app ideas – we can help ensure as much as possible that patients utilise only the safest and most effective

Digital Technology

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

products. This requires our apps library to become part of a properly integrated digital NHS, with the NHS.uk digital platform (the successor to NHS Choices) its patient-facing hub. We intend that patients will be able to create an account with NHS.uk so we will be able to serve them with the personalised content and facilities that most benefit them. No one tool is going to solve all our challenges. But by enabling innovation, and giving patients the digital toolkit they need, we can bring about significantly better healthcare to our public. " FURTHER INFORMATION apps.beta.nhs.uk

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Putting Patient Safety First in Over 40 Hospitals Across the UK

Traceability of products against patients Improved product recall

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Patient safety alerts throughout the patient journey

Tracking of instruments throughout sterilisation Full searchable audit of tray processing and patient use Improved inventory visibility and stock control Fast track facility for urgent trays

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Enabling safe and efficient patient care through GS1 adoption

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PATIENT SAFETY

Written by Glen Hodgson, head of healthcare, GS1 UK

Improving safety through surgical equipment tracking Glen Hodgson, head of healthcare at GS1 UK, explores how GS1 standards are helping NHS trusts identify individual instruments used in procedures – improving patient safety and inventory management

The ability to match patients to the care they’ve received forms the foundation of many of the policies and legislation we’re seeing come into play around the globe. Whether it’s the Department of Health’s eProcurement strategy, the Falsified Medicines Directive or the recent EU Unique Device Identification regulations, the future of the whole healthcare system depends on us being able to track and trace every person, product and place in it. And when we do, we know we improve patient safety, reduce clinical variation and increase operational efficiencies. What all the legislation and policies have in common is that they recommend the use of GS1 standards to provide unique and accurate identification – they’re the most implemented global standards system of their kind, endorsed by the Department of Health, NHS Digital, NHS England and the Medicines and Healthcare products Regulatory Agency (MHRA). While they’re now being rolled out across the NHS, one of their first applications was for surgical instrument traceability and management. One of the main reasons for this was the risk posed by cross-contamination between patients, for example with variant Creutzfeldt-Jakob disease (vCJD). There are at least nine million individual surgical trays in circulation in the NHS at any one time, and hospitals need reassurance that they’re being managed and identified effectively in order for cross-contamination not to happen.

The Departm of Heal ent mandat th has all acut ed that England e trusts in supplie , and their rs, complia are GS1 nt b 2020 y

UK GUIDELINES In the UK, the Department of Health and MHRA guidance states that hospitals need to track instruments to at least tray level. But many hospitals choose to take this further, with each individual instrument uniquely identified. In an ideal world, the same instruments are kept in the same tray but this can be challenging to achieve – identifying each instrument means trusts can be certain of what instruments have been used on which patients. More specifically, this involves the global and unique identification of each instrument tray or individual instrument, depending on the level the hospital requires. Each tray or instrument is identified by a unique GS1 Global Trade Item Number (GTIN), plus other information such as a serial number and an expiry date. On top of this, every component of the set needs a unique asset number – a GS1 Global Individual Asset Identifier (GIAI) – so that each instrument can be traced accurately to a procedure. Using GS1 barcodes, this means all items are traceable from production to the point of care. It gives that certainty of truth of knowing

Barcoding

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exactly which instrument has been where, and which person it’s been used on. For patient safety this is vital, but it also helps save money – lost instruments can cost a 500-bed hospital over £100,000 per year.

IDENTIFYING EQUIPMENT Like many trusts, University Hospitals of Morecambe Bay NHS Foundation Trust (UHMB) was having trouble managing its surgical instruments, with tracking and tracing of single instruments proving difficult from decontamination through to the patient. It was using a method of 1D instrument marking and it was becoming unviable due to the size of the barcode label and the size of the instruments needing to be identified. The trust knew GS1 standards could provide the solution, not least because it had been recommended by the Department of Health; but the question was which technologies to use. There were a number of options available. The barcode for surgical instruments is the two-dimensional GS1 DataMatrix symbol, but there are a number of ways to mark this. The most frequently used include dot peening, laser etching, electro-chemical etching, and ink jet marking. UHMB chose dot peening, a method of marking instruments !

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Automation in Healthcare

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By offering hospitals clinically-integrated technology, we empower Trusts to take control of their supply chain in order to improve safety, compliance, cost audits and traceability of their supplies. Our solution does this by tracking medical supplies and implants from hospital entry point through every phase of distribution and use within the healthcare setting including the Theatre. By connecting vital healthcare data throughout the workflow process, we give Trusts accurate information in real-time for better decision making.

PATIENT SAFETY & COMPLIANCE

Our integrated system captures virtually any kind of tracking code (barcode, 2D matrix, QR, etc.) including GS1, making it simple and easy to track supplies by batch, lot numbers, and expiration dates - improving recall management and patient safety. Our Technology and support services were designed with the NHS and their largest orthopaedic suppliers. The technology underpins NHS directives such as the eProcurement strategy, GS1 and Scan4Safety Initiatives.

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PATIENT SAFETY

Procurement in Healthcare

Barcoding

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

Procurement in Healthcare, to be held as part of the UK Health Show on 27 September 2017 at Olympia, London, connects the NHS with partners and suppliers as its seeks to leverage its purchasing power to achieve the best value of goods and services. The Procurement in Healthcare Plenary Stage will feature a keynote session, titled Scan4Safety and GS1 UK – next steps and how Trusts can benefit, exploring how GS1 standards are being introduced in acute trusts across England to link people, products and places in the healthcare system. In this session, Glen Hodgson, head of Healthcare at GS1 UK, will highlight the successes and challenges of the Scan4Safety programme so far and the next steps beyond the demonstrator sites. Glen will outline the benefits of this initiative across the six S4S sites, which include improving patient safety, enhancing clinical effectiveness and driving operational efficiencies. This will be followed by a panel discussion, titled ‘How are the Scan4Safety demonstrator sites influencing wide-scale trust adoption of GS1 and PEPPOL?’ The panel will provide insight on the direct impact Scan4Safety is having in hospitals across the country and share learning, challenges and opportunities from the demonstrator sites. Panellists include: Chris Slater, associate director for Procurement and Commercial, Leeds Teaching Hospitals NHS Trust; Andrew McMinn, chief procurement officer, Plymouth Hospitals NHS Trust; and Rob Drag, Scan4Safety programme manager, Salisbury NHS Foundation Trust. For further information on the UK Health Show, please read the Health Business preview on page 37.

The future of the whole healthcare system depends on us being able to track and trace every person, product and place in it. When we do, we improve patient safety, reduce clinical variation and increase operational efficiencies

# with GS1 2D DataMatrix using a diamond-tipped stylus. The use of this technology by UHMB has enabled it to identify every single instrument it has, tracking and tracing them from decontamination to patient use. It gives the trust a full history of every single instrument used on a patient and means it has an accurate inventory of all the instruments it !

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The Changing Space of the NHS A view on the wider importance of GLNs by Ken Gordon Micad Systems (UK) Ltd. By now everyone is familiar with the core concepts enshrined in the GS1 NHS trials of: • • • •

People Product Place Process

There is also a generally widespread understanding of the importance of the Scan4Safety initiative in reducing unwarranted variation in the NHS meaning: increased efficiency, reduced costs and improved patient safety. The role of GLNs (Global Location Numbers) in this context should not be underestimated. They are the foundation for building a National Registry of spaces within the NHS beyond the initial 6 Demonstrator sites (4 of whom are Micad users). Furthermore the widespread use of GLNs has implications and benefits outside of the Scan4Safety Project. The beauty of the GLN is its simplicity and unadulterated nature. The unique and unambiguous identification of a barcoded GLN forms a primary index for many systems and facilitates EDI (Electronic Data Interchange) within and across organisations. As part of Lord Carter’s review and the need to use technology to reduce costs in the NHS, the application of GLNs against spaces paves the way for the creation of a central repository in each Trust for subjects such as: • Patient Administration Systems (PAS) • Service Line Reporting (SLR) and departmental occupancy ccurate and verified states eturn Information Collection ( IC) • Premises Assurance Model (PAM) • Asbestos data • Cleaning Functional Areas • Maintenance and Asset Management (GIAs) • Lease demises (GIAs) With the appropriate consideration and a suitable container, the humble GLN becomes central to the work of clinical, procurement and operational staff. Furthermore, they provide the foundation for national registries on a multitude of subject areas, and drive convergence of Trusts data irrespective of their room or space numbering systems. Micad are working with Dakota Healthcare to supply a turn-key solution for existing and new Micad users. We have developed a GLN Barcode App to work with existing hardware commonly used in Trusts to allocate, validate and feedback on the status of GLN usage so that Trusts can manage their GLN allocation and reserve via a well governed process. The ability to visualise progress and consumption on live dashboards as well as CAD plans is an important part of the verification and cyclical management process. The output can then be presented in an open format to facilitate EDI.

For more information on how Micad can help you manage your space and GLN register contact us through one of the channels below: T

0161 2

5 3

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PATIENT SAFETY # has on-site – increasing patient safety and making its asset management more efficient. STEP-BY-STEP PROCEDURES Derby Teaching Hospitals NHS Foundation Trust (DHFT) has taken this even further. Three years ago, it was running low on theatre space and needed a cost-effective solution. The trust introduced GS1 barcodes not only as a way of managing its inventory, including surgical instrument trays, but of tracking everything that takes place during a procedure. It scans the patient, the location, who is present and what job they’re actually doing, the type of anaesthetic used and anything that happens to the patient - in particular anything that’s implanted. This gives the Trust full traceability, meaning that in the case of a product recall it can identify all patients that may have been affected. Before GS1 implementation this could take DHFT around 50 hours per patient, now it takes 30 minutes. And, it now earns over £1 million extra per year through the increased accuracy of its recording of OPCS codes. Another benefit of this approach is that using barcodes has integrated its inventory management solution, product catalogue and financial system – automating the creation of orders to the trust’s suppliers, based on its actual usage of products and supplies. It’s reducing waste, saving £1.2 million in 2016/17, and saving valuable

Barcoding

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

The use of dot peening technology by University Hospitals of Morecambe Bay NHS Foundation Trust has enabled it to identify every single instrument it has, tracking and tracing them from decontamination to patient use clinical time that had been spent ordering stock. Barcode scanning also gives the trust a lot of data, it’s now recorded over 97,000 theatre episodes – information it can use to better understand patient outcomes and differences in clinical treatment. This data also has huge implications for surgeons preparing for operating procedures. If someone comes to them who has been operated on previously at DHFT, they can know exactly what treatment that patient has received and what instruments they might specifically need to use. This could be, for example, someone who has had a facial reconstruction involving titanium plates and screws. The surgeon will know what screws were used and therefore what type of screw head to expect – invaluable in the preparation of trays for surgery. THE FUTURE OF CARE The benefits of tracking and tracing surgical instruments have implications for the whole healthcare system, and trusts like

UHMB and DHFT have proven this. What has started as a better way to manage inventory in theatres can actually lead to a safer, more efficient system throughout a whole hospital – DHFT are rolling out scanning to their wards at the moment. With the NHS increasingly being asked to do more with less, new ways of working that save money whilst also increasing patient safety are vital for the future. The Department of Health recognises this, which is why they’ve mandated that all acute trusts in England, and their suppliers, are GS1 compliant by 2020. The level of traceability available for surgical instruments is just one example of how the whole healthcare system could operate. And, with increasing numbers of regulations and government policies backing GS1 standards, it’s the future of care. " FURTHER INFORMATION www.gs1uk.org/healthcare

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Advertisement Feature Written by Joe Kim, EVP, Engineering & Global CTO, SolarWinds

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

DATA SECURITY

CLOUD AS A PLATFORM FOR DIGITAL TRANSFORMATION

Digital transformation is one of the UK government’s latest challenges. On one hand, citizens are demanding increased digital access to government information and services. However, government organisations are facing a roadblock of fear when it comes to implementing one of the primary technologies critical to digital transformation: the cloud and are agile enough to easily scale up or down depending on an agency’s needs. The flexibility of cloud services better equips government organisations to handle the shifting sands of the threat landscape.

The benefits of migrating data to the cloud include everything from cost savings to improved productivity. SolarWinds’ annual IT Trends Report found that 95 per cent of government IT professionals said their organisation has migrated critical applications and IT infrastructure to the cloud over the past year. As many as 68 per cent of respondents said their organisations have received either most or all expected benefits (cost efficiency, availability, or scalability) from cloud technologies. Despite these benefits, a sense of trepidation still exists—around cloud security. Many government IT personnel get nervous at the thought of relinquishing control of important data to cloud service providers. In fact, the research found that security is one of the key reasons for organisations (including government) to move from the cloud back to on-premises. Ironically, deploying a cloud IT infrastructure can keep your data more secure, as on-premises data is often stored in legacy IT systems, even if such systems are out-of-date and represent potentially easy targets for attackers. GREAT REASONS Check out these three reasons why moving data to the cloud can help manage the increasingly complex threat landscape. MINIMISE ADMINISTRATIVE EFFORTS IT professionals know well that traditional hardware can be high maintenance. In

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SolarWinds’ Government Cybersecurity Survey, 48 percent of respondents said that difficulty supporting their IT environments had resulted in increased security challenges. Cloud services, however, relieve this burden. In adopting cloud services, government IT professionals can focus their energy on other critical aspects in support of their organisation, whether it’s monitoring data and intelligence, strengthening security, or innovating for the future. AUTOMATIC SOFTWARE UPDATES Out-of-date systems can create serious vulnerabilities for an organisation hoping to protect itself from increasingly sophisticated attackers. Manually buying and applying updates to ensure that everything is up-to-date can be expensive. Cloud-based solutions offer automatic software updates, implementing the latest security patches and intelligent design. With rapidly delivered updates addressing immediate threats, agencies are in a better position than ever to repel harmful attacks. SCALABLE CLOUD INFRASTRUCTURES AND INSTANTANEOUS DEPLOYMENT Installing legacy technologies can take weeks – even months. Adding to the challenge, traditional systems are often inflexible and difficult to scale, and may leave a government organisation with no choice but to stick with the technology for an extended period, even if it ultimately doesn’t meet their needs. Cloud services can be deployed immediately

EVALUATE YOUR OPTIONS Once you decide to implement a cloud solution, evaluate cloud service providers and ensure that their security models match the needs of your organisation. If you prefer to keep some data on-premises and some in the cloud, a hybrid IT may offer you the best of both worlds. If you do opt for a hybrid approach, be sure to invest in the right tools. According to the SolarWinds IT Trends Report, the number one challenge created by hybrid IT is lack of control/visibility into the performance of cloud-based applications. Monitoring and reporting provide this control and visibility, and are vital to ensuring that you have optimal efficiency across your environment, regardless of its location. Real-time reporting provides insight into who is accessing networks and applications, which is key to safeguarding your agency from leaks. As government agencies face increased pressure to move to a digital model, one of the first steps is to adopt a cloud infrastructure. As you can see, security is not a reason to abstain. Our advice? Adopt cloud, then start down the path toward digital innovation. SolarWinds provides powerful and affordable IT management software to government agencies worldwide, including the UK’s National Health Service, European Parliament, NATO, Ministry Of Health-Turkey, and nearly every U.S. civilian agency, DoD branch, and intelligence agency. SolarWinds products are designed to solve the problems government IT professionals face every day and eliminate complexity from every IT process imaginable. Learn more today. " FURTHER INFORMATION + 353 21 233 0440 nationalgovtsales@solarwinds.com www.solarwinds.com/government


CYBER CRIME

James Kelly, of the British Security Industry Association, discusses the impact cyber security has been having on society and the work being done to reduce the risk of product-related cyber crime With the NHS recently being one of A RISING CRIME the highest-profile victims of a global In recent years, cyber crime has been taken ransomware attack, after computers more seriously across the globe, with the UK at hospitals and GP surgeries across the government demonstrating their commitment UK were blocked by harmful malware, to cyber security with the launch of the there has never been a more essential nation’s first National Cyber Security Centre time for the health sector to consider cyber (NCSC), which opened last year. security. Cyber criminals do not only The NCSC forms part target computers, laptops or mobile of the Government phones, but they can also attack Communications R P D G With ply in connected security products Headquarters ap such as video surveillance (GCHQ) and o t e u d m o systems, alarm systems or was set up to r f the UK 18, the access control devices. help protect

20 25 Maynce of data a import ion should be protect focus for all a key isations organ

the UK’s critical services from cyber attacks, as well as providing guidance and advice on cyber security. While initiatives like this have been in place to prevent attacks, some have still managed to slip through the net. The ransomware cyber attack on the NHS earlier in the year was thought to have also affected nearly 100 countries around the globe, with 45,000 attacks being recorded. For the NHS, the attack proved detrimental, with ‘operations being cancelled, ambulances being diverted and documents such as patient records made unavailable in England and Scotland’, according to The Guardian. !

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

Passing the health check: secure connected products

Data Security

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

Contains public sector information licensed under the Open Government Licence v3.0

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# Ransomware is extremely malicious software which prevents users from accessing files or devices until they pay a ransom of a certain amount of money. Ransomware can be acquired in a number of ways, such as phishing emails or clicking on links on untrustworthy websites. As such, a crucial element of cyber security is ensuring that all staff members are effectively trained in cyber security and are able to identify harmful links or attachments. Ensuring that anti-virus programs are up to date and fully functioning is also essential both in the workplace and at home. While the attack on the NHS did not seem to actually access the patient data – but rather block access to it – it still brings to light the importance of cyber security and how that relates to the protection of personal data. DATA PROTECTION With the General Data Protection Regulation (GDPR) due to apply in the UK from 25 May 2018, the importance of data protection should be a key focus for all organisations. The GDPR will apply to controllers and processors of personal data, with the controller being the person that states how and why personal data is being gathered and processed, and the processor being the person that takes action with the data. The adoption of the GDPR will affect those who are currently subject to the Data Protection Act (DPA), which is, of course, extremely relevant to the health sector. The GDPR will place specific legal obligations on both controllers and processors, with significantly more legal liability placed on persons responsible for a breach. While some may feel that a cyber attack is out of their control, it is absolutely essential that organisations can prove that they have taken all the necessary steps to prevent their networks and products from being affected by cyber crime.

Photo by Timothy Muza on Unsplash

Data Security

CYBER CRIME

Earlier this year, the BSIA convened a working group, the Cyber Security Product Assurance Group (CySPAG), which aims to provide guidance on best practice in cyber resilience to product manufacturers, installers and users CONNECTED PRODUCTS As mentioned before, it is not just computers or personal devices that can be affected by cyber crime; security products that are connected via the internet can also be vulnerable to such threats. In terms of Video Surveillance Systems, IT technology has played a major role in driving innovation and changes within the sector, such as HD, UHD, H264 and Power over Ethernet. Access control systems have also integrated effectively with IT technology, such as cloud-based access control, allowing for the integration of access control systems with other information management systems. Alongside ease of use and installation, cloud-based services can also allow for regular updates without the need to store large servers on-site – which could be vulnerable to attack – consequently freeing up space and resources. While connected products allow for security applications to integrate more easily and beneficially with each other, it is still essential that such products are adequately protected from cyber threats. Last October, a cyber attack targeted infrastructure company DYN in the United States, hacking Internet of Things (IoT) devices – including CCTV cameras and DVRS – in order to carry out a Distributed Denial of Service (DDoS) attack. The attack itself infected thousands of devices with a malicious code, known as a ‘botnet’, in order to force a DDoS attack.

Worryingly, according to The Guardian, researchers who worked closely with DYN found that the attack was linked to a ‘network of web-enabled CCTV cameras made by a single Chinese company, XiongMai Technologies’, meaning that the ‘CCTV cameras and digital video recorders were forcibly networked together using the sophisticated malware program Mirai to direct the crushing number of connection requests to DYN’s customers’. This situation proves that IP-connected security systems must be as secure as possible, as an insecure camera or device can become the weak link that ultimately provides a hacker with an entry point into an organisation’s network. Within the healthcare sector, the implications of such an attack can be wide-ranging, with the risk of sabotage in an effort to disrupt operation being a large concern. Should an attack occur, personal data, including health or financial information, is also severely at risk, and if stolen, this can be detrimental to an organisation, resulting in a loss of patient trust, denigration of reputation and ultimately financial losses. When it comes to procuring security solutions within the healthcare sector, it is vital that cyber security is a key priority for each party involved in the supply chain of internet connected security equipment. Manufacturers should ensure that accidental design or implementation !

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Advertisement Feature

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

DATA SECURITY

DATA IS AN INVALUABLE ASSET AND SHOULD BE USED ACCORDINGLY The NHS is one of the most prolific gatherers of data in the world. It’s not surprising as it employs 1.4 million people, caters for a population of nearly 70 million and sees over 800,000 patients every day Every interaction with a patient, whether on the phone, a home visit, at a GP surgery or a stay in hospital, results in data being generated and stored away in a myriad of systems. This collection of data will only accelerate over time as new methods of treatment are implemented and the use of technology is extended. All this generated data is nothing less than gold dust which has far reaching consequences not only for you and me (the individual patient) but can, and does, drive drug development, models of care and government policy in a whole set of areas. Of course, the data can be used in more insidious ways, for example by insurance companies but this happens anyway, try getting reasonably priced life insurance as you get older. What is undeniable is the data collected by the NHS and its affiliated organisations, if or when used intelligently, has the power to transform the lives of all our citizens in this country and the wider world, for the good. KNOWLEDGE OF DATA Analysing data effectively does not come without its challenges. A recent report by Cumberlege on maternity services in the North West revealed the problem of excess data, rather than timely and relevant information. The simple answer to this problem depends on knowledge (of the data), process (making relevant data available to the right person at the right time) and analytical tools which are fit for purpose. Knowledge and understanding of the data is dependent on the professional users of that data. For example, one expects a clinician to understand all the nuances of a procedure taking place in an acute setting and the significance of all fields (bits of data) contained in a record about that procedure. A layman (IT) can look and read the information but may need to be guided on what is vital in the context and what is not. IT professionals can be guilty of guessing what an end user (in this case a clinician) might want to see but not understanding what is vital. This means, in a report key information can exist but

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is hidden by too much other information, so its significance is lost. Both parties have a responsibility to avoid this outcome. PRESSURE AND COSTS So here is the rub, is all this data leveraged in a way that drives up productivity and efficiency generally within the NHS? This is critical in an era where we have an increasingly ageing population but with more and more treatments available, this is a recipe for continuous upward pressure on costs; and this pressure is not going to go away. Is the data made available on a timely basis to the widest possible audience that can use it to good effect to the benefit of everyone? Probably not. There is, of course, a huge elephant in this room called Information Governance (confidentiality to you and me), but this shouldn’t be an insurmountable barrier. Data anonymisation is a well understood technique so no identifiable patient details need to be revealed if the data is circulated more widely. There is an argument that even revealing some aspects of the demographic details of data may be too revealing but if you choose to get too cute about all of this nothing would get shared. There will always be the possibility that the data could be used for the wrong reasons but that needs to be managed, not used as a reason for not sharing

the data with appropriate parties. So, in a perfect world is the NHS able to leverage this data? The answer, as always, is yes and no. Yes, because somewhere you will find within this huge organisation centers of excellence when it comes to use of data; however, unlike bad news, good news doesn’t always travel fast so good practice is not necessarily communicated, let alone acted upon. By comparison you will still find data analysts within the NHS beavering away using inappropriate systems (often spreadsheet-based), trying to make sense of all this gold dust and struggling to deliver meaningful results and/or within a meaningful timeframe. This leads to extreme inefficiency. The retail industry has for decades ‘sweated’ its data assets to become more competitive and ultimately this has benefited the consumer with better products, better choice, better service. Shouldn’t the NHS be encouraged to ‘sweat’ its enormously valuable data assets (i.e. become a smart NHS) to help drive transformational change, becoming more efficient and which will ultimately benefit the patient with better services. When we have answered that question in the affirmative we will know we are onto a winner. " FURTHER INFORMATION www.totalintelligence.co.uk


CYBER CRIME ! errors are kept to a minimum and that systems are regularly scanned for vulnerabilities. They should also be proficient in secure coding and testing procedures and should ensure that their products are capable of supporting the stringent controls necessary for secure network communication. This can include encrypted database communication, denial of service protection, system auditing, alerting and management and highly customisable user access and permissions. While the responsibility is on the manufacturer, there is also responsibility on the end user. It is vital that specifiers are ensuring that they have asked essential questions around cyber security and are sure that the products they have chosen are fit for purpose. CYBER PRODUCT ASSURANCE The BSIA understands the vital need to protect customers from the risk of product-related cyber crime. Earlier this year, the BSIA convened a new working group called the Cyber Security Product Assurance Group (CySPAG) which aims to provide education and guidance on best practice in cyber resilience to product manufacturers, installers and users. The group is formed of representatives from a number of sections of BSIA membership and focuses on the increasing connectivity of security systems and how the growing links to home and

Data Security

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

Within the healthcare sector, the implications of a cyber attack can be wide-ranging, with the risk of sabotage in an effort to disrupt operation being a large concern business networks can leave individuals and companies vulnerable to cyber attacks. Any single system can be subject to a number of vulnerabilities at different stages of its life-cycle, so its resilience depends not only on initial product design but also on proper installation and configuration, as well as responsible use and maintenance by the end customer. The CySPAG group’s primary objective is to provide best practice guidance at every stage of this chain, from design and testing, to installation and maintenance. Currently, the group is finalising a Code of Practice which will provide guidelines for connected security systems. The document will include a framework of guidelines to minimise the exposure to digital sabotage of network-connected equipment, software and systems used in electronic alarm systems specifically. The BSIA also launched its official cyber ‘offering’ at IFSEC 2017, which included the creation of a dedicated cyber security information portal. Effective cyber security relies

on compliance by manufacturers and installers, but also the specifiers who are actually utilising the systems. When deciding on a specific security solution, ultimately, the end user must take responsibility for the security of their network. If using an IP-connected security product, it is paramount that you enlist the services of a reputable installer/integrator that is fully committed to best practice and can demonstrate their understanding of and resilience to cyber crime, with comprehensive cyber security and information security policies in place. In addition to this, they should also comply with any other relevant British and/or European standards related to their products or services. Members of the BSIA are all required to meet strict quality criteria and their membership of the association is your assurance that a supplier will provide a reputable service. " FURTHER INFORMATION www.bsia.co.uk

MOBILE EDGE UK Helping to make the world a safer place through intelligent security solutions.

Mobile Edge provides a capability to identify and verify people based on one of more documents – such as their passport, driving licence or identity card. We provide a mobile, hand-held device; you simply scan their documents or fingerprint and receive instant results. Our solutions, are used by Government and can be customised to your specific needs and adapted to suit a variety of environments. The products include ‘watch lists’ that allow you to register individuals that should be highlighted; either to deny access to areas, or facilitating them by fast tracking through a process. Designed to be quick and easy to use, you’ll quickly see the benefits of less work and a more secure workplace with added benefits of reporting and data collection. In today’s unsettled world, can you afford to be without it? For more information contact us at health-sales@mobileedge-uk.com or phone 0203 384 2727 www.mobileedge-uk.com

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The largest UK Conference and Exhibition for senior healthcare professionals and decision makers UK Health Show Content Programme FREE to attend With 150 leading speakers across 14 theatres, UK Health Show education programme features over 55 hours of cutting-edge CPD accredited content across four topical subjects: Technology, Commissioning, Procurement and Cyber Security

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HEALTHCARE INFORMATION

The government has issued its response to the third Caldicott report. Highland Marketing’s Lyn Whitfield looks over the report and the response with Dr Alan Hassey, a member of the National Data Guardian panel, ahead of his appearance at this year’s UK Health Show Talk about data use or data security in the NHS and one topic invariably comes up: care. data. The project, launched the best part of five years ago, set out to expand the Hospital Episode Statistics and combine them with new data sets, starting with GP data. The idea was to create a resource within the ‘secure safe haven’ of the Health and Social Care Information Centre (now NHS Digital) that would be available to ‘researchers and others’. Unfortunately, the idea went down badly with privacy campaigners and medics, who worried that the information could be sold to private companies, and that the public was not being told enough about the proposals to give informed consent to them. Alan Hassey, a retired GP who sits on the National Data Guardian panel, says there is no doubt that the

episode was a ‘low point’ in attempts to make use of the ‘fantastic resource’ of health data. THE THREE CALDICOTT REPORTS As it became clear that care.data could not proceed, Health Secretary Jeremy Hunt asked Dame Fiona Caldicott, the National Data Guardian, to conduct a review of information governance and security in the NHS. Dame Fiona had already conducted two similar reviews. The first, in 1997, was launched as the NHS started to use information technology, and led to the introduction of Caldicott Guardians at NHS organisations to protect and advise on the use of

Written by Lyn Whitfield

Building public and patient trust in healthcare information

UK Health Show

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

patient information. The second, in 2013, revisited the earlier report and updated the six Caldicott Principles that it had also introduced for handling identifiable patient information. Importantly, it added a seventh principle: that the duty to share information was sometimes as important as the duty to protect patient confidentiality. In her third Review of Data Security, Consent and Opt-Outs, published last year, Dame Fiona says it is ‘frustrating’ that this has led to ‘little positive change’ in the amount of legitimate information sharing that is going on across health and social care. However, she also says that there is now ‘a very significant opportunity to improve #

SeventhThe Principl Caldicott to share e: The duty was sominformation importa etimes as n to protet as the duty c confide t patient ntiality

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HEALTHCARE INFORMATION

Ten data security standards

UK Health Show

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

People - the first three data security standards say: staff should make sure that personal confidential information is handled correctly; that they should understand their obligations; and that they should have appropriate training. Leadership - the next four standards say: personal confidential information should only be accessible to people who really need it; that security processes should be tested annually; that cyber threats should be identified and addressed; and that plans should be in place for if things go wrong. Technology - the last three standards say: no unsupported systems, software or internet browsers should be in use in the NHS; that there should be a strategy to protect systems from cyber attacks; and that suppliers should follow these standards.

! the use of data in people’s interests’ while also improving ‘transparency for the public about when their data will be used and when they can opt out of such usage’. Dr Hassey, who will be talking about Caldicott at the UK Health Show in September, says the theme underlying all of Dame Fiona’s work has been this issue of building trust in how personal, sensitive information is being used. He says: “We know that people want their records to be available to professionals at the point of care, but we also know they want to exercise some control over how their data is used beyond direct care. With the development of new areas of research, and genomics, and artificial intelligence, there are fantastic opportunities in the use of data; but Dame Fiona’s conviction is that we need to take the public and patients with us.” DATA SECURITY STANDARDS AND CYBER STEPS The government published its response to Caldicott 3 in July. At the same time, it accepted the findings of a Care Quality Commission report on data security that

We know that people want their records to be available to professionals at the point of care, but we also know they want to exercise some control over how their data is used beyond direct care was published last summer, but given new impetus by the WannaCry ransomware attack that hit the NHS in May. In effect, therefore, the response falls into three parts. The first agrees to ‘adopt’ ten data security standards set out in Caldicott 3, and to take positive steps to ‘promote’ them in the NHS. NHS Improvement will publish a Statement of Requirements this summer that will clarify the action that organisations need to take. However, the response says they will include making a named member of the board responsible for data and cyber security and drawing up an annual Statement of Resilience to confirm that the standards are being implemented. In addition, the Care Quality Commission will build compliance with the standards into its new inspection regime,

there will be a new Information Governance Toolkit, and new training programmes for staff. The second part of the response deals with cyber security. It says £21 million of capital funding will be spent to ‘increase the cyber resilience of major trauma centres’ and another £50 million will be spent on ‘addressing structural weaknesses’ such as the widespread use of out of date IT systems in the NHS. It also flags up further investment in NHS Digital’s CareCERT service, which is responsible for sending out alerts about major threats and issuing advice to health and social care organisations. WANNACRY: REASONS TO BE CHEERFUL? Dr Hassey, whose presentation at the UK Health Show will focus on the role of the #

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A database to revolutionise your care. The Care Database is an intuitive, efficient and secure web-based system to help professionals provide better care for patients and families. Exceeding the functionality and accessibility of any other care system on the market, The Care Database offers an extensive list of features and benefits.

Key benefits Remote access on any device with an internet connection, providing greater flexibility and efficient working on the move. A comprehensive rostering tool incorporating key HR functions including shift patterns, sickness, training, diaries, pay and staff preferences such as term-time working. Fully customisable care plans allowing each hospice to build bespoke plans in line with their service, and which generate dependencies. A roster built around patient dependencies and staff competencies for the safest care. Booking systems for different activities including therapy sessions, residential stays and community visits. Access for patients and families to request bookings. Access for healthcare professionals. A highly secure database, hosted in one of the world’s leading data centres, and N3 accredited for interoperability. Integrated invoicing to external funders and those with personal budgets. Intuitive and easy-to-use interface, plus the ability to customise the interface based on the functionality required. Comprehensive ad hoc and static reporting suite.

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INFORMATION

! ten national data security standards in building public trust, says the WannaCry attack has made the response ‘timely’; and he is confident that it will be acted on. He says: “If there is something good to come out of the attack, it is that the NHS had the chance to test itself in a situation that had not been war-gamed, and to learn the lessons from that. We know there are a number of reviews going on, and they will come up with checklists of things for organisations to do, and not do, next time. But the most important thing, and the thing that the government response recognises, is that this has to be owned ‘at the top of the house’. This has to be a board-level responsibility.” ANONYMISED DATA: OUT OF THE OPT-OUT The third part of the government’s response deals with the bigger and more contentious part of Caldicott 3: how to make sure that the public and patients are both informed about what is happening to their health data, and how to make sure they have some control over it. Dame Fiona’s Review of Data Security, Consent and Opt-outs discusses this in the context of both identifiable information and information that has been anonymised or, strictly, de-identified (that has had some elements removed or changed so that what remains cannot be linked to an individual). Some critics of the care.data scheme objected to anonymised data being included on the grounds that this is still patient data and that it is possible to re-identify it in some circumstances. However, Dame Fiona argues that this kind of data is so important to the NHS and to researchers that it should not be covered by her new opt-out rules. However, her report also argued there should be tough new penalties for ‘the deliberate and negligent re-identification of individuals’. The government’s response accepts this. However, to address some of the concerns that GPs raised about care.data, it says ‘NHS Digital will develop and implement a mechanism to de-identify data on collection from GP practices’ – instead of doing this within the NHS Digital ‘safe haven’.

service. Again, the government’s response accepts this. It also promises that ‘people will be able to access a digital service’ to see who has accessed their NHS Summary Care Record from December next year and how other services are using their data from March 2020. A CAUTIOUS WELCOME Dame Fiona’s latest proposals, and the government’s response, have been given a cautious welcome by privacy and medical groups. A group of charities that argued strongly in favour of care.data, because of its potential benefit to research, issued a letter saying: “Now the hard work can begin, to address the detailed questions needed for effective implementation.” MedConfidential, which led the privacy charge against care.data, issued a statement saying: “We welcome the clear commitment that patients will know how their medical records have been used, both for direct care and beyond. Some of the details remain

to be worked out, but… it is now up to NHS England and NHS Digital to deliver.” Interestingly, Dr Hassey feels much the same: the government’s response is good, but ‘the devil in terms of the opt-out will be in the detail of exactly what it will look like’. Specifically, he wonders how people will be informed about where their data is going, since there is plenty of evidence that public understanding of even big and important data stores, such as the cancer registries, is limited at the moment. Also, he also wonders how this information will be presented, given that public consultations and citizens juries have shown that people are reluctant to give their information to companies – until they are shown that they will use it for public benefit.

UK Health Show

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

A JOURNEY, NOT A DESTINATION So, is information governance and data security in a better place than it was two years ago? Dr Hassey thinks it is, because ‘we have #

When it comes to patient identifiable data, Dame Fiona’s report says there should be a new, national opt-out model, that gives people the chance to opt-out of whether their information is used for research

IDENTIFIABLE DATA: NEW RULES WILL APPLY Dr Hassey admits that, as a former GP, this move is close to his heart: “GPs are in a different position, both because they are data controllers in their own right, and because they have the interests of their patients very much to heart. So I can completely understand where GPs are coming from.” When it comes to patient identifiable data, Dame Fiona’s report says there should be a new, national opt-out model, that gives people the chance to opt-out of whether their information is used for research and/or activities to run and regulate the health

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UK Health Show

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

The only AV company you will ever need

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CDEC, an award-winning provider of AV/IT solutions across the UK, has been serving the needs of the healthcare sector since 2000. During this time the company has seen huge changes in the sector; not least the significant increase in pioneering technology across all aspects of medical facilities, from operating theatres and teaching spaces, to reception areas and wards. CDEC continues to be at the forefront of these changes, offering innovative, effective, cost-efficient solutions, such as digital signage and video walls for reception and waiting areas, interactive collaboration devices for meeting rooms and offices, and patient flow management and telemedicine systems to boost efficiency and aid patient safety. The company’s experienced and knowledgeable team is on hand to advise on the best solutions for your needs, and also offers AV maintenance contracts, training and helpdesk facilities to

LapCabby has ideal solutions for the growing deployment of mobile devices within the healthcare community. The company has been developing innovative products for the last 20 years that its customers love, such as portable storage trolleys and charging solutions for tablets, mini devices, Chromebooks, laptops and netbooks. Whether users have employeeowned or institution-owned devices, LapCabby has a variety of secure charging solutions that can improve the workflow of deploying your iPads, mini devices, phones and laptops. It’s the smart way to keep your tech safe, charged, and in one secure place. LapCabby’s products include some ingenious features to ensure they do everything you need them to – and a little more besides. Intelligent Power7 staggered charging, surge prevention and internal heat sensors are just some of them.

ensure you continue to get the most out of your investment. CDEC understands that there is no room for error in the healthcare sector; whether it is supplying AV solutions to hospitals, training facilities or regional health centres, reliability, effectiveness and ease of use are key and patient safety is at the core of everything the company does. Contact CDEC today via telephone or email to find out more. FURTHER INFORMATION Tel:01689 885 380 sales@cdec.co.uk www.cdec.co.uk

Maximising the value of the NHS estate and back-office systems Thursday 28 September 2017

Are you working on estates or procurement plans to drive value for your NHS organisation? This one-day event will provide updates on national policy, lessons from good practice, and information about the support that is available to help you develop and deliver your plans.

Find out more and register at www.kingsfund.org.uk/NHSvalue

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HEALTH BUSINESS MAGAZINE | Volume 17.4

The wide range of units means there is always a LapCabby for you whether you need to charge and store iPads, mini devices or laptops in mobile, static or individual deployments. The company’s lifetime warranty on all parts and 5 years electrical warranty shows how much it trusts in its products. Take a look at the work LapCabby already does with the healthcare sector here: www.lapcabby.com/en/sectors/ lapcabby-for-healthcare/ FURTHER INFORMATION Tel: +44 (0) 115 982 1771 askus@lapcabby.com www.lapcabby.com

Helping you revolutionise your care management The Care Database is an intuitive, efficient and secure web-based system to help healthcare professionals revolutionise their care management. The system can be used across a variety of care settings, including surgeries, hospital wards, care homes, respite centres and hospices, and offers an extensive list of features and benefits. These include remote access for flexibility and efficiency, customisable care plans, and staff competencies which match to patient dependencies and then generate team rosters. Healthcare professionals, such as GPs, are able to access patient notes and care plans, while other features include access for patients or families to request bookings, key HR functions such as sickness, pay and training, and integrated invoicing. The first of its kind on the market, The Care Database has been developed by Geeks, a UK software developer and recipient of the Queen’s Award

for Enterprise and Innovation, and Shooting Star Chase children’s hospice, who have 15 years’ experience as the market leader in managing clinical records and information in the children’s sector. The Care Database is competitively priced and comes with full implementation, training and maintenance by the team who developed and use the system. To find out more and arrange a no-obligation demonstration, visit the company’s website. FURTHER INFORMATION Tel: 01932 823 111 hello@thecaredatabase.com www.thecaredatabase.com


The UK Health Show brings senior healthcare professionals and decision makers together to help the NHS and the wider sector promote and improve service delivery for better healthcare outcomes across the UK ! a government that knows this is important’ and lots of organisations are on board with the idea that ‘the lessons of care.data have to be learned’. However, there is still work to be done, and some of it won’t be easy. He asks: “We need to take people with us: but how do you have a conversation with 65 million people? What are their expectations, do the public and patients think the same, how does their knowledge of IT affect their views? The opt-out is a journey, not a destination. In some ways, that journey has only just begun.” "

Dr Alan Hassey was a GP in Skipton in North Yorkshire until June 2013. He advises a number of NHS and industry bodies on information governance and security issues, and is a member of Dame Fiona Caldicott’s National Data Guardian panel. The UK Health Show, taking place on 27 September at Olympia, London, brings senior healthcare professionals and decision makers together to help the NHS and the

Seven Caldicott Principles

UK Health Show

HEALTHCARE INFORMATION

The original Caldicott Principles say: personal confidential information should not be used unless ‘absolutely necessary’; that if it is used, its use should be ‘justified’; and even then, only the ‘minimum necessary’ should be used. Also, that: access should be on a ‘need to know basis’, everybody who has access should be aware of their responsibilities; and they should comply with the law. The seventh principle, added in 2013, says: “The duty to share information can be as important as the duty to protect patient confidentiality.”

wider sector promote and improve service delivery for better healthcare outcomes across the UK. Over 4,000 delegates will come together to network with peers, engage with suppliers and learn from best practice case studies across four focused show areas: Technology, Commissioning, Procurement and Cyber Security. FURTHER INFORMATION https://ukhealthshow.com/

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Advertisement Feature

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

EMERGENCY CARE

IMPROVING MEDICATION MANAGEMENT WITH NEW TECHNOLOGY Karen Kelsey, Senior Clinical Matron for Emergency Care at North Tees and Hartlepool NHS Foundation Trust, discusses how the introduction of innovative technology has improved medication management within their hospital “Effective management of medication in Emergency Care is paramount. We need to get the right drug to the right patient, on time, every time. Managing stock levels is key to that and yet traditional old-fashioned ‘drug cupboards’ – which can result in delays in getting medication and missed doses – are still being used in many hospitals. Without doubt nurses and frontline staff are stretched and working under increasing pressure in the NHS. Significant numbers of patients are being prescribed complex medication regimes – in North Tees alone we manage as many as 441 lines on one ward. Here at North Tees, we decided to look into automated medication technology systems with a view to replacing our old emergency ward drug cupboards. A significant amount of pharmacy time was being absorbed with manual stocktakes required every couple of days and nurses on the ward couldn’t always access the right medication needed for patients resulting in vital treatment delays. It was a big frustration for us as nurses as it impacted patient care delivery. These unnecessary delays in accessing medication can have a long-term impact on a patient’s recovery and it affects the very heart of our promise to deliver effective care to all. STAND-OUT SOLUTION Omnicell’s automated medication dispensing cabinets were the stand-out solution for the hospital as they were easy to implement, allowed frontline staff to clearly see the medication they needed, and ensured that it was stored safety and securely. Since installing the system, the Trusts has had a stock reduction of £2,800 or 10 per cent of the stock on hand has been achieved – we also know that further reductions could be possible when we review usage patterns too. The expiry date reports also help the pharmacy to see which stock is due to go out of date, allowing them to move medication around the hospital – so it all gets used instead of wasted. This means that there is now very little stock expiry on the wards. Keys were another major issue. Authorised

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staff were responsible for the drug cupboard keys and nurses wasted endless time searching for the people who had hold of the keys. Unsurprisingly, we even had times when nurses accidentally took the drug cupboard keys home after a busy and stressful shift. The cabinets are keyless with nurses gaining access via their unique fingerprint. Once logged in, they are then directed to the medication they need for patients via a guiding light system. This is helping to eliminate the risk of medication errors and as a result is improving patient safety. GREAT SUCCESS Such is the success of the initial project, the Trust has now rolled out Omnicell across the hospital in different locations. We have 56 cells on various wards. North Tees and Hartlepool NHS Foundation Trust is one of six pilot sites for Scan 4 Safety

across the UK. We are in the process of implementing our GS1 strategy, using Omnicell as a leading partner in our plan. Put simply, it’s now easier for staff to do their job effectively with regards to medication management and administration and we have more time to care for patients. We don’t find out of date items anymore and we don’t run out of things. The time taken to get medications is much quicker, and we can always get the medication we need when we need it. That makes it much safer for staff and patients and it instills confidence in our nurses. The new approach to medication management and stock rotation ensures we always have immediate access to vital drugs which help patients recover quicker and speed up discharge times.” " FURTHER INFORMATION www.omnicell.com


PHARMACUTICAL

GLOBAL LEADERS IN HIGH PERFORMANCE AEROSOL DRUG DELIVERY

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Aerogen technology reduces Emergency Department admissions by 32 per cent when compared to a standard jet nebuliser1 Data recently released reinforced Aerogen’s credentials as global leaders in high performance aerosol drug delivery. The results from this study showed a 32 per cent1 reduction in the admission of patients to hospital from the emergency department when treated with their vibrating mesh technology compared to traditional jet nebulisers. The same research also showed that patients treated with Aerogen technology in the same setting required 75 per cent1 less medication versus those treated with traditional small volume jet nebulisers. Secondary analysis also confirmed a significant reduction in median length of stay of 37 minutes1. Commenting on the results, John Power, managing director and CEO of Aerogen said: “This large clinical study demonstrates the impact Aerogen technology can have in the Emergency Department and is further evidence of the outstanding clinical results we’ve seen when Aerogen technology is used in critical care units all over the world.“ “When patients feel better and can go home faster, without an extended hospital stay, it benefits everyone. This is truly great news for patients, clinicians and hospital administrators alike.” Lead investigator and study author Robert Dunne, MD, vice chair of emergency medicine at St. John Medical Centre, Detroit said: “The study results prove what we saw everyday treating patients in our emergency room: people who needed treatment with a bronchodilator got better faster, with less medicine, and required fewer admissions when using the Aerogen Solo and Ultra than patients receiving treatment with a traditional small volume jet nebuliser.” To download the full study poster visit: https://www.aerogen.com/wp-content/ uploads/2016/10/2016-Dunne-StJohns-Hospital-poster.pdf RCSI STUDY A new clinical efficacy study by Royal College of Surgeons in Ireland (RCSI) provides further proof that treatment by Aerogen Ultra enhances patient outcomes.2 When comparing a single standard bronchodilator dose delivered by the Aerogen Ultra versus an SVN, there was a

Significant Improvement in FVC and Improved patient symptom score. The Aerogen Ultra improves lung response which has been associated in other studies with enhanced exacerbation recovery.3 Aerogen will be exhibiting at ERS, Milan (9-13 September), HAI, Berlin (21-23 September). For a full list of Aerogen events visit www.aerogen.com ABOUT AEROGEN Aerogen (www.aerogen.com) is the world’s leading medical device company specialising in the design, manufacture and commercialisation of aerosol drug delivery systems. Aerogen’s patented vibrating mesh technology turns liquid medication into a fine particle mist, gently and effectively delivering drugs to the lungs of critically ill patients of all ages. Aerogen’s innovative products, such as the Aerogen® Solo and Aerogen® Ultra, significantly improve aerosol drug delivery resulting in better patient care throughout the hospital. Founded in Galway, Ireland in 1997, Aerogen has grown to become the global leader in high performance aerosol drug delivery and has partnered its technology with the leading mechanical ventilation companies. Aerogen technology is used by millions of patients and caregivers in over 75 countries worldwide, and it has partnered its technology with world leading companies including Philips Healthcare, GE Healthcare, Covidien, Maquet, Drager, Hamilton and ResMed. Aerogen, which employs over 100 people in

Ireland, has reported 30 per cent business growth year on year for the past eight years, surpassing annual growth targets. Having invested over €40 million in creating a breakthrough high performance nebuliser and setting a new standard of aerosol drug delivery in critical care, Aerogen products are supplied to over 75 countries and to date have benefitted over four and a half million patients worldwide. " Dunne R et al: Aerosol dose matters in the Emergency Department: A comparison of impact of bronchodilator administration with two nebulizer systems. Poster at the American Association for Respiratory Care. 2016 1

Cushen B, Alsaid A, Abdulkareem A and Costello RW: A Pilot Study To Assess Bronchodilator Response During An Acute Exacerbation Of COPD Using A Vibrating Mesh Nebuliser Versus Jet Nebuliser For Bronchodilator Delivery. ITS poster presentation. 2016 2

Cushen B, McCormack N, Hennigan K, Sulaiman I, Costello RW and Deering B: A pilot study to monitor changes in spirometry and lung volume, following an exacerbation of Chronic Obstructive Pulmonary Disease (COPD), as part of a supported discharge program. Respiratory medicine. 2016; 119: 55-62. 3

FURTHER INFORMATION www.aerogen.com

Volume 17.4 | HEALTH BUSINESS MAGAZINE

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EVENT PREVIEW

Building innovative and productive partnerships in asset management

Healthcare Estates

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

This year’s Healthcare Estates conference theme aims to tackle key topics in three streams: strategy and leadership; engineering and facilities management; and planning, design and construction. Health Business examines the three in more detail Healthcare Estates is attended by over 3,500 highly engaged, curious visitors with a passion for new solutions, technology and answers at the industry’s foremost event for the healthcare sector. It is the ideal event for meeting face-to face with industry colleagues, discussing the key issues within their sectors while finding out about latest technologies at this festival of ideas and discovery in the healthcare sector. The show features six enlightening and challenging seminar theatres which focus on key areas in the healthcare sector – each zone offers free to attend theatres delivering specialist content and case studies, while exhibitors showcase a range of specialist products and services. Steve Webb, Healthcare Estates show director, said: “Following recent events in the UK – a terrorist attack, the devastating fire at Grenfell Tower, and the NHS cyber attack – NHS estates and facilities directors are understandably concerned about their requirement to ensure corporate governance and assurance to their board. Healthcare Estates has gathered key figures from the NHS, including Simon Corben, past president of IHEEM, Paul Kingsmore, director of services at Manchester Metropolitan University, and Kevin Oxley, director of Estates, Facilities and Capital Planning at South Tees Hospitals NHS Foundation Trust, to discuss and consider the highly topical subject of corporate governance assurance and give their individual standpoints.” The conference opens with keynote speaker Simon Corben, director of NHS Estates and Facilities at NHS Improvement, who will reflect on his first six months in office, and discuss the need for stronger and more robust corporate governance assurance, a subject that will be picked up in the panel discussion session that follows.

STRATEGY AND LEADERSHIP There has been little real attention given to how the NHS estate could help to improve efficiency, move

The NH is a hig S hly energy i n t e nsive organis a t i o n trusts a with all n d f o u n trusts s pendingdation o £560 m illion onver energy eac year h

more care out of hospitals and exploit new technologies. The discussions in the ‘strategy and leadership’ stream look at how models of care are still designed around buildings, and asks whether re-thinking the way that the #

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EVENT PREVIEW ! NHS uses its estate could catalyse change. The NHS workforce will require significant transformation across all disciplines to keep pace with the changing service and financial environment. The new national Apprenticeship Levy creates opportunities, but has significant cost and organisational implications alongside. Brighton & Sussex University Hospitals NHS Trust is pursuing a multi-dimensional approach to workforce transformation – creating coherent career development pathways for NHS staff, delivering sustainable pay cost reductions overall, and ensuring improvements in the quality and safety of patient care. The need for workforce transformation is made more urgent by the £486 million redevelopment of the Royal Sussex County Hospital in Brighton, the first major stage of which opens in 2020. This will deliver a step-increase in capacity in clinical services known to have national and local supply-side/

recruitment challenges, and significant changes in physical design (proportion of single rooms, size, layout of facilities), for which innovative approaches to staffing models and role design will be critical. The ‘Efficiency in Workforce Development’ presentation, hosted by Duane Passman, director of 3Ts at the trust, will highlight the approach being taken and how it is being developed and implemented in practice. It will identify key learning points and the

experiences of developing this programme in a dynamic and operationally-pressured environment whilst ensuring clinical leadership and engagement.

Healthcare Estates

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

THE ROYAL LIVERPOOL UNIVERSITY HOSPITAL The construction project for the new Royal Liverpool University Hospital includes an innovative sustainable communities programme. The programme consists of #

Following the UK terrorist attacks, the Grenfell Tower fire, and the NHS cyber attack, NHS estates directors are understandably concerned about their requirement to ensure corporate governance and assurance to their board

Volume 17.4 | HEALTH BUSINESS MAGAZINE

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BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

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A ll C o n

Healthcare Estates


Spirotech. When failure is not an option. Spirotech products can ensure facilities managers in Healthcare estates best maintain their heating systems, keeping them free of air and dirt, improving system efficiency and minimising any chance of a system breakdown. Spirotech has the experience and expertise of working with major hospital installations and big commercial contracts that have yielded strong efficiency savings, reduced maintenance costs as well as a reduction in the system’s carbon footprint.

Spirotech understands the need for continuous learning and for this reason have created CPD courses, accredited by CIBSE. • Deaeration and dirt separation techniques • Understanding pressurisation design, installation and implementation Want to find out more? Visit us on stand F8 or call us on 0208 451 3344 or visit www.spirotech.co.uk


EVENT REVIEW

! three key areas: reducing worklessness, local economic regeneration and community. Reducing worklessness includes targets for apprenticeships and work experience opportunities. One of the successes of the programme has been the upskill programme, which has supported long-term unemployed people through training to get the ‘construction site ready’. Local economic regeneration has been supported through working with Liverpool in Work (the city council’s employment arm) to ensure that local businesses are aware of upcoming opportunities. Community regeneration has been supported through a programme of community volunteering, which has provided construction support for local charities. Carillion also provided £100,000 for a Liverpool Community Fund. Ian Stenton, the trust’s head of Sustainability, will host this session alongside Carillion’s community regeneration manager. John Simpson, ex-estates and facilities director at the Royal Stoke University Hospital, will also present in this theatre on ‘Mergers & Acquisitions – Lessons learnt’, providing a reflection on the 2014 acquisition and merger of Mid-Staffordshire NHS Foundation Trust and University Hospital North Staffordshire.

Healthcare Estates

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

The NHS workforce will require significant transformation to keep pace with the changing service and financial environment. The national Apprenticeship Levy creates opportunities, but has significant cost implications alongside ENGINEERING AND FACILITIES MANAGEMENT The NHS is not unique in finding estates and property difficult to manage, and this task is increasingly being outsourced. While all of this means that there are unexploited opportunities for improving value for money, perhaps the most important concern is that opportunities for new models of care are not being maximised and that the existing estate is an obstacle to innovation. There needs to be more ambition in the way the NHS estate is used. The current model of ownership and operation needs to be challenged and new methods of financing need to be developed that avoid the very significant downsides of PFI, in particular, the associated intergenerational transfer of debt. As part of the ‘engineering and facilities

management’ sessions, Malcolm Thomas will present a seminar on ‘Operating Theatres – The surgeon’s panel’. All operating theatres should have an information display colloquially known as the ‘Surgeon’s panel’, whose primary function is to bring together information on the operational state of the facility so that the surgical team can decide whether it is safe to commence a surgical case. Traditionally these panels used coloured lights, meters and clocks that were hard wired on a stainless steel plate. Today most panels are touch screen with menu driven displays. While they have many advantages they can suffer from presenting too much information in a confusing way. Lack of clarity has resulted in surgery being undertaken when the ventilation was not operating or was in ‘set back’, resulting in increased infection rates. #

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City & Guilds Accredited Legionella and Water Hygiene Training

City & Guilds Accredited Legionella and Water Hygiene Training Impartial and Independent Advice Risk Assessments and Site Audits IHEEM Registered Authorising Engineers AE (Water) Quality Training and Services for all aspects of water safety T:Impartial +44 and (0)1257 233307 Independent Advice

Risk Assessments and Site Audits E: sue@immersetraining.org IHEEM Registered Authorising Engineers AE(Water)

www.immersetraining.org

Are you fully compliant? Stay right up to date with Immerse Training

Antimicrobial Technology Coatings

Medical Devices

Surfaces

Textiles

Permanent antibacterial protection for your healthcare estate Visit us at IHEEM stand B23 Addmaster (UK) Ltd. | +44 (0)1785 225656 info@addmaster.co.uk | www.biomasterprotected.com

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EVENT PREVIEW ! The Specialised Ventilation for Healthcare Society (SVHSoc.) has produced a paper that itemises the information that should be present on a surgeon’s panel and clarifies the method of display. Malcolm’s presentation will launch that paper and explain the thinking behind it. There are a number of physical and biological tests described in HTM 03-01 for both validation and verification of critical ventilation systems. In conventional theatres microbiological sampling is required at validation only. However, carrying out sampling at verifications can indicate where there are problems which can go unnoticed by normal visual inspections. Surely it is better to do simple active air microbiological sampling annually rather than wait until problems manifest in infection rates. This second presentation, delivered by Jerry Slann, of the Institute of Occupational Medicine, will highlight the advantages of carrying out some additional tests during verification which the author believes to be invaluable to estates, infection control and users. OVERCOMING FINANCIAL BARRIERS The NHS is a highly energy intensive organisation with all trusts and foundation trusts spending over £560 million on energy each year. The installation of energy efficiency technologies is at the centre of the action to not only decarbonise the UK but also reduce energy spend for the NHS. In this session, Mark Hogan, energy and environmental manager from Wrightington, Wigan and Leigh NHS Foundation Trust will be joining Salix to discuss the trust’s previous and current energy efficiency projects and how they have utilised over £2.6 million of Salix funding across their

There needs to be more ambition in the way the NHS estate is used. The current model of ownership and operation needs to be challenged and new methods of financing need to be developed hospitals. Their projects include boiler retrofit economisers, replacing steam plate heat exchangers and heat recovery systems, and are estimated to save the trust over £590,000 each year. Salix Finance provides interest-free government funding to trusts and foundation trusts to improve their energy efficiency, reduce carbon emissions and lower their energy bills. Salix will draw on its extensive experience of funding over £48 million of energy efficiency projects in over 55 NHS trusts and foundation trusts across England to showcase best-practice examples of projects that provide quick paybacks on investment, creating both significant carbon and financial savings for NHS trusts. PLANNING, DESIGN AND CONSTRUCTION The third theme of the show offers a packed programme, focusing on Hopewood Park – Northumberland, Tyne and Wear

Healthcare Estates

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

NHS Foundation Trust’s exemplary new 122-bed inpatient facility for adults and older people. The redevelopment forms part of a wider scheme known as PrIDE (Providing Improved Mental Health and Learning Disability Environments) in Sunderland and South Tyneside. The trust’s long-term strategic approach to managing and upgrading the estate infrastructure sets them apart. From the outset, each individual project was always undertaken with full knowledge of the wider context and future-proofed to be sustainable for the changing needs of the trust for years to come. The rest of the world has sat up and noticed, too; these award-winning developments attract international interest from those eager to learn. This presentation will look back on the achievements of this partnership, including: the background to the trust and the starting point of their estates’ redevelopment; the history of the partnership; the estate’s geography; the projects leading up to Hopewood Park; and the lessons learned. Health service estate requires improvement and change on an on-going basis to meet the challenges of changing patient demand and financial constraints. Modular buildings have a number of advantages over traditional build, including speed of delivery, quality, control of costs and timescale. The ‘Lessons #

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Healthcare Estates

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

Quality and innovative system water solutions

Reducing wastage and increasing efficiency

Spirotech, the UK’s leading supplier of heating and cooling system protection, water conditioning and analysis, will be showcasing its range of solutions at Health Estates 2017. Visitors to stand F8 at Manchester Central will be able to learn more about how Spirotech products can ensure facilities managers best maintain their heating systems; keeping them free of air and dirt, improving system efficiency and minimising any chance of a system breakdown. A live demonstration of the SpiroVent Superior S4 fully automated vacuum degasser will be a main feature on stand. The fully electronically controlled product causes almost all free

GEMchem is a specialist water treatment company, providing an alternative, simple and efficient state-of-the-art, foodsafe boiler water treatment service. The system also has the benefit of relieving site staff of most of the daily treatment testing procedures, freeing them up for other duties. The treatment performs three major functions. Firstly, it increases the steam system efficiency, reduces the boiler’s fuel consumption, leading to lowering fuel bills by up to five per cent. Secondly, it more effectively protects the boiler, hotwell and associated equipment from scale and corrosion attack, leading to greater reliability and longer plant life. Finally, it very successfully deals with corrosion throughout the steam and condensate circuit, with large savings in maintenance and replacement costs. GEMchem also specialises in hot and chilled water circuits as well as cooling water systems.

air, microbubbles and dissolved gasses to be expelled from a heating or cooling system, meaning that the chance of any corrosive activity within the system is eliminated. Spirotech representatives will be available on the stand to talk through existing and past projects, including major hospital installations and big commercial contracts that have yielded strong efficiency savings and reduced maintenance costs. To find out more, visit stand F8 at Healthcare Estates, Spirotech’s website or Twitter @SpirotechUK. FURTHER INFORMATION Tel: 0208 451 3344 info@spirotech.co.uk www.spirotech.co.uk

The company prides itself in the partnerships that it forms with its customers which give rise to the longstanding relationships it develops with them. GEMchem can put you in touch with a range of very happy current NHS users who can detail their experience of converting to GEMchem. To the company, the emphasis is on improving the efficiency and reliability of the customer’s plant. Contact GEMchem to see how it can protect your system and also save you money at the same time. FURTHER INFORMATION Tel: 0117 9225544 info@gemchem.co.uk

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Theatre capacity available on demand. Would you like more theatre capacity to meet patient needs? Our mobile operating theatres offer: • Anaesthetic room • Operating room • aminar o ventilation • bed rst stage recovery area • Integrated full medical gas bank uipment and clinical staf ng options are also available to further alleviate capacity pressures. For more information contact us at:

0845 630 6979* www.vanguardhs.com *Calls to this number cost 3ppm, plus your service provider’s access charge

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Healthcare Estates

EVENT REVIEW

! Learned: Modular Installation of Laminar Theatres at Daisy Hill Hospital’ presentation will detail the modular installation at Daisy Hill Hospital of two laminar-flow theatres, an endoscopy suite and a 28-bed recovery facility and explain how the building was connected to an existing theatre block on the third floor, on a severely sloping hillside. EVELINA LONDON CHILDREN’S HOSPITAL Informed by ethnographic and design research into reducing violence and aggression in A&E, the art scheme for Evelina London Children’s emergency department aims to bring reassurance and stimulation to families and children, ensuring they feel well-cared for throughout their journey, as well as promoting role model behaviours and acceptance of information. John Criddle, paediatric emergency medicine consultant at the Evelina London Children’s Hospital, will be joined by Martin Jones, director of Art In Site, to discuss the project that ensures that children and families feel well looked-after throughout their hospital journey. WORKING TO REDUCE CARBON FOOTPRINTS The Energy & Sustainability Theatre will showcase the latest techniques and innovation in reducing the carbon footprint across the NHS, allowing the NHS to meet its legal targets set out in the Climate Change Act. In-depth content will also be delivered by the Carbon and Energy Fund (CEF), specifically created to fund, facilitate and project manage complex energy infrastructure upgrades for the NHS. Sessions confirmed for this theatre include ‘The future of energy use in the NHS – How modern steam plants can save energy, lower carbon emissions and reduce utility costs’, and ‘Increasing efficiency of steam and hot water systems’, which will be delivered by Mark Hogan, Energy and Environment Manager at the Wrightington, Wigan and Leigh NHS Foundation Trust.

Apprenticeship programmes can be a cost-effective way to create a skilled, flexible and motivated workforce, and can help employees keep pace with developments in technology and working practices within healthcare The Facilities Management Theatre will run a two-day programme focusing on hard and soft facilities management in healthcare. Topics to be explored in this theatre include: ‘The cost of slips, trips and falls within healthcare’; ‘The Internet of Things – digital disruption in FM’; ‘The importance of food standards in the NHS’; and ‘The importance of cleaning within healthcare environments’. HEALTHCARE DESIGN Each year, the Healthcare Design Management Theatre is a ‘must attend’ destination for architects, contractors and clients as it features the latest case studies, findings from post occupancy evaluation as well as the sharing of best practice in healthcare design. This year the theatre will feature presentations from Architects for Health, BIM4Health, ProCure22, specifiers and many more. Philip Ross and Jeff Bartle, board members at the Design In Mental Health Network, will address quality control for mental health environments in their session on ‘Independent Product Performance Testing’. Jenny Gill, chairman of the Design in Mental Health Network, will also present ‘Best Practice Guidance’ on the second day of the conference. The Hospital Engineering Theatre will feature presentations by leading NHS trusts on recently completed innovative engineering projects. The theatre is supported by IHEEM and NAHFO and will feature examples of engineering excellence, case-studies and best practice. Elsewhere, NHS estates and facilities professionals can listen to and meet

companies that provide solutions for water safety across the NHS in the Water & Infection Control Theatre. This covers specialist subjects such as rapid microbiology, existing and emerging water pathogens, and the challenges of infection control and engineering. NEW FOR 2017 There are significant changes on the horizon within the health sector, including the introduction of new roles and changes to how training will be funded. Many trusts are looking at NHS apprenticeships as a way of meeting the challenges that lie ahead. Apprenticeship and traineeship programmes can be a cost-effective way to create a skilled, flexible and motivated workforce, and can help employees keep pace with developments in technology and working practices within healthcare. In light of this, the 2017 edition of Health Care Estates will host an Apprentice Today Leaders Tomorrow Theatre. IHEEM AWARDS DINNER The annual Healthcare Estates IHEEM Awards Dinner takes place on the first night of Healthcare Estates, 10 October 2017 at the Mercure Manchester Piccadilly. The Awards Dinner is a fantastic occasion, celebrating the best in the industry whilst networking with the biggest names in the healthcare sector. The awards are highly competitive and winning is a great achievement. Former professional snooker player Steve Davis has been revealed as the after dinner speaker. " FURTHER INFORMATION www.healthcare-estates.com

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Specialising in electrical and digital infrastructures Legrand is a global expert in electrical and digital building infrastructures, with a presence in over 80 countries and a total workforce of over 36,000 employees worldwide. Legrand UK & Ireland is organised into the following specialist divisions: assisted living and healthcare, cable management, power distribution, wiring devices and data communications. Legrand’s assisted living & healthcare division designs, manufactures and supplies innovative technology-enabled care solutions for health, housing and social care services. The division brings three separate brands, Tynetec, Aid Call and Jontek together, to position Legrand as a leader in the assisted living market. Tynetec supplies a range of hardware and software solutions that are all manufactured in-house, including grouped living systems, telecare devices and access control systems,

to local authorities and housing associations. Jontek provides monitoring and response centre software solutions, incorporating telecare, telehealth and mobile care (m-Care) to public and private sector organisations across the UK. Aid Call has been the leading manufacturer of wireless nurse call technology for over 40 years, with a range of products and bespoke solutions that are designed to specifically meet the needs of care homes, care groups and hospitals in both the private and public sector. FURTHER INFORMATION Tel: 01670 352 371

Porous load steam sterilizers and laboratory autoclaves Based in Northamptonshire, ESTS is a specialist service provider and manufacturer of the Logiclave™ range of clinical sterilizers and laboratory autoclaves for healthcare and scientific laboratory applications. Providing innovative and high-quality equipment and services is the motivation behind the organisation’s management and is supported by a network of experienced service technicians. The company provides an extensive range of services to all types and makes of autoclaves, washer disinfectors and endoscope washer driers including preventative maintenance and periodic testing in accordance with the requirements of industry standards such as HTM 01-01. Understanding that equipment failure and breakdowns can

have a significant negative impact on patient care, ESTS provides flexible preventative maintenance service contracts and always aims to minimise downtime by providing a same day callout response and next working day response as standard. In all cases an on-call engineer with telephone support is available 24/7. ESTS Logiclave™ will be exhibiting at Healthcare Estates Exhibition & Conference on 10-11 October 2017 at Manchester Central. Visit ESTS on stand D18 to discuss the Logiclave™ range. FURTHER INFORMATION Tel: 01933 270999 www.autoclave.uk.com

ALS – offering a range of testing solutions

Protecting you against the dangers you can’t see

Global experts in laboratory analysis, ALS is your ideal partner to assist you in complying with ACoP L8, HSG 274 and HTM04-01 regulations. Utilising MALDI-ToF confirmations for all microbial analysis, ALS is able to offer an instant confirmation on Legionella, Pseudomonas, Stenotrophomonas and any other water-borne bacteria as well as a full species identification as part of our routine service. As a member of the Legionella Control Association, all ALS laboratories are UKAS ISO 17025 accredited for a broad portfolio of water and waste water analysis. ALS can support your routine monitoring of Renal Dialysis Waters and BSRIA related heating and chilling systems as well as microbial analysis such as Pseudomonas and Legionella. With laboratories in Coatbridge, Coventry, Wakefield and Otterbourne, and a network of in-house refrigerated vehicles, ALS is your national analytical partner. All of your data is reported using

Healthcare associated infections are among the most common complications of hospital care. With increasing pressure on services and budgets it is important to offer the best levels of hygiene in high risk areas. Biomaster by Addmaster provides an effective first line of defence to reduce the threat of microbial crosscontamination on just about any surface or contact point. Independently tested in thousands of applications, Biomaster is proven to inhibit the growth and spread of bacteria most commonly identified as HAIs including MRSA, ESBL, VRE, Acinetobacter baumannii and Pseudomonas aeruginosa. Biomaster technology inhibits the growth of harmful microbes around the clock, providing permanent and safe product protection for the useful lifetime of the treated article. It is used extensively in healthcare facilities around the world to

online reporting system myALS, and ALS is able to integrate reports with a range of facilities management software providers. By working with a broad portfolio of customers for over twenty years, ALS has been able to develop a range of analytical services that meet your specific needs, including industry, regulatory and bespoke analytical suites. ALS also offers in-house field sampling and monitoring, direct data transfer, sample scheduling, automation of registering and a host of other support services. FURTHER INFORMATION Tel: 02476 421213 info.ukenviro@alsglobal.com www.alsenvironmental.co.uk

HEALTH BUSINESS MAGAZINE | Volume 17.4

reduce cross-contamination by managing exposure pathways. Biomaster is very easy to specify. Addmaster will work with your existing supply chain and tell you what charges are for the additive so you have control over costs. The company also gives you free technical and marketing support. To find out how to incorporate Biomaster antimicrobial technology into your existing supply chain or manufacturing process, visit Addmaster’s website or give the company a call. FURTHER INFORMATION Tel: +44 (0)1785 225656 info@addmaster.co.uk www.addmaster.co.uk


Bespoke and cost-effective Learn how to effectively roofing solutions manage water systems Surveyroof is a leading provider of flat roof waterproofing membrane condition surveys, leak detection and integrity testing in the UK. The company’s success is based on its commitment to exceptional service and accurate results. Surveyroof has no affiliation to any roofing contractor or membrane manufacturer so it truly is independent. Surveyroof is serving clients nationwide, so wherever you are in the country, its quality assurance and training standards ensure you will benefit from the highest level of service. Surveyroof continues to be a leading authority in waterproofing membrane leak detection and integrity testing offering surveys and testing methods in both wet and dry conditions, conducted by fully trained survey technicians using state of the art testing equipment. Surveyroof will provide a detailed, independent,

confidential report on the condition of your waterproofing system, identifying the location and nature of each defect, allowing targeted, cost effective repairs to the waterproofing membrane by your nominated contractor. Surveyroof also offers a range of associated services such as thermal imaging surveys, visual roof condition surveys to metal profile and standing seam roof area and roof maintenance programmes to provide you with a complete solution for your roof leak detection and maintenance needs. FURTHER INFORMATION Tel: 0845 257 7663 sales@surveyroof.co.uk

Immerse Training is a dynamic training company established and run by experts in the Legionella and water hygiene field. The company focuses on quality, cost, convenience and courses. Quality – All trainers are working industry consultants who know and understand hygiene issues in building water systems. Three of the eight trainers are IHEEM registered authorising engineers (AE) water, and the team has an ex HSE principal specialist inspector and an HSE specialist inspector from the Biological Agents Unit. Cost – The company keeps its costs down so that it can keep your costs down. Its one-day courses are competitively priced

at £190 per delegate and there are discounts for ten or more. Convenience – Immerse Training comes to you and delivers courses at your site, saving delegates time and travel costs. Courses – All ten courses are City & Guilds accredited. The latest ‘Water Hygiene Training in Healthcare Building Water Systems’ course addresses all the training requirements called for in the revised HTM04-01, 2016 and encompasses all fifteen topics to ensure staff are fully up to date and compliant. FURTHER INFORMATION Tel: 01257 233307 info@immersetraining.org www.immersetraining.org

Helping you to save as many lives as possible

Leading in the design of modern alarm solutions

Getinge is a global provider of innovative solutions for operating rooms, intensive care units, sterilisation departments and life science companies and institutions. Based on first-hand experience and close partnerships with clinical experts, healthcare professionals and medtech specialists, the company is improving everyday life for people – today and tomorrow. The landscape of hospital budgets has changed dramatically in recent years. There are significant pressures being placed on both capital and revenue budgets. There is a substantial increase in activity and an expectation for hospitals to deliver an extensive range of services with state of the

Static Systems Group is well respected for innovative thinking and the advancement of alarm and communication solutions within healthcare environments. At Healthcare Estates the company is this year inviting attendees to help shape the future of its nurse call development programme. Static is the only specialist to develop both ‘wired’ and ‘wireless’ nurse call systems in-house. This unique position allows it to recommend the best solution to match requirements and budget. Focusing on patient safety and experience, workflow efficiency and long-term reliability, Static is leading the way in delivering improvements to the patient pathway. Of particular interest to estates and facilities managers will be the company’s extensive after-sales support, upgrade options and FusionWare; a range of add-on products designed to enhance existing installed systems.

art equipment. The need for integrated solutions and access to knowledge is essential as technology evolves and therapies become more sophisticated. As your full-service partner, Getinge supports you through the entire clinical pathway so that you can continue to provide excellent care and enable cure without ever compromising on quality and safety. Therefore Getinge has developed a suite of new flexible and innovative solutions under the brand name Getinge Guaranteed Solutions in order to help the hospitals meet these needs. FURTHER INFORMATION Tel: 01773 814730 info@getinge.com

Healthcare Estates

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

The event is also a chance to learn about further development of the company’s Design & Innovation Centre (D&IC). Based on the P22 Repeatable Rooms initiative, the D&IC features a 4-Bed Bay displaying the company’s range of bedhead services trunking solutions together with partner products. In addition, the D&IC now includes a single bed ‘concept ward’. Alongside nurse call, discover how Static Systems can protect the hospital estate with its range of fire alarm systems. FURTHER INFORMATION Tel: +44 (0) 1902 895 551 sales@staticsystems.co.uk

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UKATA Asbestos Awareness - Half Day Under Regulation 10 “Information, instruction and training” of the Control of Asbestos Regulations 2012, every employer must provide adequate training (which includes information and instruction) to employees who are, or may be, exposed to asbestos at work. The UKATA Asbestos Awareness course is suitable for anyone engaged in construction, maintenance, refurbishment, renovation and demolition of property or for anyone who may come into contact with asbestos. It satisfies the current legislation that surrounds asbestos in the work place. What you will learn
 This course will give you all the necessary information about asbestos and detailed instruction on what to do when asbestos is found in the work place. 

Course content • • • • • • • • •

Types and properties of asbestos Health effects of exposure to asbestos Uses, identification and location of asbestos Asbestos containing material and products Legislation and Control of Asbestos Regulations 2012 What work could cause asbestos exposure and the importance of preventing exposure How work can be done safely and what equipment is needed Emergency procedures Decontamination

Course Duration
 The course is held over half a day totalling 4hrs including coffee breaks. The course is Usually held on client’s premises, and delivered specifically for their employees Assessment and certification
 Assessment is a 15 question multiple choice assessment paper. Upon successful completion, delegates receive UKATA Asbestos Awareness certification.

Contact Bob Bridge Bridge Safety and training 92a Arundel Street Sheffield S1 4RE Tel 0114 2490312 Mob 07779354252 Email bsatbob@outlook.com Web www.bsat.pro


HEALTH & SAFETY

The problem of asbestos in hospitals is not going away any time soon and there are no easy solutions. The UK Asbestos Training Association discusses asbestos awareness within UK hospitals and the best way to manage it on the NHS estate Successful and safe asbestos management can be a challenge for any organisation and the NHS faces more obstacles than most when it comes to asbestos. Budget and logistical issues are key factors in the current financial climate but, with the right approach, it is possible to protect staff and patients from a substance that remains the UK’s biggest workplace killer without breaking the bank. The news has been full of worrying reports of asbestos in hospitals over recent years. In July this year, hospital asbestos was described as a ‘ticking time bomb’ in a BBC article and many others tell a similar story. As most hospitals in the UK are older buildings, they almost certainly contain asbestos and total removal is not always a practical or cost-effective solution. If the latest discoveries of asbestos in hospitals tell us anything, it is that strict compliance

with regulations is vital. Failing to abide by current regulations runs the risk of potentially large fines, compensation claims and criminal convictions. This is without the very real human suffering caused by asbestos related diseases such as mesothelioma. Estimates suggest that over 1.5 million buildings in the UK still contain asbestos, yet diagnosis is one thing – treatment for this unwanted legacy is quite another for those NHS trusts charged with managing and maintaining buildings saddled with asbestos. The majority of these buildings are still in regular use and 94 per cent of London hospitals alone contain asbestos. The case of hospitals poses particular problems at a time when both NHS budgets and A&E departments are under unprecedented pressure and now have this legacy problem to confront. Trusts must fulfil their statutory obligations to conduct proper and regular surveys on asbestos in hospital buildings, to ensure that all those who might encounter the material are properly warned of its existence and all steps for

Each d l an hospita ing will ild each bu t its own presen of features, set unique nges and type challe asbestos of in situ

its safe control in buildings are observed. Trusts are now appearing to act and not before time. Remedial works are expensive in themselves, not counting the potential cost to patient care with beds out of action. Yet this must be weighed against the cost of doing nothing and the need for safety to be the top priority. When removing asbestos, it is also important that it is replaced with suitable products. The Grenfell Tower tragedy has shown just what can happen if asbestos is replaced by inferior products, unfit for purpose, so hospitals have a difficult balancing act to complete.

Written by the UK Asbestos Training Association

Asbestos in hospitals: a question of trust?

Asbestos

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

NO ONE-SIZE-FITS-ALL SOLUTION Each hospital and each building will present its own unique set of features, challenges and type of asbestos in situ, meaning that each case in each hospital must be judged on its merits. Asbestos management is one field where a one-size-fits-all approach is hard to apply. Serious cases may need removal, but in others a policy of watchful waiting may be fine if there is confidence the asbestos present can remain safely undisturbed. There are already strict rules and regulations in place nationally so asbestos is registered and contained, but these must be adhered to and the necessary trained and competent experts brought #

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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.

• • • • • • • • • •

Surety of cost and programme Significantly faster build programmes compared to traditional build Minimal site disruption Designed to be DDA, HTM & HBN compliant Durable and resilient building system Using BIM for more efficient and collaborative ways of working Easily relocated, extended or modified, purchased or hired as required Environmentally friendly – using sustainable materials and timber that is harvested from approved FSC managed forests Excellent acoustic performance Available for hire or sale

0800 316 0888 sales@premiermodular.co.uk www.premiermodular.co.uk @premier_modular Linkedin.com/company/premier-modular


HEALTH & SAFETY ! in to manage and (where deemed necessary) dispose of the substance. Asbestos was only banned outright in the UK in 1999 so any building constructed before this date may contain it in some form. In the case of hospitals, it was widely used, particularly below ground level, with boiler rooms and central heating systems. Where hospitals have been found to contain crocidolite, (more commonly known as ‘blue asbestos’) for example, leaving it in place is rarely an option, as this is one of the more lethal forms of the material. Breathing in asbestos fibres can cause a variety of illnesses, from mesothelioma to asbestosis. Those diagnosed with mesothelioma have a life expectancy of just under a year and there is no cure. It is not always easy to tell whether a product contains asbestos, so it is not surprising it remains at the root of so many deaths, decades after its use was discontinued. What is needed in all cases is a proper asbestos risk register of what asbestos is in the hospital building in question and where. This must be a reliable and up to date document and not just part of a box ticking exercise. UKATA has been writing and commenting on this issue for the last four years and given the number of cases still being reported, many industry watchers fear this registration and containment is not being done everywhere to an acceptable standard. However, as mesothelioma can take years to develop, it can be some time before a change in cases (up or down) is seen. A NATIONAL DATABASE Far from being a central government responsibility, the Department of Health makes clear that each local NHS organisation is the ‘duty holder’ required under health and safety legislation to assess the risk to staff and patients from asbestos within their buildings, although NHS Improvement, part of the Department for Health, clearly has a role to play and now work with trusts to ensure the hospital environment is a safe one. UKATA agrees with the HSE view that providing asbestos is sealed and well maintained, staff and patients should not be at risk during normal activities. However, given the list of breaches there have been of hospitals not keeping proper records and cases of poor maintenance and record keeping, a case can be made for central government and/or NHS Improvement having an increased role. A national database of asbestos in public buildings and a central asbestos register have been suggested and certainly merit a closer look, but the current approach can and does work – if correctly implemented. While the level of risk is very real, it needs to be kept in perspective. So long as proper reviews are undertaken and staff are aware of their role, asbestos can be managed safely. A culture of reporting any concerns needs to be the rule rather than the exception, together with the full understanding that concerns will be listened to, investigated and if necessary, addressed appropriately. Healthcare professionals must be vigilant, common sense, coupled with awareness training, can go a long way. Damage to walls inside buildings, for example, should be reported on the assumption they may contain asbestos. Nurses who have developed mesothelioma could have been exposed while walking in underground passageways where pipes and insulation panels that were almost certainly lagged with asbestos were not properly maintained - again any such situations should be reported. REGULATIONS Contact with asbestos and its removal is regulated by law. If you own, occupy, manage or have responsibilities for premises which may contain asbestos, you have a legal duty to manage the risk from the material. The key legislation known as the ‘Duty to Manage’ Asbestos, or Regulation 4, was originally enshrined in the Control of Asbestos at Work Regulations 2002. This legislation applies to all non-domestic buildings and includes commercial, public and industrial premises. These asbestos regulations were significantly updated again five years ago in the Control of Asbestos Regulations 2012. Coming into force on 6 April 2012, these modified the 2006 regulations in response to European Commission opinion. The commission felt the 2006 regulations

Asbestos

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Given the list of breaches there have been of hospitals not keeping proper records and cases of poor maintenance, a case can be made for central government having an increased role in asbestos management omitted certain key terms from the European Directive for the protection of workers from the risk of being exposed to asbestos, and demanded the UK fully implement the Directive, which led to the update. The problem of asbestos in hospitals is not going away any time soon and there are no easy solutions. Yet, if the existing rules and regulations are implemented in full, then we should start to see a reduction in cases coming to court and a safer working environment for all. "

UKATA exists to set and verify standards and to emphasise the importance of best practice in training when it comes to the safe handling, removal and disposal of asbestos. Public sector managers should ensure asbestos is only handled by trained professionals. Tasked by the HSE in 2008 for taking-on, managing and developing the list of training providers for licensed asbestos work in the UK, UKATA is now the leading authority in all levels of asbestos training in the UK. FURTHER INFORMATION www.ukata.org.uk

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If you are looking for a helpful and professional team of flooring contractors then contact us at Design Contract Flooring Ltd today on 01924 496407 and we can offer free advice on our huge range of products and our services.

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Flooring

FACILITIES MANAGEMENT

Flooring: a firm foundation of the healthcare environment There are a number of key requirements for flooring within the healthcare sector – such as ease of cleaning, durability, versatility and hygiene benefits. Health Business examines why hospital flooring must be suitable to accommodate the needs of the environment whilst withstanding the contamination that can be generated While many hospitals across the UK are making their buildings more aesthetically pleasing, the role of flooring in the NHS is far deeper than visual appeal. The type of flooring employed contributes to the cleanliness, hygiene and safety of the environment, which in the hospital is an important aspect of care. Being able to control the hospital environment usually involves managing the ventilation and heating systems, but looking at appropriate flooring to maintain temperature, minimise the spread of infection

and prevent accidents can actually save hospitals large sums of money. Hospital floors must offer durability, slip resistance, easy maintenance and good hygiene. In hospital operating theatres, where walls, doors, ceiling and floor are regularly cleaned as part of aseptic regimes, the flooring must not only be easy to clean, but also resistant to cleaning chemicals and straining. This is particularly true of flooring in vulnerable cleaning spots, such as below sinks, soap dispensers and other hand washing facilities. Cleaning must be

Certain nts me environ likely to e are morips, slips and tr induce nd this is no falls, a erent in diff care a healthng setti

an easy process, so the flooring must be flat and devoid of cracks, joins or edges – as this is where debris, germs and dust will gather. RESIN FLOORING The most important factor of the aforementioned flooring specifications is the hygienic properties of the flooring and its ability to be cleaned and maintained. Seamless resin floors have a proven track record in the strictest of hygiene environments. Resin flooring is applied in situ to a prepared concrete surface either as a flowing or trowelled mortar or as a surface coating. A polymerisation or curing process then takes place to produce the final synthetic resin finish. Large areas of seamless flooring can thus be installed without the need for any joints other than where there are movement joints in the #

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FACILITIES MANAGEMENT ! base concrete. The lack of joints is beneficial since such recesses are more difficult to clean and risk harbouring harmful bacteria. The fully cured Resin flooring is impervious, non-absorbent, washable and non-toxic. Typical floor areas in the healthcare sector could be split into public and private, or more likely to be front of house and back of house such as reception areas, waiting rooms, corridors, wards, staff rooms, stock rooms, theatres, X-ray rooms, intensive care units, laboratories, mortuaries, kitchens, canteens, and plant rooms. With the wide range of conditions to be encountered, it is important to identify the specific environment in each case to choose a suitable flooring material. To give good service, the flooring material must satisfy all the mechanical, chemical, physical, biological, and practical requirements of the user: mechanical – to support machinery and to withstand impact and abrasion; chemical – to be resistant to (and protect the substrate from) chemicals to be encountered; physical – to withstand temperature changes (thermal shock) and prevent ingress of contaminants; biological – not to support biological growth; and practical – to be easy to clean, to be hygienic, to be slip resistant, to be aesthetically pleasing, and to be durable. A WELCOMING WALKWAY Much of modern day hospital design is about establishing a relaxing environment for patients, staff and visitors, in the belief that a ‘home-from-home’ feel can aid the healing process and make it more comfortable for long-term patients. Therefore, alongside lighting and furniture choices, the flooring and floor covering can have a major impact on the ‘feel’ of a hospital. An article in the Contract Flooring Journal explains the importance of this ‘feel good’ factor. The Royal Aberdeen Children’s hospital were keen to utilise the colour green in its

renovation work due to its symbolic nature to the outside world and nature. Tinto Architecture specified flooring in a palette predominantly consisting of greens and blues to create an interior that is said to have had a profoundly positive effect on patients and staff. Further to this, a large tree structure was created as the centrepiece of the hospital ward, with the architecture firm using green tones to link with the beautiful new hospital garden and reflect its calming nature. Design, colour and the use of patterns can transform any healthcare facility to positively comfort patients, staff and visitors through the creation of welcoming, bright and airy spaces. When part of an overall scheme, colour can assist with way-finding and zoning and help the flow of traffic, supplies and services around a busy healthcare environment. SLIPS AND TRIPS Certain environments are more likely to induce trips, slips and falls, and this is no different in a healthcare setting. Therefore, specific consideration must be taken when planning the flooring and floor covering for all hospital entrance areas, reception points, canteens and bathrooms. The main causes of slips and trips incidents in healthcare are: slippery/wet surfaces, caused by water and other fluids; slippery surfaces caused by dry or dusty floors; contamination, such as plastic, lint or talcum powder; obstructions, both temporary

Flooring

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

and permanent; and uneven surfaces and changes of level, such as unmarked ramps. However, other factors can be: poor levels of lighting and external glare; human factors such as employees rushing; running or carrying heavy/cumbersome items; the wearing of unsuitable footwear; or the use of improper cleaning regimes. Slip resistance is a measure of the co-efficiency of friction of a floor and is measured in U values. Currently, there are three main testing methods – the Ramp Test, the Pendulum Test, and Tortus. The Pendulum test is fast becoming the test of choice, with many leading health and safety experts recommending it as the only test that accurately ensures maximum safety and comfort of flooring. It has a swinging arm with a rubber slider, which mimics the action of heel when walking. The healthcare environment presents a very wide range of diverse requirements for any flooring system. Often regulated under tight budgetary controls, it is important that the correct selection is made to provide a cost effective and practical solution. The high cost of reinstalling a floor, in terms of disruption, inconvenience, and loss of practical use of a sensitive area such as an operating theatre, makes it important to get the floor right the first time. This requires a thorough understanding of the environment, the best possible design, and the choice of the most suitable product for the job. "

Much of modern day hospital design is about establishing a relaxing environment for patients, staff and visitors. Alongside lighting and furniture choices, the flooring and floor covering can have a major impact on the ‘feel’ of a hospital

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Lighting Written by Brendan Keely, Society of Light and Lighting

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

Longer lasting and more efficient

Organisations across the UK have been increasingly using LED lights for their environmental and budgetary benefits. Brendan Keely, secretary at the Society of Light and Lighting, reflects upon their efficiency savings and the versatility of the technology Just under a year ago, the UK government affirmed its commitment to the 5th Carbon Budget which binds it to a target of 57 per cent cut in carbon emissions by 2032 – with a view to an 80 per cent cut by 2050. This is a refreshingly ambitious target, but according to Dr Hywel Davies, of the Chartered Institution of Building Services Engineers (CIBSE), it will mean that the government must maintain all of its current climate policies and find further ways to make cuts if it is to stand any chance of hitting this goal. This means the government is going to have to get creative in order to eke out savings above and beyond what it is already doing. Much has been made of the great efficiency savings that can be made with LED technology. Since the year 2000, LED lights have become ten times more efficient and can boast far longer lifespans than even the most advanced fluorescent lights. Combined with other measures to boost efficiency, such as controls systems, LED solutions can represent a step-change in the efficiency of a building’s lighting – up to 80 per cent savings in some cases.

LONG LIFE, LOW MAINTENANCE The maths also looks good from a lifetime perspective as well. A combination of a long life, energy efficiency and low maintenance costs are a great asset to facilities managers worried about the overall cost of a new technology. In this vein, they are also easy to integrate into existing energy management systems as they can easily be set to dim automatically or turn off altogether to reflect the number of people in a room, the time of day or the time of year. This applies on the scale of a single room, a whole building, a stretch of road or a whole town, and can save money without jeopardising safety because their efficiency actually increases when they are dimmed. The energy and carbon savings possible with LED lights are well documented, and local government and the NHS has bought into their potential on a large scale – but simply seeing LED as a cheaper, newer replacement for fluorescent lights that tick a few green boxes seriously underestimates their other benefits. At the recent CIBSE Technical Symposium, Ashley Bateson of Hoare Lea observed that

Simply as LED seeing r, newer e a cheap ment for replace ent lights fluoresca few green k that tic s seriously boxe s their e t a m i t underes r benefits othe

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only one per cent of the cost of running a business is energy-related while nine per cent is rental and a massive 90 per cent is staff costs. The health and well-being of the occupants who live and work in a building is hugely important to a company’s bottom-line, because staff absence and illness costs more than any amount of inefficiency, but it can’t be easily measured on a meter, so is often overlooked. The effects of the built environment on health are numerous, complex and touch just about every element of a building. Just sitting next to an open window can reduce a staff member’s sick days by as much as six per cent, for example, and higher CO2 concentrations can reduce student’s cognitive performance by 72 per cent. Lighting is no exception to this. THE CIRCADIAN RHYTHM The most well-known application of lighting to well-being is in the human Circadian Rhythm – the biological processes that regulate our waking and sleeping hormones. Since researchers discovered that this cycle is greatly affected by light, when less light enters the eye it tells our brains that it’s dark and time to sleep or when brighter – time to wake up. Much has been made of the role of artificial light in this process. Too much blue light in the evening can fool the body into thinking that it’s day time – thereby interfering with the natural sleep cycle. Daylight remains the most effective means


of keeping the Circadian Rhythm in check, but with the advent of LED lights that can mimic a range of colours and intensities, it is increasingly able to replicate natural changes in the spectral distribution of the light to mimic natural light, to the extent that it can offset the damage to mood and sleep cycles linked to prolonged periods in doors. The light changes colour during the day – from colder blue light in the afternoon when we need a boost to be active, to warmer colour temperature light in the evening when we’re resting. In the winter months when it gets dark early, it could even mean the difference between a well-rested workforce and a tired one. The versatility of LED technology also allows designers to create bespoke solutions that create a balance between the light’s usefulness and its impact on health. Obviously a workplace needs to be well-lit enough to be safe and functional, but the impact of lighting too intensely from above can be anything from eye pain caused by glare or flicker. It can even make a room harder to see, by creating dark areas where there isn’t a balanced light distribution. Using control systems in conjunction with LEDs, it is possible to reduce these problems by setting light intensity to match the local requirements, and allow office users to choose their

Lighting

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

The versatility of LED technology also allows designers to create bespoke solutions that create a balance between the light’s usefulness and its impact on health own settings for comfort. Even the ability to adjust lighting levels gives building users a psychological boost that lowers absenteeism and increases productivity. LED lighting is crucial here because they not only produce light, but the right kind of light for a workplace environment. There are numerous studies that link brighter offices with increased productivity, motivation and enhanced well-being. The flexibility of LEDs not only allows us to light the room more effectively, but with the right kind of light to ensure the least disruption. While the savings attributable to energy efficiency caused by the switch to LED lighting is great for local authorities, it really only scratches the surface of what is possible for the whole range of publicly-owned buildings – from workplaces to leisure facilities, schools, hospitals and libraries. A one per cent increase in productivity or health of employees can far outweigh all of the savings achieve through efficiency. But it’s all down to how LEDs are implemented

and deployed within buildings. In order to ensure that the technology is properly utilised so that it is as effective and efficient as possible, local councils will have to ensure that it is professionally designed as part of a wider strategy that bakes efficiency into the design of their buildings. It’s not as simple as replacing one technology with another like-for-like: it needs to be properly designed and installed by an engineer or designer following industry guidance, such as that produced by the Society of Light and Lighting and the CIBSE, to be as effective as it can be, and ensure that it works harmoniously with the building, the occupants and the other systems in play. "

The article first appeared in Government Business 24.4. FURTHER INFORMATION www.cibse.org/society-oflight-and-lighting

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HEALTHY EATING

Stewart McKenzie, the new national chair of the Hospital Caterers Association, looks at the role that healthy catering in the NHS has to play in the fight against obesity and diabetes As chair of the Hospital Caterers Association (HCA), I am keen to build on the strong foundations to ensure that the patient is at the heart of everything we do. The HCA and its members understand the key role nutritious food can play in supporting patients with their recovery and we are actively promoting that message with our hospital colleagues. I want to make sure the collective voice of hospital caterers is heard loud and clear, not just within hospitals but on the wider political platform. The Lead Association for Catering in Education (LACA), the HCA’s counterpart in education catering, recently demonstrated how powerful lobbying can be, with the government reversing its decision to remove Universal Infant Free School Meals in England. Well done to all involved for their fight to keep such a vital service. Just as it’s important for patients to receive a hot nutritious and tasty meal, it’s equally important for children to be provided with one. The health of children will ultimately have an impact on the NHS now and in the years to come. We should ensure children are taught valuable lessons about food and good nutrition, so they become well-informed adults.

several initiatives introduced in our hospitals and schools to improve the health of the nation. In doing so, we are likely to reduce the pressure on our services in the future. A couple of weeks into my chairmanship, NHS England announced its intention to limit sugary drinks sales in hospital shops. The HCA welcomed the news that several suppliers had already pledged to cut sales of sugary drinks to 10 per cent or less within hospitals over the coming year. It’s great to see initiatives being introduced to help fight against obesity, diabetes and tooth decay across the country, with the NHS leading the way. We hope more suppliers follow suit and introduce measures voluntarily, rather than having an outright ban forced on them in April 2018. In the last year, we have seen progress being made with hospitals removing price promotions on sugary drinks and snacks and making sure healthy options are available to patients, staff and

s Caterer tart -s can kickition a nutr n and io revolut ic sector l the pub dy at the is alrea front fore

visitors. It will be interesting to see how retailers also respond to the further targets imposed by NHS England for confectionery and pre-packed sandwiches and meals. Combating obesity isn’t easy and it can’t be solved with one simple solution. We need to make sure we are addressing matters and taking steps in the right direction and that includes making the health and wellbeing of NHS staff a priority. Our role as hospital caterers is particularly important for the patients we serve. However we need to ensure our staff also have access to healthy and nutritious meals and snacks, so they are best placed to carry out their role.

Written by Stewart McKenzie, Hospital Caterers Association

Recognising progress in healthy NHS catering

Catering

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HEALTHCARE CAMPAIGNS The HCA believes a multi-disciplinary approach is pivotal in ensuring patients are at the heart of hospital services. In recent years, we have sought greater collaboration between caterers, nurses and dietitians as part of our ‘Power of 3’ campaign. This important initiative of working together to help improve nutritional outcomes for #

OBESITY CRISIS An obesity crisis is in full swing in the UK and childhood obesity is becoming a major problem. Research has shown that obese children are more likely to become obese adults, with a higher risk of developing type 2 diabetes and heart disease. Such health problems will put even greater strain on an already suffering NHS. In the UK, we now have 700 amputations per year from diabetes alone. Furthermore, worldwide obesity rates have more than doubled since 1980, according to the World Health Organisation (WHO), who suggest that 40 per cent of all adults are now overweight or obese, and the figure is rising. Fat used to be enemy number one but now we’re fighting a raging war on sugar. Caterers can be the ones to kick-start a nutrition revolution and the public sector is already at the forefront. We have seen

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HEALTHY EATING ! patients overarches much of what we are aiming to achieve as an association. Stemming from this, the HCA has been working hard to increase awareness of malnutrition, which affects around one in three people admitted to hospital. The association has delivered a national campaign to improve patient screening on hospital admission to ensure early identification of malnutrition. Our efforts have secured media coverage and support from key stakeholders including NHS England, which has resulted in an increased awareness of the need to create bespoke nutrition plans for patients. We have also launched our 24-7/365-day nutrition and hydration awareness campaign to highlight the importance of good nutrition every day of the year. It aims to raise awareness about food and hydration being an important part of quality care, the risks of malnutrition and what can be done to prevent the condition in health and social care environments. The HCA will continue to campaign to improve hospital catering at ward level, with its ‘Last 9 Yards’ initiative that aims to deliver an excellent mealtime experience for every patient, every time. The ‘Last 9 Yards’ taskforce addresses failings identified at the point of service for patients including issues with meal presentation, food being out of reach for patients, crockery, water jugs, glasses and packaging. It has led to a wide range of improvements being introduced at several hospitals, such as blue plates and finger food for patients with dementia, as well as initiatives such as ‘little and often’, extended choice for long-stay patients and 24/7 availability. The campaign presents the case for food quality and enjoyment, arguing that food must form part of the

patient’s recovery plan. It highlights if food is not eaten it can do no nutritional good and food waste is money wasted. COLLABORATION I plan to build on the work of my predecessor Phil Shelley to ensure national prominence for the organisation in what continues to be a challenging time for hospital caterers. The HCA is proud to have forged closer working relationships with other public sector catering bodies such as the National Association of Care Catering (NACC), LACA and The University Caterers Organisation (TUCO). I believe that if we take a more joined up approach we are likely to have a better chance of getting our messages heard and in turn will have greater influence on the political stage. This could prove vital in light of the uncertainty facing the public sector and the UK as a whole. The association has also brokered alliances with several clinical and auxiliary agencies, by the signing of a memorandum of understanding or the forming of strategic partnerships. Organisations include NHS England; the British Dietetic Association (BDA); the Health Estates & Facilities Management Association (HEFMA); the Association for Healthcare Cleaning (ahcp); and the Soil Association. Fundamentally, everything we do is about the patients in our care and a desire to deliver service excellence. Every year our Leadership and Development Forum plays a significant role in supporting the continuing professional development of members and the sharing of best practice. Additionally, branch activities take place throughout the year, including formal meetings, seminars and study days with guest speakers, supplier demonstrations, exhibitions and social events.

It’s great to see initiatives being introduced to help fight against obesity, diabetes and tooth decay across the country, with the NHS leading the way. We hope more suppliers follow suit and introduce measures voluntarily

Catering

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

In our bid to deliver service excellence we recognise the need to sometimes look to others for advice, encouragement and support and that’s why our collaborations are important to us. The partnerships and collaborations the HCA has already formed make us collectively stronger and it’s important we continue to strengthen these. Although this will be a focus of the HCA, the association will remain independent and will not be afraid to say when we disagree with something. THE NHS AND THE HCA With 15 branches across the UK and more than 250 hospitals represented in its membership, the HCA network is the single largest group of healthcare catering providers within the NHS and is recognised as the sector’s lead voice. Next year will mark the 70th anniversary of the NHS and the HCA is looking forward to celebrating its coinciding milestone. Throughout its history, the NHS has evolved and overcome many challenges, and no doubt it will continue to do so. Hospital catering also presents its own challenges and obstacles and often hospital caterers have been faced with the daunting task of trying to do more with less. It’s certainly a complex area and there are many factors to take into consideration at each individual site. Financial constraints and pressures continue to be a big challenge and on top of that there are inequalities in catering funding across the country. I have real concerns regarding the fragmented nature of the service in England with individual trusts operating in isolation. Then we have issues relating to recruitment and staff retention, promoting a healthy workforce and the introduction of compliance standards, and that’s before we assess the impact Brexit is likely to have on our services. Whatever the service model, we need to make sure we go the extra mile to support patients and their needs. I strongly believe people who work in the NHS tend to do so because they care and that’s no different for caterers. Seeking excellence in service delivery and knowing we are aiding patients in their recovery is immensely rewarding. Being chair of the HCA is a significant role and I look forward to helping drive up standards to improve hospital catering for the most vulnerable people we serve. "

Stewart McKenzie is the new national chair of the Hospital Caterers Association (HCA). He took over from Phil Shelley at the HCA’s Leadership and Development Forum, held in Belfast in April. McKenzie has more than 35 years’ experience in the NHS and currently works as site facilities manager at NHS Greater Glasgow & Clyde. He is also a Fellow of the Institute of Hospitality. FURTHER INFORMATION www.hospitalcaterers.org

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HCAIs

Cleaning

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Preventing HCAIs and cleaning excellence High standards of cleaning are vital in the fight against infection, particularly within the healthcare environment. Health Business examines the complex and challenging aspects of sanitising NHS buildings and facilities, and reports on the work of West Suffolk NHS Foundation Trust People visiting or receiving treatment in the hospital environment are already vulnerable to the spread of infection, so making sure that effective cleaning regimes are in place for waiting rooms, corridors, reception areas and wards is integral. The key to reducing the incidence of healthcare associated infections (HCAIs) and cross contamination is to keep caring environments cleaned to a standard as near to ultimate hygiene as possible. HCAIs are infections that do not originate from the patient’s original condition that caused them to be admitted to the healthcare establishment. Most infections that become evident after 48 hours of hospitalisation are considered to be healthcare acquired. The overall cost of HCAIs to the NHS is estimated to be over £1 billion per year. HCAIs are caused by viral, bacterial and fungal disease causing organisms (pathogens;, although not all HCAIs are a result of contact with infected surfaces. HCAIs of the urinary and respiratory tracts show that many of these originate within the body, and that only a part of the total will have arisen because infection control practices were inadequate. Respiratory infections associated with both surgery and intubations are largely caused by the patient’s own organisms, rather than organisms carried through the air or liquids they have ingested. There is always an element of risk of acquiring HCAIs and, given colonisation rates in the general population, it is impossible to eradicate all traces of them, so it is the obligation of those responsible for all aspects of care, from hand hygiene, surgical hygiene, prescribing practice and cleaning to minimise the risk as much as possible. There are a number of different types of infection that can occur in many places in the body; the most common of which occur in hospitals are urinary (23 per cent), lung (22 per cent), wound (nine per cent) and blood (six per cent). The most high-profile type of HCAI is Methicillin-Resistant Staphylococcus Aureus, popularly known as the MRSA superbug. MRSA includes several strains or types of staphylococcus aureus that is not killed by B-lactam antibiotics. Around 30 per cent of the UK population carry the SA germ in their nose or on their skin. In healthy people, this does not pose a risk, nor do any adverse symptoms occur.

Another prominent HCAI is clostridium difficile (C. diff). Although this is bacteria that is present naturally in the gut of around two-thirds of children and three per cent of the adult population, in some cases it can prove fatal. Older people are most at risk of infection, and most cases occur in people aged over 65.

‘robots’ that will free up our team to focus on improving standards around the trust, such as deep-cleaning programmes, air mattress sanitation, and laundry services.” THE SERCO SITUATION The growing trend towards outsourcing cleaning services, recently in the news with Barts Health NHS Trust, means that the number of contractor opportunities will expand, even if individual contracts may be cut back as a result of budget pressures. Cleaners, domestic staff, porters, and security staff based across four London hospitals in the Barts Health NHS Trust began 48 hours of strike action in July after 99 per cent of Unite members voted in favour of strike action over a proposed pay increase of £0.30 an hour. "

CLEANING INDUSTRY MANAGEMENT STANDARD At the end of 2016, West Suffolk NHS Foundation Trust’s housekeeping team received the CIMS Award for Commitment to Excellence at the British Institute of Cleaning Science’s annual awards ceremony, recognising the dedication of individuals for their commitment to excellence and the CIMS (Cleaning Industry Management Standard) programme. Cleanliness is a high priority FURTHER INFORMATION across the trust with a www.wsh.nhs.uk particular focus on HC infection prevention infectioAIs are and staff work not orig ns that do together to lead the fight against the pat inate from infections such conditioient’s origina as clostridium difficile, them to n that causedl b norovirus to the h e admitted and MRSA. e Carlos Alves, establis althcare hment housekeeping services manager at the trust, said: “All 150 members of our housekeeping team are highly motivated and fully aware of the importance of their contribution to the safety of our patients, staff and visitors. We take cleanliness and hygiene very seriously and with the support of our senior management team we are encouraged to think outside the box and continuously look for ways to improve how we deliver our services. This award is proof of that. The team deserve this praise and I thank them for all their hard work. “Cleaning is a science, and we want to be at the forefront of research and development in this field. I am pleased to say that we are looking to introduce automated floor washing

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WATER TREATMENT

On behalf of the Water Management Society, Dr Paul McDermott and Dr Susanne Lee write about the the control of Legionella risks and other water-related hazards in health care environments

ital All hospo use staff whthe care or water f nts need to of patieare of their be aw ortance in p own imibuting to contr t safety patien

The Department of Health provides best practice guidance to those providing healthcare services in England to assist in the management of the physical estate in the form of a series of Health Technical Memoranda (HTM) and Health Building Notes (HBNs). In 2006 HTM 04-01: The control of Legionella, hygiene, safe hot water, cold water and drinking water systems, was published which focused primarily on the control of Legionella risks. Following an outbreak of Pseudomonas aeruginosa infections in 2012, which resulted in three neonatal deaths, an addendum to this HTM was published in March 2013 to provide advice to trusts on how to manage the risks from Pseudomonas aeruginosa in augmented care units. In May 2016 an updated version of the HTM 04-01 was published as Safe water in healthcare premises, in three parts: Part A, Design, installation and commissioning; Part B, Operational management; and Part C, Pseudomonas aeruginosa – advice for augmented care units, which were released together with supplementary guidance performance specification D08: thermostatic mixing valves (healthcare premises), first published in July 2015. The 2016 version of the HTM 04-01 takes

into account the recent updates to the Health and Safety Executive’s (HSE) Approved Code of Practice and associated guidance HSG274 (Parts 2 and 3), the Healthcare Associated Infections Code of Practice and Health and the Social Care Act 2008 (Regulated Activities) Regulations 2014, and provides broader coverage of water-related hazards and risks in health care; not just from Legionella and Pseudomonas aeruginosa, but also other waterborne opportunistic pathogens. INCORPORATING A HOLISTIC APPROACH The new version advocates a more holistic approach to all water used for treatment and diagnosis as well as how to design, commission and manage water distribution systems, and, like HSG274 (part 2), advocates the World Health Organisation’s ‘Water Safety Plan’ (WSP) approach with guidance included on the aims and objectives of WSPs and the remit of ‘Water Safety Groups’ (WSG) who now play a key role in the governance and management of all healthcare water systems with clearly identified lines of accountability up to the CEO and board. The WSG also has a role in ensuring those engaged to carry out water safety risk assessments can demonstrate their competence in assessing specific risks – not only microbiological, but

also from chemical and physical hazards. There is also additional guidance related to clinical and scalding risks where a risk assessment approach is advised for the fitting of thermostatic mixing valves (TMVs) on water outlets, together with advice on water storage capacity and turnover, and resilience to take into account risks from climate change. Perhaps the most striking message delivered in the revised guidance is the greater emphasis on the need for expertise and competence amongst all parties and individuals with responsibilities for delivering water safely, especially those whose actions can have direct influence on water quality and the safety of patients who use it. In Part B of the 2016 guidance, no fewer than 35 references are made to training needs, compared to only six in the 2006 version. As has been said, managing water safety requires a holistic approach and this is particularly true in the healthcare setting. A properly represented WSG and a well conceived and implemented WSP are central to this, but even the best of these can be let down if tasks are not performed correctly. In particular, controlling microbiological risks can present a significant challenge due to the specialist nature of the topic and the complexities surrounding infection control in many hospital areas. All hospital staff that perform tasks on hospital water systems, or who use water for the care or treatment of patients, need to be aware of the risks presented by waterborne pathogens and their own importance in contributing to patient safety. Understanding the consequences of their actions and omissions is likely to increase ‘ownership’ of the risks and result in better reporting of problems and improved patient safety.

Written by Dr Paul McDermott, PJM-HS Consulting Ltd & Dr Susan Lee, Leegionella Ltd

Managing water safety in healthcare premises: a stream of competence

Infection Control

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

KNOW YOUR RESPONSIBILITY Once these basic building blocks have been put in place, training can focus on the activities carried out by different groups. Estates staff provide and support the delivery of safe water to the point of use across the hospital and their responsibilities centre, amongst other things, on maintaining the #

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Infection Prevention

2017

Manchester Central 18th – 20th September 2017

The UK’s premier infection prevention conference is now open for abstract submission and delegate registration.

Professor Michael A. Borg Head of the Infection Prevention and Control Department Mater Dei Hospital, Malta

Professor Sanjay Saint

Chief of Medicine, VA Ann Arbor Medical Center and George Dock Professor of Internal Medicine University of Michigan Medical School, USA

Julie Storr

Consultant World Health Organisation Infection Prevention Unit

Dr Deverick J. Anderson Associate Professor in the Division of Infectious Diseases and Department of Medicine Duke University Medical Centre

Ruth May

Executive Director of Nursing, NHS Improvement, Deputy Chief Nursing Officer and National Director for Infection Prevention and Control

Highlights include:

• Oral presentations and posters • Annual IPS awards ceremony and gala dinner • Ayliffe Lecture to be presented by Professor Sanjay Saint and E.M Cottrell Lecture by Julie Storr • Opportunities to learn from Scott Drawer, Head of Performance Hub at Team Sky and Dr Ruth May, Director of Nursing and National Lead for Infection Prevention and Control for NHS Improvement

@IPS_Infection | #IP2017 | #IPS10 Infection Prevention Society

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Infection Prevention in Dentistry One Day Conference Who should attend? • Dental surgeons • Dental nurses • Infection control support dental nurses • General dental practitioners • Orthodontic group nursing managers • Special dentist nurses

Infection Prevention for Estates and Facilities One Day Conference Who should attend?

• Facilities managers • Estates managers • Water engineers • Building services managers • Catering managers

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MONDAY 18th September

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TUESDAY 19th September

• Specialist streams on new to infection prevention, audit and surveillance, international engagement and mental health

WEDNESDAY 20th September

• UK’s largest infection prevention exhibition

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WATER TREATMENT ! infrastructure of water systems and often the equipment connected to it as well. At times this will involve making modifications to the distribution services and repairing and replacing parts of the system. Engineering and plumbing staff have the potential to introduce contamination into the system when carrying out such modifications or even routine maintenance tasks. Water hygiene awareness training for those working on water distribution systems might include an understanding of what augmented care means and that more stringent precautions are needed when working in these high risk areas. This should form the focus of training, explaining the importance of hygienic storage and installation of fittings and components and why greater care may be required in these areas to avoid cross-contamination, for example, by using separate, dedicated tools and overalls. Nursing staff provide invaluable hands-on care to hospital patients, and their training provides a sound understanding of conventional infection prevention and control practices. However, for some, the potential for infection via hospital water systems may be less understood. There are subtle differences in the modes of transmission for different waterborne pathogens and nursing practices can have a significant influence on the potential for infection, particularly where patients with impaired immunity receive treatment. So training of nurses should focus on the activities where either they, or their patients come into, contact with water or water systems. This is likely to include washing, bathing and shaving patients, as well as disposing of wash water and other fluids. Maintaining hospitals in a clean and hygienic condition is an important part of any infection control regime, and cleaning staff have a vital role in maintaining water safety and minimising waterborne pathogen infection risks. In carrying out their day-to-day duties cleaning staff open water outlets, which allow water to flow through pipework, avoiding stagnation in the supply that can encourage proliferation of harmful bacteria, and drawing through hot water and biocide (if applied) to the periphery of the water system to exert its bactericidal effect. Running outlets during cleaning helps increase the overall turnover of water throughout the system, which in itself is an effective control measure. However, it is crucial that cleaning staff appreciate fully the dual aspects of the important work that they do. Experience has shown that the infection control element of their work may not always be conducted as planned. This is perhaps understandable; if staff believe that the only purpose of their cleaning activities is to ensure that water outlets and surrounding areas appear clean, then those outlets that have not been recently used and therefore appear clean, so they may not be flushed through because there is no apparent need. Unfortunately, this type of situation is most likely to occur in hospital wards where patients are so poorly they cannot use the hygiene facilities provided and in particular, en-suite outlets can go unused. It is also the case that patients in these hospital wards are likely to be among the most susceptible to waterborne pathogen infection if they are then exposed to water from these unused outlets subsequently. The way in which cleaning activities are conducted is also pivotal in reducing cross-contamination from outlet to outlet and is again of particular significance in augmented care areas of the hospital. Defined procedures detailing precisely how water outlet stations should be cleaned, for example clean to dirty, top down, the use of different cleaning cloths and cleaning products and their disposal, are required. Providing training to domestic cleaning staff presents a significant challenge to many hospital trusts partly because of the number of staff involved, but also because there tends to be a relatively high staff turnover in this sector and English may not always be the first language of workers. There is a requirement that both management and staff are aware of their individual and collective responsibilities for the provision of wholesome and safe hot and cold water. However, as with the HSE guidance, following this HTM 4-01 series is not mandatory, but if a healthcare facility chooses otherwise it must demonstrate that equally effective measures are in place. " FURTHER INFORMATION www.wmsoc.org.uk

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Infection Prevention 2017

–EVENT

PREVIEW

Minimising the impact of infection in hospitals 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 meetthe-expert sessions. This years programme sees the introduction of a new international engagement stream and also 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 from 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.

It is ed that estimat patients 0 300,00 in England a year healthcare a acquire ted infection RESISTING associa sult of care COLONISATION Dr Nicola Fawcett, chief as a re hin the investigator of the Antibiotic wit Resistance in the Microbiome NHS 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 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 #

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Infection Prevention 2017

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Since 1987, Merit Medical has consistently prioritised solutions to your procedural challenges, with the goal of making your job safer, accurate and more efficient. The company believes that having the right tools enhances patient’s outcome. Merit Medical’s comprehensive Cardiovascular and Critical Care (CCC) product portfolio offers these healthcare solutions. This includes custom kits that decrease set-up time and reduce waste, as well as products like blood pressure monitoring systems for the Critical Care settings that enhance the accuracy of patient care. The company’s products like the Futura® Safety Scalpels and Advance® Safety needles aim

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EVENT PREVIEW ! 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, causes, and examine the evidence for prevention from a public health perspective. FACILITY DESIGNS Professor Satoshi Hori, director of 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.

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

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 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. 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.

Infection Prevention 2017

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

PUTTING A STOP TO THE CUTS 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 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 is celebrating 10 years of IPS on the 8th June this year and will be celebrating and showcasing its 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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Patient Handling

Handle with care: moving hospital patients The moving and handling of patients is a regular activity for hospital staff but is one which brings with it many health and safety risks. Hillingdon Hospitals NHS Foundation Trust’s Sue Manthorpe and Claire Mowbray examine the issue Moving and handling patients is a routine activity in a hospital setting. However, it has become more complex in recent years with an increasing number of frail, elderly patients and an increase in the number of obese or plus-size patients. According to the Office of National Statistics (ONS), 9.2 million (16 per cent) of the usual residents of England and Wales were aged 65 and over in 2011, an increase of almost one million from 2001. The ONS’ figures for 2017 show that the number of centenarians (people aged 100 and over) has risen by 65 per cent over the past decade. In the UK, 25 per cent of adults are currently obese and it is projected that, by 2050, 60 per cent

of men and 50 per cent of women could be clinically obese. Both groups of patients can have complex moving and handling needs. COMPLEXITIES OF CARE

Elderly patients may be ent c r e admitted with a range of p 5 2 e r a conditions which affect s t l u of ad bese and their mobility. They o y l may have been injured t , n t e a r h t cur d e following a fall and may t c e j it is pro , 60 per cent develop a fear of falling, which makes it more by 2050n and 50 per difficult to rehabilitate e of m them. Others may have women f o t n suffered a stroke and need e c e b o intensive physiotherapy and may als occupational therapy to restore their physical function. Medical or Care of the Elderly wards also care for patients with dementia who may resist movement or who may become aggressive during moving and handling activities.

Plus-size people are classified by their body shape and this will determine what normal patterns of movement they are unable to achieve. For example, a patient who has apple ascites distribution of adipose tissue will carry the excess weight high with limited drifting of the abdomen below the waist. The abdomen may be rigid due to ascites or the build-up of fluid. The patient’s leg size may be relatively normal. These patients will have limited trunk flexion, so will not be able to lean forward in order to sit down in a chair or get into bed. They are also unable to tolerate lying flat and will need to be nursed in a raised position. Other patients may present with anasarca, which is severe generalised oedema, with body fluids leaking into soft tissue. These patients will be unable to bend their limbs, which makes it more difficult to roll the patient in bed. Again, they will also have limited ability to bend at the waist which leads to difficulty transferring from sitting to standing. Extensive training has been provided # Volume 17.4 | HEALTH BUSINESS MAGAZINE

Written by Sue Manthorpe, assistant director of Health and Safety & Claire Mowbray, manual handling advisor, Hillingdon Hospitals NHS Foundation Trust

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Case Study

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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

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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


HEALTH & SAFETY ! for staff in recent years to enable them to recognise these restrictions on mobility. ASSESSING THE TASK A moving and handling risk assessment is completed for each patient. At Hillingdon Hospitals NHS Foundation Trust, this assessment is completed within six hours of admission to a ward. Four areas are assessed: the task; the individual capabilities of staff; the load, in this case, the patient; and the environment. The tasks the patient needs assistance with are assessed to identify any awkward postures adopted by staff. For example, rolling a plus-size patient in bed may involve staff over-stretching while moving a confused patient may involve sudden movements if the patient resists the move. The individual capabilities of staff are also considered, as any technique which is reliant on physical strength or height will place some staff at a higher risk of musculoskeletal injury. The environment is assessed to ensure that it is conducive to best practice in moving and handling. Loughborough University conducted a research study on the bed space required to move a plus-size patient safely and recommended a minimum area of 16.61m2 (Hignett and Lu 2008). The standard hospital bed space is 13.32m2 (NHS Estates 2005). In practice, this means that the neighbouring bed space has to be closed to admissions, to provide sufficient space to provide quality care. The patient is assessed individually on their physical ability to assist in the moving and handling and whether they are able to understand or follow instructions. Goals are established by the multidisciplinary team, in partnership with the patient, as part of their rehabilitation programme. Following the risk assessment, a detailed care plan is written documenting how the patient is to be moved, what equipment is required and how many staff are needed for each task. The aim of the care plan is to maximise the abilities of the patient whilst reducing the risk of injury to staff. It also ensures continuity of care, as the patient is moved in the same way by all members of staff. The assessment is updated whenever the patientâ&#x20AC;&#x2122;s condition changes. For some patients, for example in end-of-life care, this may be updated daily. For other patients, such as elderly patients with long-term conditions, the assessment will be updated less frequently. SIGNIFICANT ADVANCES Although patients are presenting with more complex needs, there have been significant advances in both the knowledge and skill of staff and the design of patient-handling equipment. All clinical staff receive regular face-to-face training in moving and handling and often bespoke training in moving plus-size patients and caring for patients with dementia. The latter training includes the communication skills required of staff.

Patient Handling

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Although patients are presenting with more complex needs, there have been significant advances in both the knowledge and skill of staff and the design of patient-handling equipment Innovative equipment has been designed which has reduced the volume of manual handling required. It is now standard practice in hospitals to care for patients on electric profiling beds. The beds will sit the patient forward and the knee break reduces the number of times the patient slides down the bed and needs assistance to be repositioned. Hospitals also have access to beds which go down very low to the floor, which are ideal for confused patients who are at risk of falling. Bariatric beds for plus-size patients are also available, which are usually 4ft wide and provide the space for the patient to be rolled onto their side for pressure area care or for personal care. Gantry hoists are often provided for plus-size patients who require hoisting. This in an A-frame which is installed over the bed. It has a motor on the top rail which the hoist sling is attached to. The patient is hoisted off the bed and the motor slides along the rail to transfer the patient into an armchair or wheelchair. This eliminates the need for staff to push and pull a patient in a mobile hoist and it provides a smoother transfer for the patient. Inflatable devices are also widely used to lift a fallen patient off the floor in a lying position. This is particularly useful for

plus-size patients or for elderly patients who have a suspected fractured femur. Techniques for moving and handling patients have also advanced. There are now ways of positioning slide sheets and hoist slings under patients without having to move the patient. This is a useful technique for both frail elderly patients and plus-size patients. Most hospitals have manual handling advisors in post, who can provide specialist advice on techniques for moving patients. They in turn are supported by National Back Exchange, which exists to develop, disseminate and promote evidence-based best practice in moving and handling. IOSHâ&#x20AC;&#x2122;s Health and Social Care Group also provides advice on manual handling and moving of patients, recently running an awareness raising conference. Although hospitals are seeing patients with more complex needs, healthcare professionals have adapted by increasing their knowledge and skills in moving and handling and by utilising equipment to ensure that patients are moved in a safe and dignified manner. " FURTHER INFORMATION www.iosh.co.uk

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Obesity

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AMBULANCE SERVICE

Obesity & A&E: an ever-growing problem The number of obesity-related A&E admissions is dramatically climbing, leading to a nationwide increase in spend on bariatric ambulances to cope with the growing demand. Health Business examines the difficult situation and whether it is likely to get bigger Obesity is a growing problem in most developed countries and is responsible for a significant degree of morbidity and mortality in the Western world. More than 2.1 billion people (nearly 30 per cent of the global population) are overweight or obese. The McKinsey Global Institute report, Overcoming obesity: An initial economic analysis found the global economic impact from obesity is roughly $2.0 trillion, or 2.8 per cent of global GDP, which is roughly equivalent to the global impact from smoking or armed violence, war, and terrorism. The UK has the highest rates of obesity in Europe. Although this recent increase in the prevalence of obesity has been seen in virtually every country in the world, the rate of increase in England has been particularly high. The prevalence in England has more than doubled in the last twenty-five years, with results for 2013 showing that around 62.1 per cent of adults were overweight or obese (67.1 per cent of men and 57.2 per cent of women).

78,000. The North West Ambulance Service, a merger of ambulance trusts from Greater Manchester, Cheshire and Merseyside, Cumbria and Lancashire, has eight bariatric vehicles in operation and has spent £184,000 on specialist equipment since 2015. The ambulances have reportedly been used 40,000 times in four years. In contrast, South East Coast Ambulance has spent £562,000 on three ambulances reinforced to take heavy loads since 2010, which have been used 1,700 times in the last five years. Additionally, the trust has fitted other vehicles with lifts and large stretchers at a cost of £36,000. The BBC reported in February this year that one ambulance trust – South Central – has spent more than £1 million in the last three years to upgrade nearly two thirds of its 180-strong fleet.

c Bariatriare s vehicle provide d to designeand dignified a safe rt solution to transpo hose weight those wes specialist requir nsport tra

AMBULANCE SERVICE STRAIN According to a BBC South East freedom of information request, the results of which were published in May this year, ambulance services across England have been forced to spend hundreds of thousands of pounds to ensure vehicles can cope with a growing number of obese patients. The figures highlighted how the number of obesity-related A&E admissions increased from 52,000 in 2006 to 520,000 in 2016. Bariatric vehicles are designed to provide a safe and dignified transport solution to those whose weight, or condition, requires specialist transport. In response to a 10-fold spike in hospital visits linked to obesity in the past decade, they have been equipped with wider stretchers, more lifting gear and space to accommodate double-width trolley stretchers. Regionally, the BBC figures show that the north west had the highest number of obesity-related admissions in 2016, with

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The Department of Health claims to spend more annually on the treatment of obesity related ill-health, a reported £5.1 billion in 2014/15, than the government does on ‘the police, fire service and judicial system combined’. NHS obesity statistics suggest nearly 60 per cent of women and 70 per cent of men are overweight. Additionally, a third of children aged two to 15 are also overweight or obese. Jonathan Fox, of the Association of Professional Ambulance Personnel, said: “It is becoming increasingly frequent that the size of patients causes problems moving them and that in turn increases the risk of injury to staff. That is why we need this equipment. We are not just talking about those that are really heavy, even patients who are 16, 17 stone can pose difficulties.” WIDENING AMBULANCES IN WEST MIDLANDS Patients are getting larger and larger and ambulances need to be able to respond immediately to what could be life-threatening situations. All 420 A&E


ambulances in the West Midlands are bariatric-capable, but it has also bought four specialist bariatric ambulances at a combined cost of more than £300,000. Alongside Yorkshire, the North West and Wales, the West Midlands is on its way to upgrading the rest of its fleet. Nigel Wells, an operations manager at the trust, told the BBC: “It is all about safety for our patients and safety for our crews. We have got a greater number of patients who are larger in size. A few years ago – probably only 10 years ago – your average patient was 12 to 13 stone, now that’s probably 17 to 18 stone. And we quite regularly see patients around 30 stone in weight and even bigger than that.” NORTH OF THE BORDER In Scotland, it is reported that approximately 30 per cent of people are obese, with health experts predicting the proportion to rise to 40 per cent by 2030. This costs the Scottish economy an estimated £2.37 billion per year. The Scottish Sunday Post revealed last month that overweight patients accounted for more than 21,000 ambulance journeys in 2016/17, compared to the 9,399 journeys in 2010/11. On top of this, specialist bariatric ambulances were also used 76 times to take similar patients to A&E wards in the last year, while firefighters were called out 40 times during the same period to deal with call-outs for obese

patients – the highest number since 2010/11. Tam Fry, chair of the National Obesity Forum, said: “These ambulances can take people who weigh up to 70 stone. It’s a tragic sign of the times that we now have people that big. The same is happening with the fire service. It is having to invest in bigger hoists

Obesity

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even without being obese, is killing millions of people around the world. The Institute for Health Metrics and Evaluation (IMHE) argue that nearly four million people died from disease related to their weight, most commonly from heart disease, in 2015 alone.

The BBC reported in February this year that the South Central ambulance trust has spent more than £1 million in the last three years to upgrade nearly two thirds of its 180-strong fleet to cater for obese patients and stretchers to bring these people out of difficult circumstances such as first floor flats. “They are having to break down walls and windows to get these people out of their homes. It’s a huge expense. You can be talking about six-figure sums with the number of personnel required. It’s a tragedy but it’s par for the course and it’s going to get worse.” A DISTURBING GLOBAL PUBLIC HEALTH CRISIS A new medical paper, published in the New England Journal of Medicine, has claimed that being overweight,

However, only 60 per cent of those were technically obese, with the 1.6 million in the remaining 40 per cent deemed overweight but not obese. Professor Azeem Majeed from Imperial College London, one of the study’s authors, said: “The risk of death and diseases increases as your weight increases. People who are overweight are at high risk of mortality and other diseases [beyond obesity itself]. People often assume you need to be really fat to be at risk. But once you hit a BMI of 25, your risk of diabetes, heart disease and cancer all begin to increase.” "

MED-PTS Ambulance Services, Nationwide Private ambulance service • Private Ambulance • Air Ambulance • Bariatric Ambulance • Event First Aid Cover

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Parking Written by Dave Smith, British Parking Association

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NHS ESTATE

Accessing good parking with the NHS A number of political parties included promises to abolish parking charges at hospitals in their pre-election manifestos. The British Parking Association looks at the challenge of managing parking and ensuring fair access for everyone Parking is regularly in the news and often for the wrong reasons. A recent case at Cardiff and Vale University Hospital made headlines after a judge ruled that the employees, including nurses, doctors and admin staff, must pay parking charges dating

back to April 2016 after losing a legal fight with Indigo, the private operator that manages the car park at the University Hospital of Wales. The court case involves 78 individuals, a small proportion of those who park at the hospital, who have persistently ignored parking charge notices (PCN), specifically looking

Parkings facilitie ort nsp and tra d to be e links neged for mana efit of the ben, not just e everyonployees em

HEALTH BUSINESS MAGAZINE | Volume 17.4

at 206 of these PCNs. In addition, there are approximately a further 14,000 outstanding PCNs owed at Cardiff, rather than the 100,000 quoted, and the total amount owed in unpaid PCNs is actually around 15 per cent of the ÂŁ12.8 million reported by the press. The dispute began last year when Indigo and the Cardiff and Vale University Health Board agreed new measures for parking on the hospital site. The hospital has 6,000 staff but the car park has only 1,800 spaces, so


many said they were left with no choice but to park in spots reserved for visitors. Many staff decided to veto payment of fines in protest. The British Parking Association (BPA) considers the Cardiff and Vale University Health Board to have one of the most transparent, clear and robust parking and traffic management policies seen in the NHS. Managing parking alone can be immensely challenging and at times rather contentious, even more so at hospitals, with space at a premium and sensitivity to the nature of environment bringing some unique issues. Staff parking is often a cause of anxiety with colleagues wishing to park on site and arrive at work on time. The juggling of priorities is therefore a skill the parking officer must apply to decisions made. Clinical services cannot be delayed, but patients must be ready at stated times for appointments. As important as initiatives such as park and ride allowing planned visiting to alleviate site demand, so too must the parking of staff working regular office hours, with minimal clinical input, be considered for alternative options to reduce pressure.

Parking

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A number of political parties included promises to abolish parking charges at hospitals in their pre-election manifestos with various explanations about how this would be paid for Good integrated and sustainable travel plans, including alternatives to single car use, can assist immensely in managing these clashes of priority. It must include an overall approach to the management of parking facilities, traffic management and enforcement. Organisations and parking managers have a responsibility to ensure parking facilities which are provided are available to those that require them most, and to reduce operational pressures of parking with effective management plans, infrastructure and resource. Kelvin Reynolds, BPA director of corporate and public affairs, says: “Parking facilities at hospitals are usually oversubscribed and demand often outstrips supply; for this reason, parking facilities and transport links need to be managed for the benefit of

everyone, whether they’re a patient, visitor or employee and it is really disappointing that a very, very small proportion of staff felt that they were being unfairly treated by a system designed to be fair for everyone. “At Cardiff and despite every effort by Indigo to reduce the financial burden for them, some staff declined to accept the offer. The court’s decision has reflected the need for good parking management and reiterates that no-one is exempt from complying with the terms and conditions. The BPA strongly advises all motorists not to ignore a PCN. If you disagree that it should have been issued you should appeal to the parking operator and if that is unsuccessful then the motorist can take their appeal to POPLA, the independent appeals service.” #

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NHS ESTATE ! CHARGING FOR PARKING When parking charges were abolished in hospitals in Scotland and Wales, patient accessibility didn’t improve; instead nearly all the spaces were taken up by commuters and staff to the detriment of visitors and patients. Because demand isn’t managed properly it spilled onto yellow lines, grass verges and nearby residential streets. In some cases bus companies actually refused to offer a service because they couldn’t get through. So it seemed like a good idea, but those that relied on public transport, those very people that MPs champion for, ended up the hardest hit. In reality, there’s no such thing as a free parking place – somebody is paying for it. This is true everywhere: in town centres, at the beach, in the countryside and at the hospital. Like most NHS medical services,

car-borne visitors should pay for this service. We also believe there should be exceptions where long-term or vulnerable patients should receive discounted or free parking. TAKING THE PULSE OF HEALTHCARE PARKING The BPA, in partnership with the Healthcare Facilities Consortium (HFC), has launched a benchmarking survey for the healthcare parking sector which aims to examine the provision and management of parking. This is a chance for those that manage and deliver parking services at healthcare facilities to help build a comprehensive picture of parking right across the healthcare sector. A number of healthcare facilities have already completed the survey. However we do still need more responses, to

Managing an effective transport and logistics solution, including the provision of parking, requires a professional and strategic approach that considers the needs of patients, visitors and staff and strives to deliver excellence some car parks may be free at the point of use but someone, somewhere is paying for their upkeep and maintenance. If they are patrolled to keep them safe someone is paying for that too. Your so-called free parking is always paid for – by someone else. Is that fair? A number of political parties included promises to abolish parking charges at hospitals in their pre-election manifestos with various explanations about how this would be paid for. The BPA believes that healthcare budgets should not be used to provide parking facilities for those who choose to drive to hospital; additionally is free parking fair on those who arrive by public transport and continue to pay? Healthcare budgets should be used to provide healthcare and

complete the survey visit: https://www. surveymonkey.co.uk/r/62WTJ5W. We know that parking at healthcare facilities can be an emotive and complex issue for staff, patients and visitors, and healthcare providers often have to defend themselves against media scrutiny. By completing this survey, healthcare providers will contribute to the most detailed and comprehensive study of parking and travel-planning data ever seen in the healthcare parking sector. All participants will receive a free copy of the benchmarking results and these results will also be available to all BPA Healthcare Members. BPA healthcare members met in Sheffield for the most recent Healthcare Parking special interest group. The group provides an

Parking

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

opportunity for the sharing of knowledge and best practice, as well as campaigning for better recognition of the services provided and the need for them to be properly funded. Chair of the group is Keith Fowler, head of Facilities Services at Northern Lincolnshire and Goole NHS Foundation Trust. A number of topics were discussed at the meeting including car park space maximisation, in particular mezzanine parking; a presentation on the BPA’s recent Manifesto for Parking and how the BPA supports its healthcare members; presentations by suppliers in parking management, electric vehicle charging and parking search providers; and how to reduce vehicle crime in car parks. The BPA Healthcare Parking special interest group is usually for members only, but we would like to extend an open invitation to all NHS trusts to come along to the next meeting and find out more about our work. If you would like to attend please e-mail Yasmin Jefferies at the BPA – yasmin.j@britishparking.co.uk – for details of our next meeting. There is no charge for attendance at this event. Managing and delivering an effective transport and logistics solution, including the provision of parking at healthcare facilities, requires a professional and strategic approach that considers the needs of patients, visitors and staff and strives to deliver excellence. "

The BPA is dedicated to making parking a recognised profession and raising standards in parking management and operations. The Professionalism in Parking Accreditation (PiPA) is an accreditation programme, supported by the Department of Health, available for organisations to work towards. This builds upon the existing voluntary hospitals parking charter, developed by the BPA in conjunction with other stakeholders, and will enable hospitals to work towards a nationally-accredited standard for their parking services. FURTHER INFORMATION www.britishparking.co.uk

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Emergency Services Show

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EVENT PREVIEW

The Emergency Services Show is all about you With the strapline ‘It’s all about you’, this year’s Emergency Services Show offers anyone working in emergency medical response a valuable opportunity to focus on their own career development and personal health and well-being. Health Business looks ahead to the show Returning to Hall 5 at the NEC, Birmingham from 20-21 September 2017, the event will feature a host of new learning opportunities including CPD-accredited seminars and a First Aid and Trauma Challenge – as well as the ever-popular College of Paramedics workshops. A new seminar theatre dedicated to health and well-being will offer advice on health and safety and mental health issues such as Post Traumatic Stress Disorder (PTSD). Strategies for supporting crews post-incident will be shared, and an Emergency Medical Technician from North West Ambulance Service NHS Trust who was diagnosed with PTSD will share his story. There will be updates on the Mind Blue Light Programme and the blue light well-being framework for all emergency services being developed by The College of Policing in conjunction with Public Health England. FRONTLINE RESPONDERS TO CBRN INCIDENTS Terrorism and search and rescue are among the topics planned for the Lessons Learnt Theatre (sponsored by UCLan PROTECT). North West Ambulance Service, for example, will present a session on the Manchester Arena terrorist attack. In the early stages of a suspected CBRN incident, the first 15 minutes are vital for reducing harm to casualties. The programme will include sessions explaining what this means for control rooms and frontline responders, led by experts from the National CBRN Centre. Emergency services and partner agencies will also share their experiences of responding to real incidents. The British Red Cross will talk about its response to the Grenfell Tower fire, how it worked with and supported the local community, and how this ties in with its new Community Reserve Volunteering project. The nationwide project, launching this year, aims to recruit a taskforce of thousands of volunteers who will only be called out if a major emergency, like Grenfell, were to happen in their own community. North West Ambulance Service will present a session on the New Ferry Gas Explosion, alongside Merseyside Police and Merseyside Fire & Rescue Service. There will also be a case study of a United Nations Medical Field Hospital.

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REDUCING DEMAND AND IMPROVING PATIENT CARE Meanwhile in the Innovations Theatre, Dr Syed Masud, lead clinician at Thames Valley Air Ambulance, will tell visitors about a live streaming project to improve patient care. The Innovations seminar programme includes a session on the work undertaken by the Centre of Excellence for Information Sharing to reduce high demand on blue light services from local residents through education and intervention. There will also be a presentation on the capabilities of the NEXES app and the benefits this offers both call centre operatives and citizens, especially those with special or additional needs. In the new Road Safety seminar theatre, community first responder Dave Harford will highlight the dangers contained within a car that could impact on how rescuers respond to a Road

Traffic Collision (RTC). The Road Rescue Recovery Association will explain how road recovery firms have knowledge, expertise and resources which can assist emergency responders at the scene of a RTC and there will be a presentation from UK HEMS (a charitable collaboration of UK helicopter air ambulance services). The Air Ambulance Association will present on the future of UK highways in the context of the All Lanes Running roll out which will impact on emergency responders attending incidents. After attending each seminar, visitors will be able to visit the CPDme stand to create a digital certificate (which will be emailed to them) or print off a physical certificate. CPDme will also be launching its new website and free mobile app at the show enabling users to create and manage a portfolio of old certificates, combined with any learnings from The Emergency Services Show and future practice.


PARAMEDICS WORKSHOPS AND TRAUMA CHALLENGE The College of Paramedics will once again deliver a programme of free 30-minute CPD workshops. This year’s programme includes a reflective account on the London bombings and a review of the changes to the AACE Maternity Guidelines. Visitors can attend workshops on trauma, frequent caller management, airway management, paediatric cardiac arrest, newborn life support, infectious diseases, paediatric resuscitation, basic and advanced life support. A new feature dedicated to road safety and rescue will incorporate a First Aid and Trauma Challenge within an Educational Immersive Tent. To add authenticity to the trauma scenarios, West Midlands Fire Service Casualty Simulation Group will be providing casualties with realistic make-up and prosthetics. Their knowledge of first aid and trauma, combined with their understanding of excellent patient care, will give teams competing in the challenge, as well as spectators, a full and completely realistic experience. TECHNOLOGY SHOWCASE Over 400 exhibiting companies and organisations will be showcasing the latest solutions in communications, emergency medical care, protective clothing, uniforms, outsourcing, training and vehicles. These include Oxylitre, Stryker/Physio Control, MedTree, Viamed and Class Professional Publishing. Water-Jel International will

The British Red Cross will talk about its response to the Grenfell Tower fire, how it worked with and supported the local community and how this ties in with its new Community Reserve Volunteering project be exhibiting its burn-treatment dressings specifically designed to draw heat out of a burn and Celox will showcase Celox Rapid its fastest haemostatic gauze that stops life-threatening bleeding with only 60 seconds compression. Key training providers exhibiting include the ATACC group which last year successfully won the Police Framework Contract for delivery of First Aid, Trauma & Casualty Care (now available nationally). North East Ambulance Service which provides paramedic-led first aid and health and safety training for public, private and third sector organisations is also exhibiting. Suppliers of simulation aids and training mannequins include Simulaids, Ruth Lee and Bariquins. With the prevalence of obesity becoming an everyday issue, Bariquins’ mannequins (weighing 25 stone) have been designed to assist training personnel to safely and efficiently manoeuvre or rescue plus-size people whilst maintaining their subject’s dignity. Meanwhile Allied Fleet, Baus, BMW Group, Cartwright Conversions, O & H Vehicle Conversions and Volvo Emergency Vehicles are among the leading names exhibiting vehicles and equipment for the ambulance sector. NEW EXHIBITORS Over 50 companies are exhibiting at The Emergency Services Show for the first time. Among these new exhibitors is Nielson Chemicals which has developed a range of cleaning products for emergency vehicles which kill bacteria and infection. Following a successful pilot with South Central Ambulance Service, new exhibitor Doc-works will launch its Scribe electronic patient record (ePCR) solution and showcase its cloud based clinical AuditOnline solution. Another new-comer is online print shop Mediprinting UK, which offers high quality low-cost custom design and printing for everything from staff ID badges to patient records and tourniquets. Global medical device company Bellascura will be exhibiting in the UK for the first time, showcasing its lightweight, compact evacuation sled, Slyde™, among other products. AMBULANCE NETWORKING In The Collaboration Zone, over 80 voluntary groups, charities and NGOs will be sharing details of the support they offer, while members of other blue light services will be available to discuss co-response, current trends and share ideas. Clive Dickin, national director of the

Emergency Services Show

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Association of Air Ambulances (AAA), who will be exhibiting once again this year, explains the many benefits of this ‘networking hub’ of the show: “The AAA’s involvement in the 2016 Emergency Services Show was integral in our strategy to network and raising awareness for the helicopter emergency medical services (HEMS) and air ambulance community of the UK. It enabled us to support not only our air ambulance charity and ambulance service members; but also provide support and build awareness around our associate members and important stakeholders such as BMW Government and Authorities Division and Zoll Medical. “As technology continues to move forward and drone use is becoming a larger issue across the country, we had the opportunity to discuss this with a fellow exhibitor – National Air Traffic Services – and we are now involved in dialogue to provide further support for emergency services air assets as they approach landing sites.” Steve Irving, executive officer at the Association of Ambulance Chief Executives and Ambulance Leadership (AACE), agrees: “The Emergency Services Show is always a good opportunity for AACE staff to meet with a wide variety of stakeholders. Attending events alongside colleagues from the other emergency services is a good opportunity to reinforce the collaborative work ambulance services engage in on a daily basis and helps reinforce interoperability across the blue light services. These types of events are also a useful opportunity for us to meet representatives from emergency services organisations from all over the world to discuss the broad range of consultancy services that AACE provides.” At this year’s show, AACE will be promoting the updated JRCALC clinical guidelines which include new guidance on sepsis and a revised obstetrics and gynaecology section. Visitors can also find out about the online clinical guidelines app ‘iCPG’ and the next version of the online CPD/CPG programme, based wholly on JRCALC clinical guidelines. Other organisations exhibiting in The Collaboration Zone include the Independent Ambulance Association, NHS Commercial Alliance and National Ambulance Procurement Group, British Red Cross, South Western Ambulance Service NHS Foundation Trust and UK Registry of Emergency Medical Technicians. " FURTHER INFORMATION www.emergencyuk.com

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Products & Services

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APPS

FLOORING

iPLATO Healthcare has been awarded a contract by The Small Business Research Initiative for Healthcare (SBRI Healthcare) to develop and trial ‘Intelligent Care Navigation’, to improve access to care for patients and help the NHS manage demand for primary care services. The trial will include a small number of practices and lasts from June to August. In partnership with GP practices, this new approach will provide patients with personalised, localised and quality assured information to help some of them receive appropriate care faster than waiting for their scheduled GP appointment. Research suggests that only one in three people visiting a GP practice should be seen by a doctor and half of patients currently being seen by GPs could be seen by another member of the clinical team. Today, around 7,700 GP practices are managing a staggering 372 million

Spa Carpets & Flooring is a family-owned business based in Leamigton Spa, Warwickshire. It is the complete flooring solution for all commercial and residential clients. The company has in-house fitters, combining 30 years of experience, who have worked in the local area for over 16 years. Many other local flooring retailers call upon Spa Carpets & Flooring for advice and installation services, in addition to rectifying poor workmanship. The firm has extensive experience in completing all types of flooring works in commercial properties. Whether it is consultation rooms in GP surgeries, surgery rooms in dental practices or living accommodation in assisted living and residential care homes, Spa Carpets & Flooring always offers the most suitable flooring available, laid in the most suitable way for the requirements of the client. Friendly and professional

Introducing intelligent care navigation

appointments according to NHS England figures. Switching some of these GP appointments to appropriate interventions by other healthcare professionals can save the NHS millions. Tobias Alpsten, CEO, iPLATO comments: “We are all incredibly excited about the investment from SBRI, allowing us to introduce a smarter and seamless process to care navigation. Transforming access to primary care offers obvious advantages to patients and their carers, but it also benefits commissioners and tax payers by reducing pressure on the healthcare system.” FURTHER INFORMATION Tel: 0208 834 1133 info@iplato.net

FLOORING

Offering comprehensive floor fitting services SJ Flooring offers a large range of affordable and high quality carpets, safety flooring and vinyl floors for the commercial sector. Providing cost-effective and reliable flooring installations comes naturally to the company as it has been doing so for over two decades. The firm has worked alongside main contractors, designers and end users within the commercial sector and also with other trades. The company’s service is based on a customer-focused approach that includes great communication, well-kept commitments and adaptable schedules to fit around you. With full design, planning and supply to back up the installations, you’ll get a fully comprehensive flooring service based on the business’s detailed initial consultation. SJ Flooring offers unrivalled experience and expertise in fitting carpets and flooring across London and the Home Counties,

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and has built a reputation for outstanding quality and tailored flooring to suit its clients. For a free no obligation consultation and survey get in touch and let SJ Flooring take away the stress of flooring choices and installation so you can focus solely on your business. FURTHER INFORMATION Tel: 0333 200 5400 mail@sjflooring.co.uk www.sjflooring.co.uk

HEALTH BUSINESS MAGAZINE | Volume 17.4

Offering the complete flooring solution

fitters work as flexibly as possible to accommodate the needs of the client as well as other contractors. Spa Carpets & Flooring always works to the highest standard and will complete all necessary works to ensure that the finished product is to the client’s satisfaction, both in the areas you can see as well as the areas you can’t - as the company considers these just as important as the visible areas. FURTHER INFORMATION Tel: 01926 337 947 Mob: 07973 771 975 www.spacarpetsand flooringlimited.co.uk

FLOORING

Providing professional quality flooring services

Meadee Flooring Ltd is a commercial flooring contractor established in 2003. Based in Reading in Berkshire, it services a radius of 50 miles from RG2 which includes London. Whilst the company supplies and fits a variety of different floor coverings, it specialises in the supply and installation of safety vinyl, also sometimes referred to as non-slip. Manufacturers used by the firm include Altro, Polyflor, Forbo, Tarkett and Gerflor. All offer a number of different styles

and colours, but all meet high standards of production and are rigorously tested. If you are looking for a floor which needs to be hygienically clean and safe in a commercial environment such as a dental practice, doctors surgery, hospital, vet, clinic, classroom or similar, please contact Meadee Flooring for a quote. FURTHER INFORMATION Tel: 01189 862200 info@meadeeflooring.co.uk www.meadeeflooring.co.uk


FLOORING

Quality suppliers of flooring in the South East

Established in 1977, Youngs Flooring has been supplying and installing carpets, contract flooring and hygienic wall cladding protection systems to health sector clients across the south east of England for the many years. Working with residential, commercial and trade clients, Youngs is respected for offering clients quality installation and excellent customer service. Youngs is instructed to carry out projects from the smallest repairs to complete refurbishments of whole wards. The company is currently committed to a long term maintenance contract with Essex Partnership University NHS Foundation Trust. Youngs is competitive, reliable and trustworthy. Experienced fitters combined with excellent

communication from the office ensures a hassle-free relationship from start to finish. If you are in need of a genuinely good company to assist with flooring requirements from sub floor repairs, carpeting or Karndean/Amtico, wet room installation or just to supply materials without fitting, do not hesitate to contact Youngs. The company also has many clients who are further afield but still enjoy using Youngs services for the best prices on supply only of materials. The firm delivers across the whole of mainland UK and provides installation work to London and the Home Counties. FURTHER INFORMATION Tel: 01702 522123 info@youngs-flooring.com

FLOORING

Specialising in industrial and hard-wearing flooring

Teco Interiors Ltd was established back in 1985. It is a commercial flooring contractor based in the South East providing all types of floor coverings to the public sector, and the company prides itself on quality of service and competitive prices. It offers advice on supply and installation and has built strong relationships with its customers – especially in the healthcare sector. The firm also provides a repair and maintenance service. As well as floors, Teco Interiors installs hygienic wall cladding using products such as Whiterock and Mediclad, which means it can provide a complete wet room package (floor and walls). The company uses manufacturers such as Altro,

FACILITIES MANAGEMENT

PARKING

SPIE UK, a subsidiary of SPIE group, the independent European leader in multitechnical services in the areas of energy and communications, provides energy, safety and environmentally focused solutions across multi-technical and support services from initial design, through installation, testing, commissioning to long term maintenance and facilities management. SPIE UK employs more than 3,000 people from a network of regional offices throughout the UK. SPIE UK is a leading provider of facilities services nationwide – keeping buildings functioning, and maintaining a positive environment for the people working in them. The company’s highly skilled team of engineers bring together all the core elements of facilities management and support services across a broad range of built environments. With proven experience across

WPS has been a global leader in parking systems for over 25 years. In addition to its extensive portfolio of hospitals and healthcare trust clients, its customer base includes shopping centres, operators, local authorities, hotels, leisure facilities and airports. WPS is part of Dynniq, a dynamic, high-tech and innovative company with a comprehensive knowledge of managing mobility, parking and energy using advanced systems engineering. WPS has a long-held reputation for engineering excellence and providing the industry’s most reliable solutions. Renowned also for exceptional maintenance and service, WPS delivers dependable operation during the entire life-cycle of your equipment investment. The company’s ParkAdvance™ Pay on Foot system, with its state-of–the-art TCP/IP based

Your partner of choice for facilities management

single disciplines to total facilities management covering individual buildings to multi-site, multi-location portfolios, it can offer you a tailor-made solution whatever your challenge. SPIE UK’s commitment to technical innovation and the continuous development of skills and techniques across its teams is a testament to its success, and with a strong focus on forming close and effective working relationships with customers, the company can genuinely understand your building, your business and your day-to-day operations, enabling it to deliver bespoke solutions every time. FURTHER INFORMATION www.spieuk.com

Products & Services

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

Polyflor, Forbo Flooring, Tarkett and Heckmondwike and lays vinyls (smooth, non-slip and conductive), carpets, carpet tiles, rubber, resin and entrance mattings. Teco Interiors has also recently added surface preparation to its portfolio, i.e. concrete grinding. Other customers of the company include the MOD, schools, colleges, councils, Mental Health and NHS Community Services. All the firm’s fitters have security clearance including DBS (CRB) checks and the company has CHAS (SSIP) Certification. FURTHER INFORMATION Tel: 01634 267474 sales@tecointeriors.co.uk www.tecointeriors.co.uk

Innovative parking solutions for your business

software architecture, provides industry-leading functionality combined with direct network and web interconnectivity. This opens up exciting new possibilities for car park management and ensures operators are ready to take full advantage of technology developments in the future. Smart, reliable and futureproof, ParkAdvance™ is the ideal car park system choice. FURTHER INFORMATION Tel: 0845 094 1543 sales@wps-uk.com www.wpsparkingsolutions.com

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Products & Services

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

LEGIONELLA

FLOORING

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

Teco Interiors Ltd was established back in 1985. It is a commercial flooring contractor based in the South East providing all types of floor coverings to the public sector, and the company prides itself on quality of service and competitive prices. It offers advice on supply and installation and has built strong relationships with its customers – especially in the healthcare sector. The firm also provides a repair and maintenance service. As well as floors, Teco Interiors installs hygienic wall cladding using products such as Whiterock and Mediclad, which means it can provide a complete wet room package (floor and walls). The company uses manufacturers such as Altro,

Quality water treatment at a competitive price

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

CLEANING

CLEANING

Food is only as good as the kitchen it’s cooked in. Whether you run a restaurant or a community centre with a small kitchen, your organisation can benefit from deep kitchen cleaning. Central Park Cleaning Solutions uses only the most powerful kitchen cleaning equipment to give you the very best in hygiene and cleanliness. Commercial kitchens are also subject to certain health and safety regulations. Central Park can assure that you pass with flying colours. What’s more, the company’s services can be tailored to meet your timescale. Central Park understands that commercial kitchens don’t work to the usual 9-5 schedule, so its kitchen cleaners can work to a contract designed around your hours. The company will take care of extraction system cleaning and anything else you need. Extraction system cleaning is particularly essential as it could

EnvirocupXL is a new cup collection and recycling bin from Leafield Environmental that can accommodate every size of disposable cup up to the 103mm diameter, including the larger cups popularised by major high street coffee house chains. Cups dropped through the six, circular apertures nest neatly inside the collection tubes, dramatically increasing the number that can be collected in a bin and reducing the number of times each bin has to be collected and emptied by operatives. By highlighting the separate collection of cups the EnvirocupXL will help users avoid the additional charges imposed when paper cups contaminate mixed recycling streams. The EnvirocupXL also incorporates a removable 7.5 litre central liquid hub reservoir to deal with the cold coffee

Cleaning your kitchen so you don’t have to

100

Specialising in industrial and hard-wearing flooring

pose a fire risk if left untended. Central Park’s kitchen cleaners can also reach tricky areas such as canopies, filters and wall surfaces above 6 foot. Is your insurance provider asking for proof that your extraction systems are clean and safe? Central Park can give you certificates and reports to demonstrate that you’ve done your part to keep your business and premises safe. Clean extraction and ducting systems are a must if you’re going to meet Health and Safety requirements. FURTHER INFORMATION Tel: 0800 808 9901 jason@centralparkcs.co.uk www.centralparkcs.co.uk

HEALTH BUSINESS MAGAZINE | Volume 17.4

Polyflor, Forbo Flooring, Tarkett and Heckmondwike and lays vinyls (smooth, non-slip and conductive), carpets, carpet tiles, rubber, resin and entrance mattings. Teco Interiors has also recently added surface preparation to its portfolio, i.e. concrete grinding. Other customers of the company include the MOD, schools, colleges, councils, Mental Health and NHS Community Services. All the firm’s fitters have security clearance including DBS (CRB) checks and the company has CHAS (SSIP) Certification. FURTHER INFORMATION Tel: 01634 267474 sales@tecointeriors.co.uk www.tecointeriors.co.uk

The complete cup collection solution

and dregs that invariably pose a disposal problem. Combined with Enviropods for the collection of cup lids and thermal sleeves, the EnvirocupXL is now the complete solution for cup, lid and sleeve collection. Easy to empty and clean and available in 100 per cent recycled material, the EnvirocupXL is offered at a suggested RRP of £177.00. Optional extras include graphics personalisation and A3 size signage kits. FURTHER INFORMATION Tel: 01225 816500 www.leafieldenvironmental.com


FACILITIES MANAGEMENT

Your partner of choice for facilities management SPIE UK, a subsidiary of SPIE group, the independent European leader in multitechnical services in the areas of energy and communications, provides energy, safety and environmentally focused solutions across multi-technical and support services from initial design, through installation, testing, commissioning to long term maintenance and facilities management. SPIE UK employs more than 3,000 people from a network of regional offices throughout the UK. SPIE UK is a leading provider of facilities services nationwide – keeping buildings functioning, and maintaining a positive environment for the people working in them. The company’s highly skilled team of engineers bring together all the core elements of facilities management and support services across a broad range of built environments. With proven experience across

single disciplines to total facilities management covering individual buildings to multi-site, multi-location portfolios, it can offer you a tailor-made solution whatever your challenge. SPIE UK’s commitment to technical innovation and the continuous development of skills and techniques across its teams is a testament to its success, and with a strong focus on forming close and effective working relationships with customers, the company can genuinely understand your building, your business and your day-to-day operations, enabling it to deliver bespoke solutions every time. FURTHER INFORMATION www.spieuk.com

FACILITIES MANAGEMENT

Improving compliance and measuring KPI’s

SmartTask is an advanced employee scheduling and mobile workforce management system for facilities managers in the NHS. The cloud-based software solution offers significant opportunities to NHS facilities managers who wish to take control of their remote teams, helping them to deliver a speedy and reliable service through improved communications and increased transparency. SmartTask enables organisations to plan better and manage their employees, so they are at the right place, at the right time. It combines intelligent rostering, live monitoring and integrated proof of attendance across both static and mobile teams, making it the ideal tool to improve operational

SECURITY

SECURITY

Established in 2008, Origen ESP Ltd has grown and developed into a leading automated system engineering specialist. Over the years Origen ESP Ltd has developed a glowing reputation and is recognised by both suppliers and customers for using the latest automation technologies along with the highest installation standards and unparalleled aftercare service. It is the preferred partner to many organisations across a range of industries in both the public and private sector. The relationships it forms with new and existing customers has been one of the keys to their success. Simon Clay, managing director, said: “Origen ESP Ltd is committed to investment in its people, this ensures all members of our teams have

Macs Automated Bollard Systems Ltd provides the complete solution for the use of automatic rising bollards to control vehicle access. From local authority pedestrian areas, bus gates and traffic control areas, to commercial and residential projects. Whatever your requirements, there is sure to be a Macs system to suit your needs. As suppliers of a full range of automatic and semi automatic bollards, retractable energy distribution towers, road barriers, road blockers and static bollards, along with a variety of equipment to complement these systems such as ANPR and a bespoke fault monitoring system, Macs offers a complete and professional service for applications where control of vehicle access is needed, such as emergency service access lanes and restriction of unauthorised vehicles.

Specialists in anti-terror security solutions

the relevant training and knowledge to succeed within in the industry and deliver the best in class service to our clients.” Origen has a diverse product range and engineering capabilities which allows it to offer its customers with cost effective and secure solutions for their premises. With offices nationwide, Origen has always been committed to supporting the police, local authorities, and the British public with the latest counter terrorism systems to ensure safety and continuity within the community. FURTHER INFORMATION Tel: 01892 731090 www.origenesp.co.uk

Products & Services

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

control, enhance service levels and support duty of care. It can also be used for care worker scheduling and call monitoring helping community healthcare providers to operate more efficiently, protect their staff and ensure service users receive the quality of care they deserve. SmartTask enhances how teams are coordinated by improving diary management, removing unnecessary travel and duplicate reporting. This means care workers can avoid being bogged down by administration to spend considerably more time in front of patients. FURTHER INFORMATION Tel: 01494 444044 smarttask@skillweb.co.uk www.smarttask.co.uk

Rising bollards for the 21st century

The company’s services include: Highways Agency approved automatic bollard systems; nationwide installation, repair and servicing of automatic bollard systems; professional aftercare, and a 24/7, 365 days a year callout service; optional remote bollard monitoring system; and an affordable ongoing service contract to keep your bollards running in top condition. For more information on any Macs products or services, please visit the website. FURTHER INFORMATION Tel: 0161 3206462 www.macs-bollards.com

Volume 17.4 | HEALTH BUSINESS MAGAZINE

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Advertisers Index

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

APPS

CLEANING

iPLATO Healthcare has been awarded a contract by The Small Business Research Initiative for Healthcare (SBRI Healthcare) to develop and trial ‘Intelligent Care Navigation’, to improve access to care for patients and help the NHS manage demand for primary care services. The trial will include a small number of practices and lasts from June to August. In partnership with GP practices, this new approach will provide patients with personalised, localised and quality assured information to help some of them receive appropriate care faster than waiting for their scheduled GP appointment. Research suggests that only one in three people visiting a GP practice should be seen by a doctor and half of patients currently being seen by GPs could be seen by another member of the clinical team. Today, around 7,700 GP practices are managing a staggering 372 million

Capital Power Clean is proud to present the healthcare industry with a means to minimise cross contamination risks associated with floor cleaning equipment, whilst maximising labour resources and presenting additional environmental and cost benefits. Traditional scrubber dryer design presents difficulties in removing contamination from brush housings and recovery tanks – ideal breeding grounds for bacteria which may then be transferred from one area to another. i-mop’s fully-presented brush deck allows easy removal of the brushes and fast, efficient cleaning of the underside, while tanks can be fully removed for cleaning and may be left to air-dry. Additional colour-coded tanks and brushes are also available to further minimise cross contamination risks. Patented, award-winning

Introducing intelligent care navigation

appointments according to NHS England figures. Switching some of these GP appointments to appropriate interventions by other healthcare professionals can save the NHS millions. Tobias Alpsten, CEO, iPLATO comments: “We are all incredibly excited about the investment from SBRI, allowing us to introduce a smarter and seamless process to care navigation. Transforming access to primary care offers obvious advantages to patients and their carers, but it also benefits commissioners and tax payers by reducing pressure on the healthcare system.” FURTHER INFORMATION Tel: 0208 834 1133 info@iplato.net

i-mop: the most flexible and powerful mop around

design offers unsurpassed manoeuvrability for cleaning in toilets, changing rooms and sluice areas; yet despite this, i-mop is ideal for cleaning larger spaces, with an incredible productivity of 1300m²/ hour. Using just 0.08 litres/m² for floor cleaning, i-mop saves on both water and chemical usage, supporting environmental policies and reducing costs. Lithium-ion batteries offer a run time of one hour from just one hour’s charging – with a spare set of batteries, i-mop will continue to combat contamination 24/7! FURTHER INFORMATION Tel: 01506 854 585 www.capitalpowerclean.co.uk

ADVERTISERS INDEX

The publishers accept no responsibility for errors or omissions in this free service 7/7 Cleaning Services Addmaster Aerogen Agfa Healthcare Alfamax Catering ALS Enviromental Aquarius Water Solutions Assistive Partner Blackburn Special Products Bosse Interspice Bridge Safety and Training Capital Power Clean Carecheck Cdec AV Integrator Central Medial Supplies Central Park Cleaning CK Group Consumer Direct Lighting Daikin Applied Service Datix Design Contract Flooring ESTS Falcon Contract Flooring Fitwise Management Garran Lockers GEMChem Genesis Automation

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76 54 45 22 74 50,58 100 12 78 70 60 76, 102 8 38,42 78 84,100 76 69 66 88 64 50,58 64 80 10 50,56 26

HEALTH BUSINESS MAGAZINE | Volume 17.4

Gorse Hill ImmerseTraining Intersystems iPlato ISS Mediclean LA Marketing Lapcabby LED by Vision Legrand Electric MED-PTS Ambulance MacCormack Media Macmon Secure Macs Automated Bollard Maquet Meadee Flooring Merit Medical Micad Systems Misco MJog Mobile Edge Natas Asbestos: Training NH Case Olivetti Olympus Omnicell Origen ESP PFU

74 54, 59 20 98 6 100 42 69 16,46 91 81 IBC 101 48 98 82, 84 28 4 18 35 63 72 14 BC 44 101 IFC

Premier Modular PS24 Q Medical Technologies Sajas Group SJ Flooring Skillweb SolarWinds Spa Carpets and Flooring Space Facility Services Spie Spirotech Stanley Healthcare Static Systems Group Step Exhibitions Surveyroof Teco Interiors The Care Database The King’s Fund Total Intelligence Trisoft Ultralinq Healthcare Solutions Vanguard Healthcare Solutions Worth Fire Protection WPS United Kingdom Wyatt International Youngs Flooring

62 94 84 50 98 101 30 98 76 99 52,56 86 54,59 51 59 99 40,42 42 34 24 32 56 64 99 66 99


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Health Business 17.4  

Business Information for Healthcare Professionals